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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.

Scene flow tracks the three-dimensional (3D) motion of each point in adjacent point clouds. It provides fundamental 3D motion perception for autonomous driving and server robot. Although the Red Green Blue Depth (RGBD) camera or Light Detection and Ranging (LiDAR) capture discrete 3D points in space, the objects and motions usually are continuous in the macro world. That is, the objects keep themselves consistent as they flow from the current frame to the next frame. Based on this insight, the Generative Adversarial Networks (GAN) is utilized to self-learn 3D scene flow with no need for ground truth. The fake point cloud of the second frame is synthesized from the predicted scene flow and the point cloud of the first frame. The adversarial training of the generator and discriminator is realized through synthesizing indistinguishable fake point cloud and discriminating the real point cloud and the synthesized fake point cloud. The experiments on Karlsruhe Institute of Technology and Toyota Technological Institute (KITTI) scene flow dataset show that our method realizes promising results without ground truth. Just as human, the proposed method can identify the similar local structures of two adjacent frames even without knowing the ground truth scene flow. Then, the local correspondence can be correctly estimated, and further the scene flow is correctly estimated.   Corresponding author(s) Email: [email protected]

Leukocyte differential test is a widely performed clinical procedure for screening infectious diseases. Existing hematology analyzers require labor-intensive work and a panel of expensive reagents. Here we report an artificial-intelligence enabled reagent-free imaging hematology analyzer (AIRFIHA) modality that can accurately classify subpopulations of leukocytes with minimal sample preparation. AIRFIHA is realized through training a two-step residual neural network using label-free images of isolated leukocytes acquired from a custom-built quantitative phase microscope. By leveraging the rich information contained in quantitative phase images, we not only achieved high accuracy in differentiating B and T lymphocytes, but also classified CD4 and CD8 cells, therefore outperforming the classification accuracy of most current hematology analyzers. We validated the performance of AIRFIHA in a randomly selected test set and cross-validated it across all blood donors. Owing to its easy operation, low cost, and accurate discerning capability of complex leukocyte subpopulations, we envision AIRFIHA is clinically translatable and can also be deployed in resource-limited settings, e.g., during pandemic situations for the rapid screening of infectious diseases.  Corresponding author(s) Email:    [email protected],  [email protected]

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.

Cannabis sativa is an extraordinarily versatile species. Hemp and its cousin marijuana, both C. sativa, have been used for millennia as a source of fibre, oil and for medicinal, spiritual and recreational purposes. Because the consumption of Cannabis can have psychoactive effects, the plant has been widely banned throughout the last century. In the past decade, evidence of its medicinal properties did lead to the relaxation of legislation in many countries around the world. Consequently, the genetics and development of Cannabis as well as Cannabis-derived products are the subject of renewed attention.Here, we review the biology of C. sativa, including recent insights from taxonomy, morphology and genomics, with an emphasis on the genetics of cannabinoid synthesis. Because the female Cannabis flower is of special interest as the site of cannabinoid synthesis, we explore flower development, flowering time well as the species’ unique sex determination system in detail. Furthermore, we outline the tremendous medicinal, engineering, and environmental opportunities that Cannabis bears. Together, the picture emerges that our understanding of Cannabis biology currently progresses at an unusual speed. A future challenge will be to preserve the multi-purpose nature of Cannabis, and to harness its medicinal properties and sustainability advantages simultaneously.

Quantum chemistry must evolve if it wants to fully leverage the benefits of the internet age, where the world wide web offers a vast tapestry of tools that enable users to communicate and interact with complex data at the speed and convenience of a button press. The Open Chemistry project has developed an open source framework that offers an end-to-end solution for producing, sharing, and visualizing quantum chemical data interactively on the web using an array of modern tools and approaches. These tools build on some of the best open source community projects such as Jupyter for interactive online notebooks, coupled with 3D accelerated visualization, state-of-the-art computational chemistry codes including NWChem and Psi4 and emerging machine learning and data mining tools such as ChemML and ANI. They offer flexible formats to import and export data, along with approaches to compare computational and experimental data.

