Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

Daylight during winters and symptoms of depression and sleep problems: A within-individual analysis

BACKGROUND

With climate change Northern areas of the globe are expected to have less daylight during winters due to less snow and more cloudiness. While wintertime has been linked to mental health problems, the role of wintertime daylight has been scarcely studied. We examined longitudinal associations for wintertime objective exposure to global radiation and self-reported daylight exposure with symptoms of depression and sleep problems.

METHODS

Our analytical sample included 15,619 respondents from three Swedish Longitudinal Occupational Surveys of Health (2012, 2014 and 2016). Objective exposure was global radiation (MJ/m2, November-January and November-February). Subjective exposure was based on self-reported time spent outdoors in daylight (<1 h vs. ≥ 1 h, November-January). Symptoms of depression were evaluated using a six-item subscale of the (Hopkins) Symptom Checklist. Fixed-effects method with conditional logistic regression controlled for time-invariant participant characteristics by design and time-varying covariates were added into models.

RESULTS

One unit increase in the four-month averaged global radiation was associated with lower odds of depressive symptoms (OR 0.69, 95 % CI 0.52-0.91). These findings were confirmed using four-month cumulative exposure (OR 0.91, 95 % CI 0.85-0.98). Individuals reporting ≥ 1 h exposure to daylight during winter months were less likely to report depressive symptoms (OR 0.72, 95 % CI 0.60-0.82) compared to time when their exposure was < 1 h. Higher three-month exposure to global radiation suggested a protective association for sleep problems.

CONCLUSION

These findings suggest that higher exposure to daylight during winters may contribute to lower likelihood of depression symptoms.

Regional differences in annual prevalence of sustainable working life in Swedish twin cohort

The global rise in life expectancy transforms age structure consequently having impact to the sustainability of social protection systems and working life. This descriptive study aimed to illustrate the annual prevalence of sustainable working life across Swedish residential regions, and investigate differences between age groups, sex, or being identical or fraternal twin. The study sample included 81,231 twins with linkage to national register data on sickness absence, disability pension, unemployment, and residential regions. Regions were classified by Swedish municipalities into nine groups. Sustainable working life were then followed in 1998, 2003, 2008, and 2013. Annual prevalence and Generalized Estimating Equation (GEE) with log linear models for interaction test were used. Medium to large size municipalities (15-24%) had higher annual prevalence of sustainable working life than smaller municipalities (1-7%). Young adults in medium to large size municipalities had high annual prevalence of sustainable working life. We found no differences for sexes or being identical or fraternal twin. To conclude, annual prevalence of sustainable working life in 1998, 2003, 2008 and 2013 differed by region being highest in medium to large size municipalities which may have importance for targeting policies, regulations, and practices in a region-specific way. Further studies on residential regions and sustainable working life would be merited to confirm associations and other influential factors.

Family-Related Life Events as Predictors of Labor Market Marginalization Trajectories: A Cohort Study of Swedish Twins

OBJECTIVES

The aims of the study are to investigate trajectories of labor market marginalization (LMM) and to examine the associations between family-related life events and LMM trajectories while accounting for familial factors.

METHODS

This is a prospective cohort study of 37,867 Swedish twins. Data were analyzed by group-based trajectory modeling. Associations of family-related life events with trajectory groups were estimated by multinomial logistic regression.

RESULTS

Most participants had no or low levels of LMM. Individuals who stayed married over time or changed from single without children to married with children had a decreased risk of LMM. The risk of LMM over time was higher among individuals who changed from married to being single.

CONCLUSIONS

Being or getting married as well as having children decreases the risk of LMM while divorce is a risk factor for LMM.

Assessment of proline function in higher plants under extreme temperatures

Climate change and abiotic stress factors are key players in crop losses worldwide. Among which, extreme temperatures (heat and cold) disturb plant growth and development, reduce productivity and, in severe cases, lead to plant death. Plants have developed numerous strategies to mitigate the detrimental impact of temperature stress. Exposure to stress leads to the accumulation of various metabolites, e.g. sugars, sugar alcohols, organic acids and amino acids. Plants accumulate the amino acid 'proline' in response to several abiotic stresses, including temperature stress. Proline abundance may result from de novo synthesis, hydrolysis of proteins, reduced utilization or degradation. Proline also leads to stress tolerance by maintaining the osmotic balance (still controversial), cell turgidity and indirectly modulating metabolism of reactive oxygen species. Furthermore, the crosstalk of proline with other osmoprotectants and signalling molecules, e.g. glycine betaine, abscisic acid, nitric oxide, hydrogen sulfide, soluble sugars, helps to strengthen protective mechanisms in stressful environments. Development of less temperature-responsive cultivars can be achieved by manipulating the biosynthesis of proline through genetic engineering. This review presents an overview of plant responses to extreme temperatures and an outline of proline metabolism under such temperatures. The exogenous application of proline as a protective molecule under extreme temperatures is also presented. Proline crosstalk and interaction with other molecules is also discussed. Finally, the potential of genetic engineering of proline-related genes is explained to develop 'temperature-smart' plants. In short, exogenous application of proline and genetic engineering of proline genes promise ways forward for developing 'temperature-smart' future crop plants.

Access to Alcohol Outlets From Home and Work in Sweden: Longitudinal Associations With Problem Drinking

OBJECTIVE

The association of proximity of alcohol outlets to the workplace with problem drinking has not been previously studied. We examined longitudinal associations of living and working in proximity to alcohol outlets with problem drinking.

