Point Increment Research Articles

Influence of Variable Intensity Ultraviolet on the Performance of SBS Modified Asphalt

Previous scholars studied UV aged asphalt performance under constant UV intensity. This study proposed a method of UV aged asphalt based on the time-varying UV intensity, which is more capable of realistically simulating the UV aging of asphalt under natural conditions. The softening point, viscosity, and DSR tests were used to analyze changes in conventional and rheological properties of UV aged asphalt and compared them with RTFO (Rolling Thin-Film Oven) aged asphalt. Fourier transform infrared (FTIR) spectroscopy and scanning electron microscope (SEM) tests were analyzed for the microscopic characteristics. The aging index was also used to evaluate the percentage of asphalt aging attributable to each UV aging cycle. The results show that the softening point is more susceptible to UV radiation, with UV-6 cycles exceeding the softening point increment of RTFO. On the contrary, the viscosity is more susceptible to thermo-oxidative aging, and the viscosity increment of RTFO is 39.3% higher than that of UV-12 cycles. Based on DSR's test results, the rutting factor magnitude of RTFO was between 9-12 UV aging cycles The phase angle results indicate that thermo-oxidative aging is more likely to convert asphalt to elastomer than RTFO asphalt. UV aging process of asphalt produced sulfinyl and, carbonyl and other polar functional groups, asphalt intermolecular forced to enhance the production of a harder oxidation layer, the asphalt surface began to appear cracks. As aging time increases, the cracks become longer and deeper. Practical image recognition technology can identify the areas of the cracks. The crack area follows a linear pattern during cycles 3 to 9, while the growth rate slows down during cycles 9 to 12.

The short-term aging effects of Polyvinyl Chloride (PVC) and Nano Silica (NS) as modifiers on asphalt binders

Many studies have shown that for a pavement paved with an asphalt-aggregate mixture, to achieve its design life, the asphalt mustn’t age too hard during storage, during the production process, or while on the road. The short-term aging effects of Polyvinyl Chloride (PVC) and Nano silica (NS) as modifiers on asphalt binders were investigated. The physical properties, penetration, softening points, viscosity measurements, dynamic shear rheometer (DSR), and multiple stress creep recovery (MSCR), under the aging conditions of unmodified and modified asphalt were determined for various PVC and NS contents. To simulate the aging in a short term in the laboratory, the rolling thin film oven test was conducted. Obtained results indicated that adding 5% PVC and 1% NS had a significant positive effect on the aging resistance of asphalt binder through increasing 59.49% penetration aging ratio (PAR) values. It was also observed that adding PVC and NS reinforced the aging resistance of the asphalt binder. Nevertheless, adding PVC and NS reduced softening point increment (SPI), viscosity aging index (VAI), as well as rutting factor aging index (AIR). The asphalt binder modified with PVC/NS demonstrated better performance compared to the asphalt binders only modified with PVC or NS. The results of this study demontrate the feasibility of applying the PVC/NS combination treatment to asphalt in practical applications.

Childhood socio-economic disadvantages versus adverse care experiences: Mediation and moderation impacts on late-life depressive symptoms.

Whether material deprivation-related childhood socio-economic disadvantages (CSD) and care-related adverse childhood experiences (ACE) have different impacts on depressive symptoms in middle-aged and older people is unclear. In the Guangzhou Biobank Cohort Study, CSD and ACE were assessed by 7 and 5 culturally sensitive questions, respectively, on 8,716 participants aged 50+. Depressive symptoms were measured by 15-item Geriatric Depression Scale (GDS). Multivariable linear regression, stratification analyses, and mediation analyses were done. Higher CSD and ACE scores were associated with higher GDS score in dose-response manner (P for trend <0.001). Participants with one point increment in CSD and ACE had higher GDS score by 0.11 (95% confidence interval [CI], 0.09-0.14) and 0.41 (95% CI, 0.35-0.47), respectively. The association of CSD with GDS score was significant in women only (P for sex interaction <0.001; women: β (95% CI)=0.14 (0.11-0.17), men: 0.04 (-0.01 to 0.08)). The association between ACE and GDS score was stronger in participants with high social deprivation index (SDI) (P for interaction = 0.01; low SDI: β (95% CI)=0.36 (0.29-0.43), high SDI: 0.64 (0.48-0.80)). The proportion of association of CSD and ACE scores with GDS score mediated via education was 20.11% and 2.28%. CSD and ACE were associated with late-life depressive symptoms with dose-response patterns, especially in women and those with low adulthood socio-economic status. Education was a major mediator for CSD but not ACE. Eliminating ACE should be a top priority.

