High Population Research Articles

A prospective study of a novel pocket compression device to reduce pocket hematoma after cardiac implantable electronic device implantation in a high bleeding risk population

Abstract Background Pocket hematoma (PH) is one of the most common complications after cardiovascular implantable electronic device (CIED) implantation resulting in an up to 9 times higher risk for CIED infections.(1) Different preventive strategies have been proposed with mixed results. Current standard of care consists of preventive elastic adhesive tape leaving 2 major disadvantages: unpredictable pressure on the pocket and inability to visually assess the pocket with the bandage applied. Aim To evaluate the safety and effectiveness of a novel pocket compression device in patients undergoing CIED implantation in a high bleeding population. Material and methods This randomized controlled trial included 32 patients in the study group (pocket compression device) and 33 in the control group (elastic adhesive tape). The studied pocket compression device contains an inflatable compartment to modify the degree of pocket compression which is transparent facilitating pocket evaluation. The primary outcome was the incidence of various grades of PH. The secondary outcomes comprised the incidence of pressure lesion, pain score (0-10) and endocarditis during follow-up. Results There were no clinical or procedural differences between groups (age 78.01±9.71, heart failure 53.8%, kidney failure 20.0% and on antithrombotic drugs 49.2%). There were significantly less pocket hematomas in the study group (1/32 (3.1%) vs 20/33 (60.6%), P<0.001). Most pocket hematomas were grade I for which watchful waiting was applied (1/32 (3.1%) vs 17/33 (51.6%), P<0.001). Grade II and grade III PH only occurred in the control group (respectively 1/33 and 2/33) resulting in hospitalization prolongation and longer interruption of antithrombotic drugs >24hours. Two control patients eventually received the study device to control PH. None underwent reoperation. Pressure lesions did not occur. Patients in the study group had lower pain scores at application (0.75±1.12 vs 1.80±1.38, P=0.009), after 2 hours (0.81±1.36 vs 1.94±1.50, P=0.002) and the next day (0.38±0.91 vs 1.06±1.634, P=0.042). None of the patients experienced endocarditis during mean follow-up of 1 year. Conclusion The use of a pocket compression device in patients undergoing CIED implantation in a high bleeding population leads to less PH and postoperative pain in comparison to conventional elastic adhesive tape.bandage study

Arterial stiffness for predicting major adverse cardiovascular events in post-infarcted patients

Abstract Introduction According to recent 2021 ESC prevention guidelines arterial stiffness (aortic pulse wave velocity –PWV, augmentation index - Aix) predicts future major adverse cardiovascular events (MACE). Both parameters have a prognostic relevance in different patient population (hypertension, diabetes, chronic kidney disease), however in post-infarcted, very high cardiovascular risk population the exact prognostic value for PWV and Aix needs to be clarify. Purpose We evaluated PWV and Aix cut-off values for MACE prediction and validated the prognostic relevance of high stiffness parameters in post-infarcted patients. Methods Oscillometric based pulse wave analysis method (Arteriograph) was applied for calculating arterial stiffness. We aimed to evaluate PWV and Aix cut-off values for predicting MACE (comprising all-cause death, non-fatal myocardial infarction, ischemic stroke, hospitalization for heart failure and coronary revascularization) in post-infarcted, very high cardiovascular risk patient population. 114 patients (89 male, average age: 62,5±10,5 years) were investigated in this long term, median 16,2 (IQR: 6,5-17,4) years follow-up study. Results Strong, significant correlation was found between PWV and Aix values (Spearman rho: 0,648, p<0,001). Totally 140 MACE events occurred during the 16,2 years follow-up period. Optimized PWV and Aix cut-off values for MACE prediction were calculated (PWV: 9,84 m/s, AUC: 0,754 (95% CI: 0,66-0,85), p<0,001; Aix: 34,8 %, AUC: 0,67 (95% CI: 0,57-0,77), p<0,05) by ROC analysis (Figure 1.). Kaplan-Meier analysis in both parameters showed a significantly lower event-free survival in case of high PWV and Aix values (p<0,05; Figure 2.). Multivariate Cox regression analysis revealed PWV and Aix as an independent predictor of MACE (PWV HR: 1,32 (95% CI: 1,15-1,53), p<0,001; Aix HR:1,04 (95% CI: 1,01-1,08), p<0,05). Conclusions Arterial stiffness, particularly elevated PWV predicts MACE in post-infarcted, very high cardiovascular risk patient population. All these findings emphasize the clinical relevance for the future measurement of arterial stiffness might contribute to improve individual risk stratification in patients after myocardial infarction.ROC analysis for the prediction of MACEKaplan-Meier curves for MACE

