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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: mpw1001@cam.ac.ukThe 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

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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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Stephan Tap

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Cocaine use disorder (CUD) is becoming more prevalent in females, but research into sex-dependent neural mechanisms underlying cocaine use is lacking. Accordingly, the main objective of the current study was to investigate sex-dependent differences in the neural correlates of cocaine and emotional cue reactivity within regular cocaine users (CUs) and non-cocaine-using controls (non-CUs). A cocaine and emotional cue-reactivity fMRI paradigm was completed by 31 male and 26 female CUs and 28 male and 26 female non-CUs. A region of interest analysis was performed to test for sex-specific differences in cocaine and emotional cue-induce activation of the dorsal striatum (DS), ventral striatum (VS), amygdala, and dorsal anterior cingulate cortex (dACC). Although there were no significant sex-dependent differences between CUs and non-CUs in neural cocaine and emotional cue reactivity, exploratory analyses demonstrated that the association between cocaine cue-induced activation of the DS and amygdala and cocaine use severity was significantly moderated by sex: while this association was positive female CUs, it was negative in male CUs. Similarly, the relationship between emotional cue-induced activation of the dACC and VS and years of regular cocaine use was also moderated by sex: while this association was negative in female CUs, it was positive in male CUs. While exploratory, the current findings highlight the importance of taking into account sex differences when studying the underlying mechanism of CUD, as this may pave the way for the identification of sex-specific treatment targets.

Santosh Thapa-Magar

and 4 more

The unique landscape of Nepal supports diverse ecological niches that are home to valuable plants, benefiting various ethnic groups. Wild edible plants have been essential for the livelihoods of indigenous peoples and local communities due to their affordability, ease of harvest, and renewable nature. However, climate change is altering the habitat, distribution, ecology, and phenology of plant species in the Himalayas. One such important species in Nepal is Arisaema costatum, which has multiple indigenous uses. Unfortunately, deforestation and land use changes have led to continuous changes in the distribution and habitats of wild edible plants. We conducted field research involving 280 quadrats (2×2 meters) and 210 interviews. By utilizing MaxEnt modeling and considering different climate change scenarios (Shared Socioeconomic Pathways 4.5 and 8.5) as well as climatic predictors and species localities, we analyzed 196geospatial data points. This allowed us to evaluate the present suitable environment and predict potential habitats in 2050 and 2070. Our findings revealed that A. costatum is used as a vegetable by indigenous and local communities in the Nepal Himalayas. Traditional fermentation and detoxification techniques are employed for its preparation. The plant plays a vital role in household food and nutrition, income generation, and health security. Elevation, annual mean temperature (BIO-1), and precipitation during the warmest and coldest quarters (BIO-18 and BIO-19) were identified as the most influential factors for projecting the future distribution of A. costatum in the Nepal Himalayas. Approximately 14% (21121.75 km2) of Nepal’s land was found to be suitable habitat for this species, with the Gandaki, Bagmati, and Koshi provinces in the temperate regions particularly well-suited compared to other provinces. Given the anticipated loss of A. costatum habitats and the increasing temperatures due to climate change in the Nepal Himalayas, urgent integrated research and development programs are necessary to address this issue.

AN HE

and 1 more

As a wireless ad hoc network, VANET is susceptible to various threats including eavesdropping and tampering, due to its insecure wireless channels. The group key agreement protocol is widely used in VANET due to its ability to allow participants to communicate securely in insecure network environments. However, excessive reliance on trusted authority (TA) in traditional group key protocols may cause single point of failure. Additionally, having a high computational and communication cost is a common phenomenon in existing protocols. To address the above issues, we have designed a lightweight group key agreement protocol using blockchain technology and Chinese remainder theorem(CRT). In our protocol, the blockchain technology is used to facilitate faster negotiation of group key between Roadside Units (RSUs) and vehicles within its communication range. To avoid Single point of failure, TA only provides services during the user joining and leaving phase. To reduce computational and communication costs during the identity authentication process, RSU can perform batch authentication on vehicles. At the same time, participating vehicles only need to obtain the correct session key from the return message broadcasted by the RSU. Our protocol also supports dynamic management of vehicles. We used formal security proof and performance analysis in our scheme, indicating that our scheme meets the basic security requirements of the block key protocol design in VANET. Meanwhile, the analysis of computational costs and communication burden shows that our scheme is more effective in VANET group scenarios.

