Headwater streams can constitute up to 80% of river channel length and are vulnerable to anthropogenic pressures due to their high connectivity to adjacent land, large relative catchment size and low dilution capacity. In these environments unrestricted cattle access is a potential significant cause of water quality deterioration, resulting from increases in stream bank erosion, riparian damage and sediment deposition among others. Several studies have reported improvements in physico-chemical and hydromorphological conditions of streams following elimination of cattle access; few, however, have focussed on the ecological impacts of such management practices. Here, such impacts are assessed. We look at the short-term effects by comparing habitat condition, sediment deposition, and instream macroinvertebrate communities upstream and downstream of cattle access points prior to, and one year following exclusion via fencing. The long-term effects are also measured by reassessing a small stream catchment entirely fenced off from cattle access in 2008 under a concerted management effort. In the short term, cattle exclusion led to reduction in deposited sediment downstream of cattle access points and a related homogenisation of macroinvertebrate community structure between upstream and downstream sampling points. Increased abundances of specific indicator taxa ( Ancylus fluviatilis, Glossosomatidae and Elmidae) in the fenced catchment following 9 years of exclusion highlight the long-term ecological benefits of such mitigation practices. These findings highlight the importance of incentivised agri-environment schemes in reducing the negative impacts of cattle access to these vulnerable ecosystems.

Functional connectivity (FC) during sleep has been shown to break down as non-rapid eye movement (NREM) sleep deepens before returning to a state closer to wakefulness during REM sleep. However, the specific spatial and temporal signatures of these fluctuations in connectivity patterns remain poorly understood. The goal of this study was to investigate how frequency-dependent network-level FC fluctuates during nocturnal sleep in healthy young adults using high-density electroencephalography (hdEEG). Specifically, we examined source-localized FC in resting-state networks during NREM2, NREM3, and REM sleep in the first three sleep cycles of 29 participants. Our results showed that FC within and between all resting-state networks decreased from NREM2 to NREM3 sleep in multiple frequency bands and in all sleep cycles. The data also highlighted a complex modulation of connectivity patterns during the transition to REM sleep whereby delta and sigma bands hosted a persistence of the connectivity breakdown in all networks, whereas a reconnection was observed in the default mode (DMN) and the attentional networks in frequency bands characterizing their organization during wake (i.e., alpha and beta bands, respectively). Finally, all network pairs (except the visual network) showed higher gamma-band FC during REM sleep in cycle three compared to earlier cycles during the night. Altogether, our results unravel the spatial and temporal characteristics of the well-known breakdown in connectivity observed as NREM sleep deepens. They also shed light on a complex pattern of connectivity during REM sleep that is consistent with both breakdown and reconnection processes that are network- and frequency-specific.

In this issue of the Journal, Kushnir, et al. provide a report of temporal trends in first time ablation at a large academic medical center over a 10 year period. This editorial provides commentary on the report.

Introduction: Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a rare inherited disorder usually affecting the right ventricle (RV), characterized by fibro-fatty tissue replacement of the healthy ventricular myocardium. It often predisposes young patients to ventricular tachycardia, heart failure, and / or sudden cardiac death. However, recent studies have suggested predominantly left ventricle (LV) involvement with variable and / or atypical manifestations. Cardiac Magnetic Resonance (CMR) imaging has emerged as the non-invasive gold standard for the diagnosis of ARVC. Case summary: A 21-year-old athletic male with a family history of unknown ventricular arrhythmias, presented with near syncope, chest pain and exertional palpitations. He had an initial work-up that was grossly unremarkable including, electrocardiography (ECG), echocardiography and CMR imaging. Six months later, he presented again with recurrent symptoms during exercise and his ECG demonstrating a new epsilon wave. He had markedly elevated cardiac biomarkers, (troponin I >100 ng/dl, normal value < 0.04 ng/dl). A subsequent coronary angiogram was performed, which was normal. Holter monitoring further showed subsequent episodes of ventricular tachycardia with a right bundle branch morphology. An endomyocardial biopsy was performed, which was negative. A follow-up CMR demonstrated the new development and prominent left ventricular epicardial scar in the lateral wall. The patient underwent familial genetic testing, which confirmed the presence of an isolated JUP gene mutation and showed multiple genes consistent with ARVC in his mother. Thus, he manifested a partial transmission of only one abnormal gene for ARVC and exhibited a markedly different expression in his disease without evidence of typical right-sided heart pathology. A third CMR study was performed, which showed partial improvement in myocardial fibrosis after exercise cessation. Conclusion: We present a case of a young male with a newly diagnosed isolated JUP gene mutation and a genetically diagnosed family history of ARVC. During his course, he demonstrated the progression of a characteristic epsilon wave on ECG and the presence of new, atypical, left ventricular fibrosis on repeat CMR imaging. This case demonstrates a complex interplay between variable genetic penetrance, phenotypical heterogeneity, and lifestyle factors including exercise, in his disease expression and provides insight on the natural course of an isolated JUP mutation. Although rare, clinicians should have a high threshold for the suspicion of ARVC or variants of this disorder even in the absence of classic right sided pathologies and /or an initially normal work-up.

