Abstract Background and Objectives: Better phenotyping of the heterogenous bronchiolitis syndrome may lead to targeted future interventions. This study aims to identify severe bronchiolitis profiles among hospitalised Australian Indigenous infants, a population at high-risk of bronchiectasis, using Latent Class Analysis (LCA). Methods: We included prospectively collected clinical, viral and nasopharyngeal bacteria data from 164 Indigenous infants hospitalised with bronchiolitis. We undertook multiple correspondence analysis (MCA) followed by LCA. The best-fitting model for LCA was based on adjusted Bayesian information criteria and entropy R2. Results: We identified five clinical profiles. Profile-A’s (23.8% of cohort) phenotype was previous preterm (90.7%), low birth-weight (89.2%) and weight-for-length z-score <-1 (82.7% from combining those with z-score between -1 and -2 and those in the z-score of <-2 group) previous respiratory hospitalisation (39.6%) and bronchiectasis on chest high-resolution computed tomography scan (35.4%). Profile-B (25.3%) was characterised by oxygen requirement (100%) and marked accessory muscle use (45.5%). Infants in profile-C (7.0%) had the most severe disease, with oxygen requirement and bronchiectasis in 100%, moderate accessory muscle use (85% vs 0-51.4%) and bacteria detected (93.1% vs 56.7-72.0%). Profile-D (11.6%) was dominated by rhinovirus (49.4%), mild accessory muscle use (73.8%) and weight-for-length z-score <-2 (36.0%). Profile-E (32.2%) included bronchiectasis (13.8%), RSV (44.0%), rhinovirus (26.3%) and any bacteria (72%). Conclusions: Using LCA in Indigenous infants with severe bronchiolitis, we identified 5 clinical profiles with one distinct profile for bronchiectasis. LCA can characterise distinct phenotypes for severe bronchiolitis and infants at risk for future bronchiectasis, which may inform future targeted interventions.

Dear Editor, With great interest, I read the article by Flécher et al1 and congratulate them on the quality of the review carried out on the history of surgical treatment of cardiac wounds. It is an exciting topic, so I would like to briefly comment on some facts narrated in this work.The well-known surgical approach to the heart, described by Larrey in the subxiphoid region, should not be placed in a close historical relationship with the pericardiotomy he performed in 1810 through a thoracotomy. It was not until 1824 that, after treating a soldier who had suffered a penetrating wound between the xiphoid appendix and the 7th costal cartilage, the French surgeon began experimenting on cadavers in search of a faster route to the heart. In 1829 he proposed his oblique subcostal incision which is currently practically not used.2During Milton’s service in Egypt, he surely performed several thoracic surgeries in extremis situation, but there is no evidence to support the claim that median longitudinal sternotomy (MLS) was created during an emergency approach3 or that has been designed for this type of procedure. When he decided to operate on a living human being on January 25, 1897, he used it for an elective total sternectomy in a patient with sternal tuberculosis and ruled out its use in patients with true mediastinal tumors, who needed more urgent surgeries.On the other hand, it can hardly be said that MLS is currently the gold standard for cardiac surgeons to safely and quickly manage a cardiac stab wound. In patients such as those shown in the article,1 an approach using a MLS would be very difficult since lateral mobilization of the costal wall during the necessary separation of the two halves of the sternum would displace the knife, causing probably fatal bleeding.In the emergency room, the gold standard for quickly managing a penetrating cardiac injury is anterolateral thoracotomy in the fifth intercostal space. A 1906 article on experimental surgery in dogs has led some authors to mistakenly consider Spangaro to be the creator of this incision.4 They forget that in 1893 Daniel Hale William performed his famous pericardioraphy (the second in history) precisely using that approach.5References1. Flécher E, Leguerrier A, Nesseler N. An odyssey of suturing cardiac wounds: Lessons from the past. J Card Surg. 2020;35(7):1597-9.2. López de la Cruz Y, Quintero Fleites YF. Modifications to the classic simple-longitudinal inferior pericardiotomy (Sauerbruch technique). CorSalud. 2019;11(3):225-32.3. Milton H. Mediastinal Surgery. Lancet. 1897;1:872 - 5.4. Pust GD, Namias N. Resuscitative thoracotomy. International Journal of Surgery. 2016;33:202-8.5. Buckler H. Doctor Dan. Pioneer in American surgery. Boston: Little, Brown and Company; 1954.Correspondence: “July 26” Ave., No. 306, Apt. 18. Santa Clara. Villa Clara. Cuba. Postal code: 50 200. E-mail: yoandylc@infomed.sld.cu