METHOD

The data consisted of 13,306 employed respondents to the Swedish Longitudinal Occupational Survey of Health between 2012 and 2018. Road distances from the respondents' home and workplace to the nearest liquor outlet, beer outlet, and bar were calculated by Statistics Sweden. We used distance variables both as categorized, to indicate changes in distance, and as continuous variables. Self-reported problem drinking was assessed using modified Cut-Annoyed-Guilty-Eye (CAGE) questions. Binomial logistic regression with generalized estimating equation was used to examine the associations.

RESULTS

A decrease (vs. remained unchanged) in the distance from home to a liquor outlet was associated with a higher likelihood of problem drinking (odds ratio = 1.21, 95% confidence interval [1.02, 1.45]). A protective association for problem drinking was observed when the distance from home to a beer outlet increased (vs. remained unchanged) (0.65 [0.44, 0.95]). A decrease (vs. remained unchanged) in the distance from work to a bar was also associated with a higher likelihood of problem drinking (1.37 [1.00, 1.88]). The likelihood of problem drinking was increased also per 1-km decrease in distance from home to liquor outlets (1.01 [1.00, 1.02]), risk estimates being higher for women than for men.

CONCLUSIONS

Alcohol outlet proximity to the workplace could be an additional determinant of harmful alcohol consumption behavior. Reducing the number of on- and off-premise alcohol outlets could reduce the level of harmful alcohol consumption.

Trajectories of sustainable working life in nine Swedish residential regions: A longitudinal twin cohort study

OBJECTIVE

To investigate trajectories of sustainable working life (SWL, ie, no interruptions or transitions in working life due to sickness absence (SA), disability pension (DP), or unemployment) in Swedish residential regions using a population-based twin cohort, while assessing sociodemographics and twin pair similarity.

METHODS

Sample of 60 998 twins born in 1925-1958. SWL was assessed through main labor market status in each year in 1998-2016 based on > 180 days with SA/DP, > 180 days with unemployment, or >half of yearly income from old-age pension for not in SWL, and employment (in paid work and did not fulfill the criteria SA/DP, unemployment, or old-age pension) for SWL. Residential regions were classified into nine groups based on Swedish municipalities. Group-based trajectory models and multinomial logistic regression were applied separately for all regions.

RESULTS

In all regions, the largest trajectory group was sustainable working life. Three to four trajectory groups developed toward unsustainable working life with different exit points from sustainable working life. A small proportion were grouped with partial stable or increase in sustainable working life. Increased age, being a woman, <12 years of education, and history of unstable working life increased, and being married and twin pair similarity decreased the likelihood of belonging to trajectories toward unsustainable working life.

CONCLUSIONS

In all regions, most of the individuals followed a sustainable working life trajectory. A reasonable proportion of individuals followed trajectories developing toward unsustainable working life. The influence of sociodemographic and familial factors on trajectory groups was similar in all regions.

Growth, physiological, biochemical and molecular changes in plants induced by magnetic fields: A review

The Earth's geomagnetic field (GMF) is an inescapable environmental factor for plants that affects all growth and yield parameters. Both strong and weak magnetic fields (MF), as compared to the GMF, have specific roles in plant growth and development. MF technology is an eco-friendly technique that does not emit waste or generate harmful radiation, nor require any external power supply, so it can be used in sustainable modern agriculture. Thus, exposure of plants to MF is a potential affordable, reusable and safe practice for enhancing crop productivity by changing physiological and biochemical processes. However, the effect of MF on plant physiological and biochemical processes is not yet well understood. This review describes the effects of altering MF conditions (higher or lower values than the GMF) on physiological and biochemical processes of plants. The current contradictory and inconsistent outcomes from studies on varying effects of MF on plants could be related to species and/or MF exposure time and intensity. The reviewed literature suggests MF have a role in changing physiological processes, such as respiration, photosynthesis, nutrient uptake, water relations and biochemical attributes, including genes involved in ROS, antioxidants, enzymes, proteins and secondary metabolites. MF application might efficiently increase growth and yield of many crops, and as such, should be the focus for future research.

Distance to sports facilities and low frequency of exercise and obesity: a cross-sectional study

Background

Little research has investigated the associations between proximity to physical activity facilities and behavior-related health and the majority have focused on proximity from home address. We add to the literature by examining proximity of these facilities to work and home address and including a wide range of physical activity facilities. We assess the associations for proximity of physical activity facilities from home and work address with self-reported frequency of exercise and obesity.

Methods

Our analytical sample of 7358 participants was from the 2018 wave of the Swedish Longitudinal Occupational Survey of Health. We used logistic binomial regression adjusting for age, sex, education, civil status, individual socioeconomic status, neighborhood socioeconomic status, number of children under 12 years of age, work strain, and chronic disease.

Results

Longer distance from home to paid outdoor and paid indoor physical activity facilities was associated with low frequency of exercise (fully adjusted Relative Risk for both 1.01, 95% CI 1.01–1.02). Associations of any or free outdoor facility with low frequency of exercise were not robust. Findings also indicated associations between long distance from workplace to any and paid outdoor facility and low frequency of exercise. Results for obesity were in the similar direction, however, these were not statistically significant.

Conclusion

Increased distance of paid outdoor and paid indoor physical activity facilities from home and of paid outdoor facilities from work was associated with low frequency of exercise. Longitudinal and larger studies are needed to confirm our findings, particularly regarding obesity.

Night work and sustainable working life - a prospective trajectory analysis of Swedish Twins

Objectives

Night work has been widely studied for the associations with diseases, sickness absence (SA) and disability pension (DP), but less for sustainable working life. We aimed to investigate the longitudinal changes in sustainable working life among those with or without baseline night work.

