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The kinetics of IgG antibodies after coronavirus disease 2019 (COVID‐19) remain poorly understood. We investigated factors influencing severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) IgG antibody levels and time to seronegativation during the follow‐up of severe and critically ill patients. We retrospectively reviewed serological evaluations drawn during the follow‐up of severe or critical laboratory‐proven COVID‐19 patients hospitalized at a large academic hospital. Specific IgG titers were measured using a chemiluminescent assay targeting anti‐spike and anti‐nucleocapsid protein IgG. The influence of time, demographic factors, clinical and paraclinical characteristics, and COVID‐19 therapeutics on IgG levels were assessed through linear regression using a mixed‐effect model, and delay until IgG negativation through a Weibull regression model. The cohort included 116 patients with a total of 154 IgG measurements drawn at a median of 79 days after diagnosis. IgG antibodies were increased with age (p = 0.005) and decreased significantly over time (p = 0.0002). Using elapsed time and age as covariates, we demonstrated higher IgG levels in patients with a higher body mass index (BMI) (p = 0.0026) and lower IgG levels in immunocompromised patients (p = 0.032). A high BMI was further found to delay and immunodeficiency to hasten significantly seronegativation, whereas no significant effect was observed with corticosteroids. These data highlight the waning over time of IgG antibodies after severe or critical COVID‐19. Age, BMI, and immunosuppression also appear to influence the IgG kinetics, while short‐term corticotherapy does not. Those data improve the understanding of SARS‐CoV‐2 serology while further research should determine the determinants of long‐term seroprotection., Highlights Anti‐SARS‐CoV‐2 IgG antibody levels measured during follow‐up of severe and critical COVID‐19 were studied. We analyzed the influence of time, demographics, clinical and paraclinical characteristics and COVID‐19 treatments on specific IgG levels and time to seronegativation. Time and immunodepression were associated to reduced IgG levels at follow‐up, while age and BMI were associated to increased levels. Corticosteroids given as short‐term treatment for COVID‐19 did not show influence. BMI and immunodepression were respectively associated with decreased and increased rates of seronegativation.

A 12-year-old boy presented to our palliative care cancer clinic with Ewing Sarcoma and anaemia in failure. Transfusion reactions were noted during several blood transfusions, which manifested as acute onset of breathlessness, mild chest pain, sweating, general discomfort, increased heart rate, respiratory rate, and blood pressure. All the possible causes of transfusion reaction were ruled out, other than transfusion-associated anxiety resembling transfusion reaction. In this case, adequate reassurance, counselling about the blood transfusion, distraction techniques, and the visual technique of masking the blood bag with black polythene foil helped overcome the patient's anxiety during the blood transfusion, and was uneventful henceforth. Since transfusion-associated anxiety is not an established and well-studied aspect of transfusion medicine yet, there is a need to have high clinical suspicion to recognise, assess, and forthwith prevent any such transfusion reactions without any delay.

Adding new connections to your in-person social network could rightly be seen as a risk as we live in a time in which relationships often connote risk and are viewed as a means for the novel coronavirus to spread. This article details the story of how one Georgia neighborhood banned together to support it's older residents.

In medicine, a legacy effect is defined as the sustained beneficial effect of a given treatment on disease outcomes, even after cessation of the intervention. Initially described in optimized control of diabetes, it was also observed in clinical trials exploring intensification strategies for other cardiovascular risk factors, such as hypertension or hypercholesterolemia. Mechanisms of legacy were particularly deciphered in diabetes, leading to the concept of metabolic memory. In a more discreet manner, other memory phenomena were also described in preclinical studies that demonstrated long-lasting deleterious effects of lipids or angiotensin II on vascular wall components. Interestingly, epigenetic changes and reactive oxygen species (ROS) appear to be common features of “memory” of the vascular wall.

Weaknesses in computer systems such as faults, bugs and errors in the architecture, design or implementation of software provide vulnerabilities that can be exploited by attackers to compromise the security of a system. Common Weakness Enumerations (CWE) are a hierarchically designed dictionary of software weaknesses that provide a means to understand software flaws, potential impact of their exploitation, and means to mitigate these flaws. Common Vulnerabilities and Exposures (CVE) are brief low-level descriptions that uniquely identify vulnerabilities in a specific product or protocol. Classifying or mapping of CVEs to CWEs provides a means to understand the impact and mitigate the vulnerabilities. Since manual mapping of CVEs is not a viable option, automated approaches are desirable but challenging. We present a novel Transformer-based learning framework (V2W-BERT) in this paper. By using ideas from natural language processing, link prediction and transfer learning, our method outperforms previous approaches not only for CWE instances with abundant data to train, but also rare CWE classes with little or no data to train. Our approach also shows significant improvements in using historical data to predict links for future instances of CVEs, and therefore, provides a viable approach for practical applications. Using data from MITRE and National Vulnerability Database, we achieve up to 97% prediction accuracy for randomly partitioned data and up to 94% prediction accuracy in temporally partitioned data. We believe that our work will influence the design of better methods and training models, as well as applications to solve increasingly harder problems in cybersecurity., Comment: Under submission to KDD 2021 Applied Data Science Track

