Objective: Congenital cardiac outflow defects (COD) are the largest group of congenital heart defects, with ventricular septal defect (VSD) as the most prevalent phenotype. Increased maternal age, excessive oxidative stress and inflammation are involved in the pathophysiology and enhance telomere length (TL) shortening. We aim to study the association between periconception maternal TL, as future predictive biomarker, and the risk of having a child with COD. Design: HAVEN-study, a multicenter case-control triad study conducted in the Netherlands. Setting and population: 306 case mothers of a child with COD and 424 control mothers of a child without a congenital malformation were selected. Methods: TL was estimated, on DNA from venous blood samples, by qPCR. Multivariable logistic regression was used to compute crude and adjusted odds ratios (OR) per standard deviation (SD) decrease between maternal T/S ratio and COD and VSD risk. Main outcome measures: The risk of COD in offspring. Results: A significant association was shown between maternal TL shortening (per standard deviation) and a 29% increased risk of VSD in offspring (OR 1.29(95% CI 1.04-1.61), P= 0,02), which remained significant after additional adjustment for maternal age (adjOR 1.25(95% CI 1.01-1.55), P= 0,04). No association between maternal TL and the risk of overall COD in offspring was observed. Conclusion: Shortening of maternal TL, due to maternal conditions including age, is associated with an approximately 1.3-fold increased risk, per SD in TL-shortening, of VSD in the offspring. These findings need further confirmation in other studies on the predictive value of maternal TL.

Surface water storage—including wetlands and other small waterbodies—has largely been disregarded in traditional hydrological models. In this paper, the grid resampling method is adopted to study the influence of the digital elevation model (DEM) grid resolution on depression storage (DS) considering different rainfall return periods. It is observed that the DEM grid size highly affects DS, and the higher the grid resolution is, the larger the DS value. However, when the grid resolution reaches a certain value, the maximum DS value decreases. This suggests that a critical grid resolution value exists at which the water storage capacity of depressions is maximized, namely, 20 m in this work. This phenomenon is further verified in two test cases with and without the infiltration process, i.e., calculations of the local area and without infiltration area, respectively. This research may facilitate the accurate computation of the DS process, which is greatly affected by the grid resolution, thereby improving the reliability of hydrological models.

The Budyko framework, which can describe a simple but useful partitioning of precipitation under supply and energy limits, is used widely to estimate evapotranspiration (ET). Previous studies have investigated time-variant Budyko functions on annual or interannual scales but seldom on the intra-annual scale. This study used a monthly two-parameter ( κ and y0) Budyko function and three schemes that considered single observations (ET or streamflow (Q)) and dual observations (ET and Q) to assimilate the time-varying parameters using the ensemble Kalman filter method. The study considered the contiguous USA (CONUS) using the Model Parameter Estimation Experiment dataset. The time-varying parameters were explained on the basis of time series analysis and correlation with meteorological data. Three conclusions were as follows. (1) The identified time-varying parameters ( κ and y0) of the Budyko function could effectively simulate ET. (2) The assimilation using only ET observations could identify a plausible set for parameter κ but was inadequate for y0 . (3) Most time-varying parameters exhibited a 12-month period, and the trend and change points detected for Midwest CONUS were related to anthropogenic influences such as extraction and use of groundwater. The findings show that changing environment can be detected by using the proposed time-varying parameters of the Budyko function.

Faced with the anthropic activities of urban streams stretches through rectification with concrete, there is a concern about the modifications of the aquatic habitats and consequent ecological damages to the ecosystems. Based on biophilic engineering, there is a great opportunity to idealize and test interventions to revitalize such hampered ecosystems. Hence, we verified the performance of biological and organic factors, after the implementation of one-off interventions in three rivers using biophilic handmade materials and structural elements in their fixation. We carried out the project in urban stretches of concrete bed streams, located in Sorocaba-SP, Southeast of Brazil. In two years, we conducted biweekly in situ and laboratory measurements to characterize the study sites, idealize, scale, implement the projects, and, evaluate the ecological responses of the implementations. We collected sampling in two points: upstream and downstream interventions. We evaluated the performance of the interventions through the analysis of SWOT (Strengths, Weaknesses, Opportunities, and Threats) factors and by using the Analytic Hierarchy Process (AHP). We presented the results through a decision-making matrix for stakeholders, which indicated that our ideas are of low cost and easy to implement. Then, we got the following scenario of SWOT priorities: opportunity (58.55%), strength (24.71%), threat (10.74%), and weakness (6.00%). They demand constant efforts for maintenances and they need adjustments to a better understood by residents and the watershed management. We concluded that the strengths observed in the project turn our idea replicable in any part because it attaches the idea of caring about the environment through biophilic techniques, and the weaknesses are liable to modifications (improvements) in future projects that consider such proposal.

