Summary: The unusual genetic diversity of the Omicron strain has led to speculation about its origin. The mathematical modeling platform developed for the Stockholm Paradigm (SP) indicates strongly that it has retro-colonized humans from an unidentified animal reservoir originally infected by humans. The relationship between Omicron and all other SARS-CoV-2 variants indicates oscillations among hosts, a core part of the SP. Such oscillations result from the emergence of novel variants following colonization of new hosts, replenishing and expanding the risk space for disease emergence. The SP predicts that pathogens colonize new hosts using pre-existing capacities. Those events are thus predictable to a certain extent. Novel variants emerge after a colonization and are not predictable. This makes it imperative to take proactive measures for anticipating emerging infectious diseases (EID) and mitigating their impact. The SP suggests a policy protocol to accomplish this goal. This is the DAMA Protocol: comprising DOCUMENT to detect pathogens before they emerge in new places or colonize new hosts; ASSESS to determine risk; MONITOR to detect changes in pathogen populations that increase the risk of outbreaks; and ACT to prevent outbreaks when possible and minimize their impact when they occur.

Correspondence: Mikaela I Poling, 8501 Arlington BLVD, Ste 420, Fairfax, VA 22031, USA; Tel. +1 304-460-9038; Fax +1 703-207-2002; E-mail: research@duplastics.comAuthor Contributions: Both authors contributed equally.Acknowledgments: We thank CM Poling, M Pócket, W Cloud, and ES Tu. This manuscript is dedicated to the memory of Calvin Yang, formerly of the 2nd Battalion, 27th Infantry Regiment “Wolfhounds” of the US Army, who lost his life to complications of posttraumatic stress disorder several years after serving.Conflict of Interest: The authors have no financial or other competing interests to disclose.Funding: This work was unfunded.Word Count: 810 (Body)

Correspondence: Mikaela I Poling, 8501 Arlington BLVD, Ste 420, Fairfax, VA 22031, USA; Tel. +1 304-460-9038; Fax +1 703-207-2002; E-mail: research@duplastics.comAuthor Contributions: Both authors contributed equally.Acknowledgments: We thank CM Poling, M Pócket, W Cloud, and ES Tu. This manuscript is dedicated to the memory of Calvin Yang, formerly of the 2nd Battalion, 27th Infantry Regiment “Wolfhounds” of the US Army, who lost his life to complications of posttraumatic stress disorder several years after serving.Conflict of Interest: The authors have no financial or other competing interests to disclose.Funding: This work was unfunded.Word Count: 842 (Body)

The ongoing COVID-19 pandemic strained medical systems worldwide. We report on the impact on pediatric oncology care in Latin American (LATAM) during its first year. Four cross-sectional surveys were electronically distributed among pediatric onco-hematologist in April/June/October 2020, and April/2021 through the Latin American Society of Pediatric Oncology (SLAOP) email list and St Jude Global regional partners. 453 pediatric onco-hematologists from 20 countries responded the first survey with subsequent surveys response rates above 85%. More than 95% of participants reported that treatment continued without interruption for new and active on-going patients, though with disruptions in treatment availability. During the first three surveys, respondents reported suspensions of outpatient procedures (54.2%), a decrease in oncologic surgeries (43.6%), radiotherapy (28.4%), stem cell transplants (SCT) (69.3%), and surveillance consultations (81.2%). Logistic regression analysis showed that at the beginning of the first wave, participants from countries with healthcare expenditure below 7% were more likely to report a decrease in outpatient procedures (OR:1.84, 95%C:1.19;2.8), surgeries (OR:3, 95%CI:1.9;4.6) and radiotherapy (OR:6, 95%CI:3.5;10.4). Suspension of surveillance consultations was higher in countries with COVID-19 case fatality rates above 2% (OR:3, 95%CI:1.4;6.2) and SCT suspensions in countries with COVID-19 incidence rate above 100 cases per 100,000 (OR:3.48, 95%CI:1.6;7.45). Paradoxically, at the beginning of the second wave with COVID-19 cases rising exponentially, most participants reported improvements in cancer services availability. Our data show the medium-term collateral effects of the pandemic on pediatric oncology care in LATAM, which might help delineate oncology care delivery amid current and future challenges posed by the pandemic.