Disparities by region, age, and sex in cardiovascular disease burden attributable to high fasting plasma glucose in China, 2010-2018: a nationwide, population-based study

Abstract Background Elaborating and understanding disparities in the burden of cardiovascular disease (CVD) attributable to high fasting plasma glucose (FPG) is important to improve diabetes prevention and promote cardiovascular health. In this study, we aimed to estimate the burden of CVD and its subtypes attributable to high FPG between 2010 and 2018 in China, by age, sex, region and socio-demographic index (SDI). Methods We pooled data on 791 373 people aged 25 years and older from three population-based surveys, and the temporal-spatial Bayesian hierarchical model was used to estimate age- specific, sex- specific, province- specific, and year-specific average FPG levels from 2010 to 2018. We estimated population attributable fraction for CVD by age and sex for 31 provinces. Data on CVD deaths at the provincial level were obtained from surveillance systems, which were used to compute death numbers and years of life lost (YLLs) due to CVD that could be attributed to high FPG using the counterfactual scenario of theoretical minimum risk level. We also decomposed changes in attributable burdens into four explanatory components, including population growth, population aging, risk exposure to FPG, and in risk-deleted mortality rates for CVD. Results In 2018, an estimated total of 512·29 thousand (95% uncertainty interval [UI] 488·60 to 538·65) adults aged 25 or older were attributable to high FPG in China, with 281·54 thousand (95%UI 267·89 to 295·05) of these deaths occurring in men and 229·75 thousand (95%UI 210·98 to 251·89) in women. The age composition of CVD mortality caused by high FPG suggested a trend toward older ages from 2010 to 2018 (Figure 1). High FPG accounted for 1 093·45 crude YLLs per 100 000 people (95%UI 1 059·13 to 1 131·73) due to FPG-related CVD in 2018, with substantial variation across provinces. The age-standardised CVD mortality rate attributable to high FPG increased by 3·99%, from 41·93 per 100 000 people (95%UI 40·07 to 43·88) in 2010 to 43·60 per 100 000 (95%UI 41·77 to 45·62) in 2018. In 2018, the higher age-standardised CVD mortality rate attributable to high FPG was observed in the high-middle SDI region and the middle SDI region. By province, the age-standardised mortality rate due to FPG-related CVD in both sexes combined varied from 21·31 per 100 000 people in Tibet to 77·66 per 100 000 people in Heilongjiang in 2018. Nationally, compared to 2010, exposure to high FPG and population aging in 2018 were the primary drivers of increased FPG-related deaths due to CVD (Figure 2). Conclusions The CVD burden attributable to high FPG was still large in China, and varied markedly across regions and provinces. Exposure to high FPG and population ageing were associated with substantial changes in the number of FPG-related CVD deaths between 2010 and 2018. Findings of this study emphasize the importance of developing population-specific tailored measures in China and other regions with similar condition.Figure 1Figure 2

The diagnostic accuracy of aortic valve calcium score in patients with low gradient and high gradient aortic stenosis

Abstract Introduction The standard imaging modality for diagnosing aortic stenosis (AS) is echocardiography (echo), by which the definition of severe AS is based on the transvalvular mean gradient (AMG) (>40 mmHg) and aortic valve area (AVA) (<1 cm2). However, in around one quarter of the cases, echo provides discordant findings (AVA<1 cm2, despite of an AMG <40 mmHg), complicating clinical decision making. Computed tomography aortic valve calcium scoring (CT- AVCS) offers an alternative diagnostic method. In cases with discordant echo measurements current guidelines recommend the use CT-AVCS to decide on severity. Purpose Our aim was to validate the sensitivity of the recommended AVCS thresholds within our patient population, as well as to identify any factors associated with below cut-off AVCS values despite confirmed severe AS (low AVCS). Methods Our retrospective study included 332 consecutive patients with severe AS (AVA ≤1 cm2), who underwent CT angiography (CTA) for transcatheter aortic valve implantation (TAVI) planning. Based on the AMG the patients were classified into high gradient (HG: AMG ≥ 40 mmHg) and low gradient (LG: AMG <40 mmHg) groups. In the LG group AS severity was assessed by a multiparametric algorithm. To specify the predictors of low AVCS among patients with HG-AS, logistic regression analysis was used. The patients were followed for 50 months. Cox proportional hazard model was used to assess the risk of death from any cause. Results The HG-AS group consisted of 244 and the LG-AS cohort of 88 patients. In the HG-AS population the sensitivity of AVCS to diagnose severe AS was 89%. Within the HG severe AS group, logistic regression analysis revealed an association between low AVCS and the AMG (OR 0.89, CI 0.83 – 0.95, p <0,001), whereas none of the other tested factors (age, sex, hypertension, diabetes, left ventricle function, renal function) showed any association. In the LG-AS group, contrary to the HG- AS patients, the sensitivity of AVCS to define severe LG AS was limited (53% in males and 67% in females). Over a median follow-up of 50 months, the prognosis of HG AS patients with low AVCS was more favourable than that of the high AVCS patient population (HR 0.41; CI 017 – 097; p=0.04), however, in the LG AS group, the prognosis was not different when stratifying the patients according to high or low AVCS (p=0.21). Conclusions Our results confirmed that among patients with HG AS, the recommended AVCS thresholds provide a good diagnostic sensitivity for severe AS. Nonetheless, the number of severe AS patients with low AVCS is not negligible, especially within the LG-AS population, where the diagnosis is the most challenging. Our findings underline that in patients with discordant echocardiographic findings, a personalized, multiparametric diagnostic approach is needed, instead basing the final diagnosis exclusively on AVCS.

