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BACKGROUND: Cholera in Kolkata remains endemic and the Indian city is burdened with a high number of annual cases. Climate change is widely considered to exacerbate cholera, however the precise relationship between climate and cholera is highly heterogeneous in space and considerable variation can be observed even within the Indian subcontinent. To date, relatively few studies have been conducted regarding the influence of climate on cholera in Kolkata. METHODS: We considered 21 years of confirmed cholera cases from the Infectious Disease Hospital in Kolkata during the period of 1999-2019. We used Generalised Additive Modelling (GAM) to extract the non-linear relationship between cholera and different climatic factors; temperature, rainfall and sea surface temperature (SST). Peak associated lag times were identified using cross-correlation lag analysis. RESULTS: Our findings revealed a bi-annual pattern of cholera cases with two peaks coinciding with the increase in temperature in summer and the onset of monsoon rains. Variables selected as explanatory variables in the GAM model were temperature and rainfall. Temperature was the only significant factor associated with summer cholera (mean temperature of 30.3 °C associated with RR of 3.8) while rainfall was found to be the main driver of monsoon cholera (550 mm total monthly rainfall associated with RR of 3.38). Lag time analysis revealed that the association between temperature and cholera cases in the summer had a longer peak lag time compared to that between rainfall and cholera during the monsoon. We propose several mechanisms by which these relationships are mediated. CONCLUSIONS: Kolkata exhibits a dual-peak phenomenon with independent mediating factors. We suggest that the summer peak is due to increased bacterial concentration in urban water bodies, while the monsoon peak is driven by contaminated flood waters. Our results underscore the potential utility of preventative strategies tailored to these seasonal and climatic patterns, including efforts to reduce direct contact with urban water bodies in summer and to protect residents from flood waters during monsoon.
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Cólera , Humanos , Pueblo Asiatico , Cólera/epidemiología , Cambio Climático , Inundaciones , Agua , Estaciones del Año , Clima , India/epidemiologíaRESUMEN
BACKGROUND: In the Bengal Delta, research has shown that climate and cholera are linked. One demonstration of this is the relationship between interannual ocean-atmospheric oscillations such as the El Niño Southern Oscillation (ENSO) and the Indian Ocean Dipole (IOD). What remains unclear in the present literature is the nature of this relationship in the specific context of Kolkata, and how this relationship may have changed over time. RESULTS: In this study, we analyse the changing relationship between ENSO and IOD with cholera in Kolkata over recent (1999-2019) and historical (1897-1941) time intervals. Wavelet coherence analysis revealed significant non-stationary association at 2-4 year and 4-8 year periods between cholera and both interannual timeseries during both time intervals. However, coherence was notably weakened in the recent interval, particularly with regards to ENSO, a result supported by a complementary SARIMA analysis. Similar coherence patterns with temperature indicate it could be an important mediating factor in the relationship between cholera and oscillating climate phenomena in Kolkata. CONCLUSIONS: This study reveals a shifting relationship between cholera and climate variables (ENSO and IOD) in Kolkata, suggesting a decoupling between environmental influences and cholera transmission in recent years. Our results therefore do not suggest that an intensification of ENSO is likely to significantly influence cholera in the region. We also find that the relationship between cholera and interannual climate variables is distinct to Kolkata, highlighting the spatial heterogeneity of the climate-cholera relationship even within the Bengal Delta.