Impacts of ultraviolet absorption by zinc oxide nanoparticle modifiers on asphalt aging

Ultraviolet absorption ability of modifiers is essential to protect asphalt from ageing. However, the detailed correlation between them remains unclear. In this study, zinc oxide nanoparticles were used as modifiers, and their ultraviolet absorption ability was manipulated by magnesium and aluminum doping. The influence of ultraviolet absorption ability of the nanoparticles on asphalt ultraviolet ageing was investigated experimentally, and their correlation was revealed in detail by curve fitting. The results show that aluminum doping enhances the ultraviolet absorption ability of nanoparticles, leading to superior anti-aging performance in aluminum-doped zinc oxide modified asphalt compared to pure zinc oxide. Conversely, magnesium doping shows a contrary modification. Evaluating the ultraviolet absorption ability of nanoparticle modifiers by bandgap and absorption intensity, we found that softening point increments, viscosity ageing index, and sulfoxide index exhibit a decreasing trend mainly in the bandgap range of 3.269 to 3.334 eV, whereas carbonyl index shows a decreasing trend mainly in the lower bandgap range of 3.183 to 3.269 eV. This phenomenon is primarily due to the different reactivity of carbon and sulfur with oxygen in asphalt. Curve fitting analysis revealed an exponential correlation between the ageing index of asphalt and the ultraviolet absorption ability of nanoparticles. To achieve superior anti-ultraviolet ageing performance, the nanoparticles should possess an absorption intensity above 0.961 a.u. and a bandgap below 3.299 eV. Moreover, stronger ultraviolet absorption ability of nanoparticles is needed to prevent the formation of carbonyl compounds. The underlying correlation established in the present work has significant implications for selecting suitable modifiers to prevent ultraviolet ageing of asphalt.

Air pollution, life’s essential 8, and risk of severe non-alcoholic fatty liver disease among individuals with type 2 diabetes

BackgroundThe impacts of long-term exposure to air pollution on the risk of subsequent non-alcoholic fatty liver disease (NAFLD) among participants with type 2 diabetes (T2D) is ambiguous. The modifying role of Life’s Essential 8 (LE8) remains unknown.MethodsThis study included 23,129 participants with T2D at baseline from the UK Biobank. Annual means of nitrogen dioxide (NO2), nitrogen oxides (NOX), and particulate matter (PM2.5, PM2.5–10, PM10) were estimated using the land-use regression model for each participant. The associations between exposure to air pollution and the risk of severe NAFLD were evaluated using Cox proportional hazard models. The effect modification of LE8 was assessed through stratified analyses.ResultsDuring a median 13.6 years of follow-up, a total of 1,123 severe NAFLD cases occurred. After fully adjusting for potential covariates, higher levels of PM2.5 (hazard ratio [HR] = 1.12, 95%CI:1.02, 1.23 per interquartile range [IQR] increment), NO2 (HR = 1.15, 95%CI:1.04, 1.27), and NOX (HR = 1.08, 95%CI:1.01, 1.17) were associated with an elevated risk of severe NAFLD. In addition, LE8 score was negatively associated with the risk of NAFLD (HR = 0.97, 95% CI: 0.97, 0.98 per point increment). Compared with those who had low air pollution and high LE8, participants with a high air pollution exposure and low LE8 had a significantly higher risk of severe NAFLD.ConclusionsOur findings suggest that long-term exposure to air pollution was associated with an elevated risk of severe NAFLD among participants with T2D. A lower LE8 may increase the adverse impacts of air pollution on NAFLD.