1. L’OBSERVATION : Une femme, âgée de 64 ans, était hospitalisée à la fin du mois d’avril pour dyspnée évoluant depuis un mois. Dans ses antécédents, on notait un reflux gastro-œsophagien, une hypothyroïdie substituée, des migraines, une hypertension artérielle, une hypercholestérolémie et une arthrodèse lombaire. Elle était fonctionnaire, ne fumait pas et consommait de l’alcool de manière occasionnelle. Elle appréciait les balades en forêt. Son traitement comportait : propanolol 40 mg/j, oméprazole 20 mg/j, L-thyroxine 25 μg/j, acide folique 4 mg/j. Fin mars, après une chute de la 11e marche d’un escalier, elle présentait une fracture et une plaie du poignet, nécessitant une attelle plâtrée puis une chirurgie de l’extenseur de l’index droit. C’est en revoyant l’orthopédiste à la consultation de contrôle post-opératoire qu’elle mentionnait pour la première fois une dyspnée de grade 3, associée à des douleurs thoraciques d’effort. Elle était donc hospitalisée en cardiologie où un bilan était réalisé : ECG montrant des ondes T négatives de V1 à V3, échographie cardiaque retrouvant une discrète hypertension artérielle pulmonaire (HTAP), angioscanner pulmonaire négatif, coronarographie normale. Une anémie macrocytaire (hémoglobine : 7,2 g/L) était découverte. Le bilan biologique montrait également une carence en folate substituée. Une gastroscopie mettait en évidence une petite ulcération antrale traitée par oméprazole. Il existait un syndrome inflammatoire (CRP : 200 mg/L), pour lequel les prélèvements bactériologiques (hémocultures, culture urinaire) restaient stériles. [...] Titre en anglais : Dyspnea in a 64 year-old woman

Between 1990 and 2008, many industrializing countries have experienced tremendous economic growth, which coincided with a substantial increase in the use of materials. That poses the question how a continued economic convergence of developing nations will affect the use of biomass, fossil fuels, and minerals. Building on the Environmental Kuznets Curve hypothesis, this study investigates whether material use reaches a maximum at a certain level of economic development and declines in income thereafter. Two indicators operationalize material use. Domestic Material Consumption (DMC) measures the apparent use of materials in a country. The Material Footprint (MF) quantifies all materials extracted to produce a country's final demand, including materials embodied in imports. Employing a panel consisting of 144 countries, initial estimations results suggest an S-shaped (cubic) relationship between GDP per capita and material use, but the relationship is monotonically positive over most of the income range. The coefficients of the cubic model tend to become nonsignificant once endogeneity and non-stationarity are accounted for. A linear specification yields a significant (positive) coefficient irrespective of the estimation method and can thus be considered a satisfactory approximation to the income-material use relationship. The linear models that account for endogeneity and non-stationarity suggest a greater income-materials elasticity for MF than for DMC. The long-run income elasticity is estimated to be 0.562 for DMC and 0.752 for MF. The income elasticity of MF is rather uniform across country groups. While being below average for biomass, it is greater than unity for fossil fuels.

Concomitant arterial and venous thrombosis is an infrequent event often associated with malignancy, hyperhomocysteinemia, and thrombophilic conditions. Some overlapping pathophysiology mechanisms suggest an association between arterial and venous thrombosis. It is reported that thrombosis in the arterial and venous systems develops through distinct mechanisms affecting inflammatory and oxidative pathways. Recently, the aromatase inhibitors have moved to the forefront of adjuvant hormonal therapy, however, the adverse effects of these agents are not yet fully understood. It is generally accepted that tamoxifen, but not aromatase inhibitors, is associated with an increased risk of thrombosis in women with breast cancer. Here, we report an unusual case of an 87-year-old female on anastrozole therapy with aortic thrombus extending into the left subclavian artery with associated diffuse venous thromboembolism (VTE). An 87-year-old-female with a history of breast cancer in remission, obesity, hypertension, and dyslipidemia presented to the emergency department with new onset of left arm weakness and tingling sensation. Vital signs showed respiratory rate of 20 per minute, oxygen saturation of 95% on 3 L of oxygen via nasal cannula, blood pressure of 150/79 mmHg, and pulse 81 beats per minute. Computed tomography angiography (CTA) neck showed an aortic thrombus extending into the left subclavian artery and bilateral pulmonary emboli (PE). Doppler ultrasound of the lower extremities showed a deep venous thrombosis (DVT) in the left lower extremity. Echocardiography showed no patent foramen ovale. She was started on continuous heparin infusion and subsequently transitioned to an oral anticoagulation medication upon discharge. Symptomatic ischemic lesions of the upper extremity due to thrombosis of the subclavian artery are extremely rare, occurring in less than one percent of the population. While this patient had a history of early-stage breast cancer, she was on adjuvant anastrozole therapy with no evidence of recurrence or further tumor burden as per her outpatient oncologist, who also followed her during her hospital stay. She also had no prior history of thromboembolic disease or clotting disorders. Her only risk factors appear to be her age and her obesity (with a BMI over 30). Nevertheless, the extent of thromboembolism seen in this patient is greater than that might be expected with these factors. This case highlights a concomitant rarity of arterial and venous thrombosis. Also, there are not enough studies on anastrozole effect on thromboembolism. Given these risk factors, we recommend a high degree of suspicion for VTE in patients who are on anastrozole therapy.

Capecitabine has been more recognized for its cardiotoxicity with an incidence that varies widely. It demonstrates its toxicity in the forms of acute coronary syndrome, arrhythmias and, to a lesser extent, cardiomyopathy. There are several proposed theories including coronary vasospasm, endothelial injury, and oxidative stress. We present a case of capecitabine-induced cardiomyopathy in a patient with pancreatic cancer and mild coronary artery disease, and shed light on other cardio-toxic agents, their proposed mechanism of cardiotoxicity, and on cardiomyopathy in general.

