The intrapulse modulation radar signal detection is essential for contemporary electronic intelligence reconnaissance and other domains. However, there are difficulties in modulated signal recognition due to the complicated electromagnetic environment and poor signal-to-noise ratio. Even though the recognition accuracy has been increased by the current methodologies, the computing pressure are high, and generalization capacity are limited either. In this paper, the Dual-Path Dilated Convolution Attention (DDCA) is proposed. This method is proposed as a lightweight improvement technique to increase the model performance, and a lightweight recognition method by combining denoising convolutional neural networks and improved MobileViT. The simulation results demonstrate that the proposed method effectively reduces the parameter size of network. Meanwhile, a sustainable high recognition accuracy is obtained, the network inference speed is accelerated, and the hardware requirements are alleviated. Based on simulation, the recognition accuracy for ten types of radar signals attains as high as 91.4% when the signal-to-noise ratio is - 16 dB.

The chemodivergent synthesis of carbonyl-containing polycyclic quinazolinones have been reported, which features green reaction conditions, good functional group compatibility, compatible of 1°, 2° and 3° alkyl free radical precursors and applicable to gram-scale synthesis. Mechanistic experiments indicate a radical cascade cross-coupling/cyclization process is involved. It is an efficient example describing the direct activation of inactive α‐halocarbonyls to synthesize 2,3-fused polycyclic quinazolinone skeletons, which possess a wide range of biological activities.

Objective: To evaluate the safety and effectiveness of the Stem Cell Regenera Treatment for oocyte activation in women with ovarian failure in routine clinical practice Design: Retrospective observational study From January 2023 to December 2024 Setting: IVIRMA Alicante Clinics, Spain. Population or Sample: Women diagnosed with ovarian failure including Poor Ovarian Response, Diminished Ovarian Reserve and Premature Ovarian Insufficiency. Methods: The study involved mobilizing Hematopoietic stem cells from bone marrow into peripheral blood using granulocyte colony-stimulating factor, followed by intraovarian injection of Stem Cell Factor-enriched Platelet Rich Plasma. Effectiveness was assessed by correlating leukocytes and CD34+ on day five with oocyte activation criteria and safety assesed by clinical and bilogical parameters. Main Outcome Measures: The primary outcome measures were effectiveness assessed by the rate of oocyte activation, leucocytes and stem cells count, and pregnancy rates. Oocyte activation was defined as an increase in total Antral Follicle Count of three or more follicles after treatment and/or at least a 20% rise in Anti-Müllerian Hormone levels. Safety was assessed based on adverse effects of treatment. Pregnancy rates were evaluated both for spontaneous gestation and following in vitro fertilization treatment. Results: A total of 145 women were included. The overall activation rate was 68.28%, with 7.07% achieving spontaneous gestation and 14.14% achieving pregnancy following IVF. Mobilization of CD34+ cells was successful in all participants, with an average collection of 32.96 CD34+ cells/ µl and no severe adverse effects were observed. Conclusions: The Stem Cell Regenera Treatment is effective and safe for oocyte activation in women with ovarian failure in routine clinical practice

