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Michael Weekes

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Nick K. Jones1,2*, Lucy Rivett1,2*, Chris Workman3, Mark Ferris3, Ashley Shaw1, Cambridge COVID-19 Collaboration1,4, Paul J. Lehner1,4, Rob Howes5, Giles Wright3, Nicholas J. Matheson1,4,6¶, Michael P. Weekes1,7¶1 Cambridge University NHS Hospitals Foundation Trust, Cambridge, UK2 Clinical Microbiology & Public Health Laboratory, Public Health England, Cambridge, UK3 Occupational Health and Wellbeing, Cambridge Biomedical Campus, Cambridge, UK4 Cambridge Institute of Therapeutic Immunology & Infectious Disease, University of Cambridge, Cambridge, UK5 Cambridge COVID-19 Testing Centre and AstraZeneca, Anne Mclaren Building, Cambridge, UK6 NHS Blood and Transplant, Cambridge, UK7 Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK*Joint first authorship¶Joint last authorshipCorrespondence: [email protected] UK has initiated mass COVID-19 immunisation, with healthcare workers (HCWs) given early priority because of the potential for workplace exposure and risk of onward transmission to patients. The UK’s Joint Committee on Vaccination and Immunisation has recommended maximising the number of people vaccinated with first doses at the expense of early booster vaccinations, based on single dose efficacy against symptomatic COVID-19 disease.1-3At the time of writing, three COVID-19 vaccines have been granted emergency use authorisation in the UK, including the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech). A vital outstanding question is whether this vaccine prevents or promotes asymptomatic SARS-CoV-2 infection, rather than symptomatic COVID-19 disease, because sub-clinical infection following vaccination could continue to drive transmission. This is especially important because many UK HCWs have received this vaccine, and nosocomial COVID-19 infection has been a persistent problem.Through the implementation of a 24 h-turnaround PCR-based comprehensive HCW screening programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT), we previously demonstrated the frequent presence of pauci- and asymptomatic infection amongst HCWs during the UK’s first wave of the COVID-19 pandemic.4 Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and cycle threshold (Ct) values in the asymptomatic arm of our programme, which now offers weekly screening to all staff.Vaccination of HCWs at CUHNFT began on 8th December 2020, with mass vaccination from 8th January 2021. Here, we analyse data from the two weeks spanning 18thto 31st January 2021, during which: (a) the prevalence of COVID-19 amongst HCWs remained approximately constant; and (b) we screened comparable numbers of vaccinated and unvaccinated HCWs. Over this period, 4,408 (week 1) and 4,411 (week 2) PCR tests were performed from individuals reporting well to work. We stratified HCWs <12 days or > 12 days post-vaccination because this was the point at which protection against symptomatic infection began to appear in phase III clinical trial.226/3,252 (0·80%) tests from unvaccinated HCWs were positive (Ct<36), compared to 13/3,535 (0·37%) from HCWs <12 days post-vaccination and 4/1,989 (0·20%) tests from HCWs ≥12 days post-vaccination (p=0·023 and p=0·004, respectively; Fisher’s exact test, Figure). This suggests a four-fold decrease in the risk of asymptomatic SARS-CoV-2 infection amongst HCWs ≥12 days post-vaccination, compared to unvaccinated HCWs, with an intermediate effect amongst HCWs <12 days post-vaccination.A marked reduction in infections was also seen when analyses were repeated with: (a) inclusion of HCWs testing positive through both the symptomatic and asymptomatic arms of the programme (56/3,282 (1·71%) unvaccinated vs 8/1,997 (0·40%) ≥12 days post-vaccination, 4·3-fold reduction, p=0·00001); (b) inclusion of PCR tests which were positive at the limit of detection (Ct>36, 42/3,268 (1·29%) vs 15/2,000 (0·75%), 1·7-fold reduction, p=0·075); and (c) extension of the period of analysis to include six weeks from December 28th to February 7th 2021 (113/14,083 (0·80%) vs 5/4,872 (0·10%), 7·8-fold reduction, p=1x10-9). In addition, the median Ct value of positive tests showed a non-significant trend towards increase between unvaccinated HCWs and HCWs > 12 days post-vaccination (23·3 to 30·3, Figure), suggesting that samples from vaccinated individuals had lower viral loads.We therefore provide real-world evidence for a high level of protection against asymptomatic SARS-CoV-2 infection after a single dose of BNT162b2 vaccine, at a time of predominant transmission of the UK COVID-19 variant of concern 202012/01 (lineage B.1.1.7), and amongst a population with a relatively low frequency of prior infection (7.2% antibody positive).5This work was funded by a Wellcome Senior Clinical Research Fellowship to MPW (108070/Z/15/Z), a Wellcome Principal Research Fellowship to PJL (210688/Z/18/Z), and an MRC Clinician Scientist Fellowship (MR/P008801/1) and NHSBT workpackage (WPA15-02) to NJM. Funding was also received from Addenbrooke’s Charitable Trust and the Cambridge Biomedical Research Centre. We also acknowledge contributions from all staff at CUHNFT Occupational Health and Wellbeing and the Cambridge COVID-19 Testing Centre.

