Both surface motion and hole stress concentration have always been concerned in anisotropic medium. In this paper, a theoretical approach is used to study the scattering problem of circular holes under a scalene trapezoid on the surface. The mapping function that anisotropic medium to homogeneous medium is established, and the relationship between the free boundary of anisotropic medium and the mapping of homogeneous medium boundary is proved. In the space of homogeneous medium mapping, the wave displacement function is obtained by solving the equation of motion that meets the zero-stress boundary conditions by separating the variable method and the symmetric method. Based on the complex function, multi-polar coordinate method and region-matching technique, algebraic equations are established at auxiliary boundary and free boundary conditions in complex domain. Then according to sample statistics, least square method is used instead of the Fourier expansion method to solve the undetermined coefficient of the algebraic equations by discrete boundary. Numerical results shows that the continuity of the auxiliary boundary and the accuracy of the zero-stress boundary are nice, and the displacement of the free surface and the stress of the circular hole are related to the parameters of material medium, the position of the circular hole, the direction of the incident wave and the frequency content of the excitation. Finally the process of the wave propagation and scattering around trapezoid and shallow circle are shown in time domain through the inverse fourier transform.

Sexual Minority Individuals and Pregnancy Outcomes: A CommentaryJulie Croll, MPHa,b; Laura Sanapo, MD, MSHS, RDMSa,c; Ghada Bourjeily, MD, FCCPa,caWomen’s Medicine Collaborative at Lifespan, The Miriam Hospital, 146 West River Street, Providence, RI 02904, USAbRCSI University of Medicine and Health Sciences, School of Medicine, 123 St Stephen’s Green, Dublin 2, IrelandcWarren Alpert Medical School of Brown University, Department of Medicine, 222 Richmond Street, Providence, RI, USA

This realist enquiry applying behavioural theory aimed to identify behavioural mechanisms and contexts that facilitate prescribers tapering opioids. We identified relevant opioid tapering interventions and services from a 2018 international systematic review and a 2019 England-wide survey, respectively. Interventions and services were eligible if they provided information about contexts and/or behavioural mechanisms influencing opioid tapering success. A stakeholder group (n=23) generated draft programme theories based around the 14 domains of the theoretical domains framework. We refined these using the trial and service data. From 71 articles and 21 survey responses, 56 and 16 respectively were included, representing primary care, hospital, specialist pain facilities and prison services. We identified six programme theories that included five behavioural mechanisms: prescribers’ knowledge about how to taper; build prescribers’ beliefs about capabilities to initiate tapering discussions and manage psychological consequences of tapering; perceived professional role in tapering; the environmental context enabling referral to specialists; and facilitating positive social influence by aligning patient: prescriber expectations of tapering. No interventions are addressing all six mechanisms supportive of tapering. Work is required to operationalise programme theories according to organisational structures and resources. An example operationalisation is combining tapering guidelines with information about local excess opioid problems and endorsing these with organisational branding. Prescribers being given the skills and confidence to initiate tapering discussions by training them in cognitive-based interventions and incorporating access to psychological and physical support in the patient pathway. Patients being provided with leaflets about the tapering process and informed about the patient pathway.

Background/Purpose: Systemic sclerosis (SSc) is characterised by progressive multiple-organ fibrosis leading to morbidity and mortality. Lysyl oxidases play a vital role in the cross-linking of collagens and subsequent build-up of fibrosis in the extracellular matrix. As such, their inhibition provides a novel treatment paradigm for SSc. Experimental Approach: Lysyl oxidases are upregulated in preclinical models of fibrosis in skin, lung, heart, kidney and liver. A novel small molecule pan-lysyl oxidase inhibitor, PXS-5505, currently in clinical development for bone fibrosis treatment was evaluated in in vivo rodent models resembling the fibrotic conditions in SSc. Key Results: Both lysyl oxidase and lysyl oxidase-like 2 (LOXL2) expression was elevated in the skin and lung of SSc patients. Once-a-day oral application of PXS-5505 inhibited lysyl oxidase activity in the skin and LOXL2 activity in the lung. PXS-5505 exhibited anti-fibrotic effects in the SSc skin mouse model, reducing dermal thickness and α-smooth muscle actin compared to the disease controls. Similarly, in the bleomycin-induced mouse lung model, PXS-5505 reduced tissue fibrosis toward normal levels. The anti-fibrotic efficacy of PXS-5505 in the bleomycin exposed lungs was mediated by its ability to normalise collagen/elastin crosslink formation, a direct consequence of lysyl oxidase inhibition. PXS-5505 also reduced area of fibrosis in rodent models of the ischaemia-reperfusion heart, the unilateral ureteral obstruction kidney and the CCl4-induced fibrotic liver. Conclusion/Implication: PXS-5505 consistently demonstrates potent anti-fibrotic efficacy in multiple models of organ fibrosis relevant to the pathogenesis of SSc, suggesting that it may be efficacious as a novel approach for treating SSc.