Methods

Using data from Swedish national registers, sustainable working life was defined as employment during follow-up without interruptions due to SA/DP, unemployment, and old-age pension. Survey data for two cohorts (i.e., born before or after 1959) were utilized to assess night work at baseline (yes/no) in 1998-2003 and 2004-2006, respectively. The final samples for the two cohorts were 34680 and 19637, respectively. Group-based trajectory models were applied.

Results

Among those born before 1959 (mean age 59 years, 13 years follow-up), a five-trajectory solution was best for those with and without night work. The trajectory groups were stable sustainable working life (38-42%), stable unsustainable working life (24-25%), early (13%) or later (13%) decreasing sustainable working life, and between sustainable and unsustainable working life (7%). Among those born after 1958 (mean age 37 years, follow-up 10 years), four trajectories were detected for those with night work: stable sustainable working life (81%), stable unsustainable working life (6%) and increasing (7%) and decreasing (5%) sustainable working life. For those without nightwork, a three-trajectory solution was best: stable sustainable working life (83%), stable unsustainable working life (6%) and between sustainable and unsustainable working life (11%).

Conclusions

Sustainable working life was similar across baseline night work statuses of older cohort but differed in younger cohort. The findings suggest that at least night work at one time point does not affect sustainable working life. However, night work at early stages of working life could be accompanied with lifestyle counselling for sleep and recovery.

Key messages

• Trajectories of sustainable working life seem similar for those with or without night work adding to the understanding of effects of such work to health.

• From public health perspective, counselling employees with night work already at early stages of working life for health behaviours including sleep and recovery could support sustainable working life.

Life events as predictors of unsustainable working life trajectories from a life course perspective

Background

The association between family-related life events (e.g., getting married or having children) and unsustainable working life in terms of unemployment, sickness absence and disability pension (SA/DP) are rarely studied from a life-course perspective although having public health importance. We investigated trajectories of unsustainable working life, and the associations between change in family-related life events and unsustainable working life trajectories by controlling for familial factors.

Methods

This is a prospective cohort study of 37,867 Swedish twins aged between 20-40 years on 31st December 1994. Data on trajectories of annual unemployment, SA/DP, and a combined measure of unsustainable working life months was collected from the Swedish national registers. The trajectories over a 23-year period were analysed by group-based trajectory modelling. Associations of change in family-related life events with trajectory groups in the whole sample were estimated by multinomial logistic regression and in discordant twin pairs (n = 4,647 pairs) with conditional models.

Results

Most participants had no or low levels of unemployment, SA/DP or combined unsustainable working life during 1994-2016. Individuals who were stably married or changed from being single living without children to married living with children had a decreased risk of unsustainable working life compared to individuals with stable family-related life events. The risk of unsustainable working life months over time was higher among individuals who changed from married to single status regardless of having children (range of HRs:1.31-4.44).

Conclusions

Family-related life events such as maintaining the relationship or getting married and having children decreases the risk of unsustainable working life while divorce is a risk factor for unsustainable working life. From a public health perspective, actions to support family formation or life would consequently promote a sustainable working life.

Key messages

• Unsustainable working life was less likely among married and among those who changed from single living without children to married with children compared to those with stable family life events.

• Individuals who changed from being married to divorced status had an increased risk of unsustainable working life over time and therefore being potentially an important group for public health.

Characterization of laser-induced shock waves generated during infrared laser ablation of copper by the optical beam deflection method

The shock waves generated during laser ablation of a copper target are investigated using the optical beam deflection method. The fluence of nanosecond pulsed infrared laser beam was in the range of 15-700J/cm². The density jumps related with the influx of the shock wave at two interaction points were detected with the help of He-Ne laser probes. In general, a supersonic shock wave is produced, which propagates through air and gradually decays into an acoustic wave. Experiments were carried out to study the impact of laser fluence and propagation distance on the shock wave velocity and pressure. The shock wave velocity varies with laser fluence as v∝Fl0.3 and with propagation distance as v∝d^-1.5. These results are compared with the predictions of the theoretical models. In the investigated fluence range, shock wave pressure rises by an order of magnitude (∼1-10MPa). We demonstrated that shock wave pressure and ablated mass can be related, yielding mass-specific shock wave pressure that increases linearly with laser fluence. We have also noticed the shock-wave-induced probe beam focusing under certain conditions, which indicates that the shock wave modifies the refractive index of the compressed layer of air. The reported results are useful for the fundamental understanding and pave the way for new applications of laser-induced shock waves.

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Night Work and Sustainable Working Life-A Prospective Trajectory Analysis of Swedish Twins

The aim was to investigate the changes in sustainable working life over 10-13 years of follow-up and the effect of baseline night work. Data from the Swedish national registers were used to define sustainable working life. Survey data in the 1998-2003 "SALT" with 34,680 twins or in the 2004-2006 "STAGE" with 19,637 twins were utilized to assess night work at baseline. Group-based trajectory and multinomial regression models were applied. The results of the SALT cohort yielded five trajectory solutions: stable sustainable working life (40%), stable lack of sustainable working life (25%), later decreasingly sustainable working life (15%), increasingly sustainable working life (14%), and early decreasingly sustainable working life (7%). In the STAGE cohort, four trajectories were detected: stable sustainable working life (83%), decreasingly sustainable working life (7%), stable lack of sustainable working life (5%), and increasing sustainable working life (5%). Night work was associated with the decreasing or increasing sustainable working life in the trajectory groups. To conclude, the largest parts of both cohorts followed trajectories of stable sustainable working lives. Night work was associated with both the trajectories of decreasing and increasing sustainable working lives.