Satoshi Takashima

and 5 more

Imminent rupture of infected aortic aneurysm presenting as lower back pain in an older patient: A case report Satoshi Takashima, Tadatsugu Morimoto, Takaomi Kobayashi, Hirohito Hirata, Tomohito Yoshihara, Masatsugu Tsukamoto, Masaaki Mawatari1 Department of Orthopedic Surgery, Faculty of Medicine, Saga University.Corresponding author: Tadatsugu MorimotoMailing address: Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1- 1 Nabeshima, Saga, JapanTel: +81-95-234-2343Fax: +81-95-234-2059E-mail:sakiyuki0830@gmail.comConflict of Interest: The authors declare that they have no competing interests to declare.【Cover letter】Editor-in-ChiefClinical case reportsDear Editor:I wish to submit a case report for publication in Clinical Case Reports, titled “Imminent rupture of infected aortic aneurysm presenting as lower back pain in an older patient: A case report.” This paper was co-authored by Tadatsugu Morimoto, Hirohito Hirata, Masatsugu Tsukamoto, Takaomi Kobayashi, Tomohito Yoshihara, and Masaaki Mawatari.This paper presents the clinical case of an elderly male patient who presented to our hospital with complaints of lower back pain and an infected aortic aneurysm at the time of his initial visit. The patient had poorly controlled type II diabetes mellitus. He presented to our hospital with back pain and numbness in the left lower extremity, which had increased gradually. Further examination revealed an infectious aortic aneurysm, and the patient was referred to the cardiovascular surgery department. We believe that this case makes a significant contribution to the literature because infective aortic aneurysms are rare and are expected to increase in the future due to an increase in the number of compromised hosts.Furthermore, we believe that there are lessons to be learned from the clinical course of our patient and that this paper will be of interest to the readers of your journal. We hope that the takeaway message will serve as a reminder to physicians regarding consideration of diagnosis of infectious aneurysms when patients present with lower back pain. A delayed diagnosis can have serious consequences and may lead to unsatisfactory clinical outcomes. We hope that the information provided in this report will aid in early detection and treatment of this disease.This manuscript has not been published or presented elsewhere in part or in entirety, and is not under consideration by another journal. We have read and understood your journal’s policies and believe that neither the manuscript nor the study violates any of these policies. The authors declare no conflicts of interest.Thank you for your consideration. I look forward to hearing from you.Sincerely,Satoshi TakashimaDepartment of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, JapanTel: +81-95-234-2343Fax: +81-95-234-2059E-mail: stmh1156@gmail.com【Manuscript】Keywords: Infected abdominal aortic aneurysm, lower back pain, misdiagnosis●Introduction:Infected abdominal aortic aneurysm (IAAA) is a rare but potentially fatal sequela of infectious inflammatory disease of the aortic wall. However, it is rather an under-recognized disease. The incidence of IAAA has increased in the recent years due to the aging population and increasing number of immunocompromised hosts1. Early diagnosis and management of IAAA can improve the prognosis and survival. However, the diagnosis of IAAA is sometimes challenging in the early stages due to its varied clinical presentation, such as lower back pain2.Herein, we report the case of an older patient in whom a differential diagnosis of spinal degenerative disease was considered due to symptoms such as lower back pain, lower extremity pain, and numbness. However, the patient was ultimately diagnosed with IAAA.Case history and examination:A 63-year-old male patient presented to the orthopedic outpatient clinic with complaints of back pain and left leg numbness, which had gradually increased over the past month. The patient had a history of diabetes mellitus (DM), hypertension, and dyslipidemia, but had self-interrupted his medications. No other significant medical history was elicited by the patient.Physical examination revealed lower back pain and the patient was able to walk without experiencing any neurological deficits. He experienced swelling and local heat in the left lower limb without any erythematous changes or cold sensations in the right leg. The left dorsalis pedis artery was palpable; however, the right dorsal foot artery was poorly palpable.Investigations were performed to localize the source. His laboratory data showed marked elevation of white blood cells (26.9 × 103/L) and C-reactive protein (17.96 mg/dL; normal range < 0.3 mg/dL), along with increased glycosylated hemoglobin (HbA1c) value (9.4%; normal range < 6.0%), Aspartate Aminotransferase (155 U/L; normal range <30 U/L), alanine transaminase (ALT) (93 U/L; normal range < 42 U/L), and gamma-glutamyltransferase (437 U/L; normal range < 64 U/L) levels were also markedly elevated indicating severe infection, DM and liver dysfunction. Fever, back pain, and elevated C-reactive protein levels were suggestive of pyogenic spondylitis. Therefore, lumbar