Like many rodents, the water vole is able to reach high densities in meadows. During outbreaks, voles cause significant changes in plants communities. Although water voles consume a wide variety of plant species, dandelion hold a unique position: it is selected by voles year-round and serve as a key resource during winter. Voles harvest all parts of the dandelion and store the roots in almost monospecific food stores. As dandelions are perennial plants that take years to growth, vole activity may significantly affect dandelion populations. Our aim was to estimate the influence of dandelion density on vole space use, particularly on habitat selection during natal dispersal. We tested the hypothesis that voles select dandelion-rich plots for settlements. We also measured the variation in dandelion density due to new colonies settlements to assess potential feedback effects. We hypothesised that voles decrease dandelion populations. To achieve that, we used a drone to monitor dandelions and voles over two years. We monitored 52 quadrats, each half a hectare, three times a year. We analysed each image using remote sensing to locate voles and dandelions and then examined the interactions between their locations over time. We found that dandelion-rich plots were more likely to be colonised. In plots with low dandelion density, areas denser than the plot average were also more likely to be colonised. We observed a decrease in the number of dandelions after colony settlement. At last, we found evidence that existing burrows were more likely to be reused by new voles if dandelions were still present. 4- This study demonstrates that dandelion density is a key criterion in habitat selection for water voles and that vole colonies rapidly deplete this resource

Background. Beta-lactam allergy (BLA) labels are common in pediatric patients, but are often inaccurate, leading to unnecessary use of second line antibiotics. While direct oral challenge tests (OCTs) are effective for de-labeling, their incorporation in pediatric inpatient setting remains underexplored. This study aimed to assess the feasibility of implementing an inpatient pediatric BLA de-labeling program. Methods. A prospective study conducted in a pediatric ward involved inpatients undergoing a 2-step graded OCT. In-house pediatricians completed surveys to assess beliefs and barriers regarding inpatient OCT implementation. Follow-up included caregiver surveys and review of hospital and Health Maintenance Organization (HMO) electronic medical records (EMRs). Results. Of 192 eligible BLA-labeled patients, 32 (16.6%) were recruited, 93.8% carrying an amoxicillin allergy label and the vast majority without other drug allergy labels. All patients had a history of a mild reaction, 100% presented with a benign rash. 30/32 (93.4%) had a negative OCT. Pediatricians faced challenges such as workload pressures, staff shortages and overestimation of severe reaction risks, all serving as barriers for patient recruitment. At follow-up (median 37 months), 35.7% of caregivers reported de-labeling, while EMRs documented higher rates (HMO: 80%l; hospital: 70%). Despite successful OCTs, gaps in caregiver understanding and pediatrician support persisted. Conclusions. While direct OCTs are proved to be effective in de-labeling BLA, significant challenges persist in implementing inpatient de-labeling and ensuring their long-term success. These include low recruitment rates, pediatricians’ misconceptions and incomplete integration into EMRs. Addressing these barriers requires targeted education, improved communication and streamlined processes to improve de-labeling outcomes and support antibiotic stewardship.

Title: Thrombocytopenia and plasmacytosis: revealing a diagnosis of HIV with bone marrow biopsyDate: 12/18/24Investigators:Melissa Neumann, MDHematology/Oncology Fellow, Donald and Barbara Zucker School of Medicine at Hofstra/ R.J. Zuckerberg Cancer CenterAttending Hematology Oncology450 Lakeville RoadLake Success, New York 11042Tel: (516) 734-8900Fax: (516) 734-7687mneumann2@northwell.eduPratik Shah, MDHematology/Oncology Fellow, Donald and Barbara Zucker School of Medicineat Hofstra/ R.J. Zuckerberg Cancer CenterAttending Hematology Oncology450 Lakeville RoadLake Success, New York 11042Tel: (516) 734-8900Fax: (516) 734-7687Pshah19@northwell.eduDouglas E. Gladstone, MD

