C4F7N with excellent insulation performance has been proposed to replace the traditional SF6 as a new insulating medium in power equipment. In the present study, the molecular structure and radiative efficiency (RE) of C4F7N are calculated and compared with SF6 based on DFT calculation. The decomposition of pure C4F7N and the basic interactions between C4F7N and hydroxyl radical in the constructed co-crystal of C4F7N-H2O have been simulated by applying Monte-Carlo calculation and Car-Parrinello molecular dynamics (CPMD) method, in order to obtain reasonable and full-scale atmospheric dissociation processes. Then the detailed decomposition pathways are learned with DFT method of M062X. The rate constants of different pathways are further applied for calculating the atmosphere lifetime of C4F7N, to evaluate the possibility of applying it as an alternative gas of SF6 in power equipment. All the atmospheric chemical behaviours are determined by electronic structure and reflected by the decomposition pathways of C4F7N with interacting with hydroxyl radicals. Rather than traditional hypothesizing reaction models, this study provides a reasonable and practicable method to evaluate more alternative protective gas for understand the greenhouse effect.

Forest transition theory posits that socioeconomic development in a country or region may cause its forestland to shift from net loss to net gain. However, forest transition may also occur under various policies, resulting in forest gains in some regions but deforestation in other regions. We used the telecoupling framework to address this crucially important issue that has rarely been examined. Using time series satellite images and statistical yearbook data from 2000 to 2020, this study seeks to understand land use change patterns, the corresponding regional spillover effects, and driving forces behind such patterns in Zhejiang Province, China. The results show that large-scale continuous deforestation has taken place since 2000, causing a total loss of forestland by 186,014 ha. In parallel with this forest loss and a slight decrease in arable land, urban construction land has soared by 169.45%. We found that developed municipalities such as Hangzhou witnessed increases in urban land at the expense of large-scale deforestation in underdeveloped municipalities such as Lishui. We believe that this cross-region land change pattern may arise from the Balance of Arable Land System (BALS) policy that seeks to achieve a goal of no net loss of cropland. Whatever land use policy—such as the BALS policy—must strike a good balance between competitive land uses that have different objectives such as residents’ living, ecology, and production. In addition to enriching the forest transition theory, this study provides a solid basis for future land use decisions in developing regions or countries.

Aims: to systematically review the prevalence of DCD in individuals born preterm; explore this prevalence according to gestational age and different assessments cut-offs; and compare to full-term peers. Methods: The eligibility criteria was observational and experimental studies reporting the prevalence of DCD in preterm individuals. A systematic search was performed in databases from inception until March 2022. The selection was performed by two independent reviewers. Study quality assessment was performed using the checklists from Joanna Briggs Institute (JBI). Data analysis were performed on Excel and Review Manager Software 5.4. Results: Among the 1774 studies identified, 32 matched the eligibility criteria. The pooled estimates of DCD rate in preterm was 21% (95% CI 17.8–24.3). The estimate rates were higher as gestational age decreased, and preterm children are two times more likely to have DCD than their full-term peers RR 2.2 (95% IC 1.77–2.79). Interpretation: The limitation was high heterogeneity between studies: the assessment tools and cut-off points, as well as the age at assessment, were diverse. This study provided evidence that preterm children are at higher risk for DCD than full-term children, and the risks increased as gestational age decreased.

Neural Tube Defects (NTDs) are congenital malformations resulting from abnormal embryonic development of the brain, spine, or spinal column. The genetic etiology of human NTDs remains poorly understood despite intensive investigation. CIC, homolog of the Capicua transcription repressor, has been reported to interact with ataxin-1 (ATXN1) and participate in the pathogenesis of spinocerebellar ataxia type 1. Our previous study demonstrated that CIC loss of function (LoF) variants contributed to cerebral folate deficiency by downregulating folate receptor 1 (FOLR1) expression. Given the importance of folate transport in neural tube formation, we hypothesized that CIC variants could contribute to increased risk for NTDs by depressing embryonic folate concentrations. In this study, we examined CIC variants from whole genome sequencing (WGS) data of 140 isolated spina bifida cases and identified 8 missense variants of CIC gene. We tested the pathogenicity of the observed variants through multiple in vitro experiments. We determined that CIC variants decreased FOLR1 protein level and planar cell polarity (PCP) pathway signaling in a human cell line (HeLa). In a murine cell line (NIH3T3), CIC loss of function variants down regulated PCP signaling. Taken together, this study provides evidence supporting CIC as a risk gene for human NTD.

