Quantum chemical calculations were carried out to establish the half-sandwich structural behaviour between heavier group-14 elements (Si-Pb) and neutral Be3 ring. The proposed complexes are found to be global minima on the potential energy surface. Quantum chemical investigation revealed that the complexes found possess high bond dissociation energy and also favorable thermodynamics of their formation. The complexes were also found to possess significant aromatic behaviour. In addition, the half-sandwich complexes were found to possess promising chemical properties to be useful for potential H2 storage material under reversible conditions.

Sir, We would like to thank Scamell and colleagues for their letter in response to our paper describing the results of the Obstetric Anal Sphincter Injury Care Bundle (OASI-CB) evaluation (1,2). We have previously addressed most of the points raised in our response to an earlier critical review of the OASI-CB by two of the signatories of this letter (3). First, Scamell and colleagues indicate that they are disappointed in the quality of the evidence that supports the components of the OASI-CB. We feel that this criticism is misdirected, because the OASI-CB project was initiated in response to this lack of high-quality evidence. We developed a care bundle and we performed a multicentre study, which produced evidence of its positive effect. A second criticism expressed by the authors is that the OASI-CB does not include warm compresses. We have previously acknowledged the evidence that warm compresses reduce the risk of OASI (3). They were not included as a standardised component of the OASI-CB partly because of variation in availability and use (4), and partly because of clinical practicalities such as the feasibility of safely heating/reheating compresses. However, we do encourage the more widespread use of warm compresses because they would further improve the prevention already provided by the OASI-CB. A third concern raised by the authors is that the OASI-CB has only a small effect: a reduction in the OASI rates from 3.3 to 3.0%. As we explained in our article, this reported reduction is very likely to be an underestimate of the true effect of the OASI-CB, given that the OASI-CB also requires a careful check of the perineum following birth for the immediate detection of OASI. Therefore, we emphatically reject the suggestion that our results could be explained by ascertainment bias. Last, the authors suggest that we did not consider women's experiences and the acceptability of the OASI-CB. Women were–and still are–at the very heart of the development, evaluation and implementation of the care bundle (2). For example, women told us that they experienced a hands-on approach protecting the perineum as very positive and that good communication with the midwife was key to a calm birth (5). We are now performing the OASI2 study that evaluates the sustainability of the OASI-CB and its implementation in a wider group of units (www.rcog.org.uk/oasi2). Based on multi-stakeholder discussions and lessons learned from the original OASI-CB project (6), we updated the OASI-CB manual and antenatal discussion guide and improved our training materials. For example, the antenatal discussion guide now also includes antenatal perineal massage, birth position, importance of a slow birth and the use of warm compresses as discussion points alongside the OASI-CB elements. In OASI2, we will also explore women's perspectives further via a large-scale survey. We would like to reiterate that women's health and a positive birth experience are at the centre of the OASI-CB. Our article presents evidence of the effectiveness of the OASI-CB. It is this evidence that, together with our commitment to support women and clinicians, will empower women to make informed choices about whether or not they want the OASI-CB as part of their birth plan.

As a complex system, the urban natural resources system comprises water, land, forest, and air resources. Natural resources are the essential elements of economic and social development and the source of sustainable urban development. However, there are few articles which regard different natural resources as a comprehensive system to evaluate. This study aimed to reveal the patterns of natural resources and highlight the impact of natural resource subsystem. Firstly, this study establishes the ecological security evaluation system of natural resources based on the “Driving Force-Pressure-State-Response” model. Secondly, we use the Wind-Driven Optimization algorithm to optimize the Projection Pursuit model to calculate the value of ecological security level and the comprehensive value of ecological security in Guangdong-Hong Kong-Macao Greater Bay Area (2013-2018). The temporal characteristics and spatial layout of natural resources ecological security, the impact of mechanism of water, land, forest, and air resources subsystems on natural resources ecological security were assessed. The results shows that the ecological security level of natural resources in nine cities of Guangdong-Hong Kong-Macao Greater Bay Area is on the rise as a whole from 2013 to 2018. However, the ecological security level in the central region of the Greater Bay Area is low, which is directly related to the severe environmental pollution of its water and air resources. The results are basically consistent with the actual situation, which can provide a reference for the ecological security evaluation of natural resources in other urban agglomerations.

