Individuals with cancer, particularly those who are receiving systemic anticancer treatments, have been postulated to be at increased risk of mortality from COVID-19. This conjecture has considerable ...effect on the treatment of patients with cancer and data from large, multicentre studies to support this assumption are scarce because of the contingencies of the pandemic. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with cancer.
In this prospective observational study, all patients with active cancer and presenting to our network of cancer centres were eligible for enrolment into the UK Coronavirus Cancer Monitoring Project (UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near real-time reports to frontline doctors about the effects of COVID-19 on patients with cancer. Eligible patients tested positive for severe acute respiratory syndrome coronavirus 2 on RT-PCR assay from a nose or throat swab. We excluded patients with a radiological or clinical diagnosis of COVID-19, without a positive RT-PCR test. The primary endpoint was all-cause mortality, or discharge from hospital, as assessed by the reporting sites during the patient hospital admission.
From March 18, to April 26, 2020, we analysed 800 patients with a diagnosis of cancer and symptomatic COVID-19. 412 (52%) patients had a mild COVID-19 disease course. 226 (28%) patients died and risk of death was significantly associated with advancing patient age (odds ratio 9·42 95% CI 6·56–10·02; p<0·0001), being male (1·67 1·19–2·34; p=0·003), and the presence of other comorbidities such as hypertension (1·95 1·36–2·80; p<0·001) and cardiovascular disease (2·32 1·47–3·64). 281 (35%) patients had received cytotoxic chemotherapy within 4 weeks before testing positive for COVID-19. After adjusting for age, gender, and comorbidities, chemotherapy in the past 4 weeks had no significant effect on mortality from COVID-19 disease, when compared with patients with cancer who had not received recent chemotherapy (1·18 0·81–1·72; p=0·380). We found no significant effect on mortality for patients with immunotherapy, hormonal therapy, targeted therapy, radiotherapy use within the past 4 weeks.
Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender, and comorbidities. We are not able to identify evidence that cancer patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment.
University of Birmingham, University of Oxford.
•A novel approach for treating crumb rubber before incorporation into the concrete.•Thermally-treated rubber has a relatively strong bond with the concrete matrix.•The effects of heating time, rubber ...size, and rubber content have been investigated.•Significant increase in compressive and tensile strengths of crumb rubber concrete.
The concept of using crumb rubber as a partial replacement of natural aggregate in concrete to produce rubberised concrete and reduce environmental impacts has been a subject of research for many years. A plethora of studies have investigated various methods to improve the rubberised concrete strength using different pre-treatment methods for the rubber particles and/or using other additives for general concrete strength enhancement. However, the efficiency and applicability of these methods have been quite inconsistent and in some cases in conflict with each other. This study presents a novel approach to pre-treating crumb rubber particles using thermal treatment at 200 °C before incorporation into concrete. Heating time, rubber size, and rubber content were the variables in this experimental investigation. Scanning electron microscope (SEM) investigation was carried out on both as-received and thermally-treated rubber particles, as well as crumb rubber concrete (CRC) specimens. The results showed promising enhancements in concrete performance compared with the previous work findings. At 20% rubber content using size #40 mesh thermally-treated rubber, the compressive strength recovered by 60.3%.
Patient clinical factors and social determinants of health (SDOH) are associated with an increased risk of stroke for patients with atrial fibrillation (AF); however, the association between these ...factors and the management of AF is not well characterized, particularly among those factors commonly collected in electronic health records (EHRs). This study used EHR data to evaluate the associations between patient clinical factors and SDOH and prescribing of an oral anticoagulant (OAC) for stroke prevention in AF.
This analysis included adult patients with newly diagnosed AF who had ≥2 encounters in the Advocate Aurora Health system in Wisconsin between May 2016 and May 2021. Patient-level demographics, comorbidities, medications, and SDOH were retrospectively extracted from EHRs. Area deprivation index (ADI) was linked to patient records as a measure of socioeconomic status.
Of 16,656 patients with AF, 10,898 (65.4%) were prescribed an OAC within the first year of diagnosis. Patients were less likely to be prescribed an OAC (relative risk 95% CI) if they were widowed (0.98 0.96-0.99 vs single) or had a history of alcoholism (0.86 0.79-0.95 vs no history). Most patients (53.3%) received prescriptions from a primary care provider. A linear relationship was found between worsening ADI and increased prescriptions for warfarin vs those for direct-acting OACs.