O080 A double-blind, placebo-controlled, randomised trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication

Introduction

Intermittent claudication (IC) is a prevalent manifestation of peripheral arterial disease and affects about 3% of the UK population. Current guidance for the management of nonlife limiting IC is supervised exercise and best medical therapy. Supervised exercise however is not readily available across the nation and has poor recruitment and retention rates. Pilot data has demonstrated that Extracorporeal ShockWave Therapy (ESWT) is effective for improving walking distance in patients with IC. This study aims to consider its effectiveness for improving quality of life (QoL).

Methods

In a double-blind, sham-controlled, randomised trial, patients with IC were randomised in a 1:1 ratio to ESWT or sham treatment. The primary endpoint was change in physical functioning at 12-week follow-up, as measured by the SF-36. Secondary endpoints included changes in walking distances and ABPI.

Results

138 patients were randomised. The ESWT group had a significantly higher physical functioning score at 12 weeks (Mdn 41 vs 34, z=-2.1, p=0.033). They also had significantly longer claudication (Mdn 125 vs 88, z=-2.9, p=0.004) and maximum (Mdn 179 vs 129, z=-2.4, p=0.013) walking distances. The change from baseline to 12-weeks was also significantly greater in the ESWT group for claudication (Mdn 51 vs 24, z=-2.8, p&lt;0.01) and maximum (Mdn 63 vs 17, z=-4 p&lt;0.01) walking distance. No difference observed in ABPI.

Conclusion

This study demonstrates that ESWT is safe, well tolerated and clinically effective for improving QoL and walking distances in patients with IC.

Take-home message

Extracorporeal shockwave therapy improves quality of life and walking distances, and could potentially be used as a non-invasive adjunct to supervised exercise or in institutions were supervised exercise is not available.

Hydrogen sulfide: an emerging component against abiotic stress in plants

As a result of climate change, abiotic stresses are the most common cause of crop losses worldwide. Abiotic stresses significantly impair plants' physiological, biochemical, molecular and cellular mechanisms, limiting crop productivity under adverse climate conditions. However, plants can implement essential mechanisms against abiotic stressors to maintain their growth and persistence under such stressful environments. In nature, plants have developed several adaptations and defence mechanisms to mitigate abiotic stress. Moreover, recent research has revealed that signalling molecules like hydrogen sulfide (H₂ S) play a crucial role in mitigating the adverse effects of environmental stresses in plants by implementing several physiological and biochemical mechanisms. Mainly, H₂ S helps to implement antioxidant defence systems, and interacts with other molecules like nitric oxide (NO), reactive oxygen species (ROS), phytohormones, etc. These molecules are well-known as the key players that moderate the adverse effects of abiotic stresses. Currently, little progress has been made in understanding the molecular basis of the protective role of H₂ S; however, it is imperative to understand the molecular basis using the state-of-the-art CRISPR-Cas gene-editing tool. Subsequently, genetic engineering could provide a promising approach to unravelling the molecular basis of stress tolerance mediated by exogenous/endogenous H₂ S. Here, we review recent advances in understanding the beneficial roles of H₂ S in conferring multiple abiotic stress tolerance in plants. Further, we also discuss the interaction and crosstalk between H₂ S and other signal molecules; as well as highlighting some genetic engineering-based current and future directions.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

A systematic review of quantitative studies exploring staff attitudes to antipsychotic use in residents with dementia in care homes

Introduction

Despite significant warnings of adverse effects associated with giving antipsychotics to patients with dementia, these medicines continue to be prescribed for managing the Behavioural and Psychological Symptoms of Dementia (BPSD) in care homes. Information provided by staff working within care homes is a factor that can influence prescribing decisions and how BPSD is managed (1). This provides the rationale for the current study to understand staff attitudes towards antipsychotic prescribing in dementia within care home settings.

Aim

This quantitative systematic review of survey and questionnaire studies aims to explore the attitudes of staff within care homes towards giving antipsychotics to residents with BPSD.

Methods

A comprehensive search of the literature published in ten databases was conducted between 26-05-2020 and 19-07-2020 and updated in July 2021. The review protocol was registered and has been published on PROSPERO (CRD42021256879). No time limit was imposed on publication dates. Two reviewers (AR & HP) independently performed the systematic search of the electronic databases and assessed the reporting quality of the papers, again independently, using ‘A Consensus-Based Checklist for Reporting of Survey Studies’ (CROSS) (2). All the identified papers were read in detail, and a structured summary was produced for each according to the following four themes: attitudes toward antipsychotics; barriers to reduced usage; measures implemented within the settings; perceived needs of staff. These summarized data were then formulated as a table to allow comparison of each study and consolidation of the findings.

Results

14 papers with 2059 participants, all published in the last decade, were identified for inclusion in the review. Where measured, staff appeared to hold positive beliefs about the effectiveness of antipsychotics in BPSD (n=5). GPs were held responsible for reluctance to complete medication reviews and discontinue antipsychotics in residents (n=1). Antipsychotics were thought to be mainly prescribed for the management of behavioural problems such as agitation, aggression, resistance to care, wandering, hallucination (n=5). Risperidone was stated as a commonly prescribed antipsychotic (n=1). The most frequently reported adverse effects of antipsychotics were increased risk of falls and sedation (n=3). Lower staff education, lack of training, poor antipsychotic medication reviews, lack of resources to implement nonpharmacological methods, and longer working hours/lack of time were viewed as barriers to deprescribing of antipsychotics (n=6). Time was a constraint in managing behavioural problems (n=1). Measures used by the staff to reduce antipsychotic usage included medication reviews, staff education about dementia and its management, dose adjustment of antipsychotics, behavioural assessment tools and nonpharmacological interventions (n=5). Some staff highlighted the need for education, training, resources, and financial and clinical support to reduce the use of antipsychotics (n=4).