spine radiography and Magnetic Resonance Imaging (MRI) examination were performed. However, lumbar spine radiography and MRI revealed no findings suggestive of pyogenic spondylitis (Figure 1). Based on these results, hepatobiliary system disease was suspected and a medicine specialist was consulted. The patient was admitted due to the suspicion of liver abscess, and underwent detailed examination and treatment.Differential diagnosis, investigation, and treatmentContrast-enhanced abdominal computed tomography (CT) revealed a pseudoaneurysm in the descending aorta. The surrounding soft tissues showed a small amount of gas in the L3/4 intervertebral space and above and below them, suggesting a left psoas abscess and L3/4 vertebral spondylodiscitis (Figure 2). On reviewing the radiograph and MRI, we realized that we had missed the imminent rupture of an infected abdominal aortic aneurysm (IAAA) (Figure 1). Blood cultures were positive for Gram-negative rods, and the microorganism was identified as Escherichia coli. Based on these findings, the patient was ultimately diagnosed with a left psoas abscess and septic shock secondary to IAAA. Ceftriaxone (CTRX) (2.0 g) was administered every 12 h. Pazufloxacin (PZFX) (1.0 g) was added every 12 h to allow tissue penetration. After the initiation of antibiotic therapy, no worsening tendency was observed. Antimicrobial susceptibility testing revealed that the isolate was susceptible to cefazolin (CEZ) at the minimal inhibitory concentrationvalue. Therefore, 2.0 g of CTRX being administered every 12 h was replaced with 1.0 g of CEZ every 6 h.●Outcome and follow-upFour days later, fever and back pain worsened again. Subsequent antibiotic treatment was continued, and the fever stabilized. Laboratory data showed an improvement in white blood cell count (14.5 × 103/L) and C-reactive protein levels (3.56 mg/dL; normal range < 0.3 mg/dL). However, CT revealed a ruptured IAAA despite the patient being fully alert. An emergency surgery was performed (Figure 3). The patient underwent aorto-right external iliac bypass, femoro-femoral bypass, enterectomy, and colostomy. He was managed in the Intensive Care Unit post-surgery, but was in a state of circulatory failure since the end of the surgery. The patient was confirmed dead on the fourth postoperative day.●Discussion:IAAA was first described by Osler in 1885 as an aneurysm caused by a bacterial embolus from infective endocarditis3. The concept has since been broadened to include all aneurysms caused by infections along with those caused by the addition of infection to an existing aneurysm4. IAAA is rare, accounting for 0.7%-3% of all aortic aneurysms, and is difficult to treat. The hospital mortality rate of patients with infected aortic aneurysms is high, ranging between 5-44%5,6. In the past, bacteremia from infective endocarditis and infective emboli were the main sources of infection. However, with the increasing prevalence of atherosclerosis and medically induced arterial injury (catheters and surgery) associated with aging and an increasing number of easily infected hosts such as those with diabetes, malignancy, and collagen disease, the incidence of IAAA has been reported to increase7.Correct and early medical examination and treatment are essential because IAAA is characterized by a faster rate of enlargement8 and a higher frequency of rupture due to its multifocal nature9, in comparison to abdominal aortic aneurysm (AAA). However, while AAA is often accompanied by severe symptoms, such as abdominal pain, impaired consciousness, and abnormal blood pressure, most cases of IAAA rupture are confined to the retroperitoneum, and rupture into the abdominal cavity is extremely rare10. Back pain is often the main symptom in IAAA rather than abdominal pain11. There have been a few cases of IAAA wherein physicians and spine surgeons engaged in lower back pain treatment, and a correct diagnosis was not reached. Therefore, physicians and spine surgeons should be aware of the possibility of IAAA when the patient complains of persistent back pain even after the administration of treatment for symptomatic relief. According to reports by various authors, rupture or impending rupture of an AAA should be suspected when (1) the patient is a middle-aged or older male with a history of an abdominal mass; (2) the pain is severe, with a definite onset time and a component of lateral abdominal pain; (3) there is no tenderness in the lumbar spine or surrounding soft tissues and no neurological symptoms; (4) the iliopsoas muscle shadow is abnormal on radiography; and (5) a beating mass is detected in the abdomen9. Palpation of the abdominal mass is recommended in patients with atypical lower back pain9.The present case involved an older male patient who did not present with lumbar spinal tenderness or neurological symptoms. Remarkably, an abdominal examination was not conducted; therefore, the presence of an abdominal mass was not initially established. Regrettably, the possibility of IAAA, which could have been a potential diagnosis, was not initially considered. In addition, as in the present case, missed imaging findings can also be problematic. IAAA