This paper responds to one by Graham Martin and colleagues, who offered a critique of my previous publications on masks for the lay public in the Covid-19 pandemic. I address their charges that my co-authors and I had misapplied the precautionary principle; drawn conclusions that were not supported by empirical research; and failed to take account of potential harms. But before that, I remind Martin et al that the evidence on mask wearing goes beyond the contested trials and observational studies they place centre stage. I set out some key findings from basic science, epidemiology, mathematical modelling, case studies and natural experiments, and use this rich and diverse body of evidence as the backdrop for my rebuttal of their narrowly-framed objections. I challenge my critics’ apparent assumption that a particular kind of systematic review should be valorised over narrative and real-world evidence, since stories are crucial to both our scientific understanding and our moral imagination. I conclude by thanking my academic adversaries for the intellectual sparring match, but exhort them to remember our professional accountability to a society in crisis. It is time to lay straw men to rest and engage, scientifically and morally, with the dreadful tragedy that is unfolding across the world.

This Supporting information includes interactive plots, videos, and data captured while performing evaluation and validation experiments for our paper. 

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.  

Floral plantings are promoted to foster ecological intensification of agriculture through provisioning of ecosystem services. However, a comprehensive assessment of the effectiveness of different floral plantings, their characteristics and consequences for crop yield across global regions is lacking. Here we quantified the impacts of flower strips and hedgerows on pest control and pollination services in adjacent crops using a global dataset of 529 sites. Flower strips, but not hedgerows, enhanced pest control services in adjacent fields by 16% on average. However, effects on crop pollination and yield were more variable. Our synthesis identifies several important drivers of variability in effectiveness of plantings: pollination services declined exponentially with distance from plantings, and perennial and older flower strips with higher flowering plant diversity enhanced pollination more effectively. These findings provide promising pathways to optimize floral plantings to more effectively contribute to ecosystem service delivery and ecological intensification of agriculture in the future.

Researchers' ability to accurately screen fossil and subfossil specimens for preservation of DNA and protein sequences remains limited. Thermal exposure and geologic age are usable proxies for sequence preservation on a broad scale but are of nominal use for specimens of similar depositional environments. Cell and tissue biomolecular histology is thus proposed as a novel proxy for determining sequence preservation potential of ancient specimens with improved accuracy. Biomolecular histology as a proxy is hypothesized to elucidate why fossils/subfossils of some depositional environments preserve sequences while others do not and to facilitate selection of ancient specimens for use in molecular studies.

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.

Case Report: Metastatic Squamous Cell Carcinoma in the Parotid Disguised as Syndrome of Inappropriate Antidiuretic Hormone SecretionAuthor Details: Aditya K. Ghosh, M.D., Nivedha Balaji, D.O., Sonu Gupta, M.D.Aditya K. Ghosh – [email protected] Balaji – [email protected] Gupta – [email protected] Georgia Medical Center, 743 Spring St NE, Gainesville, Georgia 30501Financial Disclosures: NoneInformed Consent: The patient in this study provided informed consent prior to participation.Conflict of Interest: None

