Hundreds of experiments conducted over the last decades demonstrate a positive relationship between species diversity and ecosystem functions. Following good experimental practice, most of these studies have manipulated species richness artificially by assembling communities randomly. Yet, natural communities along ecological gradients often show niche-based responses to selection gradients and species extinction order is generally not a random process. Such responses are commonly trait-mediated and the effects of communities on ecosystems’ functions also depend on species traits. In an effort to disentangle the relationship of trait mean value and diversity with ecosystem functioning, we revisited a community assembly mesocosm experiment that simulated habitat heterogeneity and a typical gradient of productivity to test how body size diversity and composition of cladocerans responded to such gradients and whether and how such trait responses impacted top-down control of unicellular algae, a key ecosystem function in aquatic systems. Nutrient addition and habitat heterogeneity lead to an increase in community average size (CAS), which ultimately resulted in an increased zooplankton resource use efficiency (RUEZP). This increase in CAS acted as a buffer for ecosystems functions despite the decline in species richness under high phosphorus levels. Habitat heterogeneity also increased size diversity (SD) and species richness (S) and modified CAS and SD responses along the nutrient gradient. CAS proved to be more powerful in explaining variation in RUEZP than SD and S. Our results suggest that exploring the response of the mean value of a key trait, such as zooplankton body size, to eutrophication might offer a much better understanding of variations in the top-down control of algae compared to relying solely on taxonomic and functional diversity metrics.

Floating offshore wind (FOW) is a renewable energy source that is set to play an essential role in addressing climate change and the need for sustainable development. However, due to the increasing threat of climate emergency, more wind turbines are required to be deployed in deep water locations, further offshore. This presents heightened challenges for accessing the turbines and performing maintenance, leading to increased costs. Naturally, methods to reduce operational expenditure (OpEx) are highly desirable. One method that shows potential for reducing OpEx of FOW is LIDAR-assisted pitch control. This approach uses wind velocity measurements from a nacelle-mounted LIDAR to enable feedforward control of floating offshore wind turbines (FOWTs), and can result in reductions to the variations of structural loads. Results obtained from a previous study of combined feedforward collective and individual pitch control (FFCPC+FFIPC) are translated to OpEx reductions via reduced component failure rates for future FOW developments, namely in locations awarded in the recent ScotWind leasing round. The results indicate that LIDAR-assisted pitch control may allow for an up to 5% reduction in OpEx, increasing up to 11% with workability constraints included. The results varied across the three ScotWind sites considered, with sites furthest from shore reaping the greatest benefit from LIDAR-assisted control. This work highlights the potential savings and reduction in the overall levelised cost of energy for future offshore wind turbine projects deliverable through the implementation of LIDAR-assisted pitch control.

This study introduces an Artificial Intelligence-enhanced Consensus-Based Bundle Algorithm For Cooperative Robots Task Planning. The method combines an optimized Consensus-Based Bundle Algorithm (CBBA) with a solution to the Travelling Salesman Problem (TSP), enhancing the robots’ path planning efficiency. It uses graph convolutional neural networks (GCNNs) to better understand task requirements and the physical layout of areas, leading to more effective cooperative planning. The paper’s main contributions are two-fold: first, it introduces a GCNN-based architecture that improves how tasks are assigned to robots. Second, it integrates an improved TSP solution to optimize the paths that robots take. This approach is decentralized, allowing for effective distribution of tasks among multiple robots while considering each robot’s abilities and the need for communication between them. The effectiveness of this method was thoroughly tested in an indoor demonstration at the City, University of London.

Conservation biology requires accurate data on how human-induced threats affect wildlife fitness and survival. Gut microbiota play a critical role in health by influencing physiology, nutrition, immunology, and behaviour. Advances in non-invasive sampling, particularly scat microbiome analysis, offer scalable conservation solutions. This study establishes a benchmark using basic machine learning algorithms (SVM, Ranger, glmnet, and xgboost) to predict health outcomes in koalas from non-invasive scat microbiome data. Scat samples from 125 koalas were analysed using 16S PacBio HiFi sequencing. By incorporating a phylogenetic approach and integrating additional metrics such as sex, age, and stress metabolites, which can potentially be acquired non-invasively, we achieved high accuracy in predicting key health outcomes, including body condition score (BCS), disease status, survival outcome, and weight. The algorithms achieved a minimum accuracy of 68% and a maximum accuracy of 84%. By establishing this benchmark, we set the stage for future research to utilize wildlife hospital infrastructure for larger sample collection and advanced machine learning, with the ultimate goal of developing a predictive health diagnostics tool for wildlife.

