The Soil and Water Assessment Tool (SWAT), a semi-distributed physically-based hydrological model, is broadly used for simulating streamflow and analyzing hydrological processes in the basin. The SWAT model was applied to analyze the hydrological processes in Göksu Himmetli, Zamanti-Ergenuşağı, Göksun Poskoflu ve Hurman-Gözler Üstü sub-basins in the upper region of Seyhan and Ceyhan watersheds located in the south of Turkey. Model sensitivity analysis, calibration, and validation were performed using SWAT-CUP automatic calibration program and SUFI-2 algorithm. According to the model sensitivity analysis results, the most sensitive parameters in these basins have been seen as CN2, ALPHA_BNK, CH_K2, and GW_DELAY. In this study, 11 years (1994-2004) meteorological and eight years (1997-2004) observed flow data were used, three years for the model warm-up period, five years (1997-2001) for calibration, and three years (2002-2004) for validation. The model statistical performance was evaluated using the Nash Sutcliffe Efficiency (NSE) as the objective function. As the result of the model calibration and validation, the NSE value in the considered four sub-basins varied between 0,70 - 0,90. The results obtained in the study showed a relatively high correlation between the observed and simulated discharge data.

Background and Purpose Refractory status epilepticus is a clinical emergency associated with high mortality and morbidity. Increasing evidence suggests neuroinflammatory pathways contribute to the development of drug-refractoriness during status epilepticus. The ATP-gated P2X7 receptor (P2X7R) has been described as potential link between inflammation and increased hyperexcitability. The aim of the present study was to determine the contribution of the P2X7R to drug-refractory status epilepticus and its therapeutic potential. Experimental Approach Status epilepticus was induced via a unilateral microinjection of kainic acid into the amygdala in adult mice. Severity of status epilepticus was compared in animals overexpressing or knock-out in the P2X7R, after inflammatory priming by the pre-injection of bacterial lipopolysaccharide (LPS) and in mice treated with P2X7R-targeting and anti-inflammatory drugs. Key Results P2X7R overexpressing mice were unresponsive to several anticonvulsants (lorazepam, midazolam, phenytoin and carbamazepine) during status epilepticus. P2X7R expression was increased in microglia during drug-refractory status epilepticus, P2X7R overexpression led to a pro-inflammatory phenotype in microglia during status epilepticus and the anti-inflammatory drug minocycline restored normal responsiveness to anticonvulsants in P2X7R overexpressing mice. Pre-treatment of wildtype mice with LPS increased P2X7R levels in the brain and promoted the development of pharmaco-resistant status epilepticus, which was overcome by either a genetic deletion of the P2X7R or the administration of the P2X7R antagonists AFC-5128 or ITH15004. Conclusion and Implications Our results demonstrate that P2X7R-induced pro-inflammatory effects contribute to resistance to pharmacotherapy during status epilepticus and suggest therapies targeting the P2X7R as novel adjunctive treatments for drug-refractory status epilepticus.

Comparing genome scans among species is a powerful approach for investigating the patterns left by evolutionary processes. In particular, this offers a way to detect candidate genes that drive convergent evolution. We compared genome scan results to investigate if patterns of genetic diversity and divergence are shared among divergent species within the stickleback order (Gasterosteiformes): the threespine stickleback (Gasterosteus aculeatus), ninespine stickleback (Pungitius pungitus) and tubesnout (Aulorhynchus flavidus). Populations were sampled from the southern and northern edges of each species’ range, to identify patterns associated with latitudinal changes in genetic diversity. Weak correlations in genetic diversity (FST and expected heterozygosity) and three different patterns in the genomic landscape were found among these species. Additionally, no candidate genes for convergent evolution were detected. This is a counterexample to the growing number of studies that have shown overlapping genetic patterns, demonstrating that genome scan comparisons can be noisy due to the effects of several interacting evolutionary forces.

Myoclonus-Dystonia is a neuropsychiatric disorder with autosomal dominant mode of inheritance with variable severity and incomplete penetrance. Pathogenic variants in SGCE are the most frequent genetic cause of M-D with maternal imprinting. Herein we report a new deleterious variant based on protein modeling analysis (c.662G> T) inherited in moroccan family.

