A document by Deep Raja, written on Authorea.

Rapid urbanization leads to fragmentation of large land patches, islandization of ecological landscape, and destruction of ecological security network. As a basic guarantee of life, a sound ecological security network promotes connectivity between ecological sources, improves ecological security patterns, and mitigates the degradation of an ecological system. The objective of this study was to improve a framework for assessing the ecological security network. We demonstrated the application of the proposed framework through a case study of the urban agglomeration around Hangzhou Bay (UAHB), a rapid urbanization region in Eastern China’s Zhejiang Province. We improved the identification method of ecological sources by integrating the evaluations of ecosystem services value and ecological sensitivity, while we screened ecological sources by using the rank-size rule and the natural breaks method. Based on the screened ecological sources, the ecological corridors were reconstructed and optimized for the UAHB region. Results from this study showed that the structure and function of the ecological security network were strongly influenced by human activities and urban sprawl. The ecological security network has deteriorated locally in eastern coastal areas of UAHB during the past 20 years with strong spatial variability in ecological security patterns. To maintain a well-protected and sustainable ecological quality, we proposed a set of 5 measures to improve the ecological security pattern and the sustainable development of the ecological system in Eastern China.

In water-deficient rivers, environmental flows (e-flows) are usually sustained via inter-basin water transfer projects from water-sufficient rivers, but these projects incur tremendous costs and may lead to many negative ecological effects, such as ecological invasion. This research proposed to transfer hydropower instead of water from water-sufficient rivers, because hydropower could substitute for water to promote economic development and reduce water withdrawal from water-deficient rivers. In this research, we established a computable general equilibrium model to analyze the substitution of hydropower for water in a water-deficient river basin, and determined the water withdrawal volume that could be reduced (conserved water). In addition, we adopted a range-of-variability approach to measure the effectiveness of e-flow provisions, and optimized the use of the conserved water to better maintain e-flows. The Luanhe River was adopted as a study case. The results showed that: the water-hydropower equivalent decreased as the transferred hydropower into the Luanhe River basin increased; a transferred hydropower amount of 22.46 kWh/s, equivalent to 18.30 m3/s conserved water, was optimal for the river basin; the conserved water should be distributed to the Luanhe River in the proportions of 0.55:0.1:0.35 during the wet, normal and dry seasons, respectively; the policy could transform the macro-economy toward a lower air-pollution pattern.

Since its first emergence in 2012, cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) have continued to occur. In this study, we present two nucleic acid visualization assays that target the MERS-CoV UpE and N genes as a panel that combines reverse transcription recombinase polymerase amplification with a closed vertical flow visualization strip (RT-RPA-VF). The limit of detection was 1.2×10^1 copies/μl for the UpE assay and 1.2 copies/μl for the N assay. The two assays exhibited no cross-reactivity with multiple CoVs, including the bat severe acute respiratory syndrome related coronavirus (SARSr-CoV), the bat coronavirus HKU4, and the human coronaviruses 229E, OC43, HKU1 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The RT-RPA-VF assay does not require sophisticated equipment and provides rapid detection within 30 min, so it has potential for use in surveillance and detection of MERS-CoV in low-resource settings.

In this study, we unveiled the lumped effects at the reach spatial scale over three decades in one of the braided rivers in the Qinghai-Tibet Plateau of China, the Upper Lancang River (ULR). Using Landsat images obtained in 13 years between 1989 and 2018, we extracted flowing and non-flowing channels, active channel widths (unvegetated bars and flowing channels), and calculated lateral shifting rates of the main channel for the 13 periods. We also developed an empirical equation between vegetation area (Av) calculated from the high-resolution ortho-photo derived from an Unmanned Aerial Vehicle survey and Normalized Difference Vegetation Index for pixels of the Landsat image obtained at the same time. This relationship allowed us to estimate Av for other 12 selected years. We found that (1) braiding intensity increases with low discharges, indicating that the ULR is a very well-connected braided system with groundwater providing a large set of aquatic habitats, (2) this braided system is very well-supplied and actively shifting in relation to peak flow and flood duration, and (3) The ULR supports a progressive vegetation encroachment, which seems to be linked to temperature rising. Our study showed several similar morphological patterns to those in other braided rivers, such as the ones observed in the European Alps but much more active, well-supplied and highly connected. These similarities suggest that similar morphodynamic processes might take effect in the braided rivers with very high elevations and potentially high spots of biodiversity, indicating the ULR may be a reference for this region similarly to the Tagliamento in the Alps, but it seems that this system can be very sensitive to global change due to vegetation encroachment following temperature rising and decreases of low flows.