The prothrombotic state in patients with type 2 diabetes mellitus and ischemic heart failure: an association with endothelial dysfunction

Abstract Background Heart failure (HF) is associated with a substantial prothrombotic state and an increased risk of thromboembolism, regardless of the presence of atrial fibrillation (AF). Although oral anticoagulation in HF with known AF is recommended, there is no conclusive evidence supporting clinical benefits of chronic anticoagulation in HF subjects without AF. Other factors enhancing prothrombotic state, often concomitant with HF, are type 2 diabetes mellitus (T2D) and coronary artery disease (CAD). T2D as well as CAD are independently associated with a hypercoaguability due to multiple mechanisms including endothelial dysfunction and oxidative stress. Dysfunction of endothelium was observed in patients with HF, however a little is known about its influence on prothrombotic state in a very high risk HF population. Purpose This study aimed to investigate whether the prothrombotic state in patients with T2D, CAD, and HF, depends on the left ventricular ejection fraction (LVEF) or endothelial function. Methods We assessed 54 patients with stable chronic HF, CAD, and T2D. Based on the echocardiography examination 28 of them were those with HF with reduced ejection fraction (HFrEF) and 26 of them were classified as HF with preserved ejection fraction (HFpEF) according to current guidelines. Fibrin clot density reflected by clot permeability (Ks) and thrombin generation were evaluated. Endothelial function was determined in flow-mediated (FMD) and nitroglycerin-mediated dilatation (NMD) tests of the brachial artery. Results Subjects in both groups were comparable in terms of cardiovascular risk factors except for lower glomerular filtration rate (GFR) by 18.1%. HFrEF patients had lower Ks by 20.3%, along with higher endogenous thrombin potential (ETP) by 18.9% and maximum thrombin level (Peak) by 24.1% as compared with HFpEF. While there were no differences in FMD and NMD between subjects, we found negative correlations of NMD with ETP and Peak (r=-0.448, P=0.001; r=-0.304, P=0.034, respectively). Moreover, the proportion of NMD and FMD along with GFR and LVEF were also significantly associated with both thrombogram parameters (<0.01 for all). By the multivariate analysis of the whole population, NMD, LVEF, low-density lipoprotein and GFR were independent predictors of ETP (R2=0.530, P<0.001) while NMD, LVEF, and GFR predicted Peak levels (R2=0.327, P=0.002). Conclusion We showed for the first time that patients with ischemic etiology of HFrEF and T2D presented altered fibrin clot properties and enhanced thrombin generation compared to HFpEF subjects. It might be hypothesized that endothelial dysfunction induced by T2D could intensify hypercoagulability in patients with HF.Figurę 1

Burden and sociodemographic disparities in cardiovascular mortality rates associated with hypercholesterolemia in united states: a nationwide county-level analysis from 2010 to 2019

