Groundwater recharge in highly-fractured volcanic aquifers remains poorly understood in the humid tropics, whereby rapid demographic growth and unregulated land use change are resulting in extensive surface water pollution and a large dependency on groundwater extraction. Here we present a multi-tracer approach including δ18O-δ2H, 3H/3He, and noble gases within the most prominent multi-aquifer system of central Costa Rica, with the objective to assess dominant groundwater recharge characteristics and age distributions. We sampled wells and large springs across an elevation gradient from 868 to 2,421 m asl. Our results suggest relatively young apparent ages ranging from 0.0±3.2 up to 76.6±9.9 years. Helium isotopes R/RA (0.99 to 5.4) indicate a dominant signal from the upper mantle across the aquifer. Potential recharge elevations ranged from ~1,400 to 2,650 m asl, with recharge temperatures varying from ~11°C to 19°C with a mean value of 14.5±1.9°C. Recharge estimates ranged from 129±78 to 1,605±196 mm/yr with a mean value of 642±117 mm/yr, representing 20.1±4.0% of the total mean annual rainfall as effective recharge. The shallow unconfined aquifer is characterised by young and rapidly infiltrating waters, whereas the deeper aquifer units have relatively older waters. These results are intended to guide the delineation and mapping of critical recharge areas in mountain headwaters to enhance water security and sustainability in the most important headwater dependent systems of Costa Rica.

Organometallic sandwich complexes have been attracting tremendous interest for their potential applications in electronics and spintronics. Here, we systematically studied the structures, electronic and magnetic properties of one dimensional (1D) transition metal (TM)-anthracene (Ant) sandwich molecular wires (SMWs), [TM2Ant]∞ and [TM3Ant]∞ (TM=Ti, V, Cr, Mn), based on density functional theory calculations. Our results showed that all the 1D SMWs display normal sandwich configurations with their binding energies closely related to the choice of TM atoms. Excepting 1D [Mn2Ant]∞ and [Fe3Ant]∞ favoring antiferromagnetic ordering, most 1D [TM2Ant]∞ and [TM3Ant]∞ SMWs display robust ferromagnetic feathers. Particularly, 1D [Cr3Ant]∞ SMW is revealed to be ferromagnetic half-metal with large magnetic moment of 28.0µB per unit cell. Further spintransport calculations double proved that 1D [Cr3Ant]∞ SMW are good spintransport molecular devices. Our findings shed light on the properties of 1D Ant based SMWs and propose a new way to design potential electronic and spintronic devices.

A document by Peter Shaw. Click on the document to view its contents.

Background: We tested the hypothesis that multiple obesity-related risk factors (obesity, physical activity, cardiopulmonary physical fitness, sleep-disorder breathing (SDB), and sleep quality) are associated with childhood asthma using a Mendelian randomization (MR) design. Furthermore, we aim to investigate whether these risk factors were associated with incident asthma prospectively. Methods: In total, 7069 children aged 12 from the Taiwan Children Health Study were enrolled in the current study. Cross-sectional logistic regression, one-sample MR, summary-level MR sensitivity analyses, and prospective survival analyses were used to investigate each causal pathway. Results: In MR analysis, three of the five risk factors (obesity, SDB, and sleep quality) were associated with asthma, with the highest effect sizes per interquartile range (IQR) increase observed for sleep quality (odds ratio [OR] =1.42; 95% confidence interval [CI]: 1.06 to 1.92) and the lowest for obesity (OR = 1.08; 95% CI: 1.00–1.16). In the prospective survival analysis, obesity showed the highest risk of incident asthma per IQR increase (hazard ratio [HR] = 1.28; 95% CI: 1.05 to 1.56), followed by SDB (HR = 1.18; 95% CI: 1.08 to 1.29) and sleep quality (HR = 1.10; 95% CI: 1.03 to 1.17). Conclusion: The most plausible risk factors for asthma were obesity, SDB, and poor sleep quality. For the prevention of childhood asthma, relevant stakeholders should prioritize improving children’s sleep quality and preventing obesity comorbidities such as SDB.

Bipolar disorder is a chronic and recurring psychiatric illness. Emphasis on enhancing key protective factors like social support systems and promoting this to minimize risk factors like non-compliance is one of the key strategies tied to enhance overall health for symptoms remission and relapse prevention even during the COVID-19 Pandemic.