Studies on physiological effects due to gravitation and acceleration have become a hot topic of research since the last century. Scientists and engineers have been putting their best efforts to excavate more about the physiological changes that occur in jet aircraft pilots and astronauts. This study focuses on a few prominent and recent observations related to the alterations of physiological functioning due to gravitational and acceleration forces.

Classic Congenital Adrenal Hyperplasia in males usually presents late until before puberty, but rarely at birth. In cases of undiagnosed CAH, severe deficiency of cortisol may lead to life threatening situation in an infant with acute salt losing crisis. Screening for CAH at birth can lead to better outcomes.

Coronavirus disease 2019 (COVID-19) is an emerged pandemic disease caused by a new coronavirus known as SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2).

Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease caused by a combination of prenatal and postnatal factors that leads to the disruption of lung development and abnormal repair, this is a condition that is commonly seen in premature infants. With the improvement of treatment technology, the survival rate of very early preterm infants has increased significantly compared with before, and the incidence of severe BPD has decreased, however, the prevalence of BPD has not decreased. The overall prevalence of BPD is 45%.The prevention of prematurity, the systematic use of non-aggressive ventilator measures, the avoidance of supra-physiological oxygen exposure, and the administration of diuretics, caffeine and vitamin A have all been shown to lead to a significant reduction in the risk of BPD development. A growing number of clinical studies have shown that caffeine not only prevents apnea, but also reduces the incidence of BPD. We review the clinical value of caffeine in the treatment of BPD and its potential mechanisms of action, include anti-inflammatory, antioxidant, anti-fibrotic, anti-apoptotic pathways, and the regulation of angiogenesis. Our aim was to provide a new theoretical basis for the clinical treatment of BPD.

A 59-year-old man with a long smoking history presented with sudden back pain. Frank's sign was noticed in his bilateral ears, and computed tomography revealed Stanford type A acute aortic dissection. If young patients have Frank's sign, attention should be paid to atherosclerotic disease including aortic disease.

1. Competition from invasive species is an increasing threat to biodiversity. In Southern California, the western gray squirrel (Sciurus griseus, WGS) is facing increasing competition from the fox squirrel (Sciurus niger, FS), an invasive congener. 2. We used spectral methods to analyze 140 consecutive monthly censuses of WGS and FS within a 11.3 ha section of the California Botanic Garden. Variation in the numbers for both species and their synchrony was distributed across long timescales (> 15 months). 3. After filtering out annual changes, concurrent mean monthly temperatures from nearby Ontario Airport (ONT) yielded a spectrum with a large semiannual peak and significant spectral power at long timescales (> 30 months). Squirrel-temperature cospectra showed significant negative covariation at long timescales (> 35 months) for WGS and smaller significant negative peaks at 6 months for both species. 4. Simulations from a Lotka-Volterra model of two competing species indicates that the risk of extinction for the weaker competitor increases quickly as environmental noise shifts from short to long timescales. 5. We analyzed the timescales of fluctuations in detrended mean annual temperatures for the time period 1915-2014 from 1218 locations across the continental USA. In the last two decades, significant shifts from short timescales to long timescales have occurred, changing from less than 3 years to 4-6 years. 6. Our results indicate that (i) population fluctuations in co-occurring native and invasive tree squirrels are synchronous, occur over long timescales, and may be driven by fluctuations in environmental conditions; (ii) long timescale population fluctuations increase the risk of extinction in competing species, especially for the inferior competitor; and (iii) the timescales of interannual environmental fluctuations may be increasing from recent historical values. These results have broad implications for the impact of climate change on the maintenance of biodiversity.

We report a preterm male neonate presenting with a skeletal dysplasia associated with multiple congenital anomalies. Radiologic findings and genetic studies are consistent with spondylocostal dysostosis (SCD) and autosomal dominant brachydactyly. This is the first case report of spondylocostal dysostosis and brachydactyly associated with TBX6 and IHH variants.

This report describes a case of a 50-year-old man with hypertension who was admitted with a history of fever, chills, and shortness of breath and tested positive for COVID-19. Shortly after resolving his ARDS, he developed an adipsic hypernatremia with associated confusion, lethargy, and weakness.

The COVID-19 vaccination programs have sparked several concerns and ongoing debates over safety issues. Here, we presented three cases of patients with serious adverse events, encephalopathy; Vaccine induced thrombotic thrombocytopenia, and Leukocytoclastic Vasculitis, after receiving the ChAdOx1 nCoV-19 vaccine.

A 54-year-old lady was brought to our A+E after falling from a stepladder onto the metallic base of her artificial Christmas tree. The metallic rod impaled her through the right buttock. X-rays and a CT was performed prior to transport to a trauma centre causing delays to her surgery.