Abstract Background Hypercholesterolemia (HC), a major public health concern, has seen a rising prevalence in US adults and globally, leading to increased morbidity and mortality. Despite well-established links between HC and cardiovascular mortality (CVM), the specific impacts and disparities at the population level remain poorly understood. Purpose This study aims to assess the independent effects of HC on VM across the overall US population, examining variations across sociodemographic groups and geographic locations. Methods Age-adjusted county-level CV rates (ACVM per 100,000 individuals) between 2010 to 2019 were obtained using the Center for Disease Control and Prevention (CDC) database. Using the CDC surveillance system, HC rates per county were assessed as the proportion of adults (+18) with high total blood cholesterol. County health ranking project databases were utilized to acquire county characteristics and demographics. Poison generalized estimating equation models were employed to assess incidence rate ratios (IRR). Results Of 307,045,656 residents who lived in 3142 US counties in 2010, a total of 8,157,580 (2.7%) CV deaths occurred between 2010-2019. In a fully adjusted model*, high HC rates associated with high ACVM (Standardized IRR: 1.049; Figure 1). In subgroup analyses, HC rates associated with a greater ACVM among counties with high minority (IRR: 1.070) versus low (IRR: 1.043), and in rural areas (IRR: 1.052) versus urban (IRR: 1.041). Notably, this association was prominent in areas with high poverty (Q4 vs. Q1) (IRR: 1.062 vs. 1.035; p interaction <0.001; Figure 1). Further, higher ACVM rates related to HC were observed in the South and Northeast U.S. regions. Conclusions HC rates are independently associated with high ACVM across most sociodemographic groups and locations, with the most pronounced effect in areas with high poverty levels and minority populations. These findings call on targeted interventions and policymaking aimed at mitigating the prevalence of HC and cardiovascular burden, particularly in vulnerable populations.

Tradeoffs and synergy between material cycles and greenhouse gas emissions: Opportunities in a rapidly growing housing stock

AbstractManagement of building materials’ stocks and flows is a major opportunity for circularity and de‐carbonization. We examine the relationship between material consumption and associated greenhouse gas (GHG) emissions under different scenarios in Israel, a developed country with an already high population density that expects tremendous growth in its housing stock by 2050. We created scenarios of varying housing unit sizes and additional material efficiency practices: fabrication yield, lifetime extension, material substitution, recycling, and their combination, resulting in 18 scenarios. In each scenario, the material flows and stocks needed to supply the housing demand and the resulting life‐cycle GHG emissions are quantified. No single material efficiency practice achieves a reduction in all indicators, suggesting a potential conflict between circular economy and decarbonization policies: The material substitution scenario allows for the biggest reduction in material consumption (12%–40% concrete reduction and 15%–51% steel reduction in 2050 compared with the baseline), while the recycling scenario achieves the biggest reduction in GHG emissions (22%–43% reduction in 2050 compared with the baseline). In the long‐term, the life‐extension scenario reduces most demolition waste. These findings can help policymakers and stakeholders consider the impacts of raw materials consumption and implement this knowledge in light of their priorities in policy packages. The results suggest a narrow window of opportunity within the next decade to influence material consumption and emissions to 2050. The findings could also shed light on the sustainability trajectories of other countries with similarly rapidly developing building stock, which have received little attention in this field.

Human-forest proximity and the risk infectious diseases in a changing world

Abstract Background Emerging Infectious Diseases (EIDs) pose a significant threat to global human health; they can lead to epidemics and pandemics with severe repercussions on human life, economic performance, and societal well-being. Despite the recognized negative impact of the EIDs, current research lacks a comprehensive global framework to assess the significance and interaction of various environmental and anthropogenic factors driving emergence of these diseases. Methods In this study, we examine both environmental and anthropogenic factors and their relation to the emergence of EIDs, focusing on historical trends from 1975 to 2020. We focus on 10 diseases with pandemic and epidemic potential. Spatial data on outbreaks in humans and animals from 1975 to 2020 were retrieved from the GIDEON database. Using Bayesian statistical models, we pinpoint regions at increased risk, and we focus on a new indicator based on the human-forest proximity. Conclusions Our results show that human-forest proximity together with biodiversity loss, and high population density increase the likelihood of diseases being transmitted from animals to humans, influencing where outbreaks occur among human populations. Lastly, we introduce a country vulnerability index that combines our risk assessment with the IHRC3 indicator from the WHO, which gauges a country’s capability to handle zoonotic diseases. These combined indices help us to assess each country’s ability to respond to an outbreak. The study also addresses data limitations and proposes directions for future research, emphasizing the importance of our findings in shaping public health policies and decision-making. Key messages • Anthropogenic drivers shape the distribution of outbreaks in human populations. • Human-forest proximity exacerbates the likelihood of Emerging Infectious Disease.