Objective: To evaluate the impact of a quality improvement initiative to improve compliance of obstetric anal sphincter injuries (OASIS) management. Design: Quasi-experimental study design Setting: An academic tertiary obstetric care center. Population: Women diagnosed with OASIS from August 2018 to July 2023. Methods: An OASIS practice guideline was introduced by the urogynecology program, incorporating didactic sessions and simulation training using porcine sphincter models. The guideline emphasized primary prevention, proper diagnosis, anatomic repair technique, documentation, and post-procedure management. Compliance with guideline components—including antibiotic use, bowel regimen, short-term follow-up, and proper documentation of technique, digital rectal examination, and repair location—was compared between pre- and post-intervention cohorts. Bivariable and multivariable analyses, along with control charts, were used to assess changes. Significance level was set at p<0.05. Main Outcome Measures: Compliance with evidence-based OASIS management practices, including antibiotic use, bowel regimen, digital rectal examination, documentation, and short-term follow-up. Results: A total of 226 OASIS cases were included (168 pre-intervention, 58 post-intervention). The two groups were similar in age, race, parity, gestational age at delivery, fetal weight, and length of the second stage of labor. Post-intervention, compliance improved significantly: digital rectal examination documentation increased from 41.2% to 86.2% (RR 2.08; 95% CI 1.69–2.57; p<0.001). OASIS repair documentation increased from 7.7% to 41.4% (RR 7.57; 95% CI 4.3–13.1; p<0.001). Proper antibiotic use increased from 47.0% to 67.2% (RR 1.42; 95% CI 1.12–1.18; p=0.008). Bowel regimen utilization increased from 87.5% to 96.6% (RR 1.1; 95% CI 1.02–1.18; p=0.04). Short-term follow-up attendance increased from 35.7% to 53.4% (RR 1.49; 95% CI 1.09–2.04; p=0.01). Control charts demonstrated process changes in bowel regimen use, digital rectal examination, and OASIS documentation, but no statistical change in antibiotic use, repair in the OR, or follow-up attendance. Conclusions: Implementation of an evidence-based OASIS management guideline significantly improved compliance with key evidence-based practices, including digital rectal examination, repair documentation, antibiotic use, bowel regimen utilization, and follow-up attendance.

Diffuse alveolar hemorrhage (DAH) is a clinical condition characterized by bleeding into alveolar space as a result of vascular or capillary injuries. There are three types of DAH based on the process that causes blood spillage including diffuse hemorrhage associated with vasculitis, bland hemorrhage (without vasculitis) and diffuse with another process (such as tumor). Drug induced DAH is a type of bland hemorrhage results from overreaction to various drugs. Ketorolac tromethamine is a non-steroidal anti-inflammatory drug (NSAID) used for pain alleviation at the range of opioid level. Hypersensitivity reactions due to NSAIDs usage is common and up to 20% in high risk people. In this article we report a case of DAH due to IV ketorolac prescription.

Bloom syndrome is an autosomal recessive condition of genomic instability caused by increased sister-chromatid exchange, which results in a predisposition to a variety of cancers at a young age. The early ages of these cancers, as well as the nature of Bloom syndrome itself, alter the expected response to and toxicities of chemotherapy in patients with this condition. We report a 16-year-old patient with undiagnosed Bloom syndrome who presented with metastatic mucinous adenocarcinoma and tolerated palliative chemotherapy, initially with modified FOLFOX and subsequently with FOLFIRI, both at 50% dose reduction, without significant toxicity.

Symmetrical lipomatosis of the tongue represents a rare manifestation of Madelung's disease, a condition with a prevalence of approximately 1 in 25,000, characterized by the growth of unencapsulated masses of adipose tissue, symmetrically deposited around the neck, shoulders, or other sites around the body. This paper presents the case of a

