Management of idiopathic ventricular fibrillation (IVF) is challenging because an arrhythmic substrate may be missed at initial diagnosis; therefore, careful follow-up and reassessment are necessary. Three-dimensional mapping would be useful for reassessment of IVF because it revealed an arrhythmic substrate in a patient, 12 years after his initial IVF diagnosis. .

In this report we reported the sero-prevalence of West Nile virus among the resident and migratory wild birds from different locations of Bangladesh. 48 birds (48/888, 5.4%, CI 0.04-0.07) were found sero-positive for WNV antibody.

Understanding the dynamics of small populations is critical to conserve those species at most risk. Previous work has identified demographic and environmental factors that can mutually reinforce one-another to drive populations rapidly to extinction – a process known as the ‘extinction vortex.’ However, studies investigating robustness to the extinction vortex in relation to life history and ecological traits have been lacking. Here, we assemble a database of 55 vertebrate populations monitored to extirpation and perform three analyses to investigate whether a key fitness-related phenotypic trait – body size – influences the rate at which populations succumb to the extinction vortex. We find evidence that populations of smaller-bodied species deteriorate at a faster rate, suggesting that intrinsic biological traits can alter the susceptibility of species to the extinction vortex, and may serve as a useful feature for prioritizing which populations to invest conservation effort in.

Halophyte agriculture in marginal soils using saline water offers a sustainable solution for generating biomass feedstock for carbon-neutral aviation biofuels. A full-scale sustainable energy and agriculture system (SEAS) demonstration is planned for the Abu Dhabi coast, where evaporitic gypsiferous soils pose a challenge to long-term operation because of the potential for land degradation. In this study, geochemical modelling on the Geochemist’s Work Bench (GWB®) platform was employed to: (1) Evaluate the feasibility of using coastal groundwater versus seawater as irrigation feedwater; (2) determine the change in agricultural return water salinity through site-specific soils upon different seawater irrigation rates; and, (3) assess mineral deposition effects in the soil column as a function of site-specific soil characteristics at candidate sites over a one-year period of continuous seawater irrigation. Evaporation modelling was used to evaluate potential feedwater sources while varying feedwater composition and electrolyte activity coefficient models. 1-D saturated-flow advection-precipitation/dissolution modelling was utilized to assess return water quality and mineral deposition as a function of both the electrolyte activity coefficient model and the mineral composition of site-specific soils. Results pointed to seawater as the more viable feedwater option compared to coastal groundwater because of slower onset of precipitation. This effort demonstrated that soil type did not influence agricultural return water salinity (except for strongly gypsic soils) but influenced mineral precipitation under surficial evaporation conditions. Porosity loss correlated with layers of mineral deposition. The study points to the need for careful selection of land and saline water resources for the sustainable farming of halophytes.

Let's assume we have a domain \(\Omega\) of boundaries \(\partial\Omega\) as in Figure 1.

Rationale, aims and objectives: A considerable amount of primary health care (PHC) clients comes in with medically unexplained complaints, leading to frequent consultations and high usage of services and health care costs. This study aimed to determine the prevalence of somatic symptom disorder among PHC attendees and to explore its relation with other mental disorders and risk factors. Methods: A cross sectional design was used to interview 400 attendees at five PHC centers in Nablus district, during Sept to Dec, 2019. Men and women age over 18 years old, without psychiatric diagnosis were invited to participate in the study. The Somatization scale of the Four-Dimensional Symptom Questionnaire was used to assess somatic symptom disorders. It is a valid tool to be used in PHC setting. Chi-squared test and multivariable logistic regression were used to explore determinant variables. Results: A high prevalence of somatic symptom disorder was seen in the sample [32.5% (95%CI= 27.9%-37.1%)]. The most prevalent symptoms were painful muscles (61.5%) followed by back pain (52.3%). Somatic symptom disorder was found to be associated with: Female gender [P =0.015 adjusted OR = 2.2 (95% CI= 1.3-4)], chronic diseases [P =0.027 adjusted OR = 2 (95%CI=1.1-3.6)], depression [P <0.001 adjusted OR = 3.2 (95%CI= 2.0-5.3)], and anxiety [P=0.032 adjusted OR = 3.0 (95%CI= 1.6-5.5)]. Additionally, attendees with high somatization were found to have significantly higher frequency of doctors visit [P=0.005 adjusted OR = 2.2 (95%CI= 1.3-4.0)] Conclusions: The prevalence of somatization among PHC attendees in Palestine is high. It is significantly higher among females, patients with chronic diseases, clients with anxiety and depressive disorders and patients with frequent doctors’ visits. Painful muscles and back pain are the most common symptom presented by patients, and this could be used initially by PHC physicians as a signal to consider for screening.

