Objective: To investigate the relationship between maternal ethnicity and migration status on perinatal outcomes. Design: Population-based cohort Setting: Maternity department of a large hospital in Northern England Population: Women delivering at Bradford Royal Infirmary between March 2007 and December 2010 Methods: Impact of maternal migration status and ethnicity were assessed using multiple logistic regression for categorical outcomes and multiple linear regression for continuous outcomes. Main outcome measures: Maternal and neonatal outcomes Results: First-and-second-generation Pakistani migrants had higher odds of low birthweight (aOR 1.63, CI 1.35-1.97 and aOR 2.01, CI 1.66-2.42 respectively) and gestational diabetes (aOR 2.68, CI 2.20-3.27 and aOR1.79, CI 1.43-2.23) and lower odds of macrosomia (aOR 0.30, CI 0.24-0.37 and aOR 0.30, CI 0.24-0.39) compared to white British natives. First-generation Pakistani migrants also had higher odds of stillbirth (aOR 2.01, CI 1.00-4.01) and lower odds of preterm birth (aOR 0.80, CI 0.64-0.98) and APGAR score<7 at 1 minute (aOR 0.80, CI 0.68-0.94), which was not the case for other groups with either shared ethnicity or migration status. Conclusion: This study highlights higher odds of both low birthweight and lower odds of macrosomia among migrant Pakistani mothers compared to native women, despite having higher rates of gestational diabetes. Lower odds of preterm birth in first-generation migrants compared to native and second-generation women is of interest, however other poorer neonatal outcomes are concerning. The observed intergenerational differences in particular merit further explorations. Funding: The Burdett Trust for Nursing, grant number 472356. Key words: Perinatal; Pregnancy; Ethnicity; Migration; Born in Bradford.

Background: Ex-situ donor liver machine perfusion is a promising tool to assess organ viability prior to transplantation and a platform to investigate novel therapeutic interventions. However, the wide variability in donor and graft characteristics between individual donor livers limits the comparability of results. We investigated the hypothesis that the development of a split liver ex-situ machine perfusion protocol provides the ideal comparative controls in the investigation of machine perfusion techniques and therapeutic interventions, thus leading to more comparable results. Methods: Four discarded human donor livers were surgically split following identification and separation of right and left inflow and outflow vessels. Each lobe, on separate perfusion machines, was subjected to normothermic perfusion using an artificial haemoglobin-based oxygen carrier solution for six hours. Metabolic parameters as well as hepatic artery and portal vein perfusion parameters monitored. Results: Trends in hepatic and portal vein flows showed a general increase in both lobes throughout each perfusion experiment, even when normalised for tissue weight. Progressive decreases in perfusate lactate and glucose levels exhibited comparable trends in between lobes. Conclusion: Our results demonstrate comparability between right and left lobes when simultaneously subjected to normothermic machine perfusion. In the pre-clinical setting, this model provides the ideal comparative controls in the investigation of therapeutic interventions for GMP cellular therapies.

Background: Children undergoing umbilical cord blood transplantation (UCBT) have many treat-related severe side effects, which affects their quality of life (QoL) seriously. Exercise can help mitigate fatigue, improve sleep quality and QoL, however, the effects on children undergoing UCBT is limited. Procedure: Forty-eight children patients submitted to UCBT were divided into two groups by convenience sampling. The exercise therapy group performed abdominal breathing training combined with active joint movement program 3 days a week during hospitalization. The control group received routine exercise education without any scheduled programs. The fatigue, sleep quality, and QoL were evaluated at the date of hospital admission and discharge, and the differences between two groups were estimated using Student t test. Results: The exercise therapy group showed higher scores of general fatigue, rest fatigue, cognitive fatigue and the Pediatric Quality of Life Inventory (PedsQL) Multidimensional Fatigue Scale (MFS) total score, but no significant differences were found between two groups (p＞0.05). There was an improvement in the sleep quality, verified by a reduction in the global score, subjective sleep quality, sleep latency, sleep efficiency, and daytime dysfunction (p＜0.05), analysis of the PedsQL 3.0 Cancer Module also revealed an improvement in procedure anxiety, worry, cognition, appearance, communication and total score in the exercise therapy group (p＜0.05). Conclusion: Our prospective study demonstrates that exercise therapy is safe and feasible for children undergoing UCBT, and it has beneficial effects on sleep quality and QoL．

