Primary ciliary dyskinesis (PCD) is an autosomal recessive disorder associated with impaired mucociliary clearance caused by defects in ciliary structure and function. The major clinical feature of PCD is recurring or persistent respiratory tract infection. Respiratory tract colonization with drug-resistant organisms impact the frequency of infections and lung function decline. Protective gear has been employed by caregivers in an attempt to control respiratory tract bacterial spread between patients with cystic fibrosis but use in PCD is not known. We conducted a web-based survey to investigate infection control and prevention practices of PCD centers in North America. The response rate was 87.0%. Prior to the COVID-19 pandemic, glove, gown and mask use was variable, and only 3.7% of centers used masks during encounters with PCD outpatients. After COVID-19 mandates are lifted, 48.1% of centers plan to continue to use masks during outpatient care, while the practice regarding use of gloves and gowns was not influenced by the current pandemic. There is no uniform practice for infection control in PCD care indicating the need for practice guidelines. Mitigation of respiratory virus transmission learned during the COVID-19 pandemic may impact future infection control approaches used for patients with PCD and other lung diseases.

Background: Parapneumonic effusions and empyema are the most frequent complication of paediatric pneumonia. Treatment options include chest drain and fibrinolytics (CDF) or thoracoscopic surgery. CDF is considered less invasive, more cost effective though with higher rates of reintervention. Pleural fluid characteristics on ultrasound may identify cases at increased risk of treatment failure with primary CDF. Methods: A retrospective cohort 2011-2018 of complicated pneumonia managed with primary CDF. Cases were reviewed using ultrasound criteria to describe pleural fluid. We compared ultrasound findings and treatment failure. Results: We report 137 cases with a median age 3.8 years and 43% female. Treatment failure occurred for 32/137 (23%) cases. The interobserver reliability was substantial for the number of septations (Kappa 0.72, 95% CI 0.6 to 0.8), moderate for the size of the largest locule (Kappa 0.55, 95% CI 0.4 to 0.7) and fair for the level of echogenicity (Kappa 0.22, 95%CI 0.1 to 0.3), pleural thickening (Kappa 0.28, 95% CI 0.2 to 0.4), maximum effusion depth (Kappa 0.37, 95%CI 0.2 to 0.5) and radiologist’s risk for reintervention (Kappa 0.32, 95% CI 0.2 to 0.5). Hyperechoic pleural fluid was associated with treatment failure, with cases nearly five times more likely than anechoic fluid to have a reintervention (OR 4.9 95%CI 1.7 to 14.2, p=0.04). Treatment failure was not associated with other variables. Conclusion: We did not find an association between ultrasound characteristics and treatment failure for complicated pneumonia managed with primary CDF. Inter-observer agreement of ultrasound findings was difficult despite more objective criteria.

In this article, we want to present a patient with Burtonian or lead line at the gum tooth line, a rare presentation of lead poisoning.

Bhutan has a total of 2006 cases (1271 Male, 735 Females) with one death[3]. Among 735 females, four pregnant mothers had COVID-19 infection. One mother infected with COVID-19 at 16 weeks of gestation developed polyhydramnios. The present study reports a rare finding of polyhydramnios in COVID-19 infected pregnant woman.

Stream temperature is an important determinant of fish growth, migration, and survival, and can thus impact the structure and function of stream ecosystems. Fluctuations in water temperature can occur spatially and temporally, occurring naturally or because of anthropogenic pressures. Many streams in Michigan and elsewhere in North America receive groundwater inputs that help regulate instream conditions by stabilizing discharge as well as stream temperature. However, groundwater withdrawal through high-capacity wells is important to the agricultural industry and water users for irrigation or municipal water supplies. Withdrawal can cause reductions in streamflow which typically results in increased stream temperature. Other atmospheric and hydrologic variables (i.e. overland discharge) also impact the rate at which stream temperature changes as it flows downstream. In this study we deployed paired up- and downstream water pressure and temperature loggers within 21 stream reaches throughout the state of Michigan to quantify and model relationships between stream discharge, air temperature, and longitudinal change in stream temperature (i.e., temperature flux). Using multi-model selection criteria, we evaluated the performance of a hierarchical suite of models that predict temperature flux rates as a function of potential driving variables. The multi-model selection criteria identified a best-fitting model that was able to model the diurnal, seasonal, and annual variations in rates of longitudinal temperature fluctuations across a majority of sample streams. Partial regression analysis indicated that proxy variables representing solar radiation at the stream surface were generally the most influential predictors of longitudinal changes in stream temperature, but air temperature and components of streamflow including groundwater input were significant predictors and important in many streams.