Background: Once diagnosis of malignancy is made in pediatric patients, it can be important to initiate therapy to prevent delay in benefits derived from treatment. These patients require provision of central vascular access to begin treatment. The aim of this study was to compare vascular access provision by a designated PVAT with surgical placement of central venous access in pediatric oncology patients. Methods: This was an IRB-approved retrospective medical record review of subjects diagnosed with an oncologic malignancy with inclusion criteria: ages 0-21 years of age, treatment for pediatric malignancy at the University of Maryland Children’s Hospital between 1/1/2017-12/31/2019. Results: We identified 69 patients who met the inclusion criteria with 39% (n=27) having undergone line placement by PVAT. The mean time from consult to line placement was 10 hours (SD = 9) in the PVAT group vs 76 hours (SD = 56) in the surgery group (p < 0.0001). There was a statistically significant difference in length of procedure, with PVAT placement requiring less time (27 +/- 12 minutes) vs surgical placement (48 +/- 19 minutes), p=0.0005. Conclusion: At our institution, having a PVAT in house has allowed for more efficient line placements, decreased length of time to provision of access and transition to placement of surgical lines when more stable. This allows for not only patients to receive care faster, but also to have lines placed in shorter times while optimizing patient safety.

Background: Adolescents and young adults with cancer (AYA) are a complex group of patients. The development of fever and neutropenia (FN) is a potentially lethal complication of chemotherapy. Risk stratification of patients with FN has become increasingly valuable allowing for early intervention and for the use of lower intensity treatments. There are risk stratification guidelines that exist, but most are validated in young children with cancer (YCWC). AYA are frequently shown to have more numerous and severe side effects from chemotherapy. This study aimed to identify whether age contributes to the incidence and severity of FN. Procedure: Patients diagnosed with a malignancy in a 5-year period at our institution were included from ages 0-18 yrs. We reviewed details of their FN events, including duration of hospital admission, source (bacterial/fungal), PICU admission and duration, positive blood cultures and mortality. Results: Adolescents with cancer (AWC) had a trend of being 1.56 times more likely to have FN events (CI 95% 0.936-2.622, p=0.087). Assessment of the duration of PICU stay showed that AWC were 4.9 times more likely to have longer admissions (CI 95% 0.998-24.067, p=0.050). There was no significant difference between the two groups in the rate of PICU admission, positive cultures, identification of a bacterial or fungal source, hospital admission duration or mortality. Conclusions: This study demonstrated a trend towards AWC being more likely to develop FN events. When such events occur in this group, the severity of them may be heightened as evidenced by longer duration of PICU admission.

Background: Coronary artery bypass grafting (CABG) is a surgical procedure used in the treatment of coronary artery disease and to improve heart function. Right ventricular (RV) function is unclear based on myocardial velocities before and after coronary artery bypass graft surgery. RV dysfunction is a known cause of hypotension in early CABG surgery. The diastolic function has been shown to be a significant contributor to mortality and cardiac morbidity in recent years. Our study aimed to assess RV diastolic dysfunction after CABG surgery. Methods: Forty-four patients with the two-vessel disease (2 VD), small vessel disease (SVD) and three-vessel disease (3 VD) facial ischemia candidates for CABG surgery were studied. All patients underwent colour Doppler and RV strain echocardiography before and one month after CABG surgery, and patients’ RV function indices were calculated. Data analysis was performed using SPSS 21 software and a value of P<0.05 was considered statistically significant. Results: Out of forty patients, the male to female ratio was 32:8 and their mean age was 65.17 ± 7.87 years and their mean body mass index was 25.59± 3.20. Four patients were operated on without pumps. One month after CABG, systolic pulmonary artery pressure (SPAP), left ventricular ejection fraction (LVEF) and RV Diameter indexes increased significantly. Fractional area change (FAC), RV global longitudinal strain (GLS), Tissue Doppler imaging systolic wave (SM), RV myocardial perfusion imaging (MPI) and Tricuspid annular plane systolic excursion (TAPSE) decreased, which was less in the 3VD group than in the 1VD/2VD group (P <0.001). There was no significant difference between RV diastolic diameter (RVDD) and left ventricular diastolic diameter (LVDD) before and one month after CABG (P <0.05). Additionally, no significant correlation was detected between changes in RV strain and pump connection time. Conclusion: RV diastolic function is significantly reduced after CABG surgery. Surgery without the pump can certainly not eliminate this dysfunction and be effective in reducing its severity.