Aims: To investigate the effects of the CYP3A4*18B, CYP3A5*3, and MDR1C3435T gene polymorphisms on the pharmacokinetics of tacrolimus in healthy Chinese subjects. Methods: Thirty healthy Chinese subjects received single oral doses of 5 mg tacrolimus and were genotyped for CYP3A4*18B, CYP3A5*3, and MDR1C3435T using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The blood concentrations of tacrolimus were determined by liquid chromatography-tandem mass spectrometry (LC/MS/MS) up to 96 h after dosing. Results: The mean tacrolimus AUC0-96, AUC0-∞ and Cmax for the CYP3A4*1/*1 carriers were 282.81±202.13 ng·h·mL-1, 308.68±211.16 ng·h·mL-1 and 38.05±30.30 ng·mL-1, respectively, which were 3.96-fold, 3.70-fold and 3.88-fold greater than those of the CYP3A4*18B/*18B carriers (71.39±21.61 ng·h·mL-1, 83.38±29.00 ng·h·mL-1 and 9.80±2.60 ng·mL-1, respectively) (P= 0.001, 0.001 and 0.004, respectively). Similarly, the AUC0–96, AUC0-∞ and Cmax for the CYP3A5*3/*3 carriers were 238.27±178.82 ng·h·mL-1, 263.78±190.72 ng·h·mL-1 and 32.53±24.52 ng·mL-1, respectively, which were 2.52-, 2.48- and 2.27-fold greater than those of the CYP3A5*1 carriers (94.69±37.70 ng·h·mL-1, 106.28±41.46 ng·h·mL-1 and 14.30±5.77 ng·mL-1, respectively) (P=0.001, 0.001 and 0.004, respectively). Although there were no significant differences in pharmacokinetics among MDR1C3435T genotypes (P>0.05), the Tmax for MDR1 CC (1.25±0.27 h) homozygotes in CYP3A4 expressers (*18B/*18B or *1/*18B genotype) was much lower than that for the MDR1 T carriers (1.82±0.72 h) (P<0.05). In addition, sex, age, alanine aminotransferase (ALT) level, haematocrit (HCT) level, serum creatinine (SCr) level, gamma-glutamyl transferase (GGT) level, and CYP3A4*18B and CYP3A5*3 gene polymorphisms affected the pharmacokinetics of tacrolimus. Conclusions: CYP3A4*18B and CYP3A5*3 are important genetic factors influencing the pharmacokinetics of tacrolimus in the Chinese population.

A Novel Approach for Challenging Coronary Angiography in Ascending Aortic Aneurysm: Utilizing an Angioplasty Wire Zaid haitham Abduljabbar 1, Ahmed Qasim Mohammed Alhatemi 2 , Hashim Talib Hashim 3, Al Talib Hashim 4Al Nasiriyah Heart Centre, coronary care unit, Thi Qar, Iraq.Al Nasiriyah Teaching Hospital, Thi Qar, Iraq.Warith Al Anbiyaa university, college of medicine, Karbala, Iraq.Golestan University of medical sciences, Gorgan, Iran.Corresponding author: Ali Talib Hashim, Golestan University of medical sciences, Gorgan, Iran. [email protected]