Conclusion

This is the first systematic review which synthesizes quantitative data exploring staff attitudes towards giving antipsychotics to care home residents with BPSD. The positive beliefs about the effectiveness of antipsychotics and the barriers to deprescribing identified provide the impetus for further research. This study was limited by excluding non-English papers. Another limitation was that some domains were rarely explored, e.g. commonly-prescribed medicines, meaning medication preferences could not be summarised.

References

(1) Janus SI, van Manen JG, IJzerman MJ, Bisseling M, Drossaert CH, Zuidema SU. Determinants of the nurses’ and nursing assistants’ request for antipsychotics for people with dementia. Int Psychogeriatr. 2017 Nov 21;29(3):475-84.

(2) Sharma A, Duc NT, Thang TL, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021 Apr 22;36(10):3179–87.

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND

The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS

Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

RESULTS

Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

CONCLUSION

Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

Living and working in proximity to alcohol outlets and problem drinking: a longitudinal study

Background

Problem drinking causes burden for healthcare and society. No prior study has investigated the association between proximity of alcohol outlets to workplace and problem drinking. We assessed longitudinal associations of living and working in proximity to alcohol outlets with problem drinking.

Methods

Data comprised of employed respondents of the Swedish Longitudinal Occupational Survey of Health between 2012 and 2018. Road distances from home and from workplace addresses to the nearest liquor outlet, beer outlet, and bar were provided by Statistics Sweden. Self-reported problem drinking was assessed using modified Cut-Annoyed-Guilty-Eye questions. Within-individual analyses (N = 777) applied conditional logistic regression where each individual served as his/her case and control at two different time points. Between-individual analyses (N = 13306) applied binomial logistic regression with generalized estimating equation. Covariates were (age and sex for between-individual models), occupational position, civil status, chronic disease, work strain, and home/workplace neighborhood socioeconomic status.

Results

Within-individuals, the odds ratio for being a problem drinker was 3.42 (95 % CI, 1.41-8.27) and 2.99 (1.11-8.05) per each successive halving of the distance from work to beer outlets and bars, respectively. No within-individual associations were observed for proximity of outlets to home. Between-individuals, halving of distance from home to liquor outlet [1.06 (1.01-1.12)] and to bar [1.07 (1.00-1.16)] was associated with problem drinking. For distance from work, estimates were similar but did not reach statistical significance.

Conclusions

These findings suggest that alcohol outlet proximity to one's workplace could be a determinant of alcohol consumption behavior. Reducing the number of on- and off-premises alcohol outlets, even those that only sell beer, could reduce the level of harmful alcohol consumption.

Key messages

Alcohol outlet proximity to one’s workplace could be an additional determinant of alcohol consumption behavior. Reducing the number of on- and off-premises alcohol outlets, even those that only sell beer, could reduce the level of harmful alcohol consumption.

Commuting distance and behavior-related health: A longitudinal study

Health benefits of active commuting and short commuting time are well-documented; however, limited evidence exists on the effects of commuting distance. We examined longitudinal associations between commuting distance and behavior-related health. Participants were from four survey waves of the Swedish Longitudinal Occupational Survey of Health (2012, 2014, 2016, and 2018). Analytical sample included 11,023 individuals and 21,769 observations. Random effects method used binomial logistic regression with generalized estimating equations. The outcomes were self-reported physical inactivity, overweight, smoking, problem drinking, and disturbed sleep. Models were adjusted for age, sex, occupational position, civil status, chronic disease, work strain, number of children under 12, and home/workplace neighborhood socioeconomic status. Using continuous measure, long commuting distance was associated with a higher odds of physical inactivity (OR 1.06; 95% CI, 1.04-1.09 per doubling of distance), overweight (OR 1.02; 95% CI, 1.00-1.04), and disturbed sleep (OR 1.03; 95% CI, 1.00-1.05) in fully adjusted models. Using categorized measure, individuals who commuted longer distance had a higher odds of physical inactivity compared to those with the shortest commute (3.1 km - <7.9 km vs. <3.1 km: OR 1.15; 95% CI, 1.04-1.28 and 7.9 km - <20 km vs. <3.1 km: OR 1.18; 95% CI, 1.06-1.32, fully adjusted model). Such dose-response associations were not observed for overweight or disturbed sleep. Our results suggest short commuting distance may be beneficial for behavior-related health.

Generalization of minimax and maximin criteria in a game against nature for the case of a partial a priori uncertainty

This study proposes a new criterion for choosing the optimal decision in a game against nature under a partial a priori uncertainty. The paper's main novelty consists in examining the situation when a part of the a priori probabilities of states of nature is known, and the other part is unknown. We prove the theorems for choosing the optimal decision as for the payoff and risk matrix, as well as for the profit matrix in the situation of a partial a priori uncertainty. The proposed approach also generalizes the Bayes, Wald, Savage, Hurwicz, and Laplace criteria since the minimum average payoff (or risk) for each of these criteria we can quickly obtain from the article's derived formulas. A practical example of a game against nature under a partial a priori uncertainty illustrates the proposed approach and shows its effectiveness compared to well-known criteria. We show that the introduced criterion provides the choice of a decision that is also optimal in conditions of risk, which indicates the effective use of the vector of known a priori probabilities.

Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

BACKGROUND

No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.

METHOD

This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).

RESULTS

Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.

CONCLUSION

Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.

Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA)

BACKGROUND

The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA).

