ABSTRACT Introduction:We describe a case of chorea induced by phenytoin in an young indian male. Case presentation: A twenty one year old indian male patient who is a known case of generalized epilepsy for past 2 years on sodium valproate presented with acute onset chorea, four days after starting phenytoin sodium with normal serum phenytoin levels. After excluding the other possible causes of chorea, phenytoin was withdrawn which resulted in a dramatic subsidence of chorea .On rechallenge with phenytoin patient again developed chorieform movements which again subsided after drug withdrawl, thus implicating phenytoin as the possible etiological agent for chorea Conclusion:Phenytoin rarely induces involuntary movements as adverse effect.During phenytoin therapy,if a patient develops involuntary movements,phenytoin toxicity should be suspected. Drug withdrawl leads to complete symptomatic improvement thereby avoiding extensive workup for other secondary causes. Key words: phenytoin induced chorea, drug induced movement disorders, antiepileptics induced dyskinesias, phenytoin and involuntary movements, anticonvulsants and dyskinesias , phenytoin toxicity

BACKGROUND: Within a finite resource-limited national health service, a significant proportion of the cost of bariatric surgery is dependent on the length of stay of inpatients. This study was designed to investigate the factors that influence the length of post-operative stay in these patients. In particular, the effect of four common factors were explored in two bariatric procedures. METHODS: This is a retrospective study examining the length of stay in patients who underwent a laparoscopic sleeve gastrectomy (SG) and a laparoscopic Roux-En-Y gastric bypass (RNY) between July 2015 and February 2018 by a single surgeon. The significance of four factors were assessed: BMI, ASA grade, a diagnosis of diabetes and the day of the week the operation occurred. RESULTS: Median length of stay for SG patients was 2 [2,3] days. This was unaffected by our factors examined. Median length of stay for RNY was 2 [2,3] days. This was unaffected by ASA grade or a pre-existing diagnosis of diabetes. Day of the week and BMI significantly affected length of stay for RNY patients. Patients operated on a Friday stayed on average one day longer (p=0.002). Patients with a BMI over 60 stayed on average 2 days more (p=0.008) CONCLUSION: To optimise costs in the health service, more attention should be placed on when RNY and SG procedures are performed during the week. This is especially relevant when dealing with patients with high BMIs.

3-year-old healthy female child with new onset of sleep disordered breathing consistent with extensive pattern of periodic breathing diagnosed by polysomnogram study. As periodic breathing is indicative of immaturity of respiratory control and the possibility of hindbrain malformation or other significant pathology, subsequent MRI was obtained and showed Chiari Type 1 Malformation. Scoring of periodic breathing pattern beyond infancy in the sleep centers using the American Academy of sleep medicine scoring manual guidelines is of great importance and may warrant further evaluation with MRI for neurological etiologies including Chiari Type 1 malformation.

Coronaviruses (CoV) were reported from Wuhan, China that also transferred from animals to humans. The SARS-CoV-2 spike protein directly binds to the host cell surface ACE2 receptor helping virus entry and replication. The amino acid positions introduced in 2019-nCoV were the corresponding residues in HIV-1 gp120 and HIV-1 Gag. No SARS‐CoV‐2 therapeutics were available, even if some treatment options have been published which await acceptance. The Autodock software version 1.5.6 and viva were used for the molecular docking process. LIGPLOT software was used for the molecular docking courses. This program automatically generates schematic diagrams of protein-ligand interactions for a given protein in a PDB file (Figure 2). Residues are identical in all seven drugs. The interactions complex between SARS-CoV-2 spike protein complex and seven suggestion drug was done. Binding energies on kcal/mol, hydrogen bonds, and hydrophobic interactions were calculated. Anakinra is proposed because the only structure that interacts with SARS-CoV-2 spike protein by simulation via software.