Fungal osteomyelitis is uncommon after cardiac surgery. A case of Candida albicans and S. epidermidis osteomyelitis with device infection after implantation of a left ventricular assist device in a male patient is presented. After confirmation with microbiological and radiological examinations, debridement was performed. Surgical specimens grew C. albicans and S. epidermidis. Fluconazole, daptomycin and negative pressure wound therapy failed to achieve healing. Total sternectomy and pectoralis muscle flap reconstruction were performed. There was no recurrent infection for C. albicans on a prolonged antifungal regime. The combination of antifungal therapy and aggressive surgical debridement may be useful to control fungal osteomyelitis.

Aims: Postoperative pain and complications are the main risk factors against patients’ recovery after colorectal surgery, and the pain can aggravate postoperative complications.This study aimed to investigate the effects of various postoperative analgesic strategies on the recovery after laparoscopic colorectal surgery. Methods: 400 patients undergoing laparoscopic colorectal cancer surgery were recruited, 335 patients were included eventually and five groups were involved: PCEA with ropivacaine in group ropivacaine, and PCIA with morphine, nalbuphine, sufentanil, or flurbiprofen plus sufentanil in the other four groups. The postoperative delirium (POD), postoperative pain, stress, and complications were recorded. Results: The incidence of POD and chronic postsurgical pain (CPSP) at 3 months or 6 months after surgery were higher in group sufentanil (P=0.004, P=0.003 or P=0.003, vs. group ropivacaine). The risks of movement-evoked pain (MEP) were much higher in group nalbuphine, group sufentanil and group flurbiprofen plus sufentanil (P=0.001, P﹤0.001, and P﹤0.001, vs. group ropivacaine ), but not in group morphine. There were no differences in cortisol and ACTH levels in the 5 groups (P﹥0.05). The incidence of pruritus was found significantly higher in group morphine than in the other groups except group S (P ﹤0.005). CPSP and POD were associated with MEP ( P ﹤0.05). Conclusion: PCEA is the first choice for postoperative analgesia in laparoscopic colorectal surgery, PCIA with morphine or nalbuphine can be considered an alternative, but sufentanil or combined with flubiprofen might not be a good choice.

Purpose: To analyze two gold-standard patient-reported outcome measures (PROMs) in knee OA (WOMAC and SF-36) and determine which questions are the most reflective of the overall score. Methods: This was a retrospective study on 4,983 patients with primary knee pain. Patients had WOMAC and SF-36 at two-time points, pre-treatment and after three months of treatment. A decision tree classifier supported with a linear mix model regression was applied to determine, identify, and categorize the most influential questions that determine the overall score in each of the questionnaires. Results: For SF-36, the most influential items were Q22 (39%), Q32 (24%), Q11 (19%), Q25 (19%). For WOMAC, the most influential predictors were Q14 (39%), Q10 (24%) and Q15 (21%). A significant improvement in WOMAC and SF-36 was seen after three months of treatment (P<0.01). For SF-36, the main predictor items were Q11, Q22 and Q32, Regression model R2 = 0.841, p<0.01, t[55.62]=0.001, Beta for Q22=0.409, Q32=0.352, Q11=0.278. For WOMAC, the main predictor items were Q10 and Q15, Regression model R2 = 0.930, p<0.01, t[35.4]=0.001, Beta for Q15=0.548, Q10=0.4639. Conclusion: Two questions from the WOMAC questionnaire predicts 93% of the overall score and four questions form the SF-36 predict 84%. The creation of a clinically meaningful assessment tool based on larger scientifically validated PROMs will help to facilitate its use by clinicians and acceptance by patients in clinical practice.