Aim: Allergic rhinitis (AR) is a disease with genetic, immunological, and inflammatory component, several therapeutic options are available. We conduct a systematic review to evaluate desloratadine and phenylephrine efficacy to control RA associated symptoms. Methods: 43 studies were included: 24 parallel-arm, 5 cross-over, one blinded, double-dummy, 7 cross-blinded, double-dummy, and 6 unblinded open-label trials. 22% were conducted in subjects with perennial allergic rhinitis, 78% were in subjects with predominantly seasonal behavior. The studies provide 6,772 subjects who underwent desloratadine, and 6,456 who received placebo or active drug. Results: A significant impact of the administration of desloratadine on TSS [week 2, MD –1.26 (95% CI -2.28 to -0.25h)] TNSS [week 2 MD –0.73 (95% CI -0.93 to -0.53)]; TNNSS [week 2 MD -0.51 (95% CI -0.72 to -0.29)]; RNCS [week 2 MD -0.16 (95% CI -0.17 to 0.50)], rhinorrhea [week 2, MD –0.28 (95% CI -0.48 to -0.07)]; nasal congestion [week 2 MD –0.25 (95% CI -0.45 to -0.06)]; quality of life [week 2, MD –0.29 (95% CI -0.42 to -0.17)]; peak nasal flow [week 2 MD 1.76 (95% CI 0.04 to 3.57)], and other parameters was identified. The impact was significant not only when compared with a placebo, but also when compared with several active ingredients of control drugs. Conclusion: Desloratadine, as well as phenylephrine are safe and effective for the control of total, nasal and non-nasal symptoms associated with allergic rhinitis, effect associated with modulation of inflammation and immunomodulatory cascades, its use in combination is an excellent therapeutic option.

Title: Chandipura Virus Resurfaces: The Indian State Gujarat’s urgent wake-up callDarshani Ransariya 1, Dhruvit Makvana1, Nirav Nimavat 1, Shruti Singh21. Department of Community Medicine, Gujarat Adani Institute of Medical Science, Bhuj, Gujarat, India.2. Department of Pharmacology, All India Institute of Medical Sciences, Patna, Bihar, India.The recent outbreak of Acute Encephalitis Syndrome (AES) cases since early June 2024 have been reported from Gujarat in children under 15 years of age. As on 31st July 2024, 148 AES cases (140 from 24 districts of Gujarat, 4 from Madhya Pradesh, 3 from Rajasthan & 1 from Maharashtra) have been reported, out of which 59 cases have died. Chandipura virus (CHPV) has been confirmed in 51 cases, serves as a stark reminder of the persistent threat posed by vector-borne diseases in India.1 This resurgence demands immediate attention from health authorities and policymakers alike. Chandipura virus, first identified in 1965 in Maharashtra, has periodically emerged as a significant public health concern, particularly in western and central India, with its alarming fatality rate of nearly 50%-75%, underscores the virus’s potency and the urgent need for robust preventive measures.2,3Comparing this outbreak to previous occurrences, we see a troubling pattern. In 2003, Gujarat faced a severe outbreak with over 300 cases and a mortality rate exceeding 50%. The virus struck again in 2004 in Andhra Pradesh, causing 16 deaths from 329 suspected cases. These historical data points, juxtaposed with the current situation, indicate that while the scale of outbreaks may have reduced, the virus’s lethality remains a grave concern.4,5 The recurring nature of these outbreaks raises critical questions about our long-term strategies for disease control and public health infrastructure. Why, despite our experiences with previous outbreaks, are we still struggling to contain the spread effectively? The answer likely lies in a combination of factors: insufficient vector control measures, inadequate surveillance systems, and perhaps a lack of sustained public awareness campaigns during inter-epidemic periods.Furthermore, the present outbreak is taking place as the healthcare system is still getting over the COVID-19 pandemic’s effects. This combination of difficulties calls for a reassessment of our strategy for controlling vector-borne illnesses.Moving forward, a multi-pronged strategy is imperative:1. Enhanced surveillance: Putting in place reliable early warning systems to find viral activity before it spreads to epidemic levels.2. Vector control: Stepping up measures to combat the sand fly population, which serves as the main vector for the Chandipura virus.3. Research and development: Funding research to learn more about the possible mutations and patterns of viral propagation.4. Public awareness: Launching extensive public education programmes about early detection of symptoms and preventative measures.5. Healthcare preparedness: Ensuring that clinics and hospitals in endemic areas have the necessary tools to quickly identify and treat Chandipura virus infections.The current outbreak in Gujarat is not just a local crisis but a national wake-up call. It highlights the need for a more proactive and sustained approach to managing vector-borne diseases. As climate change potentially expands the habitable zones for disease vectors, the threat of such outbreaks may only increase. From July 19, 2024, a decreasing trend in the number of newly reported cases of AES per day has been seen. Gujarat has implemented a number of public health initiatives, including IEC, insecticidal spray for vector control, medical staff awareness, and prompt case referrals to approved hospitals. To support the Gujarat State Government in implementing public health measures and carrying out a thorough epidemiological investigation into the outbreak, a National Joint Outbreak Response Team (NJORT) has been sent in. NCDC and NCVBDC are releasing a combined recommendation to help neighbouring States with their AES case reporting.1In conclusion, it is critical to see this as a chance to improve our general readiness against vector-borne diseases, even as we struggle with the pressing issue of managing the outbreak in Gujarat. The sad loss of life serves as a stark warning about the price of complacency. It’s time for coordinated efforts to make sure that outbreaks are avoided in the future or, at the very least, are handled more skilfully.References:1. PIB. Update on Chandipura Outbreak in Gujarat [Internet]. 2024 [cited 2024 Aug 1]. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=20399352. Bhatt PN, Rodrigues FM. Chandipura: a new Arbovirus isolated in India from patients with febrile illness. Indian J Med Res. 1967 Dec;55(12):1295–305.3. Dhanda V, Rodrigues FM, Ghosh SN. Isolation of Chandipura virus from sandflies in Aurangabad. Indian J Med Res. 1970 Feb;58(2):179–80.4. Chadha MS, Arankalle VA, Jadi RS, Joshi M V, Thakare JP, Mahadev PVM, et al. An outbreak of Chandipura virus encephalitis in the eastern districts of Gujarat state, India. Am J Trop Med Hyg. 2005 Sep;73(3):566–70.5. Rao BL, Basu A, Wairagkar NS, Gore MM, Arankalle VA, Thakare JP, et al. A large outbreak of acute encephalitis with high fatality rate in children in Andhra Pradesh, India, in 2003, associated with Chandipura virus. Lancet. 364(9437):869–74.