Analysis of population genetic data often includes the search for genomic regions with signs of recent positive selection. One of the approaches involves the concept of Extended Haplotype Homozygosity (EHH) and its associated statistics. These statistics typically need phased haplotypes and, some of them, polarized variants. Here, we unify and extend previously proposed modifications to loosen these requirements. We compare the modified versions with the original ones by measuring the False Discovery Rate on simulated whole-genome scans and quantifying the overlap of inferred candidate regions on empirical data. We find that phasing information is indispensable for the accurate estimation of within-population statistics for all but very large samples and of cross-population statistics for small samples. Ancestry information, in contrast, is of lesser importance for both. Our publicly available R package rehh incorporates the modified statistics presented here.

Objectives: Our study purpose was to assess the regulatory response of the chemokine CXCL13 in the serum of patients with systemic lupus erythaematosus (SLE) and to evaluate its influence on the inflammatory process in SLE. Methods: Serum samples from 97 SLE patients, 49 non-SLE patients (23 patients with other autoimmune diseases and 26 patients with rheumatoid arthritis ) and 50 healthy controls were analysed for the concentration of CXCL13 using ELISA. Results: The results indicated that the serum levels of CXCL13 were significantly higher in SLE patients than in non-SLE patients and healthy controls (p<0.001). Moreover, the level of CXCL13 decreased as the level of anti-dsDNA IgG decreased after treatment between the anti-dsDNA-positive SLE patients and the anti-dsDNA-negative SLE patients. In addition, serum CXCL13 levels were correlated with SLEDAI in different activities of SLE, renal involvement and active LN. Furthermore, the level of CXCL13 was positively related to the SLEDAI,level of anti-dsDNA IgG , level of ESR and RAI of high-avidity IgG ANAs (HA IgG ANAs). Additionally, ROC curve analysis revealed that the serum CXCL13 levels were robust in discriminating patients with active SLE from patients with inactive SLE and SLE patients with high-avidity IgG ANAs from SLE patients with low-avidity IgG ANAs. Conclusions: First, we demonstrated that CXCL13 was elevated in SLE patients regardless of the presence or absence of anti-dsDNA IgG ANAs. Furthermore, HA IgG ANAs might affect the circulation of CXCL13. Therefore, the chemokine CXCL13 might be a risk factor influencing the inflammatory process in SLE.

Emerging photovoltaics (PVs), focuses on a variety of applications complementing large scale electricity generation. For instance, organic, dye-sensitized and some perovskite solar cells are considered in building integration, greenhouses, wearable and indoors, thereby motivating research on flexible, transparent, semitransparent, and multi-junction PVs. Nevertheless, it can be very time consuming to find or develop an up-to-date overview over the state-of-the-art performance for these systems and applications. Two important resources for record research cells efficiencies are the National Renewable Energy Laboratory chart and the efficiency tables compiled biannually by Martin Green and colleagues. Both publications provide an effective coverage over the established technologies, bridging research and industry. An alternative approach is proposed here summarizing the best reports in the diverse research subjects for emerging PVs. Best performance parameters are provided as a function of the photovoltaic bandgap energy for each technology and application, and are put into perspective using, e.g., the Shockley-Queisser limit. In all cases, the reported data correspond to published and/or properly described certified results, with enough details provided for prospective data reproduction. Additionally, the stability test energy yield (STEY) is included as an analysis parameter among state-of-the-art emerging PVs.

