Aims In older adults with type 2 diabetes (T2D), overtreatment remains prevalent and undertreatment ignored. The main objective is to estimate the prevalence and examine factors associated with potential overtreatment and undertreatment Method Observational study conducted within an administrative database of older adults with T2D who registered in 2018 at the Portuguese Diabetes Association. Participants were categorized either as potentially overtreated (HbA1c≤7.5%), appropriately on target (HbA1c≥7.5–≤9%), or potentially undertreated (HbA1c>9%). Results of 444 participants, potential overtreatment, and undertreatment were found in 60.5% and 12.6% of the study population. Taking the patients on target as a comparator, the group of potentially overtreated showed to be more males (61.3% vs.52.2%), less-obese (34.1% vs.39.2), higher cardiovascular diseases (13.7% vs.11%), peripheral vascular diseases (16.7% vs.12.8%), diabetic foot (10% vs.4.5%), and severe kidney disease (5.2% vs.4.5%). Conversely, the potentially undertreated participants were more females (64.2% vs.47.7%), obese (49% vs.39.2%), had more dyslipidemia (69% vs.63.1%), peripheral vascular disease (14.2% vs.12.8%), diabetic foot (8.9% vs.4.5%), and infections (14.2% vs.11.9%). The odds of potential overtreatment were mostly decreased by 59% of females, 73.5% in those with retinopathy, and 86.3% in insulin, 65.4% sulfonylureas, and 66.8% in SGLT2 inhibitors users. Contrariwise, an increase in the odds of potential undertreatment was more than 4.8times higher in insulin, and more than 3.1times higher in sulfonylureas users. Conclusion potential overtreatment and undertreatment in older adults with T2D in routine clinical practice should guide the clinicians to balance the use of newer oral antidiabetic agents considering its safety profile regarding hypoglycemia.

Emerging infectious diseases have resulted in severe population declines across diverse taxa. In some instances, despite attributes associated with high extinction risk, disease emergence and host declines are followed by host stabilization for reasons that are frequently unclear. While host, pathogen, and the environment are recognized as important factors that interact to determine host-pathogen coexistence, they are often considered independently. Here, we use a translocation experiment to disentangle the role of host traits and environmental conditions in driving the persistence of remnant populations a decade after they declined 70-99% and subsequently stabilized with disease. While survival was significantly higher than during the initial epidemic within all sites, protection from severe disease only existed within a narrow environmental space, suggesting host traits conducive to surviving disease are highly environmentally dependent. Ultimately, population persistence following pathogen invasion is the product of host-pathogen interactions that vary across a patchwork of environments.

Background: Strokes are a known complication of acute type A aortic dissection (ATAAD) repair. Understanding the neuroanatomy, mechanism, and severity of stroke will facilitate efforts to improve prediction, prevention, and treatment strategies. Methods: Retrospective review of patients who sustained stroke from a consecutive series of patients undergoing ATAAD repair. Neuroimaging was interpreted by two stroke neurologists blinded to clinical results. Severity of stroke was assessed by National Institutes of Health Stroke Scale (NIHSS). Residual disability at thirty days was assessed using the modified Rankin Scale (mRS). Results: Twenty percent (38/189) of patients undergoing repair for ATAAD had stroke [unilateral 58%, bi-hemispheric 42% (p=0.33)]. All strokes were ischemic. No significant lateralization (right vs. left) was noted with unilateral strokes (26% vs 32%, p=0.67). Etiology of stroke was embolic (58%), hypoperfusion (26%), mixed (11%) and unknown (5%). There were no intraoperative variables that correlated with the neuroanatomy or mechanism of stroke. Pre-operative carotid dissection was seen in 40% (n=15), while postoperatively 10% (n=4) sustained intracranial large vessel occlusion (LVO). Strokes were moderate or severe (NIHSS ≥ 9) in 97% of cases, with 66% incidence of moderate residual disability (mRS ≥ 3) at one month postoperatively. Conclusions: Stroke associated with ATAAD is heterogeneous in etiology and location. Most strokes are severe on detection and result in significant residual disability. One in 10 strokes are due to LVO amenable to endovascular treatment. Future trials may evaluate the role for early neuroimaging and treatment of incident stroke given modern advancements in endovascular stroke therapy.

