Chyi Yin Gwee, Kritika M. Garg, Balaji Chattopadhyay, Keren R. Sadanandan, Dewi M. Prawiradilaga, Martin Irestedt, Fumin Lei, Luke M. Bloch, Jessica G.H. Lee, Mohammad Irham, Tri Haryoko, Malcolm C.K. Soh, Kelvin S.-H. Peh, Karen M.C. Rowe, Teuku Reza Ferasyi, Shaoyuan Wu, Guinevere O.U. Wogan, Rauri C.K. Bowie, Frank E. RheindtINTRODUCTIONArchipelagoes are ideal settings for unravelling complex evolutionary patterns as they constitute natural laboratories for the study of factors contributing to speciation (MacArthur and Wilson 2001; Whittaker and Fernández-Palacios 2007; Lohman et al. 2011). Among vertebrate groups that occur across archipelagoes, island radiations of birds are most well-studied (Lerner et al. 2011; Lamichhaney et al. 2015). These avian models display a great deal of variability in their diversification rates across islands, which are fundamentally linked to species’ capability to disperse over water (Diamond et al. 1976). In particular, the so-called ‘great speciators’, first characterized by Diamond et al. (1976), stand out from all other birds based on their paradoxical ability to disperse widely and colonize entire archipelagoes while, at the same time, diversifying into multiple daughter species in spite of a continuing potential for overwater gene flow (Cai et al. 2020).One of the few classical examples of ‘great speciators’ identified by Diamond et al. (1976) is the songbird genus Zosterops , or white-eyes, which are excellent dispersers capable of differentiating rapidly from source populations (Clegg et al. 2002; Moyle et al. 2009). The genus Zosterops comprises c. 100 species that have radiated across the Old World and Oceania within the past 1 to 3.5 million years, reflecting perhaps the fastest diversification rate of any vertebrate clade (Warren et al. 2006; Moyle et al. 2009; Leroy et al. 2019; Cai et al. 2020). An overwhelming proportion (more than 70%) of these species occurs exclusively in archipelagoes distributed across the Atlantic, Indian and Pacific Oceans (Fig. 1). As such, the remarkable radiation of white-eyes serves as an ideal model system with which to explore island biogeography theory (Diamond et al. 1976; Moyle et al. 2009).In order to achieve an understanding of the underlying processes driving the white-eye radiation, its phylogeny first needs to be resolved to provide a reliable backbone for hypothesis testing. In Zosterops , however, traditional methods that rely on morphological tools to infer how species are related to one another have proven to be unreliable, as plumage features of ecologically distinct and geographically disjunctZosterops species are often indistinguishable (Mees 1957; Mayr 1965). Although a more recent application of genetic methods has helped disentangle the white-eye radiation to some extent, most studies have concentrated on Melanesian and Indian Ocean members of the genus (Slikas et al. 2000; Warren et al. 2006; Moyle et al. 2009; Cox et al. 2014; Linck et al. 2016; Wickramasinghe et al. 2017; Manthey et al. 2020). There continues to be a dearth of knowledge on this radiation across the core of its Asian distribution due to limited sampling and lack of genetic data. In particular, it is crucial to unravel the phylogenetic affinities of white-eyes distributed across the Indonesian archipelago, which – comprising more than 17,000 islands – is the largest archipelago in the world and harbors about 20 endemic Zosteropsspecies (Fig. 1), including two undescribed species that were discovered in the last two decades (Eaton et al. 2016; O’Connell et al. 2019). The high density of Zosterops species across the Indonesian archipelago hints at the possible importance of this region in white-eye evolution.Apart from incomplete geographic sampling, the lack of resolution of the white-eye radiation has largely been a consequence of sparse genomic sampling: most phylogenetic studies of white-eyes have been restricted to one or a few genetic markers, resulting in trees that are plagued by unresolved polytomies, hampering useful evolutionary inference (Slikas et al. 2000; Warren et al. 2006; Moyle et al. 2009; Oatley et al. 2012; Nyári and Joseph 2013; Cox et al. 2014; Husemann et al. 2016; Linck et al. 2016; Round et al. 2017; Wickramasinghe et al. 2017; Shakya et al. 2018; Cai et al. 2019; Lim et al. 2019; O’Connell et al. 2019). Disentangling relationships within rapid and recent radiations, such as white-eyes, requires overcoming the challenges of heterogenous gene trees due to biological factors such as incomplete lineage sorting (Edwards et al. 2005; Song et al. 2012). The multispecies coalescent (MSC) model offers a promising avenue to overcoming gene tree discordance by allowing the evolutionary histories of each locus to be inferred independently (Song et al. 2012; Liu et al. 2015).An equally debilitating source of bias in reconstructing the phylogeny of rapid and recent radiations such as white-eyes is the potential for member species to engage in secondary gene flow or genetic introgression long after a speciation event has occurred (Rheindt and Edwards 2011; Edwards et al. 2016). Such introgression will be reflected in the phylogenetic signal of a varying proportion of loci, thereby leading astray efforts to search for the true species tree. Multiple analytical approaches have been devised to account for secondary gene flow, such as through tree-based analysis as implemented in Phylogeographic Inference using Approximate Likelihoods (PHRAPL) (Jackson et al. 2017a; Jackson et al. 2017b), or through SNP-based analysis like the ABBA-BABA test, which detects an excess of shared derived alleles between populations (Green et al. 2010; Patterson et al. 2012).In this study, we acquired historical and modern DNA samples from museums and recent material from our own fieldwork at remote locations to achieve a wide geographic representation of white-eyes (Table S1). We designed RNA probes using Z. lateralis (Cornetti et al. 2015) as a reference genome, targeting 832 loci at high coverage to overcome the limitations of missing data expected from degraded DNA of historical samples, thereby recovering a comparable set of loci across both historical and fresh samples (Templeton et al. 2013). Our target capture methodology addresses the recalcitrant persistence of unresolved polytomies in the phylogeny of this rapid radiation by making use of a large set of loci (Cai et al. 2019). We employed three different coalescent species tree methods to assess topological incongruence across tree-building approaches (Liu et al. 2009; Liu et al. 2010; Vachaspati and Warnow 2015). Recognizing that gene flow is commonly observed in recent radiations, we conducted PHRAPL (Jackson et al. 2017b) analysis and performed ABBA-BABA tests (Patterson et al. 2012) to assess introgression between closely related species with incongruent topologies and ultimately elucidate the likely evolutionary history of this complex radiation.

