Bimrocks feature stiff blocks randomly distributed in a soft matrix. Despite their wide distribution in nature, their significant effects on the failure of rock structures such as slopes, mines and tunnels have not been fully understood. Bimrocks behave differently as compared with other rock types since they contain mix of blocks of different strength, size and volume distribution and a matrix of different physical and mechanical characteristics. The purpose of this study is to investigate deformation behaviour and crack development trends of bimrocks containing blocks of different sizes (small <1 mm, medium 2-4 mm, and large 5-8 mm). The Brazilian disc test is performed with the digital image correlation (DIC) technique being employed for deformation analysis. It is found that the size of blocks significantly influences the deformation and failure behaviour of a bimrock. Bimrocks with large blocks exhibit both tensile cracks parallel to the loading direction and shear cracks inclined towards the loading direction. Moreover, the development of fracture process zone (FPZ) is highly dependent upon block size. In particular, bimrocks with large blocks exhibit obvious development of FPZ, while no FPZ is observed for those with small blocks. In fact, the specimens with small blocks cannot be called a bimrock since they behave similar to a homogenous intact disc specimen in which a crack splits the disc into two halves in a typical Brazilian test.

Background The diagnostic delay in children and adolescents with cancer is a public health problem in Peru leading to high rates of advanced disease and mortality. We aimed to evaluate the implementation and utility of ONCOpeds, a mobile application that provides consultations, in reducing the latency to diagnosis (LD) and referral time (RT) in children and adolescents diagnosed with cancer in Peru. Material and methods A multicenter pilot study was conducted in the region of Callao between November 2017 and April 2018. Attending primary care physicians were trained in the use of ONCOpeds in 5 educational sessions. Patients younger than 18 years living in Callao and diagnosed with cancer from all the pediatric cancer units were analyzed in two groups: referred by the mobile application or by the conventional referral. Results ONCOpeds was successfully installed in the smartphone devices of 78 attending physicians of Callao. During this period, 23 new cases of cancer in children and adolescents from Callao were collected. Ten patients were referred through the application and 13 in a conventional manner. The LD and RT were reduced in the group referred by ONCOpeds by 66% and 68%, respectively; however, only the RT reached statistical significance (p = 0.02). Conclusions The implementation of the use of ONCOpeds was feasible in this pilot study, having a potential utility in improving the diagnosis and referral in children and adolescents with suspected cancer. A larger study at the national level is required to demonstrate the effectiveness of this telemedicine tool.

The objective of this work was to approach a freehand restorative technique for class IV in composite resin. The procedure was performed on a mannequin containing elements 12, 11,21 and 22, the technique was performed on element 21, the same was provided with the ready preparation, vestibular bevel, drill used with 1190 tapered diamond tip, the resins of choice were CT, dentin A3, body A3, WB and enamel A2 all from Z350 - 3M, as each contains different chromas. Today for restorations on teeth older than 3M it is the best option on the market, with the patent for nanoparticulate resins. The professional must learn the rules of aesthetics of natural teeth for the use of these materials. Treating that natural teeth are polychromatic, while composite resins are monochromatic. Given the existence of a wide variety of resins and technical possibilities, the following text proposes a clinical sequence of reconstruction of anterior teeth with compromised incisal angle due to fracture or caries. Restorative rehabilitation, in addition to promoting health, provides a favorable aesthetic appearance for the smile of the patient, thus raising the patient's self-esteem. The introduction of the acid conditioning technique and the development of adhesive systems associated with improvements in the mechanical properties of composite resins have provided new perspectives for aesthetic dentistry. Keywords: Restoration. Composite resin. Anterior teeth. Class IV anterior teeth. Direct restorative technique. 