Objectives To assess the diagnostic utility of metagenomic sequencing in pediatric aerodigestive clinic patients being evaluated for chronic aspiration. Clinical metagenomics allows for evaluation of both the respiratory microbiota and the transcriptome of the host immune response. Study Design and Methods Twenty-four children referred to an aerodigestive clinic were enrolled in a prospective, single-site, cross-sectional cohort study. At the time of clinical evaluation under anesthesia, two additional samples were obtained: an upper airway sample and a sample from bronchoalveolar lavage (BAL). Samples were sent for routine culture and analyzed using Explify® Respiratory, a CLIA Laboratory Developed Test (LDT) which identifies respiratory commensals and pathogens through RNA and DNA sequencing. Incidentally obtained host transcriptomics were analyzed to evaluate the host immune response. The results of these studies were correlated with the clinical presentation of the research subjects. Results In ten patients, organisms primarily associated with oral flora were identified in the BAL. Standard culture was negative in three patients where clinical metagenomics led to a result with potential clinical significance. Transcriptomic data correlated with the presence or absence of dysphagia as identified on prior videofluoroscopic evaluation of swallowing. Differentially expressed genes included upregulation of genes involved in the immune response, such as CXCL8 (interleukin 8) and ITGB2 (CD18). Conclusions Clinical metagenomics allows for simultaneous analysis of the microbiota and the host immune response from BAL samples. As the technologies in this field continue to advance, such testing may improve the diagnostic evaluation of patients with suspected chronic aspiration.

OBJECTIVE To describe if weekly determined lung ultrasound (LU) scores in preterm infants born before 32 weeks (PTB32W) change with diuretic therapy. DESIGN This is a secondary analysis of a prospective study about weekly performed LU in PTB32W: we included infants who received diuretics, and compared LU scores according to their evolution on respiratory support (RS) before and after diuretics. RESULTS We included 17 PTB32W. Both groups were similar in terms of median gestational age: 26 weeks (interquartile rank (IQR) 25-28) in the responders group, and 27 weeks (IQR 25-29) in the other; but different in median number of days on invasive mechanical ventilation: 27 (IQR 11-43) vs. 76 (IQR 35-117) in the non-responders group, p=0.03; and number of infants with moderate-severe bronchopulmonary dysplasia: 2 (25%) vs. 8 (89%), p=0.005. The responders group showed lower LU scores at one week after diuretics: median LU score 3 (IQR 0-10) vs. 12 (IQR 12-12) in the non-responders group, p=0.04; and after three weeks of treatment: median value 6 (IQR 3-6) in the responders group vs. 12 (10-15) in the non-responders group, p=0.01. The decrease in RS was achieved since the beginning of diuretics: 4 out of 8 (50%) were extubated in the responders group, and 8 out of 9 (11%) in the non-responders group, p=0.048. CONCLUSIONS There is a group of PTB32W whose LU score improves after diuretics. This change appears later than that observed in the RS.

Throughout the history, pandemics have played a significant role in reshaping human civilizations. In this series, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), a new coronavirus strain causing novel Coronavirus-19 (COVID-19) disease that has brought the entire world to its knees. The uncertainty revolving around the virus can spark beyond our imagination if not handled appropriately. Immunity against COVID-19 can be achieved in two ways – through natural infection or through vaccination against COVID-19. The second way is the most preferred one, is to develop a safe and effective vaccine and practice mass vaccination without enduring the significant loss of precious lives. However, efficiently developing and delivering a perfect vaccine on time under tremendous pressure to meet millions of expectations is not an easy task as there are many elephants in the room. Besides, we do need a strong, vigilant, and people-friendly healthcare delivery system to translate the vaccine into vaccination without any discrimination. Until such time the vaccine is developed and mass administration takes place the silver bullets against COVID-19 would be symptomatic treatment, avoid mass gathering, social distancing, frequent hand washing, wearing masks and gloves, and generating COVID-19 related awareness in the society.

A growing body of literature has documented myriad effects of human activities on animal behavior, yet the ultimate ecological consequences of these behavioral shifts remain largely uninvestigated. While it is understood that, in the absence of humans, variation in animal behavior can have cascading effects on species interactions, community structure, and ecosystem function, we know little about whether the type or magnitude of human-induced behavioral shifts translate into meaningful ecological change. Here we synthesize empirical literature and theory to create a novel framework for examining the range of behaviorally mediated pathways through which human activities may affect different ecosystem functions. We highlight the few empirical studies that show the potential realization of some of these pathways, but also identify numerous factors that can dampen or prevent ultimate ecosystem consequences. Without a deeper understanding of these pathways, we risk wasting valuable resources on mitigating behavioral effects with little ecological relevance, or conversely mismanaging situations in which behavioral effects do drive ecosystem change. The framework presented here can be used to anticipate the nature and likelihood of ecological outcomes and prioritize management among widespread human-induced behavioral shifts, while also suggesting key priorities for future research linking humans, animal behavior, and ecology.