Here, we report the case of a patient who presented to our institution with severe, destructive, and un-reconstructable prosthetic valve endocarditis which required the planned implantation of a total artificial heart (TAH) to function as a bridge to cardiac transplantation.

(Z)–3–hexenol, a small gaseous molecule, is produced in plants under biotic stress and induces defense responses in neighboring plants. However, the research on little is known about how (Z)–3–hexenol induces plant defense–related signaling. In this study, we uncovered how (Z)–3–hexenol treatment enhances insect resistance by increasing γ–aminobutyric acid (GABA) contents in Arabidopsis thaliana leaves. First, (Z)–3–hexenol increases the intracellular content of the signaling molecule calcium in Arabidopsis leaf mesophyll cells. Both intracellular and extracellular calcium stores regulate these changes in calcium content. Then, CML8 and GAD4 are involved in calcium signaling. Yeast two–hybrid assays, firefly luciferase complementation imaging, and GST pull–down assays demonstrated that CML8 interacts with GAD4. Finally, (Z)–3–hexenol treatment increased the GABA contents in Arabidopsis leaves, thus increasing plant resistance to the insect Plutella xylostella. This study revealed the mechanism of activating plant insect defense induced by (Z)–3–hexenol, which is of great significance for the study of volatiles as biological control measures.

Background The posttreatment period is a key part of the management of pediatric cancer care. At this period, psychosocial effects (scholarly and psychological difficulties) have been described in pediatric cancer patients and can be prognostic for the success of social reintegration. Psychosocial effects and their impact may be related to the household’s socioeconomic background. The aim of this study was to estimate psychosocial difficulties during the posttreatment period based on a social deprivation score. Design This study is based on a prospective multicentric study database, and focused on the children who had received psychosocial evaluation during their follow-up after cancer treatment since 01/01/2013. We retrieved data on their learning and psychological difficulties. Socioeconomic status of the household was estimated by a social deprivation score. Results 1003 patients were analyzed. Learning difficulties at school were noted in 22% of patients. A greater social deprivation was significantly associated with learning difficulty (OR=1.09 per unit of the deprivation score). Tumor relapse, treatment with hematopoietic stem cell transplantation, and diagnosis of a CNS tumor remained significant risk factors. In the subgroup analysis of children with CNS tumors, learning difficulties were increased and associated with greater social deprivation. By contrast, psychological difficulties were not associated with the deprivation score. Conclusion There is a link between SE status and learning difficulties in survivors of childhood cancer. Further investigations should be carried out to confirm these results for children with CNS tumors, which is the population of the greatest concern.

Introduction There is lack of diagnostic and treatment resources with variable access to childhood cancer treatment in low- and middle-income countries (LMIC), which may lead to subsequent poor survival. The primary aim of this study is to determine the prevalence and types of T&CM used in Cameroon. Secondarily, we explored determinants of T&CM use, associated costs, perceived benefits and harm, and disclosure of T&CM use to medical team. Method A prospective, cross-sectional survey amongst parents and carers of children younger than 15 years of age who had a cancer diagnosis and received cancer treatment at three Baptist Mission hospitals between November 2017 and February 2019. Results Eighty participants completed the survey. Median patient age was 8.1 years (IQR4.1 – 11.1). There was significant availability (90%) and use (67.5%) of T&CM, while 24% thought T&CM would be good for cancer treatment. Common T&CM remedies included herbs and other plant remedies or teas taken by mouth, prayer for healing purposes and skin cutting. Living more than 5 hours away from the treatment center (p=0.030), anticipated costs (0.028), and a habit of consulting a traditional healer when sick (p=0.006) were associated with the use of T&CM. T&CM was mostly paid for in cash (36.3%) or provided free of charge (20%). Of importance was the fact that nearly half (44%) did not want to disclose the use of TM to their doctor. Conclusion Pediatric oncology patients used T&CM before and during treatment but would be unlikely to disclose to the child’s health care team.