The lifespan of aqueous zinc ion batteries (AZIB) has been hindered by the instability of zinc anodes, encountering challenges such as ir-regular dendritic growth, corrosion and hydrogen evolution reactions. Here, an ultrathin conductive titanium oxynitride (TiNxOy) layer with rich zincophilic sites is constructed by a high-precision and atomic-scale controlled atomic layer deposition (ALD) technique for sta-bilizing the Zn anode. The TiNxOy layer acts as a bi-functional barrier, effectively isolating metal zinc from the electrolyte and thereby mitigating spontaneous corrosion and hydrogen evolution reaction of the Zn anode. Additionally, it enhances zincophilic sites and ho-mogenizes the distribution of interfacial electric field, facilitating uniform plating and stripping of Zn at the anode. Consequently, the TiNxOy@Zn anode exhibits significantly reduced over-potential and long-term cycling stability over 1300 h at 1 mA cm-2 in symmetric cell. The full cell is assembled with a TiNxOy@Zn anode and MnO2 cathode, achieving a capacity of 85.3 mAh g-1 after 4500 cycles at 10 C.

Climate and infectious diseases each present critical challenges on a warming planet, as does the influence of climate on disease. Both are governed by nonlinear feedbacks, which drive multi-annual cycles in disease outbreaks and weather patterns. Although climate and weather can influence infectious disease transmission and have spawned rich literatures, the interaction between the independent feedbacks of these two systems remains less explored. Here, we demonstrate the potential for long-lasting impacts of El Niño–Southern Oscillation (ENSO) events on disease dynamics using two approaches: interannual perturbations of a generic SIRS model to represent ENSO forcing, and detailed analysis of realistic specific humidity data on an SIRS model with endemic coronavirus (HCoV-HKU1) parameters. Our findings reveal the importance of considering nonlinear feedbacks in susceptible population dynamics for predicting and managing disease risks associated with ENSO-related weather variations.

Resources play an important role in shaping the evolution of plant defensive strategies. Much research has focused on how resource availability impacts the overall concentration of specific defensive compounds, particularly among-species. Yet, how resource availability influences overall phytochemical diversity within species, and how this in-turn might affect herbivore damage is less well understood. Using Monarda fistulosa, a species that produces diverse terpene compounds and distinct chemotypes (i.e., thymol or carvacrol), we addressed three primary questions: 1) How do phytochemical components (i.e., total concentration, Shannon diversity, and chemotypes) vary between distinct populations from two large, widely separated regions that differ in climate and productivity? 2) How do these components influence attack by different herbivore species? 3) What are the growth costs of higher phytochemical levels in different chemotypes? Seeds were collected from 12 populations, six from a low-productivity/resource environment in Montana, and six from a high-productivity/resource environment in Wisconsin. Seedlings produced from these seeds were transplanted to a common garden in Wisconsin. Over two growing seasons, we analyzed terpene concentrations, quantified the number of herbivores damage, and measured plant above-ground biomass. Plants from Montana exhibited higher terpene concentrations but lower diversity, whereas those from Wisconsin displayed lower terpene concentrations but higher diversity. Total terpene concentration emerged as the primary predictor of herbivore damage, although some differences were observed between region of origin and with terpene richness. Herbivores exhibited mixed responses to phytochemistry; some herbivores were negatively affected, while one species, a specialized leaf galler, responded positively. Costs of producing defenses were evident, manifest by negative correlations between plant biomass and total terpene concentration (but not chemical richness or Shannon diversity). Our study revealed that regional differences in resource availability and productivity can influence the evolution of phytochemical concentration and diversity, which, in turn, affects plant damage and incurs growth-related costs.

