Wild reservoirs of Japanese encephalitis virus are under-studied globally, which presents critical knowledge gaps for JEV epidemiology and infection ecology despite decades of received wisdom regarding this high-impact mosquito-borne virus. As a result, ardeid birds, generally understood to be the primary reservoirs for JEV, as well as other waterbirds occupying landscapes at high risk for spillover to humans, are frequently ignored by current surveillance mechanisms and infrastructure. This is particularly true in India, which experiences a high annual burden of human outbreaks. Incorporating wild reservoirs into surveillance of human and livestock populations is therefore essential but will first require a data-driven approach to target individual host species. The current study sought to identify preliminary waterbird target species for JEV surveillance development based on species’ distributions in high-risk landscapes. Twenty-one target species were identified after adjusting species presence and abundance for the biotic constraints of sympatry. Furthermore, ardeid bird species richness demonstrated a strong non-linear association with the distribution of human JEV outbreaks, which suggested areas with the highest ardeid species richness corresponded to low JEV outbreak risk. No association was identified between JEV outbreaks and anatid or rallid richness. The lack of association between Anatidae and Rallidae family-level diversity and JEV outbreak risk notwithstanding, this study did identify several individual species among these two bird families in high-risk landscapes. The findings from this work provide the first data-driven evidence base to inform wildlife sampling for the monitoring of JEV circulation in outbreak hotspots in India and thus identify good preliminary targets for the development of One Health JEV surveillance.While urinary output (UOP) remains the primary endpoint for titration of intravenous fluid resuscitation, it is an insufficient indicator of fluid responsiveness. Although advanced hemodynamic monitoring (including arterial pulse wave analysis (PWA)) is of recent interest, the validity of PWA-derived indices in burn resuscitation extremes has not been established. The goal of this paper is to test the hypothesis that PWA-derived cardiac output (CO) and stroke volume (SV) indices as well as pulse pressure variation (PPV) and systolic pressure variation (SPV) can play a complementary role to UOP in burn resuscitation. Swine were instrumented with a Swan-Ganz catheter for reference CO and underwent a 40% total body surface area burns with varying resuscitation paradigms, and were monitored for 24 hours in an ICU setting under mechanical ventilation. The longitudinal changes in PWA-derived indices were investigated, and resuscitation adequacy was compared as determined by UOP versus PWA indices. The results indicated that PWA-derived indices exhibited trends consistent with reference CO and SV measurements CO and SV indices were proportional to reference CO and SV, respectively (CO post-calibration limits of agreement (LoA)=+/-24.7 [ml/min/kg], SV post-calibration LoA=+/-0.30 [ml/kg]) while PPV and SPV were inversely proportional to reference SV (PPV post-calibration LoA=+/-0.32 [ml/kg], SPV post-calibration LoA=+/-0.31 [ml/kg]). The results also indicated that PWA-derived indices exhibited notable discrepancies from UOP in determining adequate burn resuscitation. Hence, it was concluded that the PWA-derived indices may have complementary value to UOP in assessing and guiding burn resuscitation.

To compare perinatal outcomes in pregnancies with fetal growth restriction (FGR) undergoing induction of labor by extra-amniotic balloon (EAB) versus prostaglandin E

(PGE

).

A retrospective cohort study of women with singleton pregnancies and FGR, undergoing induction at term via EAB, PGE

, or both, at a single medical center (2014-2017). Primary outcome was rate of cesarean deliveries (CDs). Secondary outcomes included composite maternal and neonatal outcomes.

Overall, 266 women met the inclusion criteria. Among them, 131 (49.2%) underwent induction by PGE

, 116 (43.6%) by EAB, and 19 (7.14%) by both methods. No differences were noted in baseline characteristics. Rate of CD (17.24% vs. 6.11% vs. 10.53%, P= 0.022) and maternal composite outcome (18.97% vs. 6.11% vs. 10.53%, P< 0.01) were higher among women who underwent induction by EAB compared with PGE

or both. No difference was noted between groups in neonatal outcomes. In a multivariable logistic regression, rates of cesarean delivery and composite maternal outcome were no longer higher in the EAB group (adjusted odds ratio [aOR] 1.68, 95% confidence interval [CI] 0.68-4.16, P= 0.260; and aOR 1.94, 95% CI 0.84-4.45, P= 0.120, respectively).

EAB and PGE

have comparable maternal and neonatal outcomes when used for induction of labor due to FGR.

EAB and PGE2 have comparable maternal and neonatal outcomes when used for induction of labor due to FGR.Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs.

Our objective was to determine whether there is a numerical difference between quantitative blood loss (QBL) versus visual estimation of blood loss (EBL) during cesarean delivery (CD), and whether initiation of QBL leads to increased recognition and intervention for postpartum hemorrhage.

A retrospective review was conducted of 250 patients undergoing CD with only EBL documented and 250 patients undergoing CD with both EBL and QBL documented at Montefiore Medical Center between October 2017 and November 2018. Since May 2018, the protocol for all CD included documentation of EBL and QBL.

