Objectives To investigate the risk of stillbirth in relation to; 1) a previous CD compared to those following a vaginal birth (VB); and 2) vaginal birth after caesarean (VBAC) compared to a repeat CD. Design Population-based cohort study. Setting The Swedish Medical Birth registry Population Women with their first and second singletons between 1982 and 2012. Methods Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). Main outcome measures Stillbirth (antepartum and intrapartum fetal death). Results Of the 1,771,700 singleton births from 885,850 women,117,114 (13.2%) women had a CD in the first pregnancy, and 51,755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR:1.37 [95% CI, 1.23–1.52]) in women with a previous CD compared to VB. The odds of intrapartum stillbirth was higher in previous pre-labour CD group (aOR:2.72 [95% CI, 1.51–4.91]) than the previous in-labour CD group (aOR:1.35 [95% CI, 0.76–2.40,]), although not statistically significant in the latter case. No increased odds was found for intrapartum stillbirth in women who had VBAC (aOR:0.99 [95% CI, 0.48–2.06]) compared to women who had a repeat CD, whereas women with antepartum stillbirth were more likely to have a VBAC (aOR:4.49 [95% CI, 3.55–5.67]). Conclusions This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help health care providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.

A document by Roberto Villa. Click on the document to view its contents.

A document by Saima Imtiaz. Click on the document to view its contents.

Tidal flats can be found on most of the world's coastlines and are particularly vulnerable to anthropogenic disturbances. They are important transient ecosystems between terrestrial and marine ecosystems and their biodiversity provides important ecosystem services. Owed to their unique position between the terrestrial and the marine realm, strong environmental gradients of elevation, sediment composition but also food availability are prevailing. Here we investigate which environmental factors drive the spatial and temporal patterns in macrozoobenthos abundance, biomass, richness, diversity and species composition on back barrier tidal flats in the East-Frisian Wadden Sea. We found that with increasing mud content the total abundance of organisms in the sediment significantly increased, while biodiversity and biomass were not changing significantly with increasing mud content. Biomass of macrozoobenthos decreased with higher elevation towards the salt marsh. In contrast to expectations, increasing Chl a availability as a measure of primary productivity did not enhance biomass or abundance, but was associated with significantly reduced species richness. Species composition varied significantly among and within islands due to variation in sediment composition, resource availability and human-induced disturbance. In conclusion, macrozoobenthos biomass, abundance and biodiversity is interrelated in a complex way with the physical, abiotic and biotic processes in and above the sediment. Negative impacts of primary production on macrozoobenthos species richness demonstrate possible negative effects of nutrient inputs in tidal flat areas and the need for cross-boundary protection.

In latest years, with the gradual perception of CRISPR Cas9 technology, coupled with the many advantages of the CRISPR Cas9 system, ease of development, simplicity of use, and low material prices, its mediated gene modifying has been higher used in diagnosing and treating genetic ailments and enhancing patients' prognosis. Moreover, CRISPR Cas9 gene screening library is another hot issue which can be used to discover pathogenic genes, pick drug intervention sites, and analyze drug resistance mechanisms. Rapidly emerging gene editing technology has a huge market and is expected to cure B-cell lymphoma. This article reviews the application and progress of CRISPR Cas9 gene editing in B-cell lymphoma for further study.

IgG4 related Inflammatory Pancreatic Head Pseudotumor Mirror Pancreatic Carcinoma: A Novel Case Series with a Review of the LiteratureFaheemullah Khan, MBBS, MD1, Jehanzeb Shahid, MBBS, FCPS2, Amna Saleem, MBBS3, Uzzam Ahmed Khawaja, MBBS4, Wasim Ahmed Memon, MBBS, FCPS5, Uffan Zafar, MBBS6, Tariq Abdul Hameed, MD, DABR7, Khabab Abbasher Hussien Mohamed Ahmed, MBBS8* 1,2,5,6Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.3,4Jinnah Medical and Dental College, Karachi, Pakistan.7Department of Radiology, Indiana University School of Medicine, Indiana, US.8Faculty of Medicine, University of Khartoum, Khartoum, SudanFaheemullah Khan : Email: [email protected], ORCID:https://orcid.org/0000-0001-6369-743XJehanzeb Shahid: Email:[email protected] Saleem: Email: [email protected] Ahmed Khawaja: Email: [email protected] Ahmed Memon:Email:[email protected] Abdul Hameed: Email: [email protected] Abbasher Hussien Mohamed Ahmed: Email: [email protected], ORCID:https://orcid.org/0000-0003-4608-5321Article type : Case SeriesAbstract: 105Main text : 1907 (Main document)Tables : 0Figures : 5References : 27Pages : 10

