Ab initio and DFT calculations were performed to investigate the structure, stability, and nature of chemical bonding of the F-Rg-BR2 (R = F, OH, CN and CCH; Rg = Ar, Kr, Xe and Rn) molecules. The geometries are optimized for ground as well as transition states using the B3LYP-D3 and MP2 methods. It has been found that the F-Rg-B portion of F-Rg-BR2 species is linear in the ground state but curved in the transition state. The NBO, AIM, ELF and EDA analyses suggest that the molecules can be expressed as F-(Rg-BR2)+ due to the covalent Rg-B bond and the ionic interaction between F and Rg. Calculations assert the metastable behavior of the F-Rg-BR2 molecules, thermodynamic data shows that F-Rg-BR2 can spontaneously dissociates into BFR2 + Rg, the considerable energy barrier of this two-body dissociation channel calculated by the B3LYP-D3, MP2 and CCSD(T) methods affirms the kinetic stability of the F-Rg-BR2 molecules. Thus F-Rg-BR2 molecules are kinetically protected against the decomposition reaction and may be identified under cryogenic conditions in solid rare gas matrices or in the gas phase.

Silk Nanoparticles were synthesized using conventional desolvation and microwave-assisted radiolysis method from Muga silk fibroin. The secondary structure evolution due to two different synthesis methods was investigated using FTIR and Circular Dichroism (CD) spectroscopy. The microwave synthesized nanoparticles showed enhanced β-sheet content than desolvation synthesized nanoparticles. The conformational changes of Muga silk fibroin protein to nanoparticle followed an ordered transition from random coil to α-helix then from α-helix to β-turn and from β-turn to β-sheets where α-helix and β-turn are the intermediate forms before getting stabilized to the metastable β-sheets structure. The thermodynamics involved in secondary structure evolution was studied from CD analysis and activation energy involved in the formation of the secondary structure was determined.

The influence of Cd-stress on changes in the pectin of root cell walls (CWs), and the Cd content in the initial growth of plants of two species of Apiaceae L. (parsnips and celeriac) were investigated. Plants were grown in hydroponic systems under controlled environmental conditions, with and without the addition of Cd2+ ions. Higher amounts of Cd2+ ions were taken up and accumulated in the roots of the parsnips than in the celeriac. An increase in pectin content and its degree of methylation (DM), and a decrease in pectin methylesterase (PME) activity in parsnip root CWs under Cd stress were noted. With regard to celeriac, a decrease in pectin content and its DM occurred with increasing PME activity. The total soluble pectin content under Cd-stress was predominantly related to changes in the diluted alkali (sodium carbonate)-soluble pectin (DASP). Similar amounts of CW-bound Cd2+ in both species were caused by an increase in pectin content (parsnip) or a decrease in DM pectin (celeriac), related to an increase in PME activity under stress. Differences between parsnips and celery in Cd uptake and binding suggest that metal fixation in storage roots depends on a cell compartment other than that of the CW.

Introduction: As the pulmonary vein isolation (PVI) is the cornerstone of the atrial fibrillation (AF) ablation procedure, esophagus overheating has become a subject of great concern. Objectives: To assess whether the mechanical displacement of the esophagus (MDE), performed by a regular transesophageal echocardiogram probe (TEEP) may prevent esophagus overheating during the procedure. Methods: A 55 patient prospective-controlled study with paroxysmal or persistent AF in which RF delivery was stopped, whenever a sinusoidal probe with multiple thermocouples detected a luminal esophageal temperature (LET) elevation ≥0.5°C. A LET elevation <0.5°C during RF delivery was considered the successful endpoint after performed the MDE. In some patients, diluted barium was instilled to highlight the esophagus boundaries. Esophagogastroduodenoscopy (EGD) was performed if there were any sign or symptom of esophagus injury after the procedure. Results: The MDE was necessary in 47 of the 55 subjects enrolled to correct LET elevation (≥0.5°C). After the MDE, 41 of those 47 patients had a LET elevation <0.5°C, and none of them, had a LET elevation ≥38.5°C. The average basal LET was 35.71 ± 0.12°C. Immediately before the MDE, the average LET was 37.03 ± 0.06°C and post-displacement was 35.83 ± 0.08°C. The displacement range average was 2.25± 1.19cm (maximum: 6.17cm). After displacement, 100% of the esophagus remained in the same position. Of the total 14 patients who underwent EGD, 6 were normal, erosion was detected in 1 and superficial hematoma in 7. Conclusion: the MDE was effective and safe in preventing its overheating during RF catheter AF ablation.

