Longer Duration Research Articles

The bacterial profile and antibiotic susceptibility pattern in respiratory tract samples from art-experienced HIV-positive adults in Uganda.

Microbial infections are a major cause of morbidity and mortality among people living with HIV (PLWH). Respiratory tract infections (RTIs) are responsible for approximately 70% of illnesses among PLWH. Drug resistant bacteria are highly prevalent among PLWH and this is a public health concern. This is a retrospective analysis of data collected during the COSTOP trial between 2011 and 2013. Sputum collected on spot from participants presenting with a productive cough was examined using Gram, Ziehl-Neelsen stains and cultured on suitable bacteriological media. Antimicrobial sensitivity testing was done on isolated pathogens, by disc diffusion technique. We included 687 participants with mean age 41.3 (SD 8.2) years of whom 76.4% were female. Two hundred one sputum samples grew bacteria; Moraxella species (27.4%), Streptococcus pneumoniae(25.4%), Haemophilus influenza(22.4%), Mycobacterium species(4.5%), Pseudomonas species(4.0%), Staphylococcus aureus(4.0%), Escherichia coli (1.0%), Klebsiella species (1.0%), other bacteria (10.4%). A higher monthly income greater than or equal to 30$ (aOR = 0.63, 95%CI: 0.40-0.99) and longer duration since HIV diagnosis (aOR = 1.06, 95%CI: 1.0-1.11) were found to be independently associated with a positive bacterial culture. Moraxella sp, H. influenza and Pseudomonas had zero sensitivity towards cotrimoxazole. Sensitivity to erythromycin was low among Moraxella sp (28.6%), H. influenza (31.6%) and S. aureus(42.9%) and other bacteria (42.9%). Most isolates were sensitive to Amoxicillin + Clavulanic acid and ceftriaxone. There is a very low sensitivity of isolated bacteria to commonly prescribed antibiotics that are more available through the national supply chain, which is of public health concern. Urgent steps to tackle the high antimicrobial resistance among PLWH is required.

Abnormal temporal variability of rich-club organization in three major psychiatric conditions.

Convergent evidence has demonstrated a shared rich-club reorganization across multiple major psychiatric conditions. However, previous studies assessing altered functional couplings between rich-club regions have typically focused on the mean time series from entire functional magnetic resonance imaging (fMRI) scanning session, neglecting their time-varying properties. In this study, we aim to explore the common and/or unique alterations in the temporal variability of rich-club organization among schizophrenia (SZ), bipolar disorder (BD), and attention deficit/hyperactivity disorder (ADHD). We employed a temporal rich-club (TRC) approach to quantitatively assess the propensity of well-connected nodes to form simultaneous and stable structures in a temporal network derived from resting-state fMRI data of 156 patients with major psychiatric disorders (SZ/BD/ADHD = 71/45/40) and 172 healthy controls. We executed the TRC workflow at both whole-brain and subnetwork scales across varying network sparsity, sliding window strategies, lengths and steps of sliding windows, and durations of TRC coefficients. The SZ and BD groups displayed significantly decreased TRC coefficients compared to corresponding HC groups at the whole-brain scale and in most subnetworks. In contrast, the ADHD group exhibited reduced TRC coefficients in longer durations, as opposed to shorter durations, which markedly differs from the SZ and BD groups. These findings reveal both transdiagnostic and illness-specific patterns in temporal variability of rich-club organization across SZ, BD, and ADHD. TRC may serve as an effective metric for detecting brain network disruptions in particular states, offering novel insights and potential biomarkers into the neurobiological basis underpinning the behavioral and cognitive deficits observed in these disorders.

332. NO NEED FOR A SPONGE! ENDOLUMINAL VACUUM THERAPY WITH A SIMPLE FENESTRATED SURGICAL DRAIN FOR MANAGEMENT OF BENIGN OESOPHAGEAL PERFORATIONS