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Microplastics have been reported in wastewater treatment works across the world. The majority of microplastics are removed during the wastewater treatment process, with removal efficiencies between 57 % to 99 %. What happens to the microplastics removed from the wastewater, and how they accumulate in sewage sludge and biosolids (by-products of the wastewater treatment process), remains a topic of high interest. Here we systematically reviewed the current state of knowledge on the presence, concentration, and characteristics of microplastics in sewage sludge and biosolids globally to understand how biosolids may act as a pathway for microplastic pollution to soils. A systematic search was performed on the Web of Science and Science Direct databases. Sixty-five studies reporting on microplastic pollution in sewage sludge and biosolid products were identified, spanning twenty-five countries. Reported microplastic concentrations varied considerably from 0.193 microplastics/g to 1.69 × 105 microplastics/g with a median microplastic concentration of 22.41 microplastics/g, illustrating how many microplastics are captured during the wastewater treatment process, and retained in the sewage sludge. The extent to which biosolid recycling pollutes the terrestrial environment was compared between countries. High numbers of microplastics were estimated to reach fields via biosolid application with a wide variation of 8.2 × 1010 to 1.29 × 1015 microplastics/year between sixteen countries, although there was no significant difference in microplastic concentration between fields with a history of biosolid applications and control fields. The comparative risk this delivery of approx. 0.4 to 6430 tonnes of microplastics poses compared to the environmental benefits of nutrient and carbon recycling associated with biosolids reuse, or compared to other sources of microplastic pollution remains a global research imperative. The next step in scientific research needs to focus on solutions to the biosolid and circular economy conundrum - biosolids are a valuable source of nutrients but contain high concentrations of microplastics, which are ultimately entering the terrestrial environment.
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Microplásticos , Aguas del Alcantarillado , Plásticos , Biosólidos , Aguas ResidualesRESUMEN
Anaerobic co-digestion (AcoD) with suitable substrate ratios may have the potential to improve biogas process and could play a better role in nutrient management for biocircular economy. The goal of this study was to enhance biogas yield from AcoD of cow manure (CM) and canteen food waste (CFW), and pertinent co-digestion of suitable substrate ratios for nutrient management i. e NPK from linear to biocircular economy, using ruminant intestinal fluid as a source of inoculum. A mesophilic (37 ± 1 °C) laboratory-scale AcoD with varying CFW/CM ratios of (0:1, 1:4, 2:3, 1:1, 3:2, 4:1, and 1:0) based on wet weight was performed. The AcoD systems of different CFW/CM ratios were evaluated with a loading rate of 400 g/L in the presence of 100 g cow intestinal fluid (CIF) inoculation. All experimental AcoD systems yielded greater biogas (147-300 cm3/g VS) than the mono-digestion in which only CM (135 cm3/g VS) and CFW (146 cm3/g VS) were digested anaerobically. The AcoD system of CFW/CM with 4:1 showed the highest biogas yield (300 cm3/g VS), and VS and COD reduction rate (39.51% and 65.15%, respectively), and nutrient contents (6.53%). Moreover, the experiment results were verified by modified Gompertz model. This work provided a window of opportunity to examine the anaerobic co-digestion technology beyond biogas production and to put the current low-cost technology to use for nutrient management and as a better component of the biocircular economy for agriculture in Pakistan in order to achieve sustainable development goals.
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There is an increasing concern about the impacts of microplastic pollution in the terrestrial environment. Identifying sources, pathways and sinks of terrestrial microplastics is crucial to determining environmental exposure and applying efficient intervention measures. In the UK alone, 3.5 million tonnes (wet weight) of biosolids from the wastewater industry are recycled each year to agricultural land, raising the possibility that recycling of biosolids could be a significant source of microplastic pollution to the terrestrial environment. To address this issue, the present study determined the presence of microplastics from across the whole sludge treatment stream from one exemplar wastewater treatment works in the UK. Both sewage sludge (a liquid by-product produced from the wastewater treatment processes) and biosolids (sewage sludge that has undergone a treatment process) were examined as a source of microplastics to the terrestrial environment. Microplastics were detected in all samples taken from across the treatment process with concentrations ranging from 37.7-286.5 number of microplastics/g of sludge (dry weight). The microplastic load in the final biosolid products produced at the site ranged from 37.7-97.2 number of microplastics/g of sludge (dry weight). The wastewater treatment works in this study produces 900 tonnes of anaerobically digested sludge cake and 690 tonnes of lime stabilised cake per month. Based on the results from this study, the application of these biosolids to agricultural land as fertilisers can potentially release 1.61 × 1010 and 1.02 × 1010 microplastics in anaerobically digested and lime stabilised sludge respectively, every month (equivalent to the same volume as >20,000 plastic bank cards). The results illustrate the extent to which microplastics may enter the terrestrial environment through this route.
