It has been both a strange and unsettling  year with a lot of uncertainties related to COVID-19. Both the  premier supercomputing conferences ISC'20 and SC20 went virtual,  preventing users from exploring the show floors with their examples of novel architectures and seeing the demos of their related tools. Companies have also slowed their procurement of high-end systems during 2020, as was discussed during the presentation of top500.org statistics at the Top-500 Birds-of-a-Feather session at SC20. The Top-500 list is a measurement of the world's largest computers using the High-Performance Linpack benchmark (see www.top500.org). Systems must solve large dense systems of linear equations without using the operation-saving Strassen algorithm or a mix of lower precision, but doing the calculations conforming to LU factorization with partial pivoting using  \(⅔n^3+O(n^2)\) double-precision (64-bit)  floating point numbers.Despite less turnover of the world's largest computer systems, technologies continue to advance, and the trends are more interesting and diverse than ever.The US dominated the  computing industry—including the supercomputer industry—for years, until Japan gave the US a jolt with the introduction of the Earth Simulator back in 2002.  This put supercomputing back in the spotlight, especially in the US, but also in Europe. For the past decade, the US, Japan and China have  dominated at the top of the Top-500 list.  As can be seen from the following table, these systems were built primarily on US-designed chips from IBM and Intel, coupled with accelerators from NVIDIA.  The AMD-based Titan Cray/HPE system and the Sunway system in China, as well as the new ARM-based Fujitsu Fugaku supercomputer, are notable exceptions. In this article, we will discuss the history of ARM and its current impact on HPC as well as some other European trends.

Le tecniche che vengono impiegate per affrontare una valutazione di impatto ambientale sono varie, esistono alcune tecniche di più recente utilizzo, altre che si sono consolidate con il tempo. Nel seguente studio, infatti, vengono riprese delle tecniche ben lontane tra loro nel tempo, nello specifico la matrice di Leopold (sviluppata nel 1971) e il metodo KFCM. La matrice di Leopold viene utilizzata per la valutazione di impatto ambientale relativo al progetto di un parco eolico, in cui vengono affrontati sia gli impatti positivi e che  negativi dei diversi comparti. Segue a  questo caso studio un metodo più innovativo, per migliorare attraverso l’utilizzo dell’ANN (Artificial Neural Network), quella che è l’analisi decisionale, riducendo la soggettività, attraverso l’impiego del KFCM (Metodo Kernel Fuzzy Clusteryng Means Algoritm) e della rete neurale BP (Back propagation) , in modo tale da standardizzare il processo. L’obiettivo di questo metodo è quello di analizzare i potenziali impatti dell’opera, in modo tale da generare una soluzione di progettazione ottimizzata per ridurre i potenziali impatti ambientali.  

Il presente lavoro mostra come la Paired Comparison Technique (PCT) si configuri come un’utile tecnica di ponderazione matriciale negli studi di impatto ambientale per l’analisi delle alternative. Sono presentati i risultati di un caso studio relativo all’implementazione della PCT in merito alla progettazione di un impianto idroelettrico, al fine di individuare l’alternativa progettuale che abbia i minori impatti potenziali sull’ambiente. In particolare, la tecnica utilizzata ha consentito di gestire criteri ed alternative in maniera obiettiva ed organica attraverso l’ordinamento di fattori in funzione del loro peso relativo. I risultati conseguiti dimostrano come la PCT sia una tecnica di facile utilizzo, ma di particolare efficacia per supportare decisioni nella Valutazione d’Impatto Ambientale.

Cardiac surgical patients are often discharged to a rehabilitation facility to complete the convalescence in a protected setting. This care pathway is usually reserved for elderly and fragile patients, with severe and invalidating comorbid conditions. Between March and April 2020, nineteen patients were discharged from our unit to a rehabilitation clinic where a hotbed of SARS-CoV-2 infection was documented on April 17. After the outbreak, all patients underwent screening with real-time PCR on nasal swabs, and 18/19 patients were found positive. Diversely from other observations on perioperative COVID-19 reporting mortality rates of 30-40%, the COVID-19 had a benign course in our cohort: six patients were completely asymptomatic, and only seven patients required hospitalization (no deaths). We describe the baseline, operative and postoperative features of these patients, and present some potential explanations for the surprisingly benign course of the COVID-19 in this cohort.