IntroductionAutoimmune inner ear disease (AIED) is a condition first described by McCabe in 1979 based on a diagnostic study on a cohort of patients[1] who presented with bilateral sensorineural hearing loss (SNHL) with a specific clinical pattern that did not fit with existing diagnoses and demonstrated audiometric improvement with corticosteroid and immunosuppressive therapy. The pathogenesis of AIED is not completely understood, though several mechanisms have been proposed, including uncontrolled humoral and cell-mediated reactions against inner ear antigens, [2] resulting in autoantibody development and T-cell responses. [3]AIED accounts for <1% of SNHL cases [2]but may be under-diagnosed due to a lack of standardised diagnostic criteria. [4] The main treatment has been corticosteroids; however, the overall reported response is 60-70%[2] and only 14% remain responsive after 34 months. [5] There is a risk of further decline in hearing in the absence of therapy. Alternative immunosuppressive treatments [3] were tried but these have yielded variable results. There is no standard treatment protocol for AIED following corticosteroids as randomised controlled trials are limited.[6] Here, we report a case of AIED in a patient that responded well to infliximab.

Article type :Case reportTitle: A typical dermoscopic pattern of PLEVA

Title Page:Title: Stroke in the Young:  A Case of CNS Vasculitis Secondary to Systemic Lupus ErythematosusAuthors: John Badir1, Justin Thorson2, Emily Barr1, Tamra Ranasinghe31Wake Forest School of Medicine, Winston-Salem, North Carolina2Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina3Departement of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZCorresponding Author: John BadirCorresponding Author Affiliation: Wake Forest School of Medicine, Winston-Salem, North CarolinaCorresponding Author’s Mailing Address: 539 Power Plant Circle apartment number 243, Winston-Salem, North Carolina 27101Funding statement: This article has no funding source.Data availability: The data used to support the findings of this study are available from the corresponding author upon request.Conflicts of Interest: Authors have no conflicts of interest to disclose.Acknowledgements: This case was presented at the North Carolina Neurological Society Conference, February 2024 in Greensboro, NC, as a poster presentation by authors John Badir, Justin Thorson, and Tamra Ranasinghe.Introduction:Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems, including the skin, joints, kidneys, and the nervous system. One of the severe complications associated with SLE is an increased risk of cerebrovascular accidents. Strokes in SLE patients can result from a variety of pathophysiological mechanisms. These include traditional cardiovascular risk factors, such as hypertension, hyperlipidemia, and smoking, which are compounded by disease-specific factors 1. The chronic inflammatory state of SLE contributes to accelerated atherosclerosis, which is a significant risk factor for ischemic stroke2. Additionally, SLE patients may have antiphospholipid antibodies, which increase the risk of thrombosis, leading to both ischemic and hemorrhagic strokes.  In the context of SLE, one of the more severe neurological complications is CNS vasculitis3. CNS vasculitis secondary to SLE most commonly affects the endothelium of small vessel arteries through perivascular inflammation in a concentric pattern3. This condition represents an inflammation of the blood vessels within the brain and spinal cord, a manifestation that, while not common, poses a significant risk for stroke in SLE patients4. Our case report highlights a unique case of CNS vasculitis in a patient with active SLE that subsequently caused a stroke. The body of literature on vasculitis secondary to SLE as the cause of cerebrovascular disease is extremely limited, thus this case report addresses an important sparsity in the literature for a disease with a high associated morbidity and mortality.Case history/Examination:46 year-old female with a history of hypertension, hyperlipidemia, hypothyroidism, two prior multifocal infracts, elevated cardiolipin IgM, and migraine without aura who presented with acute onset of left facial numbness and dysarthria with word finding difficulty. Her National Institute of Health Stroke Scale (NIHSS) was 7 with a serum glucose of 88 and a blood pressure of 158/89. CT head demonstrated chronic infarcts in the right parietal and occipitals lobes and no hemorrhage. She arrived at the emergency department within 4.5 hours of symptom onset and given the concerns for an acute ischemic stroke, she received IV Tenecteplase.

A document by Nishan Uprety. Click on the document to view its contents.