Background Obesity is an increasing problem in the United States, with one in five adolescents obese. Past studies have shown that pediatric recipients of hematopoietic cell transplants (HCT) may have a higher susceptibility to overweight and obesity. Procedure This is a single-center retrospective analysis of 297 pediatric patients who received HCT between 2005-2018. Patients were divided into four weight categories of underweight (UW), normal weight (NW), overweight (OW), and obese (OB) based on age adjusted body mass index (BMI) conversion scales. Post-transplant outcomes included acute graft vs. host disease (GVHD), chronic graft vs. host disease, viral infection rates, time to platelet and neutrophil engraftment, and overall survival. Results In the pre-transplant period, the percentage of individuals who were UW, NW, OW, and OB were 5.4%, 54.5%, 22.2%, and 17.8% respectively. At the five-year post-transplant mark, those numbers were 10.6%, 48.2%, 16.5%, and 24.7%. Overall, BMI was found to increase 0.00094 ± 0.0001 kg/m2 each day after transplant (p < 0.001), with older individuals demonstrating greater trends of BMI increase. Further, there was a larger BMI increase in those who did not receive TBI compared with those who received TBI (1.29 ± 0.49, p=0.008). The rates of acute graft vs. host disease (GVHD), chronic GVHD, and viral infection, in addition to time to platelet and neutrophil engraftment and 5-year survival estimate, were not significantly different among weight groups. Conclusion Pediatric HCT recipients are at high risk of developing overweight or obesity after transplant.

Whilst climate change is recognised as a major future threat to biodiversity, most species are currently threatened by extensive human-induced habitat loss, fragmentation and degradation. Tropical high altitude alpine and montane forest ecosystems and their biodiversity are particularly sensitive to temperature increases under climate change, but they are also subject to accelerated pressures from land conversion and degradation due to a growing human population. We studied the combined effects of anthropogenic land-use change, past and future climate changes and mountain range isolation on the endemic Ethiopian Highlands long-eared bat, Plecotus balensis, an understudied bat that is restricted to the remnant natural high altitude Afroalpine and Afromontane habitats. We integrated ecological niche modelling, landscape genetics and model-based inference to assess the genetic, geographic and demographic impacts of past and recent environmental changes. We show that mountain range isolation and historic climates shaped population structure and patterns of genetic variation, but recent anthropogenic land-use change and habitat degradation are associated with a severe population decline and loss of genetic diversity. Our models predict that the suitable niche of this bat has been progressively shrinking since the last glaciation period. This study highlights threats to tropical montane biodiversity, squeezed to higher altitudes under climate change while losing genetic diversity and suffering population declines due to anthropogenic land-use change. We conclude that assessments of threats to biodiversity under global change should adopt a holistic approach, simultaneously studying the effects of multiple threats across temporal scales based on genetic, ecological and geographic information.

Abstract Objective: To determine the occurrence of olfactory and gustatory disruptions in COVID-19 patients, their association with demographic and clinical features and prognosis. Design: This observational cohort study involved consecutively diagnosed COVID-19 patients tested between March the 3rd 2020 and March the 24th 2020. Setting: A geographically defined cohort area. All COVID-19 patients were evaluated in a University Hospital. Participants: From the first 184 consecutive patients, 32 were considered ineligible and one refused to participate. Main Outcomes and Measures: The primary outcome of interest is the prevalence of smell and taste alterations, factors associated and recovery rate. Univariate and multivariate analysis by logistic regression was performed to detect factors associated to these symptoms. Results: 151 patients were included and 99 (65.3%) reported olfactory or gustatory symptoms. Olfactory dysfunction was reported by 75 patients (49.7%). Isolated anosmia was found in 2 patients (1.3%). Gustatory dysfunction was reported by 91 patients (60.3%). Factors associated with higher prevalence of smell dysfunction included age, sex, and comorbidities. The time to smell disruption development was significantly shorter in mild to moderate patients than in severe patients (p = 0.043). In 85.3% of patients with smell disruption, the symptom had been resolved in the first 2 months Conclusions and Relevance: Olfactory and gustatory dysfunction was common in COVID-19 patients. Smell disruption has high recovery rate and was associated with age, sex, and clinical severity. It may be beneficial to investigate the appearance of taste and/or smell disruptions in individual patients, with respect to diagnosis and prognosis.