Comorbidity Influence in Observational Studies: Why Ignore the Real World ?Comorbidity is any coexisting disease or medical condition with another medical condition, at a particular time point or during a particular period, in a patient. As such they can be acute or of chronic nature. Comorbidities may or may not interact with each other. Indeed, comorbid conditions may elevate the risk of the development of other conditions, increase the risk of death, reduce the quality of life, worsen the mental and physical health and impair the general functional ability of the patient. However, the literature on empirical evidence of treatment effect modification by comorbidity from randomized clinical trials (RCTs) is very limited, although this has been attributed to the underrepresentation of people with comorbidities in trials.1 Despite this, the standard assumption that efficacy is constant across subgroups of patients by levels of comorbidity in trials, is often criticised despite the power granted by treatment randomization to such studies.2 In contrast, the influence of comorbidity on health outcomes and treatment effectiveness is well established from observational studies.3-4In most observational studies, the influence of comorbidity on treatment effect is modelled as constant regardless of how long the patient has had the condition up to the start of follow-up, with the inherent assumption that the duration does not influence the outcome of interest. The question we inadvertently fail to address is whether it is reasonable to assume a constant influence for each of the comorbidities- namely, a level of influence that is independent of how long the patient has had each comorbid condition since diagnosis? We readily ignore the reality that there may be no evidence on the assumption of a constant, unchanging effect over time by the comorbidity of interest. For example, in assessing the treatment effect of a particular drug in a diabetic cohort, we generally consider the risk associated with each of the comorbidities of interest, such as hypertension as the same between patients diagnosed five years ago and those diagnosed recently. By so doing, we run the risk of not properly controlling for the influence of some of these comorbidities on the outcome of interest. Indeed, this assumption was challenged in a study that demonstrated the duration-dependent nature of the influence of certain comorbidities on survival among chronic obstructive pulmonary disease (COPD) patients in the UK’s Clinical Practice Research Datalink (CPRD) and since then, using similar approaches that are easy to apply, two other studies have also demonstrated the duration-dependent nature of certain comorbidities within the real-world evidence generation space.5-7Another common practice we find in observational studies is the modelling of and adjusting for comorbidity influence additively, either as the number of comorbidities or as an index (such as the Charlson Comorbidity Index), and we do so often without regard to the specific outcome of interest, which may be different from the outcome used in the derivation of the index.8-10 In so doing, we are inadvertently assuming that (1) the outcome is associated linearly with the comorbidity count or index and (2) the impact of every comorbidity is one directional- namely, to elevate the risk of the outcome and hence, the weights we derive from combining the set of comorbidities must be positive (i.e. the null hypothesis that outcome worsens with increasing comorbidity is inadvertently assumed as already proven). Although these common practices are generally suitable in many observational studies, there is evidence some of these assumptions may not necessary hold true in some disease populations, such as in COPD patients.11-13 One such evidence is that as a result of adequate control of COPD by medications and lifestyle changes, among others, its influence on the risk of an outcome of interest, may not necessarily be as a risk elevator - suggesting, risk reduction by an adequately managed comorbid condition is possible in real-life studies. An additional, possible consequence of these approaches is our likely loss of ability to adequately identify specific interactions between those comorbidities that influence prognosis.Some of the problems associated with our current simplistic approach to handling comorbidity influence were first highlighted in a 2012 paper on the conduct of prospective observational post-authorization safety studies.14 The paper recommends assessing the suitability of the assumptions that underpin the methodologies we intend to apply to the data within the context of the specific outcome(s) of interest as the least we could do with real-life data. In other words, we need to demonstrate that such assumptions are appropriate and reasonable on the basis of the results from exploratory assessments of the data. We need not ignore what the specific study data may reveal about the nature of the true association between the outcome and each specific comorbidity and/or combination of comorbidities. We particularly need not ignore evidence from routine clinical practice. The current common assumption in observation studies, that the influence of every comorbid condition on any health outcome of interest is independent of both its duration and management in routine clinical practice, is unlikely to be tenable in the real world.Acknowledgement :The authors are grateful to Professor Gilbert MacKenzie for his valuable contributions to initial discussions on the subject.Prof Victor A Kiri MPH, PhDEpidemiology DirectorMarket Access Consulting, RWE & AnalyticsFortreaMaidenhead, Berkshire SL6 3QHUnited [email protected] iD: https://orcid.org/0000-0001-7171-2011Dr Maurille Feudjo-Tepie PhDVice PresidentHead of GlobalRWE & Digital sciences Head of Global RWE & Digital sciencesUCBSlough, Berkshire SL1 3WEUnited [email protected] P, Hannigan L, Rodriguez-Perez J, et al. Representation of people with comorbidity and multimorbidity in clinical trials of novel drug therapies: an individual-level participant data analysis. BMC Med. 2019; 17(1):201Hanlon P, Butterly EW, Shah ASV, et.al. Treatment effect modification due to comorbidity: Individual participant data meta-analyses of 120 randomised controlled trials. PLoS Med 2023; 20(6): e1004176Iversen LH, Nørgaard M, Jacobsen J, et al. The impact of comorbidity on survival of Danish colorectal cancer patients from 1995 to 2006 – a population-based cohort study. Dis Colon Rectum 2009;52(1):71–78Lund L, Jacobsen J, Nørgaard M, et al. The prognostic impact of comorbidities on renal cancer, 1995 to 2006: a Danish population based study. J Urol. 2009;182(1):35–40; discussion 40.Kiri VA, Oyee J. Assessing the time-dependency nature of comorbidity influence in COPD, Pharmacoepidemiology and Drug Safety (2006); 15 (Suppl 2): S8Plana-Ripoll O, Pedersen CB, Holtz Y, et al. Exploring comorbidity within mental disorders among a Danish national population. JAMA Psychiatry 2019b; 76: 259–270McGrath JJ, Lim CCW, Plana-Ripoll O, et al. Comorbidity within mental disorders: A comprehensive analysis based on 145,990 survey respondents from 27 countries. Epidemiology and Psychiatric Sciences 2020; 29: [e153]Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (5):373-383Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–619.Yngvar Nilssen, Trond-Eirik Strand, Robert Wiik, et al. Utilizing national patient-register data to control for comorbidity in prognostic studies, Clinical Epidemiology 2014;395-404Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27Kiri VA, Visick G, Muellerova H, MacKenzie G. A Novel Methodology for Measuring the Influence of Comorbidity in Disease Outcome Studies, Pharmacoepidemiology and Drug Safety (2005); 14 (Suppl 2): S135Kiri VA, Muellerova H, Visick G, MacKenzie G. Assessing the multivariate structure and influence of comorbidity in COPD, Eur Respir J (2005); 26 (Suppl 49):A470sKiri VA. A Pathway to Improved Prospective Observational Post-Authorization Safety Studies. Drug Saf 2012; 35 (9): 711-724