Average EBL when documented alone (897.0ml ± 301.0ml) trended lower than average EBL when documented with QBL (940.0ml ± 371.0ml, P=0.161). For CD with both blood loss documented, average EBL (940.0ml ± 371.0ml) was significantly lower than average QBL (1065.3ml ± 649.8ml, P=0.0001). CD with both blood loss documented had a greater number of blood transfusions (24 CD, 9.6%) versus only EBL documented (14 CD, 5.6%) (P=0.125).

The use of QBL may function in the algorithm to determine up-front resuscitative intervention to improve maternal outcomes and merits further study.

The use of QBL may function in the algorithm to determine up-front resuscitative intervention to improve maternal outcomes and merits further study.

Drug survival measures the rate and duration of adherence to a given therapeutic agent and evaluates its long-term effectiveness, safety, and real-world utility. The SUSTAIN study sought to establish the drug survival and effectiveness of secukinumab for patients with severe chronic plaque psoriasis (CPP) in the Australian clinical setting.

Data of all patients (aged ≥18 years) from Australasian Psoriasis Registry (APR) treated with secukinumab were analysed. The primary objective was to describe the drug survival of secukinumab at 9months. Key secondary objectives included drug survival of secukinumab at 3, 6, 15, and 21 months, stratified by biologic-naïve vs biologic-experienced patients; proportion of patients achieving Psoriasis Area and Severity Index (PASI) 75/90/100 responses; and changes in health-related quality of life over time utilising the Dermatology Life Quality Index (DLQI).

Of 294 patients included in this analysis, 110 (37.4%) were biologic-naïve and 184 (62.6%) biologic-experienced. Kaplan-Meїer drug survival rates in biologic-naïve vs biologic-experienced patients were 0.92 vs. 0.86 (9months) and 0.82 vs. 0.68 (21 months), respectively. The proportion of patients with PASI 75/90/100 responses for biologic-naïve vs. biologic-experienced was 100/87.7/38.4 vs 98.5/61.5/27.2 (9months) and 100/81.0/41.7 vs. 98.4/62.0/24.2 (21 months), respectively. The mean (standard deviation [SD]) DLQI in biologic-naïve vs. experienced patients was 2.2 (4.1) vs. 3.1 (5.2) (9months) and 1.4 (2.5) vs. 3.1 (5.3) (21 months). No new safety signals were observed.

Secukinumab demonstrated high drug survival and sustained effectiveness in Australian real-world setting, in biologic-naïve and biologic-experienced patients with severe CPP.

Secukinumab demonstrated high drug survival and sustained effectiveness in Australian real-world setting, in biologic-naïve and biologic-experienced patients with severe CPP.Even though patients with pulmonary embolism usually present with respiratory distress and tachycardia, the patient presented with syncope only. Typical ECG changes associated with PE include right axis deviation, right bundle-branch block, S1Q3T3 pattern, arrhythmia, nonspecific ST-segment changes, QR pattern in lead V1, Brugada ECG pattern, and T-wave inversions in the precordial leads. However, his electrocardiogram showed QT-interval prolongation and simultaneous T-wave inversions in the inferior and anterior leads. This ECG pattern is crucial for diagnosing PE. The patient underwent computed tomography-pulmonary angiography, which revealed pulmonary embolism. At the same time, these ECG changes should be differentiated from those of long QT syndrome, myocardial ischemia, Takotsubo cardiomyopathy, post-pacing T-wave memory, hypertrophic cardiomyopathy, and subarachnoid hemorrhage.Patients with AMI usually present with the specific changes for electrocardiogram (ECG) and biomarkers of cardiac injury. Here, we present a rare case with chest pain and normal ECG and biomarkers of cardiac injury. Emergent coronary angiography revealed an occlusion of proximal left anterior descending coronary artery. The patient was diagnosed with AMI, and his symptom relieved after implantation of drug-eluting stents. Caution should be exercised for the exclusion of AMI in patients with chest pain and both normal ECG and biomarkers of cardiac injury.

This study aimed to describe how strong is the relationship between TEE and PAL in women living in an impoverished Brazilian urban area.

Anthropometric, hormonal (insulin, TSH, FT

, and FT

), body composition (deuterium), TEE (doubly labeled water) and PAL (metabolic equivalent task [MET]-7-day triaxial accelerometer, ActivPAL®) data were collected from 55 women (mean age 31y, mean BMI 27.4kg/m

). Adjusted-TEE models were calculated incorporating the residuals of anthropometric, hormonal, and body composition variables in the TEE, to assess the relation between MET and adjusted-TEE, through three different analyzes linear regression, nonlinear regression and change-point regression.

Most participants (89.1%, n=49) were classified as low-active. There was no association between crude TEE and MET.h/d (R

=0.05; p=0.09). There was a positive, although weak, linear relationship between adjusted-TEE and MET.h/d (β=2705.26 kcal; 95% CI 436.25; 4974.27; adj-R

=0.08). A change point of this relationship was identified in the MET.