Objectives In clinical practice, lateral nasal wall collapse during forced inspiration is widely regarded as a sign of nasal obstruction or criterion indicating nasal valve surgery. This study aims to evaluate the relationship between the degree of lateral nasal wall collapse and subjective nasal obstruction. Design Case-Control study Setting Tertiary centre hospital Participants Case group consisted of 24 patients who had been diagnosed with a deviated nasal septum or nasal valve stenosis. Control group consisted of 27 volunteers with no nasal obstruction symptoms and no septal deviation on nasal endoscopy. Main outcome measures Lateral nasal wall collapse is determined by the degree of lateral nasal wall triangle (LNWT) area reduction on frontal view during forced inspiration compared to quiet inspiration. LNWT area ratio of the patient and control groups was compared. The relationship between the lateral nasal wall collapse and clinical factors including symptom scores, nasal valve angles, skin thickness were evaluated. Results The average LNWT area ratio of the patient (n=24) and control groups (n=27) was 0.96 and 0.83 respectively (p=0.001). Symptom score (NOSE and VAS) is not related to the degree of lateral nasal wall collapse. Moreover, nasal valve angle and skin thickness were also not related to the degree of lateral nasal wall collapse. In 14 of the 19 patients, the more obstructed side corresponded to the side of narrower nasal valve angle, and 5 were not. Conclusion Lateral nasal wall collapse is not related to a patients’ nasal obstruction.

Objective: There are several types of septal deviation, including horizontal, vertical, C-shaped, S-shaped, and high deviation. One of the most difficult of these types to correct is the crooked dorsal septum, which attaches to the upper lateral cartilage and causes a high septal deviation. We propose a method for horizontal dorsal resection of a crooked septum using a mucosal through-and-through suture technique for the correction of high septal deviation. Design and setting: The medical records of 30 patients (27 men) who underwent septoplasty by one author of this study from 2019 to 2020 at our institute were reviewed prospectively. The median follow-up was 11 months (range, 4–16 months). All patients underwent a horizontal dorsal septal cartilaginous resection with mucosal through-and-through suture. Data were collected on demographics, symptoms, anatomic site of deviation, and postoperative complications. Patient self-satisfaction scores were subjectively graded using a visual analog scale ranging from 0 (excellent) to 10 (poor). Results: One surgeon performed each septoplasty using the same method; 2 (6.7%) patients underwent additional valvuloplasty. The median scores in subjective satisfaction for the 30 patients were 8.4±1.22 before surgery and 2.07±1.26 after surgery (p<0.05). Furthermore, no patient experienced a saddle deformity, septal hematoma, septal perforation, or loss of nasal tip support during follow-up. Conclusions: After horizontal dorsal resection from the upper lateral cartilage during septoplasty, the patients experienced no stability problems. This suggests that this surgical technique is a safe and effective method for correcting high deviation due to a crooked dorsal septum.

ABSTRACT The involvement of Medical Technology (MedTech) corporations in the provision of surgical care remains a topic of debate. This relationship is especially relevant in cardiac and aortic surgery as the use of grafts, stents, prostheses, and other devices is an integral component of most procedures. Many argue that the involvement of device representatives in cardiac surgical cases is valuable – they are often experts on their product and are able to contribute their expertise in challenging cases. Yet, the potential for MedTech corporations to influence surgeons’ clinical decision-making introduces a conflict-of-interest and calls into question what the ‘best practice’ for sales reps should be. The influence of MedTech corporations over policymaking bodies in the US, UK, and Europe also represents a major issue for transparency and is equally deserving of evaluation.

Fabrication of biomaterials for Tissue Engineering application by bioprinting has gained enormous attention in the research field, owing to their rapid and reproducibility factor. Progress in organic based mesoporous particles is of great interest in order to accomplish in tissue engineering treatments. Recently, researchers are focusing on different 3D bioinks for attaining 3D matrices to accommodate the drugs and cells for biological efficacies. Bioprinting is a promising field of biomaterials and regenerative medicine for the next generation therapeutics. Different polymeric substances are being evaluated for their printablity based on their rheological and biological properties. Structural fidelity is stabilized by crosslinking methods and their adaptability to microenvironment is assessed using Invitro assays. External Factors such as concentration, temperature, medium and crosslinking agents are the critical determinants for the bionks to achieve the required functionality. Moreover, the choice base chemicals used for the formulation plays a vital role in the cell viability and proliferation that lead to specific tissue growth. The mechanical strength, elastic moduli to bear strength is anchored by the porous nature of the printed scaffolds. Therefore, the influence of porosity in the mechanical and biological strength adds an appropriate value to the printed biomaterial. The present review discusses about the significance of bioprinting technique and strategies employed for printability and to achieve porosity in the developed materials

Brazil is heavily reliant on water resources. Hydroelectric plants generate about 64% of all electricity consumed. To increase yield capacity, a 2050 expansion is also planned. 78% of water used is for agriculture (irrigation and livestock), 9% for industry, and 9.1% for urban supply. However, the country has endured the worst droughts in recorded history over the last two decades, resulting in severe socioeconomic and environmental impacts. The purpose of this study was to determine the current state of knowledge regarding hydrological drought patterns, hydrometeorological factors, and their effects on the country’s hydroelectric power plants. Droughts have occurred in most of Brazil’s regions since 2014/15, causing severe impacts in many of the basins studied. Now that most hydroelectric power plants are operating at a fraction of their total capacity, the country’s hydroelectric generation is been impacted.