Physical, rheological and micro characteristics of ARA/Nano-TiO2 composite modified asphalt before and after short-term aging

This paper aims to investigate the composite application of nanomaterials and natural asphalt in order to enhance the road performance of asphalt pavement. The objective is to develop high-performance modified asphalt that improves the durability, reliability, and load resistance of asphalt roads while reducing resource waste and environmental pollution. The composite modified asphalt was prepared by adding different blends of Albanian natural rock asphalt (ARA) and 1% of nano titanium dioxide (Nano-TiO2), and the basic properties and rheological properties of the asphalt before and after aging were tested by using basic performance tests and temperature scanning tests. Subsequently, the microscopic morphological characteristics of the asphalt were observed by scanning electron microscope and atomic force microscope, and the number of bee structures, the area share of bee structures, root mean square roughness Rq, and arithmetic mean roughness Ra were used as microscopic quantitative indexes. The results indicate that the complex modulus and rutting coefficient of ARA/Nano-TiO2 composite-modified asphalt increase with an increase in ARA dosage when the dosage of Nano-TiO2 is 1%. The asphalt modified with Nano-TiO2 composite blended with 15% ARA exhibits higher residual needle penetration, composite modulus ratio, rutting coefficient ratio and lower softening point increment compared to 70# asphalt. The bitumen modified with titanium dioxide nanocomposite blended with 15% ARA exhibits higher Rq and Ra and a more stable phase structure before and after aging. 15% of ARA/Nano-TiO2 composite-modified asphalt has higher Rq and Ra before and after aging, and its phase structure is more stable. The results show that ARA/Nano-TiO2 composite-modified asphalt has better high-temperature deformation resistance and aging resistance than 70# and that 15% ARA is recommended as the optimum amount of composite-modified asphalt.

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

ObjectiveTo assess the impact of tobacco control regulations and policy implementation on smoking cessation tendencies in cigarette users born between 1982 and 1991 in Chile.DesignLongitudinal cross-sectional study.SettingNational level.ParticipantsData from the...

Role of magnetic resonance imaging in the prediction of histological grade in soft tissue sarcomas.

Soft tissue sarcomas are rare malignant tumors with significant heterogeneity. The importance of classifying histological grades is fundamental to defining the treatment approach. To evaluate magnetic resonance imaging (MRI) in predicting the histological grade of soft tissue sarcomas. A retrospective observational study included patients over 18 years undergoing MRI and primary tumor surgery at AC Camargo Cancer Center from January 2015 to June 2022. Two radiologists evaluated MRI criteria (size, margin definition, heterogeneity of the T2 signal, high-intensity peritumoral signal on T2, and postperitumoral contrast), and a grading prediction score was calculated. χ2 and logistic regression analyses were conducted. Sixty-eight patients were included (38 men; median: 48 years). Moreover, 52 high-grade and 16 low-grade tumors were observed. The MRI criteria associated with histological grade were peritumoral high-intensity T2-weighted signals (p < 0.001) and peritumoral postcontrast enhancement (p = 0.006). Logistic regression confirmed their significance (odds ratio [OR]: 11.8 and 8.8, respectively). Each score point increment doubled the chance of high-grade tumors (OR: 2.0; p = 0.014). MRI effectively predicts histological grades of soft tissue sarcomas. Peritumoral high-intensity T2-weighted signals and peritumoral postcontrast enhancement are valuable indicators of high-grade tumors. This highlights MRI's importance in treatment decision-making for sarcoma patients.

Long term survival in patients with classic infantile Pompe disease reveals a spectrum with progressive brain abnormalities and changes in cognitive functioning.