soil types differentiated the response of their properties to environmental disturbance. Despite the impact of hydrological stresses on soil properties being widely reported in riparian zones, little is known about how the effect of hydrological stresses on soil carbon dynamics varies among soil types. Here we have studied the effect of hydrological stresses and soil types on organic carbon fraction, carbon concentration in bulk soils and aggregate fractions, total carbon content, pH, bulk density and soil mechanical compositions. The results showed that hydrological stresses induced by around 10 years' of operation of the Three Gorges Reservoir not only had a direct impact on carbon contents and carbon fractions, but also had an indirect impact on carbon contents via modifying edaphic factors including soil aggregates and carbon fractions in the riparian zone. Soil types were differentiated in the response of their physical properties to the weak and non- hydrological stresses. However, the original differences of soil physical properties among three main soil types were homogenized by the strong hydrological stress, which can be indicated by a small macro-aggregate proportion and fine particulate organic carbon concentration. Additionally, more than 3.95 Tg of carbon was stored in the topsoil of the whole riparian zone of the Three Gorges Reservoir, and the lowest stability but highest carbon storage was in Regosols. Much attention should be given to this. Further studies are recommended to focus on carbon saturation in different soil types under different hydrological stresses.

       Johann Sebastian Bach, 21 Mart 1685 doğumlu Alman barok müzik bestecisi ve orgcudur. Bach 19. yüzyılda müziğinin tekrar çalınmaya başlaması ve ilginin tekrar canlanmasına kadar kendi döneminde büyük bir besteci olarak bilinmemiş ancak bugün en büyük bestecilerden biri olarak kabul edilir.Bilginler ve müzisyenler yıllarca matematiği kullanarak müzikleri analiz ettiler, hatta yarattılar. Birçok iyi besteci müziğin altında yatan matematik ilkelerinin derin anlamını kavrayabildi. Bunlardan bir tanesi ise görkemli Johann Sebastian Bach’tır. Bach’ın besteleri dahiliğinin bir parçası olsa da aslında onların temelinde de basit matematik vardır.Matematikçiler çalışmalarının estetiksel yönünü vurgulamaktan çekinmezler. Hem matematik hem müzik ikisine de desenler hakimdir. Matematikçinin kalıpları, bestecinin kalıpları gibi güzel olmalı; fikirler uyumlu bir şekilde bir araya gelmelidir. G.H. Hardy’nin dediği gibi, ”Güzellik ilk testtir: dünyada çirkin matematik için kalıcı bir yer yoktur.”Simetri    Simetri aslında müziğin temel yönüdür bu nedenle ,simetri için matematiksel çerçeve olan, grup teorisinin müzikal analize uygulanması şaşırtıcı değildir. Transpozisyon, inversiyon ve retrogression müzikal teknikleri grup işlemleri olarak yorumlanabilir ve bu bakış açısı eski kompozisyonlar üzerine yeni bir ışık tutmuştur. Birçok besteci geometrik dönüşümleri bir kompozisyon cihazı olarak kullanmıştır. Dönüşümler ve simetriler, bestecilerin kreasyonlarını zenginleştirmeleri için bir dizi araç olarak düşünülebilir. Böylece, seçilen bir tema, varyasyonlar üretmek için zaman içinde aktarılabilir, tersine çevrilebilir veya yansıtılabilir.(Lynch, 2017)Bir besteci karşı noktaya odaklandığında, vurgu, müziğin dikey eksenine (Akorlar ve uyum) değil, yatay eksene (melodi telleri) yerleştirilir böylece çalışmanın amacı, aynı anda gerçekleşen çeşitli müzikal çizgiler arasındaki etkileşim haline gelir.Kanon*larla yaratıcı olmanın her türlü yolu vardır. Cevap, konunun kesinlikle birebir bir kopyası olmak yerine, aslında geriye doğru, baş aşağı, çift hızda ya da yarım hızda ya da bunlardan herhangi birinin bir kombinasyonu olabilir. Kuralları katıdır, ancak birkaç önemli seçenek sayesinde mevcut olasılıklar sonsuzdur.Asıl zorluk, bu tür müziğin iyi bir ses çıkarmasıdır: sadece öngörülen kuralları takip etmek, sonucun hoş veya ilginç olacağına dair bir garanti değildir, bu nedenle hem uygun malzeme bulmak hem de hangi kuralların en iyi şekilde uygulanacağını belirlemek için büyük bir estetik arıtma gereklidir. Bu da Bach’ın mükemmel olduğu kısımdır.Bach (1685-1750) hiçbir şekilde bu tarz bir kompozisyonun mucidi değildi. Buxtehude ve Schütz gibi 17.yüzyıl Kuzey Alman öncüllerinden miras aldı ama kanonun kabul edilen büyük ustasıydı (hala öyle) ve çalışmaları Batı müziğindeki zirvesini temsil ediyor. Onun özel dehası sadece karşı notayı ustalıkla ele alma meselesi değil, aynı zamanda büyük bir aralık ve duygu derinliğini ifade etme ve bu matematik-y tekniklerini sarsılmaz bir disiplinle kullanarak dengeli, güzel orantılı kompozisyonlar üretme yeteneğiydi.(Lindsay, 2017)Kanon*, taklit karşı noktanın temel tekniğidir. Kanon'da bir melodi kurulur(konu) ve devam ettiği gibi, aynı melodinin ikinci bir girişi gerçekleşir(cevap) ve iterasyonla etkileşime girerek melodinin kendisini  "taklit" veya "kovaladığı" izlenimini verir.Goldberg Varyasyonları    Genel bir arka plan olarak, Goldberg varyasyonları 2 arya ve 30 varyasyondan oluşan klavsen için yazılmış bir eserdi. Bach, Lutheran olan son derece dindar bir adamdı ve bu parçada kullandığı iki kavram birlik ve üçlü fikirlerdi. Genel gözlemler, her biri 32 çubuklu 3, 9, 21 ve 30 varyasyonları ve 95 barlı varyasyon 16 hariç olmak üzere, varyasyonların hepsinin 64 bara sahip olduğunu içerir.