This paper aims to investigate the ecological role of Merlucicius merluccius, Linnaeus, 1758, in the southern and central Tyrrhenian Sea (GSA 10, Resolution GFCM/33/2009/2 General Fisheries Commission for the Mediterranean), analysing ontogenetic diet shift, geographical variations on prey composition and feeding habits. A sample of 734 hake specimens between 6 cm and 73 cm of total length (TL) were collected in 2018. To value the ontogenetic shifts in prey composition, five size-classes were created from the sample and for each class were calculated quantitative feeding indices. The cluster and MDS analysis, based on the % IRI, resulted in three trophic groups of hake size classes. The most abundant preys for small hake (size class I) were the Euphausiids, Stylocheiron longicorne and Mysidacea, while for hake with size over 10.5 cm of TL were crustaceans and fish. Engraulis encrasicolus was the most abundant prey fish for hake, followed by Boops boops and Myctophids. The mesopelagic fauna had a relevant role in the European hake diet in the southern zone. The high presence of Euphausiids, Mysids, Myctophidae and Sternoptychidae in the gut content of juvenile hakes (6-23 cm) showed the importance of organic matter and energy flowed from the mesopelagic environment to the epipelagic. Important is also the presence of decapod crustaceans in hake with size over 36 cm TL considering that our study area includes an important Gulf for the fishing of decapod crustacea.

Mardini–Nyhan or LACHT (lung anomaly, congenital heart defect, and thumb anomaly) syndrome is extremely rare. The literature contains only 12 reported cases in the pediatric population. We herein describe an adult patient with this syndrome.

The spin polarization of carbon nanomaterials is crucial to design spintronic devices. In this paper, the first-principles is used to study the electronic properties of two defect asymmetric structures, Cap-(9, 0)-Def [6, 6] and Cap-(9, 0)-Def [5, 6]. We found that the ground state of Cap-(9, 0)-Def [6, 6] is sextet and the ground state of Cap-(9, 0)-Def [5, 6] is quartet, and the former has a lower energy. In addition, compared with Cap-(9, 0) CNTs, the C adatoms on C30 causes spin polarization phenomenon and Cap- (9, 0)-Def [6, 6] has more spin electrons than Cap-(9, 0)-Def [5, 6] structure. Moreover, different adsorb defects reveal different electron accumulation. This finding shows that spin polarization of the asymmetric structure can be adjusted by introducing adatom defects.

The novel coronavirus disease 2019 (COVID-19) has shown the danger that can be caused by small, airborne and contagious virus particles such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To prevent the mass spreading of such viruses, the use of electromagnetic waves could be used to combat the spreading of the virus. Particularly, the waves could force any virus particles to oscillate in resonance with the frequency of the wave and destroy themselves before the virus would enter the respiratory system. This paper describes the use of numerical simulations to analyze the effects of exposing a SARS-CoV-2 particle to electromagnetic waves at a range of frequencies and to determine which frequencies have the potential of causing resonance within the virus which would yield to the maximum energy absorption. Such technique could be utilized in preventive/protective devices and disinfection equipment.

The disjunct temperate rainforests of the Pacific Northwest of North America (PNW) are characterized by late-successional dominant tree species western redcedar (Thuja plicata) and western hemlock (Tsuga heterophylla). The demographics of these species, along with the PNW rainforest ecosystem in its entirety, have been heavily impacted by the geological and climatic changes the PNW has experienced over the last 5 million years, including mountain orogeny and repeated Pleistocene glaciations. These environmental events have ultimately shaped the history of these species, with inland segments potentially being extirpated during the Pleistocene glaciation. Here, we collect genomic data for both species across their ranges in order to develop multiple demographic models, each reflecting a different hypothesis on how the ecosystem dominant species may have responded to dramatic climatic change. Results indicate that inland and coastal populations in both species diverged an estimated ~2.5 million years ago and experienced a decrease in population size during glaciation, with a subsequent population expansion. Importantly, we found evidence for gene-flow between coastal and inland populations during the mid-Holocene. It is likely that intermittent migration in these species has prevented allopatric speciation. In conclusion, the combination of genomic data and population demographic inference procedures involving machine learning establish that populations of the ecosystem dominants Thuja plicata and Tsuga heterophylla persisted in refugia located in both the coastal and inland regions, with populations expanding and contracting in response to glacial cycles with occasional gene-flow.