The raw case fatality rate (CFR, reported number of COVID-19 deaths divided by the number of cases) is a useful indicator to quantify the severity or treatment efficacy in a locality. In many countries, the pandemic showed a two-wave pattern now, namely the daily reported cases once reached a low level and now went up. To our knowledge, no study has compared the CFR for the two waves. In this work, we report that in 53 countries or regions with the highest deaths, the CFR is reduced in 43 countries or regions in the on-going second wave. We discussed the possible reasons. Also, we compare the two-wave pattern of COVID-19 with the weekly influenza positive tests. The influenza activity in pre-pandemic era provided an indicator for climate in a country, since it is well-known that influenza is driven by weather. The sharp drop in 2020 influenza activity is an indicator of the effects of social distancing.

Rationale, aims, and objectives: The complexity of healthcare systems makes errors unavoidable. To strengthen the dialogue around how physicians experience and share medical errors, the objective of this study was to understand how experienced generalist physicians make meaning of and grow from their medical errors. Methods: This study used a narrative inquiry approach to conduct and analyze in-depth interviews from 26 physicians from the generalist specialties of emergency, internal, and family medicine. We gathered stories via individual interview, analyzed them for key components, and rewrote a ‘meta-story’ in a chronological sequence. We conceptualized the findings into a metaphor to draw similarities, learn from, and apply new principles from other fields of practice. Results: Through analysis we interpreted the story of an elite athlete (physician) who is required to make numerous decisions in a short period of time within the construct of a chaotic sports field (clinical environment) among spectators (the patient’s family) whilst abiding by existing rules and regulations. Through sharing stories of success and failure, the team coach (clinical mentor) helps optimize the players’ professional and psychological development. Similarly, through sharing and learning from stories, team members (colleagues) and junior team members (trainees) also contribute to the growth of the protagonist’s character and the development of the overall team (clinic/hospital) and sport (healthcare system). Conclusion: We draw parallels between the clinical setting and a generalist physician’s experiences of a medical error with the environment and practices within professional sports. Using this comparison, we discuss the potential for meaningful coaching in medical education.

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease caused by Aspergillus induced hypersensitivity that occurs in immunocompetent but susceptible patients with asthma and/or cystic fibrosis (CF). In children, ABPA remains mostly undiagnosed, resulting in one of the most common causes of poorly controlled asthma and highly significant morbidity in children with CF. Currently, no specific diagnostic criteria of ABPA for children are available. Corticosteroids and itraconazole are the mainstays of therapy, althoughthere is a lack of randomized clinical trials regarding their usefulness for ABPA in children. Several monoclonal antibodies, such asomalizumab and mepolizumab, may be potential therapies for refractory ABPA in pediatric patients; however, further data are required to clarify the optimal dose and duration of therapy as a routine treatment approach.

Variation in solar ultraviolet (UV) radiation induces a wide-range of plant responses from the cellular to whole-plant scale. We demonstrate here for the first time that partial stomatal closure caused by UV exposure significantly increases leaf temperature independently of any increase in incident energy on the leaves. Significant leaf warming in response to UV radiation was consistent in tomato (Solanum lycopersicum L. ) across different experimental approaches. Exposure to UV radiation significantly decreased stomatal conductance and increased leaf temperature by up to 2°C in field experiments where solar UV was attenuated using filters. Smaller but significant increases in leaf temperature due to decreases in stomatal conductance occurred in multi-day controlled environment (CE) growth room experiments and in short-term (< 2 hours) irradiance response experiments, both using fluorescent lamps to provide UV treatments. We show that leaf warming due to partial stomatal closure is independent of any direct warming effects of UV manipulations. We discuss the implications of UV-induced warming both for crop production and understanding broader plant and ecosystem responses to UV radiation.

