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and reduced their signs and symptoms significantly. It also shows some manageable side effects mostly those related to heart rhythm. In the absence of FDA-approved medications to treat COVID-19, the repurposing of HCQ and azithromycin to control the disease signs and symptoms can be useful.This article looks at the period in Shane's career when she was based in the library at the Charing Cross Hospital Medical School (1970-1984) and then the Charing Cross and Westminster Medical School (1984-1991), following the merger. The topics covered include audio-visual materials and new technology, user education, staff training and development, word processing and automation in the library and Shane's involvement and activities in the wider profession.The co-founderof African Hospital Libraries (AHL) chronicles how this charity grew from a tiny pop-up library set up by two VSO volunteers and the hospital management team, to establishing health care library services in three provincial government referral hospitals (Makeni, Bo, Kenema) in Sierra Leone, and supporting link-ups with a shared maternity and paediatric hospital library service in Freetown and two libraries in healthcare training institutions. She reflects on the impact that Shane Godbolt had and continues to have on the work and growth of the organisation.

Trends of male factor causes of couples' infertility over time have been poorly investigated.

We investigated trends in the causes of pure male factor infertility (MFI) throughout the last 10years in a tertiary-referral academic andrology center.

Baseline characteristics at first presentation from a cohort of 1647 consecutive male factor infertility patients belonging to primary infertile couples between 2008 and 2018 have been comprehensively collected over time. Seven major causes of male factor infertility were identified varicocoele; history of cryptorchidism; hypogonadism (primary and secondary); obstructive azoospermia; genetic abnormalities; other causes (large group including the remnant conditions of known causes); and idiopathic infertility. Rates of different male factor infertility causes over the study period were analyzed. Multivariable logistic regression models tested the likelihood of male factor infertility causes over time. Estimated trends were explored graphically.

Of all, varicocrtions of varicocoele and cryptorchidism at first presentation was observed over the last 10 years; conversely, the proportions of idiopathic cases, hypogonadal patients, and infertile men presenting with other male factor infertility causes significantly increased over the same time frame at a single tertiary-referral academic andrology center.Neophobia is an animal's avoidance of novelty. Animals tend to respond to novel objects by increasing their latency to approach the objects, and they eventually habituate after repeated exposure by attenuating this increased approach latency. Interestingly, the physiological stress response does not appear to have a causal link to neophobia, although acute stress can prevent animals from habituating to novel objects, possibly through a permissive effect. Chronic stress can induce an anxiety-like state in animals, while often disrupting the ability to respond to acute stress. We thus hypothesized that chronic stress may increase neophobia and tested this by inducing chronic stress in wild-caught European starlings (Sturnus vulgaris). Four distinct anthropogenic stressors were administered daily for 30 min each in a randomized order for 21 days. We then evaluated whether exposure to chronic stress altered the latency to approach a novel object placed on or near a food dish presented after overnight fasting. Chronically stressed birds and nonstressed controls exhibited similar initial neophobic responses to novel objects and showed similar habituation in response to repeated exposure. However, when birds were exposed to 15 min of restraint before repeated exposure to the same object, habituation was eliminated in control birds (i.e., they continued to respond with neophobia), whereas chronically stressed birds continued to show habituation as measured by attenuated approach latencies. These results demonstrate that an acute stress response (restraint) has a different impact on neophobia depending upon whether the bird is or is not concurrently exposed to chronic stress.

The role of dynamic changes in lactate concentrations on prognosis in acute heart failure has been poorly investigated. The aim of this study was to explore the predictive value of 24h time-weighted lactate (LAC

) in patients with acute heart failure.

Ninety-six consecutive acute heart failure patients presenting to the Emergency Department of San Paolo Hospital, Naples, Italy, were prospectively enrolled. Arterial blood lactate was measured at admission and during the following 24h at random time intervals. LAC

was obtained by the sum of the average lactate values among consecutive time points multiplied by the intervals between consecutive time points and dividing the sum by the total time (24h). The outcome was a composite of need of admission to the intensive care unit, hospitalization duration >7days, or intra-hospital death. Admission lactate, maximum measured lactate, and LAC

were collected. selleck products Univariate and multivariate Cox regression analysis was applied to determine the hazard ratio (HR) of developing the outcome. Forty-three patients experienced the pre-specified outcome. In sex-adjusted and age-adjusted multivariable analysis, LAC

predicted the outcome occurrence (HR 1.51, 95% confidence interval 1.24, 1.84, P<0.001). Risk stratification analysis based on LAC

tertiles demonstrated a gradual increase in risk of developing the outcome (HR 17.32, 95% confidence interval 2.30, 130.23, P=0.006) for the highest LAC

tertile.

In acute heart failure patients, 24h LAC

had a significant independent predictive value for adverse intra-hospital outcome. LAC

could be a useful index at identifying high-risk patients who may require a more aggressive treatment during hospitalization.

In acute heart failure patients, 24 h LACTW had a significant independent predictive value for adverse intra-hospital outcome. LACTW could be a useful index at identifying high-risk patients who may require a more aggressive treatment during hospitalization.