A document by Nagham Ailabouni. Click on the document to view its contents.

A 34-year-old woman with breast cancer and the BRCA2: p.Gln3047Ter was treated with olaparib. After tumor progression, cancer genomic profiling testing revealed the BRCA2 p.Gln3047Ter and p.Gln3047Tyr, with 48.9% and 0.37% allele frequency, respectively. These findings shed light on reversion mutation as a resistance mechanism to olaparib in breast cancer.

Cardiac hydatidosis is a relatively rare complication of echinococcosis, with a potentially life-threatening condition. Here, we reported a large interventricular septal hydatid cyst with bulging in the left ventricle accompanied by a huge cervical lamp with recurrent hepatic cysts that underwent cardiac surgery to excise the cyst uneventfully.

Lung cancer can present with unilateral atypical facial pain, a rare symptom due to vagus nerve involvement or paraneoplastic syndrome. This manifestation is usually missed, delaying the diagnosis and prognosis. We discuss a case of a 45-year-old male who presented with right-sided hemifacial pain and with normal neurological investigations.

We describe the case of a Jehovah's witness patient undergoing pelvic exenteration for recurrent endometrial carcinoma, focusing on the preoperative, intraoperative and postoperative measures that allowed uncomplicated surgeries. Our case shows that pelvic exenteration is feasible in patients refusing blood products, if performed with a multidisciplinary team and careful planning.

Response to “Delay in AF ablation costs lives”Andrew J. Sessions BS1, Heidi T. May, PhD, MSPH2, Brian G. Crandall, MD2, John D. Day, MD3, Michael J. Cutler DO, PhD2, Christopher A. Groh MD4, Leenapong Navaravong MD4, Ravi Ranjan MD, PhD4, Benjamin A. Steinberg MD, MHS4, T. Jared Bunch, MD4Corresponding Author: Dr. T. Jared BunchUniversity of Utah School of Medicine, Salt Lake City, Utah, USADepartment of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USASt. Marks Hospital, Salt Lake City, UtahDepartment of Internal Medicine, Division of Cardiology, University Hospital, Salt Lake City, Utah, USAAddress for correspondence: T. Jared Bunch, M.D.University of Utah School of Medicine Division of Cardiology, Department of Internal Medicine 50 N Medical Drive Salt Lake City, Utah 84132 Phone: 801-585-7676Short Title: Impact of delays in catheter ablationFunding : None

A document by Liza Gibbs R. Click on the document to view its contents.

To predict suitable growing regions for Leonurus japonicus and to provide scientific sopport for the habitat conservation and the exploitation and utilization of germplasm resources under climate change conditions, this study combined niche and priority conservation models to assess the future potential distribution of L. japonicus in China. To this end, distribution points and samples of L. japonicus were gathered through online and field surveys. The Maxent model with optimized parameters was used for predicting the suitable habitats of L. japonicus at different stages, and the Marxan model was used to determine the priority of protected areas. The results showed that the highest temperature in the hottest month, the lowest temperature in the coldest month, the precipitation in the wettest month, the precipitation in the driest month, and altitude were the main environmental factors influencing the distribution of L. japonicus. Under the three climate change scenarios, the centroid of the suitable area of L. japonicus migrated northward, and the migration position tended to expand further northwest. In the future, there would be no significant niche differentiation of L. japonicus; the Marxan results showed that priority protected areas for L. japonicus were in southwestern central China, Lingnan, southern east China, and Guizhou. Overall, the results of this research can provide a strategy for the determination of priority protection areas for Leonurus japonicus in China.

This survey introduces 101 new publications on applications of Clifford’s geometric algebras (GA) newly published during 2022 (until mid-January 2023). The selection of papers is based on a comprehensive search with Dimensions.ai, followed by detailed screening and clustering. Readers will learn about the use of GA for mathematics, computation, surface representations, geometry, image- and signal processing, computing and software, quantum computing, data processing, neural networks, medical science, physics, electric engineering, control and robotics.