The aim of this longitudinal cohort study, is to provide more insight into the pattern of brain abnormalities, and possible consequences for cognitive functioning, in patients with classic infantile Pompe disease. We included 19 classic infantile Pompe patients (median age last assessment 8.9 years, range 1.5-22.5 years; 5/19 CRIM negative), treated with ERT. Using MR imaging of the brain (T1, T2, and FLAIR acquisitions), we classified progression of brain abnormalities on a 12-point rating scale at multiple time points throughout follow-up. Additionally we noted specific white matter patterns and examined atrophy. Cognitive development was studied using Wechsler IQ assessments obtained by certified neuropsychologists. The association between age and cognitive functioning, and MRI ratings and cognitive functioning was assessed by linear regression models. All but one patient developed brain abnormalities. The abnormalities progressed in a similar pattern throughout the brain, with early involvement of periventricular white matter, later followed by subcortical white matter, gray matter structures, and juxtacortical U-fibers. We found a significant decline (p < 0.01), with increasing age for full scale IQ, performance IQ and processing speed, but not for verbal IQ (p = 0.17). Each point increment in the 12-point MRI rating scale was associated with a significant decline (3.1-6.0 points) in all the IQ index scores (p < 0.05). The majority of long-term surviving patients in our cohort develop incremental brain MRI abnormalities and decline in cognitive functioning. This highlights the need for new therapies that can cross the blood-brain barrier in order to treat this CNS phenotype.

Mo-fi-disc scoring system: Towards understanding the radiological tools to better delineate the disease process and enhancing our solutions for low back pain in artificial intelligence era

Background‘Mo-fi-disc’ is a new scoring system that quantifies degeneration of the lumbar spine and predicts the intensity of low back pain (LBP). However, its association with LBP-related disability is unknown. In the present study, we aimed to analyze whether ‘Mo-fi-disc’ scoring system could predict LBP-related disability and distinguish patients with LBP from asymptomatic subjects, while the spine medicine marching towards the era of artificial intelligence (AI). MethodsThis is a cross-sectional analysis of a prospectively collected database. We included age-, gender-, and BMI-matched 132 subjects (patients: 66, asymptomatic subjects: 66). Modic changes (Mo), fatty infiltration in the paraspinal muscles (fi), and intervertebral disc degeneration (disc) were evaluated using ‘Mo-fi-disc’ scoring system on lumbar spine magnetic resonance imaging. Pain and disability were evaluated with visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. ResultsA Mo-fi-disc score of 5.5 was the most appropriate cut-off value. Mo-fi-disc scoring system had an OR of 1.79 in distinguishing patients with LBP from asymptomatic subjects. One point increment in VAS and ODI had ORs of 1.82 and 1.13 for predicting higher Mo-fi-disc scores. Conclusion‘Mo-fi-disc’ scoring system is a useful tool depicting intensity of LBP and LBP-related disability. The cut off value of Mo-fi-disc score is 5.5 to distinguish patients with LBP from asymptomatic subjects. This scoring system, with progressive improvement of its faults, could help clinicians to select appropriate patients for conservative and surgical management in the very near future, in AI-based spine medicine. IRB approval noATADEK 2019-12/4.

Cost-benefit ratio of modern medical education using micro-costing: amodel calculation using the example of an innovative breast brachytherapy workshop.