Absent pulmonary valve syndrome and L-transposition of the great arteries are rare congenital anomalies. To our knowledge, patients with both have not been previously reported. We present a case of surgical success in the patient with absent pulmonary valve, L-transposition of the great arteries, dextrocardia, double outlet left ventricle, hypoplastic anatomical right ventricle, valvular aortic stenosis and tracheomalacia. We performed anatomical left ventricle to pulmonary artery shunt using an 8-mm expanded polytetrafluoroethylene bicuspid-valved conduit, pulmonary artery plication, and tracheostomy. The patient was discharged in a stable condition while waiting for the Glenn procedure until getting her parent's permission.

Androgen deprivation therapy is a standard of care for metastatic prostate cancer, however, eventually, all men relapse. A paradoxical approach utilizing high doses of testosterone in castration-resistant prostate cancer patients demonstrated clinical responses. Here we report on four heavily pretreated CRPC patients successfully treated with supra-physiological doses of testosterone.

Not only carbon dioxide (CO2) but also air pollutants, such as sulfur oxides (SOx) and nitrogen oxides (NOx), are present in flue gas, and their reasonable and effective utilization is conducive to reducing the cost of microalgal biomass production. By utilizing simulated flue gas, the absorption characteristics of different components in transfer units were explored. The results showed that the presence of SO2 decreased the absorptivity of CO2, which reduced the concentration of the available carbon source for microalgal cells in the culture medium at the same pH value. Moreover, the presence of high-concentration oxygen (O2) in flue gas could improve the absorptivity of nitric oxide (NO). Scenedesmus dimorphus was cultured by using sulfur- or nitrogen-deficient culture media. The results showed that SOx and NOx in flue gas did not significantly influence the growth and biochemical compositions of microalgal cells when these gases were dissolved in water. Based on the above results and the metabolic kinetics of microalgal cells for nutrient elements, an adjustment strategy for the initial gas source when culturing microalgae with flue gas is proposed: (1) flue gas should be partially desulfurized so that the SOx and CO2 concentrations after desulfurization satisfy a certain relationship with the components; and (2) denitrification should not be performed because flue gas can be oxidized before utilization to increase the rate of utilization of NO.

This research studied the seepage diseases (water discharge and salt precipitation) in Maijishan Grottoes from the perspective of hydrogeology. Maijishan Grottoes is one of the extent large group of grottoes in China, where its cliff, on mount Maiji, the carrier of the grottoes, has been reinforced by concrete cover in a large area. As a case study, the physical and chemical processes of the seepage are deduced through the relationships between the flow rate of discharge water (DW) and precipitation, and through the water chemistry diversity including pH, electrical conductivity (EC), and Ionic composition between DW and rainwater (RW) and a controlled spring water (SW). Constructive results are obtained. Firstly, a perched aquifer is confirmed in the mount. All the RW will gather at the aquifer, and then discharge through 3 independent routes that connect the aquifer and grotto site. 3 kinds of water discharge response to precipitation are defined to correspond to the 3 routs: Immediate Response (I.Resp), Delay Response (D.Resp), and Stealth Response (S.Resp), these responses make up the majority of the DW. On the other hand, 2-staged chemical evolution is also been confirmed during the seepage, where stage I took place in the aquifer and stage II took place at shallow, the concrete only participate in the chemical evolution at stage II, resulted in high pH [7.77, 11.69] and EC [513, 3540] (µS/cm) in DW compared to the SW and RW.

Objectives: To estimate the frequency and factors associated with foregone and delayed medical care attributed to the COVID-19 pandemic among non-elderly adults from August to December 2020 in the US. Methods: We used three survey waves from the Urban Institute’s Household Pulse Survey (HPS) collected between August 19 to 31, October 14 to 26, and December 9 to 21. The final sample included 155,825 non-elderly (18 to 64) respondents representing 135,835,598 million individuals in the US. We used two multivariable logistic regressions to estimate the association between respondents’ characteristics and foregone and delayed care. Results: The frequency of foregone and delayed medical care were 26.9% and 35.9%, respectively. Across all income levels, around 60% of respondents reported difficulties in paying for usual household expenses in the last 7 days. More than half reported several days of mental health issues. The regression results indicated that foregone or delayed care were significantly associated with difficulties in paying usual household expenses (across all income levels) (P<.001), worse self-reported health status (P<.001), increased mental health problems (P<.001), Veterans Affairs (P<.001) or Medicaid (P=.002) coverage compared to private healthcare coverage, and older age groups. Individuals who participated in the latter two waves of the survey (October, December) were less likely to report foregone and delayed care compared to those who participated in wave 1 (August). Conclusion: Overall, the frequency of foregone and delayed medical care remained high from August to December 2020 among non-elderly US adults. Our findings highlight that pandemic-induced access barriers are major drivers of reduced healthcare provision during the second half of the pandemic and highlight the need for policies to support patients in seeking timely care.