Laccases are oxidoreductases with the outstanding ability to oxidize phenolic and non-phenolic substrates coupled to the reduction of O2 to H2O. Among them, bacterial enzymes are suitable biocatalysts for application in industrial processes under harsh conditions. However, to be active on high redox potential substrates, bacterial laccases requires of redox mediators: electron carriers between the laccase and other compounds not directly oxidizable by the enzyme. Here we demonstrate that β-(10-phenothiazyl)-propionic acid can be used as an efficient and low-cost redox mediator for decolorization of synthetic dyes by bacterial laccases. Using this laccase-mediator system, more than 80% of Indigo Carmine and Malachite Green decolorization was reached after 1 h or 2 h of incubation, respectively, both at pH 8 and in tap water (pH 6.8). Furthermore, more than 40% of Remazol Brilliant Blue R and 80% of Xylidine ponceau were decolorized after 5 h at pH 8 and 50°C. In addition, we showed this system supports at least 3 decoloration cycles without loss of activity, representing a promising biological process for cost-effective and environmentally friendly decolorization and degradation of synthetic dyes and for other industrial applications of laccases requiring neutral or alkaline pH.

Mechanisms that control of root system architecture are well characterised but little is known about how these processes respond to plant growth promoting rhizobacteria. We therefore studied how the presence of Pseudomonas oryzihabitans PGP01 altered wild type RSA and how these changes were modified in mutants that are defective antioxidant capacity (vtc2-1, vtc2-2, pad2-1, cad2-1 and rax1-1) or strigolactone (SL) synthesis (max3-9 and max4-1) or signalling (max2-3). The presence of P. oryzihabitans PGP01 decreased the length of primary and lateral roots but increased the number of lateral roots and lateral root density in the wild type roots but not in the SL mutants. The presence of synthetic SL, GR24 in combination with P. oryzihabitans PGP01 significantly decreased the number and length of lateral roots in the WT, max3-9 and max4-1 but not max2-3 seedlings. Lateral root density was increased in all genotypes in the presence of bacterium, but this effect was less pronounced in the ascorbate deficient vtc2-1 and vtc2-2 roots and absent from glutathione –deficient (pad2-1, cad2-1 and rax1-1) seedlings. Taken together, these results demonstrate the importance of SL-mediated signalling in root responses to growth promoting rhizobacteria, as well roles of cellular redox controls in these processes.

Bovine viral diarrhea virus (BVDV) is a major cause of economic loss in the cattle industry, worldwide. Infection results in reduce productive performance, growth retardation, reduced milk production, and increased susceptibility to other diseases leading to early culling of animals. There are two main measures used to control the spread of BVDV: the elimination of persistently infected (PI) animals and vaccination. Currently, modified live or inactivated vaccines are used in BVDV vaccination programs, but there are safety risks or insufficient protection, respectively, with these vaccines. Here we report the development and efficacy of the first targeted subunit vaccine against BVDV. The core of the vaccine is a fusion of the BVDV structural protein, E2, to a single-chain antibody, APCH, together termed, APCH-E2. The APCH antibody targets the E2 antigen to the major histocompatibility type II molecule (MHC-II) present on antigen-presenting cells. Industrial production of the vaccine is carried out using the baculovirus expression vector system (BEVS) using single-use manufacturing technologies. This new subunit vaccine induces strong BVDV-specific neutralizing antibodies in guinea pigs and cattle. Importantly, in cattle with low levels of natural BVDV-specific neutralizing antibodies, the vaccine induced strong neutralizing antibody levels to above the protective threshold, as determined by a competition ELISA. The APCH-E2 vaccine induced a rapid and sustained neutralizing antibody response compared to a conventional vaccine in cattle. The development of this subunit targeted vaccine provides cattle and dairy producers with an inexpensive, easily administered, safe, and efficacious BVDV vaccine.