Abstract Background and aims Multidisciplinary team (MDT) meetings provide a regular, structured meeting of a core group of professionals to provide expert decision-making in individual patient care. We describe our experiences in establishing a virtual pediatric oncology MDT between twinning partners in Cameroon (4 hospitals) and the UK. Methods Monthly video conferencing MDT meetings were established in March 2019, initially using Google meet then using Zoom platforms. Case details were circulated using formal proformas. Standard operating procedures were outlined for the MDT conduct. Results There have been 269 discussions of 201 patients in 21 meetings. Patients have been varied in age (up to 24 years). Eighty-seven (43.3%) patients had NHL, 16 (8.0%) had Wilms tumour, 20 (10.0%) had Acute Lymphoblastic Leukaemia, 19 (9.5%) had Retinoblastoma and 59 (29.4%) had other malignancies. Four of the patients did not have a malignancy. The majority of patients had stage 3 (51, 45.1%) or stage 4 (59, 52.2%). Nine patients had relapsed disease. Core team members reported positive benefits from the MDT, including defining goals of care, shared decision making, professional education and team-building. Conclusions Virtual MDT meetings between geographically dispersed teams are possible and have proved particularly valuable during the COVID-19 pandemic when in-person visits are not permitted. Cancer treatment cannot be done in isolation; the regular MDT meetings have paved the way for informed care through regular consultancy.

OBJECTIVE  To determine the overall survival (OS) and prognostic factors influencing outcomes in children and adolescents with malignant extracranial germ cell tumours (MEGCTs) in preparation for the development of a harmonised national treatment protocol.METHODS A retrospective folder review was undertaken at nine South African paediatric oncology units to document patient profiles, tumour and treatment-related data and outcomes for all children with biopsy proven MEGCTs from birth up to and including 16 years of age. RESULTS Between 1 January 2000 and 31 December 2015, 218 patients were diagnosed with MEGCTs. Female sex (HR 0.284 p=0.037) and higher socio-economic status (SES) (HR 0.071; p=0.039) were associated with a significantly lower risk of death. Advanced clinical stage at diagnosis significantly affected 5-year OS: stage I -96%; stage II - 94.3%; stage III -75.5%; (p=0.017) and stage IV (60.1%; p<0.001). There was a significant association between earlier stage at presentation and higher SES (p=0.03). Patients with a serum AFP level of more than 33,000 ng/ml at diagnosis had significantly poorer outcomes (p=0.002). The use of chemotherapy significantly improved survival, irrespective of the regimen used (p<0.001). CONCLUSIONS The cohort demonstrated a 5-year OS of 80.3% with an EFS of 75.3%. Stage, the use of chemotherapy and an elevated serum AFP level of more than 33,000ng/ml were independently predictive of outcome. The relationship between SES and outcome is important as the implementation of the new national protocol hopes to standardise care across the socio-economic divide. 

Our case series showed that eculizumab is efficacious and safe in treating atypical hemolytic-uremic syndrome, as well as it has positive effects on quality of life. Further extensive studies are required to develop unified treatment guidelines.

One of the most recently identified types is Leukocyte chemotactic factor 2 amyloidosis (LECT 2) which was found to be common in certain ethnic backgrounds. It is suggested that the diagnosis of this type is vital to prevent any therapy-related complications when it is erroneously diagnosed as AL amyloidosis.

Background: The risks for exposure to suspected and confirmed COVID patients during transthoracic echocardiograms (TTE) led us to endorse an abbreviated scanning protocol. We sought to determine whether this impacted the TTE quality measures that were being followed in our lab prior to the pandemic. Methods: Data were collected retrospectively for four quality measures reported quarterly in our lab: Diagnostic error rate, Appropriateness of initial outpatient TTE orders and American College of Cardiology Initial TTE Image Quality Metric (IQM) and Comprehensive Exam Metric (CEM). These measures were compared between two similar quarters in pre-COVID (2019) and COVID era (2020) for non-COVID patients. Additionally, IQM and CEM of 40 TTEs in COVID patients were compared with those of non-COVID patients. Results: The IQM and CEM scored significantly less in COVID patients compared to non-COVID patients (p<0.001 for both). Systemic and pulmonary veins, pulmonary arteries and arch were not adequately evaluated in COVID patients. In non-COVID patients, there were no significant differences in the IQM and diagnostic error rate but improvement in CEM and appropriateness of TTE orders from 2019 to 2020. There was no significant change in TTEs ordered for Rarely Appropriate indications, but the proportion of those ordered for syncope, palpitations and arrhythmias increased in 2020 compared to 2019. Conclusion: Though the diagnostic error rate did not change during the pandemic and the proportion of TTEs ordered for appropriate indications increased, the imaging quality in COVID patients was significantly compromised, especially for systemic and pulmonary veins, pulmonary arteries, and arch.