Background: Priming with ChAdOx1 followed by heterologous boosting have been considered in several countries. Nevertheless, analyses that provide a comparison of the immunogenicity of heterologous booster in comparison to homologous primary vaccination regimens and natural infection are lacking. In this study, we aimed to conduct a comparative assessment of the immunogenicity between heterologous prime-boost vaccination using BNT162b2 or mRNA-1273 and homologous primary vaccination regimens. Methods: We matched vaccinated naïve individuals (VN; n=673) who had received partial vaccination (n=64), primary vaccination (n=590), or primary series plus one mRNA vaccine heterologous booster (n=19) with individuals with a documented primary SARS-CoV-2 infection and no vaccination record (natural infection; NI cohort; n=206). We measured the levels of neutralizing total antibodies (NTAbs), total antibodies (TAbs), anti-S-RBD IgG, and anti-S1 IgA titers. Results: Homologous primary vaccination with ChAdOx1 not only showed less potent NTAb, TAb, anti-S-RBD IgG, and anti-S1 IgA immune responses compared to primary-BNT162b2 or mRNA-1273 vaccination regimens (P<0.05), but also showed ~3 fold less anti-S1 IgA response compared to infection-induced immunity (P<0.001). Nevertheless, heterologous booster dose resulted in a significant boost of at least ~12 folds in the immune response. Furthermore, correlation analyses revealed that both, anti-S-RBD IgG and anti-S1 IgA significantly contributed to virus neutralization among NI individuals, particularly in symptomatic and pauci-symptomatic individuals, whereas, among VN individuals, anti-S-RBD IgG was the main contributor to virus neutralization (r > 0.90, P < 0.001). Conclusion: The results emphasize the potential benefit of using heterologous mRNA boosters to increase antibody levels and neutralizing capacity.

Frameworks are essential for software development, providing code design and reuse for its users. Well-known Java frameworks and APIs such as Spring, JUnit, and JPA rely on metadata usage, commonly defined by code annotations. Those frameworks use the Java Reflection API for consuming and processing these annotations. Code elements usually have some similarities and can also have the same annotation. This paper proposes a model for defining conventions over configuration for annotations usage decoupled from the metadata reading logic. With this model, if a convention is present, the framework will consider that the element is configured by a specific target annotation, even if the code element does not have the annotation. We implemented this model in the metadata reading framework Esfinge Metadata API. The model implementation was evaluated refactoring an existing framework to add support to conventions using our approach. As a result, it was possible to introduce the conventions only by adding configurations to the annotations. The model was further evaluated in an experiment in which participants implemented the Conventions over Configuration pattern using the Esfinge Metadata API and Java Reflection API. Based on the results, approach fulfilled its goal of supporting the definition of conventions decupled from the framework logic, making the code more readable and easier to maintain according to the participants perception.

Model-driven engineering (MDE) has become a leading methodology for the design and development of Real-Time Embedded Systems (RTES). It makes use of automatic code generation tools to reduce time, cost and effort associated with writing and maintaining software. However, automatic code generators tend to produce poor quality and inefficient code, which is unacceptable for safety critical systems. The verification and validation of such systems are crucial activities that require high-level code quality and coverage enforced by standards such as DO-178C/ED-12C for airborne software or ECSS in the European space domain. Simulink is a modelling tool offered by MathWorks widely used in the aerospace sector to develop and simulate models. The QGen tool-suite offers a C and Ada code generator appropriate for Simulink and Stateflow models. In this paper, we evaluate QGen aiming to demonstrate its applicability in embedded software products, its integrability in other modelling tools, and the quality of the autogenerated software. To that end, a set of Key Performance Indicators (KPI) have been defined to measure quantitative values mostly obtained with open-source tools. The evaluation adopts the Attitude Control System from the UPMSat-2 satellite as the technology demonstrator and its simulation and control Simulink models serve as evaluation models for this analysis. The contribution of this study has been to establish a quantitative methodology for the evaluation of the QGen tool-suite based on software metrics at varying granularity levels such as model and source code. This methodology should help the researchers to identify further metrics and use them to analyze not only automatic code generators, but also to establish a criterion to assess the technology readiness of other software products and tools.