This article discusses from a pharmacological point of view, the points of weakness in a correspondence published at the Lancet Respiratory Medicine that has suggested a hypothesis relating ACEIs, ARBs and ibuprofen to be associated with a higher risk for COVID-19 infection and complications. This article also explains some unfortunate mistakes that have been made by some who have adopted this hypothesis and decided to unwisely recommend against these important drugs.

In December 2019, with the outbreak of the unidentified pneumonia, a novel coronavirus was confirmed to be accountable for this disease and aroused great attention around the entire world. The World Health Organization (WHO) officially named the novel coronavirus as SARS-CoV-2 and the pneumonia of unknown origin as Corona Virus Disease (COVID-19). At present, COVID-19 has become an unprecedented global health crisis, with over 6 million confirmed cases and 350,000 deaths worldwide. The main manifestations are usually fever, cough, fatigues, breathlessness, and among others. To date, specific antiviral agents against the SARS-CoV-2 are not available. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. In this review, we detail current evidence and understanding of the etiology, epidemiology, clinical characteristics, treatment of COVID-19, which may provide a reference for future studies and help in the prevention and control of the COVID-19 epidemic.

Background It has been reported that antibody testing could improve diagnostic efficiency of COVID-19 infection. However the IgM/IgG changes in asymptomatic and discharged patients with reoccurring positive RT-PCR test (RP) remained elusive. Methods 111 patients with positive RT-PCR test and 40 suspected patients were enrolled. We evaluated the diagnostic performance of IgM/ IgG antibodies. Furthermore, the IgM/IgG levels with the disease progress in asymptomatic and RP patients were analyzed. Results Of the 111 RT-PCR positive cases, 17 (15.5%), 42(38.2%), 22 (20%) and 30(27.0%) were categorized into severe, common, mild and asymptomatic group respectively. We find sensitivity and specificity for IgM of 63% and 92.5%, for IgG 77.8 and 95 % respectively. Combining the IgM, IgG and CT we find the best overall performance with95.1 % sensitivity, 75 % specificity. The median IgM and IgG levels were lower in asymptomatic group (IgM0.37, IQR: 0.24-0.78, IgG0.38, IQR: 0.17-1.45) than symptomatic group (IgM1.73, IQR: 0.56-3.74, IgG5.67, IQR: 0.79-18.5) (P < 0.01). All asymptomatic cases were not tracked to infect others. Among 15 RP cases, IgM levels of RP group at the time of discharge (IgM2.79, IQR: 95-5.37) and retest (IgM 2.35, IQR: 0.88-8.65) were significantly higher than those of NRP group (IgM on discharge: 0.59, IQR: 0.33-1.22, IgG on retest: 0.92, IQR: 0.51-1.58). Conclusion Persistent low levels of IgM/IgG in asymptomatic patients may be correlated to less possibility of conversion to symptomatic cases as well as low infectivity. An elevated IgM level may have implications for the identification of RP patients before discharge

There is a serious concern over the variation of case fatality that reflects the preparedness of the medical care system in response to the surge of pneumonia patients. The variation of fatal COVID-19 was in parallel with the heterogeneity of progression from pneumonia to ARDS, ranging from 3.4% to 63% based on data from 12 countries, accounting for 95% positive association between this key indicator and case fatality rate of COVID-19. Predicting fatal COVID-19 with the progression from pneumonia to ARDS is conducive to the preparedness of medical care facilities for the optimal management of a spectrum of COVID-19 patients.

