A dynamic case report in which the authors present a multidisciplinary collaboration in a dyspnoic adolescent girl who coughs up blood, has a high temperature and rapidly progresses to respiratory failure. Laboratory findings, imaging results, and their interpretation are shown. Current recommended management is discussed.

Background: People with cystic fibrosis (PwCF) have chronic lung disease and may be at increased risk of COVID-19-related morbidity and mortality. This study aimed to determine seroprevalence and clinical characteristics of SARS-CoV-2 infection in children with CF, and to assess antibody responses following SARS-CoV-2 infection or vaccination. Methods: Children and adolescents with CF followed at Seattle Children’s Hospital were enrolled between July 20, 2020 and February 28, 2021. SARS-CoV-2 serostatus was determined on enrollment, at 6 and 11 months (+/-2 months) for nucleocapsid and spike IgG. Participants completed intake and weekly surveys inquiring about SARS-CoV-2 exposures, viral/respiratory illnesses, and symptoms. Results: Of 125 PwCF enrolled, 14 (11%) had positive SARS-CoV-2 antibodies consistent with recent or past infection. Seropositive participants were more likely to identify as Hispanic (29% vs 8%, p=0.04) and have pulmonary exacerbations requiring oral antibiotics in the year prior (71% vs 41%, p = 0.04). Five seropositive individuals (35.7%) were asymptomatic, while six (42.9%) reported mild symptoms, primarily cough and nasal congestion. Anti-spike protein IgG levels were approximately 10-fold higher in participants following vaccination compared with participants who had natural infection alone (p < 0.0001) and resembled levels previously reported in the general population. Conclusions: A majority of PwCF have mild or no symptoms of SARS-CoV-2 making it difficult to distinguish from baseline respiratory symptoms. Hispanic PwCF may be disproportionately impacted, consistent with racial and ethnic COVID-19 disparities among the general US population. Vaccination in PwCF generated antibody responses similar to those previously reported in the general population.

With the ever-changing social environment, individual creativity is facing a severe challenge induced by stress. However, little is known about the physiological mechanisms by which acute stress affects creative cognitive processing. The current study explored the effects of neuroendocrine response on creativity under stress and its underlying cognitive flexibility mechanisms. The Enzyme-Linked Immuno Sorbent Assay was used to assess salivary cortisol, which acted as a marker of stress-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis. Eye blink rate (EBR) and pupil diameter were measured as respective indicators of dopamine and noradrenaline released by activation of the sympathetic-adrenal medullary (SAM) axis. The Wisconsin Card Task (WCST) measured cognitive flexibility, while the Alternative Uses Task (AUT) and the Remote Association Task (RAT) measured separately divergent and convergent thinking in creativity. Results showed higher cortisol increments following acute stress induction in the stress group compared to the control group. Ocular results showed that the stress manipulation significantly increased EBR and pupil diameter compared to controls, reflecting increased SAM activity. Further analysis revealed that stress-released cortisol impaired the originality component of the AUT by increasing perspective errors of the WCST. Serial mediation analyses showed that both EBR and pupil diameter were also associated with increased perspective errors leading to poor originality on the AUT. These findings confirm that physiological arousal under stress can impair divergent thinking through the regulation of different neuroendocrine pathways, in which the deterioration of flexible switching plays an important mediating role.

C. Abstract AIM: Sevoflurane is an ether-based inhalational anesthetic that induces and maintains general anesthesia. Our study aimed to detect sevoflurane-induced nephrogenic diabetes insipidus using Data Mining Algorithms (DMAs) and molecular docking. The FAERS database was analyzed using OpenVigil 2.1 for disproportionality analysis. Methods: We analyzed FAERS data from 2004 to 2022 to determine the incidence of nephrogenic diabetes insipidus associated with sevoflurane. Reporting Odds Ratios (RORs) and Proportional Odds Ratios (PRRs) with 95% confidence intervals were calculated. We also used molecular docking with AutoDock Vina to examine sevoflurane’s binding affinity to relevant receptors. Results: A total of 554 nephrogenic diabetes insipidus cases were reported in FAERS, of which 2.5% (14 cases) were associated with sevoflurane. Positive signals were observed for sevoflurane with reporting odds ratios (ROR) of 76.012 (95% CI: 44.67-129.35) and proportional odds ratios (PRR) of 75.72 (Chi-sq: 934.688). Of the 14 cases, 50% required hospitalization, 14% resulted in death, and the remaining cases were categorized as other outcomes. Molecular docking analysis showed that sevoflurane exhibited high binding affinity towards AQP2 (4NEF) and AVRP2 (6U1N) with docking scores of -4.9 and -5.3, respectively. Conclusion: Sevoflurane use is significantly associated with the incidence of nephrogenic diabetes insipidus. Healthcare professionals should be cautious when using this medication and report any adverse events to regulatory agencies. Further research is needed to validate these findings and identify risk factors while performing statistical adjustments to prevent false-positives. Clinical monitoring is crucial to validate potential adverse effects of Sevoflurane.