I read the recently appeared article in your journal by Atalla et al. entitled “Readmissions among Patients with COVID-19” with great interest. In their study, 19 patients previously diagnosed with COVID-19 were readmitted within 30 days after discharge. I think that there are a few questionable points in this study.

Objective: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. Methodology: The centers participating in the study were divided into three groups as tertiary referral centers, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated; also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. Results: A total of 51 centers participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the third week of pandemics in state hospitals and tertiary referral centers; however the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared; a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared to normal life. Conclusions: Covid-19 pandemic significantly effected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

The control of nutrient availability is critical to large-scale manufacturing of biotherapeutics. However, the quantification of proteinogenic amino acids is time-consuming and thus is difficult to implement for real-time in situ bioprocess control. Genome-scale metabolic models describe the metabolic conversion from media nutrients to proliferation and recombinant protein production, and therefore are a promising platform for in silico monitoring and prediction of amino acid concentrations. This potential has not been realized due to unresolved challenges: (1) the models assume an optimal and highly efficient metabolism, and therefore tend to underestimate amino acid consumption, and (2) the models assume a steady state, and therefore have a short forecast range. We address these challenges by integrating machine learning with the metabolic models. Through this we demonstrate accurate and time-course dependent prediction of individual amino acid concentration in culture medium throughout the production process. Thus, these models can be deployed to control nutrient feeding to avoid premature nutrient depletion or provide early predictions of failed bioreactor runs.