The emergence of coronavirus diseases (COVID-19) has presented a global health threat. The number of COVID-19 cases continues to increase in Africa; this poses a challenge to the African healthcare system, particularly the intensive care unit (ICU). More so, individuals with severe COVID-19 would often have a prolonged intensive care stay, requiring mechanical ventilation and sedation and this may increase their risk of developing physical, cognitive and psychosocial impairments. These post-ICU sequelae of morbidities have been termed Post Intensive Care Syndrome. The African healthcare system needs to be prepared to manage the adverse effects of Post Intensive Care Syndrome (PICS) largely characterized by a decline in functional capacity and health-related quality of life. It is thus expedient that multi-targeted measures such as early rehabilitation, adequate screening, patient/caregiver education and post-discharge rehabilitation be adopted to combat imminent poor health outcomes in COVID-19 survivors. In this editorial, we provided a brief review of PICS and highlighted strategies for preventing and managing PICS in the critically ill within the African context Key words: Pandemic, COVID-19 Survivors, African healthcare, Intensive Care Unit, Rehabilitation

We performed coronary intervention for a distal left main bifurcation lesion using a preshaped Y-stent technique. The technique, which we herein propose for the first time, comprises two parts: ex vivo stent preparation and subsequent modified Y-stenting using the prepared stents.

This case series identified a sub cohort of healthcare workers with COVID-19 who experienced a prolonged symptomatic course and remained unable to return to work for many weeks. It notes their demographic and clinical characteristics and suggest ways to support them returning to work in a graded and supported manner.

Smallholder agriculture is a major source of income and food for developing nations. With more frequent drought and increasing scarcity of arable land, land use planning can be used to better allocate land resources to support regional agricultural activity. To support this objective, we used the Land Capability Classification (LCC) system to map the basic limitations to agricultural use of land. The LCC is a stepwise hierarchical land assessment system that can be used to understand factors that limit land use potential. We carried out our assessment in the Dosso region of Niger. Using two public soil data sets, Food and Agriculture Organization Harmonized World Soil Database and International Soil Reference and Information Center (ISRIC) SoilGrids, and a modified version of the LCC, we developed 250 m gridded maps of LCC values across the region. To validate the LCC maps, we interpolated soil physical data from 1308 field sites in the Dosso region and created LCC maps based on these interpolated data. We find that across the region, land is very severely limited for agricultural use by available water-holding capacity (AWC) which limits dry season agricultural potential, especially without irrigation, and requires more frequent irrigation where supplemental water is available. If the AWC limitation is removed in the LCC algorithm (i.e. simulating the use of sufficient irrigation or a much higher and more evenly distributed rainfall than is received by the Dosso region), the dominant regional limitations become less severe and more spatially varied.

The sediment transport capacity must be considered because it provides a theoretical basis for accurate prediction of soil erosion. Existing studies tended to study sediment transport capacity using a particular soil, but the models derived from one kind of soil cannot be applicable to other soil types. To obtain a prediction model for a variety of soils and evaluate its applicability, sandy loess and loess soil (d50=0.095 mm and d50’=0.04 mm) were chosen in the indoor artificial simulated sediment transport experiments. The experimental slopes ranged from 7% to 38.4% and the unit discharges were adjusted from 0.00014 to 0.00526m2/s. Moreover, this study combined the experimental data with cohesive soil and cohesionless sand from four scholars so as to analyze the response relationship between sediment transport capacity and each flow intensity parameter through dimensionless processing. Results showed that the dimensionless sediment transport capacity varied with its power function relationship with the flow intensity parameters. Through analysis, the effective stream power could be seen as an optimum indicator (R2=0.9692). After considering the effective stream power and volume sediment concentration, this study derived a formula for calculating the sediment transport capacity. It was better than the ANSWERS (Areal Nonpoint Source Watershed Environment Response Simulation) model, improved WEPP (Water Erosion Prediction Project) model, Zhang’s formula and Ali’s model due to its superior applicability to cohesive soil and cohesionless sand. These findings lay a basis for establishing prediction models of soil erosion.