The core-mantle boundary (CMB) and the outermost core are dynamic and heterogeneous regions with time-dependent flows. We examine two seismic raypaths - diffracted P and PKP precursors – both replete with scattering, with precisely repeating earthquakes. These earthquakes, occurring in the South Sandwich Islands, were recorded on the Yellowknife array in Canada, the Alice Springs array in Australia, and Eilson Array in United States for the past 30 years. In all the most resolved cases, five for diffracted P and 19 for PKP precursors, we observe 1-2 Hz scattered waves that exactly repeat within the resolution of our study for more than 10 seconds. Although the absence of observable changes is unsurprising, it imposes constraints on potential temporal variations near the CMB. This suggests that any dynamic processes in this region might either be too subtle to detect, even with the high-frequency waves, or occur on different timescales.

Royal jelly (RJ) contains 10-hydroxydecanoic acid (10HDAA), which is expected to have immune activation effects, such as promoting M cell differentiation. To enhance the use of RJ as a functional immunostimulatory food ingredient, it is desirable to increase its 10HDAA content. Our aim was to isolate bacteria capable of converting 10-hydroxy-2-decenoic acid (10H2DA) contained in RJ to 10HDAA, thereby applying the isolate for producing fermented RJ with a high 10HDAA content. A strain of lactic acid bacteria, strain M1, was successfully isolated from the digestive tract of queen bees, capable of converting 10H2DA to 10HDAA. It was identified as Lactobacillus panisapium. By cultivating strain M1 in a protease-treated RJ broth, fermented RJ (fRJ) containing five times the amount of 10HDAA compared to conventional RJ was produced. Preliminary evaluations of fRJ’s immune-stimulating effects revealed several benefits. It promoted the differentiation of M cells, which play a crucial role in intestinal immunity, activated the phagocytic ability of macrophages, and increased IgA secretion in individuals with reduced salivary immunoglobulin (Ig) A secretion. Safety tests confirmed that fRJ is safe for consumption. fRJ acts on M cells, which tend to decrease with age, and promotes salivary IgA secretion. This suggests that fRJ could be a novel immune-stimulating food rich in active ingredients.

SR/RS dipeptide repeats vary in both length and position and are phosphorylated by SR protein kinases (SRPKs). PIM-1L, the long isoform of PIM-1 kinase, the splicing of which has been implicated in acute myeloid leukemia, contains a domain which consists largely of repeating SR/RS and SH/HS dipeptides (SR/SH-rich). In order to extend our knowledge on the specificity and cellular functions of SRPK1, here we investigate whether PIM-1L could act as substrate of SRPK1 by a combination of biochemical and computational approaches. Our biochemical data showed that the SR/SH-rich domain of PIM-1L was able to associate with SRPK1, yet it could not act as a substrate but, instead, inactivated the kinase. In line with our biochemical data, molecular modeling followed by a microsecond-scale all-atom molecular dynamics (MD) simulation suggests that the SR/SH-rich domain acts as a pseudo-docking peptide that binds to the same acidic docking-groove used in other SRPK1 interactions and induces inactive SRPK1 conformations. Comparative community network analysis of the MD trajectories, unraveled the dynamic architecture of apo SRPK1 and notable alterations of allosteric communications upon PIM-1L peptide binding. This analysis also allowed us to identify key SRPK1 residues, including unique ones, with a pivotal role in mediating allosteric signal propagation within the kinase core. Interestingly, most of the identified amino acids correspond to cancer-associated amino acid changes, validating our results. In total, this work provides insights not only on the details of SRPK1 inhibition by the PIM-1L SR/SH-domain, but also contributes to an in-depth understanding of SRPK1 regulation.

Background: Premature ventricular contractions (PVCs) are frequently observed with left ventricular (LV) systolic dysfunction, although the prevalence of these associated conditions in the general population remains unknown. Objective: We sought to understand the prevalence of frequent PVCs (defined PVCs>5%) and high burden PVCs (defined PVCs>10%) and LV systolic dysfunction in patients receiving ambulatory Holter monitors (HM). Methods: A prospective multicenter (8 US medical centers) cross-sectional study collected demographic and PVC burden data from consecutive patients undergoing 24-hour, 48-hour, and 14-day HM (July 2018-June 2020). Left ventricle ejection fraction (LVEF) data was collected if obtained within 6 months of HM. Four PVC burden groups were analyzed (<1%, 1-5%, 5.1-10% and >10% burden) and stratified by normal LVEF (≥50%) or presence LVEF<50%. Results: The prevalence of PVC burden of 5.1-10% and >10% was 4% and 5%, respectively in the population undergoing HM (n=6,529). Age was significantly different between PVC groups (p<0.001). In those with LVEF assessment (n=3,713), the prevalence of LVEF<50% and both LVEF<50% and PVC>5% was 16.4% and 4.2%, respectively. The prevalence of PVC>5% and PVC>10% in patients with LVEF<50% was 26% and 16%, respectively. PVC>5% were more prevalent in older, male, and Caucasians (p<0.001). Females had a lower prevalence of PVC>5% than males (6% vs. 11%; p<0.001), but not among those with LVEF<50% (24% vs. 26%, p=0.10). Conclusion: PVC>5% and PVC>10% and LVEF<50% are prevalent in patients undergoing HM. PVC>5% are associated with older age. Females have a lower prevalence of PVC>5% than males but similar combined PVC>5% and LVEF<50%.