Our case was rare in that multiple phenomena of postpartum stroke occurred at the same time. What is remarkable about this case was the confirmation of the reversibility of these pathological conditions through multifaceted evaluations, including the MRI MSDE method.

Storing and manipulating Next Generation Sequencing (NGS) file formats for understanding biological phenomena is an essential but difficult task in the life sciences. Yet, most methods for analysing NGS data require complex command-line tools in high-performance computing (HPC) or web-based servers and have not yet been implemented in comprehensive, easy-to-use software. Here we present easyfm (easy file manipulation), a free standalone Graphical User Interface (GUI) software with Python support that can be used to facilitate the rapid discovery of target sequences (or user’s interest) in NGS datasets for novice users (more accessible to biologists). It enables them to perform end-to-end reproducible data analyses using a desktop application (Windows, Mac and Linux). Unlike existing tools, the GUI-based easyfm is not dependent on any HPC system and can be operated without an internet connection. For user-friendliness and convenience, easyfm was developed with four work modules and a secondary GUI window, covering different aspects of NGS data analysis, including post-processing, filtering, format conversion, generating results, real-time log, and help. In combination with the executable tools (BLAST+ and BLAT) and Python, easyfm allows the user to set analysis parameters, select/extract regions of interest, examine the input and output results, and convert to a wide range of file formats. To help augment the functionality of existing web-based and command-line tools, easyfm, a self-contained program, comes with extensive documentation (https://github.com/TaekAndBrendan/easyfm). This specific benefit allows easyfm to seamlessly integrate visual and interactive representations of NGS files, supporting a wider scope of bioinformatics applications in the life sciences.

This is a case of a 16-year-old African boy with Osteomyelitis presenting with symptoms of reactive arthritis (Reiter’s syndrome) KEYWORDS Osteomyelitis, Reiter’s syndrome, Fever, Bone pain, Erythema, Ewing sarcoma

The combined study of C and O isotopes in plant organic matter has emerged as a powerful tool for understanding plant functional response to environmental change. The approach relies on established relationships between leaf gas exchange and isotopic fractionation to derive a series of model scenarios that can be used to draw inferences about changes in photosynthetic assimi-lation and stomatal conductance driven by changes in environmental parameters (CO2, water availability, air humidity, temperature, nutrients). We review the mechanistic basis for model and research to date, and discuss where isotopic observations don’t match our current under-standing of plant physiological response to environment. We demonstrate that 1) the model has been applied successfully in many, but not all studies, and 2), while originally conceived for leaf isotopes, the model has been applied extensively to tree ring isotopes in the context of tree phys-iology and dendrochronology. Where isotopic observations deviate from physiologically plau-sible conclusions, this mismatch between gas-exchange and isotope response provides valuable insights on underlying physiological processes. Overall, we found that isotope responses can be grouped into situations of increasing resource limitation versus higher resource availability. Thus, the dual isotope model helps to interpret plant responses to a multitude of environmental factors.

 During Movement Control Order (MCO) of COVID-19, many information has been disseminated through both traditional and social media. Some of that information was credible and came from reliable sources while other information was fake and included misinformation, disinformation, and infodemic. The people needed credible information rather than fake one in this critical time. This study aimed to explore the credibility of media, information sources, the main issues, and preferred communication patterns and method of works perceived by Malaysians during MCO. A total of 300 questionnaires were distributed, and 210 were returned. The results of this study showed that the majority of respondents 69% relied on new media as their main source of information compared to 30.9% who relied on traditional media. However, a total of 64.8% of respondents considered traditional media as more credible and accurate compared to 35.2% for new media. Additionally, the main concerns and issues followed by respondents on media were health, economic, social, education and others. Finally, a total of 55.7% preferred face to face communication compared to 44.3% who preferred online communication. A total of 51% of respondents preferred to work from the workplace or office compared to 49% who preferred to work from home. Television played a significant role during the pandemic period due to its high credibility as perceived by Malaysians. The main intriguing implication of this study is considering the traditional media as more credible than social media by the Malaysians although the social media was their main source of information.Keywords: Communication patterns; COVID-19; credibility; infodemic; misinformation

