Adequate quantification of precipitation and its spatio-temporal variability is crucial for understanding the physical and biological processes within a watershed. Mountain watersheds pose particular challenges due to strong spatial heterogeneity in precipitation and typically sparse in-situ monitoring networks. The increasing availability of gridded precipitation products can help address these limitations, but their reliability at local or sub-regional scales remains difficult to assess. This study proposes a novel, process-based approach that incorporates daily streamflow data to evaluate the performance of four widely used gridded precipitation datasets (CHIRPS-v2, MSWEP-v2.8, GPCC-v2022, and TerraClimate). Five key watersheds in central-western Argentina (ca. 30–37°S) serve as case studies. The evaluation framework is based on five process-informed expectations derived from the region’s climate and topography: (a) most annual precipitation should fall as snow during winter (April–September); (b) a strong positive relationship should exist between winter precipitation and summer streamflow; (c) interannual variability of precipitation should exceed that of streamflow due to basin-scale damping effects; (d) runoff coefficients should be statistically lower than unity, reflecting mass conservation; and (e) winter precipitation should be concentrated at higher elevations. We apply simple non-parametric statistical tests to evaluate how well each dataset meets these expectations. A comparative assessment identifies the most reliable product for each watershed. Our findings show that MSWEP and TerraClimate perform best overall, particularly in capturing total precipitation and its seasonality. Other datasets fail to reproduce key hydrological signals, likely due to a lack of physically based inputs (e.g., reanalysis). Overall, this process-based, catchment-integrative evaluation offers a promising framework for assessing precipitation products in other snow-dominated mountain regions with limited ground observations, provided that the dominant hydroclimatic processes are well understood.

The complexity and hierarchical organization of genomic information pose a fundamental challenge for both efficient data compression and the preservation of biologically meaningful patterns. Here we propose a symbolic, recursive information framework called ϕ ∞ that enables encoding of molecular sequence motifs and structures in DNA, RNA, and proteins in a unified algebraic form. In contrast to conventional sequence compression algorithms (e.g., Lempel-Zivbased methods) which maximize redundancy elimination but risk obscuring functional patterns, ϕ ∞ explicitly retains and represents genomic motifs and higher-order folding relationships during compression. The ϕ ∞ framework is defined as a recursive algebra over sequence alphabets, allowing repetitive or structurally conserved motifs to be represented by self-referential symbols across multiple scales. We demonstrate that ϕ ∞ can encode codon sequences and their amino acid translations, preserve RNA base-pairing interactions through augmented symbolic strings, and represent protein α-helix motifs via looped symbolic constructions. Results include a ϕ ∞ recursion tree derived for a segment of the human TP53 gene, illustrating how codons and regulatory repeats can be hierarchically parsed and compressed without loss of semantic information. Additionally, a symbolic folding map for an example RNA segment shows that ϕ ∞ encoding of a sequence together with its secondary structure (χ ⊕ ∆(χ)) is consistent with the direct encoding of the folded structure. Compared to probabilistic models (e.g., hidden Markov models) and recent deep learning embeddings, ϕ ∞ offers improved interpretability, structural consistency, and potential for recursive inference across molecular scales. This approach opens new avenues for integrative genomic data compression, pattern discovery, and knowledge-driven augmentation of computational protein folding tools.