The representation of rainfall is important for hydrological modelling, particularly for spatially distributed models. Accurate estimation of rainfall is particularly challenging in mountainous regions where observations are often sparse relative to the spatial variability of rainfall, making interpolation challenging. In these regions, orographic processes lead to complex patterns of rainfall enhancement and rain shadow depletion. This study tests one deterministic method, Natural Neighbour Interpolation (NNI), and two geostatistical methods, ordinary kriging (OK) and ordinary cokriging (CK), to determine if CK improves rainfall interpolation during three extreme rainfall events that occurred in the north west of England. Preliminary analysis using long-term annual average rainfall totals, including additional high elevation rainfall observations, showed that CK with an effective elevation index as a secondary variable performed better than NNI and OK with an overall improvement of around 40%. Using rainfall totals for long-term wind direction and wind speed rainfall classes, CK performance was variable across classes but provided an improvement of approximately 15% for wind direction classes without an easterly wind component. For 15-minute timesteps during extreme rainfall events, there were comparatively small differences between interpolation methods, attributed to having only relatively low elevation rainfall observations for cross-validation, providing weak constraint. Importantly, cross-variogram estimation (that controls the strength of the correlation between rainfall magnitude and the secondary variable) provided differing cross-validation results when estimated for different rainfall total periods: 15-minutes, hourly, daily and long-term. Variograms and cross variograms estimated at a 15-minute timestep frequency were robust for many timesteps, but were difficult to fit automatically for others. Variograms estimated from longer periods were more reliably estimated, but tended to have lower variance and cross-variance and longer correlation ranges producing a smoother interpolated rainfall field. Given the weak cross-validation constraint, care must be taken in identifying the most appropriate method and variogram estimation period.

Understanding the role diet plays in the structure of food webs is vital, and dietary knowledge is key for conservation management success. There is limited knowledge of the diets of woodland bird species, due largely to difficulties in accurately identifying plant and invertebrate taxa being consumed. Here, we show the effectiveness of multi-marker faecal metabarcoding to provide the most in-depth dietary analysis of a generalist passerine, the Hawfinch (Coccothraustes coccothraustes, Linnaeus), to date. Faecal samples were obtained from 2016-2019 from Hawfinch populations prior to and during the breeding season throughout the UK. DNA was extracted from 263 samples and amplified using Internal Transcribed Spacer 2 (ITS2) and cytochrome C oxidase subunit I (COI) barcodes. Using high-throughput sequencing (HTS), we identified 49 and 97 ITS2 and COI zero radius operational taxonomic units (zOTUs) respectively which equated to reputed dietary items. The herbivorous element of Hawfinch diet was dominated by naturally occurring taxa such as beech (Fagus sylvatica, Linnaeus), hornbeam (Carpinus betulus, Linnaeus) and oak (Quercus sp., Linnaeus). The most taxon rich and commonly recorded invertebrate taxon identified was Lepidoptera. We found Hawfinch diet varied spatially, as well as between sexes. Hawfinch showed broad dietary plasticity and utilised multiple resources within their foraging environments. Our study shows the potential of multi-marker DNA metabarcoding to reveal subtle dietary differences, but also highlights the challenges of studying omnivorous species using metabarcoding methods.