Radiation oncology is an essential component of therapeutic oncology and necessitates well-trained personnel. Multicatheter brachytherapy (MCBT) is one radiotherapeutic option for early-stage breast cancer treatment. However, specialized hands-on training for MCBT is not currently included in the curriculum for residents. Arecently developed hands-on brachytherapy workshop has demonstrated promising results in enhancing knowledge and practical skills. Nevertheless, these simulation-based teaching formats necessitate more time and financial resources. Our analyses include computational models for the implementation and delivery of this workshop and can serve as abasis for similar educational initiatives. This study aimed to assess the cost-effectiveness of apreviously developed and evaluated breast brachytherapy simulation workshop. Using amicro-costing approach, we estimated costs at adetailed level by considering supplies, soft- and hardware, and personnel time for each task. This method also allows for acomprehensive evaluation of the costs associated with implementing new medical techniques. The workshop costs were divided into two categories: development and workshop execution. The cost analysis was conducted on aper-participant basis, and the impact on knowledge improvement was measured using aquestionnaire. The total workshop costs were determined by considering the initial workshop setup expenses including the development and conceptualization of the course with all involved collaborators, as well as the costs incurred for each individual course. The workshop was found to be financially efficient, with aper-participant cost of € 39, considering the industrial sponsorship provided for brachytherapy equipment. In addition, we assessed the workshop's efficacy by analyzing participant feedback using Likert scale evaluations. The findings indicated anotable enhancement in both theoretical and practical skills among the participants. Moreover, the cost-to-benefit ratio (CBFR) analysis demonstrated aCBFR of € 13.53 for each Likert point increment. The hands-on brachytherapy workshop proved to be avaluable and approximately cost-effective educational program, leading to asignificant enhancement in the knowledge and skills of the participants. Without the support of industrial sponsorship, the costs would have been unattainable.

Beat the Clock: Assessment of Night Eating Syndrome and Circadian Rhythm in a Sample of Greek Adults.

The night eating syndrome (NES) is characterized by excessive food intake during the evening and night hours, with 25% of the daily intake being consumed post-dinner, paired with ep-isodes of nocturnal food intake, at a frequency of more than twice weekly. The NES has been associated with a misaligned circadian rhythm related to a delay in overall food intake, increased energy and fat consumption. The present cross-sectional study aimed to assess NES in a Greek population and evaluate possible links between NES and chronotype. NES was assessed using the Night Eating Questionnaire (NEQ), and circadian rhythm, sleep and mood were evaluated with the Sleep, Circadian Rhythms, and Mood (SCRAM) questionnaire. A total of 533 adults participated in the study. A relatively high prevalence of NES was revealed, with more than 8.1% (NEQ ≥ 30) of the participants reporting experiencing NES symptoms, depending on the NEQ threshold used. Most participants had the intermediate chronotype. NEQ score was positively associated with the morning chronotype, and SCRAM was negatively related to "Good Sleep". Each point increment in the depression score was associated with 6% higher odds of NES. The early identification of NES gains importance in clinical practice, in a collective effort aiming to reduce NES symptomatology and its detrimental health effects.

An Enhanced Multi-Sensor Simultaneous Localization and Mapping (SLAM) Framework with Coarse-to-Fine Loop Closure Detection Based on a Tightly Coupled Error State Iterative Kalman Filter

In order to attain precise and robust transformation estimation in simultaneous localization and mapping (SLAM) tasks, the integration of multiple sensors has demonstrated effectiveness and significant potential in robotics applications. Our work emerges as a rapid tightly coupled LIDAR-inertial-visual SLAM system, comprising three tightly coupled components: the LIO module, the VIO module, and the loop closure detection module. The LIO module directly constructs raw scanning point increments into a point cloud map for matching. The VIO component performs image alignment by aligning the observed points and the loop closure detection module imparts real-time cumulative error correction through factor graph optimization using the iSAM2 optimizer. The three components are integrated via an error state iterative Kalman filter (ESIKF). To alleviate computational efforts in loop closure detection, a coarse-to-fine point cloud matching approach is employed, leverging Quatro for deriving a priori state for keyframe point clouds and NanoGICP for detailed transformation computation. Experimental evaluations conducted on both open and private datasets substantiate the superior performance of the proposed method compared to similar approaches. The results indicate the adaptability of this method to various challenging situations.

