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“Coconut atrium” or complete dystrophic left atrial wall calcification is rare and occurs almost exclusively in the middle-aged and the elderly, often following chronic conditions such as rheumatic heart disease, end-stage renal disease and tuberculosis. Hyperparathyroidism, lipid storage disease and use of xenografts are known causes of incomplete intra-cardiac dystrophic calcification in older children. The present report describes a rare case of cardiac calcification demonstrated by Trans-thoracic 2-D Echocardiography in a two-year old Indian boy who presented at a private hospital in Hyderabad, India with breathlessness. Unfortunately, his parents declined further extensive investigations and treatment, but this case was instructive due to the rarity of complete dystrophic left atrial wall calcification, the exclusion of the common known aetiologies and the extremely young age of the patient.

Paleontological site monitoring in National Park Service units can deviate from the recommended cyclical protocol because of unique challenges each unit may face. These challenges include staffing limitations or turnover, difficulty accessing remote sites, and high work volume. Insufficient monitoring of fossil sites might result in the loss of knowledge or data due to degradation or loss of resources. New monitoring protocols were tested at the Copper Canyon ichnofossil locality in Death Valley National Park (DEVA) to address the highlighted management challenges. The monitoring protocol presented here was designed to be streamlined and simple, to be utilized by paleontologists and non-paleontologists alike, and to overcome challenges, thereby, improving undermanaged sites. The monitoring protocol included baseline evaluation and imaging of the 78 track localities within Copper Canyon. Each site was assigned a sensitivity status; identifying its recommended monitoring cyclicity of high, moderate, or low. It was determined that monitors could take as few as two field trips to Copper Canyon per year and monitor between five to ten sites each trip. This could be accomplished by DEVA’s resources management, interpretation, or law enforcement staff, or a volunteer. Monitors use a portable device, pre-loaded with site-specific paleontological data, to interactively record changes at a site and complete a short seven question form with their observations. Data are stored on the device and later transferred to a central paleontological database. Through this protocol, DEVA can utilize a community-based approach to better manage fossil resources, one which could be replicated by other National Park Service units that grapple with similar monitoring challenges.

Indonesian has become the official language of the UN. Many BIPA students want to learn Indonesian online. However, online learning creates obstacles such as time differences between teachers and BIPA students, internet connections, and providing less than optimal feedback. This research aims to develop m-learning with automatic feedback for BIPA level 2 learners. This research uses a 4D development model: define, design, develop and deploy. This study's instrument is a questionnaire distributed to 2 validators and 18 BIPA learners. The results of this study are m-learning products that minimize internet connections; once installed, students only need to be connected to the internet when working on questions. In addition, m-learning is also equipped with automatic feedback that appears immediately after students answer questions. The results of the product trial show that students can use m-learning to learn anytime and anywhere, including in areas with minimal internet access. Automatic feedback in m-learning also helps students learn independently because they do not need to wait for feedback from teachers. The automatic feedback in M-learning is only for listening and reading questions while speaking and writing questions are still in the form of answer keywords or assessment rubrics that the teacher must correct. Based on expert validation and product trials with an average score of 88.8, we conclude that the development of m-learning is suitable for BIPA level 2 students.

Abstract Aims Chronic kidney disease (CKD) is a well‐established risk factor for heart failure (HF); however, patients with an estimated glomerular filtration rate (eGFR) eGFR ≥ 30 and eGFR eGFR ≥ 30 and 72.2% for patients with eGFR eGFR ≥ 30 and eGFR 30 (4 year incidence of kidney outcome as the first event was 5.0% for eGFR ≥ 60, 4.8% for 60 > eGFR ≥ 30 and 20.1% for eGFR

Aim: To compare the Subfoveal Choroidal Thickness (SFCT) measured by Enhanced Depth Imaging (EDI) technique of Spectral Domain Optical Coherence Tomography (SD-OCT) in healthy pregnant and preeclamptic women. Methods: Our study was cross-sectional hospital-based study in which healthy pregnant women and women having preeclampsia were selected from Obstetrics and Gynecology department and enrolled in it. The guidelines of the American College of Obstetricians and Gynecologists were used to diagnose the cases of preeclampsia. The study included 100 women (200 eyes) which were grouped into 50 healthy pregnant women (group 1), i.e., n = 100 eyes and 50 preeclamptic women (group 2), i.e., n = 100 eyes. SFCT was measured using the EDI technique of SD-OCT and data were entered in a Microsoft Excel sheet. Statistical analysis was done using Epi Info. Software version 7.2.1.0 (Atlanta, Georgia, US) and the results of both the groups were compared. Results: The mean SFCT in both the eyes of the healthy pregnant group and the preeclamptic group was 318.12 ± 37.12 µm and 209.04 ± 26.73 µm, respectively, with a P-value 0.001 showing a statistically significant difference between both the groups. Conclusion: The SFCT is significantly decreased in preeclamptic pregnant women than in healthy pregnant women.