Despite the great promises that artificial intelligence (AI) holds for health care, the uptake of such technologies into medical practice is slow. In this paper, we focus on the epistemological issues arising from the development and implementation of a class of AI for clinical practice, namely clinical decision support systems (CDSS). We will first provide an overview of the epistemic tasks of medical professionals, and then analyse which of these tasks can be supported by CDSS, while also explaining why some of them should remain the territory of human experts. Clinical decision-making involves a reasoning process in which clinicians combine different types of information into a coherent and adequate ‘picture of the patient’ that enables them to draw explainable and justifiable conclusions for which they bear epistemological responsibility. Therefore, we suggest that it is more appropriate to think of a CDSS as clinical reasoning support systems (CRSS). Developing CRSS that support clinicians’ reasoning process therefore requires that: 1) CRSSs are developed on the basis of relevant and well-processed data; and 2) the system facilitates an interaction with the clinician. Therefore, medical experts must collaborate closely with AI experts developing the CRSS. In addition, responsible use of an CRSS requires that the data generated by the CRSS is empirically justified through an empirical link with the individual patient. In practice, this means that the system indicates what factors contributed to arriving at an advice, allowing the user (clinician) to evaluate whether these factors are medically plausible and applicable to the patient. Finally, we defend that proper implementation of CRSS allows combining human and artificial intelligence into hybrid intelligence, were both perform clearly delineated and complementary empirical tasks. Whereas CDRSs can assist with statistical reasoning and finding patterns in complex data, it is the clinicians’ task to interpret, integrate and contextualise.

Abstract Rationale, Aims, and Objectives: To determine the extent to which nurses reportedly assess evidence-based falls risk factors and identify targeted prevention implemented for medical and surgical patients in China. Method: This was a multicenter retrospective observational study. Respondents were nurses working in medical and surgical units of Chinese 662 hospitals. Fall-risk factors assessments and targeted interventions by health professionals were collected online by the Nursing Management Committee of Chinese Nursing Association in China, in 2019. Results: A total of 68527 valid questionnaires were recovered (95.0%). In medical and surgical units, nurses were most likely to report assessing balance, mobility and strength (81.6%) and orthostatic hypotension (76.4%) for falls and least likely to continence (61.3%) and feet and footwear (55.8%). Appropriate footwear (79.3%) and managing syncope, dizziness and vertigo (73.8%) were the most frequently falls multiple interventions, while managing postural hypotension (48.8%) and cognitive imparement (48.4%) were the least. Nine fall-risk factors with clearly matched multifactorial interventions were determined in medical and surgical units (68.2%~ 97.5%). On comparative analysis, Cognitive therapy, Toileting-assistance, Indwelling catheter, Monitor postural blood pressure, Dizziness and vertigo interventions, Minimise asthma triggers, Educating medication use, Keeping floor surface clean and dry were more common in medical ward, while With the head of the bed raised, Assessments and referrals and Bed brakes locked in surgical ward. Conclusion: Health professionals are generally concerned about risk factors and prevention for falls with their patients in much of China, however limited attention was directed at the continence, feet and footwears assessment and managing cognitive imparement. Evidence-based prevention should be further tailored to the individual, based on an individual risk factors.