A novel method to improve anti-aging properties of SBS modified bitumen by zinc oxide/expanded vermiculite composite: Influence of zinc oxide particle loadings

Styrene-butadiene-styrene copolymer modified bitumen (SBSMB) has been commonly used in pavement construction for its excellent performance. However, during construction and service life, SBSMB is inevitably subjected to thermal-oxidative or ultraviolet aging as a result of factors in the environment like heat, light and oxygen. This study investigated the effects of zinc oxide/expanded vermiculite composite (Z/E) on SBSMB, in particular the effects of Z/E with different zinc oxide (ZnO) particle loadings on SBSMB. And Z/E with different ZnO particle loadings were prepared and characterized by X-ray fluorescence spectrometer, field emission scanning electron microscope, UV–Visible spectrometer and Fourier transform infrared spectrometer tests. To age bitumen samples, thin film oven test, pressure aging vessel and ultraviolet aging tests were used. Eventually, the effects of Z/E with various ZnO particle loadings on the storage stability, physical, rheological and anti-aging properties of SBSMB were investigated. According to the results, Z/E with different ZnO particle loadings are successfully prepared. There are uniform ZnO particles on the surface of expanded vermiculite and ZnO particle loadings are increased with the concentration of the ZnO precursor solution. Furthermore, the high-temperature performance of SBSMB is enhanced, but the low-temperature performance is slightly affected by Z/E. Whatever the aging mode, the introduction of Z/E can obviously reduce the viscosity aging index, softening point increment, complex modulus aging index and increase phase angle aging index of SBSMB, demonstrating that the aging resistance of SBSMB are significantly enhanced. It was determined that SBSMB with 29.5 wt%Z/E had the best aging resistance.

Association between total body muscle percentage and prevalence of non-alcoholic fatty liver disease in Korean adults findings from an 18-year follow-up: a prospective cohort study.

This study aimed to elucidate the association between total lean muscle mass and the incidence of non-alcoholic fatty liver disease (NAFLD) in the adult Korean population. Utilizing data derived from the 18-year prospective cohort of the Korean Genome and Epidemiology Study, NAFLD was diagnosed via the hepatic steatosis index with an established cutoff value of 36. Lean muscle mass was assessed via bioelectrical impedance analysis and subsequently divided into tertiles. A generalized mixed model with a logit link was employed for repeated measures data analysis, accounting for potential confounders. Analysis encompassed 7,794 participants yielding 49,177 measurements. The findings revealed a markedly increased incidence of NAFLD in the lower tertiles of muscle mass, specifically, tertile 1 (odds ratio [OR], 20.65; 95% confidence interval [CI], 9.66-44.11) and tertile 2 (OR, 4.57; 95% CI, 2.11-9.91), in comparison to tertile 3. Age-dependent decreases in the OR were observed within the tertile 1 group, with ORs of 10.12 at age of 40 years and 4.96 at age of 80 years. Moreover, each 1%-point increment in total muscle mass corresponded with an estimated OR of 0.87 (95% CI, 0.82-0.93) for NAFLD resolution. The study demonstrates a significant association between total muscle mass and NAFLD prevalence among Korean adults. Given the potential endocrine role of muscle mass in NAFLD pathogenesis, interventions aimed at enhancing muscle mass might serve as an effective public health strategy for mitigating NAFLD prevalence.

Healthy lifestyles in relation to cardiometabolic diseases among schoolteachers: A cross‐sectional study

AbstractBackgroundWe aimed to explore the associations of adherence to an overall healthy lifestyle with cardiometabolic diseases (CMDs) among schoolteachers in China.MethodsWe conducted a cross‐sectional analysis among 2983 teachers (aged 39.8 ± 9.3 years, 73.8% women) in Zhejiang Province, China. A healthy lifestyle score (0–7) was constructed based on seven low‐risk factors: healthy diet, noncurrent smoking, noncurrent drinking, regular exercise, normal body mass index (BMI), adequate sleep duration, and limited sedentary behavior. CMDs included self‐reported hyperlipidemia, hypertension, diabetes, coronary heart disease, and stroke. Multivariable‐adjusted logistic regression models were used to evaluate the associations between healthy lifestyle and CMD.ResultsA total of 493 (16.5%) participants had at least one CMD, with hyperlipidemia, hypertension, and diabetes being the three leading CMDs. Each point increment in a healthy lifestyle score was associated with 20% lower odds of having CMD (p‐trend &lt; 0.001). Compared with 0–3 low‐risk factors, the odds ratios (ORs) and 95% confidence intervals (CIs) were 0.66 (0.50–0.88) for 4 low‐risk factors and 0.51 (0.39–0.67) for 5–7 low‐risk factors. We observed independent associations for normal BMI (OR = 0.50, 95% CI = 0.40–0.63), noncurrent drinking (OR = 0.53, 95% CI = 0.36–0.77), and limited sedentary behavior (OR = 0.77, 95% CI = 0.62–0.96) in relation to CMD. Healthy diet (OR = 0.75, 95% CI = 0.55–1.01) exhibited marginally significant association with CMD.ConclusionsOur findings suggest that adherence to an overall healthy lifestyle is associated with lower odds of CMD among schoolteachers.