Abstract Rapidly waning immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires continued global access to affordable vaccines. Globally, inactivated SARS-CoV-2 vaccines have been widely used during the SARS-CoV-2 pandemic. In this proof-of-concept study we adapted an original-D614G SARS-CoV-2 virus to Vero cell culture as a strategy to enhance inactivated vaccine manufacturing productivity. A passage 60 (P60) virus showed enhanced fitness and 50-fold increased virus yield in a bioreactor compared to the original-D614G virus. It further remained susceptible to neutralization by plasma from SARS-CoV-2 vaccinated and convalescent individuals, suggesting exposure of relevant epitopes. Monovalent inactivated P60 and bivalent inactivated P60/omicron BA.1 vaccines induced neutralizing responses against original-D614G and BA.1 viruses in mice and hamsters, demonstrating that the P60 virus is a suitable vaccine antigen. Antibodies further cross-neutralized delta and BA.5 viruses. Importantly, the inactivated P60 vaccine protected hamsters against disease upon challenge with original-D614G or BA.1 virus, with minimal lung pathology and lower virus loads in the upper and lower airways. Antigenicity of the P60 virus was thus retained compared to the original virus despite the acquisition of cell culture adaptive mutations. Consequently, cell culture adaptation may be a useful approach to increase yields in inactivated vaccine antigen production.

Abstract Background Enamelin is an enamel matrix protein that plays an essential role in the formation of enamel, the most mineralized tissue in the human body. Previous studies using animal models and proteins from natural sources point to a key role of enamelin in promoting mineralization events during enamel formation. However, natural sources of enamelin are scarce and with the current study we therefore aimed to establish a simple microbial production method for recombinant human enamelin to support its use as a mineralization agent. Results In the study the 32 kDa fragment of human enamelin was successfully expressed in Escherichia coli and could be obtained using immobilized metal ion affinity chromatography purification (IMAC), dialysis, and lyophilization. This workflow resulted in a yield of approximately 10 mg enamelin per liter culture. Optimal conditions for IMAC purification were obtained using Ni2+ as the metal ion, and when including 30 mM imidazole during binding and washing steps. Furthermore, in vitro mineralization assays demonstrated that the recombinant enamelin could promote calcium phosphate mineralization at a concentration of 0.5 mg/ml. Conclusions These findings address the scarcity of enamelin by facilitating its accessibility for further investigations into the mechanism of enamel formation and open new avenues for developing enamel-inspired mineralized biomaterials.

OBJECTIVES: The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure–response relationship for asbestosis in a general working population setting. We examined the exposure–response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population. METHODS: We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure–response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders. RESULTS: The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95% confidence interval (CI) 1.15– -1.22]. The IRR was 1.94 (95% CI 1.53–2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population. CONCLUSIONS: This study found exposure–response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.

Summary: Background: Total neoadjuvant treatment (TNT) for locally advanced rectal cancer (LARC) increases pathologic complete response (pCR) rate and reduces the risk of systemic recurrences over chemoradiotherapy (CRT) in randomised trials, e.g., the RAPIDO trial. A modified RAPIDO schedule was prospectively explored in Sweden to evaluate TNT in routine health care before the RAPIDO results were published. Methods: Between July 2016 and June 2020, 273 patients with high-risk LARC (clinical tumour stage cT4, clinical nodal stage cN2, extramural vascular invasion, involved mesorectal fascia or enlarged lateral lymph nodes) were treated in a prospective observational cohort study at 16 hospitals (LARCT-US). Another 189 patients at 18 (including the 16) hospitals were similarly treated (ad modum LARCT-US, AdmL) during the same period. Inclusion and exclusion criteria were identical to the RAPIDO trial. Patients received short-course radiotherapy (5 × 5 Gy for 5 days) followed by four cycles of CAPOX or six FOLFOX-6, followed by total mesorectal excision or, if clinical complete response (cCR), inclusion into a watch-and-wait (W&W) study. The primary endpoint was complete response (CR), i.e., the sum of pCR in specimens and cCR exceeding one year in W&W patients. Safety was assessed in all patients. Findings: Compared to the RAPIDO trial, patients were older, and tumours more advanced. Median follow-up was 4.8 years (IQR 4.2–5.2). In LARCT-US all patients received radiotherapy and 268 (98%) started chemotherapy whereas in AdmL all patients received radiotherapy and chemotherapy. In LARCT-US 34 patients had pCR and 31 sustained cCR resulting in a CR-rate of 24% (95% CI 20–28). In AdmL, results were similar (23%, 95% CI 17–30). Locoregional recurrences were 6% (95% CI 4–10) and 5% (95% CI 2–9), respectively, both at 3 years and at last follow-up. Neurotoxicity, recorded in LARCT-US, was lower than in RAPIDO (EORTC-QLQ-CIPN20 tingling toes or feet mean score 24 (SD 31) vs 43 (SD 37)). One treatment-associated death occurred. Interpretation: Despite older patients and more advanced tumours, results similar to the RAPIDO trial were obtained. Hence, two chemotherapy cycles less do not compromise the results maintaining a high CR-rate. This TNT schedule resulted in favourable outcomes in a nation-wide real-life situation. Funding: Swedish Cancer Society.