Abstract Background: Location of cancer care (LOC: pediatric versus adult center) impacts outcomes in adolescents and young adults (AYA) with some cancer types. Data on impact of LOC on survival in AYA with osteogenic sarcoma (OGS) and Ewing sarcoma (EWS) are limited. Objectives: To compare differences in demographics, disease/treatment characteristics, and survival in a population-based cohort of AYA with OGS or EWS treated at pediatric versus adult centers Methods: The IMPACT Cohort captured demographic, disease, and treatment data for all AYA (15-21 years old) diagnosed with OGS and EWS in Ontario, Canada between 1992-2012. Patients were linked to provincial administrative healthcare databases. Outcomes were compared between patients treated in pediatric versus adult centers using appropriate statistical methods. Results: 137 AYA were diagnosed with OGS (LOC: 47 pediatric, 90 adult) and 84 with EWS (LOC: 38 pediatric, 46 adult). AYA treated at pediatric centers were more likely to be enrolled in a clinical trial (OGS 55% vs 1%, [p<0.001]; EWS 53% vs 2%, [p<0.001]) and received higher cumulative chemotherapy doses. Five-year event-free survival (EFS ± Standard Error) in OGS and EWS were 47% ± 4 and 43% ± 5, respectively. In multivariable analysis, the impact of LOC (pediatric vs adult center) on EFS in OGS (adjusted hazard ratio [HR] 1.15, 95% CI 0.58-2.27, P=0.69) and EWS (adjusted HR 1.82, 95% CI 0.97-3.43, P=0.06) were not statistically significant. Conclusion: Outcomes did not differ by LOC suggesting that AYA with bone tumors can be treated at either pediatric or adult centers.

Title: The Practical Matters of Including Patient Reported Outcomes in Pediatric Oncology Clinical CareEmily L Mueller, MD MSc1,2Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN 46202Correspondence:Emily L Mueller, MD, MSc705 Riley Hospital Dr, ROC 4340Indianapolis, IN 46202Cell: 312-399-0245 Fax: [email protected] word count: 0Main text word count: 6654Number of tables: 0Number of figures: 0Short Title: Practicalities of PRO in Clinical CareAbbreviations:

The Impella 5.5 with SmartAssist (Abiomed; Danvers, MA) is a life-saving treatment option in acute heart failure which utilizes a continuous heparin purge solution to prevent thrombosis. In patients with contraindications to heparin, alternative anticoagulation strategies are required. We describe the stepwise management of anticoagulation in a coagulopathic patient with persistent cardiogenic shock following a coronary artery bypass procedure who underwent Impella 5.5 placement. A direct thrombin inhibitor-based purge solution was utilized while evaluating for heparin-induced thrombocytopenia. Use of a novel bicarbonate-based purge solution (BBPS) was successfully used due to severe coagulopathy. There were no episodes of pump thrombosis or episodes of severe bleeding on the BBPS and systemic effects of alkalosis and hypernatremia were minimal.

The work reported in this investigation involves the determination of the hydrodynamic properties of the Trickle Bed Reactor which has been loaded in various ways to mark the effect of the loading methodologies employed to pack the catalyst pellets. The bed structure of a packed three-phase reactor is critical to study as it provides the essential contact between the phases and provides the catalytic sites where the reaction takes place. Depending on the structural properties of the bed such as local void structure, liquid distribution, two-phase pressure drop, and holdup of fluids gets affected. The study aims to envelop the catalyst bed characteristics such as the local void structure, the length of the catalyst bed, flow characteristics such as liquid and gas flow rate, and liquid distributor at the top of the catalyst bed to gauge and quantify their effect on the hydrodynamics of a trickle bed reactor.