METHODS

The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up.

RESULTS

The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013).

CONCLUSION

Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.

Optimal NH4 + /NO3 - ratios enhance the shade tolerance of soybean seedlings under low light conditions

In the maize-soybean intercropping system, shade is the major chronic restraint that affects normal growth of soybean. Different spatial patterns of this system affect the microclimate of soybean through shading from maize plants. However, the negative impacts of shading stress can be mitigated by providing optimal ratios of different fertilizers. Therefore, to test this hypothesis, soybean plants were grown under different light conditions (normal light or shade) to evaluate the response to varying NH4 + /NO3 - ratios. Seeds of soybean (Glycine max L. cv. Nan-99-6) were grown in nutrient solution with a total concentration of 5 mM N using different NH4 + /NO3 - ratios (T0  = 0:0, T1  = 0:100, T2  = 25:75, T3  = 50:50 and T4  = 75:25) for 40 days in a greenhouse at PPFD 320.95 μmol m-2  s-1 (low light) or 967.53 μmol m-2  s-1 (normal light). Under low light, growth and photosynthesis of soybean seedlings significantly decreased as compared to normal light conditions. However, the optimal ratios of NH4 + / NO3 - improved growth and photosynthesis of soybean seedlings under both light conditions. Our results indicated that soybean seedlings supplied with optimal NH4 + /NO3 - ratios (25:75 and 50:50) have maximum biomass yield, chlorophyll pigments, leaf gas exchange, photochemical activity and root growth as compared to low and high NH4 + /NO3 - ratios (T1 and T4 ). High ratios of NH4 + /NO3 - (T4 ) resulted in reduced plant growth due to nutrient accumulation in plant tissues; therefore, we suggest that optimal ratios of NH4 + /NO3 - (T2 and T3 ) can enhance the shade tolerance of soybean seedlings.

Silver decorated 2D nanosheets of GO and MoS2serve as nanocatalyst for water treatment and antimicrobial applications as ascertained with molecular docking evaluation

In this work, synthesis of graphene oxide (GO) and reduced graphene oxide (rGO) was realized through a modified Hummers route. Different concentrations (5 and 10 wt%) of Ag were doped in MoS₂and rGO using a hydrothermal technique. Synthesized Ag-MoS₂and Ag-rGO were evaluated through XRD that confirmed the hexagonal structure of MoS₂along with the transformation of GO to Ag-rGO as indicated by a shift in XRD peaks while Mo-O bonding and S=O functional groups were confirmed with FTIR. Morphological information of GO and formation of MoS₂nanopetals as well as interlayer spacing were verified through FESEM and HRTEM respectively. Raman analysis was employed to probe any evidence regarding defect densities of GO. Optical properties of GO, MoS₂, Ag-rGO, and Ag-MoS₂were visualized through UV-vis and PL spectroscopy. Prepared products were employed as nanocatalysts to purify industrial wastewater. Experimental results revealed that Ag-rGO and Ag-MoS₂showed 99% and 80% response in photocatalytic activity. Besides, the nanocatalyst (Ag-MoS₂and Ag-rGO) exhibited 6.05 mm inhibition zones againstS. aureusgram positive (G+) and 3.05 mm forE. coligram negative (G-) in antibacterial activity. To rationalize biocidal mechanism of Ag-doped MoS₂NPs and Ag-rGO,in silicomolecular docking study was employed for two enzymes i.e.β-lactamase and D-alanine-D-alanine ligase B (ddlB) from cell wall biosynthetic pathway and enoyl-[acylcarrier-protein] reductase (FabI) from fatty acid biosynthetic pathway belonging toS. aureus. The present study provides evidence for the development of cost-effective, environment friendly and viable candidate for photocatalytic and antimicrobial applications.

Impact of wind speed and air pollution on COVID-19 transmission in Pakistan

This study investigated the effect of wind speed and air pollution on COVID-19 from March 10, 2020, to October 04, 2020, in Pakistan. Wind speed and COVID-19 had positive correlation in Pakistan and its provinces. The inverted U-shaped dose-response curve was found for wind speed and COVID-19 in Punjab. Initially, the dose-response curve showed a positive link between wind speed and COVID-19 in Pakistan, Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory. Later, it becomes downward sloped in Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory. The expected log count of COVID-19 was increased by 0.113 times (Pakistan), 0.074 times (Punjab), 0.042 times (Sindh), and 0.082 times (Khyber Pakhtunkhwa) for a 1 km/h increase in the wind speed. The correlation between particulate matter and COVID-19 was positive (Pakistan, Punjab, and Islamabad Capital Territory) and negative (Sindh). The dose-response curve for particulate matter and COVID-19 had inverted U-shaped (Pakistan, Punjab, and Khyber Pakhtunkhwa) positively sloped (Islamabad Capital Territory), and negatively sloped (Sindh). The inverted U-shaped association shows that the COVID-19 initially increased due to a rise in the particulate matter but reduced when the particulate matter was above the threshold level. The particulate matter was also responsible to wear face masks and restricted mobility. The expected log count of COVID-19 cases was reduced by 0.005 times in Sindh for 1 unit increase in particulate matter. It is recommended to reduce particulate matter to control respiratory problems. The government should use media (print, electronic, social) and educational syllabus to create awareness about precautionary measures.

Home and Workplace Neighborhood Socioeconomic Status and Behavior-related Health: A Within-individual Analysis

Background

The influence of individual and home neighborhood socioeconomic status (SES) on health-related behaviors have been widely studied, but the majority of these studies have neglected the possible impact of the workplace neighborhood SES.

