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Alaric has often been seen as the leader of the Visigothic people, from 395 to his death in 410. Before his rebellion against the Roman Empire in 395, he served in the Roman military, participating in the campaign against Eugenius and Arbogast in 394. His early career is mentioned in the work of the historian Zosimus. But his background is shrouded in mystery. In the middle of the 6th century, Jordanes wrote about his noble origin and the Visigothic dynasty of Balthi. This has led some historians to look for Alaric’s origins among the chieftains and nobility of the Gothic tribe of the Thervingi. Among contemporary authors, only the verses of the poet Claudian mention Alaric’s birth. This article explores the possibilities of Alaric’s origin and the internal policies of the Goths living in Roman territory. Most likely, the person of Alaric was more closely associated with the Roman army than is usually thought.

The fatty acid (FA) composition of milk fat can be positively influenced by the modification of dairy farming and the possible selection of raw material for processing. The question arises as to whether the benefits of a better FA composition will be maintained even after processing dairy products. Thus, the aim was to obtain a more favourable FA composition by a targeted selection of cow's milk (grazing vs stabled herds) and then compare FAs of milk and fermented product (yoghurt). Bulk tank milk of grazing herds had significantly better FA composition than milk of stabled herds (for example, C16:0 28.07% vs 32.27%, P < 0.001; C18:3n-3 0.83% vs 0.41%, P < 0.001; C18:2 cis-9, trans-11 (conjugated linoleic acid; CLA) 1.02% vs 0.41%, P < 0.01). The differences between the FAs in milk and yoghurt samples were negligible (in relative values from 0.04% to 5.21%). The correlations between milk and yoghurt for nutritionally important FAs were high, from 0.925 0 (C18:2n-6) to 0.998 8 (CLA; both P < 0.001). The minimal effect of milk fermentation on the original FA composition of milk fat was found. In conclusion, systematic selection of raw cow's milk or modification of farming conditions can also provide a nutritionally desirable composition of final dairy products.

In some cases, making of physical abuse diagnosis can be difficult if the findings were derived from an unusual disease or an unexpected finding of a common disease. A female infant was admitted to emergency department of our hospital, who was suffering from loss of consciousness. Examination and imaging methods revealed subarachnoid hemorrhage, old and new femur fractures, bilateral retinal hemorrhage. Performing genetic tests with multidisciplinary approach concluded that our case was found to have a mutation, DOCK8 (NM_001190458; c.2071G>A; p.Val691Met), suggests to Job syndrome (JS). JS is not only an immunodeficiency syndrome but also can be manifested by skeletal and connective tissue disorders. The fractures were most likely due to JS. Physicians must be aware of these probabilities. On the other hand, though it was only reported in a heterozygous form in GenomAD (genome aggregation database) it has big value that it was homozygous in our case.

Study objectivesThe coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in a single individual, also known as overlap syndrome (OVS), is associated with higher cardiovascular risk and mortality than either OSA or COPD alone. However, the underlying mechanisms remain unclear. We hypothesized that patients with OVS have elevated systemic inflammatory biomarkers relative to patients with either disease alone, which could explain greater cardiovascular risk observed in OVS.MethodsWe included 255 participants in the study, 55 with COPD alone, 100 with OSA alone, 50 with OVS, and 50 healthy controls. All participants underwent a home sleep study, spirometry, and a blood draw for high-sensitivity C-reactive protein and total blood count analysis. In a randomly selected subset of 186 participants, inflammatory protein profiling was performed using Bio-Rad Bio-Plex Pro Human Cytokine 27-Plex Assays. Biomarker level differences across groups were identified using a mixed linear model.ResultsLevels of interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and granulocyte colony stimulating factor (G-CSF) were higher in participants with OVS and COPD compared with healthy controls and participants with OSA. Furthermore, participants with OVS had higher circulating levels of leukocytes and neutrophils than those with COPD, OSA, and controls.ConclusionsCOPD and OVS are associated with higher systemic inflammation relative to OSA and healthy controls. This work proposes the potential utilization of interleukin 6, granulocyte colony stimulating factor, and high-sensitivity C-reactive protein as screening biomarkers for COPD in patients with OSA. Inflammatory pathways may not fully explain the higher cardiovascular risk observed in OVS, indicating the need for further investigation.CitationSanchez-Azofra A, Gu W, Masso-Silva JA, et al. Inflammation biomarkers in OSA, chronic obstructive pulmonary disease, and chronic obstructive pulmonary disease/OSA overlap syndrome. J Clin Sleep Med. 2023;19(8):1447-1456.