Guangming Wang

and 4 more

Tam Hunt

and 1 more

Tam Hunt [1], Jonathan SchoolerUniversity of California Santa Barbara Synchronization, harmonization, vibrations, or simply resonance in its most general sense seems to have an integral relationship with consciousness itself. One of the possible “neural correlates of consciousness” in mammalian brains is a combination of gamma, beta and theta synchrony. More broadly, we see similar kinds of resonance patterns in living and non-living structures of many types. What clues can resonance provide about the nature of consciousness more generally? This paper provides an overview of resonating structures in the fields of neuroscience, biology and physics and attempts to coalesce these data into a solution to what we see as the “easy part” of the Hard Problem, which is generally known as the “combination problem” or the “binding problem.” The combination problem asks: how do micro-conscious entities combine into a higher-level macro-consciousness? The proposed solution in the context of mammalian consciousness suggests that a shared resonance is what allows different parts of the brain to achieve a phase transition in the speed and bandwidth of information flows between the constituent parts. This phase transition allows for richer varieties of consciousness to arise, with the character and content of that consciousness in each moment determined by the particular set of constituent neurons. We also offer more general insights into the ontology of consciousness and suggest that consciousness manifests as a relatively smooth continuum of increasing richness in all physical processes, distinguishing our view from emergentist materialism. We refer to this approach as a (general) resonance theory of consciousness and offer some responses to Chalmers’ questions about the different kinds of “combination problem.”  At the heart of the universe is a steady, insistent beat: the sound of cycles in sync…. [T]hese feats of synchrony occur spontaneously, almost as if nature has an eerie yearning for order. Steven Strogatz, Sync: How Order Emerges From Chaos in the Universe, Nature and Daily Life (2003) If you want to find the secrets of the universe, think in terms of energy, frequency and vibration.Nikola Tesla (1942) I.               Introduction Is there an “easy part” and a “hard part” to the Hard Problem of consciousness? In this paper, we suggest that there is. The harder part is arriving at a philosophical position with respect to the relationship of matter and mind. This paper is about the “easy part” of the Hard Problem but we address the “hard part” briefly in this introduction.  We have both arrived, after much deliberation, at the position of panpsychism or panexperientialism (all matter has at least some associated mind/experience and vice versa). This is the view that all things and processes have both mental and physical aspects. Matter and mind are two sides of the same coin.  Panpsychism is one of many possible approaches that addresses the “hard part” of the Hard Problem. We adopt this position for all the reasons various authors have listed (Chalmers 1996, Griffin 1997, Hunt 2011, Goff 2017). This first step is particularly powerful if we adopt the Whiteheadian version of panpsychism (Whitehead 1929).  