REIT capital structure strategy in the aftermath of hurricanes

This paper studies the causal impacts of hurricanes on capital structure. The sample covers 181 US public equity Real Estate Investment Trusts (REITs) throughout 2011–2018, during which 8 catastrophic hurricanes made landfalls in the contiguous US. This study finds that a basis point (0.01%) increment in REIT sudden exposure to hurricanes leads to a negative liquidity shock of 15.3% in corporate cash. Such shock is immediately followed by a 26.4% increase in leverage, measured as total debt over total assets. The effects are temporary, lasting only one quarter during the shock. REIT reactions to hurricanes are consistent with the pecking order theory of capital structure. Overall, hurricane ramifications to REIT capital structure strategy can be as impactful as any distress event that alters corporate liquidity and ability to maintain its daily operation.

#4724 MULTIPLE AIR POLLUTANT EXPOSURE AND RISK OF ALL-CAUSE MORTALITY IN DIALYSIS PATIENTS: A FRENCH REGISTRY-BASED NATIONWIDE STUDY

Abstract Background and Aims According to the Global Burden of Disease, mortality attributed to chronic kidney disease (CKD) is steadily increasing worldwide, with an estimated increase of more than 30% since 2005. Among the candidates mentioned to explain this inflation, air pollution is attracting more and more attention. Although the link between air pollution and the incidence of CKD and kidney failure seems increasingly clear, there is currently very little data regarding the potential effect of exposure to air pollutants on mortality in dialysis patients. Beyond the lack of data in the literature, their interpretation is hampered by the conventional analysis of air pollutants on an individual basis, whereas ambient pollution actually corresponds to a complex combination of multiple pollutant exposure. Composite spatial indices that account for multi-exposition have recently been developed and are now recognized as relevant indicators for global air exposure assessment. The main objectives of this project are to study the association of the level of multi-exposure to air pollutants with all-cause and cause-specific mortality in dialysis patients. Method We included all incident dialysis patients in France between January 1, 2012 and December 31, 2020, identified in the REIN registry. Annual mean levels of exposure to fine particulate matter (PM10, PM2.5) and nitrogen dioxide (NO2) were extracted over the entire study period based on the data from the French ‘Institut National de l’Environnement Industriel et des Risques (INERIS)’. A composite environmental score was created from the first component of a standardized, annualized principal component analysis of exposure levels to the three pollutants and estimated at the municipal level of each patient residency. This score was used as a continuous and categorical indicator (highest levels corresponding to the most exposed areas). The association between this score and all-cause mortality in dialysis patients was analyzed by multivariate Cox models considering comorbidities, modalities of dialysis start, socio-environmental factors (population density, social deprivation and distance to the nearest dialysis center), and the center effect. These analyses were declined according to the cause of death (all-cause, cardiovascular, infectious or cancer) and to different pre-dialysis exposure lags (1, 2 or 3 years). Interaction studies and subgroup analyses were performed according to age, gender and level of autonomy. Results A total of 90,373 patients were included in this study (64% men, median age 72 years) for a median follow-up of 46 months. Over the study period, 44,242 deaths were observed (20% of cardiovascular origin). The mean annual levels of each air pollutant exposure were 11.5 (± 2.5), 18.0 (± 2.5) and 16.8 (± 7.0) μg/m3 respectively for PM2.5, PM10 and NO2. For each point increment in the environmental score, we observed a linear 1.6% increase in the risk of all-cause mortality (HR = 1.016 [1.007-1.025] p &amp;lt; 0.001). Compared with the lowest exposure areas (Q1), patients residing in quartile 3 and 4 municipalities had an increased risk of all-cause death (HRQ2 = 1.00 [0.96-1.04] p = 0.99, HRQ3 = 1.06 [1.02-1.10] p = 0.005, and HRQ4 = 1.09 [1.05-1.13] p &amp;lt; 0.001 for quartiles 2, 3, and 4 of the environmental score respectively – see Figure). A significant interaction was observed with the level of autonomy of the patients, the risk of death associated with environmental exposure being higher in partially or totally dependent patients compared to fully autonomous ones (p for interaction = 0.006). These results were similar for deaths from cardiovascular or infectious causes and consistent regardless of exposure lag and each air pollutant taken individually. Conclusion In total, this is to our knowledge the first study describing an association between environmental multi-exposure and the risk of all-cause or cause-specific death in dialysis patients on a national scale. These results argue for intensified efforts to limit air pollution, particularly for the highly vulnerable dialysis patient population.