Geonor T-200B weighing precipitation gauge (Geonor) and Chinese standard precipitation gauge (CSPG) are widely used for measuring precipitaion in the Qinghai-Tibet Plateau. However, their measurements must be adjusted due to wetting, evaporation loss and wind-induced undercatch. Some transfer functions had been proposed in previous studies, but their applicability in the Qinghai-Tibetan Plateau has not been evaluated. In our study, a precipitation measurement intercomparison experiment was carried out from August 2018 to September 2020 at a station in the central Qinghai-Tibet Plateau, and these transfer functions are also evaluated based on the results of the experiment. The results show that: (1) the catch efficiency of Geonor for rain, mixed, snow, hail are 92.06%, 85.32%, 68.08% and 91.82% respectively, and the catch efficiency of CSPG are 92.59%, 81.32%, 46.43% and 95.56% respectively. (2) K2017b has the most accurate correction results for Geonor solid and mixed precipitation at 30 minutes time scale, and the M2007e scheme has the most accurate correction results for Geonor solid precipitation at event scale. (3) The current transfer functions for CSPG underestimate the solid precipitation, while overestimate the liquid precipitation. Based on the results of the comparative observation in our study, new CSPG transfer functions are proposed for the central Qinghai-Tibet Plateau. (4) Hail is also an important precipitation type in the central Qinghai-Tibet Plateau. Because the capture rate of hail precipitation is close to that of rain, and the temperature when hail precipitation occurs is high, it is not necessary to determine the hail precipitation type, and the transfer functions recommended in this study can also get a good correction results.

Silent RSV in infants with SARS‑CoV‑2 infection: a case seriesAntonietta Giannattasio, MD, PhD1, Marco Maglione, MD, PhD1, Carolina D’Anna, MD1, Stefania Muzzica, MD1,Francesca Angrisani, MD1, Sabrina Acierno, MD1, Alessandro Perrella2, MD, PhD2, Vincenzo Tipo, MD11Santobono-Pausilipon Children’s Hospital, Pediatric Emergency and Short Stay Unit, Naples, Italy2Cardarelli Hospital, Infectious Disease-Health Policy Direction, Naples, Italy

Detecting fat globules in blood in diagnosing fat embolism syndrome (FES) remains controversial. This case illustrated two life threatening episodes possibly due to FES, with a dramatic increases of fat globules in blood. Significance of quantitative change of fat in blood in diagnosing FES should be evaluated in the future.

In South Vietnam, live bird markets (LBMs) are key in the value chain of poultry products and spread of avian influenza virus (AIV) although they may not be the sole factor to determine avian influenza (AI) prevalence in the southern part. Therefore, a risk analysis of AIV spread was conducted by including all possible value chain factors. A cross-sectional study was performed in backyard farms, high-biosecurity farms (bio-farms), LBMs, and poultry delivery stations (PDSs) in the four districts of Vinh Long Province in December 2016 and August 2017. A total of 3 597 swab samples were collected from individual poultry at 101 backyard farms, 50 bio-farms, 58 sellers in LBMs, and 17 traders in PDSs and then investigated for AIV isolation. Concurrently, information related to participants and birds was collected and used to identify the fixed and random effects of factors in AIV infection. A total of 274 birds were positive for virus isolation, with a prevalence of 7.6% (95% confidence interval [CI]: 6.8–8.5) at the individual poultry level, and the adjusted prevalence based on the sampling weight was 7.9% (95% CI: 7.6–8.2). The significantly higher prevalence in PDSs (20.7%) and LBMs (14.2%) compared to backyard farms (3.0%) and bio-farms (0.6%) suggested that PDSs are another hot spot for AIV circulation. The high diversity in the seller and trader population characteristics was revealed using multiple-correspondence analysis to analyze the participants’ demographic factors in LBM and PDS. The mixed-effect logistic regression model revealed that keeping duck at the sampling time and the owner’s older age should be risk factors of AIV infection in PDS. Therefore, functional AI control efforts to monitor the PDS system should be emphasized to minimize AIV circulation risk in Vietnam.