The repair process of devices is an important part of the business of many original equipment manufacturers. The consumption of spare parts, during the repair process, is driven by the defects found during inspection of the devices, and these parts are a big part of the costs in the repair process. In previous work we proposed a data-driven method for Supply Chain Control Tower solutions to provide support for the automatic check of spare parts consumption in the repair process. In this paper, we continue our investigation of a multi-label classification problem and explore alternatives in the learning-to-rank approach, where we simulate the passage of time using more data while training and comparing hundreds of Machine Learning models to provide an automatic check in the consumption of spare parts. We investigate the effects of different train set sizes, retraining intervals, models and hyper-parameter search using Bayesian Optimization. The results show that we were able to improve the trained models and achieve a higher mean NDCG@20 score of 86% when ranking the expected parts. Focusing on the most recent data, we achieve a NDCG@20 score of 90%, while obtaining a ratio of marked parts of just 4% of the consumed parts for use in alert generation.

The dental clinic air microbiome incorporates microbes from the oral cavity and upper respiratory tract (URT). This study aimed to establish a reliable methodology for air sampling in a dental clinic setting and quantify the abundance of culturable mesophilic aerobic bacteria present in these samples using regression modeling. Staphylococcus hominis, a potentially pathogenic bacterium typically found in the human oropharynx and URT, was consistently isolated. S. hominis was the most abundant species of aerobic bacteria (22% to 24%) and comprised 60% to 80% of all Staphylococcus spp. The study also assessed the susceptibility of S. hominis to 222nm-far-UVC light in laboratory experiments, which showed an exponential surface inactivation constant of k = 0.475 cm2/mJ. This constant is a critical parameter for future on-site use of far-UVC light as a technique for reducing pathogenic bacterial load in dental clinics.

Health systems encourage switching from originators to biosimilars as biosimilars are more cost-effective. The speed and completeness of biosimilar adoption is a measure of efficiency. We describe the approach to biosimilar adoption at a single hospital and compare its efficiency against the English average. We additionally follow up patients who reverted to a previously used biologic, having switched to a biosimilar, to establish whether they benefitted from re-establishing prior treatment. The approach we describe resulted in a faster and more complete switch to biosimilars, which saved an additional £380,000 on drug costs in 2021/22. Of patients who reverted to their original biologic, 85% improved short-term where the concern was tolerability, and 90% where it was efficacy. Patients remained on treatment for a prolonged period after reverting. Our approach to biosimilar adoption outperformed the English average and permits patients to revert to their original biosimilar post-switch if appropriate.

Background: We aimed to retrospectively investigate the role of neoadjuvant chemotherapy in low-risk patients with hepatoblastoma (HB) who underwent curative resection between February 2009 and December 2017. We also verified the feasibility of the risk stratification system to select the optimal patients for upfront resection. Procedure: We compared 5-year overall survival (OS) and event-free survival (EFS) between the upfront surgery (US) (n=26) and neoadjuvant chemotherapy (NC) (n=104) groups at three oncology centers in Beijing, China. To reduce the effect of covariate imbalances, propensity score matching (PSM) was used. We explored whether preoperative chemotherapy affected surgical outcomes and identified the risk factors for events and death, including resection margin status, PRETreatment EXTent of disease stages, age, sex, pathology classification, and α-fetoprotein levels. Results: The median follow-up period was 64 months (interquartile range 60–72). After PSM, 22 pairs of patients were identified and the patient characteristics were similar for all variables included in propensity score matching. In the US group, the 5-year EFS and OS rates were 81.8% and 86.3%, respectively. In the NC group, 5-year EFS and OS rates were 81.8% and 90.9%, respectively. No significant differences in EFS or OS were observed between the groups. Pathological classification was the only risk factor for death and disease progression, tumor recurrence, diagnosis of other malignant neoplasms, and death from any cause ( p=0.007 and p=0.032, respectively). Conclusion: Upfront resection can achieve long-term disease control in low-risk patients with resectable HB, thus reducing the cumulative toxicity of platinum-based chemotherapy drugs.

This paper aims to investigate the time fractional Keller-Segel system with a small parameter. After the fractional order traveling wave transformation, the heteroclinic orbit to the degenerate time fractional Keller-Segel system is demonstrated through the method of constructing a suitable invariant region. Moreover, the persistence of traveling waves in the system with a small parameter can be further illustrated. The results are mainly reliance on the application of geometric singular perturbation theory and Fredholm theorem, which are fundamental theoretical frameworks for dealing with problems of complexity and high dimensionality. Eventually, the asymptotic behavior is depicted by the asymptotic theory to illustrate the rate of decay for traveling waves.