Abstract 1. Elephants frequently raid farmers’ crops within their ranges in Africa and Asia. This can have a large impact on agricultural productivity and food security for farmers. 2. Previous studies have examined susceptibility of crop fields to elephant raids using field characteristics such as field size and proximity to water sources. However, there are limited studies investigating how different crop types, individually and in their combinations influence crop susceptibility to elephant raiding. Also, spatio-temporal patterns in elephant crop raids in agro-ecological landscapes have not been extensively examined. 3. This study utilised data collected from crop fields raided by elephants between 2008 and 2018. Data on crops grown, the number of crop-raiding incidences for each crop, and elephant raiding incidences were recorded for each field assessed. Incidence risks (IR) and field risk value (RV) were computed using an adaptive epidemiological approach. 4. The results showed that elephant crop raiding incidents varied significantly amongst crop types, and over space and time (P<0.0001). Cereal crops (millet: Eleusine conaracana, maize: Zea mays) incurred a higher number of crop raiding incidents compared with leguminous crops (cowpea: Vigna unguiculata; groundnut: Arachis hypogea). Field RVs significantly varied depending on which crop was present in the field. There was a significant negative correlation between the number of crop types and the susceptibility of the field to raiding (R2 = -0.680, P<0.0001). 5. Our results suggest that the susceptibility of the fields to elephant raids could be minimised by selecting crop types and combinations less susceptible to elephant damage, thus enhancing food security for local subsistence farmers. Keywords: crop raiding, crop species, incidence risks, field risk value, food security, human-elephant conflict

Birds provide important ecological services for the maintenance of ecosystems’ integrity. However, there is limited research on ecological roles of different bird species in maintenance of habitats in South Africa yet many bird species are experiencing continuous conservation threats. In this study, we aimed to document the diversity of bird species in South Africa’s Wild Coast nature reserves, and to determine potential role of each bird species in habitat maintenance using bird feeding mode classifications as a species function’s proxy. Bird observations were conducted afield over four years (2017 to 2020). Over 864 hours of field sampling in 2017-2020, we accumulated 818 bird records containing 178 different bird species classified into 58 families. Shannon-Wiener Diversity Indices showed very high overall species diversity, and across the nature reserves (H > 3.5) with however, all nature reserves being non-significantly different. We noted 32 bird species representing 30 families occurring across four nature reserves with Silaka Nature Reserve having significantly more diverse bird families than Mkhambathi Nature Reserve while not significantly different to others. Forest bird species were more dominant (42.1%; N = 178) throughout observations than other habitat species. Annual bird species diversity across the observation years remained very high (H > 3.5) with non-significant differences across the years. However, the year 2018/2019, showed significantly higher abundance of birds across all nature reserves. Among different feeding modes, potential seed dispersers had a significantly greater number of records than other groups while pollinators were not significantly different in number compared to seed predators. A non-significantly different number of birds in medium to large size body size classes suggest availability of a variety of both pollinators and subsequent seed dispersal vectors. Consistent with other studies, conservation status and implications of bird species loss on sustainable vegetation integrity must be prioritised.

Competition is among the most important factors regulating plant population and community dynamics, but it is not well understood how different vital rates respond to competition and jointly mediate competitive population dynamics and species coexistence. We used integral projection models (IPMs) to model the population growth of 112 pairwise combinations of 14 competing herbaceous plant species across an elevation gradient (n = 324 IPM models in total). We showed that the response of individual growth and seedling establishment contributed most strongly to competition-induced declines in population growth compared to survival, flowering probability and fecundity that frequently showed complementary responses that occurred in 92% of species pairs. Complementary responses significantly promoted population growth under competition by 22% on average and strengthened species coexistence. Our study emphasises the need to investigate demographic processes to better understand competitive population dynamics and species coexistence.