is difficult to diagnose because the main symptom is fever, and the patient presents with a variety of symptoms, including thoracoabdominal pain and back pain, depending on the location of the aneurysm12. IAAAs are easily overlooked when fever is not the primary symptom. Blood investigations showing signs of infection, such as increased white blood cell counts and elevated C-reactive protein levels, along with positive blood cultures and the presence of soft tissue infiltration around the aorta, as shown on CT or magnetic resonance angiography (MRA), may lead to a diagnosis of IAAA. IAAA does not present with serious symptoms in the early stages, and back pain is the main complaint in 44% cases; therefore, orthopedicians are likely to be involved. However, in cases of lower back pain without the primary complaint of fever, abdominal examinations and blood investigations are rarely performed, and orthopedic surgeons tend to focus only on their area of expertise in diagnostic imaging13,14. Focusing on the spine and spinal cord, without paying attention to the soft tissues that appear in the imaging, can lead to overlooking serious diseases such as IAAA. In the present case, the diagnosis was made on the same day as the patient was suspected of a serious disease and internal medicine and radiology department was consulted, although it had been missed at the time of the initial visit. It should be noted that physicians treating lower back pain tend to look at the ABC (Alignment, Bone, Cartilage) but miss the soft tissues15. It is necessary to review images from the edges to ensure that entities such as aortic disease, neoplastic lesions of the spine, and hip disease are not missed during this process.●Consent:Written informed consent for the publication of this case report (including photographs, case progress, and data) was obtained from the patient’s relatives.【Author Contributions】ST and TM designed and outlined the main conceptual ideas. TY and TK collected the data. MT, MT, and HH. aided in the interpretation of the results and worked on the manuscript. MM supervised this study. ST wrote the manuscript with the support of MT, M.T, and HH. All the authors discussed the results and commented on the manuscript.【Funding Information】No funds, grants, or other support was received.【COI statement】The authors declare that they have no conflicts of interest.【Data availability statement】Data sharing is not applicable to this article as no datasets were generated or analyzed in the current study.【ORCID】Satoshi Takashima: 0009-0009-5013-5812.【References】1. Huang J., Cano, et al. Infected aneurysm of the native aorta due to coccidioides posadasii. Infectiou Disease Society of America 2021; 8(6)2. Ng J.H., Heng K.W.J. Infected native aortic aneurysm with spondylodiscitis in an elderly septic man with back pain. BMJ Case Rep 2021; 14(2)3.  Lucas R.B.,Lucia R.,Aida R.,Manuel M. Mycotic Aortic Aneurysms. Aortic Aneurysm and Aortic Dissection 20184.  Cheng-Hsin Lin., Ron-Bin Hsu. Primary Infected Aortic Aneurysm. Acta Cardiol Sin 2014; 30(6): 514-5215. Corvera J.S., Blitzer D., Copeland H., Murphy D., Hess P.J., Jr., Pillai S.T., Fehrenbacher, J.W. Repair of thoracic and thoracoabdominal mycotic aneurysms and infected aortic grafts using allograft. Ann Thorac Surg. 2018;106:1129–1135.6. Sharma A., Pawar P., Raju R., Ayappan M.K., Mathur K. Neo aortoiliac system repair of Burkholderia cepacia infected mycotic aneurysm with impending rupture. Indian J Vasc Endovasc Surg. 2018;5:129.7.  Okada K, Yamanaka K, Sakamoto T, et al. In situ total aortic arch replacement for infected distal aortic arch aneurysms with penetrating atherosclerotic ulcer. J Thorac Cardiovasc Surg 2014; 148: 2096-100.8.  Shao CC, McFarland GE, Beck AW. Emergent repair of infected aortic aneurysm with contained rupture using a femoral vein neoaortoiliac system. J Vasc Surg Cases Innov Tech 2021; 7(3): 502-5059.  Padmanabhan C, Poddar A. Infections of the aorta: Indian J Thorac Cardiovasc Surg 2022; 38: 101-114.10.  Tang T, Boyle J.R., et al. Inflammatory Abdominal Aortic Aneurysms 2005; 29(4): 353-36211.   Patelis N, Nana P, Spanos K, et al. The association of spondylitis and aortic aneurysm: Ann Vasc Surg 2021; 76: 555-56412.  Garrity BM, Sugarman E, Pulley S. Abdominal aortic aneurysm rupture presenting with focal weakness and altered mental status: Int J Emerg Med 2022; 15(1): 2813.  Waindim F, Crim J. MRI of difficult discs: Clin Radiol 2023; 78(3): 201-20814. Onder O, Yarasir Y, Azizova A, Durhan G, Onur MR, Ariyurek OM. Errors discrepancies and underlying bias in radiology with case examples: a pictorial review. Insights imaging 2021; 12(1): 5115. Goes PCK, Pathria MN. Radiographic/MR imaging correlation of the shoulder. Magn Reson Imaging Clin N Am 2019; 27(4): 575-585【Figure/Table】Figure 1Radiographic and Magnetic resonance imaging (MRI) of the lumbar spine before treatment.Lumbar spine radiograph and (B) MRI showing no findings suggestive of discitis or vertebral body destructive lesions at the time of the initial examination. We observed the presence of an imminent rupture of the infected abdominal aortic aneurysm (white arrow) on reexamination.