Rationale, aims and objectives: Over the last decade, policy changes have prompted Canadian medical education to emphasize a transformation to competency-based education, and subsequent development of evaluation tools. The pandemic provides a unique opportunity to emphasize the value of reflexive monitoring, a cyclical and iterative process of appraisal and adaptation, since tools are influenced by social and cultural factors relevant at the time of their development. Methods: Deductive content analysis of documents and resources about the advancement of primary care. Reflexive monitoring of the Family Medicine Longitudinal Survey (FMLS), an evaluation tool for physician training. Results: The FMLS tool does not explore all training experiences that are currently relevant; including, incorporating technology, infection control and safety, public health services referrals, patient preferences for care modality, and trauma-informed culturally safe care. Conclusion: The results illustrate that reflection promotes the validity and usefulness of the data collected to inform policy performance and other initiatives. Keywords: program evaluation; health professions education; reflexive monitoring; competency-based education; healthcare policy

We present the case of a 9-year-old girl who was referred to our service with a recent history of shortness of breath on exertion and fatigue in addition to visual disturbances and gastrointestinal symptoms. A Transthoracic Echocardiography demonstrated the presence of 3 large intracardiac masses in both the right and left atrium protruding into the mitral and tricuspid valve orifices causing bilateral inflow obstruction. The patient underwent urgent surgical excision of the masses which was uncomplicated. Histological testing was consistent with a rare intracardiac location of Burkitt's Lymphoma.

The use of NGS datasets has increased dramatically over the last decade, however, there have been few systematic analyses quantifying the accuracy of the commonly used variant caller programs. Here we used a familial design consisting of diploid tissue from a single Pinus contorta parent and the maternally derived haploid tissue from 106 full-sibling offspring, where mismatches could only arise due to mutation or bioinformatic error. Given the rarity of mutation, we used the rate of mismatches between parent and offspring genotype calls to infer the SNP genotyping error rates of FreeBayes, HaplotypeCaller, SAMtools, UnifiedGenotyper, and VarScan. With baseline filtering HaplotypeCaller and UnifiedGenotyper yielded one to two orders of magnitude larger numbers of SNPs and error rates, whereas FreeBayes, SAMtools and VarScan yielded lower numbers of SNPs and more modest error rates. To facilitate comparison between variant callers we standardized each SNP set to the same number of SNPs using additional filtering, where UnifiedGenotyper consistently produced the smallest proportion of genotype errors, followed by HaplotypeCaller, VarScan, SAMtools, and FreeBayes. Additionally, we found that error rates were minimized for SNPs called by more than one variant caller. Finally, we evaluated the performance of various commonly used filtering metrics on SNP calling. Our analysis provides a quantitative assessment of the accuracy of five widely used variant calling programs and offers valuable insights into both the choice of variant caller program and the choice of filtering metrics, especially for researchers using non-model study systems.

Bladder Rhabdomyosarcoma is a rare disease. It can be diagnosed by imaging and histological examination and managed using multi-modal therapy. Herein, we report a large non-metastatic rhabdomyosarcoma mass positioned in the bladder which was successfully eradicated through open surgery.

A total of 89 children had their urinary catheters removed 4 weeks after the operation.The children, diagnosed with urine leakage, were successfully repaired after the leakage occurred one year later at one time.The one-time success rate of this operation was 87.6% and the incidence of the urethral fistula was 12.6%

Initial guidelines advised that sensitization to PEG should be taken into consideration in suspected subjects before a recommendation on the administration of vaccines for COVID-19 containing PEG or its cross-reactive analogues. 3 However, PEG shows an important variability in terms of molecular weights and conjugation forms. In that sense, although it is known that PEG-2000 (MW: 2000g/mol) conjugated with lipids is the form contained in the vaccines for COVID-19, there has been great variability in the PEG molecules used in allergy tests to evaluate sensitization of suspected subjects in the context of the current COVID-19 vaccination campaigns. 4 In this context, recent findings have shed light on the specific form of PEG that could be responsible of the hypersensitivity reactions to the mRNA vaccines for COVID-19.

Sturmberg and Martin’s application of systems and complexity theory to understanding Universal Health Care (UHC) and Primary Health Care (PHC) is evaluated in the light of the influence of political economy on health systems. Further the role that neoliberal approaches to governance have had in creating increased inequities is seen as a key challenge for UHC. COVID-19 has emphasized long standing discrepancies in health and these disadvantages require government will and cooperation together with adequate social services to redress these discrepancies in UHC.