The favourable social climate of the teaching staff is one of the key indicators of the quality of school functioning. The text presents five research phases of a qualitative longitudinal pre-post quasi-experiment implemented in the environment of school life. In 37 schools, the climate of the teaching staffs was repeatedly measured with the OCDQ-RS questionnaire in the pre- and post-intervention phase of the experiment. In six of these schools, qualitative research procedures were carried out in order to determine the causes and contexts of the state of the climate and intervention procedures aimed at supporting the development of a favourable teaching staff climate. In the post-intervention phase, focus groups were implemented in six intervened schools to supplement the context. The aim of the research was to find out what effects intervention procedures can have on the climate and under what conditions they can be successful. The results confirm repeated findings about the key role of school leadership in shaping and maintaining a favourable climate of the staff by increasing trust across the staff, promoting open communication and meaningful cooperation of all actors, and leading to shared meanings of events in the school and general acceptance of the school’s values and concept.

Abstract Canine liposarcoma is an uncommon tumor that shares morphological similarities with its human counterpart. In dogs, the genetic features of this tumor are unknown and, based on immunohistochemical studies, amplification of the gene MDM2 and the mutation of TP53 are suspected. In this study 51 cases of primary liposarcomas were immunohistochemically stained for MDM2 and p53 and subjected to fluorescent in situ hybridization and next-generation sequencing to detect MDM2 amplification and TP53 mutations, respectively. MDM2 and p53 were expressed in 21 and 6 cases, respectively. MDM2 amplification and TP53 mutations were identified in 10 and 15 cases, respectively. Statistical analysis revealed an association of the myxoid subtype and the mitotic count with p53 expression and TP53 mutation. No association was found between MDM2 amplification and MDM2 expression or tumor subtype. These results suggest that despite morphological similarities, canine liposarcoma differs from its human counterpart, for which MDM2 amplification is diagnostic for well differentiated and de-differentiated variants, and TP53 mutations are more common in pleomorphic liposarcoma rather than the myxoid one as occur in our cases. Furthermore, canine myxoid liposarcoma likely represents a distinct disease rather than a mere morphological variant.

Abstract Sleeve and double‐sleeve lobectomies are lung‐sparing techniques for treating central lung cancers. However, if the tumour extends to involve the bronchi and vessels, lung auto‐transplantation may be an alternative to pneumonectomy. Neoadjuvant therapy after surgery is the most common strategy for patients with extensive central lung cancer. Herein, we report a case of central lung cancer in a patient who underwent immunochemotherapy as neoadjuvant therapy following lung auto‐transplantation. A 68‐year‐old man with stage IIIA non‐small cell lung cancer and left upper lobe squamous cell carcinoma underwent neoadjuvant immunochemotherapy. Following partial regression, a multidisciplinary team decided on a back‐table procedure with auto‐lung transplantation after pneumonectomy to preserve pulmonary function. The patient had an uneventful recovery and was discharged after three weeks with no residual tumour or lymph node metastases. Lung auto‐transplantation can be successfully performed in non‐lung transplantation centres, potentially broadening treatment options for patients with central lung cancer.

Purpose: To report an aggressive and rapidly progressive case of atypical T-cell lymphoproliferative infiltration both with intraocular and orbital involvement and preretinal infiltrates.Methods: Medical records and imaging of the patient were retrospectively reviewed.Case presentation: A 25-year-old woman presented first with preretinal infiltrates resembling uveitis and developed orbital and intracranial signs eventually during her evaluation. Clinical presentation worsened gradually. The patient developed bilateral proptosis, pupillary dilation and uvula deviation. Diagnostic orbital incision biopsy revealed T-cell lymphoproliferative disease. Conclusion: This case gives evidence that intraocular involvement due to T-cell lymphoproliferative disease may present as a masquerade syndrome and should be kept in mind in patients with extraordinary presentation.