Obesity and COVID-19 mortality are correlated

In view of a conspicuous absence of any cross-country study linking obesity and COVID-19 mortality, we conduct an empirical analysis of plausible associations between COVID-19 mortality and the proportion of obese in the adult population distributed across 142 countries around the globe. We observe a statistically significant positive association between COVID-19 mortality and the proportion of obese in adult populations spanning 142 countries. This association holds across countries belonging to different income groups and is not sensitive to a population’s median age, proportion of the elderly, and/or proportion of females. The estimated elasticity of COVID-19 mortality, with respect to the proportion of obese in adult populations, is the highest for the sub-sample of countries that belong to the high-income group. While limits of confidence intervals around the point estimates of these elasticities range between 0.7 and 2.1, on an average, every percentage point increment in the proportion of obese in adult populations contributes to an additional 1.5% points to COVID-19 mortality for high income countries. A positive association, observed between COVID-19 mortality and the proportion of the obese in a country’s adult population, is robust subject to alterations in the conditioning information set on age, gender, and income.

Association of sleep patterns and cardiovascular disease risk is modified by glucose tolerance status.

To investigate whether the association between sleep patterns and cardiovascular disease (CVD) risk differs according to glucose tolerance status. This prospective study included 358,805 participants initially free of CVD from the UK Biobank. We created a sleep score based on five sleep factors (sleep duration, chronotype, insomnia, snoring, and daytime sleepiness) with one point for each unhealthy factor. Cox proportional hazards models were used to examine the association between sleep and incident CVD, including coronary heart disease (CHD) and stroke, according to normal glucose tolerance (NGT), prediabetes, and diabetes. During a median follow-up of 12.4years, 29,663 incident CVD events were documented. There was a significant interaction between sleep score and glucose tolerance status on CVD (P for interaction=0.002). Each 1 point increment in sleep score was associated with a 7% (95% confidence interval 6%-9%), 11% (8%-14%), and 13% (9%-17%) higher risk of CVD among participants with NGT, prediabetes, and diabetes, respectively. Similar interaction patterns were observed for CHD and stroke. Among the individual sleep factors, sleep duration and insomnia significantly interacted with glucose tolerance status on CVD outcomes (all P for interaction <0.05). All five unhealthy sleep factors accounted for 14.2% (8.7%-19.8%), 19.5% (7.4%-31.0%), and 25.1% (9.7%-39.3%) of incident CVD cases among participants with NGT, prediabetes, and diabetes, respectively. The CVD risk associated with a poor sleep pattern was exacerbated across glucose intolerance status. Our findings emphasise the importance of integrating sleep management into a lifestyle modification programme, particularly in people with prediabetes or diabetes.