Aim: The purpose of this study is to develop a novel protocol to predict the concentration profiles of a target drug based on the PBPK model of a structurally similar template drug by combining two software for PBPK modeling, the SimCYP simulator and ADMET Predictor. Methods: The method was evaluated by utilizing 13 drug pairs which come from 18 drugs in the built-in database of the SimCYP software. All drug pairs have their Tanimoto scores no less than 0.5. Three versions (V1, V2 and V3) of models for the target drug were constructed by gradually replacing the corresponding parameters of the template drug with those predicted by ADME Predictor for the target drug. Normalized RMSE and Wilcoxon rank-sum test were introduced for the evaluation of the model performance. Results: Overall, V3 models demonstrated better performance than the V1 and V2 models did. The relationship between the model performance and structural similarity of drug pairs was also explored. Three protocols have come out as guidance on how to build PBPK models for target drugs: (1) V1 models are recommended when the structural similarity is very high; (2) V2 models are recommended when the similarity is below 0.65 or high than 0.85; (3) V3 models are recommended when the similarity is below 0.85. Conclusion: By leveraging the prediction accuracy and application practicality, this novel approach has a great promise in predicting the preliminary PK profiles for novel drugs, propelling the drug discovery process by suggesting drug candidates with promising PK profiles.

Purpose: St. John’s wort (SJW, hypericum perforatum) has a long history of medicinal use mainly for its antidepressive effect and for wound healing. However, to the best of our knowledge, this is the first clinical study evaluating the effects of topical SJW oil macerates on the intractable skin lesions of idiopathic granulomatous mastitis (IGM). Materials and Methods: SJW oil massage (two times daily for two minutes) was recommended between 2016 and 2019, only for patients with persistent or intractable skin lesions, after complete regression of granulomatous mass with two cycles of high-dose oral steroid and empiric antibiotic. Skin lesions were assessed and graded before and after treatment, as clear, mild, moderate and severe. A mini-questionnaire was also filled in for each patient at the end of six-week treatment. Results: A total of 21 patients with persistent IGM lesions used SJW oil after completion of the standard treatment protocol. All patients were women, and the mean age was 36.6 years. Hyperemia (100%), scaling (61%), induration (52%) and ulcer (28%) were the predominant skin lesions, Distribution of the lesions according to the degree of severity were as mild, moderate and severe, and seen in 35%, 41% and 23% of the patients, respectively. When compared with pre-treatment scores, there were very significant regression (clear: 76.4%, mild: 17.6%, moderate: 3.9%, severe: 1.9%; p<0.001 for each). The overall success rate (total clearance plus mild signs) of treatment was 94%. Conclusion: SJW oil massage seems to be very effective in patients with IGM-related persistent skin lesions.

Title: Age-related risk of household transmission of COVID-19 in SingaporeRachael Pung1, Minah Park2,3, Alex R Cook2,3, Vernon J Lee1,21 Ministry of Health, Singapore2 Saw Swee Hock School of Public Health, National University of Singapore3 National University Health System