During the history of range expansion, the populations encounter with variety of environments. They respond to the local environments by modifying the mutually interacting traits. Therefore, to understand the whole life history of the populations, it is ideal to capture the history of their range expansion with reference to the series of surrounding environments and to infer the coadaptation of the multiple traits. Toward this end, we provide an exploratory analysis based on the features of populations: site frequency spectra of populations, population-specific FST, association between genes and environments, positive selections on traits mapped on the admixture graph, and GWAS results. Correspondence analysis of genes, environments, and traits provides a bird’s-eye view of the history of population differentiation and range expansion and various types of environmental selections at the times. Principal component analysis of the estimated trait-specific polygenic adaptations mapped on the admixture graph enables to understand the coadaptation of multiple traits. The potential usefulness was confirmed by analyzing a public dataset of wild poplar in northwestern America. In response to the northern cold temperature and longer daylength, the populations increased the photosynthetic activity and nutrient use efficiency at the expense of the risk of pathogen invasion, and in response to warm temperature, they increased the growth. At higher altitude, they shifted the maximum activity to earlier period in spring to reduce the activity in dry summer. The R codes for our representation method and simulations of population colonization used in this study are available as supplementary script.

We described a rare case of nadroparin-induced skin necrosis with thrombocytopenia.LMWH therapy is used in thrombosis prophylaxis, it is important to recognize that skin necrosis can be a part of HIT early in its course and change heparin or LMWH to non-heparin anticoagulants such as director thrombin III inhibitors.

This case report presents one important aspect of promoting ACP in Japanese culture, which is different from Western cultures. The report suggests the possibility that legal support contributes to the promotion of ACP, while considering differences in cultural contexts.

CDC estimates 1 million dogs are imported into the United States annually. With the movement of large numbers of animals into the United States the risk of disease importation is a concern, especially for emerging diseases. Dogs that arrive to the United States ill or dead are investigated by public health authorities to ensure dogs are not infected with diseases of concern (such as rabies). We identified factors associated with illness and death in imported dogs and estimated the initial investigation cost to public health authorities. Dog importation data from the CDC’s Quarantine Activity Reporting System were reviewed from 2010–2018. The date of entry, country of origin, port of entry, transportation method, and breed were extracted to examine factors associated with illness and death in dogs during international travel. Costs for public health investigations were estimated from data collected by the Bureau of Labor Statistics and Office of Personal Management. Death or illness was more likely to occur in brachycephalic breeds (aOR=3.88, 95%CI 2.74–5.51). Transportation of dogs via cargo (aOR=2.41, 95%CI 1.57–3.70) or as checked baggage (aOR=5.74, 95%CI 3.65–9.03) were also associated with death or illness. On average, 19 dog illnesses or deaths were reported annually from 2010–2018. The estimated annual cost to public health authorities to conduct initial public health assessments ranged from $2,071–$104,648. Current regulations do not provide adequate resources or mechanisms to monitor the rates of morbidity and mortality of imported dogs. There are growing attempts to assess animal welfare and communicable disease importation risks; however, responsibility for dogs’ health and well-being is overseen by multiple agencies. A joint federal agency approach to identify interventions that reduce dog morbidity and mortality during flights while continuing to protect U.S. borders from public health and foreign animal disease threats could be beneficial.

Objectives: To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and postoperative pain. Design: A retrospective controlled study. Setting: All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD. Participants: children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010-2020. Main outcome measures: Wound-related complications and visual analog scale (VAS) pain scores at discharge were compared between children who had a MPD applied following surgery and those who did not. Results: 119 cases were included. The demographic characteristics of the patients and surgical techniques employed similar for both groups. There were 91 patients in the MPD group and 28 in the non-mastoid dressing (NMPD) group. In the MPD group, 5 patients developed minor wound dehiscence, 8 experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had a SSI, while another had a local hematoma. Therefore, there were no differences between the groups in relation to postoperative complications (p = 0.47). Despite these similitudes, the NMPD patients suffered less postoperative pain, as measured by the VAS (p =.02). Conclusions: This study shows that no significant benefit is derived from using a MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent postoperative wound complications. Our study supports the abandonment of routine MPD on children following mastoidectomy.