BACKGROUND: The impact of the COVID-19 pandemic on functional exercise capacity seemed quickly clinically evident. The objective of this study was to assess the functional exercise capacity of patients with severe COVID-19 and to evaluate the effect of a telerehabilitation program in the specific context of the COVID-19 pandemic. METHOD: Patients hospitalized for severe or critical COVID-19 were recruited. The functional exercise capacity (1-min sit-to-stand test (STST)) was prospectively quantified at discharge. A telerehabilitation program was then proposed. A control group was composed with the patients refusing the program. RESULTS: At discharge, none of the 48 recruited patients had a STST higher than the 50th percentile and 77% of them were below the 2.5th percentile. SpO2 was 92.6 ± 3.0% after STST and 15 patients had oxygen desaturation. After 3-months of follow-up, the number of repetitions during STST significantly increased either in telerehabilitation (n = 14) (p < 0.001) or in control groups (n = 13) (p = 0.002) but only one patient had a result higher than the 50th percentile (in Telerehabilitation group) and 37% of them were still under the 2.5th percentile for this result. The improvement was significantly and clinically greater after the telerehabilitation program (p = 0.005). No adverse events were reported by the patients during the program. CONCLUSIONS: Patients hospitalized for COVID-19 have a low functional exercise capacity at discharge and the recovery after three months is poor. The feasibility and the effect of a simple telerehabilitation program were verified, this program being able to substantially improve the functional recovery after three months.

In the early stage of the COVID-19 pandemic, Belgian health authorities endorsed the interim guidelines for the treatment of COVID-19 pneumonia: hydroxychloroquine (HCQ) recommended for treatment of hospitalized patients with moderate to severe disease. As a growing number of patients were admitted, inevitably, our internal medicine team questioned the efficacy and safety of HCQ, especially with regard to cardiac side effects. In parallel with our concerns, data regarding the safety and efficacy of HCQ were published, with discordant results and debate in the medical community. Media coverage of the possible risks and benefits of HCQ use in COVID-19 also caused confusion amongst the public. In this Perspectives in Rheumatology article, we review the use and safety of HCQ in autoimmune disease and its putative efficacy and toxicity in COVID-19. Finally, we share our concern about the future of this widely used and inexpensive drug after the COVID-19 pandemic has passed.

Background The severity of coronavirus disease 2019 (COVID-19) is highly variable between individuals, ranging from asymptomatic infection to critical disease with acute respiratory distress syndrome requiring mechanical ventilation. Such variability stresses the need for novel biomarkers associated with disease outcome. As SARS-CoV-2 infection causes a kidney proximal tubule dysfunction with urinary loss of uric acid, we hypothesized that low serum levels of uric acid (hypouricemia) may be associated with severity and outcome of COVID-19. Methods In a retrospective study using two independent cohorts, we investigated and validated the prevalence, kinetics and clinical correlates of hypouricemia among patients hospitalized with COVID-19 to a large academic hospital in Brussels, Belgium. Survival analyses using Cox regression and a competing risk approach assessed the time to mechanical ventilation and/or death. Confocal microscopy assessed the expression of urate transporter URAT1 in kidney proximal tubule cells from patients who died from COVID-19. Results The discovery and validation cohorts included 192 and 325 patients hospitalized with COVID-19, respectively. Out of the 517 patients, 274 (53%) had severe and 92 (18%) critical COVID-19. In both cohorts, the prevalence of hypouricemia increased from 6% upon admission to 20% within the first days of hospitalization for COVID-19, contrasting with a very rare occurrence (P P P Conclusions Among patients with COVID-19 requiring hospitalization, low serum levels of uric acid are common and associate with disease severity and with progression to respiratory failure requiring invasive mechanical ventilation.

Dear Editor, Hypoxaemia is a typical feature of the coronavirus disease 2019 (COVID-19). The rapid rise in the number of patients requiring oxygen therapy during the pandemic may cause a sharp increase in oxygen demands and potential threats of supply disruption, particularly in developing countries1 or nursing homes. Moreover, the use of elevated oxygen flows via nasal cannula raises concerns about exhaled air dispersion distance and the potential risk of generating aerosols [...]

Background Evidence of immune-mediated neurological syndromes associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is limited. We therefore investigated clinical, serological and CSF features of coronavirus disease 2019 (COVID-19) patients with neurological manifestations. Methods Consecutive COVID-19 patients with neurological manifestations other than isolated anosmia and/or non-severe headache, and with no previous neurological or psychiatric disorders were prospectively included. Neurological examination was performed in all patients and lumbar puncture with CSF examination was performed when not contraindicated. Serum anti-gangliosides antibodies were tested when clinically indicated. Results Of the 349 COVID-19 admitted to our center between March 23rd and April 24th 2020, 15 patients (4.3%) had neurological manifestations and fulfilled the study inclusion/exclusion criteria. CSF examination was available in 13 patients and showed lymphocytic pleocytosis in 2 patients: 1 with anti-contactin-associated protein 2 (anti-Caspr2) antibody encephalitis and 1 with meningo-polyradiculitis. Increased serum titer of anti-GD1b antibodies was found in three patients and was associated with variable clinical presentations, including cranial neuropathy with meningo-polyradiculitis, brainstem encephalitis and delirium. CSF PCR for SARS-CoV-2 was negative in all patients. Conclusions In SARS-Cov-2 infected patients with neurological manifestations, CSF pleocytosis is associated with para- or post-infectious encephalitis and polyradiculitis. Anti-GD1b and anti-Caspr2 autoantibodies can be identified in certain cases, raising the question of SARS-CoV-2-induced secondary autoimmunity.