Alpine wetlands play a sensitive function in global carbon cycle during the ongoing climate warming, yet the temporal patterns of carbon dynamics from in situ ground-based long-term observations remains unclear. Here, we analyzed the continuous net ecosystem CO2 exchange (NEE) measured with the eddy covariance technique over an alpine peatland on the northeastern Qinghai-Tibetan Plateau from 2007 to 2016. The wetland acted as a net CO2 source with a positive NEE (120.4 ± 34.8 gCm-2year-1, Mean ± S.D.), with the mean annual gross primary productivity (GPP) of 500.3 ± 59.4 gCm-2year-1 and annual ecosystem respiration (RES) of 620.7 ± 74.2 gCm-2year-1. At the seasonal scale, the classification and regression trees (CART) analysis showed that aggregated growing season degree days (GDD) was the predominant determinant on variations in monthly NEE and monthly GPP. Variations in monthly RES were determined by soil temperature (Ts). Furthermore, non-growing season Ts had a significant positive correlation with the following year annual GPP (p<0.05). Non-growing season RES only accounted for about 25% of annual RES, but had significant correlation with annual RES and annual NEE (p<0.05). The further partial correlation analysis showed that non-growing season air temperature (Ta, p = 0.05), rather than precipitation (PPT, p = 0.25) was a predominant determinant on variations in annual NEE. Our results highlighted the importance in carbon dynamics of climate fluctuations and CO2 emission from the non-growing season in alpine wetlands. We speculated that the vast peadlands would positively feedback to climate change on the Tibetan plateau where the non-growing season warming was significant.

The arrival of novel predators can trigger trophic cascades driven by shifts in prey numbers. Predators also elicit behavioural change in prey populations, and this may also contribute to trophic cascades. We document rapid demographic and behavioural changes in rodent populations (grassland melomys) following the introduction of an ecologically novel predator (northern quoll). Within months, melomys from quoll-invaded populations suffered reduced survival relative to quoll-free populations. They also exhibited increased shyness which became fine-tuned to more threat-specific antipredator behaviour. These behavioural shifts were associated with lower per-capita seed take, and avoidance of quoll-scented seeds. These behavioural shifts could reflect phenotypic plasticity or may be adaptive responses to selection imposed by predation. Overall, our study reveals rapid numerical and behavioural shifts in response to a novel predator and shows that both behavioural and numerical responses can drive trophic cascades.

Background: Change in airway resistance and inflammation are the two most commonly accused pathogenetic processes in the coexistence of asthma and obesity. The aim of this study was to compare airway resistance between normal weight and overweight/obese children using impulse oscillometry (IOS). Methods: We consecutively enrolled 3 to 10-year-old children with asthma who presented to our department between May and August 2018. Ones with a body mass index percentile at or above 85th percentile were grouped as overweight/obese. Sociodemographic characteristics such as age, sex and family history of allergy were recorded and Test for Respiratory and Asthma Control in Kids (TRACK) was filled in for all. Finally, impulse oscillometric (IOS) measurements were taken. Results: We enrolled 170 subjects; among which 114 (67.1%) were normal weight while 56 (33%) were overweight/obese. Sociodemographic characteristics were not significantly different between the two groups, but asthma control was significantly worse in the overweight/obese group (75.9±21.1 vs 85.9±17.8, p=0.001). Impulse oscillometric measurements of resistance and reactance were nor significantly different between the two groups. Conclusion: Asthma control in children who are overweight or obese are worse compared to the normal weight ones but, airway resistance and reactance measured by IOS at different frequencies are not significantly different between these two groups. This implies that airway resistance change may not the main pathogenetic mechanism underlying the uncontrolled asthma and obesity coexistence.