Abstract Background Conventional endoluminal vacuum therapy (EVT) uses a sponge and can be an effective technique for management of benign esophageal perforations. We describe a unique method of positioning a simple fenestrated surgical drain with applied vacuum suction at or through the site of perforation. We aimed to see whether this was a safe and effective management approach for benign esophageal perforations whilst reducing the frequency and need for general anaesthetic (GA) based endoscopic exchanges. Methods A retrospective case-series was performed on consecutive patients with benign esophageal perforations from 2019 to 2023 at a tertiary hospital in the United Kingdom. Included patients had undergone initial management of benign esophageal perforation with EVT and fenestrated surgical drain. The drain was either placed in an intraluminal or intracavitary position depending on the size of perforation. Primary outcome assessed was complete epithelialisation of the fistulous orifice with EVT. Secondary outcomes included: 90-day mortality, Length of Stay (LOS), re-operation, complications, percentage of EVT procedures under GA, duration of EVT and interval between endoscopic exchanges. Results Seven patients met inclusion criteria (median age: 66 (23–79) years). In four instances aetiology of perforation was iatrogenic from gastroscopic procedures with remaining cases due to Boerhaave’s syndrome, foreign body ingestion and benign ulceration. Six patients achieved full healing of perforation with EVT, with one patient requiring oesophageal stenting. There was 0%, 90-day mortality and two patients underwent re-operation for thoracic drainage procedures. Median LOS was 22 days and mean duration of EVT was 14 days. Patients underwent on average 2.6 gastroscopies during admission, 75% of which were performed without GA. The mean interval between EVT repositioning/exchange was 8 days. Conclusion EVT with a surgical drain achieved complete healing in all but one case of benign esophageal perforation. In contrast to EVT with sponge it can be performed without GA and with a longer duration between drain exchanges and gastroscopies. Additionally, as the same drain can be used for the duration of therapy it may reduce material cost. Further studies should perform prospective and direct comparisons with alternative EVT strategies for benign esophageal perforations.

Comparisons of Retention and Lag Characteristics of Rainfall–Runoff under Different Rainfall Scenarios in Low-Impact Development Combination: A Case Study in Lingang New City, Shanghai

An increasing focus has been given to stormwater management using low-impact development (LID), which is regarded as a “near-nature” concept and is utilized to manage and reduce surface runoff during the rainfall–runoff process. According to the hydrological monitoring data, we evaluated the retention and lag characteristics of rainfall–runoff in LID combination under three rainfall-intensity scenarios (light–moderate, heavy, and torrential rainfall) in Lingang New City in Shanghai. LID facilities have been constructed for three years in the target study area, including rain gardens, retention ponds, green parking, porous pavement, and grass swales. The average runoff retention was 10.6 mm, 21.3 mm, and 41.6 mm under light–moderate, heavy, and torrential rainfall scenarios, respectively, and the corresponding runoff retention rate was 72.9%, 64.7%, and 76.1% during the study period. By comparing rainfall, runoff retention, runoff retention rate, cumulative rainfall, and lag times, it becomes evident that the ability to retain runoff can be greatly improved in the LID combination. The average runoff retention was significantly enhanced by nearly two times and four times under the heavy and torrential rainfall scenarios compared to the conditions under the light–moderate rainfall scenario. Furthermore, the lag time from the end of rainfall to the end of runoff (t2) and the lag time between the centroid of rainfall and the centroid of runoff (t3) showed a significantly negative correlation with rainfall intensity. Meanwhile, t3 presented an incredibly positive correlation with rainfall duration. In this study, the LID combination demonstrated superior benefits in extending the duration of runoff in rainfall events with lower rainfall amounts, and demonstrated significant overall lag effects in rainfall events with longer durations and lower rainfall amounts. These results confirmed the vital role of the LID combination in stormwater management and the hydrologic impact of the LID combination on rainfall-induced runoff retention and lag effects. This work has provided valuable insights into utilizing LID facilities and can contribute to a better understanding of how runoff retention and lag characteristics respond to different rainfall intensity scenarios.

Pharmacokinetics of Cannabidiol: A Systematic Review and Meta-Regression Analysis.