Background: Mounting evidence demonstrates that meditation can lower pain and emotional distress in adults, and more recently, in children. Meditation may be an effective form of emotion regulation in children because it is easily accessible and more easily done across a variety of settings in which toys may not be available, for e.g., settings requiring a “clean” environment (e.g., surgical prep). Further, neuroimaging studies in adults suggest that meditation techniques are neurobiologically distinct from other forms of emotion regulation, such as distraction, that rely on prefrontal control mechanisms, which are underdeveloped in youth. Rather, meditation techniques may not rely on “top-down” prefrontal control and may therefore be utilized across the lifespan. Procedure: We examined neural activation in children with cancer, who experience significant distress. During neuroimaging, children viewed distress-inducing video clips while using martial arts-based meditation (focused attention, mindful acceptance) or non-meditation (distraction) emotion regulation techniques. In a third condition (control), participants passively viewed the video clip. Results: We found that meditation techniques were associated with lower activation in default mode network (DMN) regions, including the medial frontal cortex, precuneus, and posterior cingulate cortex, compared to the control condition. Additionally, we found evidence that meditation techniques may be more effective for modulating DMN activity than distraction. There were no differences in self-reported distress ratings between conditions. Conclusion: Together, these findings suggest that martial arts-based meditation modulates negative self-referential processing associated with the DMN, and may have implications for the management of pediatric pain and negative emotion.

Key Points · Perventricular device closure of peri-membranous ventricular septal defects is safe and effective when compared to conventional surgery and transcatheter device closure. · Intraprocedural transesophageal echocardiography can effectively guide perventricular device closure of peri-membranous ventricular septal defects and improve safety and success rate. · Hybrid approach improves the outcomes in select patients with congenital heart diseases and complex anatomical defects.

Optimal Therapy for Stroke Prevention in Atrial Fibrillation: Is it Left Atrial Appendage Closure?

Re: There is no association between combined oral hormonal contraceptives and depression: a Swedish register-based cohort studyJack Lowe-Zinolaa, Oguljemal Redjepovab, Christopher Griffinc

Cutaneous squamous cell carcinoma (cSCC) is the second most common non melanoma skin cancer after Basal cell carcinoma, characterised by the malignant proliferation of epidermal keratinocytes. We report a case of an inoperable cSCC of the scalp extending into the sagittal sinus, now responding well to the monoclonal antibody Cemiplimab.

Paroxysmal dysarthria and Ataxia (PDA) is a rare neurological manifestation of stereotyped attacks of sudden ataxic symptoms lasts for few seconds to minutes, of variable frequency. We report a case of PDA in a 61 years old male with an isolated homogenously enhancing solitary midbrain lesion and positive HLA-B51.

In this paper, a blow-up criterion of classical solutions to the Cauchy problem for the compressible Navier-Stokes equations with degenerate viscosities is established, as well as the Shallow water equations. Moreover, we prove that the maximum norm of the gradient of velocity controls the possible breakdown of regular solutions for compressible Navier-Stokes equations with degenerate viscosities.