In recent decades, the rising severity of summer heatwaves has increased the co-occurrence of heat and drought stress leading to forest mortality and to reductions in crop yield. Plant responses to this combined stress can be unique from the response to either independent stress, yet few studies have investigated these responses in tree species. Our work examines adjustment of several primary metabolites and polyamine (stress indicating secondary metabolites) in paper birch and white spruce subjected to two seasons of repeated heatwaves, drought, and elevated CO2. Our objectives were to determine if the metabolic adjustments in response to heatwave+drought stress are: 1) unique or shared with either individual stress; 2) greater in birch compared to spruce; and 3) carried over into the following season. Our data show that white spruce displayed many metabolic responses that were unique to the combined stress, especially in the first year, while paper birch displayed few. Further, the unique responses in spruce seen in the first season stress exposure did not carry into the following season indicating possible stress memory. Our data highlights the importance of considering species-specific responses to multiple stressors when making predictions about forest response to future climate scenarios.

The mechanical properties and fatigue responses of double-edge-cracked Ti/APC-2 hybrid nano-composite laminates by tensile and cyclic tests were obtained. The double-edged cracks were cut with the crack lengths of 2.0 mm and 3.0 mm symmetrically and anti-symmetrically. The mechanical properties of symmetrically cracked samples are more detrimentally than those of anti-symmetrically counter parts. The greater the cracked angles, the greater the maximum load, however, the results of crack lengths were on the contrary. The fatigue life increased with the crack angle increasing, and also decreased with the crack length increasing. The enhancement of laminates by adding nano-powder did improve the fatigue life and maximum load, but not significantly. It is attributed to the local stress intensity factors at the crack tips mainly dominating the mechanical properties. Hence, the spreading of nano-power at the interface does not effectively strengthen the resistance to fatigue and fracture globally.

Please allow me call you mum,Inside or outside of the uterus,It is not my choice.My home located at the Fallopian tube,Not the uterus where I have been expecting,It is not my choice.The small room I am living,The pressure I am confronting,The poor nutrition I am absorbing,Mum, mum…I am so painful.I don’t want to live here.Mum, mum…I can’t breathe.But I can’t go away this way.Mum, mum…I am still alive.But who ever heard me crying?Mum, mum…What you may lose is not only your hope for the future,But also, the fertility for my future sisters and brothers,But it is not my choice.I also have the right to life,I also ever imagined the rich and colorful of the outside world,But I don’t know if I have the opportunity to see it.Though I live in such tragic,I still believe everyone is created equal,What makes me dangerous to life is not life itself,But the environment I am living.Who to be blamed is you–my mum,Sometimes you are innocent,But sometimes you could have done something to avoid it happening,But keeping silence.At the end,Together with the Fallopian tube,I was removed from your body.You are safe now,But will never be perfect.Painful,Not only at present,But may last a lifetime.

Extracellular adenosine triphosphate (eATP) mediates pro-inflammatory responses by recruiting and activating inflammatory cells. eATP is hydrolyzed by CD39 to adenosine monophosphate (AMP), which is converted to the immunosuppressive nucleoside adenosine (ADO) by CD73. CD39 is the rate-limiting enzyme in this cascade and can be viewed as an immunological switch that shifts ATP-driven pro-inflammatory immune cell activity to an anti-inflammatory state mediated by ADO. CD39 is expressed by a broad range of immune cells and can be influenced by genetic and environmental factors. Accumulating evidence suggests that CD39 is involved in several pathophysiological events, such as inflammatory bowel diseases, sepsis, ischemia-reperfusion injury, allergic diseases, systemic lupus erythematosus, diabetes, and cancer. Here, we focus on the current understanding of CD39 in immunity, and presents a comprehensive picture of the multiple roles of CD39 in a variety of disorders.