Background: In this review, we provide an updated assessment of available evidence on the pharmacokinetics (PK) of CBD and explore the impact of different factors on PK outcomes. Materials and Methods: This systematic review and meta-regression analysis was preregistered (PROSPERO: CRD42021269857). We systematically searched Medline, Embase, PsycInfo, and Web of Science Core Collection up to November 19, 2022. Trials of CBD in healthy adults were included if they reported at least one of the PK parameters of interest, including Tmax, Cmax, AUC0-t, AUC0-inf, and T1/2, in serum or plasma. Studies of patient populations or CBD co-administration with other medications were excluded. The National Heart, Lung, and Blood Institute's Quality Assessment Tool for Before-After Studies with no Control Group was used. Random-effects multivariable meta-regression analysis was conducted. Results: A total of 112 trial arms from 39 studies were included; 26 trial arms had a "Good" quality, 70 "Fair," and 16 "Poor." Eight arms used inhalation CBD, 29 oromucosal, 73 oral, and 2 intravenous. CBD formulations could be categorized to nanotech (n=14), oil-based (n=21), alcohol-based (n=10), water-based (n=12), Sativex (n=17), and Epidiolex® (n=22). For single-dose studies, CBD doses ranged between 2 and 100 mg in inhalation, 5-50 mg in oromucosal, and 0.42-6000 mg in oral administration. Sixty-six trial arms had only male participants or a higher number of male than female participants. The duration of the PK session was between 4 and 164 h. A higher CBD dose was associated with higher Cmax, AUC0-t, and AUC0-inf. Compared with oral administration, oromucosal administration was associated with lower Cmax, AUC0-t, and AUC0-inf. Fed status was associated with higher Cmax and AUC0-t when compared with the fasting status. A higher ratio of female participants was associated with lower Tmax in oral administration and higher Cmax. Conclusion: As expected, CBD dose, route of administration, and diet were major determinants of CBD PK with oral routes providing higher bioavailability and nanotechnology formulations a faster onset. Although CBD appeared to have a faster onset and longer duration in women, more studies are required to delineate the role of biological sex. Factors that influence CBD PK have implications for medication development and appropriate dosing in clinical practice.

Health-related quality of life in Chinese individuals with type 2 diabetes mellitus: a multicenter cross-sectional study

BackgroundType 2 diabetes mellitus (T2DM) is a chronic and life-threatening disease. Health-related quality of life (HRQoL) is vital for individuals with T2DM. However, little is known about the impact of psychological stability factors on HRQoL among individuals with T2DM in mainland China.MethodsThis multicenter cross-sectional study was conducted in five tertiary grade-A hospitals in Chongqing, China, from January to December 2019. A total of 385 individuals with T2DM were included by the convenient sample method. Fear of Progression (FOP) Questionnaire-short Form, Hypoglycemia Fear Survey II, diabetes-management self-efficacy scale, and EuroQol-5 Dimensions were used for data collection.ResultsThe mean age of the 385 individuals was 57.65 (SD = 15.15) years, three-quarters of whom had a high school or above education level. The participants in our study had moderate HRQoL and were more likely to have poor scores in the pain/discomfort dimension. The FOP level was moderate on average, and 23.1% of individuals suffered from psychological dysfunction. The participants had higher levels of fear of hypoglycemia (FOH) and self-efficacy (SE). Multiple steppage-regression analysis predicted that higher levels of FOP and FOH, reduced SE, older age, longer duration since diagnosis, lower educational attainment, higher levels of HbA1c, and living with comorbid conditions were related to lower HRQoL.ConclusionThis study showed that the HRQoL among Chinese T2DM patients may be impaired by increased FOP and FOH, decreased SE, and poor glycemic control. In addition, as the patient’s age and duration since diagnosis increase, their HRQoL further declines. We recommend improving HRQoL by encouraging individuals to attain more health education and resilience skills to enhance SE and reduce negative emotions among individuals with T2DM.

Start-of-day oculomotor screening demonstrates the effects of fatigue and rest during a total immersion training program

BackgroundInvestigating changes in sleep and fatigue metrics during intensive surgical and trauma skills training, this study explored the dynamic association between oculomotor metrics and fatigue. Specifically, alterations in these relations over extended stress exposure, the influence of time of day, and the impact of fatigue exposure on sleep metrics were examined. MethodsThirty-nine military medical students participated in 6 days of immersion, hyper-realistic, and high-stress experiential casualty training. Participants completed surveys assessing the state of sleepiness with oculomotor tests performed each morning and evening, analyzing eye movement and pupillary change to characterize fatigue. Participants wore Fitbit TM devices to measure overall time asleep and time in each sleep stage during the training. ResultsFitbit data showed increased average minutes in rapid eye movement, deep sleep, and less time in light sleep from day 1 to day 4. The microsaccade peak velocity-to-displacement ratio exhibited a morning decrease but not in afternoon sessions, indicating repeated but temporary effects of accumulated fatigue. There were no findings regarding pupil reactivity to illumination changes. ConclusionThis study describes characteristics of fatigue measured by rapid and individually calibrated oculomotor tests. It demonstrates oculomotor relationships to fatigue in start-of-day testing, providing a direction for timing for optimal fatigue testing. These data suggest that improved sleep could signal resilience to fatigue during afternoon testing. Further investigation with more participants and longer duration is warranted. A deeper understanding of the interrelationships between training, sleep, and fatigue could improve surgical and military fitness.

