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In our pursuit of a fulfilling and contented life, the study of well-being has emerged as a fundamental field of research. Higher levels of well-being are associated with better mental health outcomes. Individuals with better mental health might possess the personal resources necessary to set and pursue meaningful goals, maintain positive expectations, and overcome adversities. We aim to explore the positive relationship between well-being (hedonic, psychological, and social) and dispositional hope. We suggest that mental health acts as a mediator in this relationship, since improved mental health can create a conducive environment for the development and maintenance of dispositional hope. Data were collected using an e-survey through social media during the last quarter of 2022. The hypothesis of this study was tested using mediation analysis. The sample was composed of 471 participants (85.4% female) with a mean age of 47.72 ± 11.86 years. Participants were mainly workers (88.6%), followed by pensioners (6.8%), university students (2.5%), and unemployed (2.1%). Results revealed that well-being was positively and significantly associated with dispositional hope. Additionally, well-being presented a significant and positive relationship with mental health, which, in turn, also presented a significant and positive relationship with dispositional hope. Finally, using the Hayes process macro for SPSS, we found that mental health mediates the relationship between well-being and dispositional hope. Our findings reinforce the conceptual frameworks that consider well-being and mental health as key contributors to a resilient and optimistic mindset. Interventions that aim to cultivate positive affect, facilitate personal growth, and foster supportive social environments might help improve mental health outcomes.

Abstract Background Infertility is a marginalized sexual and reproductive health issue in low-resource settings. Globally, millions are affected by infertility, but the lack of a universal definition makes it difficult to estimate the prevalence of infertility at the population level. Estimating the prevalence of infertility may inform targeted and accessible intervention, especially for a resource-limited country like Ethiopia. This study aims to estimate the prevalence of female infertility in Ethiopia using the Demographic and Health Survey (DHS) through two approaches: (i) the demographic approach and (ii) the current duration approach. Methods Data from 15,683 women were obtained through the 2016 Ethiopian DHS. The demographic approach estimates infertility among women who had been married/in a union for at least five years, had never used contraceptives, and had a fertility desire. The current duration approach includes women at risk of pregnancy at the time of the survey and determines their current length of time-at-risk of pregnancy at 12, 24, and 36 months. Logistic regression analysis estimated the prevalence of infertility and factors associated using the demographic approach. Parametric survival analysis estimated the prevalence of infertility using the current duration approach. All estimates used sampling weights to account for the DHS sampling design. STATA 14 and R were used to perform the statistical analysis. Results Using the demographic definition, the prevalence of infertility was 7.6% (95% CI 6.6–8.8). When stratified as primary and secondary infertility, the prevalence was 1.4% (95% CI 1.0-1.9) and 8.7% (95% CI 7.5–10.1), respectively. Using the current duration approach definition, the prevalence of overall infertility was 24.1% (95% CI 18.8–34.0) at 12-months, 13.4% (95% CI 10.1–18.6) at 24-months, and 8.8% (95% CI 6.5–12.3) at 36-months. Conclusion The demographic definition of infertility resulted in a lower estimate of infertility. The current duration approach definition could be more appropriate for the early detection and management of infertility in Ethiopia. The findings also highlight the need for a comprehensive definition of and emphasis on infertility. Future population-based surveys should incorporate direct questions related to infertility to facilitate epidemiological surveillance.

Context Robust associations have been identified between fertility during adolescence and the disablement process, including pathologies, impairments, functional limitations and disability. Limited theoretical or empirical research considers how and why such relationships exist generally or with the individual associated components of disablement.Objective To consolidate and critically evaluate literature to describe testable, theory-based hypotheses to guide future research on the mechanisms by which fertility during adolescence contributes to disablement.Methods Targeted literature review of research from diverse global settings contextualised in two well-accepted theoretical frameworks in life-course epidemiology: the cumulative risk model and the critical period approach.Results Five hypothesised causal pathways linking adolescent fertility to disablement in later life are described: 1) Causal relationship initiated by fertility during adolescence; 2) Common cause(s) for both, such as adverse childhood experiences; 3) Contributing cause(s) to adolescent fertility; 4) Interaction between adolescent fertility and other risk factors; and 5) Critical period effects unique to adolescence. Most research on the topic is on pathologies versus functional limitations and disability.Conclusion We highlight promising research avenues to inform future research and interventions on adolescent fertility and the disablement process. This work provides theoretical clarity, identifies research gaps, and offers hypotheses-testing opportunities for future research.

Key Clinical Message Symmetrical drug‐related intertriginous and flexural exanthema, commonly known as “baboon syndrome” due to its typical involvement of the gluteal area, is an erythematous symmetrical rash associated with systemic drug administration.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition that manifests in early childhood, in which the maternal metabolic syndrome may be a risk factor. The kidney is a barometer of maternal metabolic syndrome duration and severity. Objective: The main objective of this study is to determine whether periconceptional kidney function is associated with ASD in early childhood. Design, Setting, and Participants: This retrospective population-based cohort study was completed in Ontario, Canada. Included were singleton children born in an Ontario hospital between April 2007 and March 2021, who were alive at age 48 months and whose mother had a recorded prepregnancy body mass index (BMI) and a measured serum creatinine (SCr) between 120 days preconception and 28 days postconception. Measurement: The main study outcome was a diagnosis of ASD between ages 24 and 48 months. Methods: Relative risks (RRs) of ASD in association with periconceptional SCr were generated using modified Poisson regression and adjusted for several confounders. Results: The cohort comprised 86 054 women, who had 89 677 liveborn children surviving to at least 48 months of age. There was no significant association between periconceptional SCr and ASD (RR: 0.86; 95 % confidence interval: [0.67, 1.10]). Limitations: Selection bias may have arisen had SCr been ordered on clinical grounds. Conclusions: Further study is warranted to determine whether prepregnancy glomerular hyperfiltration is a marker of ASD and other behavioral conditions in childhood. To do so, a more accurate measure of hyperfiltration is needed than SCr.