Reaching a position on this fundamental question of how mind relates to matter must be based on a “weight of plausibility” approach, rather than on definitive evidence, because establishing definitive evidence with respect to the presence of mind/experience is difficult. We must generally rely on examining various “behavioral correlates of consciousness” in judging whether entities other than ourselves are conscious – even with respect to other humans—since the only consciousness we can know with certainty is our own. Positing that matter and mind are two sides of the same coin explains the problem of consciousness insofar as it avoids the problems of emergence because under this approach consciousness doesn’t emerge. Consciousness is, rather, always present, at some level, even in the simplest of processes, but it “complexifies” as matter complexifies, and vice versa. Consciousness starts very simple and becomes more complex and rich under the right conditions, which in our proposed framework rely on resonance mechanisms. Matter and mind are two sides of the coin. Neither is primary; they are coequal.  We acknowledge the challenges of adopting this perspective, but encourage readers to consider the many compelling reasons to consider it that are reviewed elsewhere (Chalmers 1996, Griffin 1998, Hunt 2011, Goff 2017, Schooler, Schooler, & Hunt, 2011; Schooler, 2015).  Taking a position on the overarching ontology is the first step in addressing the Hard Problem. But this leads to the related questions: at what level of organization does consciousness reside in any particular process? Is a rock conscious? A chair? An ant? A bacterium? Or are only the smaller constituents, such as atoms or molecules, of these entities conscious? And if there is some degree of consciousness even in atoms and molecules, as panpsychism suggests (albeit of a very rudimentary nature, an important point to remember), how do these micro-conscious entities combine into the higher-level and obvious consciousness we witness in entities like humans and other mammals?  This set of questions is known as the “combination problem,” another now-classic problem in the philosophy of mind, and is what we describe here as the “easy part” of the Hard Problem. Our characterization of this part of the problem as “easy”[2] is, of course, more than a little tongue in cheek. The authors have discussed frequently with each other what part of the Hard Problem should be labeled the easier part and which the harder part. Regardless of the labels we choose, however, this paper focuses on our suggested solution to the combination problem.  Various solutions to the combination problem have been proposed but none have gained widespread acceptance. This paper further elaborates a proposed solution to the combination problem that we first described in Hunt 2011 and Schooler, Hunt, and Schooler 2011. The proposed solution rests on the idea of resonance, a shared vibratory frequency, which can also be called synchrony or field coherence. We will generally use resonance and “sync,” short for synchrony, interchangeably in this paper. We describe the approach as a general resonance theory of consciousness or just “general resonance theory” (GRT). GRT is a field theory of consciousness wherein the various specific fields associated with matter and energy are the seat of conscious awareness.  A summary of our approach appears in Appendix 1.  All things in our universe are constantly in motion, in process. Even objects that appear to be stationary are in fact vibrating, oscillating, resonating, at specific frequencies. So all things are actually processes. Resonance is a specific type of motion, characterized by synchronized oscillation between two states.  An interesting phenomenon occurs when different vibrating processes come into proximity: they will often start vibrating together at the same frequency. They “sync up,” sometimes in ways that can seem mysterious, and allow for richer and faster information and energy flows (Figure 1 offers a schematic). Examining this phenomenon leads to potentially deep insights about the nature of consciousness in both the human/mammalian context but also at a deeper ontological level.