Serial Measurements of Serum Glial Fibrillary Acidic Protein in Moderate-Severe Traumatic Brain Injury: Potential Utility in Providing Insights into Secondary Insults and Long-Term Outcome.

In patients with traumatic brain injury (TBI), serum biomarkers may have utility in assessing the evolution of secondary brain injury. A panel of nine brain-injury- associated biomarkers was measured in archived serum samples over 10 days post-injury from 100 patients with moderate-severe TBI. Among the biomarkers evaluated, serum glial fibrillary acidic protein (GFAP) had the strongest associations with summary measures of acute pathophysiology, including intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain tissue pO2 (PbtO2). Group based trajectory (TRAJ) analysis was used to identify three distinct GFAP subgroups. The low TRAJ group (n = 23) had peak levels of 9.4 + 1.2 ng/mL that declined rapidly. The middle TRAJ group (n = 48) had higher peak values (31.5 + 5.0 ng/mL) and a slower decline over time. The high TRAJ group (n = 26) had very high, sustained peak values (59.6 + 12.5 ng/mL) that even rose among some patients over 10 days. Patients in the high TRAJ group had significantly higher mortality rate than patients in low and middle TRAJ groups (26.9% vs. 7.0%, p = 0.028). The frequency of poor neurological outcome (Glasgow Outcome Score Extended [GOS-E] 1-4) was 88.5% in the high TRAJ group, 54.2% in the middle TRAJ group, and 30.4% in the low TRAJ group (p < 0.001). ICP was highest in the high TRAJ group (median 17.6 mm Hg), compared with 14.4 mmHg in the low and 15.9 mm Hg in middle TRAJ groups (p = 0.002). High TRAJ patients spent the longest time with ICP >25 mm Hg, median 23 h, compared with 2 and 6 h in the low and middle TRAJ groups (p = 0.006), and the longest time with ICP >30 mm Hg, median 5 h, compared with 0 and 1 h in the low and middle TRAJ groups, respectively (p = 0.013). High TRAJ group patients more commonly required tier 2 or 3 treatment to control ICP. The high TRAJ group had the longest duration when CPP was <50 mm Hg (p = 0.007), and PbtO2 was <10 mm Hg (p = 0.002). Logistical regression was used to study the relationship between temporal serum GFAP patterns and 6-month GOS-E. Here, the low and middle TRAJ groups were combined to form a low-risk group, and the high TRAJ group was designated the high-risk group. High TRAJ group patients had a greater chance of a poor 6-month GOS-E (p < 0.0001). When adjusting for baseline injury characteristics, GFAP TRAJ group membership remained associated with GOS-E (p = 0.003). When an intensive care unit (ICU) injury burden score, developed to quantify physiological derangements, was added to the model, GFAP TRAJ group membership remained associated with GOS-E (p = 0.014). Mediation analysis suggested that ICU burden scores were in the causal pathway between TRAJ group and 6-month mortality or GOS-E. Our results suggest that GFAP may be useful to monitor serially in moderate-severe TBI patients. Future studies in larger cohorts are needed to confirm these results.

Synthetic α-Helical Nanopore Reactor for Chemical Sensing.

The use of nanopores for the single-molecule sensing of folded proteins and biomacromolecules has recently gained attention. Here, we introduce a simplified synthetic α-helical transmembrane pore, pPorA, as a nanoreactor and sensor that exhibits functional versatility comparable to that of engineered protein and DNA nanopores. The pore, built from the assembly of synthetic 40-amino-acid-long peptides, is designed to contain cysteine residues within the lumen and at the pore terminus for site-specific chemical modification probed using single-channel electrical recordings. The reaction of the pore with differently charged activated thiol reagents was studied, wherein positively charged reagents electrophoretically driven into the pore resulted in pore blocking in discrete steps upon covalent bond formation. The asymmetric blockage patterns resulting from cis and trans-side addition of reagents reveal the pore orientation in the lipid membrane. Furthermore, activated PEG thiols covalently blocked the pores over a longer duration in a charge-independent manner, establishing the large diameter and orientation of the formed pores. While the covalent binding of thiol reagents caused a drop in the pore conductance, cationic cyclic octasaccharides produced time-resolved translocation events, confirming the structural flexibility and tunability of the pores. The ability of the pore to accommodate large analytes and the considerable current amplitude variation following bond formation events are promising for developing platforms to resolve multistep chemical reactions at the single-molecule level for applications in synthetic nanobiotechnology.