Bt cotton is a genetically modified pest-resistant plant that produces an insecticide from Bacillus thuringiensis (Bt) to control Lepidopteran species. Surprisingly, there is no study – yet, that characterizes the signalling mechanisms in transgenic cotton plants attacked by non-target insects, such as aphids. In this study, we characterized the production of electrical signals on Bt and non-Bt cotton plants infested with Aphis gossypii and, in addition, we characterized the dispersal behaviour of aphids to correlate this behaviour to plant signalling responses. Electrical signalling of the plants was recorded with an extracellular measurement technique. Impressively, our results showed that both Bt and non-Bt cotton cultivars, when attacked by A. gossypii, emitted potential variation-type electrical signals and clearly showed the presence of distinct responses regarding their perception and the behaviour of aphids, with evidence of delay, in terms of signal amount, and almost twice the amount of Cry1F protein was observed on Bt cotton plants at the highest density of insects/plant. We present in our article some hypotheses that are based on plant physiology and insect behaviour to explain the responses found on Bt cotton plants under aphid stress

We report 10 laboratory-acquired Brucella infection cases and two S2 vaccine outbreak infection events during 2006-2016. Most laboratory-acquired Brucella infections were found in southern China, an emerging area of brucellosis. Microbiologists had a higher risk of laboratory-acquired Brucella infections, and the identification and handling of samples suspected of Brucella infection without recommended biosafety protection was the main reason for the infection. However, the S2 vaccine outbreak infection events were mainly observed in northern China, historically an area of human and animal brucellosis. The majority of infection cases were found among grassroot veterinarians and workers in animal vaccine production. Therefore, we suggest that identified suspected strains in biosafety facilities (BSL-3 and BSC) and abide biosafety practices are compulsory in southern, moreover, strengthening the preventive awareness of the clinical laboratory staff and physicians. In contrast, improving personal protection and launch biosafety education to high-risk of population exposure to S2 vaccine in northern is recommended.

Pituitary hyperplasia due to endemic hypothyroidism is very rare and should be considered in the differential diagnosis of pituitary neoplasm, especially if the patient hails from endemic iodine deficient regions such as the Himalayas. Establishing correct diagnosis may save the patient of any unnecessary neurosurgical intervention.

The emergence of mobile mcr genes mediating resistance to colistin is a critical public health issue that has hindered the treatment of serious infections caused by multidrug-resistant pathogens in humans and other animals. We report the emergence of the mcr-9.1 gene in a polymyxin-resistant extended-spectrum β-lactamase (ESBL)-producing Enterobacter kobei infecting a free-living Franciscana dolphin (Pontoporia blainvillei), threatened with extinction in South America. Genomic analysis confirmed a wide resistome with additional presence of genes conferring resistance to clinically relevant β-lactam [blaCTX-M-15, blaACT-9, blaOXA-1 and blaTEM-1B], aminoglycoside [aac(3)-IIa, aadA1, aph(3’‘)-Ib and aph(6)-Id], trimethoprim [dfrA14], tetracycline [tetA], quinolone [aac(6’)-Ib-cr and qnrB1], fosfomycin [fosA], sulphonamide [sul2], and phenicol [catA1 and catB3] antibiotics. The identification of mcr-9.1 in a CTX-M-15-producing pathogen infecting a critically endangered animal is worryingly, due to the restricted therapeutic options, and should be interpreted as a sign of further spread of critical-priority pathogens and their resistance genes in threatened ecosystems.

