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Covid-19 appeared in Wuhan (China), by December 2019 and rapidly spread to the rest of the world. Many countries adopted measures against its spread to protect people and national healthcare services. However, at the moment, more than 2.5 million people got infected and more than 175 thousand died in the 213 countries, areas and territories reached by the disease (official records at April 23, 2020). Countries began to adopt also measures to protect the economy and to prepare the economic recovery, once the effects are tremendous worldwide. In Portugal, measures allowed a flattered curve for Covid-19 spread. In this paper, we use an analogy to the 'drop of honey effect' to show how this curve develops. The 'drop of honey effect' is studied in terms of chaos theory and dynamic systems and is used as a framework to the way systems change in social phenomena.

We read with interest the paper by Layer et al. regarding the identification of staphylococci with automated systems including VITEK-2 (bioMerieux, Marcy l'Etoile, France) (6). Of 86 strains analyzed in their study, 4 were Staphylococcus hominis and all were correctly identified by the colorimetric ID-GP VITEK-2 cards. Identical results have been reported in recent studies evaluating 13 and 14 S. hominis isolates (3, 7).

We explore the way in which uncertain descriptions of aquifer heterogeneity and groundwater flow impact one's ability to assess the worth of collecting additional data. We do so on the basis of Maximum Likelihood Bayesian Model Averaging (MLBMA) by accounting jointly for uncertainties in geostatistical and flow model structures and parameter (hydraulic conductivity) as well as system state (hydraulic head) estimates, given uncertain measurements of one or both variables. Previous description of our approach was limited to geostatistical models based solely on hydraulic conductivity data. Here we implement the approach on a synthetic example of steady state flow in a two-dimensional random log hydraulic conductivity field with and without recharge by embedding an inverse stochastic moment solution of groundwater flow in MLBMA. A moment-equations-based geostatistical inversion method is utilized to circumvent the need for computationally expensive numerical Monte Carlo simulations. The approach is compatible with either deterministic or stochastic flow models and consistent with modern statistical methods of parameter estimation, admitting but not requiring prior information about the parameters. It allows but does not require approximating lead predictive statistical moments of system states by linearization while updating model posterior probabilities and parameter estimates on the basis of potential new data both before and after such data are actually collected.

In this work, we have spectroscopically characterised CYP157C1 from Streptomyces coelicolor A3(2) which has the motif E(297)QSLW(301) rather than the invariant EXXR motif in the P450 K-helix. Site-directed mutagenesis of native E(297)QSLW(301) in CYP157C1 to E(297)ESLR(301) or E(297)QSRW(301) both containing standard EXXR motifs produced cytochrome P420 proteins thought to be inactive forms of P450 even though wild type CYP157C1 has the spectral properties of a normal P450. These results indicate that the EXXR motif is not required in all CYP tertiary architectures and only a single cysteine residue, which coordinates as the fifth thiolate ligand to the P450 haem iron, is invariant in all CYPs structures.