This spring, instructors moved their courses online in an emergency fashion as campuses were closed due to the pandemic. As colleges prepare for the next academic year, there is a need to provide flexible instruction that is more intentional for quality online learning. We taught two undergraduate courses online for the first time this spring and surveyed our students’ reactions to the course experiences. From our experiences and student feedback we identified design elements and activities that were beneficial in promoting student engagement, sense of connectivity, and learning. We describe four qualities for a successful transition to online learning: 1) big questions and core concepts; 2) peer groups including reflective writing; 3) outreach to broader scientific community; and 4) instructor’s social presence in the class. Our experience gives us confidence that courses can be redesigned for online without compromising rigor or essential learning goals.

Background: Open living donor hepatectomy (OLDH) is a highly painful procedure. Advanced strategies for enhancing perioperative analgesia and accelerating recovery are needed for patients undergoing OLDH. This study evaluated the effects of intravenous infusion of dexmedetomidine (DEX) during OLDH on postoperative analgesia and recovery. Methods: This prospective, randomized, double-blinded, and placebo-controlled study included 34 patients randomized to a control group (group C) and a DEX group (group D). Utilization of intravenous patient-controlled analgesia (IV-PCA) pump, pain intensity, and postoperative recovery variables were recorded. Moreover, intraoperative anesthetic consumption, hemodynamic parameters, and fluid status were also recorded. Results: During the first 24 hours after surgery, patients in group D had a lower pain intensity. The cumulative numbers of IV-PCA pump presses and fentanyl consumption within 24 and 48 hours postoperatively in group C were significantly higher than in group D. The time to first IV-PCA attempt was prolonged in group D. In addition, faster flatus passage was observed in group D. Intraoperatively, fewer anesthetic agents were required in group D. Less fluctuation in hemodynamics and reduced bleeding were also found in group D. Conclusions: The present study revealed that the addition of intravenous infusion of DEX during OLDH provided several benefits in relieving postoperative pain and promoting recovery. Therefore, we concluded that intraoperative DEX infusion may play an important role in enhancing recovery of patients undergoing OLDH.

A patient with Birt-Hogg-Dubé Syndrome (BHDS) developed metastatic follicular thyroid cancer, which until now has never been described in someone with BHDS. Thyroid cancer is not currently recommended for screening with BHDS. This case presents implications for future guidelines and planning for renal transplant in patients with this condition.

Objectives: To investigate the effect of NBI examination on the differentiating between benign and malignant neoplasms involving nasal cavity. Design, Setting, Participants: A retrospective case series from January 2018 to December 2019 were performed at a single center. A total of 188 consecutive patients who were first diagnosed with lesions in unilateral nasal cavity underwent complete examination with white light endoscopy (WLE) and NBI endoscopy, respectively. Biopsy was harvested from the target lesion and sent to the pathologist for definite diagnosis. Participants with a history of congenital malformation, trauma and surgery in nasal cavity were excluded from the study. Main outcome measures: Endoscopic diagnosis was assessed using sensitivity, specificity, accuracy and positive and negative predictive values (PPV and NPV, respectively). Results: In identifying benign and malignant lesions of nasal cavity, NBI had a significant higher sensitivity (92.7% vs 70.7%, P = 0.020) and NPV (98% vs 92.3%, P = 0.032) than WLE, but there were no significant differences between NBI and WLE in specificity (98.6% vs 97.3%, P = 0.684), accuracy (97.3% vs 91.5%, P = 0.416) and PPV (95% vs 87.9%, P = 0.400). Conclusion: The emerging technique of NBI can improve the diagnostic accuracy of distinguishing benign and malignant lesions in nasal cavity, and remains a promising and helpful adjunct to the traditional endoscopy techniques.