Rationale, aims and objectives: Joint contractures are common complications among elderly residents in long-term care facilities, causing activity limitations and participation restrictions and affecting quality of life (QOL). The aim of this study is to examine the psychometric properties of the Chinese version of the PaArticular Scales in joint contractures population. Methods: A cross-sectional study design. A sample of elderly residents aged over 64 years with joint contractures in one important joint who have lived at a facility for more than 6 months in twelve long-term care facilities in Taiwan (n = 243). The Chinese version of the PaArticular Scales of joint contractures was generated through 5 stages: translation, review, back-translation, a panel of specialists, and a pretest. Test-retest reliability, internal consistency reliability, construct validity, and criterion validity were evaluated, and the results were compared with those for the WHOQOL-BREF and WHODAS 2.0-36 items. Criterion validity was assessed using correlation coefficients to examine changes in the activity limitations and participation restrictions subdomain and predict QOL. Results: The Activities and Participation subscales had excellent internal consistency (Cronbach’s α coefficient = .975; SD = 17.34). The correlation coefficients between the PaArticular Scales and the WHODAS 2.0-36 items (r = .770, p < .001) and WHOQOL-BREF were significant and highly correlated (r = -.553, p < .001). Conclusions: The underlying theoretical model of the Chinese version of the PaArticular Scales functions well in Taiwan, and the Chinese version has acceptable levels of reliability and validity.

Background: Adherence to psychotropic medication is still a concern to health care systems, mental healthcare professionals, researchers, and patients, as well. Recent literature on medication adherence increased focusing on the pervasiveness and significant impacts of adherence to medications. Purpose: The purpose of this scoping review is to identify the prevalence, contributing factors, methods of measurement, and interventions related to medication adherence among patients diagnosed with Major Depressive Disorders (MDD). Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guideline was used. The scoping review involves the review, analysis, and synthesis of a broad scope of literature. Results: A total of 36 articles met the inclusion criteria for this scoping review. The prevalence of medication adherence among patients diagnosed with MDD ranged from 10.6% to 85.4%. About 67% of studies used self-reports as methods of data collection. Illness-related factors (e.g., the onset of the illness, duration of illness, symptoms, and illness severity), medication-related factors (e.g., adverse reactions, duration of treatment, cost of treatment), and patient-related factors (e.g., beliefs, attitudes, knowledge, self-stigma) were the most reported factors to associate with medications adherence. Also, the multi-faceted intervention has been recommended over a single-element intervention to enhance medication adherence. Conclusion: There is a need to select and integrate good assessment measures of medication adherence, which lead to providing better evidence on the outcomes, risk factors, and interventions to improve medication adherence.