Case reports

Neuronal ceroid lipofuscinoses (NCL) are inherited neurodegenerative diseases characterized by psychomotor regression, seizures, and visual impairment, due to intracellular accumulation of lipofuscin. CLN5, a subtype manifesting from ages 4 to 17, is particularly rare in non-Finnish populations. Here, we report Japanese first case of CLN5 in an 11-year-old girl with progressive

IntroductionTransport and Golgi Organization Homolog 2 (TANGO2 ) deficiency is a rare genetic disorder with an autosomal recessive hereditary pattern that originates from biallelic pathogenic variants in the TANGO2 gene (OMIM: 616830) [1].Although the exact role of TANGO2 gene hasn’t been specified yet,TANGO2 deficiency disorder (TDD) can cause clinical findings such as developmental delays, seizure, life threatening rhabdomyolysis, hypothyroidism, different types of cardiac diseases which are the main reason for TDD mortality [1, 2].TDD was first described in 2016 and the incidence is estimated to be 1/1000000 with about 76 patients reported in medical studies[2, 3]. Even though most patients are involved with metabolic crises, seizures, and arrhythmias; not all the patients show a full TANGO2 -related phenotype[4]. 35% of patients in Dines et al study passed away before the age of 10 and the main reason was lethal arrhythmias leading to cardiac arrest [4].In this study we describe the clinical sequences of TDD case with homozygous allels from parents with heterozygous TANGO2 gene. Unlike most TDD cases that are commonly characterized with rhabdomyolysis and cardiac diseases[1], our case manifested no metabolic or cardiac disorder and the hallmark manifestation was episodes of seizure.

Preservation of the Posterior Meningeal Artery During Excision of a Foramen Magnum Meningioma: A Case ReportEiji Ito1, Yasuhiro Nakajima2, Takashi Izumi3, Takashi Tsujiuchi2, Ayako Motomura2, Ryuta Saito31Skull Base Surgical Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan2Department of Neurosurgery, Daido Hospital, Nagoya, Aichi, Japan3Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan* Correspondence: Eiji Ito, MD

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Background It is important to examine the effects of quality of life and determine the cost of illness of Acute Myocardial Infarction, one of the leading causes of death worldwide. factors, and comorbidities by this prospective study. Methods We calculated the cost of illness according to the bottom-up costing approach from the perspectives of patient and relatives, payer, and societal, and evaluated the disease-specific quality of life with HeartQoL and the general quality of life with EQ-5D-5L. Results The mean HeartQoL global score is 2.13±0.73. The mean EuroQol index score of the patients is 0.84±0.24, and the mean EuroQol VAS score is 70.74±22.94. The cost of illness per patient is $489.34 from the patient and relatives perspective, $641.98 from the payer perspective, and $1,131.32 from the societal perspective. The general quality of life scores of those without comorbidities are higher than those with comorbidities. Conclusion We concluded that the quality of life of patients with a family history of hypertension, diabetes, cholesterol, and obesity is lower than patients without any. It has been determined that the cost of illness is higher in patients with risk factors, and loss of income, medical supplies, and direct medical care costs have an important place in the cost of Acute Myocardial Infarction. We concluded that the quality of life of patients with low cost of illness compared better to patients with high cost of illness.

To predict natural events such as intense precipitation, flooding, and landslides, analyzing trends in rainfall patterns and conducting frequency analysis using the most suitable probability distribution function (PDF) is essential. The study aims to perform trend analysis and conduct frequency analysis after determining the best-fit PDF based on 35 years of annual rainfall data from 1988 to 2023 for nine stations in the Chittagong division, Bangladesh. Sen’s Slope Estimator and the Mann-Kendall trend model were used for trend analysis. Several PDFs, such as Gumbel, Generalized Extreme Value, Pearson Type-III, Log Pearson Type-III, Log-Normal, and Normal, were used, and return periods were estimated. Three goodness-of-fit tests—the Anderson-Darling, Chi-Square, and Kolmogorov-Smirnov—are performed to determine the best-fit PDF. All stations showed a declining trend, except CL325 (which exhibited an upward trend). Three of the stations showed statistically significant trend lines, while the remaining stations were not. Among the nine stations, the Generalized Extreme Value (GEV) distribution is the best fit for five, the Log-Normal for two, the Normal for one, and the Log Pearson Type-III for another, indicating that GEV is the most suitable for rainfall frequency analysis. For the return period, CL325 showed more variation in rainfall, whereas CL302 showed less variation. The findings of this study will enhance the understanding of current rainfall patterns and provide valuable insights into predicting future hydrological extremes, such as intense precipitation and flooding, in the region.