Article Title: ”Uterine Dehiscence: A Diagnostic Conundrum in Repeat Cesarean Deliveries”Author Information: Pamela Sarue, M.D.1, Nicholas Eynon2, Reine A. Zbeidy M.D.1,21Division of Obstetric Anesthesiology, University of Miami, Jackson Memorial Hospital, Miami, FL2University of Miami Miller School of Medicine, Miami, FLInstitutional title/position of Reine A. Zbeidy:Associate Professor of Clinical AnesthesiologyProgram Director of Obstetric Anesthesia Fellowshiprzbeidy@med.miami.eduAuthor Contribution Statement:Dr. Pamela Sarue: Conceptualization, Investigation, Project administration, Writing - original draft, Writing - review & editingMr. Nicholas Eynon: Writing - review & editingDr. Reine A. Zbeidy: Conceptualization, Investigation, Project administration, Supervision, Writing - original draftCorresponding Author: Reine A. Zbeidy1600 NW 14th St, Miami, 33136Rzbeidy@miami.eduClinical trial number and registry URL: Not applicablePrior Presentations: Not applicableAcknowledgements: Not applicableWord Count (manuscript): 250 wordsAbbreviated Title: Not applicableSummary Statement: Not applicableFunding Statement: Support was provided solely from institutional and/or departmental sourcesConflicts of Interest: The authors declare no competing interestsPatient consent: Patient consent signed and collected in accordance with the journal’s patient consent policyKey Clinical Message: Uterine dehiscence (UD), often asymptomatic and underdiagnosed, is a significant risk in patients with prior cesarean deliveries. It can lead to complications like uterine rupture, increasing maternal and neonatal morbidity. Improved diagnostic protocols, particularly antenatal imaging, are essential to differentiate UD from placenta accreta spectrum, optimize resource utilization, and enhance patient outcomes.Manuscript:A 31-year-old G5P4004 woman was scheduled for repeat cesarean delivery (CD). She had 4 prior CD, anterior placenta, and suspected placental accreta, which was intra-operatively diagnosed as uterine dehiscence (UD) (Figure 1). Most UD cases are asymptomatic with no bleeding(1), and lack of standard diagnostic protocol makes their evaluation and management challenging(2).UD is a partial division of the uterus that does not affect all three layers (endometrium, myometrium, and perimetrium)(1). It is more common with each additional prior CD(2). With CD rates increasing from 5% to 30% in the past 35 years(2), this condition merits attention.UD may lead to a ”uterine window,” a thin uterine wall segment that reveals the fetus through the myometrium, as illustrated in Figure 1(1). Often undiagnosed due to the lack of a diagnostic protocol, it can be identified intraoperatively during repeat CD or antenatally between pregnancies on transvaginal ultrasound(2). A study of patients with prior CD (n=21,420) found an incidence of 10.1% for UD and 2.8% for uterine rupture, which is UD’s most concerning complication(3).Uterine rupture increases maternal and neonatal morbidity(1). Its potential for severe impact on patient hemodynamic stability necessitates maintaining clinical suspicion for this complication in patients with prior CD presenting with abnormal imaging.The preoperative misdiagnosis of a uterine window as placenta accreta spectrum demands additional resources such as more invasive monitoring, blood product availability, and multi-service involvement, all of which could be avoided with more accurate diagnostic tools. This underscores the necessity for advanced diagnostic modalities for uterine dehiscence and windows(2).References:Togioka BM, Tonismae T. Uterine Rupture. In: StatPearls . Treasure Island (FL): StatPearls Publishing; February 28, 2023.Eleje GU, Udigwe GO, Okafor CG, et al. Intra-operative Diagnosis of Lower Segment Scar Dehiscence in a Second Gravida After One Previous Lower Segment Cesarean Section: Should We Advocate for Routine Antenatal Uterine Scar Thickness Testing?. Clin Med Insights Case Rep . 2023;16:11795476231164379. Published 2023 Mar 29. doi:10.1177/11795476231164379Fogelberg M, Baranov A, Herbst A, Vikhareva O. Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section. J Matern Fetal Neonatal Med . 2017;30(17):2058-2061. doi:10.1080/14767058.2016.1236249Figure 1: Intraoperative photograph demonstrating a markedly thinned and bulging lower uterine segment at the site of the old cesarean scar, consistent with uterine dehiscence.