Maintaining aircraft airworthiness to ensure the fleet's safe operation and maintain its readiness is critically dependent on accurate modelling and reliable predictions of fatigue crack growth. In this process a knowledge of the representative initial discontinuity sizes that cause fatigue crack nucleation and early growth in aircraft is essential. Here the effective pre-crack size of aluminium alloy 2024, from samples of aircraft production material and tested under aircraft spectra, are considered.

With the improvement of surface passivation, bulk recombination is becoming an indispensable and decisive factor to assess the limiting efficiency ( η lim ) of crystalline silicon (c-Si) solar cells. In simultaneous consideration of surface and bulk recombination, a modified model of η lim   evaluation is developed. Surface recombination is directly depicted with contact selectivity while bulk recombination is revised on the aspects of ideality factor and wafer thickness. The η lim of cutting-edge photovoltaic technologies, double-side tunneling-oxide passivating contact (TOPCon) and silicon heterojunction (SHJ) solar cells, are numerically simulated using the new model as 28.73% and 29.00%, respectively. Hybrid solar cells consisting of n-type TOPCon contact and p-type SHJ contact can approach an η lim as high as 29.18% at the optimal wafer thickness ( W opt ) of 103 μm . Our results are instructive in accurately assessing efficiency potential and accordingly optimizing design strategies of c-Si solar cells.

Designing and selecting cell culture media and their feeding are a key strategy to maximize culture performance in industrial biopharmaceutical processes. However, mammalian cells are very sensitive to their culture environment, requiring specific nutritional needs to grow and produce high-quality proteins such as antibodies, depending on cell lines and operational conditions. In this regard, previously we developed data-driven and in-silico model-guided systematic framework to investigate the effect of growth media on Chinese hamster ovary (CHO) cell culture performance, allowing us to design and reformulate basal media. To expand our exploration for media development research further, we evaluated two chemically defined feed media, A and B, in ambr15 bioreactor runs using a monoclonal antibody-producing CHO K1 cell line. We observed a significant impact of feed media on cell growth, longevity, viability, productivity and toxic metabolites production. Specifically, concentrated feed A was not sufficient to support prolonged cell culture and high titer compared to feed B. The framework systematically characterized the major metabolic bottlenecks in the TCA cycle and its related amino acid transferase reactions, thereby identifying key design components, such as asparagine, aspartate, and glutamate, which are needed for highly productive cell cultures. Based on our results, we subsequently reformulated the feeds by adjusting the amounts of those amino acids and successfully validated their effectiveness in promoting cell growth and/or titer.

Introduction : Pulsed field ablation (PFA) is a non-thermal ablative strategy that achieves cell death via electroporation. Herein, we investigated the preclinical safety and efficacy of PFA using two novel 8-French, 16-electrode spiral PFA/mapping catheters (ElePulse, CRC EP, Inc). M ethods : Bipolar PFA (>1.8 kV) was performed using 30 sec, single-shot, QRS-gated applications. Altogether, 94 atrial structures were ablated in 23 swine, 1 canine, and 1 ovine, including right and left atria and atrial appendages, pulmonary veins, and superior and inferior (IVC) vena cavae. We also examined the impact of PFA on phrenic nerve (14 swine) and on a deviated esophagus after delivery of PFA from inside the IVC (5 swine). Results: All applications were single-shot without catheter repositioning. Minimal microbubbling was observed without significant skeletal muscle twitching/activation (mean acceleration: 0.05 m/s 2). There was marked reduction in post- versus pre-PFA atrial electrogram amplitude (0.17±0.21 mV vs. 1.18±1.08 mV; P<0.0001). Durable conduction block was demonstrated up to 3 months in all targeted tissues. Lesions were contiguous and transmural, measuring 25±9 mm x 21±7 mm without any thermal effects. Magnetic resonance, gross, and histologic examinations of the brain, rete mirabile, and kidneys revealed no thromboembolism. No acute/long-term phrenic nerve dysfunction was encountered. Though within 2 hours of ablation, histologic examinations of the esophagus revealed acute PFA-related changes in the muscular layer, these completely resolved by 21±5 days. Conclusion : A novel, single-shot, spiral PFA system is capable of safely creating large, durable atrial lesions without significant adverse effects on the phrenic nerve or the esophagus.