Objectives: Risk factors for severe acute bronchiolitis in previously healthy infants are scarcely known. This study investigated the effect of tobacco smoke exposure among severely Pediatric Intensive Care Unit (PICU) patients. Design: A prospective epidemiological observational study Setting: Tertiary pediatric medical center. Pediatric Intensive Care Unit (PICU) of Children’s University Hospital La Paz Patient selection: Infants with bronchiolitis younger than 2 years of age during the October 2017 to March 2018 outbreak Methodology: On admission, parents were asked whether they smoked. In children who required invasive mechanical ventilation, endotracheal aspirate was collected at the time of intubation. Results: A total of 102 patients with bronchiolitis were studied. Among these, 14 (47%) of 30 infants whose parents smoked required invasive mechanical ventilation vs. 14 (19%) of 72 whose parents were nonsmokers (p=0.007) (RR 2.4; 95% CI 1.3–4.4). Among patients on invasive mechanical ventilation, 10 (71%) of 14 infants with secondhand smoke exposure presented PBI vs. 3 (21%) of 14 in the unexposed (p=0.012) (RR 3.3; 95% CI 1.2–9.6). PICU stay was 3 (IQR 3-6) days in infants whose parents didn´t smoke, and 5 (IQR 3-11) days in infants whose parents smoked (p=0.01). Conclusions: Secondhand smoke exposure is an additional high risk for pulmonary bacterial superinfection, invasive mechanical ventilation and PICU length of stay in infants with severe acute bronchiolitis

An unusual presentation of a spontaneous lung pseudocyst that mimicked a congenital lobar over-inflationM Ndlovu, Cert Pulm (SA) Paed; S A Thula, Cert Pulm (SA) Paed; R Masekela, (PhD); P M Jeena, PhD.

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Background: Allergen immunotherapy(AIT) is an effective treatment for allergic rhinitis, asthma and venom allergy. Compliance is essential for AIT to obtain maximal benefit as it is a long term treatment. Objective: We aimed to evaluate the real life compliance of children with subcutaneous immunotherapy(SCIT) and tried to document the factors associated. Additionally how COVID-19 pandemic effected the compliance of the patients and the reasons of drop-outs were also evaluated. Method: Patients diagnosed with allergic rhinitis, allergic asthma or venom allergy and treated with SCIT between 2012 September, 2020 July were analyzed. Results: The study population comprised of 201 children (66,7% male) with a median (interquartile range) age of 12,8(9,4-15,2) years during the first injection of SCIT. The overall compliance rate before COVID-19 pandemic was 86,1%. Short AIT follow up time and venom allergy were found to be risk factors for drop out. The leading causes of drop outs were moving to another city/country(32,1%), improvement of symptoms(17,8%), ineffectiveness(14,2%) and adverse reactions(14,2%). During COVID-19 pandemic, among 108 patients receiving AIT, 31(28,7%) dropped out the therapy. The most frequent reasons for drop-outs were fear of being infected with COVID-19(35,4%) and thinking that the AIT practise stopped due to COVID-19 pandemic(29%). Male gender and older age were found to be the independent risk factors for drop out. Conclusion: The real life compliance in children was higher than in adults. Nearly one third of children dropped out during COVID-19 pandemic. Male gender and older age are associated with AIT drop out during COVID-19 pandemic.

Background: Cow´s milk allergy is the most common cause of food allergy in young children. Ingestion of milk products in children with a milk protein allergy can lead to anaphylaxis and must be avoided. Most guidelines generally recommend the use of an extensively hydrolyzed formula (EHF) in these cases; however rare allergic reactions can still occur. Here, we present a 3-month-old who developed anaphylaxis to a cow’s milk formula. Subsequently he developed a rare systemic reaction to soy and an extensively hydrolyzed formula. Case: The patient had an unremarkable past medical history and presented with signs and symptoms consistent with anaphylaxis after being fed cow’s milk formula for the first time. Symptoms included immediate vomiting, wheezing, stridor, angioedema of eyelids and lips. Although IM epinephrine was given, the patient continued to clinically deteriorate becoming more lethargic and necessitating admission to the pediatric intensive care unit. Subsequently, a trial of soy formula ingestion reproduced similar symptoms and an EHF was given. However immediately after taking an EHF, he developed facial angioedema and diffuse urticarial lesions. Conclusion: In most cases with a cow’s milk allergy, an extensively based formula can be tolerated safely due to a hydrolyzed protein chain. However, medical providers must be vigilant when switching formula since a rare systemic allergic reaction to EHF can still occur.