Susanne Schilling*^

and 9 more

Jessica mead

and 6 more

The construct of wellbeing has been criticised as a neoliberal construction of western individualism that ignores wider systemic issues including increasing burden of chronic disease, widening inequality, concerns over environmental degradation and anthropogenic climate change. While these criticisms overlook recent developments, there remains a need for biopsychosocial models that extend theoretical grounding beyond individual wellbeing, incorporating overlapping contextual issues relating to community and environment. Our first GENIAL model \cite{Kemp_2017} provided a more expansive view of pathways to longevity in the context of individual health and wellbeing, emphasising bidirectional links to positive social ties and the impact of sociocultural factors. In this paper, we build on these ideas and propose GENIAL 2.0, focusing on intersecting individual-community-environmental contributions to health and wellbeing, and laying an evidence-based, theoretical framework on which future research and innovative therapeutic innovations could be based. We suggest that our transdisciplinary model of wellbeing - focusing on individual, community and environmental contributions to personal wellbeing - will help to move the research field forward. In reconceptualising wellbeing, GENIAL 2.0 bridges the gap between psychological science and population health health systems, and presents opportunities for enhancing the health and wellbeing of people living with chronic conditions. Implications for future generations including the very survival of our species are discussed.  

Mark Ferris

and 14 more

IntroductionConsistent with World Health Organization (WHO) advice [1], UK Infection Protection Control guidance recommends that healthcare workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) should use fluid resistant surgical masks type IIR (FRSMs) as respiratory protective equipment (RPE), unless aerosol generating procedures (AGPs) are being undertaken or are likely, when a filtering face piece 3 (FFP3) respirator should be used [2]. In a recent update, an FFP3 respirator is recommended if “an unacceptable risk of transmission remains following rigorous application of the hierarchy of control” [3]. Conversely, guidance from the Centers for Disease Control and Prevention (CDC) recommends that HCWs caring for patients with COVID-19 should use an N95 or higher level respirator [4]. WHO guidance suggests that a respirator, such as FFP3, may be used for HCWs in the absence of AGPs if availability or cost is not an issue [1].A recent systematic review undertaken for PHE concluded that: “patients with SARS-CoV-2 infection who are breathing, talking or coughing generate both respiratory droplets and aerosols, but FRSM (and where required, eye protection) are considered to provide adequate staff protection” [5]. Nevertheless, FFP3 respirators are more effective in preventing aerosol transmission than FRSMs, and observational data suggests that they may improve protection for HCWs [6]. It has therefore been suggested that respirators should be considered as a means of affording the best available protection [7], and some organisations have decided to provide FFP3 (or equivalent) respirators to HCWs caring for COVID-19 patients, despite a lack of mandate from local or national guidelines [8].Data from the HCW testing programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT) during the first wave of the UK severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic indicated a higher incidence of infection amongst HCWs caring for patients with COVID-19, compared with those who did not [9]. Subsequent studies have confirmed this observation [10, 11]. This disparity persisted at CUHNFT in December 2020, despite control measures consistent with PHE guidance and audits indicating good compliance. The CUHNFT infection control committee therefore implemented a change of RPE for staff on “red” (COVID-19) wards from FRSMs to FFP3 respirators. In this study, we analyse the incidence of SARS-CoV-2 infection in HCWs before and after this transition.

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In this study, novel Lorentz-like fractional-order dynamical systems are proposed, offering potential applications across various engineering domains. Based on a threedimensional system of the Lorentz-like type of integer order, new nonlinear dynamic systems of fractional order are constructed for four, five, and six state variables. These systems can describe real convective processes in fractal media characterized by a memory effect. For these systems, equilibrium points and stability conditions are determined using the theorem on local asymptotic stability of fractional order systems. Utilizing the frequency domain approximation method, Matlab-Simulink models were developed for novel chaos generators characterized by a fractional order index of 0.95. Through the utilization of Multisim software, we designed electronic circuits to validate the physical feasibility of our proposed systems. The simulation results obtained from both Matlab and Multisim exhibit excellent agreement, reinforcing the reliability of our proposed models. To demonstrate the synchronization of two unidirectionally coupled 3.8d chaotic systems, Matlab-Simulink models were created in two versions. The first version assumes an identical fractional index for both the master and slave systems, while the second version involves different fractional indices for the two systems. These systems were further employed for the chaotic masking of a harmonic signal. An electronic circuit implementing the chaotic masking process in Multisim is also presented. The results obtained from this proposed scheme demonstrate the success of the approach in accomplishing the encryption and decryption procedures effectively.

Riku Takahashi

and 3 more

In this paper, comprehensive double-directional channel measurements at 300 GHz in various usage scenarios in corridor environments, such as Access, Device-to-device (D2D), and Backhaul over 40 different receiver (Rx) positions using an in-house developed channel sounder, are presented. The measurement results are analyzed and validated by ray tracing (RT) simulation. The quasi-optical propagation properties at 300 GHz make an accurate estimation of relatively simple propagation in a corridor environment possible by using ray optics theory. However, even though non-trivial quadruple-bounce specular reflection paths can be identified in both scenarios, propagation phenomena other than reflection exist irrespective of the Rx positions. Thus, to model the propagation mechanism appropriately, a quasi-deterministic (QD) channel model comprising deterministic and random components is also proposed. The results generated using the proposed model are found to agree well with our prior observations and measurement results. Finally, the paper concludes by characterizing and comparing the channel for all the investigated scenarios in terms of path loss (PL) and large-scale parameters (LSP). On analyzing the measurement results using synthesized power spectra, proposed QD model, and evaluated PL and LSP it is observed that the Access and D2D scenarios share almost similar propagation mechanisms. Furthermore, in the Access and Backhaul scenario the LoS is observed to be affected by the unresolvable ceiling-reflected components. This study, across three different scenarios, can aid the design of next-generation communication systems operating in the THz spectrum.