Objective: To determine the association between treatment of persistent BV in pregnancy and risk for spontaneous preterm birth (sPTB). Design: The retrospective data from IBM® MarketScan® Commercial Database was analyzed. Setting: United States outpatient data. Population or Sample: Women aged 12–55 years with a singleton gestation. Methods: Women were linked to an outpatient medications database and medications taken during the pregnancy were analyzed. Treatment of BV in pregnancy was defined as a diagnosis of BV and treatment with Metronidazole and/or Clindamycin, and persistent treatment of BV was defined as BV in more than 1 trimester or BV requiring more than 1 antibiotic prescription. Odds ratios were calculated comparing sPTB in those with BV and persistent BV to women without BV in pregnancy. Survival analysis using Kaplan-Meier curves for the gestational age at delivery was also performed. Main outcome measures: sPTB Results: Among a cohort of 2,538,606 women, 216,611 had an associated ICD-9 or ICD-10 code for diagnosis of BV alone, and 63,817 had BV and were treated with either metronidazole and/or clindamycin. The sPTB rate among women treated with BV was 7.5% compared with 5.7% for women without BV who did not receive antibiotics. Relative to those without BV in pregnancy, odds ratios for sPTB were highest in those treated for BV in both the first and second trimester (1.66 [95% CI 1.52, 1.81]) or those with 3 or more prescriptions in pregnancy (1.48 [95% CI 1.35, 1.63]. Conclusions: Treatment of persistent BV is associated with increased sPTB risk.

Objetive: To evaluate the ultrasonographic contractile activity indices of the diaphragm in infants with moderate and severe bronchiolitis supported with high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV) to predict the need of invasive mechanical ventilation (IMV). Methods: Prospective observational study in infants admitted to a Pediatric Intensive Care Unit (PICU). Diaphragmatic excursion (dEx), diaphragmatic inspiratory (dTi) and expiratory time (dTe), and fraction of diaphragmatic thickening (dTF) were recorded at admission, 24 h and 48 h in both diaphragms. RESULTS: Twenty-six patiens were included (14 on HFNC and 12 on NIV) with a total of 56 ultrasonographic evaluations. Three patients required IMV. Sixty-four percent of the patients on HFNC required NIV as rescue therapy and 2/14 IMV (14,2%). In the HFNC group there were no differences in dEx between those who required escalation to NIV or IMV and those who didn’t. Diaphragmatic left thickening fraction (Left dTF) increased in patients on HFNC requiring IMV vs those needing NIV (Left dTF 47% vs 22% (13-30); p=0,046, r=0,7) (Fig 2). Diaphragmatic inspiratory time was higher in infants on HFNC requiring IMV and diaphragmatic expiratory time was shorter (dLET, p=0,038; dRET, p=0,022). In the NIV group there were no diffenreces in dEx, dTi, dTe or dTF between patients needing escalation to IMV and those who didn’t. We found no correlation between a clinical score and echographic dTF. CONCLUSION: In infants with moderate or severe brochiolitis receiving HFNC the use of ultrasonographic left dTF could help predict respiratory failure (RF) and need for IMV. The use of ultrasonographic diaphragmatic excursion is of little help to predict both.