The global acceleration of the pace of life has led to an increase in working hours, time pressure, and intensification of work tasks in organisations, with consequences for the physical and psychological health of workers. This acceleration and its consequences make it especially relevant to consider the principles of the slow movement and how they can be applied to the work context, focusing on the importance of slowing down the current pace of work and its implications for the sustainability of people and organisations. The key purpose of this study is to define the concept of slow work and understand its relationship with individual and organisational factors in order to extract the structuring dimensions, enabling its empirical study and practical application. Using grounded theory methodology, we conducted 12 semi-structured interviews with leaders of organisations from different sectors. Data analysis was performed using the MAXQDA programme. It was concluded that slow work is a way of working that respects the balance between individual rhythms and the objectives of the organisation, in favour of the sustainability of both parties, and that advocates qualitative goals, thinking time, individual recovery, purpose, and the humanisation of work. The main contribution is the conceptualisation of a construct that may be used in future studies, as well as in the development of organisational policies promoting the slow work culture.

Cluster headache (CH) is the most common and devastating autonomic headache with multiple and recent advances in treatment. However, it usually goes unrecognized and is found to have a delayed and inappropriate treatment. This paper aims to review the current therapeutic options for patients with CH. We conducted a narrative literature review on the treatments available for this condition using the American Academy of Neurology (AAN) classification of therapeutic evidence. We found effective and safe pharmacological and non-pharmacological therapies with heterogeneity of clinical trial designs for patients with CH, and they are divided into three phases, namely, transitional, acute, and preventive interventions. Prednisone (A) is the most studied treatment in the transitional phase; acute attacks are treated using triptans (A), oxygen (A), and non-invasive transcutaneous vagal nerve stimulation (A). Verapamil (A) and monoclonal antibodies (possible A) are considered the first options in preventive treatments, followed by multiple pharmacological and non-pharmacological options in prophylactic treatments. In conclusion, numerous effective and safe treatments are available in treating patients with episodic, chronic, and pharmacoresistant CH according to the clinical profile of each patient.

Plain language summary Premature ovarian insufficiency is the onset of premature menopause in individuals less than 40-years-old. Previous research has shown that there is a higher risk of premature ovarian insufficiency in adolescent and young adult cancer survivors, due to the toxicity of cancer treatments on reproductive organs. Prior research was limited in its applicability by having small sample sizes, only including childhood cancer, excluding young adults, and studying fewer types of cancer. This study was conducted using a large population-based approach, on all females aged 15–39 years old with cancer in Ontario, Canada from 1995 to 2015. We found that there was nearly a 2.5 times greater risk of premature ovarian insufficiency in cancer survivors compared patients without cancer. Compared to patients without cancer, this risk was highest for survivors of leukemia (14 times higher risk), followed by breast cancer (4 times higher risk), lymphomas (2–4 times higher risk), and thyroid cancer (1.2 times higher risk). There is no increased risk in melanoma survivors. The risk was higher in individuals diagnosed with cancer at a later age (30–39 years), with a risk 3 times higher than the population without cancer, while a younger age of diagnosis (15–29 years) carries a risk only 1.75 times higher than the population without cancer. These results should help improve healthcare provider and patient understanding of the risk of premature ovarian insuficiency in young cancer survivors, and guide counseling at the time of cancer diagnosis and during survivorship on future reproductive function.

We conducted a population-based, retrospective, matched-cohort study to examine the impact of breast cancer diagnosis and treatment on fertility outcomes. Relative risks of infertility, childbirth, premature ovarian insufficiency (POI; age < 40) and early menopause (age < 45) were calculated using modified Poisson regression. Our primary cohort included young women (15–39) with early stage BC diagnosed 1995–2014. Five cancer-free patients were matched to each BC patient by birth year and census subdivision. The BC cohort was further divided by treatment with chemotherapy vs. no chemotherapy treatment. 3903 BC patients and 19,515 cancer-free women. BC patients treated with chemotherapy were at increased risk of infertility (RR 1.81; 95% CI 1.60–2.04), and POI (RR 6.25; 95% CI 5.15–7.58) and decreased childbirth (RR 0.85; 95% CI 0.75–0.96), compared to women without cancer. BC patients who did not receive chemotherapy were also at increased risk of infertility (RR 1.80 95% CI 1.48–2.18) and POI (RR 2.12 95% CI 1.37–3.28). All young BC survivors face an increased risk of diagnosed infertility and POI relative to women without cancer, independent of chemotherapy. These results emphasize the importance of pre-treatment fertility counselling for young women diagnosed with BC.