Photocharging of MaterialsOleksandr Savateev*Am Mühlenberg 1, Potsdam, 14476, Germany E-mail: oleksandr.savatieiev@mpikg.mpg.deKeywords: photodoping, photocharging, semiconductor, photocatalysis, organic synthesis, hydrogen storage, solar batteryPhotocharging or photodoping is a process in which electrons are accumulated in a semiconductor upon band gap excitation followed by quenching of the photogenerated holes by reductants. In semiconductors with excess of electrons, negative charge is compensated by cations, of which the most ubiquitous is H+. Photocharging of semiconductors was studied since 1980th both from fundamental perspective and application – as source of electrons and protons for reduction of organic compounds in dark and solar-to-electric energy conversion. In this review, experimental data collected over 40 years of research is summarized and quantified. Maximum specific concentration of electrons stored in 1 gram of a semiconductor (δmax, mol[e‒] g-1), maximum average number of electrons stored per semiconductor particle (<n max>), initial rate of photocharging (R PC, mol[e‒] g-1 s-1) and initial rate of discharging (R DC, mol[e‒] g-1 s-1) are calculated for 6 classes of semiconducting materials, Ti-, Zn-, Cd-, In-, W- and carbon nitride-based. Dependence of these parameters on material specific surface area, particle volume and other properties is analyzed and trends are derived. Database of photocharged materials is created at pcmat.mpikg.mpg.de to facilitate development of high-performing materials with photocharging function.1. IntroductionTaming the energy of visible light by means of semiconducting materials to enable desirable chemical reactions has been a central research topic of many generations of researchers since the middle of the 20th century.[1] Today the scope of applications is enormous. In the context of synthesis of useful molecules rather than degradation of pollutants, semiconductors (SCs) are considered as primary photocatalysts in large-scale full water splitting under outdoor sun light.[2] On smaller laboratory scale semiconductors are actively studied in synthesis of fine organic molecules under illumination with artificial light generated by LEDs or other light sources.[3],[4],[5] Regardless of the scale and the reaction they mediate, from a very general standpoint, photocatalysts enable flow of electron from one reagent to another via photoinduced electron transfer (PET) as schematically shown inFigure 1 .

Comment on EAACI guideline: Anaphylaxis (2021 update)Authors :Stefano Miceli Sopo a, Dario Sinattia, Francesco Mastellone b, Giulia Bersani a, Mariannita Gelsomino b.

Functional traits are influenced by phylogenetic constraints and environmental conditions, but previous large-scale studies modeled traits either as species weighted averages or directly from the environment, precluding analyses of the relative contributions of inter- and intraspecific variation across regions. We developed a joint model integrating phylogenetic and environmental information to understand and predict the distribution of eight leaf traits across the eastern US. This model explained 68% of trait variation, outperforming both species-only and environment-only models, with variance attributable to species alone (23%), the environment alone (13%), and their overlapping effects (25%). The importance of the two drivers varied by trait. Predictions for the eastern US produced accurate estimates of intraspecific variation and deviated from both species-only and environment-only models. Predictions revealed that intraspecific variation holds information across scales, affects relationships in the leaf economic spectrum and is key for interpreting trait distributions and ecosystem processes within and across ecoregions.

COVID-19 infection results in extensive organ dysfunction. Thrombotic problems linked to COVID--19 disease is common and can affect the retina. We will report a case of retina hemorrhage with possibility of linkage between COVID-19 infection or immunization to determine whether these abnormalities are causal or coincidental.