Ephemeral streams in dry environments can produce high intensity sediment-laden flash floods. The research of these events is quite difficult due to far locations with limited accessibility, unexpected events, and rough weather conditions. Hence combined data of rainfall, flood hydrograph and sediment transport is rather scarce in the world. Recent extreme events (RI > 550 years) in arroyos (ephemeral streams) of the central Patagonia (Argentina) has called the attention of public and scientific community. The Sagmata basin (total drained area of 129 km2), located in the Lower Valley of the Chubut River (Province of Chubut, Argentina) has been equipped with 4 raingauges, a weather station, four cameras and sediment sampler in four reaches of the arroyos. Data from a two-year monitoring provides valuable insights about the hydrological response of basins in Patagonia, such as the time of response, the shape of hydrographs and its relations with the hyetographs and duration curves. The arroyos are wetted a short period of the time (8 to 21 hours a year). Single-peak, multi-peak and flat top hydrographs have been observed. The lag-time decreases with the increase of the rainfall intensity and the maximum water stage. Moreover, the bore front moves with mean speed which value is between 0.8 to 1.6 m s-1. The wash load in the arroyos depends on geological settings and vegetation cover of the basin. Mean values are between 23 – 46 gr l-1. The complex hydrograph shape produced by the basin has been linked to the rainfall features (duration, mean intensity and patchiness) and the basin physiography of the basin. Findings from the present study provide valuable information both for the comprehension of arroyos in drylands and hazard management as well.

Groundwater-Surface water interactions in alluvial plains facing morphological features are the subject of the study. Considered transitions zones, alluvial plains have different morphological features interfering with groundwater flow and hydrochemistry. The alluvial plain of Mogi Guaçu river (southeastern Brazil) presented topography-controlled groundwater flow, nevertheless, natural levees, wet fields, oxbow lakes, and abandoned meanders can control local flow and interfere in discharges points of the main river. Two sampling water campaigns were done in the dry and wet season for physicochemical and natural isotopes analysis, collecting in total 44 groundwaters samples from monitoring wells and eight water samples from the river, creek, and lake. The groundwaters in wet fields and terraces, and surface waters from creek and lake presented low mineralization (EC from 8 to 37 μS.cm-1), pH acidic (4.98 to 5.8), and essentially Ca and Na-HCO3 composition. River waters samples presented pH between 5.92 e 7.69 (acidic in the rainy season and basic in the dry season), and EC from 24.2 and 181.1 μS/cm (lower values in the wet season), Na-HCO3 and Na-HCO3-SO4 (dry season) and Ca-HCO3 and Na-HCO3 (rainy season) compositions. In dry season groundwaters composition showed evolution from sodium mixed (SO4 – HCO3) to bicarbonate waters and higher mineralization; in wet season waters varied from Ca to Na-HCO3 composition and low mineralization, denoting dilution due to rainwater infiltration. Closer to the river margins, in abandoned meanders and oxbows, the groundwaters have increased values of EC and major ions indicating GW-SW mixtures, and effluent-influent changes (descendent and ascendent flux) in wet and dry seasons, respectively. Natural isotopes in groundwaters imply meteoric origin, without evaporation during recharge and high d-excess can be influenced by continental air masses and Amazonia Basin low-level jet. Shallow water table, permeable silty-sand material of vadose zone, flat terrain, and pristine conditions can contribute to direct infiltration of rainwaters, recharging the shallow aquifer.

The goal of the present paper is to obtain and analyze new exact travelling wave solutions and bifurcation behavior of modified Zakharov-Kuznetsov (mZK) equation with higher order dispersion term. For this purpose, first and second simple methods are used to build soliton solutions of travelling wave solutions. Furthermore, bifurcation behavior of traveling waves including new type of quasiperiodic and multi-periodic traveling wave motions have been examined depending on the physical parameters. Multistability for the nonlinear mZK equation has been investigated depending on fixed values of physical parameters with various initial conditions. The suggested methods for the analytical solutions are powerful and benefical tools to obtain the exact travelling wave solutions of nonlinear evolution equations (NLEEs). Two and three-dimensional plots are also provided to illustrate the new solutions. Bifurcation and multistability behaviors of traveling wave solution of the nonlinear mZK equation with higher order dispersion will add some value in the literature of mathematical and plasma physics.