Introduction Treating locally advanced laryngeal squamous cell carcinoma (LSCC) with primary chemoradiotherapy (CRT) can preserve the larynx without compromising survival. However, whether this is associated with good functional outcomes remains up for debate. The aim of this study was to evaluate survival and functional outcomes in patients with locally advanced LSCC treated with primary CRT. Methods We retrospectively analysed data from all consecutive patients with stage III-IV (M0) disease treated with primary CRT between April 2010 and December 2017. Study endpoints were overall survival (OS), disease free survival (DFS), laryngectomy free survival (LFS), laryngo-oesophageal dysfunction free survival (LEDFS) and functional preservation rates. Prognostic factors were assessed by univariate and multivariate analysis. Results 69 consecutive patients treated with primary CRT were analysed. All patients were treated with Intensity Modulated Radiotherapy (IMRT). 29 patients received induction chemotherapy prior to CRT. 60 patients (87%) received concomitant platinum-based chemotherapy, and 9 (13%) concomitant Cetuximab. The median follow-up was 57 months (range 4-96). The completion rate for prescribed RT was 98.5%. The 2- and 5 year OS rates were 81.1% and 52.1%. For patients with T3 disease, the 2- and 5 year OS rates were 82.4% and 61.6%. Positive nodal status, N2b-N3 nodal staging, or stage IV disease were associated with poor OS on univariate, but not multivariate, analysis. Functional preservation was 69.1% at 2 years in all patients alive (68.1% in T3 patients). The 2-year LEDFS rate was 52%. The 2- and 5-year LFS rates was 72.4% and 43.3% respectively. There was no significant difference in LFS rate between primary tumour localization, baseline laryngeal fixation or cartilage invasion. Conclusion Our study illustrates survival and functional outcomes in line with contemporary studies. The survival and function preservation rates suggest that carefully selected patients with locally advanced LSCC can successfully be treated with larynx-preserving primary CRT.

We present a Behcet's like disease case that was accidental observed because of urinary tract infection. The ulceration was pretty serious, but the patient can't even notice. And the ulcers self-healed after antibiotic treatment.

Alzheimer’s disease (AD) is characterized by neurofibrillary tangles (NFTs), formed as a consequence of hyperphosphorylation of tau. The extent of phosphorylation of tau is regulated by protein phosphatases (PPs) like PP1, PP2A/Bα, PP2B and PP5. Interestingly, PP2A/Bα, is a major brain tau phosphatase which account for 70% of the dephosphorylation events in brain and, its activity is known to decrease by half under AD conditions. The down regulation of PP2A leads to hyperphosphorylation of Tau in the brains of AD patients. Hence, the process of reversal of tau phosphorylation needs to be achieved by the activation of PP2A, through specific molecules, as this could pave way towards development of novel therapeutics for AD. The key objective of the current study was thus to understand the affinities of various small molecules that could function as potential activators of PP2A. Molecules like Xylulose-5-Phosphate, Dihydroxy Phenylethanol, EGCG, Memantine, Sodium Selenate, Tetralone and Quinolone exhibit strong interactions across identified binding pockets of PP2A. The investigation not only confers that there could be more than one activation site in PP2A, but also offers clues as to how these molecules facilitate restoration of the phosphatases activity, thus proposing newer avenues for the treatment of AD.

A 70-year-old diabetic woman was admitted to our hospital with a complaint of high fever accompanying shaking chills for three days. The patient had no abdominal symptoms and no history of eating raw food. The patient’s body temperature was increased to 39 oC, and blood analysis showed elevations of leukocytes (17,400 /µL) and C-reactive protein (16.5 mg/dL). Computed tomography revealed air density spots in the aortic wall (Fig A ), and Salmonella enteritidis serotype O9 was detected by blood culture. Under a tentative diagnosis of Salmonella-induced infective aortic aneurysm, the patient underwent antibiotic treatment with ampicillin/sulbactam. On day 11, the air had disappeared and the aortic wall showed a varicose deformity, leading to a differential diagnosis of infective aortic aneurysm (Fig B ). The patient recovered completely with 8-week antibiotic therapy without any operation.Cases of infective aortic aneurysms account for only about 1% to 3% of total cases of aortic aneurysm. However, the case fatality has been reported to be as high as 18 percent in two years1, and an early diagnosis is essential. Salmonella species are known as a common pathogen of the crucial infection2, and so clinicians should pay attention to the development of the disease.