There is evidence of increased incidence, rapid progression, and poor prognosis of Covid-19 in patients with underlying comorbidities such as diabetes and epilepsy. It is crucial to develop effective treatment regimens for these patients. Multiple organ failure is the most common cause of death in Covid-19 patients.

Being the leading cause of mortality by a single infectious agent, tuberculosis (TB) continues as one of the most relevant issues of public health. Another pandemic disease is type 2 diabetes mellitus (T2D) is usually associated with immunodeficiency. Thus, an increased prevalence of TB-T2D comorbidity represents one of the most significant challenges for health providers. During the chronic phase of both diseases, several immunoendocrine abnormalities are occurring, but extra-adrenal production of active glucocorticoids (GCs) is a possible deleterious factor in both entities. Active GCs have been related to insulin resistance and suppression of Th1 responses, contributing to T2D and TB pathogenesis. 11-β-hydroxysteroid dehydrogenase type 1 (11-βHSD1) catalyzes the conversion of inactive GGs in their active form (cortisol or corticosterone in rodents) in the lungs and liver and could be responsible for this immunoendocrine disfunction. Dehydroepiandrosterone (DHEA) is an anabolic adrenal hormone with antagonist effects against GCs on immune cells and glucose metabolism. A synthetic analog of DHEA, the 16a-bromoepindrosterone (BEA), lacks an anabolic effect while keeping his immune and metabolic effect. The therapeutic efficiency of BEA was studied in a murine model of T2D-TB comorbidity. TB-T2D mice underwent more severe lung disease than in TB-infected but non-diabetic animals. BEA decreased the active form of GCs and 11-βHSD1 expression, while increasing 11-βHSD2 expression, which reduced hyperglycemia and liver steatosis, lung bacillary loads, and pneumonia. Thus, it seems that BEA is an efficient therapy to control metabolic and immune abnormalities caused by high active GCs production.

Pediatric immune thrombocytopenia (ITP) is an acquired disorder associated with autoimmune destruction and impairment of platelet production in children. Some children exhibit poor or transient response to ITP-directed treatments and are referred to as having refractory ITP (rITP). There is currently no consensus on the definition of rITP, nor evidence-based treatment guidelines for patients with rITP. After a survey of pediatric ITP experts demonstrated lack of consensus on pediatric rITP, we pursued a systematic review to examine the reported clinical phenotypes and treatment outcomes in pediatric rITP. The search identified 253 relevant manuscripts; following review, 11 studies proposed a definition for pediatric rITP with no consensus amongst them. Most definitions included sub-optimal response to medical management, while some outlined specific platelet thresholds to define this sub-optimal response. Common attributes identified in this study should be used to propose a comprehensive definition, which will facilitate outcome comparisons of future rITP studies.

A document by Paul Angers. Click on the document to view its contents.