Introduction: long-term observation of patients with ANCA-associated vasculitis (AAV) allows the identification of different longitudinal patterns of ANCA levels during follow-up. This study aimed to characterise these patterns and to determine their prognostic significance. Methods: all ANCA determinations performed in two university hospitals along a 2-year period were retrospectively reviewed. Patients were included in the analysis if they had high titers of anti-myeloperoxidase (anti-MPO) or anti-proteinase 3 (anti-PR3) antibodies at least once, they had ≥5 serial ANCA determinations, and they had AAV diagnosed by biopsy or ACR classification criteria. Patients’ time-course ANCA patterns were classified as monophasic, remitting, recurrent or persistent. Associations between ANCA patterns and prognostic variables (relapse rate and renal outcome) were analysed by univariate and multivariate statistics. Results: A total of 99 patients (55 with microscopic polyangiitis [MPA], 36 with granulomatosis with polyangiitis [GPA], and 8 with eosino¬philic granulomatosis with polyangiitis) were included. Median follow-up was 9 years. Among patients diagnosed with MPA or GPA, recurrent or persistent ANCA patterns were associated with a higher risk of clinical relapse (HR 3.7 [95% CI 1.5-9.1] and HR 2.9 [95% CI 1.1-8.0] respectively), independently of clinical diagnosis or ANCA specificity. In patients with anti-MPO antibodies, the recurrent ANCA pattern was associated with worsening renal function (OR 5.7 [95% CI 1.2-26.0]). Conclusion: Recurrent or persistent ANCA patterns are associated with a higher risk of clinical relapse. A recurrent ANCA pattern was associated with worsening renal function in anti-MPO-associated vasculitis.

Objectives: To reach consensus on evidence-based recommendations to develop HDP management pathways for Indonesian primary care. Design: A three-round Delphi survey Setting: N/A Population: Maternal health practitioners and experts, including GPs, midwives, nurses and health policy researchers from Indonesia and international background. Methods: Participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP managements extracted from international guidelines were feasible in Indonesian primary care settings in a mix of quantitative and qualitative questions in three-rounds Delphi survey. A minimum of 70% agreement among participants was needed for a statement to be included for the HDP pathways that the pathways drafts were presented at the third-round survey. The participants’ free text questions responses and suggestions were analysed thematically. Main Outcome Measures: Agreement scores of the statements. Results: A total of 52 participants participated, 48, 45, and 37 of them completed the first, second and third-round survey respectively. The consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. The agreement scores ranged from 70.8-100.0% and potential implementation barriers were also identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions: Most evidence-based HDP management recommendations achieved consensus represented in the developed HDP management pathways can be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the pathways in practice.

The interesting report by Karagianni P et al on the finding of increased DNA methylation of H19 locus imprinting control region in saliva samples of Sjögren’s syndrome patients correlating with low complement C4 levels, may offer insights into how C4 level may be regulated in serpinopathies such as C1-inhibitor deficiency. An undetectable or low C4 level in patients with severe angioedema is a feature of C1-inhibitor deficiency (hereditary angioedema (HAE) type I with low to absent function and antigenic levels; HAE type II with point mutations in SERPING1 gene that affect the reactive centre loop affecting protein function only). However, C4 levels do not always clinically correlate with disease activity, and up to 6% patients do not have known mutations in the SERPING1 gene.

Soil ecological stoichiometry provides powerful theories to integrate the complex interplay of element cycling and microbial communities into biogeochemical models. One essential assumption is that microbes maintain stable C:N:P (carbon:nitrogen:phosphorus) ratios independent of resource supply, although such homeostatic regulations have rarely been assessed in individual microorganisms. Here, we report an unexpected high flexibility in C:N and C:P values of saprobic fungi along nutrient supply gradients, overall ranging between 7-126 and 20-1488, respectively, questioning microbial homeostasis. Fungal N:P varied comparatively less due to simultaneous reductions in mycelial N and P contents. As a mechanism, internal recycling processes during mycelial growth and an overall reduced N and P uptake appear more relevant than element storage. The relationships among fungal stoichiometry and growth disappeared in more complex media. These findings affect our interpretation of stoichiometric imbalances among microbes and soils and are highly relevant for developing microbial soil organic carbon and nitrogen models.