Conservation research is dominated by vertebrate examples but the shorter generation times and high local population sizes of invertebrates may lead to different management strategies. Here we investigate the genetic structure of an endangered flightless grasshopper, Keyacris scurra, used in classical evolutionary studies in the 60s. It had a wide distribution across New South Wales (NSW) and Victoria in pre-European times but has now become threatened because of land clearing for agriculture. We revisited remnant sites of K. scurra, with populations now restricted to only one area in Victoria and a few small patches in NSW and the Australian Capital Territory (ACT). Using DArTseq to generate SNP markers as well as mtDNA sequence data, we show that the remaining Victorian populations in an isolated valley are genetically distinct from the NSW populations and that all populations are genetically unique, with large FST values up to 0.8. We also find that, with one exception, the NSW/ACT populations separate genetically into chromosomal races (2n = 15 vs. 2n = 17). Isolation by distance was detected across both the SNP and mtDNA data sets, and there was substantial differentiation within chromosomal races. Genetic diversity as measured by heterozygosity was not correlated with the size of remaining habitat patches, with high variation present in some remnant cemetery sites. However, inbreeding correlated negatively with estimated habitat size at 25-500 m patch radius. These findings emphasize the importance of small fragments in conserving genetic variation across the species, and they highlight populations suitable for future translocations.

In vapor liquid equilibrium (VLE) calculations with a cubic equation of state (EoS), exact solution has to be carried out numerically with an iterative approach [1,2]. This causes significant wastes of repetitive efforts and computing resources. Based on a recent study [3] on the van der Waals EoS [4,5], here we propose a procedure for analytically approximate solutions to the VLE calculation with the Soave-Redlich-Kwong (SRK) EoS [6] for the entire coexistence curve. This procedure can be applied to any cubic EoS. A simple databank can be built containing only the coefficients of a newly defined function and other thermodynamic properties will be obtained with analytical forms. For each system there is only a one-time effort. We also show that for exact solutions, the VLE problem with any cubic EoS can be reduced to solving a transcendental equation with one unknown, which can significantly simplify the methods currently employed [2,7].

Introduction Despite being key to reducing the occurrence of pre-eclampsia in high risk women, adherence to aspirin prophylaxis is low, reflecting multifactorial challenges faced by pregnant women. It is therefore important to understand the barriers and facilitators of aspirin adherence in pregnancy. This sub-analysis of a qualitative study conducted to better understand barriers and facilitators of aspirin adherence describes informational needs related to aspirin use in pregnancy. Methods Fourteen postnatal women from North-East of England, who declared various levels of non-adherence to aspirin (0–5/7 prescribed) were interviewed using The Theoretical Domains Framework as a guide. A thematic framework analysis of semi-structured interviews was used. Results Several sub-themes were identified within the “Knowledge” domain: a) Active vs passive approach, b) Partners seeking knowledge, c) Sources of information, d) Preferred format of information. Not all women actively seek information; some choose not to pursue it as they find thinking of hypothetical risks disturbing. Although partners seek information about risks and risk reduction strategies, they are often not included in conversations with health care professionals. When information is accessed women use a wide range of informational resources from scientific articles and national services (e.g. NHS) website to social media sources and word-of-mouth. Women admit that reading leaflets can be difficult, preferring to receive information in interactive ways. Conclusion New interactive and accessible informational resources are needed to engage pregnant women and their partners in aspirin prophylactic therapy.

OBJECTIVE Postoperative stroke is a serious unsolved complication after acute type A aortic dissection repair. We investigated the incidence and risk factors of stroke and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity. METHODS Between 2012 and 2019, 202 (56% men, median age 68 years) patients with acute type A aortic dissection underwent surgical repair. Clinical data, image findings,　methods of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke. RESULTS Of 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n=25). Brachiocephalic artery dissection was associated with a higher risk of stroke (odds ratio, 3.89, 95%CI 1.104-13.780; P= .035) having no relation with the presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection. CONCLUSION Brachiocephalic artery dissection was an independent risk factor of stroke after acute type A aortic dissection repair.

    Macar asıllı matematikçi George Polya, How To Solve It (Çözüm Nasıl Yapılır) adlı önemli eserinde problemlerin nasıl çözülmesi gerektiğini detaylıca anlatmıştır. MMMT olarak Polya'nın problem çözme algoritmasını inceledik ve bu incelemeyi yazıya döktük.