“Pharmacovigilance is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other medication-related problem”, according to the WHO. With the increasing volume of legislation, pharmacovigilance systems have shifted from reactive (responding to emerging risks), to planned, active, risk-proportionate approaches operating throughout the lifecycle of medicines. Whilst medicines are beneficial to society, adverse reactions represent a significant cause of concern. They are a major cause of failed regulatory authorizations, and withdrawal from the marketplace post-approval. Evaluation of real-world data plays an increasingly important role in pharmacovigilance. There is great interest on the part of the regulators, MAHs, academia and patients in optimizing the use of safety data. Innovative approaches, including pharmacogenetics and passive measures (sensors), will lead to increased complexity in data collation and evaluation, and inevitably to an increase in the volume of case reports. There is a multiplicity of regulations and guidelines on how to manage these data, with an inherent lack of harmonization. We summarize the current characterization of safety data types, sources, and the classification of these data. Using this benchmark, we discuss the future requirements of an effective pharmacovigilance ecosystem, keeping the principle of parsimony in mind.

Aim. To describe the trends in anti-infective use during pregnancy between 2010 and 2019 and determine whether they were prescribed according to drug fetal safety international classification systems. Methods. We conducted a population-based, nationwide study using the French national health data system including all pregnancies ended between 2010 and 2019. Anti-infective were considered according to their pharmacological group and potential harmful risk using the Australian and Swedish classification systems. Prevalence rate was estimated annually and by trimester. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated using Joinpoint regression. Results. Among 7,571,035 pregnancies, 3,027,031 (40.0%) received ≥ 1 antibacterial. This proportion decreased significantly from 41.5% in 2010 to 36.1% in 2019 (AAPC=-1.7%, [95%CI, -2.5% to -1.0%]). Conversely, use of antiviral agents increased during the 10 years’ study period for anti-HSV agents (AAPC=4.4%, [3.7%-5.2%]), influenza agents (AAPC=25.4%, [6.2%-48.1%]), and for HIV-antiretroviral agents (HIV-ART) (AAPC=1.3%, [0.6%-2.0%]). Use of influenza vaccine increased from 0.2% in 2010 to 4.2% in 2019 (AAPC=49.7%, [95%CI, 39.3% to 60.9%]). Among all pregnancies, 0.9% had been exposed to a potentially harmful anti-infective agent increasing from 0.7% in 2010 to 1.2% in 2019 (AAPC=6.4%, [4.4%-8.5 %]). Conclusion. Based on more than 7 million pregnancies identified from French nationwide data, this study showed that antibacterials are frequently prescribed during pregnancy although their use has decreased over the past ten years. Our results suggest that anti-infective are generally prescribed in accordance with recommendations, with however a potential for improvement in influenza vaccination.

Although mid- and long-term outcomes after the Ross procedure for aortic valve disease have been increasingly improving over the years, this is still a rather challenging operation in neonates and small children. This is particularly true for patients with associated congenital heart defects and critical clinical conditions. Herein we describe the application of this procedure as a rescue operation in emergency circumstances in a low-birth-weight neonate with severe aortic stenosis, aortic regurgitation and mitral regurgitation after a previous aortic coartectomy.

Animal-borne telemetry devices provide essential insights into the life-history strategies of far-ranging species and allow us to understand how they interact with their environment. Many species in the seabird family Alcidae undergo a synchronous moult of all primary flight feathers during the non-breeding season, making them flightless and more susceptible to environmental stressors, including severe storms and prey shortages. However, the timing and location of moult remains largely unknown, with most information coming from studies on birds killed by storms or shot at sea. Using light-level geolocators with saltwater immersion loggers, we develop a method for determining flightless periods in the context of the annual cycle. Four Atlantic puffins (Fratercula arctica) were equipped with geolocator/immersion loggers on each leg to attempt to overcome issues of leg-tucking in plumage while sitting on the water, which confounds the interpretation of logger data. Light level and saltwater immersion time-series data were combined to correct for this issue. This approach was adapted and applied to 40 puffins equipped with the standard practice deployments of geolocators on one leg only. Flightless periods consistent with moult were identified in the dual-equipped birds, whereas moult identification in single-equipped birds was less definitive and should be treated with caution. Within the dual-equipped sample, we present evidence for two flightless moult periods per non-breeding season in two puffins that undertook more extensive migrations (> 2000km), and were flightless for up to 76 days in a single non-breeding season. A biannual flight feather moult is highly unusual among non-passerine birds, and may be unique to birds that undergo catastrophic moult, i.e. become flightless when moulting. Though our conclusions are based on a small sample, we have established a freely available methodological framework for future investigation of the moult patterns of this and other seabird species.