African swine fever (ASF), considered as the most dreadful swine disease due to its very high mortality, emerged in India in 2020. The complete genome analysis of ASF viruses isolated during the first outbreaks in India showed a few unique non-synonymous mutations in MGF 369-11L, MGF 505-4R, K205R and B263R genes. Frame shiftsin the protein coding sequences were observed in DP60R, ASFV-G_ACD 00190, MGF 110-10-L- MGF110-14L fusion, MGF 360-14L and I267L genes of Indian ASFVs as compared to ASFV/Georgia/2007. Complete genome based phylogenetic analysis of p72-genotype-II viruses showed the clustering of Indian isolates with ASFV/Wuhan/2019 in a separate clade. Phylogenetic analysis of concatenated sequences of 14 open reading frames (ORF) having single nucleotide polymorphisms (SNP) showed distinct grouping of Indian ASFVs with other Asian ASFVs.Thisis the first complete genome characterization of ASF viruses isolated from domestic pigs in India. The resultsindicate that number of Tandem Repeat Sequence in the intergenic region between I73R and I329L genes, and the 14 ORFs with SNP reported in this study could be the genetic determinants to differentiate the closely related p72-genotype II viruses circulating in Asia.

The emergence of the Sars-CoV-2 Omicron variant(s) was a tipping point which led from the 2020/2021 Covid-19 pandemic to a surprisingly early endemic situation. Contrary to what is discussed by some virologists, a replacement of Sars-CoV-2 Omicron by another variant that produces more clinically problematic courses is only a theoretical possibility. In real life this will not happen. Instead Omicron seems to be even less lethal than the endemic hCoVs we have been knowing for decades. Therefore, now is the time to develop entirely new vaccines, not only against the Sars-CoV-2 virus but also to protect vulnerable populations against the human coronaviruses OC43, HKU1, 229E, and NL63. These coronaviruses are, as of early 2022, a greater public health threat than the Sars-CoV-2 virus with its Omicron variants.

Forecasting the trajectories of species assemblages in response to ongoing climate change requires quantifying the time lags in the demographic and ecological processes through which climate impacts species' abundances. Since experimental climate manipulations are typically abrupt, the observed species responses may not match their responses to gradual climate change. We addressed this problem by transplanting alpine grassland turfs to lower elevations, recording species' demographic responses to climate and competition, and using these data to parameterize community dynamics models forced by scenarios of gradual climate change. We found that shifts in community structure following an abrupt climate manipulation were not simply accelerated versions of shifts expected under gradual warming, especially when they missed the rise of species benefiting from moderate warming. Time lags in demography and species interactions controlled the pace and trajectory of changing species' abundances under simulated 21st century climate change, and thereby prevented immediate diversity loss.

Objective: The traditional outcomes of the Fontan Operation (FO) in Endocardial Cushion Defect (ECD) patients have been suboptimal. Previous studies have been limited by the smaller number of ECD patients, longer study period with an era effect and do not directly compare short-term outcomes of FO in ECD patients with non-ECD patients. Our study aims to address these shortcomings. Methods: A retrospective analysis of the Kids Inpatient Database (2009, 2012, and 2016) for the FO was done. The groups were divided into those who underwent FO with ECD as compared to non-ECD diagnosis. The data was abstracted for demographics, clinical characteristics, and operative outcomes. Standard statistical tests were used. Results: 3380 patients underwent the FO of which 360 patients (11%) were FO-ECD. ECD patients were more likely to have Down syndrome, Heterotaxy syndrome, transposition/DORV, and TAPVR as compared to non-ECD patients. FO-ECD had a higher discharge-mortality (2.84% vs. 0.45%, p=0.04). The length of stay (16 vs. 13 days, p=0.05) and total charges incurred ($ 283, 280 vs. 234, 106, p=0.03) for the admission were higher in the FO-ECD as compared to non-ECD patients. In multivariable analysis: ECD diagnosis, cardiac arrest, acute kidney injury, and post-operative hemorrhage were predictors of mortality. Conclusion: Contemporary outcomes for FO are excellent with very low overall operative mortality. However, the outcomes in ECD patients are inferior with higher operative mortality than non-ECD patients. Occurrence of post-operation complications, associated TAPVR and a diagnosis of ECD were predictive of a negative outcome.

A document by Madison S. Hill, written on Authorea.

We report a patient that underwent a redo complex AVR. In the context of severe AR and dilated LV, we experienced that it is safer to start the LV venting after aortic cross clamping. NIRS in this setting can be a useful tool to prevent potential severe neurological damage.