Understanding vegetation evolution is crucial for exploring terrestrial ecosystem changes and identifying future challenges. However, the mutation information in the vegetation change trends of Northwest China (NWC) has not been thoroughly investigated..Based on MODIS NDVI data from 2000 to 2022, this study uses the BFAST method to analyze the spatiotemporal variation characteristics of vegetation kNDVI and trend turning points (TPs) in NWC, and combines land use data to explore the impact of human activities on vegetation dynamics. Results show that: (1) The kNDVI in NWC has significant spatial heterogeneity, with high - value areas concentrated in forest - grass regions like the Qinling and Tianshan Mountains, and low - value areas in arid basins and desert zones.(2) In the study area, 36.42% of the region shows a stable increasing trend (mainly in southern Shaanxi and Gansu), while 17.59% experiences negative reversals (from increase to decrease), focusing on the Hexi Corridor and the oases of the Tarim Basin.(3) Over 75% of vegetation trend TPs occurred after 2010, with negative mutations peaking in 2016, linked to urbanization and a warmer, wetter climate.(4) Ecological restoration projects have significantly increased forestland (85.44% of areas with rising kNDVI) and improved farmland trends (71.30% of areas), but grassland degradation persists (only 45.47% of areas improved). (5) The mutation frequency in unstable vegetation areas (e.g., afforested regions) (44.59%) is significantly higher than in stable areas (31.58%), indicating that intense human intervention increases vegetation dynamics complexity. Research shows that ecological restoration projects has improved NWC’s vegetation. Yet, afforestation thresholds in arid areas, grassland overloading, and the combined effects of climate and human activities may limit sustainable development. There’s a need to optimize vegetation restoration strategies and enhance the protection of ecologically vulnerable regions. This study offers a scientific basis for vegetation restoration and adaptive management in arid and semi - arid areas.

This study developed a simulation model for the liquid-cooled thermal management system of power batteries. We designed multiple liquid-cooled plate schemes to investigate the effects of key parameters—including the number of flow paths, fluid flow direction, flow path width, flow path depth, inlet flow velocity, and stamping R-radius—on the heat dissipation performance, temperature uniformity, and system energy consumption of battery modules under a 2C discharge rate. Results revealed that fluid flow direction and flow path width significantly influenced the heat dissipation performance of the battery module. Under fluid direction I, the maximum and average temperatures were 2.16 °C and 2.15 °C lower than those under direction II. Increasing the flow path width from 10 mm to 16 mm reduced the maximum temperature by 2.07 °C and the average temperature by 2.33 °C. The maximum temperature difference under direction II was 0.87 °C lower on average than under direction I, while increasing the inlet flow velocity from 2 L/min to 10 L/min increased the pressure drop by 90.17%.

Evolution under environmental influence is an undeniable phenomenon. However, the underlying molecular-level details are yet to be completely elucidated. Many studies highlight that random mutations—that arise from errors in DNA replication and repair and are conventionally regarded as the sole source of new genetic information—alone cannot completely answer evolution, given the intricateness of living systems modern science reveals, the time elapsed between species, and abrupt evolutionary events like the Cambrian explosion. Moreover, the mechanistic insight into possible non-randomness of mutations has also come to light recently, which, in addition to challenging the long-standing paradigm of random mutations, highlights the prospect of the molecular details beyond random mutations aiming at efficient adaptive variations boosting evolution. Exploring these details is crucial to fully understand the evolutionary process. In this regard, this review looks at DNA, the code of life. A growing body of studies in recent decades establish that DNA exists as chromatin, the physiological form, in all kingdoms of life and is a highly dynamic entity: It exhibits various heritable environmentally sensitive epigenetic and genetic features that interact synergistically orchestrating diverse phenotypes with environmental changes. These features enable to modify both genome function and sequence information in response to the environment. Taken together, such findings indicate that a genome, in its physiological form, is potentially inherently capable of evolving novel lifeforms or virtually any lifeform, depending on environmental changes.

Author: Maxwel A. Abegg

This study investigates the impact of canopy openness on forest regeneration and soil nutrients in six community forests within the Chure region of Makawanpur district, Nepal. A systematic sampling approach was employed across three canopy cover classes—dense (70–100%), moderately dense (40–70%), and open (10–40%)—to assess seedling and sapling densities, tree diversity, and soil nutrient composition. The results indicate that seedling density was highest in open canopy strata (18,870 per ha), followed by moderately dense (14,281 per ha) and dense (11,185 per ha) strata, with significant differences confirmed by ANOVA (p < 0.05). However, sapling density did not vary significantly among canopy classes (p > 0.05). Tree diversity, as measured by the Shannon-Weiner and Simpson indices, was greater in dense canopy strata compared to open and moderately dense strata. Soil analysis revealed that canopy openness positively influenced soil organic matter (SOM), soil organic carbon (SOC), and nitrogen (N) levels, while phosphorus (P) and potassium (K) showed no significant variation among canopy classes. These findings highlight the dual role of canopy openness in facilitating forest regeneration and enhancing soil quality. The study concludes that balanced canopy management can optimize regeneration dynamics and soil health, providing crucial insights for sustainable forest management in subtropical ecosystems. Keywords: Canopy, Diversity, Management, Regeneration, Soil