A 44-year-old male presents with shortness of breath, non-productive cough, and chest tightness to the ski clinic in Winter Park, Colorado. He flew from his home town, San Antonio, Texas, three days earlier. Symptoms began the day after arrival and progressively worsened over the course of the last 2 days. Shortness of breath is exacerbated by physical activity and relieved by rest. He tried his son’s albuterol inhaler with no improvement in his symptoms. He denied fevers, chills, and sick contacts. He is in excellent shape and has never experienced these symptoms before despite many similar ski trips. His past medical, family, and social histories are unremarkable, and he takes no medications. On arrival he appears generally healthy, but exhibits significantly labored breathing. He is afebrile and normotensive, but tachycardic (104 BPM) and hypoxic with an oxygen saturation of 61% on room air. His lung examination is significant for diffuse rales. Chest radiography was performed (Figure 1). Open in a separate window Figure 1. Chest Radiography 2. Arguments Against Based on the patient's history, physical examination, and radiographs, which one of the following is the most likely diagnosis? Atypical pneumonia Pulmonary embolism High altitude pulmonary edema Exercise induced bronchospasm Pneumothorax 3. Conclusions The answer is C: High altitude pulmonary edema (HAPE) is the leading cause of altitude-related death (1). It is characterized by non-cardiogenic pulmonary edema occurring with rapid ascent to altitudes above 2,500 m (1-3). This patient travelled from San Antonio, TX with altitude of 235 m to Winter Park, CO with altitude of 2,800 m. Risk factors for development of HAPE include prior history of altitude illness, higher altitude, rapid ascent, male sex, cold ambient temperatures, pre-existing respiratory infections, and intense exercise (1-3). Estimates of HAPE incidence vary, but have been reported as high as 4% in un-acclimatized mountaineers above 4,600 m (2). Onset of HAPE typically occurs within 1-4 days of ascent to altitude (3). Symptoms include fatigue, dyspnea on exertion, decreased exercise tolerance, low-grade fever, and dry cough which sometimes progresses to become productive of pink, frothy, sputum (2, 3). On physical examination, patients with HAPE are tachycardic, tachypneic, and hypoxic, frequently with low-grade fevers (1-3). Pulmonary examination reveals inspiratory crackles, initially in the right middle lobe, and becoming more diffuse and bilateral later in the illness (1-3). Chest x-ray (CXR) classically shows patchy perihilar opacities, sometimes with interstitial edema and pleural effusions. Heart size is normal, which is consistent with no cardiogenic pulmonary edema (3). The cornerstones of HAPE treatment are immediate descent to lower altitude and supplemental oxygen (1-3). If descent is not possible or supplemental oxygen not available, pharmacotherapy with nifedipine may be considered as the next line of treatment, with the goal being to decrease pulmonary artery pressure (1, 3) Several studies have suggested benefit with long acting beta agonists (e.g. salmeterol) and with phosphodiesterase-5 inhibitors, but no strong evidence for either exists (1, 3). Similarly, HAPE is best prevented by gradual ascent to altitude (1-3). Pharmacologic prophylaxis can be considered, particularly in those with a history of HAPE, with nifedipine as the first-line agent and other potential options including phosphodiesterase-5 inhibitors, long acting beta agonists, and dexamethasone (1-3). Atypical organisms account for up to 40% of community-acquired pneumonia (4). Patients usually present with fevers and productive cough (4). Lung examination may reveal rales and wheezing (4). Hypoxia is rare (4). CXR may reveal patchy or circumscribed opacities (4). Pulmonary embolism (PE) may present with a sudden episode of SOB at rest (5). CXR is non-diagnostic in patients with PE and most commonly shows atelectasis, non-specific parenchymal abnormalities, or pleural effusions (5). Less commonly, the classic signs of a peripheral wedge-shaped opacity may be seen (5). Exercise-induced bronchospasm causes dyspnea and chest tightness during or after exercise (6). Physical examination is usually unremarkable with occasional wheezing (6). CXR is usually normal or may show increased bronchial wall thickening or flattening of the diaphragm (6). Pneumothorax is a relatively common condition among adults and can present with dyspnea and pleuritic chest pain (5). Physical examination typically reveals decreased chest excursion as well as decreased breath sounds on the affected side (5). CXR usually demonstrates a visceral pleural line, beyond which no pulmonary markings are present and possible mediastinal shift (5, 7). Table 1. Summary table Condition Characteristics Atypical pneumonia Fever, productive cough; unilateral or bilateral heterogeneous, patchy, reticular, segmental, peribronchial opacifications on CXR a Pulmonary embolism Acute onset of cough, dyspnea, tachycardia, tachypnea, pleuretic chest pain, and hypoxia; CXR is usually normal, but a wedge-shaped opacity of the lung tissue may be present High altitude pulmonary edema Caused by rapid ascent to high altitude above 2,500m; cough, dyspnea, hypoxia; dense bilateral patchy opacities in variable locations Exercise induced bronchospasm Cough, dyspnea, and wheezing triggered by exercise; CXR is usually normal Pneumothorax Acute onset of dyspnea, pleuretic chest pain, diminished breath sounds; CXR may reveal displacement of visceral pleura and absence of pulmonary markings Open in a separate window a chest x-ray.

We present a new method for data sharing across largecollaborations to improve reproducibility and transparency,by creating a Python package that serves as an interface (API) to the multi-omics characterization of tumors from NCI’s CPTAC program.

AbstractIn the spreading of infectious diseases, an important number to determine is how many other people will be infected on average by anyone who has become infected themselves. This is known as the reproduction number. This paper describes a non-parametric inverse method for extracting the full transfer function of infection, of which the reproduction number is the integral. The method is demonstrated by applying it to the timeline of hospitalisation admissions for covid-19 in the Netherlands up to May 20 2020, which is publicly available from the site of the Dutch National Institute of Public Health and the Environment (rivm.nl).

A 69-year-old man with a history of dilated cardiomyopathy underwent epicardial catheter ablation of repetitive ventricular tachycardia through a subxiphoid pericardial window. A perfect pace map was obtained at the lateral aspect of the left ventricular epicardium, but it was accompanied by phrenic nerve capture. We combined a 14-French Foley balloon catheter with a 5French steerable mapping catheter, (Fig. 1). The Foley balloon was then advanced into the pericardial space and navigated into position near the site of perfect pace map using the steerable mapping catheter. During the high-output pacing from the ablation catheter, the Foley balloon was inflated and resulted in the absence of phrenic nerve capture (Fig. 2). With the balloon inflated, irrigated radiofrequency current was delivered at that site. After the ablation, normal function of the left diaphragm was verified by fluoroscopy.