Probability is usually estimated as a quotient of successful attempts and total attempts. This article introduces my own formula, whose estimates are consistently better. The motivation for writing this paper was an effort to make the best possible predictions of the future shooting percentages of ice hockey teams, so this topic is used throughout the entire work. The topic of this paper is both relevant within a statistical context and, simultaneously, will also appeal to all involved with ice hockey in general. In the last section I explain the role of shot quality in the NHL and show the weaknesses of popular ice hockey statistics, such as the Corsi. _KEYWORDS:_ probability estimation, regression to the mean, beta-binomial distribution, ice hockey

Background: We analysed the results of the modified Bentall procedure in a high-risk group of patients presenting with acute type A aortic dissection (ATAAD). Methods: ATAAD patients undergoing a modified Bentall between 1996 and 2018 (n=314) were analysed. Mechanical composite conduits were used in 45%, and biological using either a bioprosthesis implanted into an aortic graft (33%) or xeno-/ homograft root conduits (22%) in the rest. Preoperative malperfusion was present in 34% of patients and cardiopulmonary resuscitation required in 9%. Results: Concomitant arch procedures consisted of hemiarch in 56% and total arch / elephant trunk in 34%, while concomitant coronary artery surgery was required in 24%. Average crossclamp and cardiopulmonary bypass times were 126 ± 43 and 210 ± 76 minutes, respectively, while average circulatory arrest times were 29 ± 17 minutes. A total of 69 patients (22%) suffered permanent neurologic deficit, while myocardial infarction occurred in 18 cases (6%) and low cardiac output syndrome in 47 (15%). In-hospital mortality rate was 17% due to intractable low cardiac output syndrome (n = 29), major brain injury (n = 16), multiorgan failure (n = 6) and sepsis (n = 2). Independent predictors of in-hospital mortality were critical preoperative state (OR, 5.6; p < 0.001), coronary malperfusion (OR, 3.6; p = 0.002), coronary artery disease (OR, 2.6; p = 0.033) and prior cerebrovascular accident (OR, 5.6; p = 0.002). Conclusions: The modified Bentall operation, along with necessary concomitant procedures, can be performed with good early results in high risk ATAAD patients presenting.

The residual stress generated during the thermal processing process such as casting and heat treatment is one of the key reasons for the irreversible deformation of the diesel engine block. However, the previous research only conducted research and analysis unilaterally from the residual stress generated by casting or the effect of annealing heat treatment on the residual stress of castings, and the analysis results were quite different from the actual ones. Therefore, a comprehensive research method is proposed to consider the whole dynamic evolution process of castings from casting residual stress to heat treatment stress elimination. Through PROCAST numerical simulation of the casting process of diesel engine blocks, the simulation results of casting residual stress are introduced into the ABAQUS, and then the model of block casting with casting residual stress is simulated by annealing heat treatment. To realize the dynamic evolution of residual stress from casting to heat treatment.

The physiology of Covid 19 and its interaction with common medical conditions and procedures is only beginning to be understood. We present a case of a woman with an acute aortic rupture who required cardiopulmonary bypass with deep hypothermic circulatory arrest. She had no respiratory issues related to Covid, but her post op course was notable for refractory status epilepticus and it is unclear if Covid 19 may have had played a role in exacerbating neurologic injury.

Multi-level societies are complex social systems where basic core units associate in a hierarchical manner, allowing animals to adjust group size in response to local conditions. Each tier of multi-level societies may have evolved under different selective pressures and understanding the effect of temporal variation in these pressures may help determine why these types of social systems form. Our goal was to examine the degree of temporal variability in inter-unit associations in a multi-level society of Rwenzori Angolan colobus monkey (Colobus angolensis ruwenzorii), and to determine whether social or ecological factors correlated with association patterns. Using social network analyses, we described the association patterns of 12-13 core units over 21-months and investigated the effect of changes in rainfall, food availability, and inter-unit dispersals. We found that core unit networks were denser and more clustered when fruit was abundant, likely due to reduced food competition. Male dispersals also occurred more at these times, suggesting that greater band cohesion allowed males to prospect for dispersal opportunities. Within the band, we observed the formation of an all-male unit and the transfer of one core unit between clans. Our findings highlight how ecological conditions can influence association patterns, interunit relationships, and ultimately social organization.