Although guideline-concordant anticoagulant use remained suboptimal, clinical characteristics were strongly associated for whether a patient with AF would be prescribed an OAC. Disparities in patient care regarding the prescribing of OACs due to SDOH and associated behaviors were small but present, particularly for national ADI.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Eight small-scale composite slab specimens were tested in push-off and pull-out setups.•Crumb rubber concrete and conventional concrete were compared as concrete topping.•The bond strength primarily ...distributed on profiled steel ribs.•CRC showed slightly better bond-slip behaviour compared to that of CC.•Push setup provided more realistic bond-slip relationship.
Longitudinal shear bond governs the load carrying capacity and performance of profiled steel reinforced composite slabs. Despite testing the load carrying capacity of composite slabs in large-scale size, many researchers have attempted to investigate the shear bond characteristics of composite slabs in small-scale experiments with direct shear load due to its cost effectiveness. With partial replacement of fine aggregate by crumb rubber in conventional concrete (CC), crumb rubber concrete (CRC) has the excellent feature of ductility, which increases the compatibility of deformation with the profiled steel deck and hence is expected to improve bond performance. In this paper, the direct shear test was implemented on small-scale composite specimens using both horizontal push-off and pull-out loads to investigate the bond characteristics between 0.75 mm-thick re-entrant profiled steel deck (Bondek) and CRC/CC with targeted compressive strength of 25 MPa. The push-off specimens were tested with and without clamping force, while pull-out specimens were tested against different sides of the deck embossment. The overall performances of CRC specimens in the elemental tests were very close to CC specimens, with only 5% difference in the ultimate bond strength. CRC material showed reduced vertical separation from the steel deck, which mitigated the longitudinal slippage between the concrete-steel interfaces. Compared to the push-off setup, the pull-out test setup showed overestimation of the bond stress which was explained from FEM model that the higher deformation in ribs and soffit of steel deck was produced. Hence, the pull-out setup is not recommended for determining bond characteristic for future study.
There is a lot of ongoing active research all over the world looking for various applications of used tyre rubber, to increase its utilisation rate. One of the common research applications is to ...incorporate rubber into concrete as a partial replacement for conventional aggregates. However, due to its poor bonding performance with cement paste, the utilisation of rubber in concrete has been hindered to date. A cost-effective and time-saving rubber pre-treatment method is of great interest, especially for the concrete industry. Out of all the various pre-treatment methods, soaking rubber particles in water is the most cost-effective and least complex method. In addition, sodium sulphate accelerates the hydration reaction of the cement composites. This study looks at the effect of soaking crumb rubber in tap water for short (2 h) and long (24 h) durations, and the optimised duration was then compared with soaking the crumb rubber in a 5% concentration of sodium sulphate solution. Compressive strength, bond behaviour, and rubber/cement interfacial transition zone (ITZ) were investigated using X-ray diffraction (XRD) and scanning electron microscopy (SEM) analysis. The results demonstrate that a soaking duration of 2 h provides much better performance in both the strength and bond properties compared to 24-h soaking. A further improvement in the 7-day strength was achieved with the rubber soaked in 5% sodium sulphate solution for 2 h, providing a more practical and economical rubber pre-treatment method for concrete industry use.
Stunting among children in low-resource settings is associated with enteric pathogen carriage and micronutrient deficiencies. Our goal was to test whether administration of scheduled antimicrobials ...and daily nicotinamide improved linear growth in a region with a high prevalence of stunting and enteric pathogen carriage.
We performed a randomized, 2 × 2 factorial, double-blind, placebo-controlled trial in the area around Haydom, Tanzania. Mother-child dyads were enrolled by age 14 days and followed with monthly home visits and every 3-month anthropometry assessments through 18 months. Those randomized to the antimicrobial arm received 2 medications (versus corresponding placebos): azithromycin (single dose of 20 mg/kg) at months 6, 9, 12, and 15 and nitazoxanide (3-day course of 100 mg twice daily) at months 12 and 15. Those randomized to nicotinamide arm received daily nicotinamide to the mother (250 mg pills months 0 to 6) and to the child (100 mg sachets months 6 to 18). Primary outcome was length-for-age z-score (LAZ) at 18 months in the modified intention-to-treat group. Between September 5, 2017 and August 31, 2018, 1,188 children were randomized, of whom 1,084 (n = 277 placebo/placebo, 273 antimicrobial/placebo, 274 placebo/nicotinamide, and 260 antimicrobial/nicotinamide) were included in the modified intention-to-treat analysis. The study was suspended for a 3-month period by the Tanzanian National Institute for Medical Research (NIMR) because of concerns related to the timing of laboratory testing and the total number of serious adverse events (SAEs); this resulted in some participants receiving their final study assessment late. There was a high prevalence of stunting overall (533/1,084, 49.2%). Mean 18-month LAZ did not differ between groups for either intervention (mean LAZ with 95% confidence interval CI: antimicrobial: -2.05 CI -2.13, -1.96, placebo: -2.05 CI -2.14, -1.97; mean difference: 0.01 CI -0.13, 0.11, p = 0.91; nicotinamide: -2.06 CI -2.13, -1.95, placebo: -2.04 CI -2.14, -1.98, mean difference 0.03 CI -0.15, 0.09, p = 0.66). There was no difference in LAZ for either intervention after adjusting for possible confounders (baseline LAZ, age in days at 18-month measurement, ward, hospital birth, birth month, years of maternal education, socioeconomic status (SES) quartile category, sex, whether the mother was a member of the Datoga tribe, and mother's height). Adverse events (AEs) and SAEs were overall similar between treatment groups for both the nicotinamide and antimicrobial interventions. Key limitations include the absence of laboratory measures of pathogen carriage and nicotinamide metabolism to provide context for the negative findings.