BACKGROUND: Workplace burnout can result in negative consequences for clinicians and patients. We assessed burnout prevalence and sources among pediatric hematology/oncology inpatient nurses, ambulatory nurses, physicians (MDs), and advanced practice providers (APPs) by evaluating effects of job demands and involvement in patient safety events (PSEs). METHODS: A cross-sectional survey (Maslach Burnout Inventory) measured emotional exhaustion, depersonalization, and reduced personal accomplishment. The NASA Task Load Index measured mental demand, physical demand, temporal demand, effort, and frustration. Relative weights analyses estimated the unique contributions of tasks and PSEs on burnout. Post-hoc analyses evaluated open-response comments for burnout factors. RESULTS: Burnout prevalence was 33%, 20%, 34% and 33% in inpatient nurses, ambulatory nurses, and MD, and APPs respectively (N=481, response rate 69%). Reduced personal accomplishment was significantly higher in inpatient nurses than MDs & APPs. Job frustration was the most significant predictor of burnout across all four cohorts. Other significant predictors of burnout included temporal demand (nursing groups & MDs) effort (inpatient nurses & MDs) and PSE involvement (ambulatory nurses). Open-response comments identified time constraints, lack of administrator support, insufficient institutional support for self-care, and inadequate staffing and/or turnover as sources of frustration. CONCLUSIONS: All four clinician groups reported substantial levels of burnout, and job demands predicted burnout. The body of knowledge on job stress and workplace burnout supports targeting organizational-level sources, versus individual-level factors, as the most effective prevention and reduction strategy. This study elaborates on this evidence by identifying structural drivers of burnout within a multidisciplinary context of pediatric hematology/oncology clinicians.

Dietary diversity during infancy and the association with childhood food allergen sensitization Authors: Kate Maslin PhD1,2, Kaci Pickett MSc3, Suzanne Ngo3,4 MD, William Anderson3,4 MD, Taraneh Dean PhD2,5, Carina Venter PhD2,3,4School of Nursing and Midwifery, University of Plymouth, Plymouth, UK.The David Hide Asthma and Allergy Centre, St. Mary’s Hospital, Isle of Wight, UKUniversity of Colorado School of Medicine, Colorado, USAAllergy and Immunology Section, Children’s Hospital Colorado, Colorado, USAUniversity of Brighton, Brighton, UKRunning title: Dietary diversity and food sensitization

The format of science papers and articles now have hardly changed since the 17th century, even though research methods and published content have evolved immensely. Why do scientists produce innovative modern-day research, but still publish it in a 400-year-old format? What can we do to produce scientific articles ‘of the future’ that better serve the global, collaborative, and data-rich science of the 21st century?Alberto Pepe, Senior Director, Strategy and Innovation, Atypon and Matteo Cavalleri, Publisher, Wiley will be discussing Wiley’s vision of the scientific article, and how preprints, interactive figures, multimedia elements and code integration are innovating scholarly publications.Part of Wiley Research APAC Webinars, recording available (free registration required) here.

A Majorana fermion is the single fermionic particle that is its own antiparticle. Its dynamics is determined by the Majorana equation, where the spinor field is by definition equal to its charge-conjugate field. In this paper, we investigated Shannon’s entropy of linear Majorana fermions to understand how this quantity is modified due to an external potential of the linear type linear. Subsequently, we turn our attention to the construction of an ensemble of these Majorana particles to study the thermodynamic properties of the model. Finally, we show how Shannon’s entropy and thermodynamic properties are modified under the linear potential action. KEYWORDS: Majorana Fermions; Thermodynamic properties; Shannon’s Entropy.