AbstractA contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known as Coronavirus disease 2019 (Covid-19). It engendered the whole civilization within a couple of months over the globe since it was first detected in Wuhan, China in late December 2019. Variation of proliferation rates in different regions assume that climatic parameters might have a vital role in Covid-19 transmission. In this study, the correlation between Covid-19 proliferation with demographic parameter (population density), and weather parameters (temperature, humidity, precipitation, wind speed, and sunshine hour) were investigated separately within the first 60 days of Covid-19 cases. To obtain a precedent correlation, weather and infection-related data of eight different geographically coordinated regions such as Alberta (Canada), Barcelona (Spain), Dhaka (Bangladesh), Île-de-France (France), Lombardy (Italy), New York (USA), Rio de Janeiro (Brazil) and West Bengal (India) having the diversity of climates were considered. It was observed that less densely populated regions (New York, Lombardy, Barcelona) were even highly affected than the highly populated regions like Bangladesh, West Bengal. A negative correlation between total cases and temperature perhaps made this difference. The higher wind speed perhaps accountable for long distance viral transmission. The non-steady humidity tentatively makes the people vulnerable towards Covid-19 infections. Higher precipitation may positively affect viral infection. Sunshine along with the higher temperatures are suspected to impede the contagion by Covid-19. Consequently, peoples in the regions of lower temperatures, higher wind speed, and unstable humidity have higher risks of Covid-19 infection.Keywords: Covid-19; population; viral proliferation; weather parameters; contagion.Introduction Covid-19 is one of the most uttered word since the outbreak of a contagious disease proliferated from the virus called SARS-CoV-2 in late December 2019. It was first detected at Wuhan in the Hubei province of China in December 20191 23. The Covid-19 has been regarded as history broken contagious disease as no other viral disease proliferated across the globe in the history at the same time. Despite taking immediate cautions to stop proliferation of this virus, it has travelled almost all over the globe through human to human interactions and engendered a pandemic situation threatening the healthcare systems of many countries. This virus is proved to be a highly contagious and proliferated more rapidly compared to any the other viruses of the Corona virus family4. Scientists around the world believe that this virus is spreading from the droplets thrown by coughing or sneezing by the infected individuals. These droplets may survive in air and in different types of surfaces for several hours and can potentially affect even healthy peoples come in contact5. However, the survival of these viral droplets may depend on some weather parameters like; temperature, humidity, and wind speed and of combined effects6 7 8. At high temperature, the viral proliferation may significantly be impeded as it deactivates the pathogen by decomposing the protecting protein layer9. Humidity can also be an integrated factor with wind speed as the droplets may survive extensive amount of time in dry, cold air and along with high speed wind that will cause faster transmission comparing to no humid areas10.Meanwhile, the human immune system can play an intricate role during the spreading of such contagious diseases. Some infected individuals may not have explicit symptoms, whereas others may face serious health conditions. Basically, immune response depends on how quickly human body can prepare its biological defenders for viral attack. These responses may be influenced by a bunch of factors specially the availability of vitamins C and D in our body. However, we all aware of the fact that the source of vitamin D is mainly sunlight where in presence of photons, the cholesterol underneath our skin converted into cholecalciferol or vitamin D11. Note that the average sunshine hour within any infected region can largely affect the immune response developed against infectious diseases12. In case of Covid-19, it can remain incubated inside human body up to 14 days13. During this incubation period, active immune response may suppress the replication of this virus and substantially leading to no visible symptoms and these cases are not likely to appear into the total number of cases identified14.However, since Covid-19 is a global issue and is a threat for whole human being, thus in the present research work, we attempted to unveil the relation between Covid-19 proliferation and various climatic parameters based on metrological data obtained from different zones over the globe as shown in global map in Fig.1 . For analysis, the geographically different eight locations such as Alberta (Canada), New York (USA), Rio de Janeiro (Brazil), Barcelona (Spain), Île-de-France (France), Lombardy (Italy), West Bengal (India), and Dhaka (Bangladesh) were selected based on the diversity of weather, Covid-19 cases and population. In this study, we considered first 60 days of Covid-19 proliferation since most of the local authorities paid their best efforts to sluggish/stop the proliferation within this period.

Hydatid cyst is an endemic disease especially in underdeveloped and developing countries affecting mostly the liver and lungs. However, a wide range of unusual anatomical sites in the abdomen has been reported, including the spleen, pancreas, kidney, and ovaries as well as dissemination within the abdominal and pelvic cavities. The location of hydatid disease in the colon is very infrequent, and very few cases have been presented. The hydatid cysts located in other sites are mostly due to rupture or extrusion of primary liver or splenic cysts. In this article, we present a case of primary left-sided colon hydatid cyst, resected laparoscopically with the affected intestinal segment. The diagnosis of hydatid cyst was made by macroscopic and microscopic examination.

Aims of the study: Staphylococcus aureus colonized in the nose of healthcare providers is an important risk factor for the development of hospital-acquired staphylococcal infections. Cross-contamination of this bacterium between the hands of healthcare providers and the surfaces is known. In this study, we aimed to evaluate the clonal relationship between eight Staphylococcus aureus strains isolated from the nose of healthcare providers and five Staphylococcus aureus strains isolated from mobile phones carried by healthcare providers. Methods: The clonal relationship between the strains and molecular epidemiological status were investigated by the pulsed-field gel electrophoresis method. Results: The first and third strains are isolated from the mobile phone and the nose of a healthcare provider working in the intensive care unit were the same. The second and fourth strains were isolated from the mobile phone and nose of another healthcare provider working in the intensive care unit were the same. The fifth strain, which was found to be the same as the second and fourth strains, was isolated from the mobile phone of another healthcare provider working in the intensive care unit. No similarity was observed between the other strains. Conclusion: Our findings indicate that Staphylococcus aureus strains colonized in the nose of healthcare providers are also transmitted to other surfaces and that the hospital environment and co-used devices pose a risk for spread. For this reason, training of healthcare providers on the infection control procedure, hand hygiene, environmental disinfection and regular cleaning of mobile phones are important components in order to prevent hospital-acquired infections.