Yttrium-doped barium cerate (BaCe0.8Y0.2O3-δ, BCY) is the most widely studied proton conducting material and is frequently fabricated as dense membranes for hydrogen separation. However, the difficulty to prepare dense BCY membranes is the extremely high sintering temperature, normally higher than 1500 oC. Herein, the BCY 7-channel hollow fiber membrane was prepared by one-step thermal processing (OSTP). It proved that adding Co2O3 as sintering aid is beneficial to the densification and 1wt% Co2O3 was the optimum addition to form a homogeneous phase structure. The dense sintering temperature was greatly reduced from over 1500 to 1350 oC. The hydrogen permeation flux of the BCY hollow fiber membrane reached up to 0.34 ml min-1cm-2 at 900 oC. The long-term stability test last for 300 h. The properties of OSTP samples were demonstrated to be essentially higher than samples made by conventional ceramic hollow fiber fabrication methods.

Objective: Otitis media (OM) is a common disease in childhood, but much less prevalent in adults, where it, however, tends to have a less benign course. The incidence of OM in children has decreased in recent years, which might be partly explained by the introduction of watchful waiting strategies, and by the introduction of conjugate pneumococcal vaccination (PCV) in children. Adult OM has been sparsely studied, and it is not known whether a herd immunity effect has been achieved after the introduction of PCV. Watchful waiting is usually not considered in adult OM patients. The purpose of this study was to use a national database to investigate the incidence of adult OM in Sweden during the last 20 years. Design: The yearly number of patients aged 20 and over, admitted to hospital with OM was obtained through a national database from 2000 to 2019. The corresponding numbers for outpatients were obtained between 2005 and 2019. Main outcome measures: incidence of acute otitis media in adults in in- and outpatient care. Results: Incidence rates decreased steadily during the study period. Comparing data on hospitalised patients from 2016-2019 to 2005-2008 (PCV was introduced in 2009), the incidence rate ratio was 0.49 (95% CI 0.45-0.53); p<0.0001. The corresponding figures for outpatients were 0.62 (95% CI 0.61-0.63); p<0.0001. The decrease in hospital admissions was most pronounced among younger patients, whereas the opposite was true for outpatient visits. Conclusions: There has been a continuous decrease in incidence of adult patients admitted to hospital with OM in Sweden during the last twenty years. Outpatient visits for OM have declined since 2009.

Root exudates can greatly modify microbial activity and soil organic matter (SOM) mineralization. However, the mechanism of root exudation and its stoichiometric ratio of C/N controlling upon paddy soil C mineralization are poorly understand. In this study, we used a mixture of glucose, oxalic acid, and alanine as root exudate mimics, employing three C/N stoichiometric ratios (CN6, CN10, and CN80) to explore the underlying mechanisms involved in C mineralization. The input of root exudates enhanced CO2 emission by 1.8–2.3-fold than that of the control. Artificial root exudates with low C/N ratios (CN6 and CN10) increased the metabolic quotient (qCO2) by 12% over those obtained at higher stoichiometric ratios (CN80 and C-only), suggesting a relatively high energy demand for microorganisms to acquire organic N from SOM by increasing N-hydrolase production. The stoichiometric ratios of enzymes (β-1,4-glucosidase to β-1,4-N-acetyl glucosaminidase) promoting organic C degradation compared to those involved in organic N degradation showed a significant positive correlation with qCO2; the stoichiometric ratios of microbial biomass (MBC/MBN) were positively correlated with carbon use efficiency. This suggests that root exudates with higher C/N ratios entail an undersupply of N for microorganisms, triggering the release of N-degrading extracellular enzymes. This in turn decreases SOM mineralization, implying the C/N ratio of root exudates to be a controlling factor. Our findings show that the C/N stoichiometry of root exudates controls C mineralization by the specific response of the microbial biomass through the release of C- and N-releasing extracellular enzymes to adjust for the microbial C/N ratio.

As in many other countries, Peru has the Water Quality Standard (WQS) as the primary tool for managing and diagnosing water resources. An analysis variable by variable to define water quality as poor or good was applied by setting concentration limits. A second group of tools commonly used are Biotic Indexes based on tolerance of benthic macroinvertebrates to pollution, that reflect the impacts caused by a group of variables, even though they cannot identify which variables determine the viability of the ecosystem. This research proposes to include the Stable States approach to evaluate the ecological integrity in central Andes rivers to explore an alternative approach with the capacity to represent a broader number of factors through multivariate analysis. A ten-year database of biological and physical-chemical variables measured in five Andean rivers were evaluated. Our results suggest these rivers fluctuate into two seasonal stable states (wet and dry season), accounting for approximately 31% of the system variability. In the wet season, the equilibrium of the state was dominated by the highest levels of suspended solids, turbidity, coliform, phosphorus, and some metals. During the dry season, the key variables were dissolved oxygen, flow, physical habitat, and biotic and diversity indexes. Likewise, there seems to be a third alternative state influenced by human pressures because of variables that exceed the WQS. Regarding water quality, the concentrations of coliforms, phosphorus, and lead usually exceeded the limits in two stations, but not every year. The ecological condition was better represented by ABI index than EPT.