Introduction Bevacizumab, a VEGF inhibitor, is used off label for treatment of severe anaemia related to epistaxis, GI-bleeding and/or severe liver arteriovenous malformations (HAVM) and right sided cardiac failure in patients with Hereditary Haemorrhagic Telangiectasia (HHT) Aim To report the experience of treatment with bevacizumab within VASCERN centres. Method A retrospective analysis of the usage, availability, efficacy and safety in HHT patients treated with bevacizumab in the European VASCERN centres. Results A total of 151 patients received treatment with bevacizumab in European VASCERN centres. Most patients were treated in Denmark, France and the Netherlands. There was an improvement in haemoglobin with a mean increase of 2.9 g/dL and significant reduction in the number of red blood cells transfusions. Cardiac output was measured and improved in 85 % of patients treated for high output cardiac failure in relation to severe HAVM. No severe adverse events were recorded, however 70 patients experienced at least one side effect. Conclusion Although this is a retrospective study, we have shown convincing efficacy of bevacizumab in treatment of patients with HHT, with a good risk-benefit balance.

Enterovirus 71 (EV71) infection gave a hard hit on young children because of fatal complication, brainstem encephalitis with pulmonary edema. Severe EV71 infections highlights an urgent necessity for the novel antivirals development and repurposing of effective products for medical use. Drugs target specific steps in cycle of viral replication and the modification of existing factors of EV71 immunopathogenesis decipher current approaches for developing antivirals. In addition to chemical compounds, identify active constituents and explore the underlying mechanisms of antimicrobial peptides and natural products may substantiate against EV71 activities to provide pharmacological benefits.

Patients with peripheral arterial disease (PAD) who have their lower extremities revascularized are nevertheless at increased risk for cardiovascular and thrombotic events. Aspirin and rivaroxaban combined antithrombotic therapies have demonstrated potential advantages over aspirin monotherapy. Hence, the purpose of this systematic review and meta-analysis is to compare the safety and effectiveness of rivaroxaban + aspirin versus aspirin alone. In accordance with PRISMA principles, randomized controlled trials (RCTs) comparing rivaroxaban (2.5 mg twice day) plus aspirin (100 mg daily) with placebo plus aspirin were included. Adverse events include significant bleeding (TIMI and ISTH criteria), cerebral hemorrhage, and fatal bleeding were among the primary outcomes. Acute limb ischemia (ALI), major amputation, myocardial infarction (MI), ischemic stroke, cardiovascular death, and composite outcomes were among the secondary outcomes that evaluated efficacy measures. There were three high-quality RCTs with a total of 20,594 patients. Aspirin and rivaroxaban together significantly decreased the incidence of composite cardiovascular events (RR = 0.83; 95% CI: 0.76–0.90; p < 0.0001) and acute limb ischemia (RR = 0.61; 95% CI: 0.51–0.72; p ≤ 0.00001). Although it was not statistically significant, there was a trend toward fewer ischemic strokes and MIs. While there were no appreciable changes in fatal bleeding or cerebral hemorrhage, the intervention group had higher major bleeding risks, such as TIMI (RR = 1.44; p = 0.008) and ISTH bleeding (RR = 1.37; p = 0.002). There was little publication bias and little heterogeneity among the majority of the results.