Objectives Adolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This study examines the association between age at first childbirth and mobility disability in national surveys from low-income and middle-income countries, and hypotheses that adolescent childbirth is associated with mobility disability.Design Cross-sectional analysis.Setting Population health surveys from 2013 to 2018 containing mobility disability measures among ever-pregnant women ages 15–49. These included 13 Demographic Health Surveys from Haiti, Pakistan, Uganda, Cambodia, Colombia, South Africa, Timor-Leste, Albania, Gambia, Maldives, Peru, Senegal and Yemen and 1 Maternal Health Survey from Ghana.Participants The sample included 157 988 women ages 15–49 years.Primary outcome measure Adolescent childbirth was defined as 10–19 years of age. Poisson regression models were used to estimate prevalence ratios (PRs) of mobility disability among women who first gave birth during adolescence and in adult life (ages 20–45 years) in each country and across the whole sample. Countries were also analysed according to the use of standard and non-standard mobility disability measures. Covariates included current age, urban/rural residence, education and household wealth.Results Prevalence of adolescent childbirth (17.5%–66.2%) and mobility disability (0.32%–21.45%) varied widely across countries. Adolescent childbirth was significantly (p

The novel coronavirus disease (COVID-19) that currently plagues the world and caused by SARS-CoV-2, has spread internationally since late 2019. The dermatologic manifestations of this virus are currently being identified. We describe a 73-year-old Caucasian female who presented to many physicians for recurrent Herpes zoster episodes that persisted, despite treatment with multiple antiviral medications. The patient was diagnosed with COVID-19 before an onset of vesicular pustular lesions. The clinical diagnoses were recurrent herpes zoster and recurrent varicella. A skin biopsy was obtained and stained with hematoxylin and eosin to confirm a diagnosis. Immunohistochemical stains for Ki-67, Phospho-Histone H3, galectin 3, glypican and IgD were positive in multinucleated cells of the skin, where the viral lesions were detected. Recidivated herpes zoster and varicella are currently being clinically associated with COVID- 19; the abnormal immune response in patients with COVID-19 may be due to the overexpression of molecules that facilitate the outbreak of these viruses.

La alimentación saludable es un elemento relevante para el bienestar de las personas; ayuda a evitar la desnutrición, al igual que enfermedades no transmisibles, por ello, resulta importante el conocer cuáles son aquellos alimentos más consumidos por parte de los ecuatorianos según la región en la que residen, con el fin de determinar cómo la alimentación presente en estas regiones influye en la salud de sus habitantes. En la presente investigación se realiza un análisis de los tipos de alimentación en las regiones Costa y Sierra del Ecuador. Para ello se empleó a las redes sociales como fuentes de datos, ya que cada vez son más utilizadas para compartir información u opiniones acerca de situaciones o elementos de diversas índoles, siendo Twitter la empleada, por ser una de las redes sociales más importantes para ello. La recolección de datos de la red social Twitter se llevó a cabo mediante el uso del lenguaje de programación Python y estuvo enfocada en Tweets que aluden a la alimentación, comparando datos de las ciudades de la Sierra y la Costa, clasificando alimentos saludables y no saludables y tipos de alimentos, lo que permite identificar en cada región los alimentos más relevantes. También se analiza la valoración del Tweets, en cuanto a cantidad de interacciones de los mismos. Obteniendo que en la Sierra se consumen alimentos más saludables, los resultados son visualizados en diferentes reportes en Power BI.

Abstract Background Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC). Methods We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups. Results Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60–1.80; I2 = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20–1.50; I2 = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00–6.51; I2 = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58–1.92; I2 = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33–1.53; I2 = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively). Conclusions Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.

Abstract Background Caesarean section rates are higher among pregnancies conceived by assisted reproductive technology (ART) compared to spontaneous conceptions (SC), implying an increase in neonatal and maternal morbidity. We aimed to compare caesarean section rates in ART pregnancies versus SC, overall, by indication (elective versus emergent), and by type of ART treatment (in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), fresh embryo transfer, frozen embryo transfer) in a systematic review and meta-analysis. Methods We searched Medline, EMBASE and CINAHL databases using the OVID Platform from 1993 to 2019, and the search was completed in January 2020. The eligibility criteria were cohort studies with singleton conceptions after in-vitro fertilization and/or intracytoplasmic sperm injection using autologous oocytes versus spontaneous conceptions. The study quality was assessed using the Newcastle Ottawa Scale and GRADE approach. Meta-analyses were performed using odds ratios (OR) with a 95% confidence interval (CI) using random effect models in RevMan 5.3, and I-squared (I2) test > 75% was considered as high heterogeneity. Results One thousand seven hundred fifty studies were identified from the search of which 34 met the inclusion criteria. Compared to spontaneous conceptions, IVF/ICSI pregnancies were associated with a 1.90-fold increase of odds of caesarean section (95% CI 1.76, 2.06). When stratified by indication, IVF/ICSI pregnancies were associated with a 1.91-fold increase of odds of elective caesarean section (95% CI 1.37, 2.67) and 1.38-fold increase of odds of emergent caesarean section (95% CI 1.09, 1.75). The heterogeneity of the studies was high and the GRADE assessment moderate to low, which can be explained by the observational design of the included studies. Conclusions The odds of delivering by caesarean section are greater for ART singleton pregnancies compared to spontaneous conceptions. Preconception and pregnancy care plans should focus on minimizing the risks that may lead to emergency caesarean sections and finding strategies to understand and decrease the rate of elective caesarean sections.