Additive manufacturing (AM) of ceramic bone implants from tricalcium phosphate (TCP) offers several benefits for bone regeneration and defect treatment. TCP scaffolds, e.g. featuring lattice or gyroid geometries, can effectively induce bone ingrowth and integration, showing a high potential in the treatment of large bone defects, e.g. as filler material for large bone defects. A major advantage of TCP is its osteoconductivity making it an effective choice for a broad range of orthopedic and dental applications. In addition, AM allows for the possibility to create precise, patient-specific implants with controllable mechanical properties. Those properties can be controlled by the implants' microstructure, e.g. in relation to bulk density and internal porosity. In this contribution, eleven resorbable bone implants were produced from β-tricalcium phosphate (β-TCP) in order to quantify the internal porosity in three dimensions using microcomputed tomography (μ CT). All components were manufactured using an extrusion-based process and scanned using an industrial μCT system at a voxel size of 10 μm. Two samples were physically prepared to allow a high-resolution μCT analysis at a voxel size of 1 μm. Results show that post-processed image data enables the non-destructive inspection of highly complex ceramic AM implants. Using μCT we were able to quantify internal porosity in β-TCP bone implant and quantify the geometry and distribution of wall thicknesses in the gyroid geometry. However, a detailed microstructural analysis is only possible using high-resolution μCT volume data, e.g. in relation to internal porosity. The findings emphasize that ceramic AM is able to produce complex components. However, NDT using μCT is crucial in the development of new materials and geometries. μCT provides high-resolution insights into the internal and external structure of ceramic AM components. It plays a critical role in detecting internal features, including small-scale porosity and delamination which are crucial for the integrity and functionality of medical implants. Moreover, μCT provides volumetric data that supports the design and manufacturing process at various stages, enabling an iterative approach of continuous improvement in mechanical performance and osseointegration.

Maternal vitamin D levels during pregnancy may be important for reproductive health in male offspring by regulating cell proliferation and differentiation during development. We conducted a follow-up study of 827 young men from the Fetal Programming of Semen Quality (FEPOS) cohort, nested in the Danish National Birth Cohort to investigate if maternal vitamin D levels were associated with measures of reproductive health in adult sons. These included semen characteristics, testes volume, and reproductive hormone levels and were analysed according to maternal vitamin D (25(OH)D3) levels during pregnancy. In addition, an instrumental variable analysis using seasonality in sun exposure as an instrument for maternal vitamin D levels was conducted. We found that sons of mothers with vitamin D levels  75 nmol/L. Continuous models, spline plots and an instrumental variable analysis supported these findings. Low maternal vitamin D levels were associated with lower testes volume and lower total sperm count with indications of dose-dependency. Maternal vitamin D level above 75 nmol/L during pregnancy may be beneficial for testes function in adult sons.

Dans notre souci de faire prévaloir l’importance du capital humain dans la sauvegarde des acquis d’une banque, la présente recherche se voudrait d’être une réponse par rapport aux préalables qu’il importe de retenir pour quiconque tiendrait à assurer la stabilité des banques de dépôts au plan interne. N’est-ce pas qu’il existe une interdépendance et une forte corrélation entre les dispositifs préventifs internes des risques bancaires, qui se manifestent souvent sous l’effet boule de neige et qui prend racines à partir des erreurs que commettent les agents préposés ? Ce qui ne peut manquer de susciter d’autres risques de porter atteinte, notamment au remboursement de crédits, à la liquidité, à la solvabilité, à la réputation,… De là tout l’intérêt d’endiguer voire de résorber tout hasard dangereux susceptible d’être le catalyseur des autres risques.