A document by Manisha Ahuja. Click on the document to view its contents.

Background: In atrial fibrillation patients undergoing left atrial appendage occlusion with a Watchman device, surveillance imaging with a transesophageal echocardiogram (TEE) is typically performed at 45 days and 1 year to evaluate for device-related thrombus (DRT) and peri-device leak (PDL) before cessation of oral anticoagulation. The incidence of these complications is relatively low, and the ideal timing and duration of surveillance is unknown. We sought to evaluate the incidence of DRT and PDL after Watchman placement at 45 days and 1 year to determine the necessity of surveillance TEEs. Methods: We retrospectively analyzed 361 patients who received a Watchman device between January 2016 and January 2020. Baseline clinical and echocardiographic data, post-procedure antithrombotic therapy and surveillance echocardiographic data were collected from the NCDR LAAO Registry. Nested backward variable elimination regression was performed to derive independent predictors of the composite outcome of DRT and PDL. Results: A total of 286 patients who had post-procedure TEEs were included in the analysis. At 45 days, 9 patients had DRT (3.2%) and 44 patients had PDL (15.0%). At 1 year, 5 patients had DRT (5.6%) and 8 patients had PDL (8.9%). All DRT at 45 days was treated with continued anticoagulation while no change in protocol occurred with PDL. All DRT at 1 year occurred in new patients without prior thrombus. A history of prior transient ischemic attack (TIA) and thromboembolism were significantly associated with DRT or PDL at 1 year. Conclusions: We identified several patients with device-related complications at 45 days and 1 year despite appropriate device sizing and adequate use of antithrombotic therapy. The incidence of DRT increased from 45 days to 1 year and occurred in patients without prior thrombus. These findings highlight the importance of surveillance imaging and suggest the potential need for extended surveillance in select patients.

Aircraft cabins have high-performance ventilation systems, yet typically hold large numbers of people in close proximity for long periods. The current study estimated airborne virus exposure and infection reductions for vacant middle seats and masking in aircraft. Tracer particle data reported by U.S. Transportation Command (TRANSCOM) and CFD simulations reported by Boeing were used, along with NIOSH data, to build nonlinear regression models with particle exposure and distance from particle source as variables. These models that estimate exposure at given distances from the viral source were applied to evaluate exposure reductions when middle seats are vacant compared to full occupancy. Reductions averaged 54% for the seat row where an infectious passenger is located and 36% for a 24-row cabin containing one infectious passenger, with middle seats vacant. Analysis of the TRANSCOM data showed that universal masking (surgical masks) reduced exposures by 62% and showed masking and physical distancing provide further reductions when practiced together. For a notional scenario involving 10 infectious passengers, compared with no intervention, masking, distancing, and both would prevent 6.2, 3.8 and 7.6 secondary infections, respectively, using the Wells-Riley equation. These results suggest distancing and masking reduce SARS CoV-2 exposure risk when an infectious passenger is present.

Abstract: Multirooted supernumerary tooth is a rare finding, which predisposes to various malocclusion. The present case report depicts the presence of a multirooted supernumerary tooth in the anterior maxilla just adjacent to the midline in a 24-year-old patient. Keywords: anterior, maxilla, multirooted, supernumerary.

Background and Aim: We assessed the anatomical variations in coronary arterial patterns relative to the techniques of reimplantation in the setting of the arterial switch operation, relating the variations to influences on outcomes. Methods: We reviewed pertinent published investigations, assessing events reported following varied surgical techniques for reimplantation of the coronary arteries in the setting of the arterial switch procedure. Results: The prevalence of reported adverse events, subsequent to reimplantation, varied from 2% to 11%, with a bimodal presentation of high early and low late incidence. The intramural pattern continues to contribute to mortality, with some reports of 28% fatality. The presence of abnormal course relative to the arterial pedicles in the setting of single sinus origin was associated with a three-fold increase in mortality. Abnormal looping with bisinusal origin of arteries was not associated with increased risk. Conclusion: The techniques of transfer of the coronary arteries can be individually adapted to cater for the anatomical variations. Cardiac surgeons, therefore, need to be familiar with the myriad creative options available to achieve successful repair when there is challenging anatomy. Long-term follow-up will be required to affirm the superiority of any specific individual technique. Detailed multiplanar computed-tomographic scanning can now reveal all the variants, and elucidate the mechanisms of late complications. Coronary angioplasty or surgical revascularization may be considered in selected cases subsequent to the switch procedure.