Pneumorrachis, defined as the presence of intraspinal air, is a rare radiographic finding. It is mostly caused by traumatic and iatrogenic etiologies such as pneumothoraces or pneumomediastinum. Spontaneous pneumorrachis attributable to degenerative disc disease is an exceptional condition. We report two cases of radiculopathy caused by spontaneous pneumorrachis.

Enoxaparin is a low-molecular weight heparin for management of the thromboembolic disorders. In practice, subcutaneous (SC) enoxaparin at abdominal wall for patient with ascites might be indeterminate. It is noticed that SC enoxaparin administration in patient with ascites likely affected the anti-factor Xa level of enoxaparin.

Background: There exists variability in the administration of inpatient sotalol therapy for symptomatic atrial fibrillation(AF). The impact of this variability on patient in-hospital and 30-day post-hospitalization costs and outcomes is not known. Also, the cost impact of intravenous sotalol, which can accelerate drug loading to therapeutic levels, is unknown. Methods: 133 AF patients admitted for sotalol initiation at an Intermountain Healthcare Hospital from January 2017-December 2018 were included. Patient and dosing characteristics were described descriptively, and the impact of dosing schedule was correlated with daily hospital costs/clinical outcomes during the index hospitalization and for 30 days. The CMS reimbursement for 3-day sotalol initiation is $9,263.51. Projections of cost savings were made considering a 1-day load using intravenous sotalol that costs $2,500.00 to administer. Results: The average age was 70.3±12.3 years, 60.2% were male with comorbidities of: hypertension(83%), diabetes(36%), and coronary artery disease(53%). Mean ejection fraction was 59.9±7.8% and median QTc was 453.7±37.6 ms before sotalol. No ventricular arrhythmias developed, but bradycardia(<60 bpm) was observed in 37.6% of patients. The average length of stay was 3.9±4.6(median: 2.2) days. Post-discharge outcomes and rehospitalization rates stratified by length of stay were similar. The cost per day was estimated at $2,931.55 (1:$2,931.55, 2:$5,863.10, 3:$8,794.65, 4:$11,726.20). Conclusions: Inpatient sotalol dosing is markedly variable and results in the potential of both cost gain and loss to a hospital. In consideration of estimated costs, there is the potential for $871.55 cost savings compared to a 2-day oral load and $3,803.10 compared to a 3-day oral load.

Objective: The current study aimed to evaluate eye care needs along with ocular findings in patients treated in intensive care units due to Covid-19 infection. Materials and Methods: A total of 93 patients, 58 men and 35 women, who were under follow-up and treatment in intensive care due to COVID-19 infection between 01/01/2021 and 02/15/2021 were included in the study. Detailed eye examinations of the patients were performed with a portable handheld biomicroscope and direct and indirect ophthalmoscope. Cases requiring treatment for eye diseases were identified and treated. Results: The mean patient age was 68.32 ± 9.97 years; 35 patients were followed-up and treated with non-invasive mechanical ventilation and 58 patients with invasive mechanical ventilation support. Mild, moderate, and severe chemosis was observed in 19 patients (20.4%), 10 patients (10.8%), and 4 patients (4.3%), respectively. Conjunctivitis (8.6%) was observed in 8 patients. Corneal abrasion was present in 7 patients (7.5%). Keratitis secondary to exposure keratopathy was observed in one patient. Eye care and medical treatment was initiated for these patients. We noted 8 patients (8.6%) with retinal haemorrhage; however, to the best of our knowledge, these patients may show acute retinal involvement secondary to systemic diseases or have previous retinal findings other than Covid-19 infection or treatments. Conclusion: Findings of ocular involvement due to COVID-19 infection were detected in the present study. Retinal haemorrhages were detected in addition to the common findings in viral infections. Especially in patients supported with mechanical ventilation, the detection and treatment of conditions that require eye care for exposure keratopathy is very important for recovering from the disease and the quality of vision.

A document by Christopher Threapleton. Click on the document to view its contents.