Objectives: First, to examine the predictive performance for placental dysfunction related stillbirths of the competing risks model for small for gestational age (SGA) fetuses based on a combination of maternal risk factors, estimated fetal weight (EFW) and uterine artery pulsatility index (UtA-PI); and second, to compare the performance of this model to that of stillbirth-specific model utilizing the same biomarkers and to the Royal College of Obstetricians and Gynecologists (RCOG) guideline for the investigation and management of the SGA fetus. Design: Prospective observational study. Setting: Two UK maternity hospitals. Population: 131,514 women with singleton pregnancies attending for routine ultrasound examination at 19-24 weeks’ gestation. Methods: The predictive performance for stillbirth achieved by three models was compared. Main outcome measures: Placental dysfunction related stillbirth. Results: At 10% false positive rate, the competing risks model predicted 59%, 66% and 71% of placental dysfunction related stillbirths, at any gestation, at <37 weeks and at <32 weeks, respectively, which were similar to the respective figures of 62%, 70% and 73% for the stillbirth-specific model. At a screen positive rate of 21.8 %, as defined by the RCOG guideline, the new model predicted 71%, 76% and 79% of placental dysfunction related stillbirths at any gestation, at <37 weeks and at <32 weeks, respectively, and the respective figures for the RCOG guideline were 42%, 44% and 40%. Conclusion: The predictive performance for placental dysfunction related stillbirths by the competing risks model for SGA was similar to the stillbirth-specific model and superior to the RCOG guideline.

The gut microbiomes of the host are large and complex communities, which helps to maintain homeostasis, improves digestive efficiency, and promotes the development of the immune system. The small mammals distributed in Sichuan Province are the most popular species for biodiversity research in Southwest China. However, the effects of different diets on the structure and function of the gut microbial community of these small mammals are poorly understood. In this study, whole-metagenome shotgun sequencing has been used to analyze the composition and functional structures of the gut microbiota of seven small mammals in Laojunshan National Nature Reserve, Sichuan Province, China. Taxonomic classification revealed that the most abundant phyla in the gut of seven small mammals were Bacteroides, Proteobacteria and Firmicutes. Moreover, Hafnia, Raoultella and Aeromonas were most abundant genus in the gut microbiomes of these seven species. At the functional level, we annotated a series of KEGG functional pathways, six Cazy categories and 46,163 AROs in the gut microbiomes of the seven species. Comparative analysis found that the difference in the gut microbiomes between the Soricidea and Muridae concentrated on the increase in the F/B (Firmicutes/Bacteroides) ratio in the Soricidea group, probably driven by the high fat and calorie digestive requirements due to their insectivorous diet. The comparative functional profiling revealed that functions related to metabolism and carbohydrates were significantly more abundant in Muridae group, which may be attributed to their high carbohydrate digestion requirements caused by their herbivorous diet. These data suggested that different diets in the host may play an important role in shaping the gut microbiota, and lay the foundation for teasing apart the influences of heritable and environmental factors on the evolution of gut microbial communities.

Objective To quantify parents’ experiences of respectful care around stillbirth globally. Design Multi-country, online, cross-sectional survey. Setting and Population Self-identified bereaved parents (n=3769) of stillborn babies from 44 high- and middle-income countries. Methods Parents’ perspectives of 7 aspects of care quality, factors associated with respectful care, and 7 bereavement care practices were compared across geographical regions using descriptive statistics. Respectful care was compared between country income groups using multivariable logistic regression. Main Outcome Measures Self-reported experience of care around the time of stillbirth Results A quarter (25.4%) of 3769 respondents reported disrespectful care after stillbirth and 23.5% reported disrespectful care of their baby. Gestation <30 weeks, and primiparity were associated with disrespect. Reported respectful care was lower in middle-income countries (MICs) than in high-income countries (HICs) (aOR=0.35, 95%CI (0.29-0.42), p <0.01). In many countries, aspects of care quality need improvement, such as ensuring families have enough time with providers. Participating respondents from Latin America and Southern Europe reported lower satisfaction across all aspects of care quality compared to Northern Europe. Unmet need for memory-making activities in MICs is high. Conclusions Despite improvements, many parents still experience disrespectful care around stillbirth. The gap between parents’ access to memory-making activities in MICs and HICs needs urgent attention. Tweetable abstract A quarter of parents of stillborn babies experience disrespectful care. There is global unmet need for memory-making activities