Primary cardiac tumors are rare in children, usually consist of benign tumors like rhabdomyomas and fibromas that may spontaneously regress. Primary malignant tumors are extremely rare even in adults and very few paediatric cases were reported in literature. Rhabdomyosarcoma is a rare primary malignant tumor in children and most of the reported cases occur in right ventricle, left atrium and right atrium. We report a 15 month old child with primary rhabdomyosarcoma of left ventricle presenting in cardiac tamponade and circulatory failure.

Background: Cancers, and specifically lymphomas, are one of the main causes of morbidity and mortality after heart transplant. We encountered this complication on a 54-year-old male patient, which brought to our attention the lack of a specific and appropriate treatment for a primary cardiac lymphoma on the graft. Objective: This case report highlights the challenging management of primitive heart transplant lymphoma and its treatment. Method: electronic medical record literature reviewed through Pubmed interface of Medline. Result: We report the case of an Epstein-Barr Virus (EBV) induced primary cardiac lymphoma on the graft. The lymphoma spread quickly in spite of the numerous treatments we tried and resulted in rhythmic complication. Endocavitary implantable cardioverter defibrillator was implanted but quickly removed due to local complications. The patient died from a sudden death at home shortly after. Conclusions: Primary cardiac lymphoma on the graft is highly rare with poor prognosis and rhythmic complications. Further studies are needed to assess the benefits of other treatment approaches, such as radiofrequency ablation techniques.

Background. Asthma does not seem to confer a risk for developing a disease caused by 2019 novel coronavirus (COVID-19). The aim of this study was to assess the association between asthma and severity of COVID-19 in the Mexican population. Methods. In a cross-sectional study, we analyzed the data of the population in Mexico who underwent a test to detect COVID-19 from February 27 to June 21, 2020. The primary outcomes were hospitalization, pneumonia, endotracheal intubation, and death related to COVID-19 in patients with asthma. Results. Asthma was associated with a lower risk of hospitalization (OR = 0.71, 95% CI 0.66 to 0.76), lower risk of pneumonia (OR = 0.75, 95% CI 0.69 to 0.81), and lower risk of endotracheal intubation (OR = 0.79, 95% CI 0.63 to 0.98). In addition, asthma decreased the risk of dying from COVID-19 (OR = 0.73, 95% CI 0.65 to 0.82). In a subgroup analysis, the same trend was observed in patients who required hospitalization (OR = 0.79, 95% CI 0.69 to 0.90); while in non-hospitalized patients, associations were inconsistent according to the covariates introduced to the models. There was no association between asthma and death in patients admitted to the intensive care unit (ICU); however, in hospitalized patients who did not require ICU management, asthma significantly reduced the risk of dying. Conclusion. Our results suggest that compared to patients without asthma, patients with asthma are less likely to require hospitalization, develop pneumonia, be intubated endotracheally, or die from COVID-19.

Background: Few and small studies have described the management of immunomodulant/immunosuppressive therapies or phototherapy in atopic dermatitis (AD) patients during coronavirus disease 2019 (COVID-19) pandemic. Methods: A national registry, named DA-COVID-19 and involving 35 Italian dermatology units, was established in order to evaluate the impact of COVID-19 pandemic on the management of adult AD patients treated with systemic immunomodulant/immunosuppressive medications or phototherapy. Demographic and clinical data were obtained at different timepoints by teledermatology during COVID-19 pandemic, when regular visits were not allowed due to sanitary restrictions. Disease severity was assessed by both physician- and patient-reported assessment scores evaluating itch intensity, sleep disturbances, and AD severity. Results: A total of 1831 patients were included, with 1580/1831 (86.3%) continuing therapy during pandemic. Most patients were treated with dupilumab (86.1%, 1576/1831) that was interrupted in only 9.9% (156/1576) of cases, while systemic immunosuppressive compounds were more frequently withdrawn. Treatment interruption was due to decision of the patient, general practitioner or dermatologist in 39.9% (114/286), 5.6% (16/286), and 30.1% (86/286) of cases, respectively. Fear of increased susceptibility to SARS-CoV-2 infection (24.8%, 71/286) was one of the main causes of interruption. Sixteen patients (0.9%) resulted positive to SARS-CoV-2 infection, 3 of them (0.2%) were hospitalized but no cases of COVID-related death occurred. Conclusions: Most AD patients continued systemic treatments during COVID pandemic and lockdown period, without high impact on disease control, particularly dupilumab-treated patients.