In this report we describe the clinical presentation, laboratory findings and outcomes of four patients that were referred for urgent cardiothoracic intervention and tested positive for COVID-19. Though the majority of the patients undergoing surgery had low Society of Thoracic Surgeons score and uneventful operating time, mortality was very high and driven primarily by the viral syndrome. Laboratory markers that have been associated with disease severity in the general population were also prognostic in our population. Our study shows that these patients have very high mortality, whereas prevention and preoperative screening is required in preventing nosocomial spreading of the disease.

Protective measures against Covid have a relevant impact on communication. This will have be to be considered in the future.

Aim: our aim was to explore the association between life habits and the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as the surrogate markers of liver steatosis and fibrosis in a large cohort of nonalcoholic fatty liver disease (NAFLD) patients. Methods: In this prospective, cross-sectional study we had analyzed 1998 patients with diagnosed NAFLD. Sleeping duration was categorized in three groups: short (S) (<6h), moderate (M) (6-8h) and long (L) (>8h) sleep duration. Coffee drinking was categorized into no (0), moderate (1–2) and frequent (≥3) consumption (in cups/day). Smoking was categorized as yes vs. no. Results: Frequent coffee consumers had the lowest prevalence of obesity, hypertension, dyslipidemia, and diabetes. Furthermore, coffee non-consumers had highest values of hepatic enzymes, CAP and LSM. Moderate sleep duration was associated with lower values of CAP and LSM. Coffee consumption was associated with lower CAP in all the multivariate models (CAP unadjusted and model 1,2 and 3), with largest effect in most frequent coffee consumers (≥3, model 3). Also, most frequent coffee consumers were associated with lower LSM in unadjusted model, model 1 and 2, while this was not the case for model 3 and those who consumed 1-2 cups of coffee per day. Reduced sleeping was confirmed as risk factor for elevated CAP in most of the models (unadjusted and model 1 and 2). Also, negative association of LSM was also confirmed in unadjusted model and model 2. Patients which slept 6-8 hours per day were mostly associated with lower CAP and LSM. Smoking did not affect CAP or LSM values. Conclusion: Coffee consumption has beneficial effect on CAP and LSM and this effect is dose dependent since and independent of a variety of relevant confounders. We have shown that moderate sleep duration has also beneficial effect on CAP and LSM.

Background: While a parental history of asthma has been widely reported as a risk factor for childhood asthma, less is known about the impact of multigenerational family history of asthma on the occurrence of asthma in children. Methods: From 2012 to 2013, a cross-sectional study was carried out in seven Chinese cities. Participants were randomly selected from 94 middle schools, elementary schools and kindergartens. Questionnaires, from which information on asthma, environmental exposure and family members (parents, paternal grandparents and maternal grandparents) affected by asthma were obtained, were completed by the children’s parents or guardians. Two-level logistic regressions were used to assess hereditary patterns of asthma, adjusted for potential confounding factors. Mediation analysis was performed to estimate the potential mediation effect of parents on the association between grandparental asthma and offspring asthma. Results: A paternal grandfather (OR: 2.59, 95%CI: 2.14-3.13), paternal grandmother (OR: 2.40, 95%CI: 1.93-2.99), maternal grandfather (OR: 2.08, 95%CI: 1.71-2.53) and maternal grandmother (OR: 2.08, 95%CI: 1.67-2.59) with asthma were associated with childhood asthma, independent of parental asthma. Of the children who had two family members with asthma, the risk of childhood asthma was highest when both parents had asthma (OR: 15.92, 95%CI: 4.66-54.45) or when both father and paternal grandfather had asthma (OR: 11.11, 95%CI: 5.77-21.38). Parents had a small proportion of mediation effect on the association between grandparental asthma and childhood asthma. Conclusions: A family history of grandparental asthma was associated with childhood asthma and parents only partially mediate the association.