Case Report

INTRODUCTIONOptical cloaking has seen rapid advancements due to the integration of paraxial ray optics, digital integral cloaking, and broadband cloaking systems. Traditional cloaking methods have typically relied on complex optical setups or computational post-processing to redirect light around an object. These methods have demonstrated significant promise but also possess critical limitations, such as reliance on external energy sources, image distortions, and the requirement for precise alignment.Choi & Howell (2014) introduced a paraxial ray optics cloaking method using a four-lens system, which allows for the cloaking of objects in broadband visible light [1]. Their work established the feasibility of practical cloaking without metamaterials, which were previously a dominant area of cloaking research. However, the approach is limited by its sensitivity to misalignment and the need for a controlled environment for optimal effectiveness.Howell & Howell (2013) demonstrated a broadband optical cloaking technique capable of cloaking larger objects by employing multiple flat mirrors to redirect light paths [2]. While effective, the setup required bulky external mirrors, which limited its practicality for dynamic applications. This method showcased the ability to conceal objects without computational processing but was still constrained by its size and lack of adaptability to varying environmental conditions.More recently, Choi & Howell (2016) expanded upon these advancements with digital integral cloaking, which integrates computational imaging techniques for enhanced light redirection and concealment [3]. This method allows for improved image fidelity and increased flexibility in cloaking applications. However, it requires significant computational resources and external power inputs, making it less viable for large-scale or real-world implementation.A major challenge in cloaking research is the development of an independent cloaking system that does not rely on external computational components or excessive optical elements. The HD-ICD addresses this gap by utilizing parabolic mirrors to redirect light paths in a manner that eliminates the need for external power or processing. This novel approach builds upon the principles of previous cloaking techniques while mitigating their primary limitations, offering a self-contained, energy-efficient, and scalable solution.By leveraging the natural reflective properties of parabolic surfaces, the HD-ICD provides a high-fidelity optical cloaking effect that is effective across a range of visible light wavelengths. Unlike traditional systems that rely on predefined light paths through lenses or digital processing, the HD-ICD’s self-sustained optical redirection mechanism ensures practical feasibility across diverse applications.This study presents the theoretical foundation, computational modeling, and experimental validation of the HD-ICD, demonstrating its effectiveness in achieving high-definition optical cloaking. The results provide new insights into the development of non-powered, mirror-based cloaking devices that can be utilized in fields such as defense, architectural design, and scientific optics.

As global living standards improve and medical technology advances, many infectious diseases have been effectively controlled. However, certain diseases, such as the recent COVID-19 pandemic, continue to pose significant threats to public health. This paper explores the evolution of infectious disease modeling, from early ordinary differential equation-based models like the SIR framework to more complex reaction-diffusion models that incorporate both temporal and spatial dynamics. The study highlights the importance of numerical methods, such as the Runge-Kutta method, implicit-explicit time-discretization techniques, and finite difference methods, in solving these models. By analyzing the development and application of these methods, this research underscores their critical role in predicting disease spread, informing public health strategies, and mitigating the impact of future pandemics.

This article is aimed at studying the strength characteristics of the shell of pine nuts in order to develop effective devices capable of accurately splitting the shell, while preserving the core. Rheological properties were analyzed under static and impact loading. Static tests used the ST-2 structurometer with three indenters: Tarr-Baker, 45° cone, and 90° cone. Results showed that a 90° cone indenter at 15–16% shell humidity ensures optimal energy efficiency and kernel safety.Impact tests utilized a custom setup with a jagged load at a 90° angle, dropped from a controlled height. The best cracking occurred at 0.24–0.26 J, corresponding to 35–40 m/s. Theoretical analysis classified pine nut shells as thin-walled spherical structures, allowing the application of structural mechanics principles. Brittle fracture behavior, critical stress thresholds, and impact kinetic energy were studied and experimentally validated.A review of existing devices identified pneumatic dispersion as the most gentle cracking method, though limited by low aerodynamic resistance and acceleration distance. To overcome these challenges, a new two-stage device was developed. It first accelerates nuts using a high-speed toothed disc, followed by compressed air propulsion, reducing kernel damage and improving efficiency.The proposed device enhances pine nut processing for the food and pharmaceutical industries.