L’article que voici est destiné à faire montre de l’importance de la fiscalité efficace dans la mobilisation des moyens dont ont besoin les pouvoirs publics pour leur fonctionnement à travers la décentralisation par ordre de prérogatives d’entités et des administrations commises aux différents prélèvements fiscaux et non-fiscaux. Pour y parvenir, il est exposé la nécessité de la mise en œuvre de certains préalables notamment l’innovation des méthodes dont la radiation tous azimuts des cas éventuels de fraude et évasion fiscales, l’instauration d’un système autonome digitalisé partant de l’assiette, du recouvrement jusqu’au traitement des cas litigieux d’impôts en tenant compte des réalités et du contexte congolais.

OBJECTIVES: This study aimed to estimate the validity of self-reported information on ever-night shift work among women with and without breast cancer and illustrate the consequences for breast cancer risk estimates. METHODS: During 2015–2016, 225 women diagnosed with breast cancer and 1800 matched controls without breast cancer employed within the Danish hospital regions during 2007–2016 participated in a questionnaire-based survey. Their reported night shift work status was linked with objective payroll register day-by-day working hour data from the Danish Working Hour Database and the Danish Cancer Registry. For the breast cancer patients and their matched controls, we estimated sensitivity and specificity for ever-working night shifts using the payroll data as the gold standard. We also used quantitative bias analysis to estimate the impact on relative risk estimates for a hypothetical population. RESULTS: For breast cancer patients, we observed a sensitivity of ever-night shifts of 86.2% and a specificity of never-night shifts of 82.6%. For controls, the sensitivity was 80.6% and the specificity 83.7%. Odds ratio for breast cancer in a hypothetical population decreased from 1.12 [95% confidence interval (CI) 1.03–1.21] to 1.05 (95% CI 0.95–1.16) when corrected by the sensitivity and specificity estimates. CONCLUSION: This study shows that female breast cancer patients had slightly better recall of previous night shift work than controls. Additionally, both breast cancer patients and controls recalled previous never-night shift work with low specificity. The net effect of this misclassification is a small over-estimation of the relative breast cancer risk due to night shift work.

Abstract Background The caesarean section (CS) rate has increased worldwide and there is an increasing public and scientific interest in the potential long-term health consequences for the offspring. CS is related to persistent aberrant microbiota colonization in the offspring, which may negatively interfere with sex hormone homeostasis and thus potentially affect the reproductive health. It remains unknown whether adult sons’ semen quality is affected by CS. We hypothesize that CS is associated with lower semen quality. Methods This study was based on the Fetal Programming of Semen Quality cohort (FEPOS, enrolled from 2017 to 2019) nested within the Danish National Birth Cohort (DNBC, enrolled from 1996 to 2002). A total of 5697 adult sons of mothers from the DNBC were invited to the FEPOS cohort, and 1044 young men participated in this study. Information on mode of delivery was extracted from the Danish Medical Birth Registry, and included vaginal delivery, elective CS before labor, emergency CS during labor and unspecified CS. The young men provided a semen sample for analysis of semen volume, sperm concentration, motility and morphology. Negative binomial regression models were applied to examine the association between CS and semen characteristics with estimation of relative differences in percentages with 95% confidence intervals (CIs). Results Among included sons, 132 (13%) were born by CS. We found a slightly lower non-progressive sperm motility (reflecting higher progressive sperm motility) among sons born by CS compared to sons born by vaginal delivery [relative difference (95% CI): − 7.5% (− 14.1% to − 0.4%)]. No differences were observed for other sperm characteristics. When CS was further classified into elective CS, emergency CS and unspecified CS in a sensitivity analysis, no significant differences in non-progressive motility were observed among sons born by any of the three types of CS compared to sons born vaginally. Conclusions This large population-based cohort study found no significant evidence for an adverse effect on semen quality in adult sons born by CS.