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Microplásticos , Purificación del Agua , Biosólidos , Plásticos , Aguas del Alcantarillado , Reino UnidoRESUMEN
INTRODUCTION: "Be Clear on Cancer" (BCOC) was a national campaign to raise awareness of breast cancer in women over seventy years old. Cancer Research UK conducted this campaign from 03 February 2014 to 15 March 2014. This study assesses its impact on breast care services. METHODS: BCOC campaign guidelines for hospital trusts were used as standard comparator for this retrospective case-control study. All new patients referred to breast clinic over four months from February 2014 were included, and compared to the same period in 2013. Information was recorded for referrals, biopsy rates and pathological diagnoses. Intra & inter-group comparisons were performed. RESULTS: 1646 patients were included. An increase of 25.2%(n = 184) was observed in referrals in 2014(n = 915) compared to 2013(n = 731). Cancer detection rates went down significantly (P = 0.002,Chi-square) in 2014 (5.1%,n = 47) compared to 2013 (9.0%,n = 66) due to the increase in number of referrals. In the over 70s group, a higher than predicted increase of 64.2%(n = 52) in all referrals, and 8%(n = 44) in two-week wait referrals was observed. The number of biopsies and cancers detected remained stable although the proportions undergoing biopsies (2014-29.3%,n = 39/133 versus 2013-38.3%,n = 31/81) or being diagnosed with cancer (2014-19.5%,n = 26/133 versus 2013-30.9%,n = 25/81) declined significantly (P = 0.001,McNemar) during the campaign due to an inflation in the number of referrals. Despite the overall reduction, cancer detection rate for biopsies performed remained significantly high in the over 70s (66.7%,n = 26/39) when compared with the under 70s (23.9%,n = 21/88) during the campaign. CONCLUSIONS: Although "Be Clear on Cancer" campaign resulted in a significant increase in breast cancer referrals, it did not translate into an increase in biopsy rates or cancer detection rates. The amount of work generated for the hospital because of this campaign was far greater than the predicted increase from campaign pilots. Therefore, the overall effectiveness of this campaign is questionable.
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Neoplasias de la Mama/prevención & control , Detección Precoz del Cáncer , Anciano , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Derivación y Consulta , Estudios RetrospectivosRESUMEN
BACKGROUND: The short form 36 (SF36) questionnaire is used for assessment of generic quality of life. Responses to the individual question in SF36 are also used for calculation of the SF6D index score. This score is used for calculation of quality adjusted-life years (QALYs) in economical analyses. As the individual patient questionnaires are not always available for performing systematic reviews and meta-analyses, a new formula has been developed for derivation of SF6D index score from the reported SF36-domain scores. This study aimed to evaluate the validity of this formula for use in patients with intermittent claudication. METHODS: A retrospective review of a prospectively collected database of a randomized controlled trial was performed. A total of 178 patients were recruited. Clinical indicators of ischemia were recorded. All patients completed SF36 questionnaires. Response and domain-based SF6D scores (R-SF6D and D-SF6D) and QALYs were calculated. Correlation and agreement analysis were performed. RESULTS: Response rate was 88% (n = 781) over a 1-year follow-up period. Domain-based SF6D score (mean, 0.684; standard deviation [SD] 0.110) was significantly higher (paired t-test, P = 0.001) than the response-based score (mean, 0.627; SD, 0.110) with a mean difference of 0.056 (95% confidence interval, 0.053-0.060). Mean QALY calculated using D-SF6D score (0.503; SD, 0.116) was also significantly higher than the QALY calculated from the R-SF6D score (0.467; SD, 0.121). Bland-Altman comparison showed strong agreement (limit of agreement -0.167 to 0.054) between the 2 methods with equal variances (Pitman's test, P = 0.629). D-SF6D scores showed stronger correlation with clinical indicators of ischemia (r = 0.246-0.602) compared with that of R-SF6D scores (r = 0.233-0.549). CONCLUSIONS: Domain-based estimation of SF6D score is a valid and reliable method with strong agreement to the gold standard response-based scores in claudicants. However, adjustments may be required in studies using a mixture of D-SF6D and R-SF6D scores for QALY calculation.