In this study, we observed that neither scheduled administration of azithromycin and nitazoxanide nor daily provision of nicotinamide was associated with improved growth in this resource-poor setting with a high force of enteric infections. Further research remains critical to identify interventions toward improved early childhood growth in challenging conditions.
ClinicalTrials.gov NCT03268902.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
The contamination of water catchments by nonpoint source faecal pollution is a major issue affecting the microbial quality of receiving waters and is associated with the occurrence of a ...range of enteric illnesses in humans. The potential sources of faecal pollution in surface waters are diverse, including urban sewage leaks, surface runoff and wildlife contamination originating from a range of hosts. The major contributing hosts require identification to allow targeted management of this public health concern. In this study, two high-performing Microbial Source Tracking (MST) assays, HF183/Bac242 and BacCan-UCDmodif, were used for their ability to detect host-specific Bacteroides 16Sr RNA markers for faecal pollution in a 12-month study on an urban coastal lagoon in Sydney, Australia. The lagoon was found to contain year-round high numbers of human and canine faecal markers, as well as faecal indicator bacteria counts, suggesting considerable human and animal faecal pollution. The high sensitivity and specificity of the HF183/Bac242 and BacCan-UCDmodif assays, together with the manageable levels of PCR inhibition and high level DNA extraction efficiency obtained from lagoon water samples make these markers candidates for inclusion in an MST ‘toolbox’ for investigating host origins of faecal pollution in urban surface waters.
Osteomyelitis and infections associated with orthopedic implants represent a significant burden of disease worldwide. Ceragenins (CSAs) are a relatively new class of small‐molecule antimicrobials ...that target a broad range of Gram‐positive and Gram‐negative bacteria as well as fungi, viruses, and parasites. This review sets the context of the need for new antimicrobial strategies by cataloging the common pathogens associated with orthopedic infection and highlighting the increasing challenges of managing antibiotic‐resistant bacterial strains. It then comparatively describes the antimicrobial properties of CSAs with a focus on the CSA‐13 family. More recently developed members of this family such as CSA‐90 and CSA‐131 may have a particular advantage in an orthopedic setting as they possess secondary pro‐osteogenic properties. In this context, we consider several new preclinical studies that demonstrate the utility of CSAs in orthopedic models. Emerging evidence suggests that CSAs are effective against antibiotic‐resistant Staphylococcus aureus strains and can prevent the formation of biofilms. There remains considerable scope for developing CSA‐based treatments, either as coatings for orthopedic implants or as local or systemic antibiotics to prevent bone infection.
The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the emergence of new variant lineages that have exacerbated the COVID-19 pandemic. Some of those variants ...were designated as variants of concern/interest (VOC/VOI) by national or international authorities based on many factors including their potential impact on vaccine-mediated protection from disease. To ascertain and rank the risk of VOCs and VOIs, we analyze the ability of 14 variants (614G, Alpha, Beta, Gamma, Delta, Epsilon, Zeta, Eta, Theta, Iota, Kappa, Lambda, Mu, and Omicron) to escape from mRNA vaccine-induced antibodies. The variants show differential reductions in neutralization and replication by post-vaccination sera. Although the Omicron variant (BA.1, BA.1.1, and BA.2) shows the most escape from neutralization, sera collected after a third dose of vaccine (booster sera) retain moderate neutralizing activity against that variant. Therefore, vaccination remains an effective strategy during the COVID-19 pandemic.
PDF