Immediate and non-immediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5-3% of patients receiving non-ionic ICM. The diagnosis and management of these patients is controversial among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and non-immediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Drug provocation test is the gold-standard; although, as it is a risky procedure, the decision for performing it needs to be taken based on a risk-benefit analysis. Another source of controversy is the role of in vitro tests for diagnosis and pretreatment for preventing reactions.

Article type: News and Views: Groundbreaking Discoveries in Immunology

Fetal skeletal dysplasia is a disease that is difficult to distinguish these types of diseases during the fetal period. Due to the difficulty of fetal ultrasound diagnosis, the severity of fetal skeletal dysplasia is extremely difficult to assess. For this condition, we analyzed 79 fetal samples of skeletal dysplasia from the third affiliated hospital of Zhengzhou University, China from August 2018 to April 2020, which had undergone prenatal whole exome sequencing(WES). By comparing the results of whole-exome sequencing and fetal ultrasound test results, we find that the fetal short limb phenotype found in the range of FL<-4.0SD or HL<-4.0SD through ultrasound test is closely related to FGFR3 gene mutation , and the correlation is stronger when accompanied by macrocephaly. We also find that the fetal limb curved phenotype is closely related to COL1A1 gene mutation. At the same time, we find that nasal dysplasia during fetal period is also a common phenotype of abnormal results detected by whole exome sequencing. Overall, our research shows that WES has different detection rates for various skeletal abnormalities according to the different types of ultrasound detection results, which provides a meaningful guidance for clinical diagnosis of fetal skeletal dysplasia.

Background and Purpose: Mineralocorticoid receptors (MRs), glucocorticoid receptors (GRs) and corticotropin-releasing factor (CRF) in the paraventricular nucleus of the hypothalamus (PVN) are implicated in the stress response. The present study investigated the role of GRs and MRs in the PVN in regulating depressive and anxiety-like behaviors. Experimental Approach: To model chronic stress, rats were exposed to chronic corticosterone treatment via drinking water for 21 days, and the GR antagonist RU486 and MR antagonist spironolactone, alone and combined, were directly injected in the PVN daily for 7 days before the behavioral tests. Depressive- and anxiety-like behaviors were evaluated in forced swim test, sucrose preference test, novelty-suppressed feeding test and social interaction test. The expression of GRs, MRs and CRF were detected by Western-Blot. Key Results: The rats exposed to corticosterone exhibited depressive- and anxiety-like behaviors. The expression of GRs and MRs decreased, and CRF levels increased in the PVN. The intra-PVN administration of RU486 increased the levels of GRs and CRF without influencing depressive- or anxiety-like behaviors. The spironolactone-treated group exhibited an increase in MRs without influencing GRs and CRF in the PVN, and improved anxiety-like behaviors. Interestingly, the intra-PVN administration of RU486 and spironolactone combined restored the expression of GRs, MRs, and CRF and improved depressive- and anxiety-like behaviors. Conclusion and Implications: These results suggest that the simultaneous restoration of GRs, MRs, and CRF in the PVN in this rat model of stress might play an important role in the treatment of depression and anxiety.

Background and Purpose: Obesity has become a major health threat worldwide related to type 2 diabetes, hypertension, cardiovascular disease, etc. Activating brown adipocytes and inducing browning of white adipocytes has been proposed as a potential molecular target for obesity treatment. In the present study, we investigated the effects of emodin on browning in mice with high-fat diet (HFD) and explore its underlying pharmacological mechanisms. Experimental Approach: Male C57BL/6J mice were fed with HFD for 8 weeks to induce obesity. Then the obese mice were divided into four groups randomly, HFD or emodin (40, 80 mg/kg/day) or CL 316243 (1 mg/kg/day) for another 6 weeks. Body weight and food intake were recorded every week. After 6 weeks of treatment, fasting blood glucose, oral glucose tolerance, Lee’s index, weight ratio (fat weight/body weight), blood lipids, and adipose tissues morphology were assayed. Then UCP1, CD36, FATP4, PPARα and PHB protein in subcutaneous white adipose tissue (scWAT) and brown adipose tissue (BAT) were analyzed. In addition, the lipid metabolites in adipose tissues were analyzed by Ultra Performance Liquid Chromatography with Electrospray Ionization Tandem Mass Spectrometry.