TO THE EDITOR, When a patient is hospitalizated with COVID-19, prediction of the risk of development of severe or critical illness is of great importance [1]. Several risk scores have been described such as COVID-GRAM [2], National Early Warning Score 2 (NEWS 2) [3] and 4C mortality score [4]. [...]

Halil Yildiz,1,&ast; Diego Castanares-Zapatero,2,&ast; Guillaume Pierman,1 Lucie Pothen,1 Julien De Greef,1 Frank Aboubakar Nana,3 Hector Rodriguez-Villalobos,4 Leila Belkhir,1 Jean Cyr Yombi1 1Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium; 2Department of Intensive Care Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium; 3Department of Pneumology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium; 4Department of Microbiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium&ast;These authors contributed equally to this workCorrespondence: Halil YildizDepartment of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 avenue hippocrate, Brussels, BelgiumTel +3227641902Fax +3227641046Email halil.yildiz@uclouvain.beIntroduction: The neutrophil-to-lymphocyte ratio (NLR) could be a predictive factor of severe COVID-19. However, most relevant studies are retrospective, and the optimal NLR cut-off point has not been determined. The objective of our research was identification and validation of the best NLR cut-off value on admission that could predict high in-hospital mortality in COVID-19 patients.Methods: Medical files of all patients admitted for COVID-19 pneumonia in our dedicated COVID-units between March and April 2020 (derivation cohort) and between October and December 2020 (validation cohort) were reviewed.Results: Two hundred ninety-nine patients were included in the study (198 in the derivation and 101 in the validation cohort, respectively). Youden’s J statistic in the derivation cohort determined the optimal cut-off value for the performance of NLR at admission to predict mortality in hospitalized patients with COVID-19. The NLR cut-off value of 5.94 had a sensitivity of 62% and specificity of 64%. In ROC curve analysis, the AUC was 0.665 [95% CI 0.530– 0.801, p= 0.025]. In the validation cohort, the best predictive cut-off value of NLR was 6.4, which corresponded to a sensitivity of 63% and a specificity of 64% with AUC 0.766 [95% CI 0.651– 0.881, p < 0.001]. When the NLR cut-off value of 5.94 was applied in the validation cohort, there was no significant difference in death and survival in comparison with the derivation NLR cut-off. Net reclassification improvement (NRI) analysis showed no significant classification change in outcome between both NLR cut-off values (NRI:0.012, p=0.31).Conclusion: In prospective analysis, an NLR value of 5.94 predicted high in-hospital mortality upon admission in patients hospitalized for COVID-19 pneumonia.Keywords: neutrophil-to-lymphocyte ratio, coronavirus disease, SARS-CoV-2 infection, COVID-19, risk factors, laboratory markers

Background: Patients with coronavirus disease (COVID-19) can develop severe hypoxemia. Meeting the soaring demands of oxygen may be a challenge. Objective: To test the efficacy of an easily handmade system, the double-trunk mask (DTM), in reducing oxygen consumption while maintaining patient’s oxygenation level. Methods: Hospitalized adults with COVID-19 and hypoxemia treated with low-flow oxygen therapy we recruited. The standard oxygen delivery system was replaced by the DTM with nasal cannula for 30 minutes with an oxygen output adapted to maintain an identical oxygen saturation by pulse oximetry. The standard oxygen delivery system was then reinstated for 30 minutes. Primary outcome was the absolute change in oxygen flow between the standard delivery systems and the DTM. Secondary outcomes were changes in blood gases, vital parameters and patient comfort. Results: Eleven patients were analyzed (mean age 61 years; 27% male). Compared with standard delivery systems, the oxygen output was significantly reduced with the DTM (median, 5 vs 1.5 L/min (95% CI -4 to -1.5, p=0.003)) when oxygen saturation and arterial oxygen tension remained stable. The DTM was also associated with a significant but slight increase in arterial carbon dioxide tension (median, 36 mmHg vs 37 mmHg, p=0.006), and respiratory rate (median, 26 vs 30 breaths/min, p=0.05). Other parameters were unaltered. The DTM was generally judged less comfortable than the baseline oxygen delivery system, especially in patients requiring low oxygen flow at baseline. Conclusions: The DTM is a simple and efficient system to reduce oxygen consumption. This may have clinical implications in places where oxygen supplies are limited.

Coronavirus disease 2019 (COVID-19) is commonly associated with kidney damage, and the angiotensin converting enzyme 2 (ACE2) receptor for SARS-CoV-2 is highly expressed in the proximal tubule cells. Whether patients with COVID-19 present specific manifestations of proximal tubule dysfunction remains unknown. To test this, we examined a cohort of 49 patients requiring hospitalization in a large academic hospital in Brussels, Belgium. There was evidence of proximal tubule dysfunction in a subset of patients with COVID-19, as attested by low-molecular-weight proteinuria (70-80%), neutral aminoaciduria (46%), and defective handling of uric acid (46%) or phosphate (19%). None of the patients had normoglycemic glucosuria. Proximal tubule dysfunction was independent of pre-existing comorbidities, glomerular proteinuria, nephrotoxic medications or viral load. At the structural level, kidneys from patients with COVID-19 showed prominent tubular injury, including in the initial part of the proximal tubule, with brush border loss, acute tubular necrosis, intraluminal debris, and a marked decrease in the expression of megalin in the brush border. Transmission electron microscopy identified particles resembling coronaviruses in vacuoles or cisternae of the endoplasmic reticulum in proximal tubule cells. Among features of proximal tubule dysfunction, hypouricemia with inappropriate uricosuria was independently associated with disease severity and with a significant increase in the risk of respiratory failure requiring invasive mechanical ventilation using Cox (adjusted hazard ratio 6.2, 95% CI 1.9-20.1) or competing risks (adjusted sub-distribution hazard ratio 12.1, 95% CI 2.7-55.4) survival models. Thus, our data establish that SARS-CoV-2 causes specific manifestations of proximal tubule dysfunction and provide novel insights into COVID-19 severity and outcome., Graphical abstract