Efficacy of Oral Tolerance Induction to raw apple using an Ultra-Rush protocol in 28 patients allergic to rosaceae fruits: RAAP StudyTo the Editor,The diagnosis of pollen-food allergy syndrome (PFAS) or oral allergy syndrome (OAS) relies on clinical history together with demonstration of allergen-specific IgE. PFAS is mainly observed in central and northern Europe. These symptoms follow the consumption of raw fruits1 and last 30 minutes, then stop ; but they tend to worsen over time, leading patients to avoid eating raw rosaceae fruit and many other raw fruits. This clinical presentation evolves concurrently with birch pollen allergy2. Over 70% of patients with birch allergy suffer from PFAS to rosaceae, particularly to raw apple3 . Therapeutic management is limited 4 , based on avoidance of trigger foods5.The results of betulaceae pollen immunotherapy remain limited6 . Raw Golden apple (RGA) desensitization has already been described by NUCERA et al. in 20107 in 2 patients. Likewise, RGA tolerance induction was described in 2012 by KOPAC et al8 and in 2014 by BOUVIER et al9 according to slow protocols where the maintenance dose was reached over several months.We realized a retrospective observational impact study to present an accelerated protocol or ultra-rush (UR) for resumption of RGA intake performed in two private hospitals of the Lyon region (France), the Charcot clinic and the Beaujolais clinic, on 28 patients hospitalized between June 2016 until October 2017. The study was appropriately registered (ClinicalTrials.gov Identifier: NCT04116580).Eligible patients were 10 years of age and older with allergic rhinitis related to PFAS for raw rosacea with avoidance of this family of fruits for at least 6 months. Subjects were excluded from the study in case of severe allergic reaction to rosacea or uncontrolled asthma with FEV1 < 70%. The medical procedure consisted of 4 phases. During the first consultation, each patient’s medical history was collected. Prick tests with airborne allergen and raw golden apple (RGA) were performed according to the prick-prick technic 10; specific IgE for apple, rBet v 1, rBet v 2\sout, rPru p 3 were prescribed. In total the inclusion of patients was based on their clinical history.For the UR, patients were not on antihistamines. At time 0 (T0), prick test were performed with RGA9. At T0 +20 minutes, patients took 1 g of unpeeled RGA , then by doubling regularly the doses from 2g to 128g, to reach a 255 g cumulative dose within in 3 hours.Then, half of an unpeeled RGA was consumed daily at home for one month, and one whole RGA daily the following month. For the patients who underwent the UR procedure between mid-April and mid-July, intake of other raw rosaceae was permitted at the end of week 5 post UR. A two-month evaluation consultation was conducted. Afterwards, patients had to maintain their tolerance by consuming half a raw apple of any type three times a week. A telephone interview was performed at 1 year of the UR to evidence tolerance and compliance.FIGURE 1 Shematic overview of the Ultra-Rush protocolTABLE 1 Population profile - Allergologic and Biological results

Background High agglomeration of myeloid-derived suppressor cell (MDSC) in tumor microenvironment resulted in immune escape and affected therapeutic effects. Doxorubicin (DOX) or dopamine (DA) is found the specific drug to selectively remove or maturate MDSC. How to effectively eliminate MDSC in neuroblastoma (NB) and its mechanism need to be clarified. Procedure In the present study, BALB/c tumor-bearing mice model were established by NB cells injection, then grouped into DOX2.5 mg/kg group, DOX5 mg/kg group, DA50 mg/kg group and control group. DOX or DA were injected intravenously in advance, then quantity and distribution of MDSC, proliferation and infiltration of T cell, Treg level and TAM polarization, MDSC related functional molecules in vivo and expression of proteins in signal transducer and activator of transcription (STAT) pathway in MDSC were detected and compared respectively at 14 d, 17 d and 23 d after inoculation. The tumor growth were compared between the groups. Results After DOX or DA administration, in each experimental group, MDSC ratio all decreased. STAT1, p-STAT1 and activated caspase-3 decreased, but STAT3, p-STAT3, STAT5, p-STAT5, STAT6, p-STAT6, Arg-1 and IDO increased. Simutaneously, compared with the control group, T cell proliferation in tumor first increased and then inhibited, infiltration of T cells increased, TAM polarization and Treg level reduced, the tumor growth was inhibited. Changes in above indicators were most significant in DOX2.5mg/kg group. Conclusions Low-dose DOX administration can eliminate MDSC in NB by regulating STAT signaling pathway in MDSC, thus remove immunosuppression and improve immune efficacy of NB.