Social health gradient and risk factors among patients hospitalized for COVID-19 and pre-pandemic respiratory infections. A linked national individual case-control study in Belgium

IntroductionThe literature establishes a clear social gradient in health for transmissible respiratory diseases. However, this gradient’s extent remains largely unexplored in the context of COVID-19, and it is uncertain whether the pandemic has exacerbated this gradient. The study aims to compare the socio-economic profiles and comorbidities during the COVID-19 pandemic with a control population affected by viral pneumonia/respiratory disease in 2019.MethodsThis case-control study analyzed linked data from all patients hospitalized for COVID-19 in 2020 (n = 22,087) and for respiratory diseases in 2019 (n = 7,586). Socio-economic data from the social security database were linked to clinical data from the hospital registry. We analyzed the socio-demographic and clinical factors associated with COVID-19 hospitalization (control group, wave 1, and wave 2) using multinomial regressions and logistic regression models and the length of stay during hospitalization using binomial negative regressions.ResultsA social health gradient was observed in both the COVID-19 and control groups, with a significant increase across waves for COVID-19 (p-trend < 0.0001). Men, people over the age of 45, those with comorbidities, high population density, lower income, lower socio-economic status, and people living in Brussels capital were at higher risk of COVID-19 hospitalization and longer length of stay compared to the control group. Except for sub-Saharan Africans, all patients of foreign nationality had a significantly increased risk of hospitalization (p < 0.001), but a shorter length of stay compared to Belgians.ConclusionThe socio-health gradient for COVID-19 followed the same pattern as that observed in pre-pandemic respiratory diseases, intensifying in the second wave and among the most deprived groups. This study emphasizes the importance of collecting social data alongside clinical data for a better understanding of social health inequalities and for tailoring health prevention policies.

Investigating the patterns of air pollution exposure on major cardiovascular events by cluster analysis. Insights from the EP-PARTICLES study on a Polish smog cohort

Abstract Introduction Exposure to air pollution (AP) is a modifiable risk factor for cardiovascular diseases. Aim To analyse the short-term effects of AP on the occurrence of acute coronary syndromes (ACS). Methods The EP-PARTICLES study consists of a retrospective nationwide cohort of Eastern Poland residents (N= 8,077,671). The area is characterized by a specific type of pollution - Polish smog, featuring high concentrations of particulate matter (PM), benzo(a)pyrenes (BaP) and favourable atmospheric conditions of formation. Medical data were collected from the National Health Fund and the Central Statistical Office. The records included sex and age and the causes of hospitalization. The analysis utilized air quality modeling data from the GEM-AQ system, which allowed to provide daily pollution concentration at the level of each LAU (ie. local administrative units, at municipality level), throughout the observation period. We estimated LAU specific associations of AP concentration using quasi-Poisson generalized additive models. We controlled our models for long-term trends and weather conditions. In the second stage, we pooled LAU-specific estimates with a random-effects meta-analysis. The results are presented as % risk ratio (RR), and 95% confidence intervals (95% CIs) for the two-day moving average of AP concentration on the present day and the day after exposure (ie. LAG0-1). Cluster analysis was performed on LAU levels from 19 variables using the k-mens clustering using the Ward minimum variance method. The set of variables included demographic, ecological, socioeconomic, environmental conditions. Results Over the years 2011-20, we noted 2,141,213 hospitalizations due to CVD, including 139,697 ACS cases (45.2% STEMI). The main triggers for ACS were PM2.5 (RRLAG0-1 1.04 95%CI 1.028-1.053), BaP (RRLAG0-1 1.021 95%CI 1.01-1.032). We identified three distinct clusters: Cluster 1 was characterized by high population density and GPD per capita and highest prevalence of atrial fibrillation. Cluster 2 (40% of the entire population) exhibited significantly high variability, characterized by low population density and GPD per capita, the highest prevalence of heart failure, people drinking alcohol and smoking tobacco. Cluster 3 (7% of the entire population) was in the middle but showed the highest prevalence of hypertension, diabetes and renal failure. Cluster 2 inhabited areas with low concentrations of PMs and BaP and demonstrated increased vulnerability to the effects of PM2.5 and BaP from 3% to 5.2% (P<0.001). For details see Figure 1. Conclusions PM and BaP are important factors associated with the occurrence of MACE. AP exposure should be considered in CVD prevention models. Cluster classification helps in risk stratification and prognosis. Adverse effects of AP can be mitigated by attention to improving socio-economic status and hazardous habits.Associations between AP exposure and ACS

Response of host Indian Musa germplasm against artificially induced root lesion nematodes (Pratylenchus coffeae)