Reduced representation genome sequencing has popularized the application of single nucleotide polymorphisms (SNPs) to address evolutionary and conservation questions in non-model organisms. Patterns of genetic structure and diversity based on SNPs often diverge from those obtained with microsatellites to different degrees, but few studies have explicitly compared their performance under similar sampling regimes in a shared analytical framework. We compared range-wide patterns of genetic structure and diversity in two amphibians endemic to the Iberian Peninsula: Hyla molleri and Pelobates cultripes, based on microsatellite (18 and 14 loci) and SNP (15,412 and 33,140 loci) datasets of comparable sample size and spatial extent. Model-based clustering analyses with STRUCTURE revealed minor differences in genetic structure between marker types, but inconsistent values of the optimal number of populations (K) inferred. SNPs yielded more repeatable and less admixed ancestries with increasing K compared to microsatellites. Genetic diversity was weakly correlated between marker types, with SNPs providing a better representation of southern refugia and of gradients of genetic diversity congruent with the demographic history of both species. Our results suggest that the larger number of loci in a SNP dataset can provide more reliable inferences of patterns of genetic structure and diversity than a typical microsatellite dataset, at least at the spatial and temporal scales investigated.

For the ionic liquid (IL)-solute systems of broad interest, a deep neural network based recommender system (RS) for predicting the infinite dilution activity coefficient (γ∞) is proposed and applied for a large extension of the UNIFAC model. In the RS, neural network entity embeddings are employed for mapping each IL and solute and neural collaborative filtering is utilized to handle the nonlinearities of IL-solute interactions. A comprehensive experimental γ∞ database covering 215 ILs and 112 solutes (totally 41,553 data points) is established for training the RS, where the cross-validation and test are performed based on a rigorous dataset split by IL-solute combinations. The obtained RS shows superior performance than the state-of-the-art γ∞ models and is thus taken to complete the solute-in-IL γ∞ matrix. Based on the completed γ∞ database, a large extension of the UNIFAC-IL model is finally presented, filling all the parameters between involved groups.

Both fast and turbulent fluidized beds exhibit entrainment, but the differences in the flow phenomena are not well understood. This study targeted a comparative analysis of the cluster (or streamer), mass flux, and segregation datasets from these two fluidization regimes. The particle systems were narrow particle size distributions (PSDs), binary mixtures, or broad PSDs of Geldart Group B particles. Relative to the fast fluidized bed, the turbulent bed exhibited (i) higher cluster probability and frequency, but lower cluster duration; (ii) lower local mass flux; and (iii) similar segregation extents. Regarding clusters, the relative dominance of the variables on probability was similar for both regimes, but there was a difference for probability and frequency. For overall mass flux, particle-related properties were more dominant with the turbulent bed. As for segregation, the radial position was the most influential in the fast fluidized bed, but the least in the turbulent one.

We explored the effects, on photosynthesis in cowpea (Vigna unguiculata), of high temperature and light — environmental stresses that often co-occur under field conditions. We observed contrasting responses in the light and carbon assimilatory reactions, whereby in high temperature, the light reactions were stimulated while CO2 assimilation was substantially reduced. There were two striking observations. First, the primary quinone acceptor (QA), a measure of the regulatory balance of the light reactions, became more oxidized with increasing temperature, suggesting increased electron sink capacity, despite the reduced CO2 fixation. Second, a strong, O2-dependent inactivation of assimilation capacity, consistent with down-regulation of rubisco under these conditions, a phenomenon that has not been previously reported. The dependence of these effects on CO2, O2 and light led us to conclude that both photorespiration and an alternative electron acceptor, supported increased electron flow, and thus provided photoprotection, under these conditions. Further experiments showed that the increased electron flow was maintained by rapid rates of PSII repair, particularly at combined high light and temperature. Overall, the results suggest that photodamage to the light reactions can be avoided under high light and temperatures by increasing electron sink strength, even when assimilation is strongly suppressed.