Mohammad Seyedi

and 3 more

Controlling the charging and discharging procedures of Lithium-Ion Batteries is of paramount importance as violating safety constraints, such as current deviations, can lead to significant damage to the battery or circuit or interruption in service. Thus, it is crucial to employ a robust controller capable of handling uncertainties and unexpected scenarios. PI controllers have become prevalent in recent years for managing battery dynamics, but they exhibit limited robustness in unpredictable situations. In this paper, we propose a Reinforcement Learning (RL) driven control method as a substitute for the PI controller. The agent is trained using a co-simulation approach with simultaneous employment of Python and Matlab, ensuring an accurate estimation of the environment and, consequently, enhanced performance. A prototype of the proposed controller is developed using dSPACE rapid control prototyper. The performance is compared with the benchmark controller (PI) across different fault scenarios, considering three criteria: overshoot, undershoot, and stabilization time. The comparative analysis reveals that, in most scenarios, the RL agent outperforms the PI controller, exhibiting a remarkable 50% reduction in both overshoot and undershoot compared to the benchmark controller. This research contributes to advancing battery control systems by introducing an RL-based controller that proves to be a more robust alternative, delivering improved performance in the face of uncertainties and fault scenarios.
This work proposes a novel combination of behavioural-tracking sensors and immersive virtual reality in a gamified proof-of-concept prototype, which demonstrates affective treatment concepts for hypervigilance symptoms. A number of limitations have been identified in current approaches, prompting more advanced techniques that efficiently target hypervigilance at an individual patient level. In response, we developed a virtual reality first-person shooter that responds to inertial user behaviour in a way that aims to combat detrimental symptoms, proposed as an exploratory investigation into innovative technology and its potential to maximise cognitive behavioural therapy outcomes for hypervigilance treatment. The prototype is evaluated through interactive user studies with 22 participants, gathering a large volume of qualitative data regarding participant experiences and opinions after use. Rigorous thematic analysis finds that participants can independently identify the cognitive behavioural therapy purpose of the intervention without prior knowledge of such intentions, and relate efficacious approaches from the literature to their own experiences. Despite prospective apprehension, themes also demonstrate widespread adherence and acceptance of such approaches to hypervigilance treatment, alongside perceived effectiveness both of experienced outcomes and future potential. These results support the validity of combining such technologies in the context of cognitive behavioural therapy interventions, such that the standard of future interventions may be improved.

Ali Ranjha

and 3 more

Ultra-reliable and low latency communications (URLLC) will be the backbone of the upcoming sixth-generation (6G) systems and will facilitate mission-critical scenarios. A design accounting for stringent reliability and latency requirements for URLLC systems poses a challenge for both industry and academia. Recently, unmanned aerial vehicles (UAV) have emerged as a potential candidate to support communications in futuristic wireless systems due to providing favourable channel gains thanks to Lineof-Sight (LoS) communications. However, usage of UAV in cellular infrastructure increases interference in aerial and terrestrial user equipment (UE) limiting the performance gain of UAV-assisted cellular systems. To resolve these issues, we propose low-complexity algorithms for intercell interference coordination (ICIC) using cognitive radio when single and multi-UAVs are deployed in a cellular environment to facilitate URLLC services. Moreover, we model BS-to-UAV (B2U) interference in downlink communication, whereas in uplink we model UAV-to-BS (U2B), UAV-to-UAV (U2U), and UE-to-UAV (UE2U) interference under perfect/imperfect channel state information (CSI). Results demonstrate that the proposed perfect ICIC accounts for fairness among UAV especially in downlink communications compared to conventional ICIC algorithms. Furthermore, in general, the proposed UAV-sensing assisted ICIC and perfect ICIC algorithms yield better performance when compared to conventional ICIC for both uplink and downlink for the single and multi-UAV frameworks. INDEX TERMS URLLC, multi-UAV, cognitive radio, intercell interference coordination (ICIC).