1. Resource polymorphism is common across taxa and can result in alternate ecotypes with specific morphologies, feeding modes, and behaviours that increase performance in a specific habitat. This can result in high intraspecific variation in the expression of specific traits and the extent to which these traits are correlated within a single population. Although metabolic rate influences resource aquisition and the overall pace of life of individuals it is not clear how metabolic rate interact with the larger suite of traits to ultimately determine individual fitness. 2. We examined the relationship between metabolic rates and the major differences (habitat use, morphology, and resource use) between littoral and pelagic ecotypes of European perch (Perca fluviatilis) from a single lake in Central Sweden. 3. Standard metabolic rate (SMR) was significantly higher in pelagic perch but did not correlate with resource use or morphology. Maximum metabolic rate (MMR) was not correlated with any of our explanatory variables or with SMR. Aerobic scope (AS) showed the same pattern as SMR, differing across habitats, but contrary to expectations, was lower in pelagic perch. 4. This study helps to establish a framework for future experiments further exploring the drivers of intraspecific differences in metabolism. In addition, since metabolic rates scale with temperature and determine predator energy requirements, our observed differences in SMR across habitats will help determine ecotype-specific vulnerabilities to climate change and differences in top-down predation pressure across habitats.

This is a generic template designed for submission to Wiley Journals. Please consult your specific journal's author guidelines in order to confirm that your manuscript complies with the journal’s requirements. Please replace this text with your abstract. Keywords --- keyword 1, keyword 2, keyword 3, keyword 4, keyword 5, keyword 6, keyword 7

Proteins perform critical functions, and their role is closely associated with their composition. Reliable prediction of protein function using computational techniques is becoming necessary because experimental limitations make it difficult to cover the massive rate of discovered proteins and their genetic transformation. This paper surveys the protein functions prediction, briefly discusses the employed literature's workflow and determines if the machine and deep learning techniques have been widely used for similar objectives. Furthermore, the paper discusses the trends of protein datasets and their features and summarises researchers' questions using these datasets. Many features have been identified and extracted, ranging from traditional physicochemical of amino acids and techniques for selecting features and reducing the dimensionality. Distinct from previous study manuscripts, we keep a detailed review of performance evaluation metrics and compare employed protein function prediction methods, thereby concluding the need for efficient, effective, and adaptable protein function prediction methods in real-world scenarios. We describe the machine learning processes and their development from elementary algorithms, such as logistic regression, to more sophisticated methods like conventional and highly developed sequential deep neural networks. The techniques of computing the hyper-parameters that are adopted to improve prediction efficiency have been discussed. Many studies reviewed implemented machine and deep learning approaches for protein function prediction compared with other methods. The critical challenge well noted in protein function prediction is getting relevant information. Then, approaches evaluated and provided future study prospects based on the results drawn from previous studies. This review provides important information as well as future prospects.

Sexual selection frequently promotes the evolution of aggressive behaviours that help males compete against their rivals, but which may harm females and hamper their fitness. Kin selection theory predicts that optimal male-male competition levels can be reduced when competitors are more genetically related to each other than to the population average, contributing to resolve this sexual conflict. Work in Drosophila melanogaster has spearheaded empirical tests of this idea, but studies so far have been conducted in lab-adapted populations in homogeneous rearing environments that may hamper kin recognition, and used highly skewed sex ratios that may fail to reflect average natural conditions. Here, we performed a fully factorial design with the aim of exploring how rearing environment (i.e. familiarity) and relatedness affect male-male aggression, male harassment, and overall male harm levels in a natural population of Drosophila melanogaster, under more natural conditions. Namely, we: a) manipulated relatedness and familiarity so that larvae reared apart were raised in different environments, as is common in the wild, and b) studied the effects of relatedness and familiarity under average levels of male-male competition in the field. We show that, contrary to previous findings, groups of unrelated-unfamiliar males were as likely to fight with each other and harass females than related-familiar males, and that overall levels of male harm to females were similar across treatments. Our results suggest that the role of kin selection in modulating sexual conflict is yet unclear in Drosophila melanogaster, and call for further studies that focus on natural populations and realistic socio-sexual and ecological environments.

Over the course of time, new developments associated with embryogenesis of the murine heart have served to clarify the developmental processes observed in the human heart. This evidence allows for creation of a developmental framework for many congenital cardiac defects. Here, we aim to solidify the framework related to the categorization of both solitary and multiple ventricular septal defects. Mice having genetic perturbation of the Furin enzyme have demonstrated perimembranous and juxta-arterial ventricular septal defects, permitting the inference to be made that these defects can co-exist with defects occurring within the apical muscular septum. Based on developmental evidence, furthermore, all interventricular communications can be placed into one of three groups, namely, those which are perimembranous, juxta-arterial, and muscular. All of the defects are described based on their borders as seen from the morphologically right ventricle. Our focus here will be on those defects within the muscular ventricular septum, recognizing that such defects can co-exist with those that are perimembranous. We discuss the differentiation of multiple discrete defects from those referred to as the ‘Swiss cheese’ variant. As we show, appropriate surgical management requires understanding of the specific terminology, as the surgical approach may differ depending on the combination of the individual defects. Data from the Society for Thoracic Surgeons revealed that both mortality and morbidity were increased in the setting of multiple as opposed to solitary ventricular septal defects.