A vitamin D level should be included in the initial evaluation of children with asthma.

Detecting deceased patients on remote monitoring: a case series. Christopher Monkhouse BSc CCDS, Clare Rochford BSc CCDS, Ciaran Goswell BSc CCDS CCEPS, Angela Hawkins BSc CCDS, Russell Moralee BSc, Emma Dooley BSc CCDS, Anthony W Chow MB BS BSc MD FRCP, Simon Sporton BSc MB BS MD FRCPAll authors from: Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK

Introduction: Radiofrequency catheter ablation (RFCA) has become the standard effective therapy for supraventricular tachycardias, but the reported success rates of ablation have differed across a large number of single-center studies. The main reason for tachycardia recurrence is accessory pathway (Ap)-mediated tachycardia, and the RFCA strategy may be related to recurrence. This study aims to compare the efficacy and safety of two different RFCA strategies for Ap-mediated tachycardia. Methods : We compared patients (group M) who underwent RFCA at extensive sites to patients (group S) with RFCA at a single site during the index procedure for Ap-mediated tachycardia. The efficacy and safety were assessed in the two groups. Results: A total of 882 patients with 898 Aps were enrolled in group S, and 830 patients with 843 Aps were enrolled in group M. The results showed that the cumulative numbers of recurrences (rates) at the 1st, 3rd, 6th, 12th, and 24th months after ablation were 4 (0.5%) and 17 (1.9%), p<0.05; 5 (0.6%) and 27 (3.0%), p<0.05; 6 (0.7%) and 34 (3.8%), p<0.05; 6 (0.7%) and 43 (4.8%), p<0.05; and 7 (0.8%) and 45 (5.0%), p<0.05 in group M and group S, respectively. Complications of chest pain, overactive vasovagal reaction, steam pop, and angina pectoris were rare in both groups. No valve damage, cardiac tamponade, or other serious adverse events occurred in either group. Conclusion: The strategy of performing extensive ablation reduced the recurrence rate and need for subsequent ablation of the Ap without increasing the risk of complications.

When Thetis dipped her son Achilles into the River Styx to make him immortal, she held him by the Heel, which was not submerged, and thus created a weak spot that proved deadly for Achilles. Millennia later, Achilles Heel is part of today’s lexicon meaning an area of weakness or a vulnerable spot that causes failure. Also implied is that an Achilles Heel is often missed, forgotten or underappreciated, until it is under attack, and then failure is fatal. Paris killed Achilles with an arrow ‘guided by the Gods’. At the International Congress of the Immunology of Diabetes Society, 2018, five leading experts were asked to present the case for a particular cell/element that could represent the Achilles Heel of T1D. Their arguments are summarized here, to make this case.

In recent years Next-Generation Sequencing (NGS) based methods to detect mutations in biotherapeutic transgene products have become a key quality step deployed during the development of manufacturing cell line clones. Previously we reported on a higher throughput, rapid mutation detection method based on amplicon sequencing (targeting transgene RNA) and detailed its implementation to facilitate cell line clone selection. By gaining experience with our assay in a diverse set of cell line development programs, we improved the computational analysis as well as experimental protocols. Here we report on these improvements as well as on a comprehensive benchmarking of our assay. We evaluated assay performance by mixing amplicon samples of a verified mutated antibody clone with a non-mutated antibody clone to generate spike-in mutations from ~60% down to ~0.3% frequencies. We subsequently tested the effect of 16 different sample and NGS library preparation protocols on the assay’s ability to quantify mutations and on the occurrence of false-positive background error mutations (artifacts). Our evaluation confirmed assay robustness, established a high confidence limit of detection of ~0.6%, and identified protocols that reduce error levels thereby significantly reducing a source of false positives that bottlenecked the identification of low-level true mutations.