Proning in Pregnancies Complicated by Acute Respiratory Distress Syndrome. A Call to Action During the COVID-19 Pandemic.Authors: L Cojocaru, OM Turan, A Levine, L Sollecito, S Williams, E Elsamadicy, S Crimmins, S Turan.Liviu Cojocaru, MD: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(lcojocaru@som.umaryland.edu) (ORCID No: 0000-0003-1558-702X).Ozhan M Turan, MD, Ph.D.: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(oturan@som.umaryland.edu)Andrea Levine, MD: Division of Pulmonary and Critical Care Medicine. Department of Medicine. University of Maryland School of Medicine, Baltimore, MD, USA.(andrea.levine@som.umaryland.edu)Linda Sollecito, BSN, RN, CCRN: Medical Intensive Care Unit. University of Maryland Medical Center, Baltimore, MD, USA.(lsollecito@umm.edu)Susan Williams, MS, RN, CCRN: Medical Intensive Care Unit. University of Maryland Medical Center, Baltimore, MD, USA.(susanwilliams@umm.edu)Emad Elsamadicy, MD: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(eelsamadicy@som.umaryland.edu)Sarah Crimmins, DO: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(scrimmins@som.umaryland.edu)Shifa Turan, MD, RDMS: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(sturan@som.umaryland.edu)Correspondence to: Liviu Cojocaru, MD: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA.(lcojocaru@som.umaryland.edu)Disclosures: None.Acknowledgments: We are grateful to Bill Seiler, Erin Rummel, Kelly Kennedy, Alexandra Bessent, Chris Wells, McLellan Shelby, Jessica Peterson, and Amanda Sullivan for assistance in creating the proning video instructions.Short title: Proning in pregnancies complicated by ARDS. It’s time!

Objective: To validate the Weiniger model, a multivariable prediction model for placenta accreta spectrum (PAS). Design: Multicentre external validation study. Setting: Two tertiary care hospitals in the United States. Population: Cohort A included patients with risk factors (prior caesarean delivery, placenta praevia) and/or ultrasound features of PAS (variable risk) presenting to a tertiary care hospital. Cohort B patients were referred to a tertiary care hospital specifically for ultrasound features of PAS (higher risk). Methods: Weiniger model variables (prior caesarean deliveries, placenta praevia and ultrasound features of PAS) were retrospectively collected from both cohorts and predictive performance of the model was evaluated. Main Outcome Measures: Surgical and/or pathological diagnosis of PAS. Results: The model c-statistic in cohorts A and B was 0.728 (95% CI: 0.662, 0.794) and 0.866 (95% CI: 0.754, 0.977) signifying acceptable and excellent discrimination, respectively. Based on calibration curves, the model underestimated average PAS risk in both cohorts. In both cohorts, high risk was overestimated and low risk underestimated. Use of this model compared to a “treat all” strategy had greater net benefit at a threshold probability of > 0.25 in cohort A, but no net benefit in cohort B. Conclusions: This study provides multicentre external validation of the Weiniger model for PAS prediction, making it a useful triaging tool for management of this high-risk obstetric condition. Clinical usefulness of this model is influenced by the incidence of risk factors and PAS ultrasound features, with better performance in a variable-risk population at threshold probability >25%.