Objective: To differentiate between normal and pathological vaginal discharge (PVD) in pregnant women and to identify causes of and adverse pregnancy outcomes associated with PVD. Design: A cross-sectional study. Setting: Outpatient antenatal clinics. Population / Sample: Pregnant women, Convenience sample (N=85). Methods: Data were collected through history, clinical examination and laboratory investigations. Data analysed by frequencies, descriptive statistics and Chi-Squared tests. Main outcome measures: Vaginal discharge (VD), age, gestation, parity and adverse pregnancy outcomes. Results: Women’s mean age was 27.4 (±4.67) years. Majority of women were 26-31 years old (40%), 28-35 weeks pregnant (34%) and primigravida (41%). Of 89% (n=76) women with VD, 32% (n=24) had normal VD and 68% (n=52) PVD. Normal VD was watery (100%) and odourless (96%) while PVD was yellowish curd like (33%) and foul smelling (52%). PVD was significantly associated with bacterial vaginosis (P < 0.0001), candidiasis (P = 0.005) and trichomoniasis (P = 0.018). A higher proportion of women with PVD reported irritation (P < 0.0001), pain (P < 0.0001), uterine contractions (P < 0.0001), premature membrane rupture (P < 0.0001), abortion (P < 0.042), pre-term delivery (P < 0.0001) and post-partum endometritis (P < 0.0001). PVD was also associated with low birth weight (P < 0.0001), low Apgar score at birth (P < 0.0001), respiratory distress syndrome (P < 0.0001), intensive neonatal care hospitalisation (P = 0.001) and early neonatal death (P = 0.002). Conclusions: Vaginal discharge in pregnancy requires early investigation to avoid any adverse fetomaternal outcomes associated with pathological vaginal discharge.

Objectives: To compare the efficacy of different non-invasive respiratory support modes for primary respiratory support of preterm infants with Respiratory Distress Syndrome (RDS). Design: Systematic review and network meta-analysis using the Bayesian random effects approach. MEDLINE, EMBASE and CENTRAL were searched. Interventions : HFNC (High Flow Nasal Cannula), CPAP (Continuous Positive Airway Pressure), BiPAP (Bilevel CPAP), NIPPV (Non Invasive Positive Pressure Ventilation). Main outcome measures: Requirement of invasive mechanical ventilation, any treatment failure. Results: 34 studies including 3994 patients were included. NIPPV was more effective in decreasing the requirement of mechanical ventilation than CPAP {RR [95% Credible Interval (CrI)] - 0.60 (0.44, 0.79)}and HFNC [0.66 (0.43, 0.99)]. Surface under the cumulative ranking curve (SUCRA) for NIPPV, BiPAP, HFNC and CPAP were 0.94, 0.59, 0.32 and 0.13. For the outcome of treatment failure, both NIPPV and BiPAP were more efficacious compared to CPAP and HFNC {0.56 (0.44, 0.71) [NIPPV vs CPAP], 0.69 (0.51, 0.93) [BiPAP vs CPAP], 0.42 (0.30, 0.63) [NIPPV vs HFNC], 0.53 (0.35, 0.81) [BiPAP vs HFNC]}. The SUCRA for NIPPV, BiPAP, CPAP and HFNC were 0.96, 0.70, 0.32 and 0.01. NIPPV was associated with a reduced risk of air leak compared to BiPAP and CPAP [0.36 (0.16, 0.73); 0.54(0.30, 0.87), respectively]. NIPPV resulted in lesser incidence of BPD or mortality when compared to CPAP [0.74 (0.52, 0.98)]. Nasal injury was lesser with HFNC compared to CPAP [0.15 (0.01, 0.60)]. Conclusions: Most effective primary mode of non-invasive respiratory support in preterm neonates with RDS was NIPPV.

“Minyak Ala Muncar” or abbreviated as MAM is a by-product waste of fish canning factory in Muncar Banyuwangi Indonesia. MAM was widely distributed throughout Indonesia to be used as animal feed supplements. MAM was very potential to be converted into oil rich in n-3 through the recycling process. The recycling process needs to be conducted because MAM contained trans-FA especially EA which could have a detrimental impact on health. Therefore, the aim of this research was to produce an oil fraction that rich in n-3 and low in trans-FA content. Three crystallization methods namely crystallization with n-hexane solvent, acetone solvent, and urea were chosen as the recycling method. The MAM Recycling research was carried out through several stages, namely oil hydrolysis, winterization with solvents (acetone, n-hexane), urea crystallization, fractions esterification, Fatty Acid content analysis. The results showed that both crystallization with n-hexane and acetone produced ratio value of PUFA/trans-FA, n-3/trans-FA, EPA/EA, and DHA/EA below 0.3 respectively. While urea crystallization was able to produce ratio numbers for each PUFA/trans-FA, n-3/trans-FA, EPA/EA, and DHA/EA PUFA/trans-FA 1.46±0.05, 1.36±0.04, 0.73±0.021, 0.48±0.035.