Objective

To examine within-individual associations between home and work place neighborhood SES and health-related behaviors in employed individuals.

Methods

We used participants from the Swedish Longitudinal Occupational Survey of Health who responded to a minimum of two surveys between 2012 and 2018. Data included 12,932 individuals with a total of 35,332 observations. We used fixed-effects analysis with conditional logistic regression to examine within-individual associations of home, workplace, as well as time-weighted home and workplace neighborhood SES index, with self-reported obesity, physical activity, smoking, excessive alcohol consumption, sedentary lifestyle, and disturbed sleep.

Results

After adjustment for covariates, participants were more likely to engage in risky alcohol consumption when they worked in a workplace that was located in the highest SES area compared to time when they worked in a workplace that was located in the lowest SES area (adjusted odds ratios 1.98; 95% confidence interval: 1.12 to 3.49). There was an indication of an increased risk of obesity when individuals worked in the highest compared to the time when they worked in the lowest neighborhood SES area (1.71; 1.02–2.87). No associations were observed for the other outcomes.

Conclusion

These within-individual comparisons suggest that workplace neighborhood SES might have a role in health-related behaviors, particularly alcohol consumption.

Corrosion and Heat Treatment Study of Electroless NiP-Ti Nanocomposite Coatings Deposited on HSLA Steel

Corrosion and heat treatment studies are essential to predict the performance and sustainability of the coatings in harsh environments, such as the oil and gas industries. In this study, nickel phosphorus (NiP)-titanium (Ti) nanocomposite coatings (NiP-Ti nanoparticles (TNPs)), containing various concentrations of Ti nanoparticles (TNPs) were deposited on high strength low alloy (HSLA) steel through electroless deposition processing. The concentrations of 0.25, 0.50 and 1.0 g/L TNPs were dispersed in the electroless bath, to obtain NiP-TNPs nanocomposite coatings comprising different Ti contents. Further, the effect of TNPs on the structural, mechanical, corrosion, and heat treatment performance of NiP coatings was thoroughly studied to illustrate the role of TNPs into the NiP matrix. Field emission scanning electron microscope (FESEM) and energy dispersive spectroscopy (EDX) results confirm the successful incorporation of TNPs into the NiP matrix. A substantial improvement in the mechanical response of the NiP matrix was noticed with an increasing amount of TNPs, which reached to its ultimate values (hardness 675 Hv, modulus of elasticity 18.26 GPa, and stiffness 9.02 kN/m) at NiP-0.5TNPs coatings composition. Likewise, the electrochemical impedance spectroscopy measurements confirmed a tremendous increase in the corrosion inhibition efficiency of the NiP coatings with an increasing amount of TNPs, reaching ~96.4% at a composition of NiP-0.5TNPs. In addition, the NiP-TNPs nanocomposite coatings also unveiled better performance after heat treatment than NiP coatings, due to the presence of TNPs into the NiP matrix and the formation of more stable (heat resistant) phases, such as Ni₃P, Ni₃Ti, NiO, etc., during the subsequent processing.

Dye degradation performance, bactericidal behavior and molecular docking analysis of Cu-doped TiO2 nanoparticles

Copper-doped TiO2 was prepared with a sol-gel chemical method. Various concentrations (3, 6, and 9 wt%) of Cu dopant were employed. Several techniques were implemented to assess the structural, optical, morphological and chemical properties of the synthesized samples. Evaluation of elemental composition using SEM-EDS and XRF techniques showed the presence of dopant element in the prepared samples. XRD analysis confirmed the presence of anatase (TiO2) phase with interstitial doping. Incorporation of dopant was observed to enhance the crystallinity and increase the crystallite size of the synthesized products. SAED profiles revealed a high degree of crystallinity in the prepared specimens, which was also evident in the XRD spectra. Optical properties studied using UV-vis spectroscopy depicted a shift of the maximum absorption to the visible region (redshift) that signified a reduction in the band gap energy of Cu-doped TiO2 samples. Examination of morphological features with scanning and high-resolution transmission electron microscopes revealed the formation of spherical nanoparticles with a tendency to agglomerate with increasing dopant concentration. Molecular vibrations and the formation of Ti-O-Ti bonds were revealed through FTIR spectra. PL spectroscopy recorded the trapping efficiency and migration of charge carriers, which exhibited electron-hole recombination behavior. Doped nanostructures showed enhanced bactericidal performance and synergism against S. aureus and E. coli. In summary, Cu-doped TiO2 nanostructures were observed to impede bacteria effectively, which is deemed beneficial in overcoming ailments caused by pathogens such as microbial etiologies. Furthermore, molecular docking analysis was conducted to study the interaction of Cu-doped TiO2 nanoparticles with multiple proteins namely β-lactamase (binding score: -4.91 kcal mol-1), ddlB (binding score: -5.67 kcal mol-1) and FabI (binding score: -6.13 kcal mol-1) as possible targets with active site residues. Dye degradation/reduction of control and Cu-doped samples were studied through absorption spectroscopy. The obtained outcomes of the performed experiment indicated that the photocatalytic activity of Cu-TiO2 enhanced with increasing dopant concentration, which is thought to be due to a decreased rate of electron-hole pair recombination. Consequently, it is suggested that Cu-TiO2 can be exploited as an effective candidate for antibacterial and dye degradation applications.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Promising performance of chemically exfoliated Zr-doped MoS2 nanosheets for catalytic and antibacterial applications