1. Plants are often exposed to multiple abiotic and biotic environmental variations in nature, but studies are very scarce on how plant respond to biotic variations, or interactive effects of abiotic and biotic factors. 2. Our objective was to investigate effects of light conditions on responses of plant biomass allocation to conspecific or heterospecific neighbors, and effects of these neighbors on plant response to shading vs. full light conditions. 3. We subjected plants of Buddleja lindleyana and Bidens pilosa to three treatments of solitary growth (control), intra- and interspecific interaction, under 50% shading and full light conditions, and measured a series of biomass and morphological traits on them. 4. Full light relative to shading decreased total mass, root mass and root:shoot ratio of B. pilosa under intraspecific competition, but increased them for both species grown alone and with heterospecific neighbors. Compared to those grown alone, intraspecific interaction increased mean total mass for B. lindleyana and increased root mass and root: shoot ratio for both species in shading, but reduced total mass and root:shoot ratio of B. pilosa under full light, with no effects of interspecific interaction. 5. Results suggested conspecific neighbors will more likely interfere with plant acquiring resources, making it more difficult or less efficient for plants to utilize the resources. Plants will adjust the strategy of biomass allocation for maximizing growth depending on both resource availability and accessibility, to enhance the efficiency of resource acquiring under severe environmental challenges. 6. Synthesis. By investigating responses of plants to variations in abiotic conditions and plant interactions simultaneously, we not only provided direct evidence for responses of plants to complex environmental factors, but also revised the optimal partitioning theory by emphasizing the importance of resource accessibility.

This laboratory has reported that the combined use of MicroFlow and MultiFlow assays provides information regarding chemicals’ genotoxic mode of action (MoA). In an effort to go beyond MoA assessments, we incorporated a panel of biological response modifiers that elicit specific effects on the assays’ biomarker response profiles. This was done to pursue our hypothesis that such perturbation signatures would reveal information on clastogenic mechanisms and molecular targets. For this proof-of-concept study, we exposed TK6 cells to 20 previously identified clastogens. TK6 cells in 96-well plates in the presence and absence of each of four modifying agents at one optimized concentration: talazoparib (PARP inhibitor), MK-8776 (CHK1 inhibitor), AZD-7648 (DNA-PK inhibitor), or a cocktail of reactive oxygen species scavengers. In parallel, cells were also exposed to each of the test chemicals for 4 hr, at which time cells were washed and allowed to recover for an additional 20 hours. For each of these treatment conditions, sample processing and flow cytometric analyses were performed using standard MicroFlow and MultiFlow procedures to measure micronuclei, γH2AX, phosphohistone-H3 (p-H3), p53 activation, and relative nuclei counts. The resulting biomarker response data were processed with PROAST benchmark dose (BMD) software, with modifying agent as a covariate. Unsupervised hierarchical clustering of the collective potency metrics for various combinations of biomarkers showed that clastogens with similar genotoxic mechanisms grouped together. Overall, this study shows that in combination with biological response modifiers, MultiFlow and MicroFlow biomarkers can provide mechanistic insights into chemical-induced genotoxicity.

Species must simultaneously adapt to climate stressors and other species, though available genetic variation may constrain this adaptation. Although evolutionary responses to climate can alter interactions among species, it is unknown how the intensity of selection by natural enemies influences species’ ability to withstand (i.e. survive and reproduce following) climate extremes like heat shock, and whether genetic diversity moderates these eco-evolutionary processes. Here we test whether impacts of heat shock on Drosophila simulans (host) fitness depend on their population’s history of interactions with a parasitoid or on the available host and parasitoid genetic diversity (manipulated by inbreeding). We exposed hosts to parasitoid populations over 11 host generations, then exposed their offspring and control hosts to experimental heat shocks. Heat shock more negatively affected the fitness of host populations with a history of high parasitism rates. Surprisingly, less-inbred hosts suffered more severely from heat shock, particularly when they had high historical parasitism rates. However, historically low parasitism rates were associated with a significantly reduced impact of heat shock on fitness relative to no or high parasitism, particularly for less-inbred hosts. Together these results suggest that genetically diverse host populations may retain heat-shock-vulnerable genotypes at high densities (perhaps due to a competition-tolerance trade-off), whereas lighter parasitism (at the approximate rates seen in nature) may prevent this accumulation of genotypes with low tolerance. The intensity of trophic interactions can therefore moderate species’ fitness responses to environmental change in non-linear ways.