OBJECTIVES:. Anemia has been associated with an increased risk of both cardiac arrest and stroke, frequent complications of COVID-19. The effect of hemoglobin level at ICU admission on a composite outcome of cardiac arrest or stroke in an international cohort of COVID-19 patients was investigated. DESIGN:. Retrospective analysis of prospectively collected database. SETTING:. A registry of COVID-19 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with cardiac arrest or stroke up to 30 days after ICU admission. Anemia was defined as: normal (hemoglobin ≥ 12.0 g/dL for women, ≥ 13.5 g/dL for men), mild (hemoglobin 10.0–11.9 g/dL for women, 10.0–13.4 g/dL for men), moderate (hemoglobin ≥ 8.0 and < 10.0 g/dL for women and men), and severe (hemoglobin < 8.0 g/dL for women and men). PATIENTS:. Patients older than 18 years with acute COVID-19 infection in the ICU. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Of 6926 patients (median age = 59 yr, male = 65%), 760 patients (11.0%) experienced stroke (2.0%) and/or cardiac arrest (9.4%). Cardiac arrest or stroke was more common in patients with low hemoglobin, occurring in 12.8% of patients with normal hemoglobin, 13.3% of patients with mild anemia, and 16.7% of patients with moderate/severe anemia. Time to stroke or cardiac arrest by anemia status was analyzed using Cox proportional hazards regression with death as a competing risk. Covariates selected through clinical knowledge were age, sex, comorbidities (diabetes, hypertension, obesity, and cardiac or neurologic conditions), pandemic era, country income, mechanical ventilation, and extracorporeal membrane oxygenation. Moderate/severe anemia was associated with a higher risk of cardiac arrest or stroke (hazard ratio, 1.32; 95% CI, 1.05–1.67). CONCLUSIONS:. In an international registry of ICU patients with COVID-19, moderate/severe anemia was associated with increased hazard of cardiac arrest or stroke.

Background The extent to which differences in results from Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial (ROCKET) atrial fibrillation (AF)—the landmark trials for the approval of apixaban and rivaroxaban, respectively, for non-valvular AF—were influenced by differences in their protocols is debated. The potential influence of selection criteria on trial results was assessed by emulating these trials in data from the Global Anticoagulant Registry in the Field (GARFIELD)-AF registry.Methods Vitamin K antagonist (VKA) and non-vitamin K oral antagonist (NOAC) users from GARFIELD-AF were selected according to eligibility for the original ARISTOTLE or ROCKET AF trials. A propensity score overlap weighted Cox model was used to emulate trial randomisation between treatment groups. Adjusted HRs for stroke or systemic embolism (SE) within 2 years of enrolment were calculated for each NOAC versus VKA.Results Among patients on apixaban, rivaroxaban and VKA, 2570, 3560 and 8005 were eligible for ARISTOTLE, respectively, and 1612, 2005 and 4368, respectively, for ROCKET AF. When selecting for ARISTOTLE criteria, apixaban users had significantly lower stroke/SE risk versus VKA (HR 0.57; 95% CI 0.34 to 0.94) while no reduction was observed with rivaroxaban (HR 0.98; 95% CI 0.68 to 1.40). When selecting for ROCKET AF criteria, safety and efficacy versus VKA were similar across the NOACs.Conclusion Apixaban and rivaroxaban showed similar results versus VKA in high-risk patients selected according to ROCKET AF criteria, whereas differences emerged when selecting for the more inclusive ARISTOTLE criteria. Our results highlight the importance of trial selection criteria in interpreting trial results and underline the problems faced in comparing treatments across rather than within clinical trials.

Optical tweezers are tools made of light that enable contactless pushing, trapping, and manipulation of objects, ranging from atoms to space light sails. Since the pioneering work by Arthur Ashkin in the 1970s, optical tweezers have evolved into sophisticated instruments and have been employed in a broad range of applications in the life sciences, physics, and engineering. These include accurate force and torque measurement at the femtonewton level, microrheology of complex fluids, single micro- and nano-particle spectroscopy, single-cell analysis, and statistical-physics experiments. This roadmap provides insights into current investigations involving optical forces and optical tweezers from their theoretical foundations to designs and setups. It also offers perspectives for applications to a wide range of research fields, from biophysics to space exploration.

The latest AI language modules can produce original, high quality full short-form (300-word) Physics essays within seconds. These technologies such as ChatGPT and davinci-003 are freely available to anyone with an internet connection. In this work, we present evidence of AI generated short-form essays achieving First-Class grades on an essay writing assessment from an accredited, current university Physics module. The assessment requires students answer five open-ended questions with a short, 300-word essay each. Fifty AI answers were generated to create ten submissions that were independently marked by five separate markers. The AI generated submissions achieved an average mark of 71 ± 2%, in strong agreement with the current module average of 71 ± 5%. A typical AI submission would therefore most-likely be awarded a First Class, the highest classification available at UK universities. Plagiarism detection software returned a plagiarism score between 2 ± 1% (Grammarly) and 7 ± 2% (TurnitIn). We argue that these results indicate that current natural language processing AI represent a significant threat to the fidelity of short-form essays as an assessment method in Physics courses.