Under greenhouse condition, the host response of fifty-nine banana genotypes (Musa spp.) from the Eumusa section to the root-lesion nematode (Pratylenchus coffeae) was assessed. In a factorial completely randomized design (FCRD) with five replications, healthy banana suckers of the diploid and triploid accessions were planted in cement pots. Uninoculated controls were included in the experiment as comparison to study the sensitivity of the genotypes. Two varieties (Pisang Lilin and Nendran) with known reaction to lesion nematode were also included as reference clones because of their resistance and susceptibility to P. coffeae. Banana accessions maintained in the pots were inoculated with infective juveniles of root-lesion nematode, P. coffeae at 45 days after planting at the rate of 400 nematodes/pot. Ninety days after inoculation, the plants were harvested to observe the response of the different banana genotypes to P. coffeae. Data were recorded on plant growth (plant height, girth at the base, number of standing leaves, number of roots and weight of the root system), root damage assessment (percentage of infected roots and percentage necrosis) and nematode reproduction. When inoculated with nematodes, the reduction in plant growth attributes was relatively higher in genotypes that were susceptible. The reduction in growth characters viz., plants height, number of roots and root fresh weight were maximum in the diploid genotypes Manguthamng (26.80, 27.2, 33.0 %) and Manohar (25.70, 29.2, 35.2 %) and in the triploid genotypes Kaali, Rajthali, Digjowa, Saapkal, Cheenichampa, Dasaman, Borchampa, Jahaji, Manjahaji, Barjahaji and Sabri when inoculated with Pratylenchus coffeae. Even after nematode inoculation, root investigations showed that resistant and tolerant genotypes had greater numbers of roots as well as high fresh and dry weight of roots. Root and soil population of nematodes assessed at 90 days after inoculation indicated very high population buildup of Pratylenchus coffeae (>28) in diploids Manguthamng and Nendrapadathi and in triploids Jahaji, Manjahaji, Saapkal, Borchampa, Therahaw-1163 and 1164, Ankur-I and Bersain. The rate was the lowest (<9) in the diploid genotypes Kanai Bansi, Kechulepa, M.balbisiana, Athiakol, Bhimkol and Aittakola and in the triploids Karthobiumtham and Ankur-II. The results of the experiment showed that the diploids Musa balbisiana (BB), Aittakola (BB), Bhimkol (BB), Kechulepa (BB), Kanai Bansi (AA) and Athiakol (BB) and the triploid genotypes Kachkel (ABB), Karthobiumtham (ABB) and Ankur-II (ABB) were resistant to Pratylenchus coffeae.

Absence of Coxiella burnetii in kangaroo ticks (Amblyomma triguttatum) from a high seroprevalence population of eastern grey kangaroos

Q fever, caused by Coxiella burnetii, is an important zoonotic and public health concern worldwide. Kangaroos are thought to be a likely wildlife reservoir for C. burnetii in Australia and the kangaroo tick (Amblyomma triguttatum) has often been considered a vector. In this descriptive study of ticks collected from a population of eastern grey kangaroos (Macropus giganteus) with a high serological (84 %) and molecular (65 %) prevalence of C. burnetii in northern New South Wales, a total of 72 A. triguttatum ticks were tested by PCRs targeting the IS1111, htpAB, and com1 genes of the Coxiella genome. Despite the remarkably high prevalence of coxiellosis in the host population, none of the ticks were positive for Coxiella. This finding suggests that the kangaroo tick may not play a significant role in the transmission dynamics of C. burnetii in this particular host population.

Towards Sustainable Energy Solutions: Evaluating the Impact of Floating PV Systems in Reducing Water Evaporation and Enhancing Energy Production in Northern Cyprus

Floating photovoltaic systems (FPVSs) are gaining popularity, especially in countries with high population density and abundant solar energy resources. FPVSs provide a variety of advantages, particularly in situations where land is limited. Therefore, the main objective of the study is to evaluate the solar energy potential and investigate the techno-economic perspective of FPVSs at 15 water reservoirs in Northern Cyprus for the first time. Due to the solar radiation variations, solar power generation is uncertain; therefore, precise characterization is required to manage the grid effectively. In this paper, four distribution functions (Johnson SB, pert, Phased Bi-Weibull, and Kumaraswamy) are newly introduced to analyze the characteristics of solar irradiation, expressed by global horizontal irradiation (GHI), at the selected sites. These distribution functions are compared with common distribution functions to assess their suitability. The results demonstrated that the proposed distribution functions, with the exception of Phased Bi-Weibull, outperform the common distribution regarding fitting GHI distribution. Moreover, this work aims to evaluate the effects of floating photovoltaic systems on water evaporation rates at 15 reservoirs. To this aim, five methods were used to estimate the rate of water evaporation based on weather data. Different scenarios of covering the reservoir’s surface with an FPVS were studied and discussed. The findings showed that annual savings at 100% coverage can reach 6.21 × 105 m3 compared to 0 m3 without PV panels. Finally, technical and economic assessment of FPVSs with various scales, floating assemblies, and PV technologies was conducted to determine the optimal system. The results revealed that a floating structure (North orientation-tilt 6°) and bifacial panels produced the maximum performance for the proposed FPVSs at the selected sites. Consequently, it is observed that the percentage of reduction in electricity production from fossil fuel can be varied from 10.19% to 47.21% at 75% FPV occupancy.