Nanostructured materials incorporated with biological reducing agents have shown significant potential for use in bactericidal applications. Such materials have also demonstrated considerable efficacy to counter effects of chemical toxicity. In this study, nanostructured molybdenum disulfide (MoS₂) was doped with various concentrations (2.5, 5, 7.5, 10 wt%) of zirconium (Zr) using a hydrothermal route in order to assess its antimicrobial and catalytic potential. Doped and control samples were characterized with various techniques. X-ray diffraction (XRD) analysis confirmed the presence of the hexagonal phase of MoS₂ and identification of various functional groups and characteristic peaks (Mo bonding) was carried out using FTIR spectra. Micrographs obtained from FESEM and HR-TEM showed a sheet-like surface morphology, while agglomeration of nanosheets was observed upon doping with nanoparticles. To seek further clarity regarding the layered features of S–Mo–S planes, the defect densities and electronic band structure of pure MoS₂ and doped MoS₂ samples were investigated through Raman analysis. Optical properties of Zr-doped MoS₂ nanosheets were assessed using a UV-vis spectrophotometer and the results indicated a red-shift, i.e., movement of peaks towards longer wavelengths, of the material. Dynamics of migration and recombination of excited electron–hole pairs were investigated using PL spectroscopy, which was also used to confirm the presence of exfoliated nanosheets. In addition, the synthetic dye degradation potential of pure and doped samples was investigated in the presence of a reducing agent (NaBH₄). It was noted that doped MoS₂ showed superior catalytic activity compared to undoped MoS₂. The nanocatalyst synthesized in this study exhibited enhanced antibacterial activity against E. coli and S. aureus at high concentrations (0.5, 1.0 mg/50 μl). The present study suggests a cost-effective and environmentally friendly material that can be used to remove toxins such as synthetic dyes and tannery pollutants from industrial wastewater.

Nanostructured materials incorporated with biological reducing agents have shown significant potential for use in bactericidal applications.

Photocatalytic and bactericidal properties and molecular docking analysis of TiO2 nanoparticles conjugated with Zr for environmental remediation

Despite implementing several methodologies including a combination of physical, chemical and biological techniques, aquatic and microbial pollution remains a challenge to this day. Recently, nanomaterials have attracted considerable attention due to their extraordinary prospective for utilization toward environmental remediation. Among several probable candidates, TiO₂ stands out due to its potential for use in multifaceted applications. One way to improve the catalytic and antimicrobial potential of TiO₂ is to dope it with certain elements. In this study, Zr-doped TiO₂ was synthesized through a sol–gel chemical method using various dopant concentrations (2, 4, 6, and 8 wt%). Surface morphological, microstructural and elemental analysis was carried out using FESEM and HR-TEM along with EDS to confirm the formation of Zr–TiO₂. XRD spectra showed a linear shift of the (101) anatase peak to lower diffraction angles (from 25.4° to 25.08°) with increasing Zr⁴⁺ concentration. Functional groups were examined via FTIR, an ample absorption band appearing between 400 and 700 cm⁻¹ in the acquired spectrum was attributed to the vibration modes of the Ti–O–Ti linkage present within TiO₂ nanoparticles, which denotes the formation of TiO₂. Experimental results indicated that with increasing dopant concentrations, photocatalytic potential was enhanced significantly. In this respect, TiO₂ doped with 8 wt% Zr (sample 0.08 : 1) exhibited outstanding performance by realizing 98% elimination of synthetic MB in 100 minutes. This is thought to be due to a decreased rate of electron–hole pair recombination that transpires upon doping. Therefore, it is proposed that Zr-doped TiO₂ can be used as an effective photocatalyst material for various environmental and wastewater treatment applications. The good docking scores and binding confirmation of Zr-doped TiO₂ suggested doped nanoparticles as a potential inhibitor against selected targets of both E. coli and S. aureus. Hence, enzyme inhibition studies of Zr-doped TiO₂ NPs are suggested for further confirmation of these in silico predictions.

Despite implementing several methodologies including a combination of physical, chemical and biological techniques, aquatic and microbial pollution remains a challenge to this day.

Ozone and cardiac arrest: The role of previous hospitalizations

BACKGROUND

Several studies have reported associations between exposure to particulate matter and incidence of out-of-hospital cardiac arrest (OHCA) and some have observed associations with ozone (O₃). There are no studies investigating susceptibility based on previous disease history to short-term O₃ exposure and the risk of OHCA.

AIM

To investigate the role of previous cardiovascular-related hospitalizations in modifying the associations between the risk of OHCA and short-term increase in O₃ concentrations.

METHODS

A time-stratified case-crossover analysis of 11,923 OHCA registered in the Swedish Register for Cardiopulmonary Resuscitation from 2006 to 2014 was performed. Using personal identification numbers, OHCA were linked to all previous hospitalizations in Sweden since 1987 to create susceptible groups based on the principal diagnosis code at discharge. Susceptibility was based on hospitalization for i) acute myocardial infarction; ii) heart failure; iii) arrhythmias; iv) diabetes; v) hypertension; and vi) stroke. Moving 2 and 24-h averages for O₃, PM_2.5, PM₁₀, and NO₂ were constructed from hourly averages.

RESULTS

A 10 μg/m³ higher 2-h average O₃ concentration was associated with a 2% higher risk of OHCA (95% CI, 0% 3%). Associations were similar for 24-h average O₃ and in individuals with or without hospitalizations for AMI, heart failure, diabetes, hypertension or stroke. Individuals with previous hospitalizations for arrhythmias had a lower risk of OHCA with higher O₃. No associations were observed for other pollutants.

CONCLUSIONS

Short-term exposure to O₃ was associated with an elevated risk of OHCA, however, previous hospitalizations for cardiovascular diseases were not associated with additionally augmented risks.