Objective: Cardiotocography is used worldwide to evaluate foetal well-being during pregnancy and labour. In past guidelines, the management plan was determined based on the assessment of the most severe waveform of the deceleration. There are no guidelines for evaluating the integrated recurrent decelerations; however, we believe their assessment to be essential for predicting the status of the foetus. The objective of this study was to propose an indicator for performing medical interventions during labour by creating a scoring system that reflects integrated recurrent decelerations. Design: A retrospective cohort study. Sample: Full-term single foetus births from vaginal deliveries. Methods: iPREFACE score, the integrated score index to predict foetal acidemia by intrapartum foetal heart rate monitoring was calculated using cardiotocography findings from approximately 30 min before delivery. Main Outcome Measures: We examined the iPREFACE score and fetal acidemia association and calculated the cut-off iPREFACE scores for acidaemia using receiver operating characteristic curves. Results: The study included 469 delivery cases. Their iPREFACE scores exhibited a significant negative correlation with the umbilical artery blood pH (correlation coefficient -0.43). The cut-off iPREFACE scores for the umbilical artery blood with pH <7.20, <7.10, and <7.0 were 44, 46, and 67, respectively (the areas under the curve were 0.776, 0.962, and 0.996, respectively). Conclusions: The iPREFACE score may predict foetal acidaemia and could be used as an indicator for timely medical interventions during labour. Because assessments using a cardiotocography are quick and easy to perform, the iPREFACE score could be a valuable tool in clinical practice.

Objective Pelvic Floor Fascial Mobilization (PFFM) is an innovative intervention to improve pelvic floor dysfunction. Design Pregnant women at 24-30 weeks gestation, complaining of pelvic pain, and or stress urinary incontinence, were prospectively randomized to PFFM (study group) vs. pelvic floor muscle training (PFMT). Strength and function of the pelvic floor muscles was compared before and after interventions. Setting- Outpatient pregnancy clinic at a tertiary medical center Sample- 40 women randomly allocated to PFFM or PFMT Methods Each patient was treated twice, one week apart and was assessed immediately before and after each intervention, and one week after the second treatment. Main Outcome Measures PFDI 20 questionnaire , Oxford grading scale, perineometry to measure pelvic floor symptoms function and strength, transvaginal ultrasound cervical length Results PFFM group Oxford scale improved from 2.65±1.18 to 3.45±1.28 after the first session (p<0.001) with no difference in the PFMT group 3.40±1.05 vs 3.40±1.05 (p=1). Cervical Length elongated in the PFFM group after one treatment (39.8±6.5 vs 43.4±10.2 mm, p<0.05, but not in the PFMT group 40.9±6.7 vs 40.0±8.6 respectively (p=n.s). Among 26 participants who lasted the entire study – PFMT was associated with more than 40% improvement in both Oxford as well as PFDI-20 and Perineometry was improved by 23% (23.13±15.15 vs 28.58±16.07 cmH2O (p<0.05) while no such difference was found with PFMT; 30.03±12.73 vs 30.25±9.61 cmH2O respectively (p=n.s). Conclusions PFFM may improve pelvic floor function and strength, alleviate symptoms and elongate the cervix. Further bigger study is needed to better evaluate this method.

Abstract Background: Transthoracic echocardiography (TTE) in prone position is challenging. Innovative use of transesophageal echocardiography (TEE) probe to perform TTE for such patients was described; but reproducibility and correlation of the TTE measurements by this technique with those obtained by the standard supine TTE study are still unknown. Methods: We enrolled 30 non-COVID-19 individuals, with a mean (SD) age 35 (10.9) years and 11 females, to study the agreement between the transthoracic measurements of the left ventricular (LV), left atrial (LA) and aortic dimensions obtained in prone position using an external TEE probe versus the standard supine position using the conventional TTE probe. Results: There were no significant differences between LV end-diastolic and end-systolic diameters, septal wall thickness, posterior wall thickness and aortic root dimensions in the prone versus the supine positions. While the mean ejection fraction (EF) (60.3% vs. 63.1%, P = 0.014) and mean LA dimensions (1.8 vs. 1.9 cm/m2, P < 0.001) were significantly lower in the prone position. The mean time of scans was significantly longer in the prone as compared to the supine (12.5 vs 4.5 minutes, P < 0.001). All supine studies had good quality while in the prone position 4 studies were of poor quality, and one was non-diagnostic. Conclusions: Assessment of cardiac dimensions and systolic function in the prone position using transthoracic TEE probe was feasible. LV and aortic dimensions agreed well with the standard TTE in supine position, however, LA dimensions and EF were lower in the prone position.