Aim: Early intervention services are the established and evidence-based treatment option for individuals with first-episode psychosis. They are time-limited, and care pathways following discharge from these services have had little investigation. We aimed to map care pathways at the end of early intervention treatment to determine common trajectories of care. Methods: We collected health record data for all individuals treated by early intervention teams in two NHS mental health trusts in England. We collected data on individuals’ primary mental health care provider for 52 weeks after the end of their treatment and calculated common trajectories of care using sequence analysis. Results: We identified 2224 eligible individuals. For those discharged to primary care we identified four common trajectories: Stable Primary Care, Relapse and return to CMHT, Relapse and return to EIP, and Discontinuity of Care. We also identified four trajectories for those transferred to alternative secondary mental health care: Stable Secondary Care, Relapsing Secondary Care, Long-term Inpatient, and Discharged Early. The Long-term Inpatient trajectory (1% of sample) accounted for 29% of all inpatient days in the year follow-up, with Relapsing Secondary Care (2% of sample and 21% of inpatient days), and Relapse and return to CMHT (5% of sample, 15% of inpatient days) the second and third most frequent. Conclusions: Individuals have common care pathways at the end of early intervention in psychosis treatment. Understanding common individual and service features that lead to poor care pathways could improve care and reduce hospital use.

1. INTRODUCTIONOsteochondromas (OC) are benign tumors that account for 20-50% of benign and 10% of all bone tumors. The incidence rate of OC in males is twice that of females and its peak is usually in the second decade of life (1). These lesions are inherited in an autosomal dominant manner and cause the formation of isolated lesions or multiple exostoses during the development of bones in the process of enchondral ossification in the long bones (2). Also, OC is associated with the mutation of some tumor suppressor genes, including EXT1 or EXT2 genes. OC have a periosteal origin and are formed in the active parts of bones, including the metaphysis of long bones and the cartilage at their ends. Studies show that OC can be caused after surgery/radiation-induced injury and hematopoietic stem cell transplantation (3).Osteocartilaginous exostosis is mainly detected in childhood and in the form of palpable masses, with chronic pain and sometimes with edema (4). The presence of misplaced bone masses in the joint capsule and sometimes with cartilaginous coating in radiographic images is one of its common manifestations. The most common joints involved in OC are the hip and knee joints. Patellar OC is rare and mostly affects the patellar bursa. Moraes et al. (2014) reported a patellar OC measuring 8 × 6 × 3 cm anterior to the patella in a 60-year-old man who was painless and without limitation of flexion-extension in the knee joint (5). In the present case, rare retro-patellar OC was observed in the area of the patellar ligament.

The linearized of the Poisson-Nernst-Planck (PNP) equation under closed ends around a neutral state is studied. It is reduced to a damped heat equation under non-local boundary conditions, which leads to a stochastic interpretation of the linearized equation as a Brownian particle which jump and is reflected, at Poisson distributed time, to one of the end points of the channel, with a probability which is proportional to its distance from this end point. An explicit expansion of the heat kernel reveals the eigenvalues and eigenstates of both the PNP equation and its adjoint. For this, we take advantage of the representation of the resulvent operator and recover the heat kernel by applying the inverse Laplace transform.

Uncertain fractional differential equation (UFDE) is an useful tool for studying complex systems in uncertain environments. In this paper, we study the extreme value theorems of the solution to Caputo-Hadamard UFDEs and applications. A numerical algorithm for solving the numerical solution of a nonlinear Caputo-Hadamard UFDE is presented, the feasibility of the numerical algorithm is validated by numerical experiments. The extreme value theorems are applied to the financial markets, and the pricing formulas of the American option based on the new uncertain stock model are given. Considering the properties of the American option pricing, the algorithms for computing the expected value of the extreme values based on the Simpson’s rule are designed. Finally, the price fluctuation of the American option is illustrated by numerical experiments.

Chemically, N1 nitrogen of piperazic acid is more nucleophilic than N2 nitrogen, but amide bonds predominantly formed at N2 nitrogen are prevalent in piperazic acid-containing natural products, with only one exception of sanglifehrin. Thus two orthogonal protecting groups of nitrogen are often employed to realize selective coupling of N2 nitrogen, resulting in increased synthetic steps and low synthetic efficiency. However, we developed selective deprotection of N2-Cbz from the N1,N2-diCbz piperazic acid-containing peptide to form the N2 amide exclusively, avoiding the tedious orthogonal protection strategy commonly applied to the easily-accessible N1,N2-diCbz piperazic acid as the building block. We employ this method to achieve an efficient synthesis of piperazic acid-containing cyclodepsipeptide core of verucopeptin with an overall yield of 21%. The key steps include late stage coupling of piperazic acid with 3-hydroxyleucine derivatives, and HATU-mediated macrolactamization of 19-membered macrocycle at N9 and C10. The selective deprotection of N2-Cbz from the N1,N2-diCbz-piperazic acid at late-stage would greatly facilitate the total syntheses of piperazic acid-containing cyclodepsipeptides of biological interest.