Abhishek Anchal

and 1 more

The value of colorless, directionless, and contentionless (CDC-)ROADM (reconfigurable optical add/drop multiplexer) nodes is strongly contested in the optical networking community. In this work, we compare known ROADM node designs incorporating different switching elements and account for their total nodal switching state support (in consideration of both channel routing and add/drop). This allows us to quantify the impact of directional/contentional accessibility constraints to add/drop transceivers. By considering the network node entity as a permutation network among its ingress/egress ports for all wavelength channels, which covers both through routing and add/drop assignments, we tabulate the node’s switching capacity, or total allowable connection states, per different ROADM architecture, hardware constraints, and finite number of add/drop transceivers. We further introduce the impact of idle wavelength channels on fiber links, as well as bidirectional routing assignments. Our switching capacity enumerations demonstrate that CDC-ROADM outperforms other designs, but parallel contentional aggregation hardware (partially contentional) and directional transceivers (permanently assigned to port directions) offer competitive performance under certain scenarios (at lower and higher number of deployed transceivers, or a combination of both). These findings suggest that design alternatives to the “difficult to implement” CDC-ROADM exist, with nearly equivalent switching capacity, and additional system considerations must be taken into account for ROADM design selection such as hardware availability, cost, impact of traffic churn, and disaster recovery with over-provisioned add/drop transceivers.

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Tanja Kalic

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Background: Recent studies indicated that fish-allergic patients may safely consume certain fish species. Multiplex IgE testing facilitates the identification of species tolerated by individual patients. Methods: Sera were collected from 263 fish-allergic patients from Austria, China, Denmark, Luxembourg, Norway and Spain. Specific (s) IgE to parvalbumins (PVs) from 10 fish species along with IgE to 7 raw and 6 heated fish extracts was quantified using a research version of the ALEX 2 assay. IgE-signatures of individual patients and patient groups were analyzed using SPSS and R. Results: sIgE to alpha-PV from ray, a cartilaginous fish, was not detected in 78% of the patients while up to 41% of the patients, depending on their country of origin, tested negative for at least one beta-PV. sIgE values were highest for mackerel and tuna PVs (>10 kUA/L) and significantly lower for cod (4.9 kUA/L) and sole PVs (2.55 kUA/L). 17% of the patients, although negative for PVs, tested positive for the respective fish extracts. Based on the absence of IgE to PVs and extracts, up to 21% of the patients were identified as potentially tolerating one or more bony fish. Up to 90% of the patients tested negative for ray. The probability of negativity to one fish based on negativity to others was calculated. Negativity to tuna and mackerel emerged as a good marker of negativity to additional bony fish. Conclusion: Measuring sIgE to PVs and extracts from evolutionary distant fish species indicates bony and cartilaginous fish species for tolerance-confirming food challenges.

Kévin SPINICCI

and 3 more

Hypoxia Inducible Factor (HIF), the main actor in the cell response to hypoxia, represents a potential target in cancer therapy. HIF is involved in many biological processes such as cell proliferation, survival, apoptosis, angiogenesis, iron metabolism and glucose metabolism. This protein regulates the expressions of Lactate Dehydrogenase (LDH) and Pyruvate Dehydrogenase (PDH), both essential for the conversion of pyruvate to be used in aerobic and anaerobic pathways. HIF upregulates LDH, increasing the conversion of pyruvate into lactate which leads to higher secretion of lactic acid by the cell and reduced pH in the microenvironment. HIF indirectly downregulates PDH, decreasing the conversion of pyruvate into Acetyl Coenzyme A which leads to reduced usage of the Tricarboxylic Acid (TCA) cycle in aerobic pathways. Upregulation of HIF may promote the use of anaerobic pathways for energy production even in normal extracellular oxygen conditions. Higher use of glycolysis even in normal oxygen conditions is called the Warburg effect. In this paper, we focus on HIF variations during tumour growth and study, through a mathematical model, its impact on the two metabolic key genes PDH and LDH, to investigate its role in the emergence of the Warburg effect. Mathematical equations describing the enzymes regulation pathways were solved for each cell of the tumour represented in an agent-based model to best capture the spatio-temporal oxygen variations during tumour development caused by cell consumption and reduced diffusion inside the tumour. Simulation results show that reduced HIF degradation in normoxia can induce higher lactic acid production. The emergence of the Warburg effect appears after the first period of hypoxia before oxygen conditions return to a normal level. The results also show that targeting the upregulation of LDH and the downregulation of PDH could be relevant in therapy.