Graded home introduction of egg is safe, well received and cost effective when managing childhood egg allergyTo the Editor,In Australia, an IgE mediated allergy to egg is a common food allergy in children.1-2 The 2011 HealthNuts study determined that 8.9% of children in Australia have an egg allergy.1-2IgE mediated allergy to egg can be mild and most children may outgrow this by 4-5 years of age.3-4 Almost 80% of children with IgE mediated egg allergy are tolerant of egg in a baked form with wheat being used as a matrix.1,3 Turner et al. suggests that the outcome of baked egg challenges can be unpredictable and can lead to anaphylaxis even in children with prior mild symptoms.5 Tolerance to baked egg is generally confirmed by a baked egg food challenge in hospital after which patients are encouraged to introduce baked egg products at home.6 Patients are reassessed and subsequently undergo a lightly cooked egg challenge in hospital where resolution is confirmed if successful.6Whereas there is evidence that majority of children with an egg allergy are tolerant to baked egg, there is debate as to whether it can reduce the duration of egg allergy.7-9 Recently, Gotesdyner et al found that a structured graded exposure using baked egg followed by lightly cooked egg compared to complete avoidance helped achieve tolerance to egg.3 Their findings suggest that an egg ladder may promote a faster resolution of egg allergy. However, due to the case control study design and small sample size definite conclusions could not be drawn.3Our Paediatric Allergy Service is a busy tertiary level clinic with more than 2000 outpatient interactions annually. To reduce the burden on tertiary resources, an egg tolerance ladder was developed (Appendix 1). It has been offered to patients considered low risk which includes (but is not limited to) patients with a single food allergy; mild or no eczema; mild, well controlled or no coexisting asthma; and/or a history of IgE mediated egg allergy without anaphylaxis. It has been designed to allow slow introduction of baked egg followed by foods containing small amounts of cooked egg and finally lightly cooked egg at home. Support throughout the home introduction process is provided by the treating team via email and phone contact.The aim of this study was to evaluate the use of this structured “egg ladder” with regards to its safety as well as user satisfaction and barriers that arose in negotiating it. We also attempted to determine potential risk factors which increased likelihood of clinical reaction to foods containing egg and rates of eventual tolerance to lightly cooked and raw egg achieved in the home environment. This study was approved by the Ethics Committee at John Hunter Children’s Hospital (2020/ETH01192).Patients with mild to moderate IgE mediated egg allergy aged 0-18 years seen in the Paediatric Allergy Clinic and commenced on an egg tolerance ladder by the Paediatric Immunologist were recruited retrospectively. Verbal and written education on the use of the ladder had been provided at the time of clinic review. Patients were excluded from home introduction if they had a history of anaphylaxis to any food containing egg or a non-IgE mediated egg allergy.A file audit identified a total of 98 patients for inclusion in this study who had been commenced on the egg ladder between September 2018 and June 2020. Patients were contacted by email and phone, and offered participation in a telephone survey to evaluate the use of the egg tolerance ladder. Almost half (47 patients) consented to the study. At the time of commencing the egg ladder, patients had a mean age of 40 months (IQR: 12-60 months). Six children did not have a skin prick test (SPT). The majority were sensitised with a mean SPT of 3.1mm. Most (66%) had at least one atopic comorbidity and almost half had more than one food allergy. The vast majority (87.2%) of patients commenced the egg ladder at home. This includes 23 patients already tolerant to baked egg prior to clinic presentation, based on clinical history. Only 3 (6%) used the resources of an inpatient challenge.Patients had spent an average of 15.5 months (IQR: 9-21.5 months) on the ladder. At the time of review, 43% of patients had completed the egg ladder but interestingly, four parents believed their child was still allergic to egg. The mean age of commencement on the egg ladder was higher than expected (40 months), and around the age a child is expected to outgrow an allergy to egg.3-4 Despite this, many patients reported reactions while using the egg ladder. A mild reaction was reported by 18 (38%) parents, 16 required treatment and of those one was given adrenaline. This child was 6 years of age, had an isolated egg allergy and small skin test (3.5mm). They reacted to Step 5 and have continued Step 4 at home successfully. Both families reporting a severe reaction recommenced the ladder and were able to subsequently progress successfully to Step 5 or 6. The majority had a mild skin response (rash or hives). Skin testing was a poor differentiator for clinical reaction with 38% of those with negative skin testing reporting a mild reaction with baked egg.Parental satisfaction was high with 78.7% satisfied or very satisfied with the egg ladder. Most of the remaining families were neutral with no families dissatisfied with the ladder use. Many stated that they valued the structured approach of introducing egg which helped identify their child’s level of tolerance, and allowed them to progress at their own pace. A number of parents identified the main barrier to progressing the ladder was the taste and/or texture of egg after successfully completing the ladder and subsequent difficulty maintaining regular lightly cooked egg in the diet. These families continued egg as an ingredient in cooked or baked food.There were some limitations to this study. Firstly, this was a retrospective small sized survey and some patients were unable to accurately recall timelines. As a voluntary survey there is also a risk of ascertainment bias. Baseline patient demographics (age, sex, SPT size, comorbid allergy diagnoses) of non-responders were compared to the study cohort with no significant differences identified. The initial education on commencing on the egg ladder was provided by multiple clinicians and information therefore was unable to be standardised. As expected, a number of patients at the time of the survey were still navigating the egg ladder and therefore had not had enough time to reach their individual threshold to determine if their child had outgrown their allergy. This may lead to under-reporting of egg tolerance on the ladder. Finally, follow up or assistance with the egg ladder was not provided unless the parent contacted the team. This may have resulted in less children completing the ladder due to parental anxiety over mild reactions.We have shown that the use of a structured egg ladder for egg allergic children without a history of anaphylaxis can be safe, is well tolerated and is a positive experience for families. It can prevent time consuming and costly inpatient supervised challenges unnecessarily consuming valuable and scarce resources in busy allergy clinics. Future prospective studies will help establish the role of home egg introduction in childhood egg allergy management in both tertiary and secondary health care settings.Conflicts of InterestNo conflicts to be declared.Leah Thomas1Jan Belcher1Rachael Phillips1Kahn Preece, MBBS, FRACP1Rani Bhatia, MBBS, FRACP11Department of Paediatric Allergy and Immunology, John Hunter Children’s Hospital, Newcastle, AustraliaReferences1. Osborne NJ, Koplin JJ, Martin PE, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. Journal of Allergy and Clinical Immunology. 2011;127:668-76.2. Dang TD, Peters RL, Koplin JJ, et al. Egg allergen specific IgE diversity predicts resolution of egg allergy in the population cohort HealthNuts. Allergy. 2019; 74: 2.3. Gotesdyner L, Zeldin Y et al. A structured graduated protocol with heat denatured eggs in the treatment of egg allergy. Pediatric Allergy and Immunology. 2019;30:824-832.4. Leonard SA, Sampson HA, Sicerer SH, et al. Dietary baked egg accelerates resolution of egg allergy in children. Journal of Allergy and Clinical Immunology. 2012;13:2.5. Turner PJ, Mehr S, Joshi P et al. Safety to food challenges to extensively heated egg in egg-allergic children: a prospective cohort study. Pediatric Allergy and Immunology. 2013;24:450-455.6. Clark A, Islam S, King Y. A longitudinal study of resolution of allergy to well-cooked and uncooked egg. Clinical & Experimental Allergy. 2011;41:706-712.7 Lambert R, Grimshaw K, Elis B et al. Evidence that eating baked egg or milk influences egg or milk allergy resolution: A Systematic Review. Clin Exp Allergy. 2017;47(6):829-837.8. Upton J, Nowak-Wegrzyn A. The impact of baked egg and baked milk diets on IgE and Non-IgE mediated allergy. Clinical Reviews in Allergy & Immunology. 2018;55(2):118-138.9. Leonard SA, Caubet JC, Kim, JS, Groetch M, Wegrzyn AN. Baked Milk- and Egg-Containing Diet in the Management of Milk and Egg Allergy. Journal of Allergy and Clinical Immunology. 2015;1:13 – 23.