Background We evaluated short- and mid-term outcomes with use of aortic valve-sparing root replacement to treat bicuspid aortic valves. Methods From December 2007 to January 2022, all patients with bicuspid aortic valves who underwent aortic root replacement using Tirone’s procedure were included. This study based on department database information for retrospective and follow-up data. Results Among 51 adults undergoing aortic root replacement using Tirone’s procedure, the mean age was 47.4±12.5 years, and most were men (92.2%). Three presented with a dysmorphic syndrome and one had Marfan’s syndrome. All patients were alive at 30 days, and as of January 2022, 45 were alive, two were lost to follow-up, and there were four noncardiac deaths. Two patients had infectious endocarditis and needed a Bentall’s procedure. One patient had a double biologic valve replacement in the context of severe mitral insufficiency with moderate aortic stenosis at 4.5 years post-procedure. Echocardiographic follow-up showed a left ventricular ejection fraction of 63±7% (n=36), V max 2±0.6 m/s (n=17), and a mean gradient of 9.4±5.4 mmHg (n=27). No patients had grade 3 or 4 aortic regurgitation, one patient had grade 2, and four had grade 1. Conclusion Tirone’s procedure is an option for bicuspid aortic valve surgery, with good safety and outcomes, especially in younger patients.

Tetralogy of Fallot (TOF) is rarely associated with partial anomalous pulmonary venous return (PAPVR). Unidentified PAPVR, however, might increase the risk of pulmonary valve replacement in repaired TOF patients by right ventricular (RV) dilatation and RV dysfunction. Here, we present a case of a 19-year-old male who received a correction of TOF 18 years ago and a rare type of PAPVR was identified during the follow up period. The anomalous pulmonary veins were connected to the left hepatic vein, left superior vena cava, and the right superior vena cava. Performing a pulmonary valve replacement, PAPVR was also corrected by an intra-atrial baffle with a new approach using the venous plexus between the left hepatic vein and the right hepatic vein.

Deep sternal wound infection (DSWI) with prosthetic graft infection is a rare, though lethal, complication after cardiovascular surgery via median sternotomy. This commentary is a review of a report by Takagi et al. published in the Journal of Cardiac Surgery that reported favorable outcomes in patients with DWSI with prosthetic graft infection treated with an enhanced strategy consisting of hydro-debridement with pulsed lavage and negative pressure wound therapies.

A systematized description of the morphology of congenitally malformed hearts is recognized as essential for the understanding of the important features that will determine the appropriate clinical and surgical approaches.

Cervantes-Salazar and colleagues report the long-term surgical outcomes of 414 patients with total anomalous pulmonary venous connection (TAPVC) from January 2003 to June 2019. With an overall survival rate of 87.2% from 2003 to 2019, the authors found that an increased mortality risk was associated with infra-cardiac TAPVC, pulmonary venous obstruction (PVO), and postoperative mechanical ventilation. Their comprehensive study with a large sample size of varying age groups, and patients with late referrals for surgery, provide valuable insight into TAPVC surgical outcomes. Improved survival for these patients continues to be a major goal of clinical teams striving to transform treatment paradigms. The comprehensive and promising results of the study reported by Cervantes-Salazar and colleagues gives our field hope for a better future for these patients.

This article is devoted to the study of the existence of an exponential attractor for a family of problems, in which diffusion $d_{\lambda}$ blows up in localized regions inside the domain \begin{equation*} \begin{cases} u_t^\lambda-\mathrm{div}(d_\lambda(x)(|\nabla u^\lambda|^{p(x)-2}+\eta ) \nabla u^\lambda)+ |u^\lambda|^{p(x)-2}u^\lambda=B(u^\lambda), & \mbox{ in } \Omega \\ u^\lambda = 0, & \mbox{ on } \partial\Omega\\ u^\lambda(0)=u^\lambda_0 \in L^2(\Omega),& \end{cases} \end{equation*} and their limit problem via the $l$-trajectory method.