Numerical modeling of braided channels showed no significant differences in the number of cross-sectional branches between different water periods in the middle reaches of the Yarlung Tsangpo River. During most of the year (wet, normal and dry periods), flow velocities in the higher-branching (HB) channels were significantly lower than in the other two branching categories, while the overall distribution of depth in the higher-branching channels maintained a high degree of consistency with the moderate-branching channels (MB), which partly explains why the HB channels are important habitats for fish spawning, nursery and baiting (lower flow velocity distribution with a wider range of depth). Based on the examination of the water surface width, the water surface width may not be a limiting factor for fish habitat within braided rivers. Simulation of the hydrodynamic parameters of the fish-spawning grounds revealed that the average cross-sectional flow velocity and water depth fluctuated the least at different flows during the fish-spawning period for the HB channels. By counting the hydraulic parameters of the spawning grounds during the spawning period, it can be seen that the most preferred flow velocity for fish in the braided river in the study section was 0.1-0.4 m/s, and the water depth was 0-1.2 m. This article analyses the characteristics of the hydraulic parameters of the braided river and provides theoretical support for the restoration of fish habitats in braided rivers.

Jejunal diverticulitis is a rare condition and usually occurs in the elderly. Its association with extensive diverticulosis is exceptional and makes the management more challenging. We report a case of a 74-year-old man with perforated jejunal diverticulitis with extensive diverticulosis who underwent a surgical management.

Investigation on the miniaturized multichannel-based fixed-bed devices to enhance the heat and mass transfer performance is the key focus in the present study. Residence time distribution (RTD) is one of the most critical parameters to characterize the device’s flow distribution. In the current context, the RTDs of a liquid tracer for the air-water two-phase concurrent flows across the multichannel-based miniaturized fixed-bed devices (consist of 11 number of same dimensional parallel channels) with the variable heights were measured by the conductivity measurements and represented by axial dispersion model (ADM). The stream-flow rates of the two phases varied within the range of 8.33 × 10-8 – 3.83 × 10-7 m3 s-1. The axial dispersion coefficients and the specific energy dissipation values were analyzed. The impacts of pressure loss and the geometry on the hydrodynamic characteristics and mixing properties were well expressed. Based on the experimental data, new correlations were proposed.

The droplet generation mechanism in the step T-junction remains unknown, especially for the transition stage from dripping to jetting . In this work, the droplet generation mechanism was systematically investigated in a novel modified step T-junction. We found that under different fluid regimes, different factors take action. In dripping regime, the interfacial tension dominated the formation mechanism when the surfactant concentration was controlled below micelle concentration (CMC). In jetting regime, our experimental results showed that the influence of the surfactant concentration on the size of generated droplets was rather negligible while the phase ratio indeed determined such a parameter. In the dripping-jetting transition stage, an abnormal increase of droplet size was observed despite the increase of continuous phase flow. To the best for our knowledge, it is the first study to report generation mechanism in modified step T-junction from dripping to jetting regimes.

The current pandemic caused by a novel coronavirus named as SARS-CoV2 has underlined the importance of emerging diseases of zoonotic importance. Along with human beings, several species of wild and pet animals have been demonstrated to be infected by SARS-CoV2, both naturally and experimentally. Additionally, with constant emergence of new variants, the species susceptibility might further change, warranting intensification of screening efforts. India is a vast and second most populated country, with a habitat of a very diverse range of animal species. In this study we are reporting infection of SARS-CoV2 in captive Asiatic lions. Detailed characterization revealed involvement of delta mutant (Pango lineage B.1.617.2) of SARS-CoV2 at two different locations. Interestingly, no other feline species enclosed in the zoo/park was found infected. The epidemiological and molecular analysis in this study will contribute to the understanding of SARS-CoV2 emerging mutants in wild and domesticated animals.

As human spaceflight continues with extended mission durations, the demand of effective and safe drugs is going to increase. To date, the medications used during missions (for space motion sickness, sleep disturbances, allergies, pain and sinus congestion) are administered under the assumption that they act similarly as on the Earth. During spaceflights however fluid shifts, muscle and bone loss, immune system dysregulation and changes in the gastrointestinal tract and metabolism are documented. These alterations may change the pharmacokinetics (PK) and pharmacodynamics. The information gained from bed-rest studies and from inflight observations is partial and demonstrates variability in drug PK. The objectives of this review are to report: i) the impact of the space environmental stressors on human physiology in relation to PK; ii) the state-of-the-art on experimental data in space and/or in ground-based models; iii) the validation of ground-based models for PK studies; and iv) the identification of possible research gaps.