BackgroundAcute Kidney Injury (AKI) incidence has continued to rise and is recognized as a major risk factor for kidney disease progression and cardiovascular complications. Early recognition of factors associated with post-AKI complications is fundamental to stratifying patients that could benefit from closer follow-up and management after an episode of AKI. Recent studies have shown that proteinuria is a prevalent sequela after AKI and a strong predictor of complications post-AKI. This study aims to evaluate the frequency and timing of the development of de-novo proteinuria after an AKI episode in patients with known kidney function and no prior history of proteinuria.MethodsWe retrospectively analyzed data from adult AKI patients with pre- and post-kidney function information between Jan 2014 and March 2019. The presence of proteinuria determined before and after index AKI encounter was based on ICD-10 code and/or urine dipstick and UPCR during the follow-up period.ResultsOf 9697 admissions with AKI diagnoses between Jan 2014 and March 2019, 2120 eligible patients with at least one assessment of Scr and proteinuria before AKI index admission were included in the analysis. The median age was 64 (IQR 54-75) years, and 57% were male. 58% (n-1712) patients had stage 1 AKI, 19% (n = 567) stage 2 AKI, and 22% (n = 650) developed stage 3 AKI. De novo proteinúria was found in 62% (n = 472) of patients and was already present by 90 days post-AKI in 59% (209/354). After adjusting for age and comorbidities, severe AKI (stage 2/3 AKI) and diabetes, were independently associated with increased risk for De novo proteinuria.ConclusionSevere AKI is an independent risk factor for subsequent de novo proteinuria post-hospitalization. Further prospective studies are needed to determine whether strategies to detect AKI patients at risk of proteinuria and early therapeutics to modify proteinuria can delay the progression of kidney disease.

Abstract Over the last 10 years, the spawning population of invasive pink salmon (Oncorhynchus gorbuscha) has increased in the river systems in northern Norway to a level that is causing concern about their impact on endemic fauna and ecosystem processes. The scale of transfer of pink salmon carcasses into the terrestrial ecosystem is likely to be a key determinant of terrestrial impact. Bears (Ursus sp.) are responsible for most such transfers in North America but are rare in Norway. The white‐tailed eagle (Haliaeetus albicilla) is common however, and a candidate to be a main cause of such transfers. To evaluate this hypothesis, data on the abundance of white‐tailed eagles and pink salmon were collected along the river Skallelv in northern Norway in 2021, a year the pink salmon spawned in the river, and in 2022, a year no pink salmon spawned in the river. The abundance of white‐tailed eagles along the river was much higher the year pink salmon spawned in the river. Furthermore, white‐tailed eagles were observed aggregating and catching pink salmon where and when pink salmon were present at the spawning and post‐spawning stages. Based on our observations, we suggest that the white‐tailed eagle is the main species involved in the transport of pink salmon from the river into the riparian zone in northern Norway and that other scavengers, in particular the red fox (Vulpes vulpes) and common raven (Corvus corax), play an important role in transporting pink salmon carcasses from the riparian zone to the wider terrestrial ecosystem.

Perkembangan fasilitas teknologi mempermudah manusia untuk memanfaatkan berbagai sarana platform digital yang ada termasuk platform User Generated Conten (UCG). Namun, disamping berbagai dampak positif yang ada ternyata juga membawa dampak negatif berupa maraknya pelanggaran hak cipta karya seni musik dan lagu. Tidak adanya pengaturan hukum yang jelas dan tegas bagi perlindungan karya seni dan lagu yang dimanfaatkan melalui sarana platform digital berbasis UGC ini, hal ini tentu bisa menimbulkan kerumitan dalam penegakan hukum bagi pihak-pihak yang tidak bertanggung jawab atas pemanfaatan karya seni dan lagu. Adapun fokus permasalahan yang dikaji dalam penelitian ini adalah “bagaimana pengaturan perlindungan hak cipta karya musik dan lagu di dalam digital services platform berdasarkan Undang-Undang Hak Cipta (UUHC) dan bagaimana perlindungan hak cipta karya seni musik dan lagu di dalam digital services platform berbasis UGC berdasarkan UUHC”. Metode penelitian yang digunakan adalah yuridis normatif yang sumber datanya berbasis pada data sekunder berupa bahan hukum primer dan sekunder. Hasil penelitian menunjukkan bahwa di dalam UUHC masih terdapat kokosongan norma yang mengatur mengenai perlindungan atas pemanfaatan layanan digital platform yang berbasis UGC termasuk pasal-pasal yang mengatur mengenai penegakan hukumnya. Oleh karena itu, penting bagi pemerintah untuk dapat melakukan revisi dan evaluasi terhadap beberap pasal yang relevan di dalam UUHC khususnya terhadap pasal 10 dan pasal 114. Hal ini penting guna memberikan perlindungan hukum dan kepastian hukum terhadap hak ekslusif pencipta dan pemegang hak cipta.