Obstetric care for women that use antidepressants in pregnancyLine Kolding, MD, PhDVera Ehrenstein, MPH, DSc, ProfessorLars Pedersen, MSc, PhD, ProfessorPuk Sandager, MD, PhD, Associate ProfessorOlav B. Petersen, MD, PhD, ProfessorNiels Uldbjerg, MD, DMSc, ProfessorLars H. Pedersen, MD, PhD, ProfessorCorresponding:Lars Henning PedersenAarhus University Hospital / Aarhus UniversityPalle Juul-Jensens Blvd. 99, 8200 Aarhus N, DenmarkEmail: [email protected]: +45 50526512We are grateful to Drs. Braillon and Bewley for their interest in our recent paper in the BJOG 1 and would like to elaborate on some of the important points they raise.We agree with Braillon and Bewley on the urgent need for improved pharmacovigilance of medication in pregnancy in general, and for antidepressants in particular. There are excellent international collaborations (e.g., the EuroCat) and local initiatives (e.g., the Swedish JanusInfo), but clinically we’re often forced to rely on very limited information indeed. Systematic international recording as suggested by Braillon and Bewley would represent an important step forward.On a smaller scale, we are establishing an automated surveillance system based on curated data that include information on both pre- and postnatally diagnosed malformations. We have, however, faced substantial legal and bureaucratic challenges, and have been forced to use data from the Central Denmark Region only, instead of national data. The surveillance system is consequently based on information on approx. 75,000 pregnancies, and even though it has the potential to aide clinical management, it is a drop in the ocean of the huge potential of for instance a comparable European collaboration.In our study, we used ≥2 redeemed prescriptions to define exposure with a prevalence 1.1%.1 The prevalence of pregnant women that redeemed ≥1 prescription was 3.2% (p. 3/ Table S1), and even though this is likely an overestimation due to non-adherence, the estimates are in line with previously reported prevalences in Scandinavia.2Braillon and Bewley emphasise the need to also consider non-pharmacological treatment of some pregnant women with depression and, further, to provide evidence-based and individualised treatment of women in the reproductive ages. Optimal individualised care will definitely result in non-pharmacological treatment of some pregnant women but, reversely, will cause yet other women to continue or initiate pharmacological treatment. This is in line with what is almost a truism in this field, that the potential harmful foetal effects must be balanced against the potential benefits of a pharmacological treatment, but it is no easy task. Pregnant women might overestimate the foetal risks associated with use of medication3 and discontinue important treatment, on the other hand some may use medication when there may be a better alternative for them. Regardless, we need to provide optimal obstetric care for the pregnant women that choose treatment with antidepressants. If our results are correct, prenatal follow-up of pregnant women treated with venlafaxine may include targeted foetal heart scans, even though the underlying causal explanation for the observed association with cardiac malformations is undetermined.1. Kolding L, Ehrenstein V, Pedersen L, Sandager P, Petersen OB, Uldbjerg N, et al. Antidepressant use in pregnancy and severe cardiac malformations: Danish register-based study. BJOG. 2021 May 25.2. Zoega H, Kieler H, Norgaard M, Furu K, Valdimarsdottir U, Brandt L, et al. Use of SSRI and SNRI Antidepressants during Pregnancy: A Population-Based Study from Denmark, Iceland, Norway and Sweden. PLoS One. 2015;10(12):e0144474.3. Wolgast E, Lindh-Åstrand L, Lilliecreutz C. Women’s perceptions of medication use during pregnancy and breastfeeding—A Swedish cross-sectional questionnaire study. Acta Obstetricia et Gynecologica Scandinavica. 2019;98(7):856-64.