Inferior Outcomes for Patients Transferred Between Surgical Stages for Knee Periprosthetic Joint Infection

BackgroundPeriprosthetic joint infection (PJI) in total knee arthroplasty may result in 2-stage revision surgery. There are limited data describing outcomes when the first stage is completed at an outside hospital and the patient is referred to a tertiary center. We hypothesized that patients have greater success when both surgeries occur at a single center. MethodsThere were 25 knee PJI patients who presented with an antibiotic spacer and had a minimum 2-year follow-up who were retrospectively identified at a single tertiary referral center from 2014 to 2021. A cohort matched for age, sex, body mass index, Elixhauser comorbidity measure, spacer type, infectious organism, and year of surgery was established with patients who had both stages completed at the investigating institution. Modified Delphi success criteria of no subsequent surgery or reinfection with any species were compared. ResultsThe transferred group demonstrated a treatment success of 40% compared to 84% in the continuous group (P < .01). The transferred group was more likely to have an additional procedure between stages (44 versus 8%, P < .01), with a higher number of surgeries after primary total knee arthroplasty (4.8 versus 3.0, P < .01), between stages (1.4 versus 0.2, P < .01), and after second stage (0.8 versus 0.2, P = .03). The transferred group had longer durations between stages (20.1 versus 7.0 weeks, P < .01). ConclusionPatients who have PJIs transferred between stages demonstrated higher treatment failure. Surgeons should consider transfer early with a goal of continuous management by a single institution.

Comparison of Clinical, Hematological and Biochemical Characteristics of Patients Suffering from Delta and Non-Delta Variant of COVID-19

Objective: To compare the clinical, hematological and biochemical characteristics of patients suffering from delta and non-delta variants of COVID-19. Method: This cross-sectional study was conducted at Farooq Hospital Westwood Lahore during 1st March 2022 to 31st August 2022. After obtaining informed written consent, nasopharyngeal swabs and 5 ml of blood samples in both EDTA and clotted vacutainers of eighty two infected patients with COVID-19, who were admitted in COVID-19 unit, were collected. The viral nucleic acid was isolated from nasopharyngeal swabs by using a Qiagen nucleic acid extraction kit. RT-PCR was performed to detect the delta variant in COVID-19 infected patients by using SARS-CoV-2 Variant B.1.617 identification kit. Further hematological and biochemical parameters were performed. Results: We did a comparative analysis of clinical and laboratory characteristic of delta and non-delta COVID19 patients admitted in Farooq Hospital Westwood, confirmed by RT-PCR and found that patients presented with delta variant had more severe disease with significantly more cough, fever, shortness of breath and lower SpO2 at the presentation. The hematological and biochemical markers showed more lymphopenia, greater CRP,Interleukin 6,LDHand ferritin.Hospitalstay of delta variants ofCOVID-19 patients had longer duration as compared to the non-delta COVID-19 patients. Conclusion: Delta COVID-19 had more severe disease with more dyspnea, hypoxia, hematological and biochemical parameters abnormalities compared to the non-delta COVID-19 patients. Patients suffering from delta variant of COVID-19 had greater length of hospital stay as compared to the non-delta variant of COVID-19 with more oxygen requirement and more mortality rate.

Four-parameter analysis in modified Rotarod test for detecting minor motor deficits in mice

BackgroundThe Rotarod test with commercial apparatus is widely used to assess locomotor performance, balance and motor learning as well as the deficits resulting from diverse neurological disorders in laboratory rodents due to its simplicity and objectivity. Traditionally, the test ends when rodents drop from the accelerating, turning rod, and the only parameter used commonly is “latency to fall”. The values of individual animals can often vary greatly.ResultsIn the present study, we established a procedure for mice with 4 consecutive days of training with 4 trials per day and modified the testing procedure by placing the mice back on the rod repeatedly after each fall until the trial ends (5 min). Data from the fourth training day as baseline results showed that the second, third and fourth trial were more consistent than the first, probably due to habituation or learning. There was no difference between the second, third and fourth trial, two trials may be sufficient in testing. We also introduced 3 additional read-outs: Longest duration on the rod (s), Maximal distance covered (cm), and Number of falls to better evaluate the motor capacity over the 5 min of testing. We then used this 4-parameter analysis to capture the motor deficits of mice with mild to moderate traumatic brain injuries (by a weight dropping on the skull (Marmarou model)). We found that normalization of data to individual baseline performance was needed to reduce individual differences, and 4 trials were more sensitive than two to show motor deficits. The parameter of Maximal distance was the best in detecting statistically significant long-term motor deficits.ConclusionsThese results show that by making adjustments to the protocol and employing a more refined analysis, it is possible to expand a widely used routine behavioral test with additional accessible parameters that detect relevant deficits in a model of mild to moderate traumatic brain injury. The modified Rotarod test maybe a valuable tool for better preclinical evaluations of drugs and therapies.