Background and Aims Current guidance advises that at least 90% of anterior cruciate ligament reconstructions are performed as day case operations. Same-day surgery rates achieved by surgical units have significant clinical and financial implications. The primary aim of this multi-centre study was to determine the rate of admission and causes for admissions in patients undergoing anterior cruciate ligament reconstruction. Method Patient documentations were studied for those who underwent an elective anterior cruciate ligament reconstruction between January 2015 and April 2019. Contributing factors related to admission length were investigated and included patient age, gender, body mass index (BMI), operating surgeon, operating hospital, American Society of Anaesthesiology (ASA) grade, and position of the patient on the operating list. Both univariate and multivariate analysis was conducted using the STATA/IC 16.1 statistical package. Results The day surgery rate of anterior cruciate ligament reconstructions were 52% (50/95). Patients positioned later on the operating list were more likely to be admitted post-operatively (OR – 4.49; p=0.002; 95% CI – 1.72-11.69) and this was the only factor associated with admission. A large majority of admitted patients (95.6%) were admitted without a clinical cause and were otherwise safe for same-day discharge. Conclusions The day surgery rate for ACL reconstruction remains low, despite an extremely low complication rate. Reconfiguration of the operating lists and positioning anterior cruciate ligament reconstructions earlier in the day will likely increase the same-day discharge rate.

Understanding the seasonal movements of migratory species underpins ecological studies. Nearly 600 butterfly species show migratory behaviour, yet the spatial pattern of these migrations is poorly understood. We developed climatic niche models for 405 migratory butterfly species globally to estimate patterns of seasonal movement and the distribution of seasonal habitat suitability. We discover strong seasonal variation in habitat suitability for most of the migratory butterflies with >75% of pixels showing seasonal change in predicted occupancy for 85% of species. In contrast to bird migrations, the greatest rate of seasonal switching occurs in the tropics. Several species showed extreme range fluctuations, exceeding 10-fold for 53 species (13%) and more than 100-fold for nine species (2%); such species may be at elevated extinction risk. Our results can be used to search for the ecological processes that underpin migration in insects, as well as to design conservation interventions for declining migratory insects.

Mammalian orthoreoviruses (MRVs) have been identified in various mammalian species, including humans, bats, and pigs. However, MRV isolation and complete genome sequences from wild boars have not yet been reported. In this study, we isolated, sequenced, and analyzed an MRV from a free-living wild boar in Japan using a porcine sapelovirus-resistant cell line N1380. The complete and empty virus particles were obtained from the N1380 cell culture supernatants, and complete genome sequences were obtained from complete virus particles. Sequence analyses revealed that the isolated MRV, named TY-14, was classified as MRV3 and had a close genetic relationship with lion in a Japanese zoo MRV2 (L2, L3, and M3 genes) and human MRV2 from Japan (S2 gene). Phylogenetic analyses showed that TY-14 clustered only with bat MRVs in the M1 gene, while TY-14 formed a cluster with several animal MRVs in the M2 and S3 genes, and independently branched in the L1, S1, and S4 genes, suggesting a genetic relationship with other unknown origins. Recombination events were identified in the M2 gene. These results suggest that TY-14 was generated by reassortment and recombination events involving MRVs circulating in Japan, bats, and other unknown origins.

Microbiome composition data collected through amplicon sequencing are count data on taxa in which the total count per sample (the library size) is an artifact of the sequencing platform and as a result such data are compositional. To avoid library size dependency, one common way of analyzing multivariate compositional data is to perform a principal component analysis (PCA) on data transformed with the centered log-ratio, hereafter called a log-ratio PCA. Two aspects typical of amplicon sequencing data are the large differences in library size and the large number of zeroes. In this paper we show on real data and by simulation that, applied to data that combines these two aspects, log-ratio PCA is nevertheless heavily dependent on the library size. This leads to a reduction in power when testing against any explanatory variable in log-ratio redundancy analysis. If there is additionally a correlation between the library size and the explanatory variable, then the type 1 error becomes inflated. We explore putative solutions to this problem.

Background Past active surveillance have reported prevalence of subclinical RHD amongst school children which are not comparable because of major differences in screening methods. The present study is based on the WHF criteria to assess the prevalence of subclinical carditis due to RHD and elucidate evolution of the disease when these children were placed on appropriate antibiotic prophylaxis and regular follow-up. This is the first large active surveillance study which has been conducted in a single district of India after the publication of WHF criteria and is reporting short-medium term follow-up data. Methods For active surveillance of RHD among urban and rural school children of Bikaner, a random inclusion strategy was adopted. The diagnostic labelling based on the echocardiographic criteria proposed by World Heart Federation was done by a group of experienced cardiologists. The follow up of the patients recruited in to the study was done to ascertain the early evolution of the disease in the presence of appropriate antibiotic prophylaxis. Results A high prevalence of subclinical RHD was noted in the study population. Pathological mitral and/or aortic valves regurgitation was the commonest lesion and significant proportion of cases improved on regular antibiotic prophylaxis. There was no case of fixity of leaflets/ stenosis. Conclusion The prevalence of subclinical RHD and these cases are reversible if appropriate antibiotic prophylaxis is instituted at an early stage.