Objectives Skeletal muscle mass (SMM) is most often assessed in cancer patients on abdominal computed tomography (CT) imaging at the level of the third lumbar vertebra (L3). Abdominal CT imaging is not routinely performed in head and neck cancer (HNC) patients. Recently, a novel method to assess SMM on a single transversal CT slice at the level of the third cervical vertebra (C3) was published. The objective of this study was to assess the robustness of this novel C3 measurement method in terms of interobserver agreement. Patients and methods Patients diagnosed with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) at our center between 2007 and 2011 were evaluated. Fifty-four patients with were randomly selected for analysis. Six observers independently measured the cross-sectional muscle area (CSMA) at the level of C3 using a predefined, written protocol as instruction. Interobserver agreement was assessed using intraclass correlation coefficients (ICCs), a Bland–Altman plot and Fleiss’ kappa (κ). Results The agreement in vertebra selection between all observers was excellent (Fleiss’ κ: 0.96). There was a substantial agreement between all observers in single slice selection (Fleiss’ κ: 0.61). For all CSMA measurements, ICCs were excellent (0.763–0.969; all p

Optics and lasers in engineering 101, 44-50 (2018). doi:10.1016/j.optlaseng.2017.10.001, Published by Elsevier Science, Amsterdam [u.a.]

Between 1995 and 2008, the global extraction of biomass, fossil fuels, and minerals grew from 48 to 69 billion metric tons. This study investigates how changing consumption and investment patterns a↵ected the aforementioned increase. A series of Structural Decomposition Analyses at a global level as well as for 38 major economies is conducted. The analyses disentangle the drivers of Raw Material Consumption, which measures the extraction of materials necessary to produce a country’s final demand. Data is taken from the World Input-Output Database. The results suggest that rising final demand is the predominant driver of growing Raw Material Consumption. Furthermore, final demand shifted into countries that consume material intensive goods. This shift was particularly pronounced for construction minerals and investment, indicating that infrastructure investment in industrialising nations was a key driver. The mix of goods in final demand slightly dematerialised. Falling material intensities in extractive industries as well as changes in production and trade patterns decelerated the growth of Raw Material Consumption. The country-level Structural Decomposition Analyses obtained qualitatively similar results.

This paper investigates the impact of global value chains on energy footprints. Energy footprints are consumption-based indicators which record the energy used to produce a country's final demand. In order to disentangle key characteristics of global value chains and their effects on the global energy footprint, we employ structural decomposition analyses (SDA). Furthermore, the analysis combines a retrospective with a prospective SDA approach. After an analysis of the global energy footprint for the period between 1995 and 2009, we discuss three scenarios of international integration and their implications for energy footprints for the period from 2009 to 2030. Our results show that the global energy footprint has increased by 29.4% from 1995 to 2009, and the scenarios indicate that it will increase by another 23.5% until 2030. Economic activity is the most important driver for the increase in energy footprints. Rising final demand alone would have increased the global energy footprint by 47.0% between 1995 and 2009. The composition of countries from where consumption and investment goods come adds another 12.6%. Sectoral energy intensity reductions are the most important decelerator of energy use (−27.8%). There is a substantial contribution of changing global value chains on the rise in the global energy footprint (7.5%): Stronger backward linkages in global value chains increased the global energy footprint by 5.5% between 1995 and 2009. Changes in the regional composition of intermediate inputs raised it by another 1.8%. The shift of the world economy towards East Asia alone would have increased the global energy footprint by 3.0%. The sectoral composition of global value chains, on the other hand, had a negligible effect on energy footprints.

This thesis develops an analytical dynamics-based approach for simultaneous position and orientation tracking control of a chaser spacecraft with respect to an uncontrolled target spacecraft. The control requirements are formulated as holonomic or non-holonomic constraints, which are differentiated to obtain a constraint equation linear in acceleration. Exact real-time control forces are then generated by substituting the control constraints into the Udwadia-Kalaba equation. Three major contributions are presented. Firstly, the complete six-degree-of-freedom formulation of the Udwadia-Kalaba based pose tracking controller is presented. Simulations demonstrate the achievement of the desired objectives in space. Subsequently, a planar pose tracking controller is formulated for both a single and dual chaser configuration. Simulation results highlight the planar position and orientation synchronization with respect to a spinning target. Finally, the controller is experimentally validated in the Spacecraft Proximity Operations Testbed at Carleton University. Results show that the pose tracking control objective is achieved.

While immune checkpoint inhibitors have been groundbreaking for cancer treatment, there are many reported cases of patients undergoing immunotherapy who have discontinued or temporarily interrupted treatment due to the development of autoimmune-related adverse effects. Here, we present a 63-year-old female with a history of psoriasis (in spontaneous remission) and newly diagnosed poorly differentiated lung adenocarcinoma (pTXN3M1a) who experienced a severe flare-up of her psoriasis three months after initiating single-agent pembrolizumab. The patient was initially treated with topical clobetasol propionate ointment, however, due to minimal response to this regimen, the patient was commenced on secukinumab; an IL-17 inhibitor. To our knowledge, this is the first case of the successful use of secukinumab for the treatment of immunotherapy-induced psoriasis. More importantly, immunotherapy with pembrolizumab was continued successfully with the co-administration of secukinumab without complications or the recurrence of non-small cell lung cancer (NSCLC).