High voltage atmospheric cold plasma (HVACP) treatment generates reactive gas species that induce inter and intramolecular reactions in soybean oil. The goal of this study is to analyze the effect of HVACP treatment on the chemical structure of soybean oil in a hydrogen gas environment at atmospheric pressure. HVACP was used to treat soybean oil (15g), for up to 6h by triplicate. Plasma generated reactive gas species interact with the sample producing three distinct fractions identified as a liquid, gel, and solid. Fatty acid profile, FTIR, 1H-NMR/13C-NMR, GPC, thermal properties and peroxide value, were used to characterize the chemical structure. Results indicated a lower content of polyunsaturated fatty acids, increased content of saturated fatty acids, and the presence of isomers. An insoluble portion was observed in the solid fraction and increase with treatment time up to 42% in the 6h treated samples. Plasma species may cause two main reactions: polymerization and hydrogenation.

A document by Mohamed Gamal. Click on the document to view its contents.

Trans fatty acids (TFA) have been shown to be associated with various health disorders. The major source of dietary TFA is high-temperature deodorization of vegetable oils. In this study, precision minimal deodorization was proposed to obtain healthier zero-TFA vegetable oils. Dual columns with dual temperatures (DCDT) deodorizer was designed, transformed and industrially implemented among dozens of plants. Also the deodorization temperatures were optimized and customized respectively for four kinds of vegetable oil (soybean oil and rapeseed oil: tray column 205°C and packed column 225°C, maize oil and sunflower seed oil: tray column 210°C and packed column 230°C). Four kinds of oils can all achieve zero-TFA by DCDT deodorization at the customized temperatures, and meanwhile oil qualities and shelf life stabilities were compared with corresponding conventional refining oils. The initial FFA and color were a little higher than conventional refining oils, however, they showed no significant differences in odors and shelf life stability, which indicated a good and stable oil quality of zero-TFA oils for future industrial productions and sales.

As only few studies have analyzed viral kinetics between the incubation and symptomatic periods of COVID-19 patients, we investigated the viral kinetics and compared viral loads between patients with mild and severe COVID-19. We determined the viral kinetics of 10 patients diagnosed with COVID-19 at Chosun University Hospital. Six patients were classified into the “mild” group and 4 into the “severe” group according to supplemental oxygen use during admission. Samples were collected via nasopharyngeal swabs and sputum specimens. SARS-CoV-2 was detected using real-time reverse transcription-polymerase chain reaction (RT-PCR). Chest radiograph scores during hospitalization were obtained. Ct values of the upper respiratory tract specimens were low during the early stages after symptom onset but gradually increased over time in both groups. The severe group had lower Ct values than the mild group. The Ct values of the RdRP and E genes on day 6 after symptom onset were significantly lower in the severe group than in the mild group (p < 0.05). Three of 6 patients had positive results on RT-PCR even before symptom onset; 2 of them had the lowest Ct values. The chest radiograph scores were higher in the severe group than in the mild group, and the score in the severe group was the highest at approximately 3 weeks after symptom onset. Viral load and chest radiograph scores were significantly different between the severe and mild groups of COVID-19 patients.