Parasitic plants, characterized by their dependency on host organisms for nutrients, have displayed far-reaching alterations in physiology and genetics. While significant gene losses and relaxed selection have been documented in the nuclear and plastid genomes, how parasitism impacts the molecular evolution and function of mitochondria has remained controversial. One of the main culprits hindering our understanding in this area is the lack of knowledge on nuclear-encoded mitochondrial-targeted genes (N-mt), which encode most mitochondrial oxidative phosphorylation (OXPHOS) proteins. By conducting a comprehensive survey of N-mt genes across angiosperms, we demonstrated significant gene losses and horizontal transfers associated with relaxed selection unique to holoparasitic Orobanchaceae. These putative losses and transfers have the potential to affect mitochondrial function directly and cause mitonuclear incompatibility because of breakdown between co-evolved protein complexes from mitochondrial and nuclear genomes. Our physiological assessments using high-resolution respirometry revealed that despite genetic alterations, holoparasitic Orobanchaceae maintained robust OXPHOS function but relied more on the fully nuclear-encoded succinate dehydrogenase (complex II). Our results document the first example of significant and biased gene loss in nuclear-encoded mitochondrial OXPHOS genes in parasitic plants, expanding on previous studies focused on mitochondrial-encoded genes and elucidating the mechanisms underlying the preservation of OXPHOS function despite genomic reduction.

The use of remotely sensed imagery for the monitoring of both plant biodiversity and functional traits in grassland ecosystems has increased substantially in the last few decades. More recently, uncrewed aerial vehicles (UAVs) have begun to play an increasingly important role, providing repeatable very high-resolution data, acting as a bridge between the decameter satellite imagery and the point scale data collected on the ground. At the same time, machine learning approaches are rapidly expanding, adding new analysis and modelling tools to the plethora of UAV, aircraft and satellite observational data. Here, we provide a review of remotely sensed monitoring methods for grassland plant biodiversity and functional traits (Leaf Dry Matter Content, Crude Protein, Potassium, Phosphorous, Nitrogen and Leaf Area Index) between 2018 and 2024. We highlight the key innovations that have occurred, sources of error identified, new analysis methods presented and identify the bottlenecks to and opportunities for further development. We emphasise the need for (1) the integration of observations across spatial and temporal scales, (2) a more systematic identification and examination of sources or error and uncertainty (3) more widespread use of hyperspectral satellite data and (4) greater focus on the development of grassland global spectra, species and traits data base, from multi- and hyper-spectral instruments, to accelerate the creation of more robust, scalable and generalisable remote sensing based grassland models.

Research on hydroclimatic variations explains the relationships between water masses and global climate factors. Climate change causes changes in river flow regimes and impacts ecosystems, the economy, and society. In this study, we characterized the hydroclimatology of the seven reservoirs of the Tocantins River, along 1,500 km of river and during more than 12 years of sampling, where we analyzed climatic variables such as precipitation, global solar radiation, net evaporation, and air temperature, in addition to hydrological variables such as discharge and net evaporation of the reservoirs. We identified that the discharge of the reservoirs recovered more slowly after the dry period and that these discharges decreased at a rate of 575 m3/s between 1995 and 2023, followed by a negative and significant downward trend. As with discharge, precipitation showed a downward trend. The water deficit caused by prolonged droughts between 2015 and 2017 resulted in lower flows and higher air temperatures. In addition to climatic factors, the socioeconomics of the reservoir areas demand high water withdrawals, associated with population growth and agricultural production. We conclude that the reservoirs have a hydroclimatic gradient with latitudinal variations. These gradients are mainly due to differences in precipitation and flows, but are highly dependent on temperature conditions, solar radiation, evaporation, and water withdrawal. These factors are important and should be discussed in order to mitigate the ecological and socioeconomic impacts on the Tocantins River basin.