Background：Some of the patients who have undergone mitral valve surgery may develop into aortic valve disease as time goes on. This study aimed to explore the influencing factors of the long-term outcome of the aortic valve after mitral valve surgery. Methods：Patients who underwent mitral valve surgery from 2010 to 2016 in Zhujiang Hospital were divided into two groups according to the outcome of the aortic valve. Those who had significant aortic valve disease progression after mitral valve surgery were classified into the progression group, and the other patients were classified into the non-progression group. Collected clinical data including echocardiography for statistical analysis. Results：Finally, 144 patients (59 males, 40.97%) were enrolled, with an average age of 50.35 ±11.32 years, and a median follow-up period of 4.2 years. Five related factors were determined by multivariate analysis, including tricuspid ring annuloplasty (p=0.010, OR=0.12), left ventricular diameter (p=0.023, OR=0.93), mild to moderate aortic valve disease (p=0.009, OR=7.17), mitral prosthesis size (p=0.032,=OR=2.51), aortic valve peak velocity (p=0.008, OR=3.99). Conclusions：The progression of aortic valve disease after mitral valve surgery is related to a variety of factors. It may be mainly due to the increase of left ventricular preload and a series of hemodynamic changes after mitral valve surgery. For such patients, a comprehensive consideration is needed to formulate the surgical plan, rather than using the valve area as the sole criterion for determining whether to undergo aortic valve surgery at the same time or not.

Abstract Ticks are forced vertebrate ectoparasites, including humans, and are vectors of serious diseases such as Crimean Congo Hemorrhagic Fever, Relapsing Fever, and various forms of encephalitis. Spatial assessment of the prevalence of ticks and detection of high risk areas for tick-borne disease transmission and evaluation of ecological measures are key aims of this research. Ticks were collected using standard methods From 27 villages in the region of Sarab County in north-eastern Iran during the four seasons of 2018-219 and identified using valid keys. The calculation of indices for biodiversity were based on the Margalf index, Shannon-Weiner index and Simpson index. R2.15 Statistical software was used for statistical analysis of indices of biodiversity, and ArcMap10.4.1 software and IDW and GeneralG methods and analysis were used to investigate spatial dispersion and to determine important tick hotspots. Thirty-five percent of the 2,500 animals surveyed were infected. A total of 1416 ticks were caught, 74.6 % were adult ticks, % were nymph and 1.4 percent were larvae. Ninety four percent of the ticks caught belonged to hard ticks relating to 4 genera and 6 percent to soft ticks relating to 2 genera. The highest species biodiversity was related to summer (1.4234), and the lowest was related to winter (0.7379), according to the Margalef diversity index. In the central part of the study region a large hotspot area was found. The area of study was very prone to tick-borne disease transmission in terms of tick diversity and tick species richness, and it was important to inform people to monitor to avoid diseases. Keywords: Ticks, Species biodiversity, GIS, Iran