HPAI is endemic across parts of Indonesia, but the mechanisms of viral persistence in the poultry production system have not been well investigated. This mixed methods research conducted in Purbalingga District, Java characterised poultry populations and trade and contact networks and performed risk-based sampling for the active detection of HPAI virus in live bird markets, collector yards, backyard poultry, nomadic ducks and commercial farms. Approximately 60% of households kept birds, about half of which contributed towards household income. Traders tended to use multiple collector yards and live bird markets, and poultry might be presented at multiple markets before sale. Only the commercial farm sector implemented biosecurity practices and vaccination. Samples were screened for avian influenza virus (AIV) and positive samples were tested for the H5 and H9 sub-types. H5 virus was detected in all enterprise types, although there were few positive results in commercial farms, the backyard sector and nomadic duck flocks. The highest numbers of AIV, H5 and H9 viruses were found in the live bird markets and collector yards. The odds of detection of H5 in live bird markets and collector yards were similar; however, these were 3½ to 4 times higher than in backyard birds and nomadic ducks and 25 to 30 times higher than in commercial poultry. This suggests that transmission of infection in backyard poultry and duck production was likely to be driven more strongly by the value chain than by direct or indirect contacts at source. We could not determine whether the value chain concentrates or amplifies virus along its length, or whether AIV persists and actively circulates in live bird markets and collector yards. H5 and H9 viruses were detected year-round and were co-circulating in the different enterprise types, although no inference can be drawn regarding interactions between these HPAI and LPAI viruses.

Background Currently, the coronavirus disease 2019 (COVID-19) has become pandemic globally. 10-20% of the cases are severe and more than 397,000 deaths have occurred. The risk factors for the mortality of critically ill COVID-19 patients remain to be elucidated. Conclusions Survived severe and non-survived COVID-19 patients had distinct clinical and laboratory characteristics, which were separated by principle component analysis. Logistic regression revealed several risk factors such as elder age, greater affected lobe numbers and higher level of serum CRP for the mortality of severe COVID-19 patients. Longitudinal changes of laboratory findings indicate the advancement of the disease and may be helpful in predicting the progression of severe patients.

Asthma control, self-management and healthcare access during the COVID-19 Epidemic in BeijingChun Chang a* M.D., Linlin Zhanga*B.S., Fawu Dong a* B.S., Ying Liang a M.D., Yahong Chen a M.D., Ying Shang a B.S., Mairipaiti Abulikemua B.S., Yongchang Suna# M.D.aDepartment of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.#, Corresponding to Yongchang Sun:Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.North Garden Rd. 49.Haidian District, Beijing, 100191, ChinaTel: +86 010 139 1097 9132Fax +86 108 226 6989E-mail: suny@bjmu.edu.cn* Chun Chang, Linlin Zhang and Fawu Dong contributed equally to this work;To the Editor:The pandemic of COVID-19, caused by the pathogen SARS-CoV-2, has now spread around the globe. Social distancing and restriction measures during COVID-19 pandemic may have impacts on asthma control and management in terms of medication availability and healthcare access. International societies responded quickly by releasing guidance on the management of asthma during the COVID-19 pandemic1-4. However, these temporary guidelines were based largely on previous asthma guidelines and expert consensus, because evidence from related studies was lacking. Therefore, we investigated the status of asthma control, self-management, medications and healthcare utilization of asthma patients during the COVID-19 epidemic in Beijing, aiming to provide data for guideline recommendations on asthma managements during the emergency.Patients with asthma, selected randomly from our hospital database, were interviewed by phone call. Detailed description of items in the questionnaire is available in this article’s online supplementary material.We contacted 286 patients, of whom 178 (62.2%) responded with valid results. Sociodemographic data and clinical characteristics of the patients before the COVID-19 pandemic are provided as online supplements. During the COVID-19 epidemic in Beijing (January 25, 2020 to April 25, 2020), the majority (74.2%, 132/178) of the patients felt that their symptoms had not changed as compared with usual times, while 18.0% (32/178) felt better, and 7.9% (14/178) felt worse. The mean ACT score of the 178 patients was 22.76 ± 3.06 (ranging from 8 to 25) in the last 4 weeks before the survey. According to the criteria of ACT scoring from GINA, asthma was classified as well-controlled in 89.3%, not well-controlled in 6.2%, and very poorly controlled in 4.5% of the patients. During this period, only 24.7% (44/178) of the patients had ever visited a hospital or clinic for asthma, of whom 11 patients had 2 visits, and 6 had ≥3 visits, totaling 74 visits. 14.9% (11/74) of all medical visits were due to exacerbation of asthma, while the remaining visits (63/74, 85.1%) were for regular prescription of asthma medications. Only 6 patients (3.4%) sought consultation online. (Table 1)Notably, 25.6% (45/176) of the patients experienced aggravation of asthma symptoms during the COVID-19 epidemic, but 75.6% (34/45) of them did not see a doctor, because 67.6% (23/34) of the patients thought that they did not need to go to the hospital and took more medications by themselves, and the remaining 32.4% (11/34) worried about cross-infection of COVID-19 in the hospital. No patient said that they did not see a doctor because they could not arrange an appointment. Eleven patients went to the hospital due to aggravation, 81.8% (9/11) to the outpatient, while only 18.2% (2/11) to the Emergency Department (ED).Table 1 Asthma control and management during the COVID-19 epidemic in Beijing