Patients who undergo hematopoietic stem cell transplantation may present with a variety of dermatologic complications. Clinicians must be careful to maintain a broad differential and seek a biopsy proven diagnosis as soon as possible when there is ambiguity as to cause.

We present an adult patient with Crouzon syndrome manifesting with facial deformities and panhypopituitarism. Crouzon syndrome is a rare, autosomal dominant genetic disorder characterized by facial bone deformities, such as a prominent nose, frontal bossing, and ocular proptosis, as well as headaches, seizures, and developmental delay.

The case of a 71 year-old woman with rapid atrial fibrillation who underwent electrical cardioversion and amiodarone therapy. QT interval prolongation was observed with the development of torsades de pointes that required recurrent electrical cardioversion and temporal pacemaker implantation.

As the world learned about Covid-19, the application of ECMO also evolved as health systems in the United States had some time to prepare. We report our initial experience using extracorporeal support for Covid-19 patients with the resource challenges that attend a worldwide pandemic.

A 39-year-old woman was admitted with right leg deep venous thrombosis (DVT). She was started on apixaban tablets but developed pulmonary embolism. The medical history showed sleeve gastrectomy. The failure of the antithrombotic drug shed light on the efficacy and pharmacodynamic changes of DOACs after bariatric surgery

Experience and training in field work is a critical component of undergraduate education in ecology, and many university courses incorporate field-based or experiential components into the curriculum in order to provide students hands-on experience. Due to the onset of the COVID-19 pandemic and the sudden shift to remote instruction in the spring of 2020, many instructors of such courses found themselves struggling to identify strategies for developing rigorous field activities that could be completed online, solo, and from a student’s backyard. This case study illustrates the process by which one field-based course, a UC California Naturalist certification course offered at the University of California, Davis, transitioned to fully remote instruction. The transition relied on established, publicly available, online participatory science platforms (e.g., iNaturalist) to which the students contributed data and observations remotely. Student feedback on the course and voluntary continued engagement with the participatory science platforms indicates that the student perspective of the experience was on par with previous traditional offerings of the course. This case study also includes topics and participatory science resources for consideration by other faculty facing a similar transition from group field activities to remote, individual field-based experiences.

COVID-19 created a host of challenges for science education; in our case, the pandemic halted our in-person elementary school outreach project on bird biology. This project was designed as a year-long program to teach fifth grade students in Ithaca, New York, USA about bird ecology and biodiversity, using outdoor demonstrations and in-person games and activities to engage students in nature. As a central part of this effort, we set up nest boxes on school property and had planned to monitor them with students during bird breeding in the spring. Here, we describe our experiences transitioning this program online: we live streamed nest boxes to students’ virtual classrooms and used them as starting points for virtual lessons on bird breeding and nestling development. We suggest that instituting similar programs at local schools can promote equitable learning opportunities for students across geographical locations and with various living situations. In an era of social distancing and isolation, we propose that nest box live streaming and virtual lessons can support local communities by providing access to the outdoors and unconventional science learning opportunities for all students.

The first drug specific for cystic fibrosis (CF) was approved in 1993, and since then several other drugs have been approved. Median predicted survival in people with CF has improved from approximately 30 years to 44.4 years over that same period. In 2020, highly-effective modulators of the cystic fibrosis transmembrane conductance regulator became available to approximately 90% of people with CF ages 12 years and older. These transformative therapies will surely reduce morbidity and further extend longevity. The drug development pipeline is filled with therapies that address most aspects of CF disease. As survival and CF therapies have advanced, and the complexity of CF care increases, the process of drug development has become more sophisticated. In addition, detecting meaningful changes in clinical outcomes has become more difficult as the health status of people with CF improves. Design of clinical trials in CF has become more complex, and innovative approaches are required to continue to advance drug development. This review provides a general overview of drug development from the pre-clinical phase through Phase IV. Special considerations with respect to CF are integrated into the discussion of each phase of drug development. The dawn of a new era has arrived for people with CF. As CF care evolves, drug development must continue to evolve as well, until a one-time cure is available to all people with CF.

