Anoxic and iron-rich (ferruginous) conditions prevailed in the ocean under the low-oxygen atmosphere that occurred through most of the Archean Eon. While euxinic conditions (i.e. anoxic and hydrogen ...sulfide-rich waters) became more common in the Proterozoic, ferruginous conditions persisted in deep waters. Ferruginous ocean regions would have been a major biosphere and Earth surface reservoir through which elements passed through as part of their global biogeochemical cycles. Understanding key biological events, such as the rise of oxygen in the atmosphere, or even the transitions from ferruginous to euxinic or oxic conditions, requires understanding the biogeochemical processes occurring within ferruginous oceans, and their indicators in the rock record. Important analogs for transitions between ferruginous and oxic or euxinic conditions are paleoferruginous lakes; their sediments commonly host siderite and Ca-carbonates, which are important Precambrian records of the carbon cycling. Lakes that were ferruginous in the past, or euxinic lakes with cryptic iron cycling may also help understand transitions between ferruginous and euxinic conditions in shallow and mid-depth oceanic waters during the Proterozoic. Modern ferruginous meromictic lakes, which host diverse anaerobic microbial communities, are increasingly utilized as biogeochemical analogues for ancient ferruginous oceans. Such lakes are believed to be rare, but regional and geological factors indicate they may be more common than previously thought. While physical mixing processes in lakes and oceans are notably different, many chemical and biological processes are similar. The diversity of sizes, stratifications, and water chemistries in ferruginous lakes thus can be leveraged to explore biogeochemical controls in a range of marine systems: near-shore, off-shore, silled basins, or those dominated by terrestrial or hydrothermal element sources. Ferruginous systems, both extant and extinct, lacustrine and marine, host a continuum of biogeochemical processes that highlight the important role of iron in the evolution of Earth’s surface environment.
•Precambrian marine sediments indicate frequent ferruginous conditions with euxinic intervals.•Siderite from ferruginous lakes informs formation pathways in ferruginous oceans.•Ferruginous meromictic lakes are an expected feature of postglacial landscapes.•Ferruginous lakes can be biogeochemical analogues of ferruginous oceans.
ObjectivesTo estimate the cost-effectiveness of methenamine hippurate compared with antibiotic prophylaxis in the management of recurrent urinary tract infections.DesignMulticentre, open-label, ...randomised, non-inferiority trial.SettingEight centres in the UK, recruiting from June 2016 to June 2018.ParticipantsWomen aged ≥18 years with recurrent urinary tract infections, requiring prophylactic treatment.InterventionsWomen were randomised to receive once-daily antibiotic prophylaxis or twice-daily methenamine hippurate for 12 months. Treatment allocation was not masked and crossover between arms was allowed.Primary and secondary outcome measuresThe primary economic outcome was the incremental cost per quality-adjusted life year (QALY) gained at 18 months. All costs were collected from a UK National Health Service perspective. QALYs were estimated based on responses to the EQ-5D-5L administered at baseline, 3, 6, 9, 12 and 18 months. Incremental costs and QALYs were estimated using an adjusted analysis which controlled for observed and unobserved characteristics. Stochastic sensitivity analysis was used to illustrate uncertainty on a cost-effectiveness plane and a cost-effectiveness acceptability curve. A sensitivity analysis, not specified in the protocol, considered the costs associated with antibiotic resistance.ResultsData on 205 participants were included in the economic analysis. On average, methenamine hippurate was less costly (−£40; 95% CI: −684 to 603) and more effective (0.014 QALYs; 95% CI: −0.05 to 0.07) than antibiotic prophylaxis. Over the range of values considered for an additional QALY, the probability of methenamine hippurate being considered cost-effective ranged from 51% to 67%.ConclusionsOn average, methenamine hippurate was less costly and more effective than antibiotic prophylaxis but these results are subject to uncertainty. Methenamine hippurate is more likely to be considered cost-effective when the benefits of reduced antibiotic use were included in the analysis.Trial registration number ISRCTN70219762.