Inhibition effect of NH4H2PO4 on explosion flame propagation of aluminum alloy dust cloud

To investigate the inhibitory effect of NH4H2PO4 on the flame propagation of aluminum alloy dust clouds, experiments were conducted in cylindrical vertical ducts. High-speed cameras were employed to capture the explosion flames of aluminum alloy dust clouds under the coupled effect of NH4H2PO4 with different concentrations and particle sizes. The flame propagation behavior of NH4H2PO4/aluminum alloy dust was analyzed, and mathematical models were developed to describe the maximum distance and maximum velocity of NH4H2PO4 inhibition on the flame propagation of aluminum alloy dust clouds. Additionally, the inhibition characteristics of NH4H2PO4 on aluminum alloy dust explosions were studied in a 20 L spherical explosion container, and the thermal decomposition properties of NH4H2PO4 and aluminum alloy particles were investigated using a simultaneous thermal analyzer. Furthermore, the inhibition process of NH4H2PO4 on aluminum alloy dust was explored. The results demonstrate that the concentration of NH4H2PO4 has a greater impact on the inhibition effect on aluminum alloy dust, while the particle size has a smaller influence. Generally, as the concentration of NH4H2PO4 increases, the flame propagation distance and flame development rate decrease, leading to an enhanced inhibitory effect. The addition of NH4H2PO4 slows down the peak pressure of aluminum alloy dust explosions, resulting in a longer duration and smaller peak values of the “double-peak” pressure structure. When the particle size of NH4H2PO4 decreases and the concentration increases, the possibility of the “double-peak” structure decreases, forming a single-peak structure with lower peak values and pressure rise rates. The decomposition temperature of NH4H2PO4 precedes the combustion temperature of aluminum alloy particles. NH4H2PO4 absorbs thermal energy from the reaction system, exerting an inhibitory effect on aluminum alloy dust. The research findings provide valuable references for optimizing explosion suppression parameters and improving powder explosion suppression techniques.

Development of high-volume steel slag as cementitious material by ethylenediamine tetraacetic acid induced accelerated carbonation

Steel slag, a by-product of primary steel production, is produced in large quantities and is primarily used as landfill or aggregate. Due to its high reactivity with CO2, steel slag can form calcium carbonate at room temperature and pressure, making it an ideal material for CO2 capture in the development of sustainable construction materials. Due to the transport properties of CO2 and carbonation kinetics, carbonation of steel slag is frequently carried out using pure gas under high pressure. In this study, ethylenediamine tetraacetic acid (EDTA)-induced accelerated carbonation was used to produce cement paste mixes consisting of up to 100% steel slag powder. Combination of cement and EDTA with steel slag proved to be effective in accelerating the carbonation reaction. EDTA increased the leaching of Ca from the steel slag, thereby enhancing the carbonation reaction, which was more obvious in longer durations (up to 28 days). The optimum cement paste mix (80% steel slag and 20% cement, with 0.1 mol/L EDTA solution) achieved maximum compressive strength of 14 MPa and CO2 uptake of 8.7% after 28 days of accelerated carbonation. Results demonstrated that the use of high-volume steel slag as a cementitious material has great potential in non-structural building applications.

Serological evaluation of risk factors for exposure to malaria in a pre-elimination setting in Malaysian Borneo

Malaysia has reported no indigenous cases of P. falciparum and P. vivax for over 3 years. When transmission reaches such low levels, it is important to understand the individuals and locations where exposure risks are high, as they may be at greater risk in the case of a resurgence of transmission. Serology is a useful tool in low transmission settings, providing insight into exposure over longer durations than PCR or RDT. We ran blood samples from a 2015 population-based survey in northern Sabah, Malaysian Borneo on a multiplex bead assay. Using supervised machine learning methods, we characterised recent and historic exposure to Plasmodium falciparum and P. vivax and found recent exposure to P. falciparum to be very low, with exposure to both species increasing with age. We performed a risk-factor assessment on environmental, behavioural, demographic and household factors, and identified forest activity and longer travel times to healthcare as common risk-factors for exposure to P. falciparum and P. vivax. In addition, we used remote-sensing derived data and geostatistical models to assess environmental and spatial associations with exposure. We created predictive maps of exposure to recent P. falciparum in the study area and showed 3 clear foci of exposure. This study provides useful insight into the environmental, spatial and demographic risk factors for P. falciparum and P. vivax at a period of low transmission in Malaysian Borneo. The findings would be valuable in the case of resurgence of human malarias in the region.