ABDOMINAL COCOON AND RECURRENT HEMORRHAGIC ASCITES, UNEXPECTED FINDINGS IN ENDOMETRIOSIS: A CASE REPORTRosheen Jamil1

TITLE: PITUITARY STALK INTERRUPTION SYNDROME: A RARE BUT TREATABLE CAUSE OF SHORT STATURE

The precise localization of mobile robots in unstructured environments is of utmost importance for many industrial and field applications, especially when the mobile robot is part of a more complex kinematic chain, such as a mobile manipulator. Being able to precisely localize affects the outcome of tasks that rely on an open-loop kinematic computation, such as work-station docking procedures. To achieve a repeatable and precise localization and positioning, mobile robots generally rely on onboard sensors, most commonly 2D laser scanners, whose readings are subjected to noise and numerous disturbing factors (e.g., materials reluctance). Problems arise when precise localization is needed in dynamic and unstructured environments where generally applicable methods won’t perform adequately or might be time-consuming to set up. In this work, we propose a cloud-edge computing architecture to deploy a recurrent neural network (RNN) based registration system, which uses a pair of consecutive LiDAR readings to estimate a fixed transformation. The capability of RNNs to process contiguous inputs will help neglect errors embedded in punctual laser scanner readings and output a more precise registration estimation. In such a way, the RNN can estimate a displacement error based on multiple consecutive readings and act as a sensor to be employed in a closed-loop control scheme. To tackle the dynamic and unstructured environments, the model is firstly tuned on synthetic LiDAR data to embed rigid transformations into the deep learning model, for then rapidly fine-tuned on local scenarios. After model architecture and optimization of hyperparameters, the devised model is tested in different scenarios, comparing the precise positioning capability of the AMR(autonomous mobile robot) with that of a classical registration algorithm. The results suggest that an RNN model can greatly improve the registration precision of laser scanner signals and, consequently, the precise positioning efficiency of AMRs.

Chirality and luminescence are important for both chemistry and biology, which are highly influenced by aggregation. In this work, we reported a pair of metalated tetraphenylethylene(TPE)-based organic cage enantiomers, which feature a quadrangular prismatic cage structure. These homochiral cages exhibit concentration-dependent chiral behaviors alongside a propensity for thermodynamic aggregation. Aggregation caused quench effect is found for these cages accompanying the increasing of the concentrations. When a poor solvent is added to produce a kinetical aggregation, the aggregation-annihilation circular dichroism and aggregation-induced emission behaviours are observed for these enantiomeric cages. By comparing these observations with the photophysical behaviors of a pair of structurally similar organic molecular enantiomers, the unique photophysical properties observed are intricately linked to the metal-integrated TPE-functionalized cage structures.

The heat transfer in power-law fluids across three corrugated circular cylinders placed in triangular pitch arrangement is studied computationally in a confined channel. Continuity, momentum and energy balance equations were solved using ANSYS FLUENT (Version 18.0). The flow is assumed to be steady, incompressible, 2D and laminar. A square domain of side 300 Dh is selected after detailed domain study. An optimized grid with 98187 cells is used in the study. The convergence criteria of 10 -7 for the continuity, x-momentum and y-momentum balances and 10 -12 for energy equation were used. Constant density and non-Newtonian power-law viscosity modules were used. Diffusive term is discretized using central difference scheme. Convective terms are discretized using Second Order Upwind (SOU) scheme. Pressure-velocity coupling between continuity and momentum equations was implemented using the SIMPLE (Semi-Implicit Method for Pressure Linked Equation) scheme. Streamlines show wake development behind the cylinders, which is much dominant at large ReN and n. Isotherm contours are cramped at higher values of ReN and PrN, implying higher heat transfer. Global parameters like Cd and Nu are computed for the wide ranges of controlling dimensionless parameters, such as power-law index (0.3 ≤ n ≤ 1.5), Reynolds (0.1 ≤ ReN ≤ 40) and Prandtl numbers (0.72 ≤ PrN ≤ 500). The NuLocal plot attains a pitch near corrugation of surface due to abrupt change in velocity and temperature gradients. Nu increases with ReN and/or PrN and decreases with n under otherwise identical situations. Nu is correlated with pertinent parameters, namely, ReN , PrN and n.