This paper presents an analytical dynamics based formulation for close-range planar rendezvous of two chaser spacecraft onto an uncontrolled target spacecraft. The control requirements on the chaser system is formulated based on displacement constraints with respect to target. Exact control forces are then generated based on the acceleration constraint equation, which is derived from the displacement constraint, and substituted into the Udwadia-Kalaba equation. As the major contribution, a new formulation is developed for both a single and dual-chaser close-range rendezvous. The simulation results highlight the simultaneous angular velocity synchronization and stand-off distance maintenance with respect to the target.

This article introduces a dynamic forward calibration method for New Quantitative Trade models, particularly a disaggregated Eaton and Kortum model, within a global computable general equilibrium framework. The model is parameterized based on distinct, consistent future development scenarios of the (Northwest) German energy transition with productivity growth and structural change derived through a complex scenario-creation process. The future development scenarios significantly affect European economies, particularly via the EU climate policy costs that significantly increase towards 2050. If (Northwest) Germany's energy transition fails, then its climate policy costs will increase extraordinarily. Structural change, energy efficiency improvements and nearly 100% electricity from renewables drastically reduce the costs.

Background COVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected. Research question We conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/or abnormalities in pulmonary function tests (PFT) or in lung imaging. Study design and methods: This is a single center cohort study including COVID-19 survivors who underwent a three-month follow-up with clinical evaluation, PFT and lung high-resolution computed tomography (HRCT). All clinical, functional, and radiological data were centrally reviewed. Multiple linear regression analysis was performed to identify factors associated with residual lesions on HRCT. Results Full clinical evaluation, PFT and lung HRCT were available for central review in 126, 122 and 107 patients, respectively. At follow-up, 25% of patients complained from dyspnea and 35% from fatigue, lung diffusion capacity (DLCO) was decreased in 45%, 17% had HRCT abnormalities affecting more than 5% of their lung parenchyma while signs of fibrosis were found in 21%. In multiple linear regression model, number of days in ICU were related to the extent of persisting lesions on HRCT, while intubation was associated with signs of fibrosis at follow-up (P = 0.0005, Fisher's exact test). In contrast, the severity of lung imaging or PFT changes were not predictive of fatigue and dyspnea. Interpretation Although most hospitalized COVID-19 patients recover, a substantial proportion complains from persisting dyspnea and fatigue. Impairment of DLCO and signs suggestive of fibrosis are common but are not strictly related to long-lasting symptoms.

Strategic tariffs, which raise an economy's welfare by restricting trade and improving the terms of trade, can create an obstacle to free trade. We evaluate how far trade-induced productivity gains (technology spillovers) reduce or remove this obstacle, because more intensive trade enhances these potential gains. Based on theory and the World Input-Output Database (WIOD) we estimate stronger import-induced than export-induced productivity gains. We feed the theory and the estimates into a global Computable General Equilibrium (CGE) model calibrated to WIOD. We find that the USA's, China's and the EU's optimal tariffs are reduced by less than 20%, Russia's and India's by around 25% and Brazil's by 40% when taking endogenous trade-induced productivity gains into account. Nonetheless, incentives for single economies to impose strategic tariffs persist. Particularly large, trade-intensive downstream sectors producing distinct goods incentivize high sectoral optimal tariffs. A global free trade agreement could overcome such incentives and maximize the trade-induced productivity gains.

Introduction: Fine Needle Biopsy of head and neck masses as a minimally invasive technique is particularly suitable in this sensitive area where an incisional biopsy can cause problems. A cytological diagnosis of a non-neoplastic lesion or confirming suspected metastatic or recurrent tumor can obviate the need for surgery. FNAC can effectively distinguish between benign and malignant cystic lesions of the head and neck. Aim: The aim of this study is to categorise the various head and neck lesions diagnosed by cytology and to assess the diagnostic utility of FNAC. Materials and Methods: All the cases of head and neck masses diagnosed by cytology during the period of one year were analysed. Age and sex distribution was noted. Lesions were mainly categorised into lesions of thyroid, salivary gland and lymph node. Each group were then subcategorised into various groups depending upon the neoplastic and nonneoplastic nature. In some cases histopathologic correlation was done. Results: Thyroid lesions formed 61.5 % (475) of the total number of head and neck masses. 99% of the cases were benign lesions. Lymphadenopathies formed 34 % (262) of the total number of head and neck masses. Most common diagnoses were reactive lymphadenitis (43.5%) followed by granulomatous lymphadenitis (12.5%). Salivary gland lesions formed 4.5 % (35) of the total number of head and neck masses. Sialadenitis was the most common among the benign lesions (40 %) and pleomorphic adenoma was commonest among neoplasms (37 %). Conclusion: FNAC is a reliable, safe, cost-effective and minimally invasive procedure. FNAC can be advised as a primary diagnostic tool.