Cutaneous vasculitides include a widespread and heterogeneous cluster of diseases affecting the blood vessels that are clinically characterized by polymorphic skin lesions, including palpable purpura, urticarial and/or necrotic-ulcerative lesions. Often, they can be manifestations of a systemic disease. Selected cases occur in the mouth. A 75-year-old female presented to her physician for the sudden appearance of blisters in her mouth, with severe orodynia and no history of other diseases or medication intake. A skin biopsy of the oral mucosa yielded a diagnosis of leukocytoclastic vasculitis. The direct immunofluorescence and immunohistochemistry stains demonstrated deposits of IgD, IgG, IgA, IgM, kappa, lambda, C1q, C3c, albumin and fibrinogen at the upper dermal neurovascular plexus. IgD also demonstrated positive nucleolar staining of the keratinocytes. Our case involves a rare presentation of oral cutaneous vasculitis with immune deposits of several immunoglobulins, complement, albumin and fibrinogen. Our case adds importance to studies of the IgD role in antigenic complex immune responses, especially in the mouth.

The COVID-19 pandemic produced unprecedented challenges to healthcare and medical device manufacturing (e.g. personal protective device and replacement part shortages). Additive manufacturing, 3D printing, and the maker community were uniquely positioned to respond to these needs by providing in-house design and manufacturing to meet the needs of clinicians and hospitals. This paper reviews the pandemic response of Children's Hospital of Philadelphia CHAMP 3D Lab, a point-ofcare3D printing team that supports clinical and research projects across the hospital network. The CHAMP team responded to a variety of COVID-19 healthcare needs including providing protective eyewear and ventilator components, creating a transport hook, and designing a novel transparent facemask. This case series details our response to these needs, describing challenges experienced and lessons learned in overcoming them so that others may learn from our experiences. Challenges to responding to the pandemic included the need to handle urgent pandemic related requests in addition to our standard fare. This required us to not only expand our capacity without additional resources, but also to develop a system of prioritization. Specific changes made included: streamlining workflows, identifying safety review processes, and developing/enlisting a network of collaborators. Further, we consider how to transition to a future, post-pandemic world without losing the cohesive drive of emergency-induced innovation. This paper aims to share what we have learned and to encourage both teams currently engaged in the printing community and those looking to join it

Abstract Background Although it is known that Zika virus (ZIKV) infection during pregnancy may lead to microcephaly in the fetus, the prognostic factors associated with this tragic disorder remain unclear. We conducted a systematic review and meta-analysis to assess the prognostic factors associated with the incidence of microcephaly in congenital ZIKV infection. Methods We conducted a comprehensive search in Ovid MEDLINE, Ovid MEDLINE (R) Epub ahead of print, Embase, Embase Classic, Web of Science, CINAHL, Cochrane CENTRAL, LILACS, and various thesis databases to identify human studies reporting microcephaly associated with congenital ZIKV infection. We requested primary data from the authors of the included studies to calculate summary estimates and conduct the meta-analysis of the most prevalent factors. Results We screened 4106 titles and abstracts, and identified 12 studies for inclusion in the systematic review. The assessment of ZIKV infection and the definition of microcephaly varied among studies. A total of 6154 newborns/fetuses were enrolled; of those, 1120 (18.20%) had a diagnostic of ZIKV infection, of which 509 (45.45%) were diagnosed with microcephaly. Nine studies addressed the link between congenital ZIKV infection and neurological findings in newborns/fetuses. Half of the studies provided primary data. Three out of 11 factors of interest seem to be prognostic factors of microcephaly: infant’s sex – males compared to females: Relative Risk (RR) 1.30, 95% Confidence Interval (95% CI) 1.14 to 1.49; the stage of pregnancy when infection occurred – infection in the first trimester of pregnancy compared to infection at other stages of pregnancy: RR 1.41, 95% CI 1.09 to 1.82; and asymptomatic infection compared to symptomatic infection during pregnancy: RR 0.68; 95% CI 0.60 to 0.77. Conclusion Our findings support the female-biased resistance hypothesis and reinforce the risk associated with the stage of pregnancy when ZIKV infection occurs. Continued surveillance of ZIKV infection during pregnancy is needed to identify additional factors that could contribute to developing microcephaly in affected fetuses. Protocol registration This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD 42018088075 .

Background and Aims. Childbirth in women with cirrhosis is increasing and associated with a higher risk of perinatal outcomes compared to the general population. Whether pregnancy influences the risk of liver-related events compared to nonpregnant women with cirrhosis is unclear. This study evaluates the association between pregnancy and liver-related outcomes in women with compensated cirrhosis. Approach and Results. Population-based retrospective matched cohort study in Ontario, Canada, using routinely collected healthcare data. Pregnant women with compensated cirrhosis and without prior history of decompensation between 2000 and 2016 were identified and matched to nonpregnant women with compensated cirrhosis on age, etiology of cirrhosis, and socioeconomic status in a 1 : 2 ratio. The association between pregnancy and the composite outcome of nonmalignant decompensation, liver transplant (LT), and death up to two years after cohort entry was estimated using the multivariate Cox proportional hazard regression adjusting for potential confounders. Overall, 5,403 women with compensated cirrhosis were included (1,801 pregnant; 3,602 nonpregnant; median age 31 years (IQR 27-34); 60% nonalcoholic fatty liver disease, 34% viral hepatitis). After two years of follow-up, only 19 (1.1%) pregnant women had a liver-related event compared to 319 (8.9%) nonpregnant women. Pregnant women with compensated cirrhosis had a lower hazard of a liver-related event compared to nonpregnant women (aHR 0.14, 95% CI 0.09-0.22, P