Climate change poses a significant challenge for global health. The World Health Organization estimates 250,000 additional annual deaths between 2030 and 2050 due to global warming. The healthcare sector is a major contributor to greenhouse gas (GHG) emissions, accounting for approximately 4.4-5.5% of a country’s total carbon footprint, with medicines contributing 5–10%. Research on the climate impact of medicines is needed to identify areas for emission reduction. This scoping review aimed to provide an overview of existing literature on the climate impact of medicines in the hospital sector and identify knowledge gaps. A comprehensive literature search was conducted, with articles categorized based on the type of medicine or therapeutic area, enabling a structured mapping of current areas of evidence. The review followed PRISMA-ScR guidelines, searching PubMed and Embase for peer-reviewed articles published in the last 20 years that reported original data on GHG emissions from medicines in the hospital sector. Of the 2,986 studies identified, 33 were included. Most focused on emissions from inhaled anaesthetic gases (n=16), followed by inhaler therapies (n=6), healthcare systems or whole-hospital emissions (n=5), ophthalmology (n=3), surgical procedures (n=2), and other areas (n=2). The findings show that while certain areas, particularly anaesthetic gases and inhaler therapy, have been more researched the overall research on the climate impact of medicines in the hospital sector remains limited. Knowledge gaps persist across most therapeutic areas, highlighting the need for further systematic investigations to inform effective mitigation strategies and support climate-conscious decision-making in the hospital sector.

Purpose: This study assessed the effect of the number of remaining vertical walls on fracture resistance and marginal and internal adaptation of endocrown restorations. Materials and Methods: This in vitro study was conducted on 36 extracted mandibular molars. After endodontic treatment, the teeth were randomly divided into three groups (n=12) with four, three, and two remaining walls. The teeth were scanned, endocrowns were fabricated and seated, and their marginal and internal adaptation was assessed by measuring the gap at the margin (M1), center of cervical region (C1), cervico-axial angle (C2), three points at the axial wall (A1, A2, and A3), axiopulpal angle (P1), and center of pulpal floor (P2) by the replica technique. Fracture resistance was also measured. Data were analyzed by one-way ANOVA, and Tukey’s test (alpha=0.05). Results: The number of remaining walls significantly affected the gap at C1, C2, and P2. The mean gap at C1 in the 4-wall (P=0.002) and 2-wall (P=0.047) groups was significantly higher than that in the 3-wall group. The mean gap at C2 in the 4-wall group was also significantly higher than that in the 3-wall (P=0.017) and 2-wall (P=0.029) groups. The mean gap at P2 in the 4-wall group was significantly higher than that in the 2-wall group (P=0.037). The difference in fracture resistance was not significant among the groups (P=0.196). Conclusion: The number of remaining walls had no significant effect on fracture resistance, but the higher number of remaining walls may increase the internal and marginal gap of endocrowns.

The Asian corn borer, Ostrinia furnacalis is a major global pest. This study evaluated the parasitism capacity of three Trichogramma species (T. ostriniae, T. chilonis, and T. dendrolimi) on corn borer eggs under laboratory conditions and monitored corn borer dynamics in the Huang-Huai-Hai region (2015–2022). The laboratory results showed Trichogramma ostriniae had the greatest parasitism ability. Field experiments showed T. ostriniae achieved the highest parasitism rates (up to 90%) during peak pest periods (mid-July and mid-August), nearly double that of the chemical controls. Significant reductions in corn damage were observed in 2016 and 2021 in T. ostriniae treated fields, which also showed higher natural enemy diversity, abundance, and species evenness compared to chemical control areas. Trichogramma ostriniae provides comparable pest control efficacy to chemicals while enhancing ecological sustainability, making it a viable strategy for integrated pest management.

ABSTRACTVector control strategies have long relied on chemical insecticides, including organochlorines, organophosphates, malathion, and pyrethroids. However, the increasing incidence of insecticide resistance in mosquito populations threatens the effectiveness of these interventions. Recent studies have highlighted the role of the mosquito microbiome in mediating resistance mechanisms. While microbial associations with insecticide resistance have received growing attention, the extent to which resistance-related microbiota influence life-history traits remains unclear, particularly under sustained insecticide selection across multiple generations. Life-history traits are fundamental components of mosquito fitness and vectorial capacity, and any microbiome-mediated changes could have far-reaching implications for malaria transmission dynamics. Despite its importance, this area of inquiry remains underexplored. This review aims to address this critical knowledge gap by synthesizing findings from peer-reviewed research articles, systematic reviews, and experimental studies published between 2000 and 2024. Sources were drawn from established scientific databases including NCBI, PubMed, ScienceDirect, and Google Scholar. The review explores how insecticide-driven selection pressures interact with mosquito-associated microbiota and influence vector biology over time. By examining the intersection of microbiome composition, insecticide resistance, and mosquito life-history evolution, this work contributes to a deeper understanding of the ecological and epidemiological consequences of resistance, with potential implications for improving long-term vector control strategies.