Heba Saber

and 1 more

Cristina Teixeira

and 2 more

Objective: To estimate time trends in the frequency of severe perineal tears (SPT) in Portugal and its relationship with episiotomy. Design: Nationwide register-based study by using the national inpatient database. Setting: All Portuguese public hospitals Population: All women with a singleton vaginal delivery between 2000 and 2015 Methods: Time-trend analysis using joinpoint regression models was performed to identify time trends in the prevalence of SPT and of risk factors, including episiotomy. Poisson regression models were fitted to assess the association between episiotomy and SPT. Main Outcome Measures: Annual percentage change (APC) with 95% Confidence Interval (95% CI) in the prevalence of SPT and its risk factors. Adjusted relative risk (RR) and respective 95% CI. Results: From 908,889 singleton vaginal deliveries, 20.6% were instrumental deliveries, 76.7% with episiotomy and 0.56% were complicated by SPT. SPT decreased among women with non-instrumental deliveries and no episiotomy from 2009 onwards (1.3% to 0.7%), whereas SPT kept increasing in women with episiotomy for both non-instrumental (0.1% in 2000 to 0.4% in 2015) and instrumental deliveries (0.7% in 2005 to 2.3% in 2015). Episiotomy was associated with a decrease in SPT with adjusted RR varying between 2000 and 2015 from 0.18 (95%CI:0.13-0.25) to 0.59 (95%CI:0.44-0.79) for non-instrumental deliveries and from 0.45 (95%CI:0.25-0.81) to 0.50 (95%CI:0.40-0.72) for instrumental deliveries. Conclusions: Episiotomy rate could safely further decrease as the main factor driving SPT rates seems to be an increase in awareness and reporting of SPT particularly among women who underwent an episiotomy.

mariem gdoura

and 8 more

Introduction: SARS-CoV2 serology testing is multipurpose provided to choose an efficient test. We evaluated and compared 4 different commercial serology tests, three of them had the Food and Drug Administration (FDA) approval. Our goal was to provide new data to help to guide the interpretation and the choice of the serological tests. Methods: Four commercial tests were evaluated: Cobas®Roche®(total anti-N antibodies), VIDAS®Biomerieux®(IgM and IgG anti-RBD antibodies), Mindray®(IgM and IgG anti-N and anti-RBD antibodies) and Access®Beckman Coulter®(IgG anti-RBD antibodies). Were tested: a positive panel (n=72 sera) obtained from COVID-19 confirmed patients and a negative panel (n=119) of pre-pandemic sera. Were determined the analytical performances and was drawn the ROC curve to assess the manufacturer’s threshold. Results: A large range of variability between the tests was found. Mindray®IgG and Cobas® tests showed the best overall sensitivity 79,2%CI95%[67,9-87,8]. Cobas® showed the best sensitivity after D14; 85,4%CI95%[72,2-93,9]. The best specificity was noted for Cobas®, VIDAS®IgG and Access® IgG(100%CI95%[96,9-100]). Access® had the lower sensitivity even after D14 (55,5% CI95%[43,4-67,3]). VIDAS®IgM and Mindray®IgM tests showed the lowest specificity and sensitivity rates. Overall, only 43 out of 72 sera gave concordant results (59,7%). Retained cut-offs for a significantly better sensitivity and accuracy, without altering significantly the specificity, were: 0,87 for Vidas®IgM(p=0,01), 0,55 for Vidas®IgG(p=0,05) and 0,14 for Access®(p<10-4). Conclusion: Although FDA approved, each laboratory should realize its own evaluation for commercial tests. Tests variability may raise some concerns that seroprevalence studies may vary significantly based on the used serology test.

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