Sherbaz Khan

and 3 more

Purpose: This research examines the connection between social media influencers and consumer buying intent in a longitudinal study studying the historical difference pre and post covid 19. This article utilizes the concepts of source reliability and TRA to determine what aspects of influencers—such as Trustworthiness and credibility influence consumers’ purchase decisions of health related products. Methodology: This study’s data collection used a Google Form survey of 28 predetermined questions. In total, 324 valid questionnaires were submitted by the respondents. The vast majority of these respondents were students. With the help of the Smart PLS 4 program, the study performed a partial least squares structural equation modeling (PLS-SEM) analysis of the data. The result was late cross-validated using Artificial Neural Network ANN. Findings: The data shows a positive correlation between an Influencer’s credibility and consumer decisions. The influencers’ credibility is the most critical factor in determining whether they will purchase. In particular, credibility is the most crucial factor influencing a customer’s purchase. This research shows that people’s (students’) reactions to influential figures have evolved. The Trustworthiness of influencers is a bigger draw for them. Originality: This research studied the influence of social media influencers before covid and after covid by collecting data before covid (a general study), then collecting data after covid and then comparing the result using Multi-Group Analysis (MGA) in smart PLS 4. Practical Implications: Successful social media influencer marketing is attributed to the expertise and credibility of the influencer, the product’s match within the influencer’s specialty, and the engagement of the target audience. Using this information, marketers can identify relevant influencers for their products and develop campaigns that appeal to the requirements and desires of their target demographic.

Siyi Chen

and 3 more

When memorizing an integrated object such as a Kanizsa figure, the completion of parts into a coherent whole is attained by grouping processes which render a whole-object representation in visual working memory (VWM). The present study measured event-related potentials (ERPs) and oscillatory amplitudes to track these processes of encoding and representing multiple features of an object in VWM. To this end, a change detection task was performed, which required observers to memorize both the orientations and colors of six ‘pacman’ items while inducing configurations of the pacmen that systematically varied in terms of their grouping strength. The results revealed an effect of object configuration in VWM despite physically constant visual input: change detection for both orientation and color features was more accurate with increased grouping strength. At the electrophysiological level, the lateralized ERPs and alpha activity mirrored this behavioral pattern. Perception of the orientation features gave rise to the encoding of a grouped object as reflected by the amplitudes of the PPC. The grouped object structure, in turn, modulated attention to both orientation and color features as indicated by the enhanced N1pc and N2pc. Finally, during item retention, the representation of individual objects and the concurrent allocation of attention to these memorized objects were modulated by grouping, as reflected by variations in the CDA amplitude and a concurrent lateralized alpha suppression, respectively. These results indicate that memorizing multiple features of grouped, to-be-integrated objects involves multiple, sequential stages of processing, providing support for a hierarchical model of object representations in VWM.