Araucaria araucana is an iconic long-lived endangered tree species exclusively distributed in Southern Chile and Argentina. Araucaria forest ecosystems provide a myriad of ecosystem benefits to local aboriginal Mapuche-Pehuenche communities. Among the main current threats for Araucaria forests are the increasing frequency and severity of wildfires and overgrazing. This study evaluates the effect of uncontrolled livestock grazing on soil quality indicators linked to critical functions relevant to forest regeneration and ecosystem service provision. We also aim to determine a set of soil quality indicators that are sensitive enough to grazing pressure, so they are useful as early indicators of degradation or the effectiveness of restoration practices. This study evaluated twenty soil quality indicators in two contiguous degraded forest areas with contrasting grazing pressure. We observed a substantial shift in forest structure, a reduction in tree coverage on the overgrazed sites. Overgrazing has produced significant deterioration of most soil physical, chemical, and biological quality indicators making soil conditions less suitable for seed germination and sapling establishment. We also observed an alteration in C, N, and P biogeochemical pools. Besides, soil physical indicators alterations suggest changes in these soils' hydrological behavior, potentially reducing water storage, availability, and increasing runoff. We show that uncontrolled grazing in native protected areas degrades soils and forest health, restricting forest regeneration and potentially accelerating erosive processes. Our results emphasized the need for an improved conservation plan for these forests that systematically evaluates and monitors livestock grazing and all its direct and indirect effects, including soil quality.

Warfarin has existed for more than seven decades and has been the anticoagulant of choice for many thromboembolic disorders. The recent introduction of direct acting oral anticoagulants (DOACs) has however caused a shift in preference by healthcare professionals all over the world. DOACs have been found to be at least as effective as warfarin in prevention of stroke in patients with atrial fibrillation and in treatment of venous thromboembolism. In sub-Saharan Africa, however, the widespread use of DOACs has been hampered mainly by their higher acquisition costs. As the drugs come off patent, their use in sub-Saharan Africa is likely to increase. However, very few trials have been conducted in African settings, and safety concerns will need to be addressed with further study before widespread adoption into clinical practice.

The Short Synacthen Test is the way that we most often determine whether people's adrenal glands are working. We here have shown that an extra blood sample taken at 60 minutes post Synacthen vs a 30 minute sample alone, may make the test more effective at excluding those people who do not need to go on hydrocortisone supplementation or need further evaluation.

Introduction - Treatment abandonment contributes significantly to poor survival of children with cancer in low-middle-income countries (LMICs). In order to inform an approach to this problem at our Cancer Unit, we investigated why caregivers withdraw their children from treatment. Methods – In a qualitative study, in-depth interviews were conducted with caregivers of children who had abandoned cancer treatment at the Paediatric Cancer Unit (PCU) of Mbarara Regional Referral Hospital (MRRH) in South Western Uganda, between May 2017 and September 2020. Recorded in-depth interviews with caregivers were transcribed and analyzed to identify themes of caregiver self-reported reasons for treatment abandonment. Results - Seventy-seven out of 343 (22.4%) children treated for cancer at MRRH abandoned treatment during the study period; 20 contactable and consenting caregivers participated in the study. The median age of children’s caregivers was 37 years and most (65%) were mothers. At the time of this study, eight (40%) children were alive and 5 (62.5%) were males; with a median age of 6.5 years. Financial difficulties, other obligations, the child falsely appearing cured, preference for alternative treatments, belief that cancer was incurable, fear that the child’s death was imminent and chemotherapy side-effects were the caregivers’ reasons for treatment abandonment. Conclusions and Recommendation – Treatment abandonment among children with cancer in Uganda is, most times, as a result of difficult conditions beyond the caregivers’ control and needs to be approached with empathy and support.

A subtle aortic dissection can be challenging to detect despite the availability of multiple diagnostic modalities. Whilst rare, the inability to detect this variant of aortic dissection can lead to a dismal prognosis. We present an extremely rare case of a subtle aortic dissection with supraannular aortic root intimal tear and acute severe aortic regurgitation in a patient with a bicuspid aortic valve. Initial concerns were either aortic dissection or infective endocarditis. Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and a Bentall procedure with a mechanical aortic valve was performed. As current data is limited, a literature review concerning subtle aortic dissection is provided.