A document by David Savitz, written on Authorea.

Naphthenic acids (NAs) are carboxylic acids with the formula (CnH2n+ZO2) and are the toxic, persistent constituents of oil sands process-affected waters (OSPW), produced during oil sands extraction. Currently, the proteins and mechanisms involved in NA biodegradation are unknown. Using LC-MS/MS shotgun proteomics, we identified proteins overexpressed during the growth of Pseudomonas fluorescens Pf5 on a model NA (4-n-butylphenyl)-4-butanoic acid (n-BPBA) and commercial NA mixture (Acros). By day 11, >95% of n-BPBA was degraded. With Acros, a 17% reduction in intensity occurred with 10-18 carbon compounds of the Z family -2 to -14 (major NA species in this mixture). A total of 554 proteins (n-BPBA) and 631 proteins (Acros) were overexpressed during growth on NAs; including several transporters (e.g. ABC transporters), suggesting a cellular protective response from NA toxicity. Several proteins associated with fatty acid, lipid and amino acid metabolism were also overexpressed; including acyl-CoA dehydrogenase and acyl-CoA thioesterase II, which catalyze part of the fatty acid beta-oxidation pathway. Indeed, multiple enzymes involved in the fatty acid oxidation pathway were upregulated. Given the presumed structural similarity between alkyl-carboxylic acid side chains and fatty acids, we postulate that P. fluorescens Pf-5 was using existing fatty acid catabolic pathways (among others) during NA degradation.