Mesozooplankton is a key component of the ocean, regulating global processes such as the carbon pump, and ensuring energy transfer from lower to higher trophic levels. Yet, despite the importance of understanding mesozooplankton diversity, distribution and connectivity at global scale to predict the impact of climate change in marine ecosystems, there is still fragmented knowledge. To fill this gap, we applied DNA metabarcoding to mesozooplankton samples collected during the Malaspina-2010 circumnavigation expedition across temperate and tropical oceans from the surface to bathypelagic depths. By conducting a hidden diversity analysis, we highlight the still scarce knowledge on global mesozooplankton diversity and identify the Indian Ocean and the deep sea as the most understudied areas. By analysing mesozooplankton community spatial distribution, we confirm global biogeographical patterns across the temperate to tropical oceans both in the vertical and horizontal gradients. Additionally, we reveal a consistent increase in mesozooplankton beta-diversity with depth, indicating reduced connectivity at deeper layers, and identify a water mass type-mediated structuring of bathypelagic communities, instead of an oceanic basin-mediated as observed at upper layers. This suggests limited dispersal at deep ocean layers, most likely due to weaker currents and lower mixing of water mass types. Overall, our work supports the neutral theory of biodiversity and thus the importance of oceanic currents and barriers in dispersal in shaping global plankton communities, and provides key knowledge for predicting the impact of climate change in the deep-sea.

Dry ice is one of the world’s most in-demand commodities for cold chain distribution of temperature sensitive products in insulated shippers. A rule of thumb for packaging dry ice has been that it sublimates about 2.3 to 4.5 kg every 24 hours, without any consideration for specific dry ice type, size or geometry [(CISA, 2020)](#ref-0004). This study explored sublimation rates of dry ice composition (binding agent and density), age, and geometry (size and shape). Dry ice block manufacturing often involves dosing propylene glycol-water “binder” solution to liquid carbon dioxide. Tests performed in this study revealed that the binding agent did not influence the dry ice sublimation rate. Dry ice density was found to impact sublimation rate. Fresh and aged blocks of similar dimensions and weight were found to have similar performance outcomes. Weight loss curves for pellets and various sized dry ice blocks showed a dependence on surface area and volume. Chunked blocks and pellets with and without binding agent sublimated at similar rates of 2.84 % h -1 and 2.53 % h -1 (w/w), respectively, whereas block varieties with significantly lower surface area to volume ratios had lower sublimation rates of 0.98-1.60 % h -1.

Background: Several recent studies have investigated the association between maternal diet during pregnancy and asthma in children. However, whether a specific dietary pattern during pregnancy protects children from asthma remains unclear. This study investigated the association between a healthy diet, dietary inflammation potential during pregnancy, and the risk for wheezing and atopic eczema in children. Methods: This study included 1330 mother-child pairs who attended the Kuopio Birth Cohort (KuBiCo) study and had dietary information during the last trimester and information on children’s health in the first year of life. The Alternative Healthy Eating Index for Pregnancy (AHEI-P) and Dietary Inflammatory Index (DII) indicate a healthy diet and dietary inflammation potential during pregnancy. The AHEI-P and DII were compared with reported wheezing and doctor-diagnosed atopic eczema in children during the first year of life. Results: Neither the AHEI-P nor the DII was associated with wheezing or atopic eczema in children when analyzed by continuous variables or tertiles. The odds ratio for AHEI-P and wheezing was 0.99 (0.98–1.01); for AHEI-P and atopic eczema was 1.01 (0.99–1.02); for DII and wheezing was 1.02 (0.95–1.09), and for DII and atopic eczema was 0.97 (0.91–1.04). Conclusion: In this cohort study, a maternal healthy or anti-inflammatory diet during pregnancy was not associated with wheezing or atopic eczema in the first year of life. Interventions in the overall dietary pattern during pregnancy might not effectively prevent atopic diseases in children.