Background: The purpose of this study is to describe our experience in the observation of oropharyngeal dysphagia with endoscopic evaluations in patients suffering from ALS. Methods: We conducted a retrospective study of patients suffering from ALS managed with Serial Functional Endoscopic Evaluation of Swallowing. The patients were divided into no aspiration group and aspiration group based on the PAS scores obtained during the endoscopic evaluation of swallowing. Dysphagia was classified in according to ASHA -NOMS levels. Results: A total of 32 patients was examined and a different progression pattern of dysphagia was observed. Conclusion: Non-linear evolution of dysphagia with a plateau in patients affected by bulbar onset type ALS was observed.

Background: ThyroidEx is a 19-item self-reported outcome measure designed to evaluate the expectations related to thyroid surgery. This study intended to validate the Arabic version of the ThyroidEx and measure its reliability and applicability among Arabic-speaking patients undergoing total thyroidectomy. Methods: A prospective cohort study was conducted where the ThyroidEx questionnaire was translated into Arabic and culturally adapted. In contrast to the original study, we included only patients who underwent total thyroidectomy as it suits most of the questions within the measure, such as thyroid medications and hypocalcemia concerns, while those set to undergo hemithyroidectomy or completion thyroidectomy were excluded. Participants were asked to complete the Arabic ThyroidEx questionnaire before surgery and again after surgery. The internal consistency of the questionnaire was analyzed using Cronbach’s alpha. Results: Our study revealed that patient expectations regarding mood changes due to medication adjustments significantly increased after surgery, with a P-value of 0.012. While expectations about pain and fatigue remained consistent before and after surgery, there was a slight increase in the anticipation of fatigue postoperatively. Concerns about long-term medication use, side effects of thyroid medication, and cancer recurrence also heightened after surgery, reflecting growing patient anxiety in these areas. Conclusion: The findings underscore the importance of addressing mood changes, medication side effects, and long-term management in preoperative discussions. The significant shift in mood-related expectations and the stable reliability of the Arabic ThyroidEx questionnaire highlights its effectiveness in capturing patient concerns, which can guide better patient support and improve postoperative outcomes.

In active inference, the sensory surprisal (a log-probability of sensory data) of the prediction error between prediction and sensory input is modulated by action. The urge to move (groove) induced by syncopation, which provides metric prediction errors, can be considered a case of active inference in music perception. The present study investigated whether rhythmic prediction error is modulated by improving the precision of rhythm perception through tapping in sync with the rhythm. Thirty-five participants listened to a rhythmic sequence while tapping two beats (tapping condition) or holding a pillow (no-tapping condition), and electroencephalography (EEG) was recorded. In both conditions, the timing of tone onset was rarely earlier (deviant: 20%) than the standard (80%). The timing deviant elicited mismatch negativity (MMN) in both the tapping and no-tapping conditions, reflecting a prediction error in timing. Moreover, the MMN response, weighted by precision, was larger in the tapping condition than in the no-tapping condition. Neural entrainment was measured by calculating intertrial phase coherence (ITPC), which reflects oscillatory activity synchronized to stimulus frequency, and ITPC differed between the two conditions at beat-related frequencies. These results suggest that tapping enhanced meter and beat information, and reduced the sensory surprisal of syncopation, resulting in a larger precision-weighted prediction error. These effects were not due to physiological arousal differences between conditions, as assessed by EEG power and heart rate variability. This study provides evidence for the modulation of sensory prediction error by bodily engagement within the active inference framework.