Glacitectonic deformation in the Upper Weichselian led to the tectonic framework of large-scale folds and displaced thrust sheets of Maastrichtian (Upper Cretaceous) chalk and Pleistocene glacial ...deposits in the southwestern Baltic Sea region. They form surface expressions of sub-parallel ridges and elongated valleys in between and on the Jasmund Peninsula. Geomorphological mapping and detailed landform analyses give another insight into the arrangement and the formation history of these proglacial surface structures. Light detection and ranging (LiDAR) digital elevation models (DEM) analysis techniques were applied to a proglacial rather than a subglacial environment. Results suggest a division into a northern part with morphological ridges striking NW–SE and a southern part with SW–NE trending ridges. The observation of partly truncated northerly ridges and their superimposition by the southern sub-complex suggest that the northern part was generated earlier than the southern part. The applied spatial analyses tools were used to develop a new, self-consistent genetic model integrating all parts of the 100 km2 large Jasmund Glacitectonic Complex. Results suggest a more consistent terminology for the tectonic setting and a revised genetic model for Jasmund, including three evolutional stages that are characterized by different ice flow patterns.
Sudden death syndrome (SDS) is one of the major yield-limiting soybean diseases in the Midwestern United States. Effective management for SDS requires accurate detection in soybean fields. Since ...traditional scouting methods are time-consuming, labor-intensive, and often destructive, alternative methods to monitor SDS in large soybean fields are needed. This study explores the potential of using high-resolution (3 m) PlanetScope satellite imagery for detection of SDS using the random forest classification algorithm. Image data from blue, green, red, and near-infrared (NIR) spectral bands, the calculated normalized difference vegetation index (NDVI), and crop rotation information were used to detect healthy and SDS-infected quadrats in a soybean field experiment with different rotation treatments, located in Boone County, Iowa. Datasets collected during the 2016, 2017, and 2018 soybean growing seasons were analyzed. The results indicate that spectral features, when combined with ground-based information, can detect areas in soybean plots that are at risk for disease, even before foliar symptoms develop. The classification of healthy and diseased soybean quadrats was >75% accurate and the area under the receiver operating characteristic curve (AUROC) was >70%. Our results indicate that high-resolution satellite imagery and random forest analyses have the potential to detect SDS in soybean fields, and that this approach may facilitate large-scale monitoring of SDS (and possibly other economically important soybean diseases). It may also be useful for guiding recommendations for site-specific management in current and future seasons.
Aims
To gauge the current level of diagnostic utility of uroflowmetry and to suggest areas needing research to improve this.
Methods
A summary of the debate held at the 2017 meeting of the ...International Consultation on Incontinence Research Society, with subsequent analysis by the authors.
Results
Limited diagnostic sensitivity and specificity exist for maximum flow rates, multiple uroflow measurements, and flow‐volume nomograms. There is a lack of clarity in flow rate curve shape description and uroflow time measurement.
Conclusions
There is a need for research to combine uroflowmetry with other non‐invasive indicators. Better standardizations of test technique, flow‐volume nomograms, uroflow shape descriptions, and time measurements are required.
Control and tunability of the catalytic oxidation of CO by gold clusters deposited on MgO surfaces grown on molybdenum, Mo(100), to various thicknesses are explored through temperature-programmed ...reaction measurements on mass-selected 20-atom gold clusters and via first-principles density functional theory calculations. Au20 was chosen because in the gas phase it is characterized as an extraordinarily stable tetrahedral-pyramidal structure. Dependencies of the catalytic activities and microscopic reaction mechanisms on the thickness and stoichiometry of the MgO films and on the dimensionalities and structures of the adsorbed gold clusters are demonstrated and elucidated. Langmuir−Hinshelwood mechanisms and reaction barriers corresponding to observed low- and high-temperature CO oxidation reactions are calculated and analyzed. These reactions involve adsorbed O2 molecules that are activated to a superoxo- or peroxo-like state through partial occupation of the antibonding orbitals. In some cases, we find activated, dissociative adsorption of O2 molecules, adsorbing at the cluster peripheral interface with the MgO surface. The reactant CO molecules either adsorb on the MgO surface in the cluster proximity or bind directly to the gold cluster. Along with the oxidation reactions on stoichiometric ultrathin MgO films, we also study reactions catalyzed by Au20 nanoclusters adsorbed on relatively thick defect-poor MgO films supported on Mo and on defect-rich thick MgO surfaces containing oxygen vacancy defects.