Madagascar’s biota underwent substantial change following human colonization of the island in the Late Holocene. The timing of human arrival and its role in the extinction of megafauna have received considerable attention. However, the impacts of human activities on regional ecosystems remain poorly studied. Here, we focus on reconstructing changes in the composition of terrestrial and aquatic ecosystems to evaluate the impact of human land use and climate variability. We conducted a paleoenvironmental study, using a sediment record that spans the last ∼1,145 years, collected from a lakebed in the Namonte Basin of southwest Madagascar. We examined physical (X-ray fluorescence and stratigraphy) and biotic indicators (pollen, diatoms and micro- and macro-charcoal particles) to infer terrestrial and aquatic ecosystem change. The fossil pollen data indicate that composition of grasslands and dry deciduous forest in the region remained relatively stable during an arid event associated with northward displacement of the Intertropical Convergence Zone (ITCZ) between ∼1,145 and 555 calibrated calendar years before present (cal yr BP). Charcoal particles indicate that widespread fires occurred in the region, resulting from a combination of climate drivers and human agency during the entire span covered by the paleorecord. Following settlement by pastoral communities and the disappearance of endemic megafauna ∼1,000 cal yr BP, grasslands expanded and the abundance of trees that rely on large animals for seed dispersal gradually declined. A reduction in the abundance of pollen taxa characteristic of dry forest coincided with an abrupt increase in charcoal particles between ∼230 and 35 cal yr BP, when agro-pastoral communities immigrated into the region. Deforestation and soil erosion, indicated by a relatively rapid sedimentation rate and high K/Zr and Fe/Zr, intensified between 180 and 70 cal yr BP and caused a consequent increase in lake turbidity, resulting in more rapid turnover of the aquatic diatom community. Land use and ongoing climate change have continued to transform local terrestrial and freshwater ecosystems during the last ∼70 years. The current composition of terrestrial and aquatic ecosystems reflects the legacy of extinction of native biota, invasion of exotic species, and diminished use of traditional land management practices.

Objective:. To describe work-related factors, pregnancy, and pregnancy outcomes in female surgeons is the objective of this study. Background:. Some data suggest surgeon workload may deter pregnancy and adversely affect pregnancy outcomes in female surgeons. Methods:. A cross-sectional, web-based survey was distributed via e-mail to members of the Society of Obstetrics and Gynaecologists of Canada and to surgical departments of 6 Canadian universities from October 2019 to January 2020. Results:. A total of 223 surgeons with 451 pregnancies participated. Work hours were reduced in 33.3% of pregnancies, and 28.0% had a policy for pregnancy in their workplace. A total of 57% of surgeons intentionally delayed pregnancy due to heavy workload and 39% to career concerns, and 31% reported work adversely affected their pregnancy. Adverse maternal outcomes included miscarriage (14.9%), preterm labor (6.2%), hypertension (5.5%), pre-eclampsia (2.9%), and placenta praevia (1.3%). Adverse infant outcomes included preterm birth (6.9%), small for gestational age at birth (6.9%), and neonatal intensive care unit admission (4%). Congenital anomalies occurred in 4.2% of pregnancies. Surgeons who reported a policy for working while pregnant were more likely to have reduced their work hours than those without a policy (48.4% vs 28.5% respectively, P < 0.0001). In unadjusted models, those who reduced their work hours while pregnant were less likely to have a miscarriage than those who did not (odds ratio = 0.2, 95% confidence interval, 0.1–0.4). Conclusions:. Female surgeons reported delays in pregnancy due to work, adverse effects of work on pregnancy, and some elevated rates of adverse outcomes. These data support policies for pregnancy in surgeons and surgical trainees.

Abstract Background Between 1 and 5% of children in industrialized countries are conceived through Assisted Reproductive Technologies (ART). As infertility and the use of ART may be associated with adverse perinatal outcomes, care plans specific to these pregnancies are needed. We conducted a systematic review to examine the existing care plans specific to women pregnant following Assisted Reproductive Technologies (ART). Methods MEDLINE, Embase and the Cochrane Library were searched by a senior information specialist. The population of interest included women becoming pregnant with ART (e.g., Intra-Uterine Insemination, In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), and surrogacy). All proposed care plans were sought that pertained to any aspect of care during pregnancy and delivery. Only Clinical Practice Guidelines (CPGs) addressing the recommendations and plans for the care of ART pregnant women were included. The search was restricted to the publication dates 2007 to June 12, 2017 when the search was run. The search was not restricted by language, however only English and French language guidelines were considered for inclusion. Results After screening 2078 citations, a total of ten CPGs were included. The following key clinical messages were prevalent: (1) although there was no supporting evidence, antenatal care for ART pregnancies should be provided by specialist with knowledge in obstetrics; (2) high-order multiple pregnancies are the greatest risk of ART and selective reduction options should be discussed; (3) there is some evidence of increased risk of congenital abnormalities and prenatal genetic and anatomic screening is recommended, especially in IVF-ICSI pregnancies; (4) due to a lack of or conflicting evidence, treatment of venous thromboembolism, antithrombotic therapy, treatment for hypothyroidism, and women with positive thyroid antibodies is recommended to be the same as in spontaneous pregnancies; and lastly (5) since an increased level of distress is a recognized feature in these pregnancies, psychosocial care and counselling should be considered. Conclusions There is a lack of CPGs specific to ART pregnancies. While we identified a small number of recommendations for ART pregnancies, specific interventions and models of care aiming at decreasing adverse maternal and perinatal outcomes following ART should be developed, implemented, and evaluated.

Introduction Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk.Methods and analysis This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study.Ethics and dissemination The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l’Estrie–CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation.Trial registration number ChiCTR1800017773.Protocol version November 11, 2020 (Version #5).