The complex geometrical configuration of shaped film cooling holes (FCHs) enhances the cooling efficiency of turbine blades, while the stress concentration at the shaped FCH edge and the manufacturing defects usually leads to high cycle fatigue (HCF) failure under the service conditions. In this study, HCF tests at 900 ℃ were conducted on DD6 single crystal superalloy containing dustpan and dovetail FCHs. The effect of shaped FCHs and manufacturing defects on the HCF strength was investigated, and the related HCF failure mechanism was analyzed using SEM, EDS and EBSD. The results show that manufacturing defects including pores, recast layer and polycrystalline microstructure region exist around the shaped FCH edge. The stress concentration of defective pores promotes the plastic deformation and oxidation at high temperatures, leading to crack initiation. The fatigue strength is 318.89 MPa for the dustpan FCH specimen and is 304.93 MPa for the dovetail FCH specimen, and both of them are lower than that of the traditional cylindrical FCHs due to the existence of the manufacturing defects, indicating the necessity to consider the effect of manufacturing defects in the evaluation of the HCF strength of components with the shaped FCHs.

Small-molecule non-fullerene acceptors (SM-NFAs) featuring a three-dimensional and four-bladed propeller-like structure have gained attention due to their unique molecular framework as guest component in ternary organic solar cells (TOSCs). However, there is currently a scarcity of theoretical research into the photovoltaic properties of these SM-NFAs. This gap is especially pronounced when it comes to comprehending how modifications to their end groups (EGs) influence their electronic structures. In this work, SF-BTA1, SF-BTA2, and SF-BTA3 SM-NFA are selected since they have been experimentally synthesized and have different impacts on the performance of TOSCs. Using density functional theory (DFT) and time-dependent DFT (TDDFT), we have computed and analyzed their ground state and excited state properties, including molecular planarity, electrostatic potential maps and their corresponding fluctuations, dipole moments, frontier molecular orbitals, electron-hole distributions, UV-Vis absorption spectra, singlet-triplet energy gap difference (∆E ST), and exciton binding energy, as well as the open-circuit voltage of OSCs based on these four-bladed propeller-like molecules. The theoretical results align well with experimental data. Furthermore, as a guest acceptor, SF-BTA1 exhibits the smallest electrostatic potential fluctuations and singlet-triplet energy gap (∆E ST). This implies that these two factors could play crucial roles in evaluating whether a four-bladed propeller-like molecule is suitable to serve as an effective guest acceptor. Our results not only unveil the underlying mechanism about the roles of these NFAs in TOSCs but also provide valuable insights for the further design and optimization of highly efficient TOSCs.

Raman spectroscopy, when combined with Density Functional Theory (DFT) calculations, is a powerful method for investigating the vibrational properties of a broad range of molecular systems. When the Raman laser’s wavelength resonates with the molecule’s electronic transitions absorption, certain vibrational peaks are significantly amplified in the resulting spectrum. This effect, known as Resonance Raman (rR) spectroscopy, enhances the detection of molecular features and allows the observation of species at low concentrations. However, predicting rR spectra through DFT presents significant computational challenges. The theoretical modeling of rR spectra is more complex than non-resonant Raman spectra and less documented in the literature. This guide aims to address this gap by providing detailed and practical instructions for predicting rR spectra using various computational chemistry software, including ORCA, Gaussian, and ADF. The methods outlined are designed to help researchers accurately model rR spectra, providing deeper insights into molecular structure, reactivity, and chemical transformations.

Hospital Information System (HIS) is one of the important pillars in current healthcare system practice worldwide. The study initiated after a review revealed a scarcity of applications and studies on HIS in Malaysia’s public hospital setting. This scoping review aims to explore the current practice, benefits, and barriers associated with Health Information Systems (HIS) in Malaysian public hospitals. Utilizing the PRISMA guidelines, relevant literature was sourced from the SCOPUS database, focusing on publications from 2012 to 2022. A total of nine studies were selected for analysis. The review reveals that, despite being introduced early, the implementation and utilization of HIS in Malaysian public hospitals remain limited and slow. HIS offers substantial benefits, including improved clinical documentation, administrative efficiency, and enhanced quality and coordination of care. However, several barriers hinder its successful implementation, categorized into five main areas: financial, organizational, behavioral, technological, and support-related. Addressing these challenges is essential for realizing the full potential of HIS in improving patient care and hospital efficiency. This review serves as a baseline for identifying critical issues and guiding future improvements in Malaysia’s public healthcare sector.