TouchTerrain is a simple-to-use web application that makes creating 3D printable terrain models from anywhere on the globe accessible to a wide range of users, from people with no GIS expertise to ...power users. For coders, a Python-based standalone version is available from the open-source project’s GitHub repository. Analyzing 18 months of web analytics gave us a preliminary look at who is using the TouchTerrain web application and what their models are used for; and to map out what terrains on the globe they chose to 3D print. From July 2019 to January 2021, more than 20,000 terrain models were downloaded. Models were created for many different use cases, including education, research, outdoor activities and crafting mementos. Most models were realized with 3D printers, but a sizable minority used CNC machines. Our own experiences with using 3D printed terrain in a university setting have been very positive so far. Anecdotal evidence points to the strong potential for 3D printed terrain models to provide significant help with specific map-related tasks. For the introductory geology laboratory, 3D printed models were used as a form of “training wheels” to aid beginning students in learning to read contour maps, which are still an important tool for geology.
Intermittent urethral self-dilatation is sometimes recommended to reduce the risk of recurrent urethral stricture. There is no consensus as to whether it is a clinically effective or cost-effective ...intervention in the management of this disease.
The purpose of this review is to evaluate the clinical effectiveness and cost-effectiveness of intermittent self-dilatation after urethral stricture surgery in males compared to no intervention. We also compared different programmes of, and devices for, intermittent self-dilatation. .
We searched the Cochrane Incontinence Group Specialised Register (searched 7 May 2014), CENTRAL (2014, Issue 4), MEDLINE (1 January 1946 to Week 3 April 2014), PREMEDLINE (covering 29 April 2014), EMBASE (1 January 1947 to Week 17 2014), CINAHL (31 December 1981 to 30 April 2014) OpenGrey (searched 6 May 2014), ClinicalTrials.gov (6 May 2014), WHO International Clinical Trials Registry Platform (6 May 2014), Current Controlled Trials (6 May 2014) and the reference lists of relevant articles.
Randomised and quasi-randomised trials where one arm was a programme of intermittent self-dilatation for urethral stricture were identified. Studies were excluded if they were not randomised or quasi-randomised trials, or if they pertained to clean intermittent self-catheterisation for bladder emptying.
Two authors screened the records for relevance and methodological quality. Data extraction was performed according to predetermined criteria using data extraction forms. Analyses were carried out in Cochrane Review Manager (RevMan 5). The primary outcomes were patient-reported symptoms and health-related quality of life, and risk of recurrence; secondary outcomes were adverse events, acceptability of the intervention to patients and cost-effectiveness. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Eleven trials were selected for inclusion in the review, including a total of 776 men. They were generally small; all were of poor quality and all were deemed to have high risk of bias. Performing intermittent self-dilatation versus not performing intermittent self-dilatation The data from six trials were heterogeneous, imprecise and had a high risk of bias, but indicated that recurrent urethral stricture was less likely in men who performed intermittent self-dilatation than men who did not perform intermittent self-dilatation (RR 0.70, 95% CI 0.48 to 1.00; very low quality evidence). Adverse events were generally poorly reported: two trials did not report adverse events and two trials reported adverse events only for the intervention group. Meta-analysis of the remaining two trials found no evidence of a difference between performing intermittent self-dilatation and not performing it (RR 0.60, 95% CI 0.11 to 3.26). No trials formally assessed acceptability, and no trials reported on patient-reported lower urinary tract symptoms, patient-reported health-related quality of life, or cost-effectiveness. One programme of intermittent self-dilatation versus another We identified two trials that compared different durations of intermittent self-dilatation, but data were not combined. One study could not draw robust conclusions owing to cross-over, protocol deviation, administrative error, post-hoc analysis and incomplete outcome reporting. The other study found no evidence of a difference between intermittent