A water harvesting system for research purposes has been established in the Lisan Peninsula of the Dead Sea in the middle of the Jordan Rift Valley, where no authorized guideline is available for designing water harvesting systems. Rainfall and runoff, which occurs as flash floods, are being observed at the downstream end of a gorge having a 1.12 km2 barren catchment area since September 30, 2014. Due to the extremely arid environment, water current as the runoff from the catchment is ephemeral, and the flash flood events can be clearly distinguishable from each other. Thirteen flash flood events with total runoff volume more than 100 m3 have been successfully recorded during five rainy seasons. The duration, the total rainfall depths at two points, the total runoff volume, the maximum runoff discharge, and the bulk runoff coefficient of each flash flood event are considered as the random variables to be analyzed. Correlation analysis among the variables is conducted in terms of the classical methods of Pearson’s correlation and Spearman’s rank correlation, revealing that there is no straightforward relationship between rainfall and runoff. The performance of the conventional SCS runoff curve number method is also deficient in reproducing any rainfall-runoff relationship. Therefore, probability distributions are fitted to the empirical distribution of each variable. The lognormal distribution with three parameters and the generalized extreme value distribution serve well. The results support the design of the water harvesting system and provide quantitative information for designing similar systems in the future.

Background: A systematic assessment of severe clinical outcomes associated with respiratory syncytial virus (RSV) infections in adults is lacking. Methods: Within a prospective surveillance study, we performed a nested retrospective study during two respiratory viral seasons, October 2017-April 2018 and October 2018-April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes. We explored the impact of RSV-associated hospitalizations on changes in the living situations of surviving patients from admission to discharge. Results: Overall, 403 patients were studied (median age 69 years); 29.5% were > 80 years. Common comorbidities included cardiac (47.6%) and pulmonary (45.9%) conditions and diabetes (41.4%). Severe outcomes occurred in 19.1% of patients including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had 4.43 times higher likelihood of severe RSV infection compared to those living in the community with or without assistance from family or home health aides. After discharge, 56 (15.1%) patients required an increased level of support including 36 (9.7%) with new admissions to residential living facilities. Conclusions: RSV infection was associated with severe illness in adults. Living in a facility was a risk factor for severe outcomes and likely a surrogate for frailty at admission rather than an independent risk factor. The need for an increased level of support after discharge will add RSV-related healthcare costs to those already incurred from hospitalization.

Herbivore populations are regulated by plant defenses and natural enemies. While plant defense can suppress herbivore populations, these defenses adversely affect natural enemies thereby releasing herbivores from top-down control. Over their lifespans, herbivores and their natural enemies may experience substantial variation in plant defense. Defense variability can suppress the growth of herbivores, but the impacts of defense variability on natural enemies and top-down control of herbivores are unknown. We independently manipulated the mean and variation of a plant toxin experienced by individual Trichoplusia ni caterpillars and its parasitoid Copidosoma floridanum. Increases in the mean toxin concentration, but not its variance, experienced by individual T. ni and C. floridanum decreased the fitness of C. floridanum, whereas both mean and variance impacted T. ni fitness. Thus, increased defense variability for individual herbivores suppressed herbivore fitness with no perceptible cost to top-down control. However, impacts of variability depend heavily on scale of variability.

The article analyzes the indicators of prevalence, morbidity, lethality and mortality in the new coronavirus disease - COVID-19, based on this specialized literature and official information from the state mass media. The importance of correct application of the principles of medical statistics for the analysis of these indicators in decision-making on the introduction of restrictive measures, monitoring the epidemic process, evaluating the effectiveness of these measures and the activities of medical organizations is shown. Individual pandemic forecast models are considered.

Proposed dual-mode substrate integrated waveguide (SIW) short-circuited coax filter demonstrates a passband that has transmission zeros on both upper and lower stopbands; in addition, such a filter is also inherent with good out-of-band rejection up to three times of the center frequency (fc). There are four signal paths from input port to output port. The signal routings are done by conductor-backed coplanar waveguide (CBCPW) and the slotlines on the top metal. In addition to signal routings, frequency control capacitors (CFreq), and electric coupling capacitors (CE) are on the bottom metal. The center frequency of the passband can be determined by CFreq, and the transmission zero on the lower-end can be tuned by CE respectively. The phase delay of the signal routings are investigated individually as a way to explain the generation of the transmission zero below the passband. Furthermore, capacitors’ touchstone files from the vendor are implemented in the schematic such that simulation results including all the parasitic components can be emulated to real-world measurements. In the best scenario, presented filter shows a prescribed passband centered at 4.84 GHz, and with insertion loss (IL) of 2.11 dB as well as 3-dB bandwidth of 0.46 GHz.