Background: The metabolic impact of poor diet quality in cystic fibrosis (CF), coupled with a rise in obesity and modulator-induced weight gain, is a growing concern. Our study aimed to understand knowledge and perspectives regarding dietary changes on modulators, and how measured nutrient intake changes with different dietary patterns in response to diet education. Methods: A cross-sectional survey was administered to 82 adult CF patients at the University of Alabama Birmingham. A subset of 10 participants received diet education and followed two diet patterns sequentially: a general healthful (GH) diet and a high fat (HF) diet. Three-day diet records were analyzed following each diet pattern. Results: A total of 82 adults responded to the survey and 42% of respondents reported making healthful dietary changes on modulators. Only 56% of respondents were able to correctly identify which foods contained fat. Diet record analyses showed a significant decrease in energy intake and fat intake on the GH diet compared to the HF diet. Baseline HEI scores improved significantly (p=0.0254) following education on a GH diet pattern, but were significantly lower following the HF diet (p=0.0179). Conclusions: While nearly half of survey respondents reported making healthy dietary changes on modulators, basic nutrition knowledge deficits persist. Measured diet quality was poor at baseline and significantly improved after receiving an educational session on GH eating. Findings highlight the need for targeted, basic education on GH eating patterns in the clinical practice and larger studies of nutrition interventions for improving diet quality in CF.

Cystic Fibrosis Transmembrane Related Metabolic Syndrome/Cystic Fibrosis Screen Positive, Inconclusive Diagnosis describes children with a positive newborn screen for whom follow-up tests do not confirm CF. Many are healthy carriers, but some will convert to a CF diagnosis; the natural history is not yet well understood. In children with chronic illnesses, unpredictable disease process and limited knowledge of long-term consequences present significant challenges to parental mental health. We wanted to understand the emotional wellbeing of parents with children with CRMS/CFSPID to guide the mental health support offered within the service. Parents were invited to complete validated depression and anxiety screening questionnaires and a short interview. Interview responses were transcribed and analysed using thematic analysis. Thirteen parents from 10 families completed questionnaires and/or the interview. Two of the parents had raised scores on the questionnaires. Our interviews revealed five themes explored here: difficulty adjusting to the label; concern about the future and its uncertainty; fluctuating states of anxiety (subthemes linked to respiratory tract infections and to medical appointments); difficulty explaining the label (subthemes to healthcare professionals and non-healthcare professionals); and satisfaction with the CRMS/CFSPID service. Our data reveal relatively benign scores using objective screening tools, but the qualitative data paints a picture of significant impact on wellbeing. We recommend screening parents from the time their child receives the label, and later the children themselves, for depression and anxiety and signposting to existing resources. Ultimately, a better understanding of the CRMS/CFSPID trajectory may enable us to give families the answers they need.

Dioecy is a system of sexual reproduction in plants that is characterized by the spatial separation of reproductive structures into different individuals. This system is thought to have evolved to reduce the negative effects of inbreeding that can occur in hermaphroditic ancestors. Although great progress has been made in understanding this phenomenon in recent years, the mechanisms of sex determination in plants are not yet fully understood. It is suspected that these mechanisms may have a genetic, physiological or even epigenetic basis. Cycads are dioecious plants that have considerable ornamental value but have a long period of sexual maturity, making it difficult to determine their sex at an early age. In some endemic Mexican species such as Ceratozamia mexicana Brongn., Zamia furfuracea L. f. and Zamia inermis Vovides, J.D. Rees & Vázquez-Torres, effective methods for early sex determination are crucial. To improve our understanding of dioeciousness and the mechanisms of sex determination in cycads, several different studies have been conducted. To improve our understanding of dioeciousness and the mechanisms of sex determination in cycads, several studies have been conducted using different genetic and epigenetic markers. In this study, we examine some of the developments in early sex determination that may help to create successful conservation plans for these important species, many of which have been recognized by the IUCN-2014 (International Union for Conservation of Nature) and the “Norma Oficial Mexicana” (NOM-059-ECOL-2010).