High Prevalence of Anorectal Dysfunction in Ambulatory Patients with Chronic Constipation, Regardless of Colon Transit Time.

Classification of chronic constipation (CC) into its three subtypes of slow transit constipation, defecation disorder and normal transit constipation, may improve its multifaceted management. We assessed the merits of the London classification in patients with CC, who were studied by both wireless motility capsule (WMC) and high-resolution anorectal manometry (HR-ARM), examining their relative utilities in decision-making.s PATIENTS AND METHODS: Retrospective, community-based study of prospectively collected data on patients with CC by Rome IV criteria, who underwent WMC and HR-ARM, Balloon Expulsion Test, and Rectal Sensory Testing. Clinical assessment was made by standard questionnaires. On WMC, standard criteria for colonic transit time (CTT) were used (normal CTT < 59h). The hierarchical London classification was used for HR-ARM analyses. Of 1261 patients with CC, 166 (91M; ages 22-86) received technically satisfactory WMC and HR-ARM, formed the analyzed study cohort, of whom 84 had normal CTT and 82 had prolonged CTT (> 59h). Patients with slow CTT were significantly older and had longer duration and more severe disease. Using the London classification criteria for disorders of anorectal function, we noted a high prevalence of anorectal dysfunction, regardless of CTT. Except for lower rate of anal hypertonicity in patients with slow CTT, disorders of recto-anal coordination, and rectal sensation were seen at a comparable rate in patients with CC, regardless of CTT. There is a significant overlap of anorectal disorders in patients with slow CTT. There is questionable specificity and utility of WMC and HR-ARM in assessing patients with CC. More work is needed to demonstrate the value of these studies as surrogate markers of the disease and its response to multifaceted therapy.

Comparative analysis of the influence of temperature and precipitation on drought assessment in the Marmara region of Turkey: an examination of SPI and SPEI indices

Abstract Drought is one of the most serious problems for human societies and ecosystems. Climate change has begun to affect the whole world, but regional climate change can have different effects. Precipitation is frequently used to determine drought; besides, temperature has started to be used in recent years. The effect of temperature on the occurrence of drought was investigated for the Marmara region, located in the northeast of Turkey. The spatiotemporal variability of drought in the Marmara region was analyzed by using the standardized precipitation index (SPI) and standardized precipitation evapotranspiration index (SPEI) for 3-, 6-, and 12-month series. Results show that SPEI droughts occur with longer duration and increased magnitude, which can be attributed to the rise in potential evapotranspiration rates with an increase in temperature. The correlation between SPI and SPEI is strong for the same time series, and the number of extreme drought values for SPI is higher than SPEI, while the number of severe and moderate drought values is lower compared to SPEI. The years 1989, 1990, 2001, 2007, and 2014 were characterized as the highest drought years throughout the region. The study concludes that temperature should be considered in future studies.

Initiation and duration of folic acid supplementation in preventing congenital malformations

BackgroundFolic acid (FA) supplementation is associated with a lower risk of the neural tube and heart defects and is recommended for women of childbearing age. Although there are detailed recommendations, differences in the initiation time and duration of FA supplementation remain poorly studied.MethodsA multicentre prospective study of 17,713 women was conducted. The incidence of congenital malformations in women taking a recommended dosage (e.g. 0.4 or 0.8 mg/day) of FA was compared with that in women without supplementation. The predicted probability of malformations by the initiation time and duration of FA use was estimated to determine optimal options.ResultsPericonceptional FA supplementation was associated with a lower and insignificant risk of congenital malformations (1.59% vs. 2.37%; odds ratio [OR] 0.69; 95% confidence interval [CI]: 0.44–1.08), heart defects (3.8 vs. 8.0 per 1000 infants; OR, 0.47; 0.21–1.02), and neural tube defects (7.0 vs. 11.5 per 10,000 infants; OR, 0.64; 0.08–5.15). FA use after pregnancy provided greater protection against total malformations. Statistically significant associations were found in women who initiated FA supplementation in the first month of gestation (OR, 0.55; 95% CI: 0.33–0.91) and in those who supplemented for 1 to 2 months (OR, 0.59; 95% CI: 0.36–0.98). Similar results were found for heart defects. The optimal initiation time was 1.5 (optimal range: 1.1 to 1.9) months before pregnancy and a duration of 4.0 (3.7 to 4.4) months was reasonable to achieve the lowest risk of congenital malformations. Heart defect prevention required an earlier initiation (2.2 vs. 1.1 months before pregnancy) and a longer duration (4.7 vs. 3.7 months) than the prevention of other malformations.ConclusionsThe timely initiation of FA supplementation for gestation was associated with a decreased risk of congenital malformations, which was mainly attributed to its protection against heart defects. The initiation of FA supplementation 1.5 months before conception with a duration of 4 months is the preferred option for congenital malformation prevention.Trial registrationChictr.org.cn identifier: ChiCTR-SOC-17010976.