Background: Community pharmacists are one of the most accessible healthcare practitioners worldwide used by a large proportion of the population. Expanding the roles of community pharmacists could contribute to reducing pressure on general health practice and other areas of the health services. This research aimed to evaluate the contribution of community pharmacists in the provision of public health services and to investigate the perceived barriers for the provision of these services in Saudi Arabia. Materials & Methods: This study followed a cross-sectional design using an online anonymous self-administered questionnaire. The study took place in Asir region, Saudi Arabia, between September 2019 and February 2020. A convenience sampling strategy was used to select and recruit the study participants. The questionnaire was adapted from previous research and involved three sections: demographics, involvement in public health services, and barriers for practising public health roles. Results: The total number of respondents was 193. The proportion of respondents who reported that they were “very involved” or “involved” in each service was 61.7% for weight management, 60.6% for sexual health, 57.5% for healthy eating, 53.4% for physical activity promotion, 51.3% for dental health, 46.1% for smoking cessation, 39.4% for screening for diabetes, 35.7% for screening for hypertension, 31.1% for alcohol dependence and drug misuse counselling, 30.6% for screening for dyslipidaemia, and 21.8% for vaccination and immunisation. Most of the barriers in the current research were rated as having low relevance to the provision of public health services. Conclusion: Findings in the current research suggest that community pharmacists in Asir region have intermediate to minimal engagement in practicing their public health roles. Further research needs to be undertaken to understand the barriers to the provision of public health services and what strategies would be beneficial for enhancing the public health role of community pharmacists in Saudi Arabia.

Aridity and intensive grazing have been confirmed to affect the facilitative effects of dryland shrubs. However, their combined effects on plant-plant interactions have rarely been tested. To test how these two factors affect relations between plants, we analyzed 144 plots (under shrub canopy vs. open areas) at 12 sampling areas established in the conditions of two grazing regimes (high grazing vs. low grazing intensity) and two different climatic regions (arid vs. semi-arid) in northeastern Iran. A dominant shrub, Artemisia kopetdaghensis, was selected as the model species. Further, we studied changes in plant life strategies along the combined grazing and aridity stress gradients. We used relative interaction indices to test the outcomes of plant-plant interactions, calculated for species richness, Shannon diversity and species abundances. Then we compared them using linear mixed-effect models (LMM). The indicator species analysis was used to identify species typical for the under-canopy of shrub and for the adjacent open areas. The combination of stress factors affected the type and intensity of plant-plant interactions and plant life strategies (CSR) of the indicator species. Artemisia kopetdaghensis showed the highest facilitation effect under the most intensive stress conditions (high aridity/high grazing), which turned into competition under the low stress conditions (low aridity/low grazing). In the arid region, the canopy of shrub protected ruderal annual forbs and grasses with SR and R-strategy, respectively, in both high (high aridity/high grazing) and low grazing intensity (high aridity/low grazing). In the semi-arid region and high grazing intensity (low aridity/high grazing), the shrubs protected perennial forbs with C-strategy. Our FINDINGS highlight the importance of context-dependent shrub management in the restoration of vegetation damaged by intensive grazing.

Coronavirus disease 2019 (COVID-19) is a fearsome infectious disease which cause some excessive complications along with it. the authors present a case of acute invasive rhino-orbital mucormycosis in a 62-year-old man with severe COVID-19 pneumonia, who had a history of uncontrolled diabetes mellitus along with ketoacidosis and nephropathy.

1. Ecologically meaningful seed germination experiments are constrained by access to seeds and relevant environments for testing at the same time. This is particularly the case when research is carried out far from the native area of the studied species. 2. Here, we demonstrate an alternative - the use of glass houses in botanic gardens as simulated-natural habitats to extend the ecological interpretation of germination studies. Our focal taxa were banana crop wild relatives (Musa acuminata subsp. burmannica, M. acuminata subsp. siamea and M. balbisiana), native to tropical and subtropical Southeast Asia. Tests were carried out in Belgium, where we performed germination tests in relation to exposure to sun and foliage-shading, seed burial-depth in different heated glass house compartments, as well as seed survival and dormancy release in the soil. We anchored the interpretation of these studies by also conducting an experiment in a semi-natural habitat in the species native range (M. balbisiana - Los Baños, the Philippines), where we tested germination responses to exposure to the sun and shade. Using temperature data loggers, we determined temperature dynamics suitable for germination in both these settings. 3. In semi-natural and simulated-natural habitats, seeds germinated in response to exposure to direct solar radiation. Seed burial-depth had a significant but marginal effect by comparison, even when seeds were buried to 7cm in the soil. Temperatures at sun-exposed compared to shaded environments differed by only a few degrees Celsius. Maximum temperature of the period prior to germination was the most significant contributor to germination responses and germination increased linearly above a threshold of 23°C to the maximum temperature in the soil (in simulated natural habitats) of 35°C. 4. Glass houses can provide useful environments to aid interpretation of seed germination responses to environmental niches.

Gastric MALT lymphoma is a common type of non-Hodgkin's lymphoma that has the potential for cure in patients found to have concomitant Helicobacter pylori infection.1,2 This case report explores the evaluation, diagnosis, and treatment of H. pylori negative MALT lymphoma in a patient with a history of a RYGB.