To study the hyporheic exchange driven by a single peak flood-induced water level fluctuation (i.e. flood wave), a method combining numerical simulation with theoretical derivation was proposed based on the Inbuk Stream, Korea, where flooding occurs frequently. The hyporheic exchanges induced by different flood waves were investigated by varying amplitude (A), duration (T), wave type parameter (r), and rising duration (tp), which were adopted from the real-time stream stage fluctuations. Additionally, the idea of constant upstream flood volume (CUFV) condition for flood waves was put forward, and the effects of “Botan” (T/A) and peak number (N) on hyporheic exchange were studied. The results showed that the hyporheic exchange flux (q) was controlled by the water level h (sine-type) and its change rate v (cosine-type), and was proportional to the polynomial of them q“∝” (ω∙h+v), where ω is the angular frequency of the flood wave. Based on this mechanism, the influence principles on hyporheic exchanges of the typical flood wave parameters (A, T, r and tp) as well as T/A and N under CUFV condition were clarified. The main characteristic variables of hyporheic exchange, which were maximum aquifer storage and residence time, were positively correlated. They also had positive relations to the integral of the flood wave over time, which increased when the wave became higher, wider, rounder and less skewed. However, when CUFV condition was imposed, the residence time was positively correlated with T/A, whereas the maximum aquifer storage was negatively correlated with T/A. With the increase in N, water exchanged more frequently and some water returned to the stream early, leading to the slight decrease in maximum aquifer storage and residence time. These findings enriched the theory of hyporheic exchange driven by surface water fluctuation and be of great significance to enhance pollutant degradation in the hyporheic zone downstream of reservoirs.

Macrophyte community diversity and composition respond to ecosystem conservation and local environmental factors. In this study, we developed a multidimensional diversity framework for macrophyte communities, including the taxonomic and functional alpha and beta diversity. We used the framework to explore the relationships among water level regimes and these diversity parameters in a case study of China’s Baiyangdian Lake. Analysis of indicators of hydrologic alteration divided the water level from 1959 to 2019 into four regimes (dry, <6.42 m; low, 6.42 to 7.23 m; medium, 7.23 to 8.19 m; high, >8.19 m). Alpha and beta diversity were significantly higher in the medium regime than in the low and high regimes. Redundancy analysis indicated that the maximum water depth significantly affected taxonomic alpha diversity, and total nitrogen (TN) and chemical oxygen demand (COD) concentration significantly affected functional alpha diversity, respectively. Mantel tests showed that TN, Secchi depth, and water depth in the high water level regime significantly increased the total beta diversity and turnover components. TN was the main factor that increased total taxonomic beta diversity. Interspecific competition decreased with the decreasing range (variation) of TN values and differed opposite with the variation of COD values in response to increasing water level, and reached its maximum in the medium regime. Ecosystem stability was promoted by maintaining high species richness and evenness and high differences among communities, and by reducing competition. Based on our results, the water level should be maintained between the medium and high water level regimes to promote restoration of the macrophyte community and improve ecosystem stability.

A probability prediction using conditional distribution function derived from copula provides a great deal of flexibility in the suspended sediment concentration as well as other hydrological variable estimations, but the influencing variables of the probability prediction model capability are necessary to be investigated. The bivariate conditional distribution function of suspended sediment concentration with runoff as its only influencing variable is firstly derived to assess the sensitivity of the probability prediction to the choice of copula and marginal distribution, and the probability prediction is further extended to the trivariate conditional distribution function with runoff and precipitation as its influencing variables. The approach is exemplified using stationary mean daily precipitation, runoff and suspended sediment concentration data sets from six hydrological stations in the central Yellow River located in the Loess Plateau, which is characterized by heavy sediment transport. The results of the bivariate conditional distribution functions indicate that the probability prediction is mainly influenced by the choice of copula function, and the tail dependence of the copula function determines the shape of the estimated suspended sediment concentration curve. The comparison between the bivariate conditional distribution function, trivariate conditional distribution function, and traditional sediment rating curve demonstrates the uncertainty bands from trivariate conditional distribution function are always smallest, and those from the sediment rating curve are usually largest, while the difference between different models become larger at hydrological stations with smaller sample size.