Phenolic Ecotoxins in River Water: Survey on Knowledge and Practices of Road-Side Food Vendors Operating Along River Chania Bank Fringes in Thika Sub- County, Kenya

Purpose: Phenolic ecotoxins consumed in raw surface water from river sources has been implicated in causing diseases of high burden such as cancers, in Kenya. This study was conducted in Thika Sub County, and data collected from roadside food vendors and food hawkers who operate small scale street food business along the fringes and banks of River Chania. The study’s objective was to establish the knowledge on Phenolic ecotoxins present in river water and practices of the study respondents. Methodology: A crossectional descriptive study design was used, in which combined interviews and questionnaire enquiries conducted from, n=341, small-scale road side food vendors and hawkers was analyzed. Findings: Data reveals that none of the respondents had knowledge on Phenolic ecotoxin contaminants and additionally a strongly associated correlation (P<0.001, χ222.6 and df 1), further augments the disclosure that, poor knowledge of raw river water safety and hygiene does result to body harm and ill health. Unique Contribution to Theory, Policy and Practice: There is increased need and effort to scale up the sensitization and awareness on exposure to harmful ecotoxin contaminants from the use of raw river water. Water decontamination mobile units should be considered and introduced especially in urban areas of high population density, transversed by rivers.

Low Lung Function Is Associated with High Population Attributable Fraction for Cardiovascular Mortality.

Chronic lung diseases are associated with increased risk of mortality due to coronary heart disease (CHD). Nonetheless, the population attributable fraction (PAF) of lung function impairment relative to other established cardiovascular risk factors is unclear. To evaluate the PAF of low lung function for CHD mortality Methods: We harmonized and pooled lung function and clinical data across 8 US general population cohorts. Impaired lung function was defined as FEV1 and/or FVC ≤95% predicted on baseline spirometry. The association between CHD mortality and risk factors was assessed using cause-specific proportional hazards and Fine-Gray proportional subdistribution hazards models, treating non-CHD mortality as a competing risk. Models were adjusted for lung function as well as age, sex, race/ethnicity, educational attainment, body mass index, smoking status, pack-years of smoking, diabetes mellitus, HDL, and high LDL (≥130 mg/dl). PAF was calculated as the relative change in the average absolute risk of ten-year CHD mortality by elimination of lung function lower than 95% predicted. Among 35143 participants, 1844 of 13174 (14.0%) deaths were due to CHD. Compared to FEV1pp >95%, the sub-distribution adjusted hazards ratio (95%CI) for low FEV1pp was 1.30 (1.18-1.44). The PAF for FEV1pp≤95% was 12%, ranking low FEV1 third in the list of PAF for CHD mortality, after hypertension and diabetes. Low FEV1pp ranked second in the subgroup of active smokers (PAF 14%), after hypertension. Low lung function, even in the range considered clinically normal, ranks high in the list of attributable risk factors for CHD mortality and should be considered in cardiovascular risk stratification.

Bridging the education gap: A comprehensive analysis of travel distance and education quality based spatial accessibility of early childhood education in Metropolitan Melbourne

In Australia, Melbourne's population is growing rapidly and will soon overtake Sydney, fuelled by a COVID-19 baby boom that has increased demand for early childhood education (ECE). In response, the Victorian Government has announced transformational reforms to improve the accessibility and quality of ECE for the growing urban population. This study aims to addresses the evolution and effectiveness of ECE reforms in Melbourne from 2021 to 2036 by proposing an innovative approach that integrates spatial accessibility and educational quality into ECE evaluations. Using the distance decay function, the Floating Catchment Area (FCA) method and the Huff model, it extends traditional geographical analyses by highlighting the importance of educational quality in parental choice and providing a refined technique for simulating local demand based on educational quality and travel distance. Overall, inequalities in educational resources have been identified, with a concentration of ECE services near the CBD, despite high population density, while peripheral areas have significant service deficits. Furthermore, the projected poor accessibility scores for 2026, 2031 and 2036 highlight the urgent need for educational infrastructure development, even in areas rated as having better accessibility in 2021.