Widespread school closures and other non-pharmaceutical interventions (NPIs), used to limit the spread of SARS-CoV-2, significantly disrupted transmission patterns of seasonal respiratory viruses. As NPIs were relaxed, populations were vulnerable to resurgence. This study within a small community assessed acute respiratory illness among kindergarten through grade 12 students as they returned to public schools from September through December 2022 without masking and distancing requirements. The 277 specimens collected demonstrated a shift from rhinovirus to influenza. With continued circulation of SARS-CoV-2 and return of seasonal respiratory viruses, understanding evolving transmission patterns will play an important role in reducing disease burden.

Reproductive isolation plays an important role in maintaining the species integrity of sympatric close relatives. For sympatric Arisaema species, interspecific gene flow is expected to be effectively prevented by pre-pollination barriers, particularly strong pollinator isolation mediated by fungus gnats. However, due to the lack of quantitative studies combining multiple pre- and post-pollination barriers, it is not known whether pre-pollination isolation is complete, and whether post-pollination barriers also contribute to reproductive isolation among some Arisaema species. We studied five pre- and post-pollination barriers (geographic isolation, phenological isolation, pollinator isolation, hybrid fruit production, and hybrid seed formation) among three sympatric Arisaema species (A. bockii, A. lobatum, and A. erubescens). The strength of individual barriers and their contribution to total isolation were quantified.The habitat elevations of the three Arisaema species mostly overlapped. Although phenological isolation and pollinator isolation reduced the frequencies of interspecific pollen transfer among these species, the partial overlap of flowering times and pollinator assemblages resulted in pre-pollination isolation that does not adequately prevent interspecific hybridization. Post-pollination barriers also contributed to reproductive isolation at the hybrid fruit and seed formation stages.We propose that, although pre-pollination barriers are expected to contribute more to total isolation than post-pollination barriers in Arisaema, pre-pollination barriers may not completely prevent interspecific pollen transfer among some Arisaema species. Post-pollination barriers, which are generally ignored, may also have contributed significantly to reproductive isolation in Arisaema.

The Mississippi River channel from New Orleans to the Gulf of Mexico (GOM) is a key deep draft navigation channel and an active deltaic lobe. Natural and engineered lateral exits from this reach into adjacent receiving basins historically has provided mineral sediment for wetland accretion in the face of rising relative sea level and supported estuarine-coastal food webs. However, our analysis indicates water losses from the channel have increased by 25% since 2004 due to (1) bank failures during large floods since 2012 that have created several large exit channels downriver of the flood protection levee, and (2) the opening of an engineered diversion at West Bay in 2004. This has resulted in a 60-80% loss in stream power in the lowermost navigation channel that is accompanied by net shoaling between 2012 and 2022 and an increased dredging need. Our 2022 survey in the GOM exit passes indicates that only 20% of the freshwater, 5% of the total suspended sediment (2% of the sand) at New Orleans now reaches the GOM: this supports previous research indicating the delta front is retreating after centuries of progradation. Together these results indicate that (1) river containment and the sustainability of the navigation channel is threatened, (2) sediment load reaching the seaward end of the delta may be insufficient to avoid major degradation, and (3) the increased freshwater flux into adjacent shallow coastal water bodies has unknown implications for coastal hypoxia and food webs, including commercial species (e.g., oysters) and marine mammals. Future acceleration in sea level rise rates and tropical storm frequency/intensity likely will worsen these trends.

Background: Students’ academic achievement is regarded as the scholastic standing of students at the end of a given study period that is expressed in terms of grades. The key to bridging the attainment gap at the end of their study period is through their cumulative grade points over the duration of the study. Predictive validity study on students first-year GPA as a predictor of their final-year CGPA was carried out to predict the students’ academic performance in Chemical, Civil, Electrical, and Mechanical Engineering. Purpose/Hypothesis: This study examined the relationship between first-year GPA and final-year CGPA, as well as the relationship between Age, Gender and Geopolitical zones on first-year GPA and CGPA of Engineering students in the Faculty of Engineering students University of Abuja, Nigeria. The data obtained from the four Departments; Chemical, Civil, Electrical and Mechanical were analyzed. Two hypotheses were formulated to guide the study. Design/Method: An ex-post factor research approach was adopted, and Pearson’s correlation and Regression Analysis were fitted with the data using Minitab software. Results: The results of the study highlighted that first-year GPA had a strong positive relationship with final-year CGPA. Age, Gender and Geopolitical zones have no correlation with students’ final-year CGPA. The regression equations can be used to predict students’ CGPA to bridge the attainment gap at the end of their studies. Conclusions: Finally, the study emphasized the need to admit more female students in Engineering studies as they constitute 12.9% of the population.

Abdominal aortic aneurysms (AAA) are typically asymptomatic. When symptomatic, AAA may present as a chief concern of musculoskeletal hip and low back pain. Assessment in the orthopaedic clinic should focus on a holistic examination of the patient.