Effects of exercise on bone mineral density in middle-aged and older men: A comprehensive meta-analysis.

To determine the effect of exercise on bone mineral density (BMD) in middle-aged and older men. We searched three electronic databases up to March 21, 2022. A systematic review of the literature according to the PRISMA statement included (1) randomised controlled trials (RCTs), with (2) at least one exercise group as an intervention versus a control group, (3) men aged ≥ 45years old, and (4) areal BMD of the lumbar spine (LS) and/or femoral neck (FN) and/or total hip (TH) and/or trochanter region. Mean differences (MD) for BMD changes at the LS, FN, TH, and trochanter were defined as outcome measures. A total of 10 eligible RCTs were included (N = 555 participants). Exercise significantly improved BMD, and the summarised MD was 0.02 (95% CI: 0.00 to 0.05) for LS BMD, 0.01 (95% CI: 0.00 to 0.02) for FN BMD, 0.01 (95% CI: 0.00 to 0.01) for TH BMD, and 0.03 (95% CI: 0.00 to 0.05) for trochanter BMD. Subgoup analyses showed the improvement effect was statistically significant in trials with longer duration and higher intensity in LS (≥ 12 months: MD, 0.01, 95% CI:0.00 to 0.03; higher intensity: MD, 0.01, 95% CI:0.00 to 0.03) and FN (≥ 12months: MD, 0.02, 95% CI:0.01 to 0.02; higher intensity: MD, 0.01, 95% CI:0.01 to 0.02). Our results suggested a relatively mild, improvement effect of exercise on LS and proximal femur BMD. Exercise has the potential to be an effective way to avert bone loss in middle-aged and older men.

Intrathecal Morphine Use Improves Postoperative Analgesia and Reduces Opioid Consumption in Patients Undergoing Total Knee Arthroplasty Under Spinal Anesthesia: A Retrospective Study.

Background Intrathecal morphine (ITM) provides effective postoperative analgesia for patients undergoing total knee arthroplasty (TKA) under spinal anesthesia (SA). The management of pain in patients undergoing TKA has remained a challenge for anesthesiologists, as no single regional anesthesia technique is adequate with regard to balancing effective analgesia with minimal side effects. Severe postoperative pain following TKA has been shown to negatively impact patient outcomes and mortality. This study is aimed to describe the effect of intrathecal morphine in patients undergoing total knee arthroplasty. Methods This was a retrospective, descriptive, and single-center study conducted on patients undergoing total knee arthroplasty from June 1, 2022, to June 1, 2023. The sample size consisted of 50 patients who were 18 years and older, American Society of Anesthesiology (ASA) class 1-3, and patients who had received either 150 mcg (experimental) or noITM dose under spinal anesthesia. Oral morphine requirement (OME) and visual analog pain scale (VAS) were used to assess pain in the first 24 hours after surgery. Results The experimental group had significantly lower OME usage in the post-anesthesia care unit (PACU) (p < 0.001) and at six hours (p = 0.040) postoperatively. At 12 hours and 24 hours postoperatively, the two groups had similar OME use (p > 0.20, for both). The experimental group had significantly less total OME use over the first 24-hour postoperative period.The experimental group had significantly lower pain scores in the PACU (p<0.001) and at six hours postop (p=0.002); there were no significant differences between groups at 12- and 24-hours postop. The ambulation distance was clinically significant and better in the ITM group but was not statistically significant (p = 0.080). There was no difference between groups in the incidence of postoperative nausea and vomiting (PONV). Conclusion The careful use of ITM with the optimal dose offers an effective addition to regional anesthesia for improved analgesia with minimal side effects. The 150 mcg ITM dose provided good analgesic effects with longer duration and was not associated with respiratory depression.