We have previously advanced the hypothesis that the allergic inflammatory response in the lungs occurs as a self-limited sequence of events that begins with the onset of inflammation and then resolves back to baseline over a predetermined time course (Pothen JJ, Poynter ME, Bates JH. J Immunol 190: 3510–3516, 2013). In the present study we tested a key prediction of this hypothesis, which is that the instigation of the allergic inflammatory response should be accompanied by a later refractory period during which the response cannot be reinitiated. We challenged groups of ovalbumin-sensitized BALB/c mice for 3, 14, 21 and 31 consecutive days with aerosolized ovalbumin. We measured airways responsiveness as well as cell counts and cytokines in bronchoalveolar lavage fluid after the final challenge in subgroups from each group. In other subgroups we performed the same measurements following rest periods and after a final single recall challenge with antigen. We determined that the refractory periods for GM-CSF, KC, and IL-5 are no longer than 10 days, while those for IFNγ and IL-10 are no longer than 28 days. The refractory periods for total leukocytes and neutrophils were no greater than 28 days, while that for eosinophils was more than 28 days. The refractory period for airways resistance was less than 17, while for lung elastance it was longer than 28 days. Our results thus demonstrate that the components of the allergic inflammatory response in the lung have finite refractory periods, with the refractory period of the entire response being in the order of a month.

Objective The objective of this study is to evaluate the effects of a community-based effort in a rural area of central India to decrease the prevalence of hypertension among the middle-aged and older population by using multiple blood pressure measurements. Methods With a prevalence of 16.8% (error of 3.36, and 95% confidence interval) from a recent study in a nearby district, the sample size required for this study was 495 subjects. A proportionally stratified random sample design was used. With maps of ten villages, where in a community-based health project had been in place for many years, 20 households and 20 backups were randomly selected from a list of all households. Multiple BP measurements were obtained and categorized and one-month period prevalence was calculated. Statistical analyses of frequency and percentage were performed. Results Approximately one-fifth of the population above 40 years of age in central India where a community-based approach is in place was hypertensive. This is significantly lower than the previously documented prevalence rate of one-third or even more prevalence rate in India. The attribute of caste and religion, a specific rural Indian characteristic did not have any significant bearing on the above results. The prevalence tended to increase progressively with age until 70 years, after which it declined. Multiple blood pressure measurements may yield an accurate prevalence of hypertension. Conclusion With the documented evidences from India, the current reduced prevalence of hypertension could have been influenced by the community-based interventions in this population.

Background: Hypoxia induces stabilization of the transcription factor HIF-1alpha (HIF-1α), associated with (chemo-)radiotherapy resistance in oropharyngeal squamous cell carcinoma (SCC). We investigated the effect of HIF-1α expression on survival in relation to human papillomavirus (HPV) status in oropharyngeal SCC. Methods: We conducted an immunohistochemical analysis of HIF-1α protein expression and downstream targets carbonic anhydrase-IX (CA-IX) and glucose transporter-1 (GLUT-1) in 274 patients with oropharyngeal SCC. Overall survival (OS) was analyzed in total and stratified for HPV status and treatment. Results: In HPV-positive tumors (n = 44), HIF-1α overexpression predicted worse OS (hazard ratio [HR] = 6.23; p = .012), whereas TNM classification or treatment modality did not. In HPV-negative tumors (n = 218), advanced T and N classification and HIF-1α overexpression all independently predicted worse OS. However, the effect of HIF-1α overexpression on OS was lower in HPV-negative (HR = 1.50; p = .024) than in HPV-positive tumors. Conclusion: HIF-1α overexpression is associated with worse OS and characterized a subgroup of patients with HPV-positive oropharyngeal SCC with poor prognosis. Possibly, patients with HIF-1α overexpressing HPV-positive tumors should not be eligible for treatment dose deescalation.

We describe the case of four patients consulting for headache and tachycardia of brutal onset. Their biological data were compatible with primary hyperthyroidism with low TSH and high T4 serum levels. Serum thyroglobulin level was low and Tc-scintigraphy showed decreased uptake with a homogenous pattern. These results allowed to conclude a thyrotoxicosis caused by thyroid hormones intake. History taking revealed consumption of beef neck meat containing all or parts of the bovine thyroid gland. Evolution was favourable with beta-blockers. A literature review of « hamburger thyrotoxicosis » is presented.

Dear Editor, Based on studies showing in vitro antiviral activity of chloroquine (CQ) and hydroxychloroquine (HCQ) on SARS-CoV-2 (1), Belgian COVID interim guidelines rapidly (March 13th, 2020) recommended treating hospitalized patients suffering from severe COVID-19 with HCQ, 400 mg bid the first day followed by 200 mg bid for 4 additional days (for GFR > 30 ml/min). [...]

We survey recent work on approximation algorithms for computing degree-constrained subgraphs in graphs and their applications in combinatorial scientific computing. The problems we consider include maximization versions of cardinality matching, edge-weighted matching, vertex-weighted matching and edge-weighted $b$-matching, and minimization versions of weighted edge cover and $b$-edge cover. Exact algorithms for these problems are impractical for massive graphs with several millions of edges. For each problem we discuss theoretical foundations, the design of several linear or near-linear time approximation algorithms, their implementations on serial and parallel computers, and applications. Our focus is on practical algorithms that yield good performance on modern computer architectures with multiple threads and interconnected processors. We also include information about the software available for these problems.

We describe the case of a 64-year-old woman admitted for fever of unknown origin, who developed nephrotic syndrome during hospitalisation and pulmonary infiltrates. Renal biopsy disclosed intracapillary glomerular invasion by intravascular large B cell lymphoma. Clinical and biological evolution was favourable after rituximab, cyclophosphamide, doxorubicine, vincristine and prednisone (R-CHOP) treatment and autologous stem cell transplant. Two years after diagnosis the patient was considered in remission.