Cancer patients are highly vulnerable to SARS-CoV-2 infections due to frequent contacts with the healthcare system, immunocompromised state from cancer or its therapies, supportive medications such as steroids and most importantly their advanced age and comorbidities. Patients with lung cancer have consistently been reported to suffer from an increased risk of death compared with other cancers. This is possibly due to the combination of specific pathophysiological aspects, including underlying pulmonary compromise due to smoking history and the increased specific pressures on respiratory healthcare services caused by the related pandemic. Rationally and safely treating patients with lung cancer during the pandemic has become a continuous challenge over the last year. Deciding whether to offer, modify, postpone or even cancel treatments for this particular patient’s population has become the crucial recurrent dilemma for lung cancer professionals. Chemotherapy, immunotherapy and targeted agents represent distinct risks factors in the context of COVID-19 that should be balanced with the short-term and long-term consequences of delaying cancer care. Despite the rapid and persistent trend of the pandemic, declared by WHO on March 11, 2020, and still ongoing at the time of writing (January 2021), various efforts were made by oncologists worldwide to understand the impact of COVID-19 on patients with cancer. Adapted recommendations of our evidence-based practice guidelines have been developed for all stakeholders. Different small and large-scale registries, such as the COVID-19 and Cancer Consortium (CCC19) and Thoracic Cancers International COVID-19 Collaboration quickly collected data, supporting cancer care decisions under the challenging circumstance created by the COVID-19 pandemic. Several recommendations were developed as guidance for prioritizing the various aspects of lung cancer care in order to mitigate the adverse effects of the COVID-19 healthcare crisis, potentially reducing the morbidity and mortality of our patients from COVID-19 and from cancer. These recommendations helped inform decisions about treatment of established disease, continuation of clinical research and lung cancer screening. In this review, we summarize available evidence regarding the direct and indirect impact of the COVID-19 pandemic on lung cancer care and patients.

Abstract Background Zika infection during pregnancy (ZIKVP) is known to be associated with adverse outcomes. Studies on this matter involve both rare outcomes and rare exposures and methodological choices are not straightforward. Cohort studies will surely offer more robust evidences, but their efficiency must be enhanced. We aim to contribute to the debate on sample selection strategies in cohort studies to assess outcomes associated with ZKVP. Main body of the abstract A study can be statistically more efficient than another if its estimates are more accurate (precise and valid), even if the studies involve the same number of subjects. Sample size and specific design strategies can enhance or impair the statistical efficiency of a study, depending on how the subjects are distributed in subgroups pertinent to the analysis. In most ZIKVP cohort studies to date there is an a priori identification of the source population (pregnant women, regardless of their exposure status) which is then sampled or included in its entirety (census). Subsequently, the group of pregnant women is classified according to exposure (presence or absence of ZIKVP), respecting the exposed:unexposed ratio in the source population. We propose that the sample selection be done from the a priori identification of groups of pregnant women exposed and unexposed to ZIKVP. This method will allow for an oversampling (even 100%) of the pregnant women with ZKVP and a optimized sampling from the general population of pregnant women unexposed to ZIKVP, saving resources in the unexposed group and improving the expected number of incident cases (outcomes) overall. Conclusion We hope that this proposal will broaden the methodological debate on the improvement of statistical power and protocol harmonization of cohort studies that aim to evaluate the association between Zika infection during pregnancy and outcomes for the offspring, as well as those with similar objectives.

Allergies and autoimmune diseases may both be considered hyper-immune responses, where the body’s immune system becomes supercharged and attacks or responds to inappropriate antigens. We describe a skin rash with a mixed allergic and autoimmune host response. A 65 year old female consulted her dermatologist for a pruritic rash. The patient had taken many medications without improvement of the rash, and lived in an area affected by environmental spills; other patients had presented with similar rashes concurrently. A clinical evaluation was performed, and skin biopsies were obtained for hematoxylin and eosin (H&E) examination, as well as for immunohistochemical (IHC) and direct immunofluorescence (DIF) studies. The H&E review revealed a mild, superficial, perivascular dermal infiltrate of lymphocytes, histiocytes, mast cells and eosinophils. Dermal sclerodermoid alterations were also noted. A mild peripheral blood eosinophilia was found; cutaneous IHC staining revealed staining for anti-HLA-DP, DQ, DR antigen and Complement/C5b-9/MAC, in the areas of the perivascular infiltrate and the sclerodermoid changes. The DIF confirmed these findings. Our case is characterized by a mixed allergic/autoimmune reaction, which did not fit exclusively into any single Gell Coombs immune response category.

Erythema multiforme is an acute, often self-limited and occasionally lethal syndrome with distinctive skin lesions and/or mucosal lesions; the disease has multiple triggers, including medications. We describe a 68 year old African American female on multiple medications; the patient suddenly presented with recurrent, flaccid bullae and erythematous circular lesions on her face, neck, genitals, hands and legs. Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) stains were performed. The histology displayed erythema multiforme with epidermal blisters, defragmented melanocytes and other cell debris inside the blister. DIF revealed deposits of IgG, IgM, IgA, IgD, Complement/C3, C4, and fibrinogen within the epidermis; and around upper dermal vessels. Anti-neutrophil cytoplasmic antibodies (c-ANCAS) were present as part of “large round bodies” inside the blisters, and as part of both cytoid and colloid bodies. Staining for Von Willembrand factor, CD68, myeloperoxidase and CD45 was seen on cell fragments within the blisters, as well as within the inflammatory infiltrate in the dermis. In this case cystoid, colloid and “large round bodies” may represent amalgamations of multiple cell fragments, with immunoglobulins and complement. Overall, a strong immunologic response was observed with c-ANCAs, caused by multiple medications.