Esophageal injury is a serious complication following atrial fibrillation catheter ablation procedures. It may manifest as atrio-esophageal fistula, pericardio-esophageal fistula (PEF) or restricted perforation with high mortality rate, if left unoperated. Chest computed tomography with intravenous contrast is the mainstay of diagnosis, however a definite imaging diagnosis is often delayed, and may worsen patient outcomes. This case demonstrates that pericardial fluid amylase detection may contribute to early differential diagnosis of PEF versus restricted esophageal perforation combined with inflammatory pericarditis, in patients with relevant symptoms who present with pericardial effusion and may guide either conservative- as our case- or surgical approach.

Electrical storm (ES) is a life-threatening condition that requires a stepwise management approach, including antiarrhythmics, anxiolytics/sedatives, antiadrenergic, and hemodynamic support. In 88% of refractory cases, cardiac sympathetic denervation has proven effective in reducing ventricular tachycardia (VT) burden and ICD shocks. We present a patient with late-presenting ST-elevation myocardial infarction (STEMI), new reduced left ventricular ejection fraction (LVEF), post coronary artery bypass graft (CABG), who experienced recurrent monomorphic VT despite amiodarone, lidocaine, and left stellate ganglion block, who was successfully treated with bilateral video-assist thoracoscopy sympathetic ganglionectomy.