Introduction: Carcinoma breast is a leading cause of morbidity and mortality in females. Metaplastic Carcinoma Breast (MCB) accounts for less than 1% of invasive breast carcinomas. This variant has an aggressive behaviour and hence poor prognosis. Since metaplastic carcinomas are rare and most patients succumb within a short span of time, detailed studies are required in this area. Moreover, being a heterogeneous group, sub classification and prediction of biologic behaviour of metaplastic carcinomas is challenging. World Health Organization (WHO) classification and recent studies show the importance of identifying the subtypes of MCB based on histopathology. Aim: To analyse the histopathological patterns and expression of Immunohistochemical (IHC) markers in MCB. Materials and Methods: All cases of MCB diagnosed in Pathology Department of our Institute during the period of six years from January 2011 to December 2016 were analysed. Age distribution, histopathological and IHC patterns were studied using the registers, histopathology slides and IHC slides in the department. The data collected were analysed using SPSS software 16.0. Results: A total of 36 cases of MCB accounting for 2.6% of breast carcinomas (n=36, total number of invasive breast carcinomas=1405) were received in our Institution, which is a tertiary care centre. Age distribution ranged between 34 to 72 years. All except one were female patients. Predominant histopathological pattern was malignant spindle cells accounting for 53% cases. Seventeen percent showed predominant squamous areas. Other types were heterologous differentiation (chondroid/osseous) in 11%, mixed pattern (squamous areas+invasive ca NST(No Special Type) in 11%, choriocarcinomatous component in 3%, fibromatosis like in 3% and low grade adenosquamous type in 3%. Lymph node metastasis was present in 41.4% (n=12) and 69.2% of cases showed triple negative pattern in immunohistochemistry. Conclusion: Majority of metaplastic carcinomas was solid grey white growths with infiltrative margins but cystic degeneration (in 24.1% cases) was associated with squamous areas. Presence of epithelial elements confers an increased chance of nodal spread and sarcomatous elements confers increased risk of extra nodal dissemination, hence this should be highlighted in the report stressing the need for a more aggressive follow up of those with sarcomatous component. The results of this study were comparable with other similar studies.

The primary objective of this study was to further characterize the role of sex, if any, in event-related potentials (ERPs). More specifically, we aimed to investigate sex sensitivity with respect to the P300 ERP. Each female and male study participant underwent an oddball paradigm electroencephalography ERP session. ERP data were subjected to preprocessing and postprocessing, as well as statistical analysis. The results of the study showed that men had larger P300 amplitudes on average for both low-probability and high-probability stimuli compared with women (P

We revisit an algorithm [called Edge Pushing (EP)] for computing Hessians using Automatic Differentiation (AD) recently proposed by Gower and Mello (Optim Methods Softw 27(2): 233–249, 2012). Here we give a new, simpler derivation for the EP algorithm based on the notion of live variables from data-flow analysis in compiler theory and redesign the algorithm with close attention to general applicability and performance. We call this algorithm Livarh and develop an extension of Livarh that incorporates preaccumulation to further reduce execution time—the resulting algorithm is called Livarhacc. We engineer robust implementations for both algorithms Livarh and Livarhacc within ADOL-C, a widely-used operator overloading based AD software tool. Rigorous complexity analyses for the algorithms are provided, and the performance of the algorithms is evaluated using a mesh optimization application and several kinds of synthetic functions as testbeds. The results show that the new algorithms outperform state-of-the-art sparse methods (based on sparsity pattern detection, coloring, compressed matrix evaluation, and recovery) in some cases by orders of magnitude. We have made our implementation available online as open-source software and it will be included in a future release of ADOL-C.

The harvest operation for table-grapes and fresh market horticultural fruits is a large and expensive logistical challenge with the choice of harvest dates and locations playing a crucial role in determining the quality of the yield and in determining the efficiency and productivity gain of the entire operation. The choice of harvest dates and locations, particularly in red varieties, is planned based upon the development of the color of the grape clusters. The traditional process to evaluate the amount of ripe, fully-colored fruit is visual assessment, which is subjective and prone to errors. The number of locations where a grower will evaluate the fruit development is statistically insufficient given the size of commercial vineyards and the variability in the color development. Therefore, an automated approach for evaluating color development is desirable. In this paper, we use a vision-based system to collect images of the fruit zone in a vineyard. We then use color image analysis to grade and predict the color development of grape clusters in the vineyard. Using our approach we are able to generate spatial maps of the vineyard showing the current and predicted distribution of color development. Our imaging measurement system achieves R 2 correlation values of 0.42-0.56 against human measurements. We our able to predict the color development to within 5% average absolute error of the imaging measurements. The prediction of spatial maps is important from the perspective of selective harvesting as it allows the precise targeting of productive zones during the harvest operation. To the best of our knowledge generation of these spatial maps that represent the current and predicted state of the color development of an entire vineyard block, before harvest and in high resolution, is a first of its kind.

BACKGROUND: The purpose of this systematic review was to determine the prognostic value of continued smoking after diagnosis on survival and recurrence rates in head and neck cancer. METHODS: A systematic search was performed and predefined inclusion and exclusion criteria were used to screen and select the articles. The remaining articles were critically appraised. RESULTS: Six articles were used for data extraction. The survival rate of patients who continued to smoke was 21% to 35% lower compared with patients who quit smoking. The recurrence rate for continued smoking was 23% and 30% higher. In 1 study, there was no difference between continuation and cessation of smoking, and 1 study showed a higher recurrence rate for patients who continued to smoke, which was not statistically significant. CONCLUSION: There is consistent evidence that survival rates are lower and recurrence rates are higher for patients who continue to smoke after being diagnosed with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.