Whether ooids are formed through biotic or abiotic progress seems to become increasingly controversial in recent decades. New studies indicate that the microbial effect could make important contributions to the construction, destruction and modification of ooids. Previous studies mainly focused on the organomineralization of carbonate minerals in ooids. This paper investigates the formation process of iron minerals in red oolitic grainstones of the Lower Jurassic Nieniexiongla Formation in the Tethyan Himalaya of southern Tibet. Petrographic studies and electron probe microanalysis revealed that the colorful minerals present in red ooids are hematites. Sulfur was detected in the hematites, which indicates that they were transformed from precursor pyrites. These hematites retain euhedral or framboid shapes of the pyrites. Hematite pseudomorphs distribute randomly in ooids and could not form a whole concentric layer of the ooids. Euhedral crystals usually have larger diameters than amorphous spheres and are scattered mostly in nuclei. Based on the distribution and morphology of hematites, we speculate that precursor pyrites were formed through metabolism of sulfate-reducing bacteria. Moreover, the timing of the pyrite formation was after the deposition but before the lithification. The decomposition of the microorganisms within the ooids by bacterial sulfate-reducing provides the HS-, the degradation of organic matters would produce spaces for the intrusion of pore water with sufficient Fe2+ to facilitate the pyrite deposition. In nuclei, the framboid aggregates of pyrites were transferred to euhedral crystals through continuous growth of the constituent microcrystals. Our study demonstrated organomineralization of sulfate-reducing bacteria mediated pyrites in carbonate ooids.

Major Histocompatibility Complex (MHC) genes encode for proteins that recognize foreign protein antigens to initiate T-cell mediated adaptive immune responses. They are often the most polymorphic genes in vertebrate genomes. How evolution maintains this diversity is still an unsettled issue. Three main hypotheses seek to explain the maintenance of MHC diversity by invoking pathogen-mediated selection: heterozygote advantage, frequency-dependent selection, and fluctuating selection across landscapes or through time. Here, we use a large-scale field parasite survey in a stickleback metapopulation to test predictions derived from each of these hypotheses. We identify over a thousand MHCIIβ alleles and find that many of them covary positively or negatively with parasite load, suggesting that these genes contribute to resistance or susceptibility. However, despite our large sample-size, we find no evidence for the widely-cited stabilizing selection on MHC heterozygosity, in which individuals with an intermediate number of MHC alleles have the lowest parasite burden. Nor do we observe a rare-allele advantage, or widespread fluctuating selection across populations. In contrast, we find that MHC diversity is best predicted by neutral genome-wide heterozygosity and between-population genomic divergence, suggesting neutral processes are important in shaping the pattern of metapopulation MHC diversity. Thus, although MHCIIβ is highly diverse and relevant to the type and intensity of macroparasite infection in these populations of stickleback, the main models of MHC evolution still provide little explanatory power in this system.

Background: Methodological and reporting assessment tools have been developed which allow us to investigate the core outcome set development process Objective: To characterise core outcome sets relevant to women’s and newborn health and assess methodological and reporting quality. Search Strategy: Systematic search using the Core Outcome Measures in Effectiveness Trials (COMET) and the Core Outcomes in Women’s and Newborn Health (CROWN) Initiative databases from inception to March 2020. Selection Criteria: Registered, progressing, and completed core outcome sets. Data Collection and analysis: Descriptive summaries of characteristics and results. Published protocols were assessed using the Core Outcome Set-STAndardised Protocol Items (COS-STAP). Completed core outcome sets were evaluated using COS-STAD (standards for development) and COS-STAR (standards for reporting). Main Results: Eighty studies were identified. Twenty-four studies had published a protocol; four (17%) met all COS-STAP criteria. This was primarily due to poorly defined steering groups and lack of discussion around the potential impact of attrition. Thirty-nine systematic reviews characterized inconsistency in outcome reporting. Twenty studies published a core outcome set development process with four (20%) and three (15%) meeting COS-STAD and COS-STAR recommendations respectively, largely due to variation in patient involvement, outcome selection and the Delphi process Conclusions: Future core outcome set developers should actively engage with the methodological and reporting criteria to enhance the quality of their studies. Clarity is also required within the assessment guidelines as to how these issues should be adequately addressed. We have identified 5 key areas for improvement for future core outcome set developers and wider stakeholders