Aim: To show if lower urinary tract symptoms (LUTS) could be symptoms of COVID-19 with validated questionnaires. Methods: The 96 COVID-19 patients who were hospitalized at a tertiary center were collected retrospectively. After the exclusion criteria, 46 patients were consisted as the study population. The male and female patients then fill formed the International Prostate Symptom Score and Urinary Symptom Profile respectively. All patients responded to these questions for the three period. Results: 27 female (58.6 %) and 19 male (41.4 %) COVID-19 patients answered the questions In the male patients, while there were no statistically significant differences in the total IPSS, the voiding IPSS score, and quality of life between the three periods (p=0.148; p=0.933, p=0.079, respectively), the storage IPSS scores had a significant difference between the three periods (p=0.05). In the female patients, low stream scores, were similar between the three periods (p=0.368). The scores of stress incontinence and an overactive bladder had a significant difference between the three periods (p=0.05 and p=0.05). Conclusion: LUTS, especially storage symptoms, might be one of the initial symptoms of COVID-19 and the clinicians should evaluate LUTS with other known symptoms of the virus when a patient is suspected of having COVID-19.

The limiting factors in photosynthesis for many crops under water deficit and rehydration conditions have been studied, but few studies of this kind on sugar beet can be found.Our study aimed to analyze the dynamic changes of mesophyll limitations, stomatal limitations, and biochemical limitations by examining the influences of water deficit and rehydration on photosynthetic characteristics, electron transport, and leaf anatomical structure. According to the analysis on photosynthetic characteristics, severe deficit irrigation treatment significantly decreased photosynthesis rate, light saturation point, and CO2 saturation point. After rehydration, there was no difference in photosynthetic characteristics between the well irrigated sugar beets and the ones with severe deficit irrigation treatment. The analysis on leaf anatomical structure found that sugar beets dealt with water deficit by increasing leaf thickness, and the severe deficit irrigation treatment significantly decreased the number of chloroplasts without influencing each one in terms of shape and cross-section area.Therefore, deficit irrigation treatments cannot significantly influence photosynthetic assimilation of sugar beets. The analysis of limitations in photosynthesis showed that the stomatal and biochemical limitations increased while the mesophyll limitations decreased when sugar beets were under water deficit; however, the stomatal and biochemical limitations decreased while the mesophyll limitations increased after rehydration.

Background and Purpose:Mu-opioids remain vastly important for pain treatment, and would represent ideal analgesics if their analgesic effects could be separated from their many side effects.Exoticin, an extract of Murraya exotica, has been shown to have an analgesic effect which can be blocked by naloxone.Here, we hypothesized that the analgesic effect of Exoticin is mediated by 6-transmembrane (6TM) of the mu-opioid receptor. Experimental Approach:We determines the analgesic EC50 of Exoticin by using the hot-plate assay.The analgesia of Exoticin was evaluated after intrathecal administration with mu, delta, and kappa antagonists in C57BL/6 mice. Antinociceptive effects of Exoticin on formalin or Complete Freund’s adjuvant (CFA) mediated allodynia and heat-hyperalgesia were assessed in exon 11 mu-opioid knockout (E11 KO) and exon 1/ exon 11 mu-opioid double knockout (E1/E11 KO) mice. Opioid-related side effects, such as respiration depression, constipation, locomotor activity and dependence were assessed.Finally, to verify the effect of 6TM on Exoticin, the analgesic effect of Exoticin mediated by 6TM of the mu-opioid receptor was determined by over-expression of the adeno-associated virus (AAV) in E1/E11KO mu-opioid mice. Key Results:Delta, kappa antagonists in WT mice had no impact on Exoticin analgesia, while mice which received the mu antagonist markedly lowered. Loss of the truncated 6TM variants in the E11 KO mouse eliminated Exoticin analgesia. Restoring expression of a 6TM variant with an AAV-mMor-1G rescued Exoticin analgesia in E1/E11 KO mouse that no expressed the 7-transmembrane (7TM) variants. Conclusion and Implications:Exoticin analgesia depended upon the expression of exon 11-associated truncated 6TM variants of mu-opioid receptor.