This pilot study draws on Vainikka and Young-Scholten’s (1994, 1996) Minimal Trees Hypothesis and aims to explore how the grammar of a third language (Chinese) is understood by transferring syntactic knowledge from the learner’s first (Hungarian) and/or second language (English). Another aim of the research is to find out whether the selected methodology is suitable for gaining meaningful empirical data that can lend itself to theoretical analysis. First, I will provide a brief introduction to the most important theoretical questions on SLA research, followed by the description of some basic tenets of the Minimal Trees Hypothesis.

In this work, we propose a rate control algorithm (RCA) which regards characteristics of multiview video coding (MVC). The proposed RCA is designed for real-time applications of MVC and optimized to provide high quality compressed video bit streams with optimal utilization of channel bandwidth and buffering delay. The proposed RCA uses a fuzzy rate controller and a deterministic quality controller to define a quantization parameter (QP) for a Group of Pictures (GOP) based on given target rate, buffer, and quality constraints. The Key point in the proposed algorithm is to provide a variable bit rate multiview video bit stream with minimum fluctuations in QP and thereafter in quality while the buffer constraints are satisfied. The experimental results show that it can control the bitrate of all views according to the specified target bit rates for each view while the buffering constraints are completely obeyed and it provides compressed video bit streams with high visual quality.

Vascular rings(VRs) are defined as congenital abnormalities of the aortic arch and its branches. The most common vascular rings include right aortic arch (RAA) and double aortic arches(DAA). Vascular rings can form a ring that may compress the esophagus and trachea ,which likely result feeding difficulties and respiratory distress. We have reported three cases about diagnosis of vascular rings using High-definition flow(HD-flow) render mode and spatiotemporal image correlation(STIC). In addition ,we have evaluated the postnatal imaging features of vascular rings.

With no end in sight to the convergence of COVID-19, countries are struggling with strategies to halt the “second wave” and mitigate economic decline. Estimated to account for around half of the infections, asymptomatic transmission of SARS-CoV-2 has been hampering the containment of the virus. A positive case rate of 10% was reported by Prabhu et al. among 625 pregnant women who were universally screened for SARS-CoV-2 on the day of admission for delivery at 3 institutions in New York City, of which 80% were asymptomatic at the time of testing including pre- and post-symptomatic patients. As evidence shows that virus sheds before symptoms appear and even after their cessation, these populations may have increased the chances of COVID-19 outbreak in the hospitals. Utilization of testing results for isolation practices was not mentioned in the report, possibly given the long turnaround time for the testing platforms at the time.While the risk of nosocomial transmission is affected by clinical settings, the intimate and prolonged nature of childbirth elevates the risk of cross-infection between midwives and women. The role of nosocomial transmission has been increasingly recognized, and its severity risk may be greater than those of community-acquired infections. A recent report has suggested facilities to consider testing pregnant women for SARS-CoV-2 at the time of admission (Rasmussen SA, et al. JAMA. 2020). International Confederation of Midwives has also called for governments to prioritize testing for all pregnant women and their care providers. Identification of infectious women prior to delivery could contribute to prevention of further transmission to patients and healthcare workers. Importance should also be emphasized on evaluating contact history due to the nature of false-negative PCR results (Woloshin S, et al. NEJM. 2020).Another significance of performing testing for SARS-CoV-2 on pregnant women is for the adequate medical management of the women and the fetuses. While outcome for mothers and neonates seems generally favorable, data suggest that pregnancy can be associated with increased risk for severity, including intensive care unit admission and receipt of mechanical ventilation (Ellington S, et al., MMWR Morb Mortal Wkly Rep 2020;69:769–775). Furthermore, a recent article has raised concerns over transplacental transmission of SARS-CoV-2 to the fetus (Vivanti AJ, et al. Nat Commun. 2020;11:3572). Collection of longitudinal data is crucial to understand the effects of SARS-CoV-2 infection on maternal and neonatal outcomes. Results of large-scale prospective cohort studies, such as INTERCOVID study, are expected to add high-quality evidence on the effects of COVID-19 in pregnancy on the health of the mothers, fetuses, and newborns.Screening a maternity population under a pandemic can be a way to provide a glimpse of the distribution of the population, since capacity constraints still impede widespread testing in many countries. Recent development of faster diagnostic testing could bring improvement, but test sensitivity will remain a challenge. Fundamental preventive measures and clinical management should be continued; that is, hygiene and social distancing practices for women themselves, and careful evaluation of each mother and fetus for care providers.