AKAP12 positive fibroblast determines immunosuppressive contexture and immunotherapy response in patients with TNBC by promoting macrophage M2 polarization

BackgroundTriple-negative breast cancer (TNBC) is a molecular subtype of breast cancer with high aggressiveness and poor prognosis. Cancer-associated fibroblasts (CAFs) are major components of the TNBC microenvironment and play an...

Optimizing Energy Yield and Economic Benefit of Renewable Energy Technologies for Urban Mediterranean Dwellings

Mediterranean European cities are characterized by high population density and limited space for large-scale implementation of renewable energy installations. This paper addresses the optimization of renewable energy installations in Mediterranean dwellings with the scope of increasing their energy contribution and cost-effectiveness. In a case study for Malta, the three technologies studied were solar photovoltaics, solar water heating, and heat pump water heating. Technical and economic analyses were performed on a number of reference configurations using Polysun software (version 2022.8). Sensitivity analyses were also conducted to study the impact that different technical and economic factors have on the performance of the configurations considered. Finally, comparisons were made between the techno-economic results obtained from the reference and sensitivity analyses. Based on data collected, the presence of renewable energy source (RES) technologies in the residential sector of Malta was characterized and correlated with the types of dwellings considered. Among the results obtained, it was found that although a solar RES installation may experience some shading, this does not mean that it is rendered economically unfeasible. Moreover, from the simulations conducted, electrical energy storage technology was considered as too premature unless strongly subsidized, making economic sense only in specific circumstances. On the other hand, although heat pump water heating technology is also relatively modern, it was concluded to be the most beneficial in terms of both energy yield and economic benefit, generally speaking. Furthermore, it was determined that in a higher occupancy dwelling, solar water heating (SWH) and heat pump water heating (HPWH) result in considerably more attractive energy savings.

Impact of Protective Measures on Mealybug and Red Cotton Bug Incidence in Bt Cotton Hybrids

The study investigated the influence of mealybug and red cotton bug populations on different cotton hybrids under protected and unprotected conditions. The results revealed that under protected conditions, the mealybug, Phenacoccus solenopsis population was significantly lower (0.23/plant) compared to unprotected conditions (1.14/plant). Among the hybrids, G. Cot. Hy. 10 BG II (0.35/plant) and Ajeet 155 BG II (0.40/plant) showed the lowest mealybug populations, while RCH 2 BG II recorded the highest (1.19/plant). Significant differences were observed in the interaction between protection levels and hybrids with lower pest populations recorded under protected conditions. Similarly, for the red cotton bug, the population was significantly lower under protected conditions (0.23/plant) compared to unprotected (0.87/plant). G.Cot.Hy.10 BG II showed the lowest red cotton bug, Dysdercus cingulatus population (0.24/plant), while RCH 2 BG II had the highest population under unprotected conditions (1.24/plant). Significant differences were found in the interaction of protection levels, hybrids, and periods with protected conditions consistently showing lower pest incidences.

Spatial and Racial/Ethnic Variation in the Prevalence of Cesarean Delivery in a South Carolina Medical Center.

While racial/ethnic disparities in cesarean delivery have been noted in the literature, less is known about the intersection between individual-level race/ethnicity and community-level social vulnerability as factors in cesarean delivery. The goal was to use medical record data from a large medical center combined with census tract-level data to examine patterns of social vulnerability, racial population distribution, and prevalence of cesarean delivery. Data were obtained from electronic medical records of patients from a large medical center in South Carolina from 2019 to 2020. The outcome variable was cesarean delivery (yes/no), and covariates included the year of delivery; age of patient; race/ethnicity; spoken language; BMI categories; clinical indications of anemia, hypertension, preeclampsia, and diabetes; and census tract Social Vulnerability Index (SVI). Generalized linear mixed models for multilevel binary logistic regression were used to test the main hypothesis that the census tract level Social Vulnerability Index is positively associated with cesarean delivery. Among a total of 5011 patients, we found that non-Hispanic Black mothers were more likely to have cesarean deliveries compared with non-Hispanic White mothers. After controlling for census tract-level SVI, the individual-level race/ethnicity association was no longer significant. Significant spatial autocorrelation across census tracts was evident for cesarean delivery prevalence, non-Hispanic Black population, and SVI. A high prevalence of cesarean delivery tended to cluster with high SVI and a high non-Hispanic Black population. We found that non-Hispanic Black mothers were more likely to have cesarean deliveries, which was explained by census tract differences in the SVI.