COVID-19 Vaccination and Atrial fibrillation: When Pandemics CollideJason S. Chinitz, MD1,2,3 and Laurence M. Epstein, MD1,2,41Northwell, New Hyde Park, NY2Northwell Cardiovascular Institute3South Shore University Hospital, Bay Shore, NY4North Shore University Hospital, Manhasset, NYShort title : COVID-19 Vaccination and Atrial fibrillationKey Words : Atrial Fibrillation, Atrial Arrhythmias, COVID-19, COVID-19 VaccinationFinancial support : none.Conflicts of Interest :Jason Chinitz, MD: Consultant for Boston Scientific, Biosense Webster, MedtronicLaurence Epstein, MD: none.Address for Correspondence :Jason Chinitz, MDNorthwell, 2000 Marcus Ave, Suite 300New Hyde Park, NY 11042-1069jchinitz@northwell.eduIn the wake of the coronavirus disease 2019 (COVID-19) pandemic, accelerated research and development efforts were made to create a new class of vaccinations to mitigate the unprecedented global health burden. However, the rapid development and approval process was a factor in prompting vaccine hesitancy, based partially on concerns regarding the safety of the vaccine. Adding to the hesitancy, reports of adverse reactions became widely disseminated in medical literature, as well as in social media. However, the lack of long-term data and controlled studies have limited interpretation of the true COVID-19 vaccine risk profile, and has hampered the effort to combat misinformation.Cardiac complications are the most frequently reported adverse reaction following COVID-19 vaccination.1 Case series have attributed exacerbations of various chronic cardiac diseases to COVID-19 vaccination, including hypertension, coronary artery disease, and arrhythmias.2 In the WHO database, palpitation and tachycardia were reported frequently across all age groups and gender following vaccination, including many cases of atrial fibrillation.2 The Vaccine Adverse Event Report System (VAERS) database of the Food and Drug Administration reported over 2600 cases of atrial fibrillation following COVID-19 vaccination, only 315 of which were reported as new-onset.3 These reports, however, are generally anecdotal, denominators are not considered, and causality cannot be inferred. Any association is further confounded when evaluating the vaccine’s effects in populations in whom cardiovascular disease is the most common comorbidity, as the prevalence of heart rhythm abnormalities is already high. In this circumstance, patients and clinicians may tend to inappropriately attribute an arrhythmia occurrence to a history of vaccination. Indeed, the majority of adverse medical outcomes that occur following vaccination may have little to do with the vaccine itself, even when the temporal relationship is suggestive.Tachycardia and arrhythmias may occur as an inflammatory or stress-related response to vaccination. Inflammatory reactions such as myocarditis and pericarditis have been shown to occur at higher rates following COVID-19 vaccination.4 A potential mechanism of post-COVID-19 vaccine adverse events has been attributed to an immune response to the detection of mRNA as an antigen, particularly in genetically predisposed individuals; in these cases, immunization may activate inflammatory cascades, leading to systemic reactions including myocarditis and potentially atrial and ventricular arrhythmias.5 Atrial fibrillation and ventricular arrhythmias have been long associated with inflammatory conditions, and are relatively common in patients with pericarditis and myocarditis.6 Accordingly, an increase in arrhythmia burden after vaccination is biologically plausible, regardless of whether the vaccine itself is pro-arrhythmic.For practicing cardiologists, atrial fibrillation can reasonably be considered a disorder of pandemic proportions. Driven by both modifiable and non-modifiable risk factors, and more ubiquitous screening and detection modalities, the incidence of AF has been reported to be 31% higher in 2017 compared to 1997, and predictive models suggest AF will impact nearly 8 million Americans by 2050.7,8Furthermore, AF burden is progressive in at least 25% of patients, including progression from paroxysmal to persistent AF in 8-15% of patients per year.9 AF interventions, particular AF ablation, have been shown to reduce the rate of progression to persistent AF markedly.10Though increasing AF burden in an individual patient may be attributed to the natural history of the disease, cardiovascular risk factors are commonly implicated as drivers of AF progression. Interestingly, the pandemic itself may have also contributed to the increasing prevalence of AF, as we have reported high rates of AF, nearly two-thirds of which was new onset, in large numbers of hospitalized patients with COVID-19.11 However, in most patients with AF who have various cardiac risk factors, identification of extrinsic factors such as a novel vaccination that may contribute directly to AF onset and progression is challenging, and non-randomized studies can be misleading due to unrecognized confounders.In the study reported in this issue of the Journal of Cardiovascular Electrophysiology by Deshmukh et al,12arrhythmia burden was extracted retrospectively in large databases of patients with CIEDs, to evaluate any temporal association between COVID-19 vaccination and AF progression. Insurance claims were used to identify patients receiving COVID-19 vaccination, and long-term trends in arrhythmia burden, occurring before and after vaccination were analyzed, and compared to similar populations not undergoing vaccination. Though the AF burden was found to increase in the 3 months following vaccination, similar increases in AF burden were observed in patients who did not receive vaccination over the same time frame, and sustained increases in arrhythmia burden were noted over the course of a year, in both populations. These findings implicate disease progression, and not the vaccine itself, as the primary driver of AF events occurring following vaccination. This manuscript’s first conclusion citing an increase in the burden of arrhythmia events in the 3 months following COVID-19 vaccination, particularly in males over 70 years in whom the prevalence of AF is already highest, is therefore potentially misleading, as a subsequently reported comparison between matched vaccinated and un-vaccinated populations yielded no statistically significant difference in AF burden.There are two primary lessons to take from this research.AF is a common and progressive disease, which is best understood in populations that have devices capable of long-term arrhythmia monitoring. Beyond observed and predicted increases in AF prevalence and incidence over time, AF burden in individual patients is progressive over time. This study further demonstrates this trend in a population with underlying cardiovascular disease who have CIEDs, regardless of whether they had a vaccination or not.Exacerbations of chronic medical disease, such as atrial fibrillation, are seen following vaccinations, and may be in-part related to the vaccine\RL’s induced inflammatory response. However, in this study, arrhythmia burden did not appear to accelerate more quickly in patients who received vaccinations relative to those who did not get vaccinated, and no long-term difference in atrial or ventricular arrhythmia burdens were noted between these populations.A risk versus benefit analysis must always be performed when evaluating any therapy, including with vaccines. While this study does not report on the benefits of the vaccine, it does provide some reassurance in recommending COVID-19 vaccination to our patients at risk for arrhythmias, who are also at high risk of complications from COVID-19 infection. Furthermore, the progressive nature of AF in patients with cardiovascular disease, who are at highest risk of AF-related morbidity and mortality, further justifies current trends towards early AF intervention.

Evans syndrome is a rare autoimmune entity comprising of autoimmune haemolytic anaemia with immune thrombocytopenia. It can be associated with a variety of autoimmune conditions, in such cases, it is classified as secondary Evans syndrome. Its association with Hashimoto's thyroiditis is very rare, and a common immunopathogenic overlap might be present between both the conditions. Here, we are reporting a case of an adolescent girl who presented with fatigue, pallor, and menorrhagia for the last two months. She had received multiple blood transfusions but continued to be severely anaemic suggesting the possibility of an ongoing haemolysis. Her haematological workup revealed autoimmune haemolytic anaemia with a positive direct antiglobulin test along with thrombocytopenia. Further work-up revealed Hashimoto's thyroiditis and associated secondary Evans syndrome. We present first such paediatric case in the Indian context along with an outline of diagnostic evaluation and further management.