Understanding niche overlap with other wild species and domestic cattle is useful to conserve and manage the wildlife in their natural habitat. We assessed habitat niche breadth and overlap among the two sympatric wild ungulates: spotted deer (Axis axis) and swamp deer (Cervus duvaucelii) and, indigenous intermediate ruminants, and domestic cattle in Shuklaphanta National Park, Nepal during the dry season. Our objective was to explore the interspecific competition by studying the habitat use by these species. The assumption was made that the presence of pellets is a proof for habitat used by species. Grid based surveys with total 96 sample plots each of size 20 m * 20 m in 6 sample grids (2 * 2 km2) with 24 sub-grids (500 * 500 m2) were used for locating pellets group. Levin’s niche breadth and Morisita’s overlap index were calculated to determine the niche breadth, and the habitat overlap respectively. The Levin’s measure of niche breadth suggested that spotted deer had the highest adaptability with an index value of 0.94 followed by domestic cattle 0.50, and swamp deer 0.33 in our study area. Thus, it was concluded that spotted deer is a habitat generalist whereas swamp deer are specialists and mostly preferred grasslands after a fire. Also, there was high habitat overlap index value of 0.83 between domestic cattle and spotted deer whereas the swamp deer and the spotted deer showed moderate habitat overlap of 0.57. The swamp deer had low habitat overlap as well as spatial overlap with domestic cattle. Grassland management should be carried out for the benefit of ungulate species as the study showed the preference of swamp deer on grassland after a fire. Similar studies should be conducted including seasons and places prior to implementing appropriate habitat management activities intended to reduce interspecific competition for co-existence.

This an atypical headache scenario in a suspected case of COVID-19.The clinical outcomes, differentials, progression, and reasoning have been discussed and highlighted as possible.

Radiotherapy and chemotherapy in patients with testicular cancer often cause infertility. We describe congenital single testis patient with testicular cancer and azoospermia who was underwent ipsilateral Onco-TESE during radical orchiectomy and succeeded in sperm collection, followed by having a healthy child after ICSI.

We present the case of a male infant diagnosed with IPEX (immune dysregulation, polyendocrinopathy, enteropathy, and X-linked) syndrome who presented a generalized rash with a BCG site reaction several months after vaccination. In our patient this dermatological manifestation might be secondary to immune dysregulation, given the important role of Tregs and Th17 cells in mycobacterial immunity, similar to that observed in Kawasaki disease patients.