The use of pesticides for suicide commitment purposes is a major problem. The present study reports a death due to committing suicide using combination of diazinon, Chlorpyrifos, Trifluralin, Fenpropathrin, Pyriproxyfen, and Cypermethrin. It is difficult to diagnose and treat patients poisoned with a combination of pesticides.

The morphological variations when one, or both, of the atrial chambers is subdivided, are many and varied. We present a synthesis of 198 published investigations of this “family” of uncommon lesions. Almost three-quarters of patients with divided atrial chambers present during infancy with severe pulmonary hypertension and cardiac failure. Associated cardiac and extra-cardiac defects are present in between half and nine-tenths of cases. Acquired division of the left atrium has been reported after the Fontan operation, orthotopic cardiac transplantation, and complicated aortic valvar infective endocarditis. Surgery under cardiopulmonary bypass remains the definitive treatment. Balloon dilation may be considered in anatomically compatible variants in the setting of cardiac failure and pregnancy as a bridge to definitive treatment. Overall, mortality has been cited between nil to 29%. Presentation during infancy, associated congenital anomalies, pulmonary hypertension, and surgery in the previous era, have been the reported causes of death. The operative survivors have long-term favourable outcomes, with near normal cardiac dimensions and low risk of recurrence. While asymptomatic patients with division of the right atrium do not need treatment, surgical resection of the dividing partition under cardiopulmonary bypass is recommended in symptomatic patients with complex anatomy, the spinnaker malformation, or associated cardiac anomalies. Balloon dilation may be considered in uncomplicated patients with less obstructive lesions. Hybrid intervention and endoscopic robotic correction also have been performed. We submit that an increased appreciation of the anatomic background to division of the atrial chambers will contribute to improved surgical management.

Understanding vegetation evaluation is critical for exploring changes in terrestrial ecosystems and identifying upcoming challenges. However, analyses that simultaneously examine abrupt changes in vegetation greenness at the national, regional, biome and pixel scales in China are still rare. Using long-term (1982–2015) satellite time series data in conjunction with the Breaks for Additive Season and Trend (BFAST) technique, we identified breakpoints in the Normalized Difference Vegetation Index (NDVI) in China. Results showed that the annual mean NDVI gradually increased during the 34-year period. 68.8% of the vegetated area exhibited upward trends in NDVI, most of which was distributed in Southeast China and the Loess Plateau. Changes in NDVI trends occurred in 78.7% of the total vegetated areas, while hotspots were concentrated in Northwest and North China. A rapid increase in breakpoints was detected after 1999, mainly concentrated in North and Northwest China, and corresponding to the times and areas with the highest ecological engineering efforts. Positive shifts in NDVI trends were more common and generally distributed on the eastern side of the Hu Huanyong line, while browning (negative) shifts were mainly distributed on the western side and were gradually expanding, indicating a possible tendency towards environmental degradation. Although unstable vegetation areas had higher frequencies of breakpoints, the proportion of stable vegetation experiencing NDVI trend shifts was higher after 2000, probably because human intervention buffered external disturbances in unstable areas. Identifying hotspot areas of shifts in vegetation greenness can provide scientific reference for sustainable land development and carbon neutrality target achievements.

Historic climate changes had always driven geographical populations of coastal plants to contract and recover dynamically, even die out completely. Species suffering from such bottlenecks usually lose intraspecific genetic diversity, but how do these events influence population subdivision patterns of coastal plants? We investigated this question in the typical coastal plant: mangrove species Aegiceras corniculatum. Inhabiting the intertidal zone of the tropical and subtropical coast of the Indo-West Pacific oceans, its populations are deemed to be greatly shaped by historic sea-level fluctuations. Using dual methods of Sanger and Illumina Solexa sequencing, we found that the 18 sampled populations were structured into two groups, namely, the “Indo-Malayan” group, comprising three subgroups (the northern South China Sea, Gulf of Bengal, and Bali), and the “Pan-Australasia” group, comprising the subgroups of the southern South China Sea and Australasia. Based on simulations using the approximate Bayesian computation method, we inferred that the southern South China Sea subgroup, which penetrates the interior of the “Indo-Malayan” group, originated from the Australasia subgroup, accompanied by a severe bottleneck event, with a spot of gene flow from both the Australasia and “Indo-Malayan” groups. Geographical barriers such as the Sundaland underlie the genetic break between Indian and Pacific Oceans, but the discontinuity between southern and northern South China Sea was originated from genetic drift in the bottleneck event. Hence, we revealed a case evidencing that the bottleneck event promoted population subdivision. This conclusion may be applicable in other taxa beyond coastal plants.