This paper introduces an advanced dual-modality imaging platform by integrating a confocal laser scanning/imaging module with flat-fielding quantitative phase contrast microscopy (FF-QPCM). The platform enables phase/fluorescence dual-modality imaging of the same samples with high resolution and contrast. Using this platform, we observed that confocal fluorescence excitation causes minimal damage to cells, whereas wide-field fluorescence excitation results in significant damage, particularly mitochondrial fragmentation and notable alterations in phase values. Additionally, in situ quantitative phase imaging was conducted on live COS7 cells with a specific region irradiated by a confocal laser. The results demonstrated that 5-minute continuous confocal laser irradiation affects only COS7 cells with fluorescently labeled mitochondria, causing mitochondrial dysfunction throughout the cell. These findings suggest that integrating FF-QPCM with a confocal laser scanning/imaging module offers a highly efficient, sensitive, and information-rich tool for cell biology research, with broad application potential.

OBJECTIVE: This study aims to investigate the effectiveness of multi-level integrated management strategies designed to enhance nutritional screening and support for oncology patients. METHODS: An interrupted time series model was employed to evaluate changes in the levels and trends of nutritional screening and support for inpatients before (January 2021 to January 2023) and after (February 2023 to November 2024) the implementation of management measures.. RESULTS: After a quality improvement project above the execution of extensive strategies to improve clinical nutrition services, there was a significant increase in the number of inpatients receiving nutritional screening (β3 = 125.17, P < 0.05), the rate of nutritional screening (β3 = 2.28, P < 0.05), and the nutritional treatment rate (β3 = 2.49, P < 0.05) among inpatients identified as at nutritional risk. Additionally, the number of inpatients receiving nutritional support (β2 = 481.45, P < 0.05) and the nutritional support rate (β2 = 5.09, P < 0.05) also significantly increased following the implementation of these improvement measures, with the results demonstrating statistical significance.Overall, these findings indicate a marked improvement in the nutrition screening rate, nutrition support rate, and nutritional treatment rate among hospitalized patients at nutritional risk after the policy intervention. governance strategies-including the establishment of a clinical nutrition management system, mandatory nutritional screening, adequate training, standardization of medical records documenting nutritional interventions, and the integration of clinical nutrition into multidisciplinary management to enhance clinical nutritional service-there was a significant increase in the number of inpatients receiving nutritional screening (β3 = 125.17, P < 0.05), the rate of nutritional screening (β3 = 2.28, P < 0.05), and the nutritional treatment rate (β3 = 2.49, P < 0.05) among inpatients identified as at nutritional risk.Furthermore, the number of inpatients receiving nutritional support (β2 = 481.45, P < 0.05) and the nutritional support rate (β2 = 5.09, P < 0.05) after these improvement measures were put into place, with the findings showing statistical significance.Overall, these findings indicate a marked improvement in the nutrition screening rate, nutrition support rate, and nutritional treatment rate among hospitalized patients at nutritional risk after the policy intervention. CONCLUSION: Through comprehensive management measures, nutritional screening and support for inpatients in specialized hospitals have significantly improved following comprehensive management measures. It is essential for healthcare institutions to increase awareness of malnutrition among cancer patients, prioritize early nutritional screening and assessment, and develop nutritional intervention plans aimed at improving the quality of survival for oncology patients.

smORF encoded polypeptides (SEPs) are difficult to predict due to their small size. While modern genome annotation tools are capable of identifying smORFs, their reliability is often uncertain. Furthermore, experimental validation of smORFs has primarily focused on a limited set of model organisms. Here we conduct a comprehensive analysis of annotated smORFs in a diverse range of bacteria interacting with eukaryotic hosts. Our analysis revealed that bacterial genomes typically harbor between 100 and 300 annotated smORFs, predominantly encoding SEPs exceeding 40 residues and annotated as hypothetical proteins. We show that functional annotation of SEPs can be improved to some extent with the currently available resources, and that SEPs exhibit distinct functional profiles in bacteria associated with different host types (plant vs. animal). We also found that most of the experimentally validated SEPs are conserved, and that all the annotated SEPs begin with methionine, while that is not always the case for the experimentally validated ones. Our findings underscore the need for improved annotation methods and further experimental characterization to fully understand the functional roles and evolutionary significance of smORFs in bacteria-host interactions.