Disturbance and connectivity control biodiversity, ecosystem functioning and their interactions across connected aquatic and terrestrial ecosystems, that form a meta-ecosystem. In rivers, detrital organic matter (OM) is transported across terrestrial-aquatic boundaries and along the river network and decomposed on the way by diverse communities of organisms, including microorganisms and invertebrates. Drying naturally fragments most river networks and thereby modify organism dispersal and OM transfers across ecosystems. This may prevent organisms from reaching and consuming OM, generating mismatches between community composition and decomposition. However, little evidence of the effects of drying on river network-scale OM cycling exists. Here, we aim to examine the effects of fragmentation by drying on the structure of consumer communities and ecosystem functioning within interacting aquatic-terrestrial river ecosystems. We monitored leaf resource stocks, invertebrate communities and decomposition rates in the instream and riparian habitats of 20 sites in a river network naturally fragmented by drying. Although instream resource quantity and quality increased with drying severity, decomposition decreased due to changes in invertebrate communities and particularly leaf-decomposer abundance. Invertebrate-driven decomposition peaked at intermediate levels of upstream connectivity, suggesting that intermediate levels of fragmentation can promote the functioning of downstream ecosystems. We found that the variability in community composition was unrelated to variability in decomposition at sites with low connectivity and high drying severity, suggesting that such conditions can promote mismatches between community composition and decomposition. Decomposition instream was correlated to decomposition in the riparian area, revealing one of the first network-scale evidence of the links between ecosystem functions across terrestrial-aquatic boundaries. Our river network-scale study thus demonstrates the paramount effect of drying on the dynamics of resources, communities and ecosystem functioning in river networks, with crucial implications for the adaptive management of river networks and preservation of their functional integrity.

Many attempts have been made in the past to regain the spectral accuracy of the spectral methods, which is lost drastically due to the presence of discontinuity. In this article, an attempt has been made to show that mollification using Legendre and Chebyshev polynomial based kernels improves the convergence rate of the Fourier spectral method. Numerical illustrations are provided with examples involving one or more discontinuities and compared with the existing Dirichlet kernel mollifier. Dependence of the efficiency of the polynomial mollifiers on the parameter P is analogous to that in the Dirichlet mollifier, which is detailed by analysing the numerical solution. Further, they are extended to linear scalar conservation law problems.

Neurofibromatosis type 1 may present as a gingival neurofibroma in a patient with no family history. Accurate diagnosis will lead to successful management of oral lesions. The present case is a report of sporadic gingival neurofibroma in an 18 year old male.

In this paper, we consider the non-fragile containment control problem of nonlinear multi-agent systems (MASs) with exogenous disturbance where the communication links among agents under consideration is directed. Firstly, based on relative output measurements between the agent and its neighbors, a disturbance observer-based control protocol is proposed to solve the containment control problem of MASs with inherent nonlinear dynamics and exogenous disturbances. Secondly, because of the additional tuning of parameters in the real control systems, uncertainties in the designing of observer and controller gains always occur, and as a result, an output feedback controller with disturbance rejection is conceived and the containment control problem of nonlinear MASs with non-fragility is thoroughly investigated. Then, depending on matrix transformation and inequality technique, sufficient conditions of the designed controller gains exist, which is derived from the asymptotic stability analysis problem of some containment error dynamics of MASs. Finally, two simulation examples are exploited to illustrate the effectiveness of the proposed techniques.

IntroductionFolliculitis is inflammation of hair follicles, most commonly due to infection. Ingrown hairs and trauma from shaving or waxing promote follicular occlusion and irritation and increase risk of folliculitis.Folliculitis is classified by depth of infection. Superficial folliculitis involves the superficial part of the hair follicle (infundibulum) while deep folliculitis involves the entire hair follicle. On examination, inflammation of superficial folliculitis is restricted to the epidermis. Deep folliculitis is distinguished by widespread erythema, edema, and tenderness involving the dermis.

Background Patients presenting with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remain challenging clinical scenarios as large variation exists in practices used to locate the primary. Objective To perform a systematic review of the literature and offer recommendations for oropharyngeal biopsies in HNSCCUP. Method Pubmed, Medline and Embase were searched to identify studies from inception to October 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Results 483 articles were included and screened, 40 studies met the inclusion criteria, including over 3400 patients from the original articles and 1575 patients from 3 meta-analyses. The primary site identification rate following random biopsies or deep tissue biopsies is less than 5% in most studies. The mean detection rate following ipsilateral tonsillectomy is 34%; two pooled analyses indicate that the mean detection rate following tongue base mucosectomy is 64%, with this figure rising when the tonsils are negative. Conclusions High level evidence is lacking, with heterogeneity in the reported studies. Published meta analyses are based on retrospective data. There is little evidence supporting the practice of random/non-directed oropharyngeal biopsies. Available evidence supports palatine tonsillectomy and tongue base mucosectomy compared to deep tissue biopsies.