Necrotising pneumonia complicated by mycotic pseudoaneurysm has been reported very rarely in infancy. Here we present a five month old girl who had an acute life-threatening presentation of cavitatory pneumonia.

Objective: To assess impact of COVID-19 on diagnosis and management of ectopic pregnancy.Design: Retrospective comparative analysis of ectopic pregnancies (EP) between January and July in 2019 (pre-COVID) and 2020.Setting: Performed at Blackpool Victoria Hospital, a district general hospital in Lancashire. There were no changes in health care personnel and EP management guidelines during both periods, however service provision was modified in line with COVID-19 regulations.Population: We identified 27 EP cases of 1780 total pregnancies presented to early pregnancy unit (EPU) in 2019 compared to 22 cases of 1782 pregnancies in 2020.Methods: Data was collected from EPU computerised database, looking at maternal age, site, side, size and gestation at diagnosis, ruptured EP, different management options. A Chi square statistical analysis compared the variables.Main outcome measures: Gestation at diagnosis and cases of ruptured EP. Secondary outcome measures were the different management options.Results: The incidence of EP cases was similar in 2020 and 2019 (22/1782; 1.23% Vs 27/1780; 1.51%, P=0.512). We found more cases of ruptured EP in 2020 compared to 2019 nonetheless statistically insignificant (6/22; 27.3% Vs 5/27; 18.5%, P=0.467). However, a stark difference noted was the gestation of EP diagnosis, 77.3% presented late (>6wks amenorrhoea) in 2020 compared to 2019, proving to be statistically significant (17/22; 77.3% Vs 25/27; 92.6%, P<0.001). Other parameters like maternal age, site and size of EP, and different management options; were not statistically significant.Conclusions: We urge women to seek help as there are infection prevention measures in place, to provide the services required in early pregnancy.

Nucleic acid based - mRNA based and adenovirus vectored - vaccines, were first ever or first commercially ever approved for the public, respectively. However, these newly emergency approved types possess a potential risk to induce auto-immune diseases e.g., thrombocytopenia, myocarditis and immune induced thrombosis and thromboembolism that might be fatal and could reason for some of the post vaccination sudden death reports. Moreover, all SARS CoV-2 types of vaccines, depending on the spike protein immunogenicity, especially the conventional inactivated ones might increase the likelihood of COVID-19 severity upon re-infection through antibody dependent enhancement which might reason for the recently described abundance of hospital admissions within seven days of vaccination and might also reason for some of the serious adverse effects encountered with administration of convalescent plasma to COVID-19 patients as well as they might share in development of some lethal SARS CoV-2 variants. Importantly, we suggest that SARS CoV-2 mass vaccination campaigns were the worst ever decision made and that making these COVID-19 vaccines compulsory or administering them to children or pregnant participants might be considered as a crime against humanity to the extent that no prior companies- governmental agreements would ever secure impunity. Finally, a full informed personalized risk benefit ratio especially for some described high-risk groups must be secured while suggesting that the subunit vaccines are the least hazardous ones.

Subcutaneous metastases at presentation in cervical cancer are rare and they are associated with ominous prognosis. In this literature review, we present a case of skin metastasis and systematically review the current literature with the aim to discuss trends, treatment and survival of the reported cases.

Single-stage endovascular treatment of cardiac and vascular diseases with combined endovascular techniques has bee increasingly reported in the contemporary literature. Although more complex cases are currently being treated with such techniques, there are still crucial issues regarding their safety and efficacy.silmutaneous

The clinical symptoms, blood laboratory data, O2 saturation and high resolution computed tomography (HRCT) findings are critical factors in diagnosis of COVID-19 infection. In this study, 105 hospitalized patients suspected of having COVID-19 were evaluated. Finally, the data of 83 confirmed cases by HRCT and RT-PCR were analyzed. 61.40% of the patients had a comorbidity disease. 89.20% had fever, 92.00% cough, 91.40% dyspnea. Abnormal CRP seen in 77.80% of the patients following by 66.70% lymphopenia, and 60.30% neutrophilia. Also, ALP (abnormal vs. normal) and score of HRCT assessment variables had a significant effect on the positiveness of HRCT findings. 87.95% had abnormal HRCT with 41% bilateral multilobar patchy ground glass opacity (GGO). Moreover, there was a statistically significant association between level of O2 saturation and HRCT results. Our findings showed that male patients with middle age and comorbidity disease were more susceptible to the COVID-19 infection. Additionally, clinical features, blood laboratory findings, O2 saturation and HRCT findings are critical factors in prognosis of COVID-19 infection.