Chen Cai

and 5 more

Individuals are apt to link various characteristics of an object or event through different sensory experiences. We conducted an electrophysiological study to examine the in-depth cognitive processing mechanisms underlying the visual search process in multisensory attention. A pilot study with two questionnaires was conducted to screen experimental materials and establish the color-flavor combinations. In the experimental study, the participants were prompted with a flavor label and asked to choose the one with it from the following four beverage bottle images. The behavioral results showed that searching for a color-flavor weak association target was slower than for a strong association one in the color-flavor congruent condition, opposite to the incongruent condition. The ERP component analysis detected smaller N2 and larger P3 and LPC amplitudes for the color-flavor incongruent targets than for the congruent targets. A further time-frequency analysis elicited that the color-flavor congruent and strong association targets evoked lower parietal theta power (range: 200–800 ms, 4–8 Hz) than the incongruent and weak association targets, respectively. Overall, our research indicated that (1) the color-flavor congruency and association strength interactively impacted the visual search efficiency, (2) the attentional switch from external stimuli to internal memory is necessary for efficient visual search, and (3) the parietal region plays a critical role in attentional processing and memory retrieval. These findings shed light on the intricate cognitive processes involved in visual search and the underlying neurocognitive dynamics.

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Shen Shen

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Optimizing the spatial configuration of diverse best management practices (BMPs) can provide valuable decision-making support for comprehensive watershed management. Most existing methods focus on selecting BMP types and locations but neglect their implementation time or order in management scenarios, which are often investment-restricted. This study proposes a new simulation-optimization framework for determining the implementation plan of BMPs by using the net present value to calculate the economic costs of BMP scenarios and the time-varying effectiveness of BMPs to evaluate the environmental effectiveness of BMP scenarios. The proposed framework was implemented based on a Spatially Explicit Integrated Modeling System and demonstrated in an agricultural watershed case study. This case study optimized the implementation time of four erosion control BMPs in a specific spatial configuration scenario under a 5-year stepwise investment process. The proposed method could effectively provide more feasible BMP scenarios with a lower overall investment burden with only a slight loss of environmental effectiveness. Time-varying BMP effectiveness data should be gathered and incorporated into watershed modeling and scenario optimization to better depict the environmental improvement effects of BMPs over time. The proposed framework was sufficiently flexible to be applied to other technical implementations and extensible to more actual application cases with sufficient BMP data. Overall, this study demonstrated the basic idea of extending the spatial optimization of BMPs to a spatiotemporal level by considering stepwise investment, emphasizing the value of integrating physical geographic processes and anthropogenic influences.

Niels Fraehr

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High computational cost is often the most limiting factor when running high-resolution hydrodynamic models to simulate spatial-temporal flood inundation behaviour. To address this issue, a recent study introduced the hybrid Low-fidelity, Spatial analysis, and Gaussian Process learning (LSG) model. The LSG model simulates the dynamic behaviour of flood inundation extent by upskilling simulations from a low-resolution hydrodynamic model through Empirical Orthogonal Function (EOF) analysis and Sparse Gaussian Process (Sparse GP) learning. However, information on flood extent alone is often not sufficient to provide accurate flood risk assessments. In addition, the LSG model has only been tested on hydrodynamic models with structured grids, while modern hydrodynamic models tend to use unstructured grids. This study therefore further develops the LSG model to simulate water depth as well as flood extent and demonstrates its efficacy as a surrogate for a high-resolution hydrodynamic model with an unstructured grid. The further developed LSG model is evaluated on the flat and complex Chowilla floodplain of the Murray River in Australia and accurately predicts both depth and extent of the flood inundation, while being 12 times more computationally efficient than a high-resolution hydrodynamic model. In addition, it has been found that weighting before the EOF analysis can compensate for the varying grid cell sizes in an unstructured grid and the inundation extent should be predicted from an extent-based LSG model rather than deriving it from water depth predictions.

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