Scalarama is a strange beast in the odd world of film festivals. Billed as “a celebration of cinema”, its screenings do not necessarily, or mainly, take place in cinemas. There are no awards or limousines, no jury and no star curator. Instead, dozens of autonomous groups and individuals choose films they want to show, organise the logistics of licenses and spaces, and use Scalarama as a framework to make their screenings more visible and more viable. In principle, anyone wanting to show films in the month of September can be part of the Scalarama programme. Given this openness, the spontaneous coherence of the festival speaks of a shared understanding, not always explicit but articulated by the history and networks through which Scalarama connects.

Psoriasis is an inflammatory skin disease. Five classic types of psoriasis have been defined: plaque, inverse, pustular, guttate, and erythrodermic. The early psoriasis immunologic skin immune response is not well understood. Here we aim to show an immune and cell signaling response in a case of early psoriasis. A 56 year old female presented with a desquamative lesion on her right leg. A skin biopsy for hematoxylin and eosin (H&E) and immunohistochemistry (IHC) staining was taken. The diagnosis indicated early psoriasis, and IHC showed positive IgD staining in the epidermal corneal layer, as well as positive staining with ribosomal protein S6-pS240 (RIBO) in the hyperproliferative epidermis. Cyclooxygenase-2 (COX-2) was also very positive in the granular layer in spots, at the basement membrane zone of the skin and in the inflammatory infiltrate in the dermis subjacent to hyperproliferative psoriatic areas. In an early case of psoriasis, we confirmed the presence of IgD, RIBO and COX-2. Each molecule seems to be playing a role in inflammation and intracellular signaling pathways in early psoriasis. The role of IgD is unknown, and this case brings to light the complexity of the pathologic changes occurring in early psoriatic lesions.

Atypical (dysplastic) melanocytic nevi are considered for many as an intermediate step in a clinicopathologic spectrum. Regression is often seen. A 45 year old male presented with a hyperpigmented macule on the patient’s back. Biopsies for hematoxylin and eosin (H&E) examination and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated a compound dysplastic nevus. IHC stain shows stains with galectin 3, CD45, B-cell lymphoma 2 cyclooxygenase-2 ribosomal protein S6-ps240 (RIBO), CD68 and tyrosinase. Some stains were not only present in the tumor, but around it. We described a case of compound dysplastic nevi with a likely effectual early antitumoral response avoiding the growth to melanoma. The fundamental mechanism has not been elucidated, but our findings indicate a mix of inflammatory as well as immune response mediators maybe involved in the immune-based obliteration of melanocytes.

Background: A new variant of endemic pemphigus foliaceus in El Bagre (El Bagre-EPF), Colombia, South America, shares features with Senear-Usher syndrome and occurs in an endemic fashion. Patients affected by El Bagre-EPF have heterogeneous antigenic reactivity not only to the skin but to other organs, including the heart. Here we test for autoantibodies to the areae compositaeof the heart (structure consisting of typical desmosomal amalgamated fascia adherensmolecules)and evaluate any possible clinical correlation. Methods: A case-control study comparing 45 patients and 45 controls from the endemic area, matched by demographics including age, gender, weight, work activities, and comorbidities, was performed. Direct and indirect immunofluorescence, immunohistochemistry, confocal microscopic studies, and echocardiogram studies were completed. Results: The main clinical abnormally seen in the El Bagre-EPF patients was left ventricular hypertrophy in 15/45 patients, compared with no such findings in the control population (P < 0.1). Seventy percent of El Bagre-EPF patients and none of the controls displayed polyclonal autoreactivity using different immunoglobulins and complement to the areae compositae of the heart using different methods and antibodies (P < 0.1). Conclusions: Patients affected by El Bagre-EPF demonstrated autoantibodies to the areae compositae of the heart. This finding was associated with left ventricular hypertrophic cardiomyopathy.The areae compositaemay play a role incell junction tension and the El Bagre-EPF patients’ autoantibodies possibly disrupting these junctions and thereby contributing to the left ventricular hypertrophy.

Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs.

The subepidermal vesiculobullous disorders include a wide variety of pathogenically unrelated entities, which share the formation of clefts or bullae. A 59 year old female presented with a sudden eruption of pruritic skin vesicles and blisters on several areas of her body. The patient was taking multiple medications. We decided to test for the expression of p0071 and ARVCF because they are linked with tight, adherens, and occludens cell junctions in the epidermis and the dermis, and study if these molecules participate in the bullae formation. Skin biopsies were taken from lesional skin and were tested by hematoxylin and eosin(H&E) staining, as well as via immunohistochemistry (IHC) and direct immunofluorescence(DIF) using multiple antibodies. ARVCF and p0071 were overexpressed in the epidermis, and in dermal cell junctions around the blisters along with ribosomal protein S6-pS240, Factor XIIIa, CD15, CD45, multiple immunoglobulins, complement, fibrinogen and HLA-DP, DQ, DR antigen. All these molecules were also overexpressed around dermal vessels, eccrine glands and in neurovascular cell junctions below the blister. A normal control did not display the overexpression. Drug reactions may cause blisters; regional cell junctions may be altered, as demonstrated by overexpression of ARVCF and p0071. The overexpression likely contributes to passage of immunologic cells and formation of edema, directly contributing to blister formation.