Using whole genome re-sequencing data we study population level associations with regional climate data and predict the response to future climate change in populations of cold-adapted grouse species from the Holarctic: rock ptarmigan (Lagopus muta), willow ptarmigan (L. lagopus), and red grouse (L. scotica). We infer the relationships among multiple regional populations of these species and examine their individual adaptations to environmental factors, genetic offset (gap) in the face of expected environmental change, and predict genes that may be associated with climate risk. Genomic vulnerability to future climate change scenarios (also known as offset or genetic gap) is predicted for each of the populations in the context of predicted range contractions under various global development scenarios. We show that different regional populations have SNP distributions implying differentiated influences of climatic parameters on predicted population-level persistence. We find evidence of adaptation in all species towards local annual temperature ranges and precipitation regimes. Ancestry proportions derived from principal components analysis identified genetic similarities between east and west Greenlandic populations of rock Ptarmigan, all Scandinavian willow Ptarmigan, and red grouse in England and Ireland. Based on our evidence of local adaptation, genetic association with these climatic variables, and expected environmental changes across the north Atlantic and Arctic, we suggest that general warming and increased rainfall will be driving pressures on these species with more stochastic weather patterns adding to threats against more geographically isolated groups with greater risks at higher latitudes.

We report a case of septal ventricular tachycardia with previous failed ablation attempts that was successfully treated using a bipolar ablation strategy, with the significant contribution of intracardiac echocardiography (ICE). ICE was utilized to enhance procedural safety by preventing steam pops and late ventricular septal defects (VSD) and to optimize outcomes by ensuring homogeneous ablation of the septal tissue, visually confirming a transmural lesion.

ABSTRACT Background VT ablation has become a cornerstone of patients care, especially for post MI VT. Several strategies have proven effective for achieving rhythm control in this population, but the workflow is highly variable and depends on physician experience. Aim This study describes the initial systematic experience of ventricular tachycardia (VT) ablation targeting wall thickness heterogeneity on cardiac computed tomography (CT) scanner used as surrogate for mapped VT isthmii. Methods Consecutive patients with post MI VT, a CT scan and a first VT ablation were included from January 2017 to May 2022. Targets were identified based on wall thickness heterogeneity. After image integration, ablation with >10 grams, 40-50 W was performed with the aim of blocking the CT channels/ render them non capturable. Only then inducibility was tested. Inducible VT, if any, were conventionally mapped and ablated with the aim of reaching non-inducibility. Results Thirty-nine patients (97.4% male, age: mean LVEF 35 ± 10%) were included. The mean number of identified CT Channels was 3.6 ± 1.8 / patient. Non-inducibility was achieved in 19 (48.7%) of patients after initial imaging guided ablation while at least one VT could be induced in 19 (48.7 %). Among these patients, 4 had VT related to unblocked or reconnected CT – determined VT channels, and 15 from other areas (border zone), typically with faster cycle length . After further mapping and ablation, 3 (7.7 %) patients remained inducible. Mean radiofrequency time was 35 ± 19 min for CT Channels ablation, with an additional 11 ± 8 min for supplementary ablation (global mean RF time 35 ± 19 min). With a mean follow-up of 47.8 ± 24.3 months, 61,9% (95% CI 44.0-75.5%) remained VT free. Conclusion CT-guided ablation represents a feasible and safe strategy for VT ablation in patients with an ischemic cardiomyopathy. Keywords: Ventricular tachycardia, catheter ablation, CT-Scan, InHeart software, imaging