Ruptured Gallbladder

A document by Ali Chamani. Click on the document to view its contents.

Science-in-brief: Report on the 2nd Dorothy Russell Havemeyer Foundation workshop on acute colitis of the adult horseLuis G. Arroyo, Department of Clinical Studies, University of Guelph, Guelph, Ontario N1G 2W1, Canada larroyo@uoguelph.caAshley E. Whitehead, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta T2N 4Z6, Canada ae.whitehead@ucalgary.caFrancisco Uzal, California Animal Health and Food Safety Laboratory, San Bernardino, 92408-2113, USA University of California, California fuzal@cafhs.ucdavis.edu

This study integrates the MaxEnt ecological niche model with a programmatic analysis framework developed in R to predict the potential distribution and spatiotemporal dynamics of Eriochloa villosa in spring maize fields across Northeast China under various future climate scenarios. Based on 201 validated occurrence records, key environmental variables were selected using multivariate correlation analysis in R. Model parameters were objectively optimized using the ENMeval package, and distribution maps were generated for the baseline period (current conditions) as well as for the 2030s and 2050s under three Shared Socioeconomic Pathways (SSP126, SSP245, SSP585). The results indicate that: (1) Annual precipitation (53.9%) and the mean temperature of the wettest quarter (33.8%) were the most influential variables, with optimal ecological ranges of approximately 500–900 mm and 21–27 °C, respectively. (2) Under current conditions, suitable habitats are concentrated in central Liaoning, northwestern Jilin, and eastern Heilongjiang, covering approximately 396,000 km². (3) Future scenarios project a significant habitat expansion (up to 195%) with spatial transitions characterized by a ”retreat of low-suitability zones, expansion of medium-suitability zones, and fluctuations in high-suitability zones,” alongside a westward shift and relative eastward stability. (4) The R-based standardized workflow enhanced model efficiency, objectivity, and reproducibility in species distribution modeling under climate change. These findings provide scientific support for proactive management of E. villosa and offer a reproducible technical approach for modeling the distribution of invasive or agricultural weed species under environmental change.

A novel method of highly efficient and selective transfer hydrogenation of azobenzenes to hydrazobenzenes catalyzed by sodium decatungstate (NaDT) has been reported for the first time. The reaction can be smoothly proceeded in the presence of isopropyl alcohol (2-PrOH) and upon 390 nm UV-light irradiation at room temperature. The corresponding 40 kinds of hydrogenated azobenzene can be obtained by selective reduction of either symmetrical or asymmetrical azobenzene in 25-960 min, and the yield can reach more than 98%. It is worth noting that NaDT maintains catalytic activity for 5 consecutive cycles in the reduction of azobenzene to 1,2-diphenylhydrazine, with little change in yield. Additionally, This reaction can be easily applied in gram-scale experiment without any changes in reaction conditions and reaction activity. Moreover, this reaction has the most catalytic effect compared with similar reactions reported recently. Furthermore, the mechanism study shows that 2-PrOH provides hydrogen source for the reaction and realizes the transformation through free radical pathway.