This study accessed the efficiency and health risks of drinking water from different sources treated by filtration, boiling, chlorination, flocculation, and solar disinfection. The microbial quality of 45 treated water samples from boreholes, wells, and pipe-borne water was analyzed to determine treatment effectiveness and to quantify risk using quantitative microbial risk assessment. The effectiveness of each treatment method was a function of sampling sources (p < 0.05) and location (p < 0.10), chlorination and boiling being the most efficient methods (100%). Shiegella in well water samples treated by filtration and flocculation had the highest daily infection risk of 69.5 × 10−1 and 67.5 × 10−1 pppd. The annual risk of infection from Salmonella, Shigella, and Staphylococcus ranged from 7.8 × 10−1 to 1.00 pppy, exceeding the U.S. EPA annual infection benchmark (≤10−4 pppy). Salmonella, Shigella, and Staphylococcus had the highest risk of illness of 4.50 × 10−1, 3.30 × 10−1, and 9.80 × 10−1, respectively. All disease burden values exceeded the WHO disease burden benchmark (≤10−6 DALYs/pppy), with Staphylococcus and Salmonella contributing the highest disease burden of 4.71 × 10−2 and 2.13 × 10−2, DALYs/pppy. Therefore, boiling and chlorination are the best disinfection methods for the pathogens tested. HIGHLIGHTS Filtration of drinking water with ceramic filters (the most common LHWT method in Bamenda, Cameroon) is the least effective method in removing bacterial contaminants such as Salmonella, Shigella and Staphylococcus.; Boiling and chlorinaIon are the most effective disinfection methods for the pathogens tested.; Filtration, flocculation, and SODIS did not reduce pathogenic concentraIons below risk levels.; Bacteria contaminants in poorly-treated drinking water exceeded the WHO disease burden benchmark.;

During lactation, dairy cows undergo various metabolic changes that are reflected not only in milk yield but also in milk composition. This study aimed to determine the milk performance and composition depending on the stage of lactation and describe relationships between energy metabolism indicators (ketone bodies: β-hydroxybutyrate (BHB), acetone) in milk and selected indicators of milk performance and composition. The study was conducted on 1,909 dairy cows (Holstein, Czech Fleckvieh, and their crossbreds), which were divided into four groups according to the stage of lactation (early (6-100 days in milk), mid (101-200 days), late (201-305 days), and extended (>305 days)). The obligatory dynamics of the main milk components were found during the entire lactation, i.e., an increase in the protein content (from 3.30 to 3.76 g/100 g) and fat content (from 4.25 to 4.42 g/100 g) and a decrease in the lactose content (from 5.06 to 4.91 g/100 g). Significantly higher (P < 0.001) contents of ketone bodies were found in early and extended lactation than in mid and late lactation. The effect of lipomobilization on milk fat composition is documented by positive correlation coefficients between ketone bodies and long-chain fatty acids (FAs) and medium-chain FAs and negative correlation coefficients between ketone bodies and short-chain FAs. Positive correlation coefficients were calculated between ketone bodies and milk fat, citric acid, fat-to-protein ratio, and somatic cell score, and negative correlation coefficients were calculated between ketone bodies and milk protein, lactose, and free FAs. Our results demonstrate that currently often realized extended lactation in high-yielding dairy cows is similarly demanding as early lactation regarding energy metabolism and, thus, milk composition changes.

Precision agriculture requires accurate methods for classifying crops and soil cover in agricultural production areas. The study aims to evaluate three machine learning-based classifiers to identify intercropped forage cactus cultivation in irrigated areas using Unmanned Aerial Vehicles (UAV). It conducted a comparative analysis between multispectral and visible Red-Green-Blue (RGB) sampling, followed by the efficiency analysis of Gaussian Mixture Model (GMM), K-Nearest Neighbors (KNN), and Random Forest (RF) algorithms. The classification targets included exposed soil, mulching soil cover, developed and undeveloped forage cactus, moringa, and gliricidia in the Brazilian semiarid. The results indicated that the KNN and RF algorithms outperformed other methods, showing no significant differences according to the kappa index for both Multispectral and RGB sample spaces. In contrast, the GMM showed lower performance, with kappa index values of 0.82 and 0.78, compared to RF 0.86 and 0.82, and KNN 0.86 and 0.82. The KNN and RF algorithms performed well, with individual accuracy rates above 85% for both sample spaces. Overall, the KNN algorithm demonstrated superiority for the RGB sample space, whereas the RF algorithm excelled for the multispectral sample space. Even with the better performance of multispectral images, machine learning algorithms applied to RGB samples produced promising results for crop classification.