The ventral tegmental area (VTA) plays an important role in the reward and motivational processes that facilitate the development of drug addiction. Presynaptic α1-AR activation modulates glutamate and Gamma-aminobutyric acid (GABA) release. This work elucidates the role of VTA presynaptic α1-ARs and their modulation on glutamatergic and GABAergic neurotransmission during cocaine sensitization. Excitatory and inhibitory currents (EPSCs and IPSCs) measured by a whole cell voltage clamp show that α1-ARs activation increases EPSCs amplitude after 1 day of cocaine treatment but not after 5 days of cocaine injections. The absence of a pharmacological response to an α1-ARs agonist highlights the desensitization of the receptor after repeated cocaine administration. The desensitization of α1-ARs persists after a 7-day withdrawal period. In contrast, the modulation of α1-ARs on GABA neurotransmission, shown by decreases in IPSCs’ amplitude, is not affected by acute or chronic cocaine injections. Taken together, these data suggest that α1-ARs may enhance DA neuronal excitability after repeated cocaine administration through the reduction of GABA inhibition onto VTA dopamine (DA) neurons even in the absence of α1-ARs’ function on glutamate release and protein kinase C (PKC) activation. α1-AR modulatory changes in cocaine sensitization increase our knowledge of the role of the noradrenergic system in cocaine addiction and may provide possible avenues for therapeutics.

Background: We have described a variant of endemic pemphigus foliaceus (EPF) in El Bagre area known as pemphigus Abreu-Manu. Our previous study suggested that Colombian EPF seemed to react with various plakin family proteins, such as desmoplakins, envoplakin, periplakin BP230, MYZAP, ARVCF, p0071 as well as desmoglein 1. Objectives: To explore whether patients affected by a new variant of endemic pemphigus foliaceus (El Bagre-EPF) demonstrated oral involvement. Materials and Methods: A case-control study was done by searching for oral changes in 45 patients affected by El Bagre-EPF, as well as 45 epidemiologically matched controls from the endemic area matched by demographics, oral hygiene habits, comorbidities, smoking habits, place of residence, age, sex, and work activity. Oral biopsies were taken and evaluated via hematoxylin and eosin staining, direct immunofluorescence, indirect immunofluorescence, confocal microscopy, and immunohistochemistry. Results: Radicular pieces and loss of teeth were seen in in 43 of the 45 El Bagre-EPF patients and 20 of the 45 controls (P < 0.001) (confidence interval [CI] 98%). Hematoxylin and eosin staining showed 23 of 45 El Bagre-EPF patients had corneal/subcorneal blistering and lymphohistiocytic infiltrates under the basement membrane zone and around the salivary glands, the periodontal ligament, and the neurovascular bundles in all cell junction structures in the oral cavity; these findings were not seen in the controls (P < 0.001) (CI 98%). The direct immunofluorescence, indirect immunofluorescence, confocal microscopy, and microarray staining displayed autoantibodies to the salivary glands, including their serous acini and the excretory duct cell junctions, the periodontal ligament, the neurovascular bundles and their cell junctions, striated muscle and their cell junctions, neuroreceptors, and connective tissue cell junctions. The autoantibodies were polyclonal. IgA autoantibodies were found in neuroreceptors in the glands and were positive in 41 of 45 patients and 3 of 45 controls. Conclusions: Patients affected by El Bagre-EPF have some oral anomalies and an immune response, primarily to cell junctions. The intrinsic oral mucosal immune system, including IgA and secretory IgA, play an important role in this autoimmunity. Our data contradict the hypothesis that pemphigus foliaceus does not affect the oral mucosa due to the desmoglein 1-desmoglein 3 compensation.

Information contained in this 4-page publication is intended for Florida blueberry growers to use as a guide in the identification of anthracnose, a group of fungal pathogens that affects a wide range of plants, including southern highbush blueberries (SHB). Written by Douglas A. Phillips, Maria C. Velez-Climent, Philip F. Harmon, and Patricio R. Munoz and published by the UF/IFAS Plant Pathology Department, May 2018. https://edis.ifas.ufl.edu/pp337

Background: The majority of the patients affected by a new variant of endemic pemphigus foliaceus in El Bagre, Colombia (El Bagre EPF or pemphigus Abreu-Manu), have experienced vision problems; we have previously reported several ocular abnormalities. Methods: Here, we aimed to investigate reactivity to optic nerves in these patients. We utilized bovine, rat and mouse optic nerves, and performed immunofluorescence and confocal microscopy to test for optical nerve autoreactivity. We tested 45 patients affected by this disease and 45 controls from the endemic area matched by age, sex and work activity. Results: Overall, 37 of the 45 patient sera reacted to the optic nerve envelope that is composed of leptomeninges; the reactivity was polyclonal and present mostly at the cell junctions (P < 0.001). The immune response was directed against optic nerve sheath cell junctions and the vessels inside it, as well as other molecules inside the nerve. No control cases were positive. Of interest, all the patient autoantibodies co-localized with commercial antibodies to desmoplakins I–II, myocardium-enriched zonula occludens-1- associated protein (MYZAP), armadillo repeat gene deleted in velo-cardio-facial syndrome (ARVCF), and plakophilin-4 (p0071) from Progen Biotechnik (P < 0.001). Conclusion: We conclude that the majority of the patients affected by pemphigus Abreu-Manu have autoantibodies to optic nerve sheath envelope cell junctions. These antibodies also co-localize with armadillo repeat gene deleted in velo-cardio-facial syndrome, p0071 and desmoplakins I–II. The clinical significance of our findings remains unknown.