Background and Purpose: People with COPD are susceptible to respiratory infections which exacerbate pulmonary and/or cardiovascular complications, increasing their likelihood of death. The mechanisms driving these complications remain unknown but increased oxidative stress has been implicated. Here we investigated whether influenza A virus (IAV) infection, following chronic cigarette smoke (CS) exposure, worsens vascular function and if so, whether the antioxidant ebselen alleviates this vascular dysfunction. Experimental Approach: Male BALB/c mice were exposed to either room air or CS for 8 weeks followed by inoculation with IAV (Mem71, 1 x 104.5 pfu)). Mice were treated with ebselen (10 mg/kg) or vehicle (5% w/v CM-cellulose in water) daily. Mice were culled 3- and 10-days post-infection, and their lungs lavaged to assess inflammation. The thoracic aorta was excised to investigate endothelial and smooth muscle dilator responses, expression of key vasodilatory and oxidative stress modulators and infiltrating immune cells. Key Results: CS increased lung inflammation and caused significant vascular endothelial dysfunction, which was worsened by IAV infection. CS-driven increases in vascular oxidative stress and suppression of eNOS were not affected by IAV infection. CS and IAV infection significantly enhanced T-cell recruitment into the aortic wall. Ebselen abolished the exaggerated lung inflammation, vascular dysfunction and increased aortic T-cell infiltration in CS and IAV-infected mice. Conclusion and Implications: Ebselen abolished vascular dysfunction in IAV-induced exacerbations of cigarette smoke-induced lung inflammation indicating it may have potential for the treatment of cardiovascular comorbidities seen in acute exacerbations of COPD.

TITLE PAGEManuscript title: Isolated neutropenia preceding acute lymphoblastic leukemia in children

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Background: Heart transplantations are ideal for most patients with end-stage heart failure refractory to medical treatment. The transplantation program at the Peruvian National Heart Institute started with a 10-year-continuity in 2010. Objective: To report the results of a 10-year heart transplantation experience at the Peruvian National Heart Institute. Methods: We studied 83 patients who underwent orthotopic heart transplantation at a single center between January 2010 and December 2019. The recipients’ profiles and survival were analyzed according to sex and age group, ensuring the information’s confidentiality. Results: The recipients’ mean age was 41.2 ± 17 years, 88% were adult, and 68.7% were male. The main indications for transplantation were idiopathic dilated cardiomyopathy. 85.5% of recipients were clinically categorized as INTERMACS Profile 1 to 3 before transplantation. There was a significant difference between sexes regarding the preoperative left ventricular ejection fraction and between age groups regarding the waiting time. The average ischemia time was 3.1 hours, operating time was 6.1 hours, cardiopulmonary bypass time was 3 hours, and aortic cross-clamp time was 1.7 hours. The principal early postoperative complications were hematological disorders and acute kidney failure. The principal late ones were kidney failure and severe anemia. The postoperative mortality was 15.9%, and the principal causes were infection and then acute rejection. The survival at one, five, and ten years was 87.5%, 79.8%, and 79.8%, respectively. The survival results were not influenced by sex or age group. Conclusion: Our patients’ postoperative complications, mortality, and survival rates coincided with those reported by the ISHLT registry.

I read with interest the articles by Wang and colleagues about comparison of risk scores for predicting outcomes after isolated tricuspid valve surgery and the commentary by Russo and colleagues about prediction of mortality in isolated tricuspid surgery1

Pulmonary infections represent the major causes of morbidity and mortality in cystic fibrosis(CF). Here, we report a3-month old infant with pancreatic insufficient CF was hospitalized with positive RT-PCRtest for COVID-19. He was treated successfully. Hypertonic saline can be hypothesized as a treatment regimen against COVID-19 infection after further investigation