Plants are often attacked by multiple antagonists, and traits of the attacking organisms, and their order of arrival onto hosts, may affect plant defenses. However, few studies have assessed how multiple antagonists, and varying attack order, affect plant defense or nutrition. To address this, we assessed defensive and nutritional responses of Pisum sativum plants after attack by a vector herbivore (Acrythosiphon pisum), a non-vector herbivore (Sitona lineatus), and a pathogen (Pea enation mosaic virus, PEMV). We show PEMV-infectious A. pisum induced several pathogen-specific plant defense signals, but these defenses were inhibited when S. lineatus was present in peas infected with PEMV. In contrast, feeding by S. lineatus induced anti-herbivore defense signals, but these defenses were enhanced by PEMV. Sitona lineatus also increased abundance of plant amino acids, but only when they attacked after PEMV-infectious A. pisum. Our results suggest that diverse communities of biotic antagonists alter defense and nutritional traits of plants through complex pathways that depend on the identity of attackers and their order of arrival onto hosts. Moreover, we show interactions among a group of biotic stressors can vary along a spectrum from antagonism to enhancement/synergism based on the identity and order of attackers, and these interactions are mediated by a multitude of phytohormone pathways.

We report a case of acute right ventricular failure in a patient with cardiogenic shock on left-sided mechanical circulatory support with Impella 5.0. The patient was successfully bridged to heart transplantation using additional right-sided support with ProtekDuo. Key learning points of the case include prompt recognition of right ventricular failure in patients on left-sided support, early consideration of right-ventricular mechanical support platforms, and timely deployment of right-sided mechanical support.

COVID-19 pandemic and associated lockdown measures has deeply modified the natural course of seasonal viral infections, such as respiratory syncytial virus (RSV). Methods We analysed French national data from three networks: emergency departments (ED) of French hospitals, general practitioners (GP), and hospital laboratories. We compared the number of ED visits and GP visits for bronchiolitis in children <2 years of age, and the percentage of RSV positive tests in the 2020-2021 season with those of the two previous seasons (2018-2019 and 2019-2020). We used time series of the previous 5 years to calculate epidemic thresholds. Results During the 2020–2021 season, the epidemic begun in February (week 05) in the Ile de France (Paris and suburbs) region, 12 weeks later compared with the previous seasons and progressively spread across all the French metropolitan regions. The highest number of bronchiolitis cases in 2021 (week 12) occurred 10-12 weeks after the previous seasonal peaks of previous seasons, but the number of cases remained lower than in the previous seasonal peaks. Conclusion We identified a delayed RSV epidemic in the period that usually corresponds at the end of the epidemic season, raising concerns for the burden of RSV in the already strained healthcare systems during the COVID-19 pandemic

Background: In this study, we conducted a retrospective review of patients at our institution with noninfectious sternal dehiscence (NISD) after median sternotomy who received thermoreactive nitinol clips (TRNC) treatment during a 10-year period. We compared TRNC patients with and without history of failed Robicsek repair. The purpose of the study was to analyze the impact of previous Robicsek repair on the treatment of sternal dehiscence with TRCN. Methods: Between December 2009 and January 2020, out of 283 patients with NISD who underwent refixation, we studied 34 cases who received TRNC treatment. We divided these 34 cases into two groups: patients who had a previously failed Robicsek procedure before TRNC treatment (group A, n=11) and patients who had been directly referred to TRCN treatment (group B, n= 23). Results: Postoperative complication rate was significantly higher in group A (p=0.026). Hospitalization duration was significantly longer in group A due to the higher complication rate (p=0.001). Operative time was significantly shorter and blood loss was significantly lower in group B (p=0.001). Conclusion: The Robicsek procedure is considered an effective method in the treatment of NISD but, in case of its failure, subsequent TRNC treatment might become cumbersome in high-risk patients. In our study, a previously failed Robicsek procedure caused significantly higher morbidity and additional operative risk in later TRNC treatment of high-risk cases. Ultimately, we speculate that a direct TRNC treatment for NISD is favorable in high-risk patients.

Maternal infanticide and cannibalism, whereby a mother killing and consumes her own offspring, occurs in various animal taxa. The ability of the tree shrew (Tupaia belangeri) to kill and consume conspecifics is accepted, but the extent of its occurrence is not fully understood due to difficulty in observation and uneven reporting. Here we discover extra interesting phenomenonand that two tree shrew respectively eating the neonate in two different experiments. This was the first recorded of evidence by dynam