Accurate determination of animal diets is difficult. Methods such as molecular barcoding or metagenomics offer a promising approach, allowing quantitative and sensitive detection of different taxa. Here we show that rapid and inexpensive diet quantification is possible through metagenomic sequencing with the portable Oxford Nanopore Technologies (ONT) MinION. Using an amplification-free approach, we profiled the stomach contents from 24 wild-caught rats. We conservatively identified diet items from over 50 taxonomic orders, ranging across nine phyla, including plants, vertebrates, invertebrates, and fungi. This highlights the wide range of taxa that can be identified using this simple approach. We calibrated the accuracy of this method by comparing the characteristics of reads matching the ground-truth host genome (rat) to those matching diet items, and show that at the family-level, taxon assignments are approximately 97.5% accurate. Some inaccuracies may arise from database biases; we suggest a way to mitigate for database biases when using metagenomic approaches. Finally, we implemented a constrained ordination analysis and show that we can identify the sampling location of an individual rat within tens of kilometres based on diet content alone. This work establishes proof-of-principle for long-read metagenomic methods in quantitative diet analysis. We show that diet content can be quantified even with limited expertise, using a simple, amplification free workflow and a relatively inexpensive and accessible next generation sequencing method. Continued increases in the accuracy and throughput of ONT sequencing, along with improved genomic databases, suggests that a metagenomic approach for quantification of animal diets will become an important method in the future.

This paper is concerned with sublinear perturbations of resonant linear polyharmonic problems. We establish some {\it a priori} bounds and use these together with Leray-Schauder continuation and bifurcation arguments to obtain extensions of some known results of Mawhin and Schmitt on the multiplicity of solutions of nonlinear elliptic eigenvalue problems with the parameter near resonance.

The dynamic of fractional covid-19 epidemic model with a convex incidence rate is studied in this article. Under Caputo operator, existence and uniqueness for the solutions of the fractional covid-19 epidemic model have been ana- lyzed using xed point theorems. We study all the basic properties and results including local and global stability. We show the global stability of disease free equilibrium using the method of Lyapunov function theory while for disease endemic, we use the method of geometrical approach. Moreover, sensitivity analysis complemented by simulations are performed to determine how changes in parameters affect the dynamical behavior of the system.

Background and Purpose: The profibrotic and proinflammatory effects induced by doxorubicin (DOX) are key processes in the development of serious heart damage. The lack of effective drugs and the unclear mechanisms of their side effects limit the clinical treatment of DOX-induced cardiac injury. This study aimed to explore the protective role of LCZ696 and the potential mechanism of Toll-like receptor 2 (TLR2) in doxorubicin-induced cardiac failure. Experimental Approach: DOX (5 mg/kg/week, 3 times) was used to establish a chronic cardiomyopathy mouse model. Heart function tests, pathology examinations and molecular biology analyses were used to explore the effects of LCZ696 and TLR2 deficiency. H9C2 cells were used to verify the protective role and mechanism of LCZ696 in vitro. Key Results: The EF% declined, and the LVIDd, pro-fibrosis marker levels and NF-κB pathway-related inflammatory response increased in the chronic cardiomyopathy group induced by DOX. LCZ696 treatment and TLR2 deficiency reversed this heart damage in vivo. In H9C2 cells, pretreatment with LCZ696 and TLR2 knockdown suppressed the DOX-induced high expression of profibrotic and proinflammatory markers. Moreover, DOX notably increased the TLR2-MyD88 interaction in H9C2 cells, which was inhibited by LCZ696 pretreatment. Conclusion and Implications: LCZ696 prevents DOX-induced cardiac dilation failure, fibrosis and inflammation by reducing the formation of TLR2-MyD88 complexes. LZC696 may be a potential effective drug to treat DOX-induced heart failure.