Postpartum placental choriocarcinoma is a rare gestational trophoblastic tumor with an incidence of approximately 1 in 50,000. Patients often present with persistent postpartum hemorrhage, leading to potential delayed diagnosis, hematogenous metastasis, and ultimately, poor prognosis. We report a successful case of early diagnosis and timely administration of FAV chemotherapy for 5 cycles in a patient with postpartum choriocarcinoma following cesarean section. During the follow-up period, the patient’s serum β-hCG levels normalized, and imaging lesions resolved completely. Introduction: Pregnancy-related causes must always be ruled out in women of childbearing age who present with irregular vaginal bleeding, even in the postpartum and lactation periods. In patients with postpartum bleeding, vigilance should be heightened to rule out the possibility of pregnancy-related sertoli cell tumor. We describe a woman with irregular vaginal bleeding after childbirth who was eventually diagnosed with postpartum choriocarcinoma.

Objective: Child marriage forces a girl into adult roles before physical and psychological maturity, which can take a toll on women’s health over the life course. This paper aims to assess whether child marriage and adolescent childbearing are associated with elevated risk of gynecologic disorders leading to hysterectomy. Design: Cross-sectional and survival analysis. Setting: India, nationally representative survey. Population: 528,816 ever married women, aged 20-49 years. Methods: Women were grouped in four mutually exclusive categories – i) married adult – not an adolescent mother (reference category), ii) married adult – adolescent mother, iii) married child – not an adolescent mother, and iv) married child – adolescent mother. Multivariable logistic regressions were fitted to assess the odds of hysterectomy for these groups. Non-parametric Kaplan-Meier survivor functions were estimated to evaluate survival rates across the groups. Main outcome measures: Whether had a hysterectomy and age when hysterectomy was performed. Results: Compared to women married as adult – not an adolescent mother, women married in childhood and who gave birth in adolescence were 1.87 (95% CI: 1.78–1.96) times more likely to have a hysterectomy and had the lowest survival rate for hysterectomy. Women married as children but not an adolescent mother also had higher odds of hysterectomy (AOR = 1.40, 95% CI: 1.31–1.50). These results were robust across sub-groups including geographic regions, urban/rural residence, education, and income. Conclusions: Our results, showing a strong relationship between child marriage and hysterectomy, contribute to the literature on later-life health consequences of child marriage and call for strengthening efforts to eradicate child marriage.

Objective To evaluate costs and cost-effectiveness to the healthcare system, and costs to families, of a national prenatal exome sequencing (pES) service additional to standard testing, compared to standard testing alone. Design A cost-effectiveness analysis combining costs, outcomes, parent and professional interview and professional survey data. Setting The English National Health Service (NHS) Genomic Medicine Service. Sample 413 cases referred for pES testing from 01/10/2021 to 30/06/2022. Methods We costed the incremental resource required to deliver the pES clinical pathway, synthesising this with unit costs and outcomes data on additional cases diagnosed to analyse cost-effectiveness. We estimated the annual NHS budget requirement based on case numbers. We determined parental costs from interviews. Main Outcome Measures Incremental costs of pES to the NHS and families, incremental cost per additional diagnosis, NHS budget impact. Results Of 413 referred cases, 241 were tested, at a cost of £2,331 (95% credibility interval £1,894-£2,856) per referred case, or £3,592 (£2,959-£4,250) per case that proceeded with testing. The incremental cost per diagnosis (yield 35.3%) was £11,326 (£8,582-£15,361). At current demand levels pES costs the NHS approximately £1.7m annually. Family costs could not be separated from other pregnancy related appointments but were not considered burdensome as most appointments were concurrent or remote. Conclusions pES is more expensive than predecessor prenatal genetic testing technologies, has a higher diagnostic yield and informs pregnancy management and decision making. Further research into potential savings from the foregone diagnostic odyssey resulting from pES may be informative.

Public health transformation aims to instigate enduring changes in healthcare services, staff roles, and patient involvement, fostering heightened satisfaction among patients and staff while bolstering financial sustainability. This scoping review maps evidence of public health transformation. Searches encompassed databases including EBSCOHost, Academic Search Complete, Africa-Wide Information, Dentistry & Oral Sciences Source, Health Source - Consumer Edition, Health Source: Nursing/Academic Edition, PUBMED, and Scopus. Abstracts and full-text articles were screened by two independent reviewers against predefined criteria. Inclusion criteria spanned peer-reviewed articles in all languages published between 2013 and 2023. The quality of the included studies was assessed using the 2018 version of the mixed method appraisal tool. Screening results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA ScR) guidelines. Of 9509 articles retrieved, 808 duplicates were excluded, leaving 8692 for title and abstract screening. Following title and abstract screening, 105 articles were deemed relevant and underwent full article screening, which resulted in 20 that became eligible for data extraction. Emergent themes included: 1) Transformation in Public Healthcare; 2) Evaluation of Health Transformation Programs; 3) Financial Implications; 4) Public Health Access; and 5) Job Satisfaction. Theme 4 featured a subtheme addressing healthcare access for minority groups. Overall, the review highlights a dearth of evidence guiding policymakers in decision-making on public health transformation, oversight of vulnerable populations, financial implications, and healthcare accessibility. Solutions should prioritize a people-centered approach in both practice and research to effectively address these gaps.