Objective: To examine glycaemic variability (GV) and glycaemic control (GC) parameters in early pregnancy with subsequent development of gestational diabetes mellitus (GDM). Design: Longitudinal observational study. Setting: Pregnant women from KK Women and Children’s Hospital in Singapore Participants: 51 study participants in the first trimester (9-13 weeks’ gestational), and 44 participants (18-23 weeks’ gestation) in the second trimester of pregnancy. Methods: Independent t-tests were used to examine the differences in the parameters between participants who developed GDM and those who did not. Main outcome measure: GDM was determined at 24-30 weeks’ gestation using oral glucose tolerance test (OGTT). GV parameters examined were, mean amplitude of glycaemic excursion (MAGE), standard deviation of blood glucose (SDBG) and mean of daily continuous 24 h blood glucose (MBG) and coefficient of variation (CV). GC parameters measured were, J-Index and % time spent in glucose target ranges. Results: In the second trimester of pregnancy, mean amplitude of glycaemic excursions (MAGE) was significantly higher in participants who subsequently developed GDM, compared to those who did not (mean (SD): 3.18(0.68) vs 2.60(0.53), p=0.02). Other study parameters measured in the second trimester of pregnancy were not significantly different between groups. There were no significant associations between all the GV and GC parameters determined from the CGM in the first trimester with subsequent development of GDM (p>0.05). Conclusion: MAGE is an important GV parameter associated to the development of subsequent GDM in pregnant women. The findings highlight the potential value of CGM in gestational glycaemic profiling.

A study on rodent species diversity and community assemblages in West Mt Kilimanjaro was conducted in seven different habitats, covering two dry and wet seasons. Data were collected using a combination of medium-sized Sherman’s live traps, snap and Havarhart traps, for three consecutive nights. General Linear Models (GLM) were used to analyze the effects of predictors (vegetation attributes, seasonality, soil physical properties, disturbance and altitude) on rodent species richness and abundance. Community structure analysis was conducted in the Primer v6 program and Canonical correspondence analysis for habitat association in PAST. A total of 1,393 individuals from 14 species of rodents were trapped. The most dominant rodent species were Rhabdomys pumilioPraomys delectorum, and Lophuromys verhageni which contributed to 68.86% of the total captures. Lophuromys verhageni occurred across all the habitats and seasons. Moreover, habitat types, seasonality, soil texture, ground cover, and altitude significantly influenced rodent species abundance (P< 0.05). Furthermore, habitat types, seasonality and altitude significantly influenced rodent species richness (F8, 759 = 629.7, p< 0.001, R2 = 0.87). In addition to that, two major rodent communities were formed in different habitats. The results show that rodent species richness, abundance, and community assemblages in Mt Kilimanjaro, are a result of change in vegetation structure along the altitudinal gradients. Therefore, information on habitat requirements of multiple species is crucial for the management and conservation of these communities.

Pneumatocele may complicate the course of SARS-CoV2 infection. Our article exhibits the value of early radiological imaging for the timely diagnosis and management of COVID-19 and its complications. Conservative management is the mainstay of treatment of pneumatoceles however prompt surgical intervention is imperative for complicated pneumatoceles.

a succesfull combination therapy with tagraxofusp-erz plus venetoclax for a pediatric case of Blastic plasmacytoid dendritic cell neoplasm brıdgıng to transplantBaşak Adaklı Aksoy 1,Selime Aydoğdu1,Özlem Başoğlu Öner 1,Gizem Zengin Ersoy 1,Funda Erol Çipe1, Ayşe Gonca Kaçar3, Zafer Başlar 3,Tiraje Celkan 3,Tunç Fışgın1,Ceyhun Bozkurt 21Altınbaş Üniversitesi Tıp Fakültesi, Medical Park Bahçelievler Hastanesi2İstinye Üniversitesi Tıp Fakültesi , Pediatrik Hematoloji- Onkoloji Bölümü3İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi

Background. We sought to evaluate the impact of changes in estimates of COVID-19 vaccine effectiveness on the incidence of laboratory-confirmed infection among frontline workers at high risk for SARS-CoV-2. Methods. We analyzed data from a prospective frontline worker cohort to estimate the incidence of COVID-19 by month as well as the association of COVID-19 vaccination, occupation, demographics, physical distancing and mask use with infection risk. Participants completed baseline and quarterly surveys, and each week self-collected mid-turbinate nasal swabs and reported symptoms. Results. Among 1,018 unvaccinated and 3,531 fully vaccinated workers, the monthly incidence of laboratory-confirmed SARS-CoV-2 infection in January 2021 was 13.9 (95% confidence interval [CI]: 10.4-17.4), declining to 0.5 (95% CI -0.4-1.4) per 1000 person-weeks in June. By September 2021, when the Delta variant predominated, incidence had once again risen to 13.6 (95% CI 7.8-19.4) per 1000 person-weeks. In contrast, there was no reportable incidence among fully vaccinated participants at the end of January 2021, and incidence remained low until September 2021 when it rose modestly to 4.1 (95% CI 1.9-3.8) per 1000. Below average facemask use was associated with a higher risk of infection for unvaccinated participants during exposure to persons who may have COVID-19, and vaccinated participants during hours in the community. Conclusions. COVID-19 vaccination was significantly associated with a lower risk of SARS-CoV-2 infection despite Delta variant predominance. Our data demonstrate the added protective benefit of facemask use among both unvaccinated and vaccinated frontline workers.