As the COVID-19 pandemic continues to surge, the conjectured linkages between pandemics, fertility, and child health observed during the great depression of 1957 in the USA and the influenza pandemic of 1918 in the USA and Japan become highly relevant.1,2 From 1900s through 1970s, along with the economic and epidemiologic transitions, standardized child mortality from infectious diseases decreased by 90% overall, birth defects remained the leading cause of ill health, and fertility rates declined. Pre-COVID-19 fertility projections for 2020 indicate that 66 countries of the countries currently experience sub-replacement fertility (Figure), below the global average fertility of 2.3 and the sub-replacement fertility level of 2.1.3 The fertility rate of 2.1 as the sub-replacement level is derived from the assumption that, in a community, two children per women are required to replace parents and 0.1 child to make up for child mortality prior to becoming an adult. Fertility rate at or below 1.7 is considered severe (45 countries) because interventions (excluding immigration of populations with high fertility) are unlikely to achieve the 2.1 replacement target.Impact of Pandemics on Fertility and Child HealthPandemics can adversely affect both fertility and child survival.1,2 The mechanisms that linked pandemics with subsequent depressed fertility during the past pandemics include a combination of reduced conceptions and embryonic losses during the first month of pregnancy, individual level stress from pandemics and pandemic-related mortality, short-run instability from environmental shocks and economic volatility leading to decreased investment in the population size of future generations.Child development may be affected by community mitigation activities including home quarantine, social distancing, and closing of economic and travel activities, reduced access to child day care, interruption in schooling and nutrition opportunities for many children. These effects are amplified if the child is cared for by single parents or parents in employment categories such as the service sector that is immediately affected by mitigation strategies. We lack contemporary studies on the impact of these outcomes. Social and family structures during historic events differed greatly from that of today. In countries that experience sub replacement fertility, population of childbearing age is characterized by single households, increased mean age of women at first birth (higher order births), nuclear families, increased participation of women in the workforce, high percentage of dissolved family unions, and inadequate unemployment benefits and social support systems to support families.4,The evolution of the COVID-19 pandemic occurred in a condensed timeframe and SARS-CoV-2 related embryonic loss has not been reported. With the addition of COVID-19 related childhood multisystem inflammatory syndrome to birth defects (current burden in developed countries, 40 to 55 per 1000 live births5), the overall child morbidity will increase. The spread of COVID-19 and mortality has been significant among many of the countries that experience sub replacement fertility and the incidence is increasing in the younger ages as currently observed in the U.S. COVID -19. Mitigation efforts can adversely impact child survival and fertility decisions due to changes in ratio of workers to dependents, changes in the labor supply of working-age adults over time, and changes in the average level of schooling.Given that the countries that face sub-replacement fertility are also the leading drivers of innovation and productivity globally (figure)3,6, further stress on fertility in these countries will no doubt impact their economic security and contribution to global development in the next two decades.Actions to Improve Fertility and Improve Child Well BeingCountries in sub-replacement fertility status have explored social, economic, and policy interventions to reverse the trend. They include policies to balance work and family obligations, financial incentives (fertility boosters, monthly childcare benefit linked to family size), speed premium (financial incentives for delivery of second child within a given time frame), free childcare, and housing subsidies.7 Immigration played a major role in sustaining fertility rates at replaceable levels in the USA. The easing of the one-child policy in China in 2016 increased the number of births by 8% over 2015. Given that fertility change is a long-term cohort effect, influenced by various exogenous factors, select measures are unlikely to achieve long-term benefits unless a complete set of supportive interventions across the lifespan of the parents and child are implemented in concert.Unlike during historic events, COVID-19’s impact on fertility should be of concern for relevant countries. Efforts to aid population growth and health outcome of children born today are needed in high-risk countries so that many more women achieve healthy reproductive goals and their children achieve optimal health. We highlight 7 actions points below.Strengthen and expand newborn screening programs to identify and provide early intervention for birth defects and assure special care the affected children.Educate the public about steps that fathers and communities can take to support women to achieve healthy reproductive outcomes.At the policy level, use COVID-19 as an opportunity to advocate, develop and integrate to social programs and labor sector a comprehensive list of supportive interventions across the life span of the parent-child dyad.Integrate pre-conception care concepts to clinical practice to enable women of childbearing age to achieve optimal mental and physical health during COVID-19 and ensure a healthy balanced diet, including folic acid fortification or supplementation, correcting iodine deficiencies and avoiding teratogens such as alcohol and tobacco.Optimize maternal health through control of chronic diseases that increases a woman’s risk for both COVID-19 and adverse child outcomes.Among intrauterine and child survivors of COVID-19, monitor potential long term impact of COVID-19 throughout the child’s growth and development period.Assure the continuity and comprehensiveness of high-quality child education and social interaction opportunities through innovative virtual programs when in-person education is unavailable.With the aging of populations and the interconnectedness of our economies, COVID-19’s potential impact in countries that are already facing sub-replacement fertility should receive due consideration in programs aimed at improving the health of the mother and child. Doing so would be a necessity not only form a national security perspective, but from a long-term economic prosperity, not just for those countries at high risk, but for all countries.Summary (optional)Pandemics can adversely affect both fertility and child survival. The pathways include adverse biological outcomes (those caused as a direct result of infections on fetus, newborn, or children), ecological impact on fertility (due to indirect causes that leads to postponement or lack of reproduction), and as a result of unintended consequences of community mitigation on growth and development of children1-4 Globally 66 countries, mostly those the global innovation hubs with the highest per capita GDP, already have fertility rates below 2.1, of which 45 are at or below the irreversible rate of 1.7. As COVID-19 incidence is increasing in the younger ages, population growth plans to avert further deterioration of fertility and assure optimal health of children are needed in countries with sub-replacement fertility.Figure. Countries facing sub-replacement fertility (TFR<2.1), their global ranking by per-capita gross domestic product (GDP) and innovation index1,6 . Fertility rates below 1.8 marked by vertical blue line are considered irreversible.