self-dilatation for six months versus for 12 months after optical urethrotomy (RR 0.67, 95% CI 0.12 to 3.64), although again the evidence is limited by the small sample size and risk of bias in the included study. Adverse events were reported narratively and were not stratified by group. No trials formally assessed acceptability, and no trials reported on patient-reported lower urinary tract symptoms, patient-reported health-related quality of life, or cost-effectiveness. One device for performing intermittent self-dilatation versus another Three trials compared one device for performing intermittent self-dilatation with another. Results from one trial at a high risk of bias were too uncertain to determine the effects of a low friction hydrophilic catheter and a standard polyvinyl chloride catheter on the risk of recurrent urethral stricture (RR 0.32, 95% CI 0.07 to 1.40). Similarly one study did not find evidence of a difference between one percent triamcinolone gel for lubricating the intermittent self-dilatation catheter versus water-based gel on risk of recurrent urethral stricture (RR 0.68, 95% CI 0.35 to 1.32). Two trials reported adverse events, but one did not provide sufficient detail for analysis. The other small study reported fewer instances of prostatitis, urethral bleeding or bacteriuria with a low friction hydrophilic catheter compared with a standard polyvinyl chloride catheter (RR 0.13, 95% CI 0.02 to 0.98). 'Happiness with the intervention' was assessed using a non-validated scale in one study, but no trials formally assessed patient-reported health-related quality of life or acceptability. No trials reported on patient-reported lower urinary tract symptoms or cost-effectiveness. GRADE quality assessment The evidence that intermittent self-dilatation reduces the risk of recurrent urethral stricture after surgical intervention was downgraded to 'very low' on the basis that the studies comprising the meta-analysis were deemed to have high risk of bias, and the data was imprecise and inconsistent. Insufficient evidence No trials provided cost-effectiveness data or used a validated patient-reported outcome measure, and adverse events were not reported rigorously. Acceptability of the intervention to patients has not been assessed quantitatively or qualitatively.
Performing intermittent self-dilatation may confer a reduced risk of recurrent urethral stricture after endoscopic treatment. We have very little confidence in the estimate of the effect owing to the very low quality of the evidence. Evidence for other comparisons and outcomes is limited. Further research is required to determine whether the apparent benefit is sufficient to make the intervention worthwhile, and in whom.
Stress urinary incontinence is common in men after prostate surgery and can be difficult to improve. Implantation of an artificial urinary sphincter is the most common surgical procedure for ...persistent stress urinary incontinence, but it requires specialist surgical skills, and revisions may be necessary. In addition, the sphincter is relatively expensive and its operation requires adequate patient dexterity. New surgical approaches include the male synthetic sling, which is emerging as a possible alternative. However, robust comparable data, derived from randomised controlled trials, on the relative safety and efficacy of the male synthetic sling and the artificial urinary sphincter are lacking.
We aimed to compare the clinical effectiveness and cost-effectiveness of the male synthetic sling with those of the artificial urinary sphincter surgery in men with persistent stress urinary incontinence after prostate surgery.
This was a multicentre, non-inferiority randomised controlled trial, with a parallel non-randomised cohort and embedded qualitative component. Randomised controlled trial allocation was carried out by remote web-based randomisation (1 : 1), minimised on previous prostate surgery (radical prostatectomy or transurethral resection of the prostate), radiotherapy (or not, in relation to prostate surgery) and centre. Surgeons and participants were not blind to the treatment received. Non-randomised cohort allocation was participant and/or surgeon preference.
The trial was set in 28 UK urological centres in the NHS.
Participants were men with urodynamic stress incontinence after prostate surgery for whom surgery was deemed appropriate. Exclusion criteria included previous sling or artificial urinary sphincter surgery, unresolved bladder neck contracture or urethral stricture after prostate surgery, and an inability to give informed consent or complete trial documentation.