Background: Increasing interest in physiological pacing has been countered with challenges such as accurate lead deployment and increasing pacing thresholds with His-bundle pacing (HBP). More recently, left bundle branch area pacing (LBBAP) has emerged as an alternative approach to physiologic pacing. Objective: To compare procedural outcomes and pacing parameters at follow-up during initial adoption of HBP and LBBAP at a single center. Methods: Retrospective review, from September 2016 to January 2020, identified the first 50 patients each who underwent successful HBP or LBBAP. Pacing parameters were then assessed at first follow-up after implantation and after approximately one year, evaluating for acceptable pacing parameters defined as sensing R-wave amplitude >5 mV, threshold <2.5 V @ 0.5 ms and impedance between 400 and 1200 Ohms. Results: The HBP group was younger with lower ejection fraction compared to LBBP (73.2±15.3 vs 78.2±9.2 years, p=0.047; 51.0±15.9% vs 57.0±13.1%, p = 0.044). Post-procedural QRS widths were similarly narrow (119.8±21.2 vs. 116.7±15.2ms; p = 0.443) in both groups. Significantly fewer patients with HBP met the outcome for acceptable pacing parameters at initial follow-up (56.0% vs 96.4%, p = 0.001) and most recent follow-up (60.7% vs 94.9%, p = <0.001; at 399±259 vs. 228±124 days, p = <0.001). More HBP patients required lead revision due to early battery depletion (0 vs 13.3%, at an average of 664 days). Conclusion: During initial adoption, as compared with LBBAP, HBP is associated with a significantly higher frequency of unacceptable pacing parameters, energy consumption, and lead revisions.

Poultry and poultry-derived products such as meat and eggs are among the main sources of non-typhoidal Salmonella (NTS) transmission to the human. Therefore, we performed a systematic review and used random-effects meta-analyses to 1) estimate the prevalence of NTS in poultry samples from birds, products and subproducts, and environmental samples, 2) examine the diversity and frequency of their serovars, and 3) estimate the prevalence and profiles of antimicrobial resistance (AMR) in NTS isolates reported in studies from the Americas. We included 157 studies from 15 countries comprising 261,408 poultry samples and estimated an overall pooled prevalence of 17.9% (95% CI: 10.8–26.3) in birds, 21.8% (17.7–26.1) in products and subproducts, and 29.5% (24.2–35.1) in environmental samples. At the national level, the prevalence of NTS was heterogenous across countries with the highest values in Mexico, the USA, and Canada. In total, 131 serovars were identified from 13,388 isolates, Heidelberg, Kentucky, Enteritidis, and Typhimurium were the most prevalent in the overall top 10 ranking (range 6.5–20.8%). At the national level, Enteritidis and Typhimurium were identified in most of the countries, though with national differences in their ranks. The prevalence of AMR increased from 24.1% for 1 antibiotic, to 36.2% for 2-3 antibiotics, and 49.6% for ≥ 4 antibiotics. Kentucky, Heidelberg, Typhimurium, and Enteritidis were the serovars with the highest prevalence of AMR and tetracycline, ampicillin, streptomycin, ceftiofur, and amoxicillin-clavulanic acid were the top five antibiotics to which NTS isolates were resistant. In conclusion, NTS was distributed through the avian production chain with high and heterogenous values of prevalence in poultry samples. Besides, there were distinctive patterns of serovars distribution across countries and an alarming prevalence of AMR among zoonotic serovars.

We report the third case of lichen planus (LP) following COVID-19 BNT162b2 vaccination in a 59-year-old woman with previous LP. The reactivation of LP in patients with dormant LP, suggests possible vaccine-induced immune dysregulation. We suggest that the already described vaccine-induced up-regulation of Th1 response, may play a relevant role.

Given the increased need for mechanical circulatory support and subsequent development of right ventricular assist devices (RVAD), appropriate imaging needs to be described to facilitate care in patients with cardiogenic shock and heart failure. We present three cases in which the upper esophageal aortic arch short axis (UE AA SAX) view on transesophageal echocardiography (TEE) was utilized to effectively image RVADs: to confirm normal positioning, to detect and guide repositioning, and to visualize malfunction. These cases support the importance of the UE AA SAX TEE view in RVAD outflow imaging and, when obtainable, should be included in routine RVAD assessment.