Atopic diseases have increased in prevalence over the last few decades and the rapid increases suggest that the predominant driving forces behind these increases are environmental factors rather than genetic alterations. A number of environmental factors have been implicated in the increased prevalence of allergic diseases. Predominant among them are increased exposure to pollutants and decreased exposure to microbes and parasitic infections. The hygiene hypothesis suggests that increased hygiene and lack of exposure to microbes and parasitic infections at an early age prevents the necessary stimulus to train the developing immune system to develop tolerogenic responses. Lifestyle factors, such as increased time spent indoors, use of antibiotics, and consumption of processed foods and decreased exposure to farm animals and pets, limit exposure to environmental allergens, infectious parasitic worms, and microbes. The lack of exposure to these factors is thought to prevent proper education and training of the immune system. Other factors that are also associated with increased risk of allergic diseases are Caesarian birth, birth order, tobacco smoke exposure and psychosomatic factors. Here, we review current knowledge on the environmental factors that have been shown to affect the development of allergic diseases and the recent developments in the field.

Shiga toxin-producing Escherichia coli (STEC) is an important foodborne pathogen capable of causing severe gastrointestinal diseases in humans. Cattle and sheep are the natural reservoir hosts of STEC strains. Previously, we isolated 56 STEC strains from anal and carcass swab samples of cattle and sheep in farms and slaughterhouses. In this study, we performed whole-genome sequencing of these isolates and determined their serotypes, virulence profiles, sequence types (STs), and genetic relationships. Our results showed that the 56 isolates belong to 20 different STs, 29 O:H serotypes, and 8 stx subtype combinations. The highly prevalent serotypes were O8:H25 and O87:H16 for bovine and ovine isolates, respectively. Five serotypes of cattle or sheep isolates are novel. The majority (63%) of cattle isolates contain stx1+stx2, subtyped into stx1a, stx2a, and stx2c. In contrast, most of the sheep isolates contain stx1 only, primarily subtyped into stx1a and stx1c. None of the isolates tested eae-positive, but virulence factors such as ehxA and espP were present with variable prevalence rates. The prevalence of saa (19.6%) and espP (12.5%) in cattle isolates is much higher than that in sheep isolates, whereas that of subA (34%), katP (14.3%), and ireA (28.6%) in sheep isolates is considerably higher than that in cattle isolates. Core-genome SNP analysis revealed that the majority of isolates could be clustered based on their serotypes or STs, whereas some clustering is associated with more than one ST or serotype. Seven-gene Multilocus Sequence Typing (MLST) indicated that nine sheep isolates and four cattle isolates were related to a few E. coli isolates associated with human HUS, suggesting their potential in causing severe human infections. Collectively, we described the characteristics of cattle and sheep STEC isolates from Xinjiang, China, which may be utilized in comparative studies of other geographic regions and sources of isolation and for surveillance.

Infection with the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) induces the coronavirus infectious disease 19 (COVID-19). Its pandemic form in human population and its probable animal origin, along with recent case reports in pets, make drivers of emergence crucial in carnivore domestic pets, especially cats, dogs and ferrets. Few data are available in these species; we first listed forty-six possible drivers of emergence of COVID-19 in pets, regrouped in eight domains (i.e. pathogen/disease characteristics, spatial-temporal distance of outbreaks, ability to monitor, disease treatment and control, characteristics of pets, changes in climate conditions, wildlife interface, human activity, and economic and trade activities). Secondly, we developed a scoring system per driver, then elicited experts (N = 33) to: (i) allocate a score to each driver, (ii) weight the drivers scores within each domain and (iii) weight the different domains between them. Thirdly, an overall weighted score per driver was calculated; drivers were ranked in decreasing order. Fourthly, a regression tree analysis was used to group drivers with comparable likelihood to play a role in the emergence of COVID-19 in pets. Finally, the robustness of the expert elicitation was verified. Five drivers were ranked with the highest probability to play a key role in the emergence of COVID-19 in pets: availability and quality of diagnostic tools, human density close to pets, ability of preventive/control measures to avoid the disease introduction or spread in a country (except treatment, vaccination and reservoir(s) control), current species specificity of the disease causing agent and current knowledge on the pathogen. As scientific knowledge on the topic is scarce and still uncertain, expert elicitation of knowledge, in addition with clustering and sensitivity analyses, is of prime importance to prioritize future studies, starting from the top five drivers. The present methodology is applicable to other emerging pet diseases.