Curriculum Ontario Grade 5 Understanding Structures and Mechanisms - Forces Acting on Structures and MechanismsLearning ObjectiveStudents will choose a famous structure to research, create and present to class Materials technology (iPads, Chromebook, laptop)informational textsBuilding Materials Students can bring in any materials from home but have some materials available for students pop sickle stickswooden dowels cardboard hot glue gunsnails/screws paint paint brushes clay pipe cleaners Lesson IntroductionDisplay different famous structures and discuss with  students what structures they know from around the world. - what makes these structures famous?- why/how did these structures become famous?Assignment In this assignment, students will choose a famous structure to research and present to the class. Students can decide whether to make a 3-D model of the structure, draw a picture of it, do a scrapbook, or make a power point presentation. Completed projects should have facts as well as images to assist in teaching and holding your classmates attention during the presentation. Information can be gathered through books, magazines, websites and even television/YouTube documentaries. Please include the following information: When was the structure built? How long did construction take? Who deigned and constructed it? What kinds of equipment or special methods were used? What materials were used and why? Were they any problems during construction? What were they? Why was the structure built? Where is it located? Extra fun facts!There are many famous structures that can be found all over the world. Structures can include bridges, towers, statues, skyscrapers, domes, lighthouses, temples, castles and even roller coasters. Feel free to choose from the list below, or find a structure of your own;Great Wall of China                 Statue of Liberty The Taj Mahal                             Ambassador Bridge CN Tower                                     The White House Empire State Building             The Colosseum Leaning Tower of Pisa             Sydney Opera HouseLesson pt 2 Allow students time to research different structures and check their success criteria to meet requirements. Meet with students to check in on their research and progress. Give students a couple days to research and then construct their famous structure. While researching students may want to build a presentation in Google Slides or Power Point, students can also create a display board for presenting their findings to the class. After students have constructed their famous structure, additional time may be needed to complete and practice their presentation. 

Background: Cardiovascular impairment is an important complication of end-stage renal disease (ESRD) undergoing hemodialysis (HD) therapy. Left atrial (LA) deformation is closely related to left ventricular (LV) filling pressure and dysfunction, but quantification of LA dysfunction remains a challenge. The purpose of this study was to evaluate the LA function in ESRD patients using four-dimensional(4D) auto left atrial quantification(4D-LAQ). Methods: Thirty-seven ESRD patients (aged 51.68±15.98 years; 43% male) on HD and 34 healthy individuals (aged 42.03±11.50 years; 38% male) were enrolled in the study. All participants underwent conventional echocardiographic examinations and 4D-LAQ. The measurements of LA dimension, volume, emptying fraction, and longitudinal/circumferential strain parameters during triphasic were obtained from the LV long axis and apical 4-chamber views, which were taken offline using software (GE EchoPac 203). Results: In patients with ESRD, LA dimension and volume were higher than the healthy group, while the LASr (22.54±6.14 vs 33.74±5.07; p<0.05), LAScd (-12.54±5.83 vs -20.03±5.21;p<0.05), LASct (-10.00±4.93 vs -13.56±5.17;p<0.05 ), LASr-c (28.00±6.61 vs 35.29±7.24;p<0.05), and LAScd-c (-13.27±5.58 vs -18.47±8.65; p<0.05) were significantly lower. Furthermore, a good positive correlation was observed between the LAEF, LASr, and LAScd-c values and LV filling pressure, which reflect diastolic dysfunction. Conclusion: We demonstrated that the LA strain in dialysis patients was impaired before the occurrence of LA dilation. LA strain is more sensitive than traditional echocardiographic parameters, and LASr and LAScd-c may be useful to detect early myocardial involvement.