Decoupling electrical and thermal properties to enhance the figure of merit of thermoelectric materials underscores an in-depth understanding of the mechanisms that govern the transfer of charge carriers. Typically, a factor that contributes to the optimization of thermal conductivity is often found to be detrimental to the electrical transport properties. Here, we systematically investigated 26 dimeric MX2-type compounds (where M represents a metal and X represents a non-metal element) to explore the influence of the electronic configurations of metal cations on lattice thermal transport and thermoelectric performance using first-principles calculations. A principled scheme has been identified that the filled outer orbitals of the cation lead to a significantly lower lattice thermal conductivity compared to that of the partly occupied case for MX2, due to the much weakened bonds manifested by the shallow potential well, smaller interatomic force constants, and higher atomic displacement parameters. Based on these findings, we propose two ionic compounds, BaAs and BaSe2, to realize reasonable high electrical conductivities through the structural anisotropy caused by the inserted covalent X2 dimers, while still maintaining the large lattice anharmonicity. The combined superior electrical and thermal properties of BaSe2 lead to a high n-type thermoelectric ZT value of 2.3 at 500 K. This work clarifies the structural origin of the heat transport properties in dimeric MX2-type compounds and provides an insightful strategy for developing promising thermoelectric materials.

Co-evolutionary adaptation of hookworms with their mammalian hosts has selected for immunoregulatory excretory/secretory (E/S) products. However, it is not known whether, or if so, how host immunological status impacts the secreted profile of hematophagous adult worms. This study interrogated the impact of host Signal and transducer of activator of transcription 6 (STAT6) expression during experimental evolution of hookworms through sequential passage of the life-cycle in either STAT6 deficient or WT C57BL/6 mice. Proteomic analysis of E/S products by LC-MS showed increased abundance of 15 proteins, including myosin-3, related to muscle function, and aconitate hydratase, related to iron homeostasis. However, most E/S proteins (174 of 337 unique identities) were decreased, including those in the Ancylostoma-secreted protein (ASP) category, and metallopeptidases. Several identified proteins are established immune-modulators such as fatty acid-binding protein homolog, cystatin, and acetylcholinesterase. Enrichment analysis of InterPro functional categories showed down-regulation of Cysteine-rich secretory proteins, Antigen 5, and Pathogenesis-related 1 proteins (CAP), Astacin-like metallopeptidase, Glycoside hydrolase, and Transthyretin-like protein groups in STAT6 KO adapted worms. Taken together, these data indicate that in an environment lacking Type 2 immunity, hookworms alter their secretome by reducing immune evasion proteins- and increasing locomotor- and feeding-associated proteins.

The recent COVID-19 pandemic, which had a significant impact on businesses in 2020 and 2021, highlighted the issue of analyzing the financial performance of banks in times of crisis. Practical experience has shown that banks with higher resilience perform better in different crises. This paper studies different banking business models and examines their resilience. In this way, by analyzing the banks' resilience variables, their situation for different types of banking business models is examined. Resilience in banks will be considered through the control of risky assets and deposits, leverage rate, capital adequacy, liquidity coverage ratio, net stable funding ratio, and diversification. Through examining the data of 33 Iranian banks and analyzing their different business models in a soft clustering method, it was found that the resilience of merchandise-oriented banks has been more than the others. Detailed analysis revealed that reducing the investment and increasing the variety of loans would reduce the systemic risk of the pandemic and its effect on other banks leading to an increase in resilience.