Humans can be replaced by artificial intelligence-based approaches in many applications to reduce the probability of human errors. These approaches can also help us predict some events by analyzing data that seems to be unimportant. The overwhelming crash of flight 752 of Ukrainian International Airlines by the Iranian air defense systems in the early days of 2020 has prompted us more to explain the need to use artificial intelligence to prevent such events. This study attempts to calculate the likelihood of airline hazards based on artificial intelligence to warn decision-makers of the occurrence of potential accidents before flights. As a case study, we investigate the proposed method on flight 752 to explain its usefulness in great details. This study was designed to gain further insights into the use of artificial intelligence in risk estimation and can be criticized or modified.

Biological invasions are among the most serious threats to native forest ecosystems worldwide due to ever-increasing global trade and climate change. Understanding invasion processes and the ecology of invasive pests in both newly invaded and native habitats is necessary to effectively mitigate and manage the risks they pose. The effects of exotic ash tree species planted from 1900 to 2019 on distribution, occurrence, and outbreak frequency of a native pest emerald ash borer, Agrilus planipennis Fairmaire, were examined. The frequency and level of pest infestations gradually increased following introduction and widespread plantings of non-native host trees, and the first recorded outbreak occurred after a time lag of 30-50 years. Increased pest populations enhanced its invasion risk to other regions including the native ranges of introduced plants.

Aims: Imipenem is a widely used antibiotic for the treatment of critically ill patients with severe infections. Here, we present a translational pharmacokinetic/pharmacodynamic mathematical model to assess fT>MIC and evaluate the clinical outcomes of imipenem treatment in critically ill patients. Methods: Critically ill patients with severe infections were included in our study. Blood samples at different time points were collected after imipenem plasma concentration reached a steady state in vivo. A one-compartment model was used for pharmacokinetic profiles. PK/PD parameters were calculated separately with or without a mathematical model. Clinical results were mainly defined as the microbiological results. The resolution of fever and the decrease in PCT and WBC levels were also considered. Results: A total of 54 patients were enrolled in our study. The fT>MIC calculated by the mathematical model was 67.26±39.96%, and the fT>MIC was 73.75±23.11% without the model. The PK/PD parameters calculated between the two groups were not significantly different. Regarding clinical outcomes, 35 (64.3%) patients were defined as having clinical success. The fT>MIC was 83.33±12.90% in the clinical success group and 59.42±19.11% in the clinical failure group. The fT>MIC was significantly different between the two groups (p=0.022). Based on the regimens, the PCT level decreased to at least 20% of the peak level and the WBC level decreased during the first 3 days when patients’ fT>MIC was greater than 70%. Conclusion: The pharmacokinetic mathematical model may be used for PK/PD parameter evaluation. To treat critically ill patients, achieving fT>MIC greater than 70% may be necessary.

Evolocumab and alirocumab have been approved based on a randomised trial. We analysed the outcomes reported in the two trials to develop an original framework of comparative assessment that uses the restricted mean survival time (RMST). The objective was to show that, in the context of a narrative review, the RMST can be an efficient though simple tool to make indirect comparisons. For each cohort of patients (13,784 patients given evolocumab, 9,462 given alirocumab, 23,242 controls; results expressed in months of event-free survival), we determined the values of RMST with 95% confidence intervals [CI] (evolocumab: 33.48, 95%CI: 33.45 to 33.50; alirocumab: 33.89, 95%CI: 36.86 to 33.92). These results, along with those of the control groups, were analysed and interpreted narratively. A univariate statistics was conducted; no network meta-analysis was done. The experience presented herein indicates that a framework of evidence assessment focused on RMST is a worthwhile option.