Case Analysis: Ultrasound Diagnosis of Hepatic Inflammatory GranulomaZhang Xiaohang, Quan Lijuan, Department of Ultrasound, Jiaxing First Hospital, Jiaxing, Zhejiang 314001The first author：Zhang xiaohang，505004658@qq.com.Corresponding author：Quan Lijuan，qlj5083@163.com.KCM: 68-year-old male presented with incidentally found liver mass. Ultrasound revealed a 13×17 mm irregular, hypoechoic lesion with ill-defined borders adjacent to hepatic veins; CDFI showed no blood flow, CEUS demonstrated hypoenhancement. Pathological diagnosis post partial hepatectomy: focal chronic suppurative inflammation with adjacent biliary epithelial atypical hyperplasia.Abstract: Ultrasound diagnosis of hepatic inflammatory granuloma refers to the process of identifying granulomatous lesions within the liver using ultrasonography. This report presents an analysis of a patient diagnosed with hepatic inflammatory granuloma via ultrasound. A thorough evaluation of the patient’s ultrasound examinations, including conventional B-mode ultrasound and contrast-enhanced ultrasound (CEUS), was performed. Lesion characteristics such as boundaries, echogenicity, and blood flow patterns were comprehensively assessed to characterize the pathology. Based on the findings, the patient underwent surgical treatment at our institution. Pathological results revealed focal chronic suppurative inflammation within the liver tissue, accompanied by atypical hyperplasia of the adjacent bile duct epithelium. Additionally, this report includes a review of relevant literature, summarizing the clinical characteristics and ultrasonographic features associated with hepatic inflammatory granuloma.Keywords: Advanced Ultrasound; Contrast-Enhanced Ultrasound; Ultrasound; Hepatic inflammatory granuloma; Case analysis; Clinical Value

Background: In most Low and Middle-Income Countries (LMICs), enrolment in community-based health insurance (CBHI) is still low. In Sub-Saharan Africa enrolment rate is less than 10%. In 1996, Tanzania introduced Community Health Fund (CHF) which was modified in 2011 whereby the government came up with the improved community health fund (iCHF). The introduction of iCHF was intended to improve service delivery to the population where an electronic integrated management information system was introduced. Objective: This study was set to explore the drivers for implementing the e-claim process of improved Community Health Funds from two districts in Central Tanzania. Methods: An exploratory case study design using a qualitative approach was adopted to explore information on the drivers of the implementation of the iCHF electronic claim process in Mkalama and Iramba districts in Singida region. In-depth interviews were used to collect data from the Eighteen (18) participants including regional health managers, district health managers, Information Technology (IT) officers, facility in charge and iCHF focal persons from dispensaries, health centres and hospitals. Data were analyzed using a thematic content analysis. Results: The drivers for implementing the iCHF e-claim process were adherence to supervision directives and government policy, resource management and client satisfaction but the e-claim system does not attract Health Community Workers (HCWs) to comply with the iCHF e-claim process Conclusion: The iCHF e-claim process is inadequately implemented and does not attract Health care workers (HCWs) due

Background: The chemotherapy regimen comprising carboplatin, vincristine, and etoposide (JOE) is commonly used to treat retinoblastoma. Carboplatin-induced ototoxicity is infrequently reported. High-frequency hearing loss may impair cochlear function and speech-in-noise recognition and elevate hearing thresholds. The aim was to assess hearing loss in retinoblastoma survivors treated with carboplatin-containing chemotherapy. Methods: This cross-sectional study was conducted at a single-center Pediatric Hematology-Oncology unit between 2021 and 2022. Survivors treated for retinoblastoma from 2011 to 2019 were enrolled. Hearing was evaluated using otoacoustic emissions, conventional pure-tone audiometry (500–8,000 Hz), and high-frequency audiometry (9,000–20,000 Hz). Results: Forty-two survivors (53 eyes; 76% intraocular, 24% extraocular) were evaluated. Median number of cycles of JOE received: 6 (IQR: 6, 9.3); cumulative carboplatin dose: 3151.5 mg/m 2 (IQR: 2213.5, 4563.5); median age at diagnosis: 32.5 months (IQR: 19, 43.5); median age at hearing assessment: 88.5 months (IQR: 19, 43.5) and median duration from diagnosis to hearing assessment: 50.5 months (IQR: 30, 78.5). High-frequency hearing loss was observed in 17 (40.5%) survivors, predominantly bilateral (65%). Two (4.8%) among the 17 also had hearing loss (40 dB) at 8000 Hz. No participant had clinically perceptible hearing loss or required hearing aids. There was a lack of association of hearing loss with age, duration from diagnosis to audiometry, weight-for-age, socioeconomic status, or cumulative carboplatin dose ( P>0.05). Conclusions: High-frequency sensorineural hearing loss was observed in 40.5% of survivors of retinoblastoma, though it was not clinically evident in any. Periodic hearing assessment is recommended to monitor the progression of hearing loss.