In this manuscript, we compare the expectations versus the real word results and handling of three repurposed COVID-19 drugs; tocilizumab, remdesivir and favipiravir providing a personal perspective to affiliate a well-known metaphor to describe their outcomes; the good, the bad and the ugly, respectively and encouraging those colleagues who consider these drugs in their COVID-19 management to consider the risk benefit ratio accordingly.

Background. Mechanical circulatory support (MCS) has been applied as an effective therapy for patients with end stage heart failure (HF). The existing donor organ shortage issue in Kazakhstan, and hence long waiting times, have resulted in left ventricular assist device (LVAD) implantation being the predominant surgical treatment method for this condition. The purpose of this study is to analyze clinical outcomes of MCS program data in our Center. Methods. This study involves a retrospective analysis of 324 patients with different types of implantable MCS including LVAD (n=319), fully implantable LVAD (FIVAD, n=2), and total artificial heart (TAH, n=3). FIVAD and TAH cases were analyzed separately from other VAD types due to their small numbers. Results. Initially, LVADs were implanted as bridge-to-transplant (BTT) in 214 (67.1%) of patients and as a destination therapy (DT) in 105 (32.9%) cases, but only 30 (9.4%) patients proceeded to transplant. The overall survival rate of all LVAD patients at years 1, 2, 3, and 4 was 84.3%, 69.7%, 62.8%, and 52.5%, respectively. The distance from the clinic (Nur-Sultan) to patients’ cities of residence (average 1015 ± 668 kilometers) was not associated with patient survival. Conclusions. Developing MCS programs is crucial in providing care for patients with HF. Using LVAD as DT produced satisfactory outcomes with favorable survival rates, which are comparable to the outcomes reported in other studies. Further trials are needed to investigate the results of TAH and FIVAD implantation in order to establish them as an acceptable alternative treatment to heart transplantation.

We describe the demographic, clinical, and laboratory characteristics of children with COVID 19 in comparison with those of not-laboratory-confirmed cases. We conducted a cross-sectional study on the epidemiological, clinical, radiological, and laboratory characteristics, and outcome of 422 children (aged 0–18 years) with suspected and confirmed COVID 19 admitted to the pediatric emergency department from March 23rd to July 23rd, 2020. Of the 422 children with suspected COVID-19 included in this study, COVID-19 was PCR-confirmed in 78 (18.4%). Fever (51.2%) and cough (43.5%) were the most prominent symptoms in children with confirmed cases. The clinical status of the patients with confirmed COVID-19 was significantly milder than that of those with suspected COVID-19. The proportion of COVID-19 pneumonia cases was 44.4%, 5.5%, 18.7%, and 8.5% for the age groups of ≤ 1, 2–6, 7–12, and ≥ 12 years, respectively. Of the 422 children, 128 (30.3%) underwent nasopharyngeal PCR testing for other respiratory viral pathogens; 21 (16.4%) were infected with viral pathogens other than severe acute respiratory syndrome-related coronavirus-2. Only one patient (4.7%) with confirmed COVID-19 had coinfection with respiratory syncytial virus and rhinovirus. The areas under the receiver-operating characteristics curves were 0.812 for WBCs, 0.752 for neutrophils, 0.717 for lactate dehydrogenase, and 0.708 for lymphocyte for predicting COVID-19 (p ≤ 0.001). Fever and cough or other clinical symptoms or signs should not be considered hallmarks of COVID 19. In this study, the WBC, neutrophil, and lymphocyte counts were predictive of COVID-19 positivity.

Pyoderma gangrenosum (PG) being a primary sterile neutrophilic dermatosis, the etiology is still uncertain and it rarely affects children. A high index of suspicion is essential to execute its prompt treatment. To the best of our knowledge this is the first reported case in our country

Cytomegalovirus (CMV) is an opportunistic organism. We report a young, healthy, immunocompetent female with no apparent cardiovascular risk factors presenting with acute myocardial infarction. She had CMV viremia and went on to develop CMV-colitis and hepatitis. This report highlights that CMV can cause clinically significant multi-organ disease in immunocompetent-patients