Both 5q-linked spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD) are fatal monogenic neuromuscular disorders caused by loss-of-function mutations. SMA is an autosomal recessive disorder affecting motor neurons that is typically caused by homozygous whole-gene deletions of SMN1. DMD is an X-linked recessive muscle disease most often due to exon deletions, but also duplications and smaller sized variants within the DMD gene. Gene replacement therapy offers the opportunity to correct the underlying genetic defect by the introduction of a functional gene. We review the transformative work from clinical trials to United States Food and Drug Administration approval of onasemnogene abeparvovec-xioi in SMA and its application in clinical practice and the early results of microdystrophin delivery in DMD. We also review the introduction of antisense oligonucleotides to alter pre-mRNA splicing to promote exon inclusion (as in nusinersen in SMA) or exclusion (as in eteplirsen in DMD) into neuromuscular therapeutics. There are multiple promising novel genetically mediated therapies on the horizon, which in aggregate point towards a hopeful future for individuals with SMA and DMD.

Team-Based Learning (TBL) is a pedagogical tool that has great potential to develop student engagement, accountability, and equity in the online classroom. TBL is rooted in evidence-based educational theories and practices that underlie many active learning approaches such as self-testing, team discussion, and application of knowledge. The use of these approaches is associated with better student performance, retention, and sense of belonging in the classroom, aspects that are often reported to be especially lacking in online courses. Here, we describe how we implemented TBL in a face-to-face and an online introductory level evolution and biodiversity course. Our experiences using TBL approaches in the online course have been rewarding, students are engaged and accountable for their learning, and performed well in the course. Our goal is to provide an example of how we designed a life science course using TBL approaches and transitioned the course to an online environment. With the current switch to remote instruction and online learning, we recommend the use of TBL as a course design approach that can improve the students online learning experience.

Abstract Background Differentiating viral from bacterial acute respiratory infections (ARIs) remains challenging, due to the non-specific clinical manifestations. The COVID-19 pandemic is putting extraordinary strain on healthcare resources. To date, molecular testing is available but has a long turnaround time and therefore cannot provide results at the point-of-care (POC) thereby exposing COVID-19/Non-COVID-19 patients to each other while awaiting diagnosis. Methods This observational study prospectively evaluated the utility of a triage strategy including FebriDx, a POC fingerstick blood test that differentiates viral from bacterial ARIs through simultaneous detection of Myxovirus-resistance protein A (MxA) and C-reactive protein (CRP), in rapidly determining viral cases requiring immediate isolation and confirmatory molecular testing, from non-infectious patients or bacterial infections requiring antibiotics. Results 75 consecutive patients were screened, 48 eligible cases were tested with FebriDx, 36 were confirmed viral infection and 35/36 had COVID-19. 31/35 COVID-19 cases tested positive for SARS-CoV-2 via rRT-PCR and (4/35) had a clinical diagnosis of probable COVID-19 based on symptoms, epidemiological history, and chest imaging (PPV 100% (35/35)). 13 cases were FebriDx viral negative and rRT-PCR was also negative. In one case, it was not possible to determine the exact cause of infection, although a viral infection could not be excluded. Including this patient, FebriDx NPV was 92.3% (12/13), exceeding the NPV of rRT-PCR a 68.3% (13/19), and diagnostic sensitivity was conservatively calculated at 97% (35/36) compared to 82.9% (29/35) for initial rRT-PCR. The diagnostic specificity of both FebriDx and rRT-PCR was 100%. Conclusions: FebriDx could be deployed as part of a reliable triage strategy for identifying possible COVID-19 patients with symptomatic ARI in the COVID-19 pandemic. Key words: Pandemic; COVID-19; SARS-CoV-2; pneumonia; viral; point of care; infection