Background/Objectives : Survivors of pediatric brain tumors (SPBT) experience difficulties with social connectedness. However, little is known about the friendship quality among survivors who have friends despite its importance to critical outcomes. This study evaluated friendship quality with an identified friend among SPBT and survivors of non-central nervous system solid tumors (SNCNST) and factors associated with friendship quality. Methods : Survivors, ages 7-14, completed study visits within 6 months of finishing tumor-directed treatment. Participants identified a friend and completed measures of cognitive function, social cognition, and family functioning. Caregivers reported on survivor physical function. Survivors and identified friends completed the friendship quality measure. Analyses compared survivor- and friend-reported Closeness between SPBT and SNCNST and identified factors associated with friendship quality. Results : In univariate analyses, SPBT reported lower Closeness with their identified friend compared to SNCNST. In general linear model analysis controlling for sex and age at diagnosis, SPBT and SNCNST no longer differed on Closeness. SPBT and SNCNST did not differ on friend-reported Closeness. Level of agreement between survivor- and friend-reported closeness was low. Regression analysis indicated that survivor sex, survivor-reported family function, and parent-reported survivor physical function were significantly associated with survivor-reported Closeness. Conclusions : Findings suggest factors outside of diagnosis (brain v. non-brain) are important to friendship quality in the early stages of survivorship. Longitudinal research is needed to evaluate friendship quality when late effects emerge. Efforts to improve survivor physical and family function may promote enhanced connections with friends, particularly soon after completing cancer therapy.

Introduction/Background: Patients are readmitted for various complications during the first year post allogeneic hematopoietic cell transplantation (alloHCT). Readmissions are associated with higher utilization of health care resources and cost, negatively impacting quality of life. While several studies have described risk factors for readmission in adult patients, limited data are available for the pediatric AlloHCT recipients. Understanding and addressing the modifiable risk factors that drive readmissions after alloHCT can potentially improve transplant outcomes and decrease healthcare utilization. Objectives: This study aimed to identify modifiable risk factors associated with hospital readmission among pediatric alloHCT recipients. Design/Methods: A single-center retrospective cohort study was conducted, encompassing children discharged from the hospital after their first alloHCT between June 1, 2008, and January 2021. The primary endpoint of the analysis was hospital readmission after initial hospitalization for alloHCT. We studied three different aspects of readmissions: 1) whether readmission occurred, 2) the quantity of post-alloHCT readmissions per patient, 3) timing of readmission (early <30 days vs. late ≥30 days from first hospital discharge). Logistic regression was employed to evaluate pre-transplant characteristics, sociodemographic factors, and transplant complications associated with readmission. Results: Of 216 patients who were discharged after alloHCT, 186 were readmitted within a year, with a median number of readmissions at 2 (ranging from 0 to 17). On multivariable analysis, significant risk factors associated with readmission were non-English speaking families, occurrence of acute graft-versus-host disease (aGVHD) prior to discharge, CD4 count <10/uL , blood urea nitrogen >20mg/dL at the time of discharge, and presence of an external central line at discharge. The impact of an institutional practice change in 2019 to remove external central lines prior to discharge was studied to determine if readmission rates changed; readmission rates were higher in 2008-2018, before the change, as compared to after the in change 2019-2021 (90% vs. 71%, respectively). The primary etiology of readmission in the earlier time period as compared to the later was identified to be due to bacteremia (25% vs. 3%, respectively). Conclusions: Most children are readmitted following discharge after alloHCT. Modifiable risk factors should be targeted in future research efforts to decrease re-hospitalization. Prospective multicenter studies are needed which could potentially improve the outcomes and quality of life of children.