We compared male synthetic sling with artificial urinary sphincter.
The clinical primary outcome measure was men's reports of continence (assessed from questions 3 and 4 of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form) at 12 months post randomisation (with a non-inferiority margin of 15%). The primary economic outcome was cost-effectiveness (assessed as the incremental cost per quality-adjusted life-year at 24 months post randomisation).
In total, 380 men were included in the randomised controlled trial (
= 190 in each group), and 99 out of 100 men were included in the non-randomised cohort. In terms of continence, the male sling was non-inferior to the artificial urinary sphincter (intention-to-treat estimated absolute risk difference -0.034, 95% confidence interval -0.117 to 0.048; non-inferiority
= 0.003), indicating a lower success rate in those randomised to receive a sling, but with a confidence interval excluding the non-inferiority margin of -15%. In both groups, treatment resulted in a reduction in incontinence symptoms (as measured by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form). Between baseline and 12 months' follow-up, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score fell from 16.1 to 8.7 in the male sling group and from 16.4 to 7.5 in the artificial urinary sphincter group (mean difference for the time point at 12 months 1.30, 95% confidence interval 0.11 to 2.49;
= 0.032). The number of serious adverse events was small (male sling group,
= 8; artificial urinary sphincter group,
= 15; one man in the artificial urinary sphincter group experienced three serious adverse events). Quality-of-life scores improved and satisfaction was high in both groups. Secondary outcomes that showed statistically significant differences favoured the artificial urinary sphincter over the male sling. Outcomes of the non-randomised cohort were similar. The male sling cost less than the artificial sphincter but was associated with a smaller quality-adjusted life-year gain. The incremental cost-effectiveness ratio for male slings compared with an artificial urinary sphincter suggests that there is a cost saving of £425,870 for each quality-adjusted life-year lost. The probability that slings would be cost-effective at a £30,000 willingness-to-pay threshold for a quality-adjusted life-year was 99%.
Follow-up beyond 24 months is not available. More specific surgical/device-related pain outcomes were not included.
Continence rates improved from baseline, with the male sling non-inferior to the artificial urinary sphincter. Symptoms and quality of life significantly improved in both groups. Men were generally satisfied with both procedures. Overall, secondary and post hoc analyses favoured the artificial urinary sphincter over the male sling.
Participant reports of any further surgery, satisfaction and quality of life at 5-year follow-up will inform longer-term outcomes. Administration of an additional pain questionnaire would provide further information on pain levels after both surgeries.
This trial is registered as ISRCTN49212975.
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in
; Vol. 26, No. 36. See the NIHR Journals Library website for further project information.
To use existing clinical trial data to assess the impact of prophylactic antibiotics on the 1-year UTI rate among people with different neurologic diseases, and to determine if UTIs impact renal ...function.
We conducted a secondary analysis of community dwelling participants with a neurologic disease and intermittent catheter use who participated in a 12-month randomized trial (AnTIC) of low dose antibiotic prophylaxis. We calculated incident rate ratios (IRR) of symptomatic UTIs that required antibiotics. Renal function was assessed using the estimated glomerular filtration rate.
We identified 138 patients who had a neurologic disease (multiple sclerosis (25%), spinal cord injury (21%), spina bifida (18%), and other disorders (36%)). The incidence of symptomatic, antibiotic treated urinary infections was 1.48 per person–year in the prophylaxis group, and 2.51 per person–year in the usual care group; the IRR was 0.59 (95% CI 0.46, 0.76) in favor of continuous antibiotic prophylaxis. The IRR was lowest (most protective) among those with spinal cord injury (IRR 0.23, p < 0.01) and highest (least protective) in those with spina bifida (IRR 0.85, p = 0.57). There were small, non-significant decreases in renal function that did not differ by randomization. There were no significant differences in pre- and post-study renal function based on the number of UTIs participants experienced.
Continuous antibiotic prophylaxis may be more effective for certain patient populations with neurologic lower urinary tract dysfunction. Renal function is not significantly impacted by a higher number of UTIs over the course of one year.
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