Background Toxoplasmosis has public health importance, particularly in immunocompromised individuals such as pregnant women leading to congenital abnormalities and fetal losses. In this study, we aimed to determine the sero-prevalence of toxoplasmosis in sheep at Mandeeq Slaughter House in Hargiesa and pregnant women attending antenatal care at Hargiesa Group Hospital. Methods Cross-sectional study design with systematic random sampling method and Questionnaire surveys were used for the collection data from sheep and pregnant women. Sera were collected and examined for anti- Toxoplasma gondii antibodies using latex agglutination test. Results The overall prevalences of toxoplasmosis were 25.5% and 28% in sheep and human, respectively. Multivariable logistic regression analysis indicated that female (AOR = 2.18; 95% CI: 1.38 - 3.47; p = 0.001) and young age groups of sheep (AOR = 3.04; 95% CI: 1.04-8.86; p = 0.041) were significantly associated with Toxoplasma gondii sero-positivity. In pregnant women, age groups between 25-34 (AOR = 2. 76; 95% CI: 1.07 - 7.14; P = 0.037), pregnant women who have cats in their home (AOR = 6.45; 95% CI: 2.37-17.52; P = 0.000), women who have close contact with garden soil (AOR = 6.74; 95% CI: 2.55-17.81; P = 0.000), poor hand washing practices before food eating (AOR = 29.5; 95% CI: 5.41– 161.11; P= 0.000) and drinking tap water (AOR = 8.4; 95% CI: 2.54 – 28.08; P = 0.000) were significantly associated with Toxoplasma gondii sero-positivity. Conclusion This is the first report regarding to toxoplasmosis in Hargeisa, where pregnant women should avoid eating uncooked mutton and close contact with cats besides good hygienic practices related to food handling.

Aim To evaluate the expression of the NLRP3 inflammasome and IL-1β cytokine in the progression of periapical lesions in wild-type (WT) and TLR2 knockout (KO) mice. Materials and Methods An experimental investigation was carried out, considering 28 WT and 27 TLR2-KO mice ( N = 55). All periapical lesions were induced in mandibular first molars, and mice were randomly euthanized after 7, 21, and 42 days of pulpal exposure ( n = 8-10 per group/period). Microscopic analysis was carried out using hematoxylin-eosin staining and immunohistochemistry for NLRP3 inflammasome and IL-1β cytokine expressions. The significance level was set at 5%. Results Pulpal exposure triggered an inflammatory reaction in both animal models. Regarding periapical bone resorption, the lesion area was significantly larger in TLR2-KO mice compared to WT after 21 days ( p = 0.006). Addressing NLRP3 inflammasome immunostaining, the stained area was significantly larger in WT mice compared to TLR2-KO after 21 days ( p = 0.006) and 42 days ( p = 0.003). Ultimately, in relation to the IL-1β cytokine expression, more positive cells were significantly observed in TLR2-KO mice compared to WT after 42 days ( p = 0.003). Correlating the expression of NLRP3 inflammasome and IL-1β cytokine, a significant, positive and weak correlation was observed in WT mice ( p = 0.039, ρ = 0.393), which was not observed in TLR2-KO ( p = 0.384). Conclusion Periapical bone resorption and the expression of IL-1β cytokine were increased in the absence of TLR2, suggesting a protective role of this receptor against osteolysis that was not mediated by the NLRP3 inflammasome.

More species-rich communities are often assumed to contain more specialist species, typically characterized by narrower niche breadths or smaller ranges. Stronger interspecific competition in species-rich communities is thought to be a key mechanism explaining these patterns. Yet, the relationship between richness and specialization has so far only been studied for a few taxa, and characterizing the effects of interspecific competition on species niches and distributions is challenging. Thus, it remains unclear how general richness-specialization relationships are. Here, we assess relationships between specialization and interspecific competition along richness gradients of bats across four understudied global biodiversity hotspots. Using a novel, integrated species distribution modeling approach that combines expert range maps and occurrence records of 49 bat species, we produced fine-scale distribution and species richness maps, allowing us to assess environmental niche breadth and range sizes. Further, contrasting potential ranges obtained from traditional distribution models with realized ranges obtained through the integration of expert ranges, we assessed range filling and derived indicators of geographic exclusion that characterize how interspecific competition is limiting species' ranges. Our results highlight that the narrowest niche breadths and strongest geographic exclusion occur in species-poor, not species-rich bat communities, in contrast to what was found for other taxa. While niche breadth peaked at intermediate richness, range sizes decreased continuously with richness. These findings show that increasing bat species richness is not closely linked to environmental specialization across the entire richness gradient and that decreasing range sizes in species-rich communities could be driven by the number of interacting species, rather than by environmental specialization or individually stronger interactions. Our study shows how innovative distribution modeling approaches can shed new light on the interplay of species richness, interspecific competition, and community structure. More generally, our findings caution against generalizing relationships between richness and specialization across taxa and geographies.