Background: Hepatic metastasis from retinoblastoma (RB) is rare. We evaluated clinical features, imaging manifestations, treatment, and prognosis in these patients. Procedure: Clinical data of five patients diagnosed with hepatic metastases of RB at the Department of Pediatrics in Beijing Tongren Hospital between January 2009 and January 2019 were analyzed retrospectively. Results: Two patients had bilateral lesions, while three had unilateral lesions. Among the seven eyes with lesions, six and one were classified as stage E and C, respectively (International Integrated Reporting Council staging). On computed tomography (CT), low-density foci were observed (three, multiple foci and two, single foci). After chemotherapy, tumor regression was observed in four patients, while there was no response in one patient. Three patients who underwent enucleation were at high risk for extensive choroidal invasion. All patients had severe disease with multiple system involvement, including central nervous system (CNS) and bone metastases. Neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) levels were significantly elevated in all patients; after treatment, they decreased in four patients and remained unchanged in one patient with end-stage disease. Two patients died, with survival durations of 1 and 3 months following the diagnosis of hepatic metastasis. Three patients survived and continued treatment. Conclusion: Hepatic metastasis from RB is rare and usually occurs with CNS and bone metastases. On CT, hepatic foci could be indicated by low-density lesions with calcification. Chemotherapy could be effective for hepatic metastases. The prognosis of these patients is poor; however, hepatic metastasis is not a direct cause of death.

While both the incidence and general awareness of food allergies is increasing, the variety and clinical availability of therapeutics remain limited. Therefore, investigations into the potential factors contributing to the development of food allergy and the mechanisms of natural tolerance or induced desensitization are required. In addition, a detailed understanding of the pathophysiology of food allergies is needed to generate compelling, enduring, and safe treatment options. New findings regarding the contribution of barrier function, the effect of emollient interventions, mechanisms of allergen recognition, and the contributions of specific immune cell subsets through rodent models and human clinical studies provide novel insights. With the first approved treatment for peanut allergy, the clinical management of food allergy is evolving towards less intensive, alternative approaches involving fixed doses, lower maintenance dose targets, co-administration of biologicals, adjuvants, and tolerance-inducing formulations. The ultimate goal is to improve immunotherapy and develop precision-based medicine via risk phenotyping allowing optimal treatment for each food-allergic patient.

Key points • SARS-CoV-2 is a possible cause of acute severe tracheitis in laryngectomees. • In our series, the clinical picture was characterized by a hemorrhagic tracheitis with a slow resolution pattern. • We observed a histological pattern of erosive inflammation of the respiratory epithelium. • Planned tracheo-bronchoscopy and tracheal toilettes are recommended to prevent critical obstruction of the airway, which can be fatal in patients with associated impairment of lung function caused by SARS-CoV-2 infection. • The present cases highlight the need for close interdisciplinary working and communication in the management of airway complications of COVID-19 infection.

Health professions education is in constant pursuit of new ways of teaching and assessment in order to improve the training of healthcare professionals. Educators are often challenged with designing, implementing, and evaluating programs in the context of their professional practice, particularly those in response to dynamic and emerging social needs. This article explores the synergies and intersections of two approaches -- quality improvement and program evaluation -- and the potential utility of their combinations within our field to design, evaluate, and most importantly, improve educational programming. We argue that the inclusion of established quality improvement frameworks within program evaluation provides a proven mechanism for driving change, can optimize programming within the multi-contextual education systems, and, ultimately, that these two approaches are complementary to one another. These combinations hold great promise for optimizing programming in alignment with social missions, where it has been difficult for institutions worldwide to generate and capture evidence of social accountability.

Ecosystems function in a series of feedback loops that can change or maintain vegetation structure. Vegetation structure influences the ecological niche space available for animals to partition, shaping many aspects of behavior and reproduction. In turn, animals perform ecological functions that shape vegetation structure. However, most studies concerning 3D vegetation structure consider only one of these relationships. Here, we review these separate lines of research and integrate them into a single concept that describes a feedback mechanism. We also show how remote sensing and animal tracking technologies are now available at the global scale to describe feedback loops and their consequences for ecosystem functioning. An improved understanding of how animals interact with vegetation structure in feedback loops is needed to conserve ecosystems that face major disruptions in response to climate and land use change.