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Claudicación Intermitente/diagnóstico , Prioridad del Paciente , Calidad de Vida , Encuestas y Cuestionarios , Anciano , Bases de Datos Factuales , Femenino , Humanos , Claudicación Intermitente/economía , Claudicación Intermitente/fisiopatología , Claudicación Intermitente/psicología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de TiempoRESUMEN
AIM: This study was aimed to evaluate the effect of steam sterilization on the accuracy (within 10%) of friction-style mechanical torque limiting devices (F-S MTLDs) to achieve their target torque values. MATERIALS AND METHODS: Fifteen new F-S MTLDs were selected from Astra Tech (25 Ncm, Hader SA, La Chaux-de-Fonds, Switzerland), BioHorizons (30 Ncm, Dynatorq ITL, Irvine, California, USA), Dr. Idhe (15-60 Ncm, Dr. Idhe Dental, Eching/Munich, Germany). Every peak torque measurement was tested ten times before steam sterilization using Tohnichi torque gauge (6Tohnichi-BTG (-S), Japan). Steam sterilization was performed using a 100 cycle autoclave. Preparation steps were carried out for the devices before each autoclave sterilization cycle. Peak torque measurements were repeated after every sterilization cycle. Mean difference between the measured and the targeted torque values were evaluated before and after aging. Repeated-measures of ANOVA were used to compare the differences of accuracy between subjects. Bonferroni post-hoc test was used for pairwise comparison. RESULTS: Autoclaving resulted in an increase in the error values (the difference between peak torque and target torque values) in all the three groups studied (P < 0.05), with only Astra Tech devices showing >10% (maximum 12%) difference from their torque values in 5% of the measurements. CONCLUSION: Steam sterilization effect differs between target torque and measured peak values with an increase trend. The peak torque values showed a significant decrease for BioHorizons, while a significant increase was noted for Astra Tech and no significant change in Dr. Idhe group after sterilization. CLINICAL IMPLICATION: Within the limitation of this study the torque output of each individual device deviated in varying degrees from target torque values. However, the majority of the new frictional-style devices tested in this study, delivered fairly consistent torque output within 10% of their preset target values after sterilization. Astra Tech devices were the only one showing more than 10% difference from their torque values in 5% of the measurements. Combined effects of sterilization and aging still needs to be determined.
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Fricción , Vapor , Esterilización/métodos , TorqueRESUMEN
PURPOSE: This study aimed to assess the combined effect of dismantling before sterilization and aging on the accuracy (±10% of the target torque) of spring-style mechanical torque devices (S-S MTDs). METHODS: Twenty new S-SMTDs from two different manufacturers (Nobel Biocare and Straumann: 10 of each type) were selected and divided into two groups, namely, case (group A) and control (group B). For sterilization, 100 cycles of autoclaving were performed in 100 sequences. In each sequence, 10 repetitions of peak torque values were registered for aging. To measure and assess the output of each device, a Tohnichi torque gauge was used (P<0.05). RESULTS: Before steam sterilization, all of the tested devices stayed within 10% of their target values. After 100 cycles of steam sterilization and aging with or without dismantling of the devices, the Nobel Biocare devices stayed within 10% of their target torque. In the Straumann devices, despite the significant difference between the peak torque and target torque values, the absolute error values stayed within 10% of their target torque. CONCLUSION: Within the limitations of this study, there was no significant difference between the mean and absolute value of error between Nobel Biocare and Straumann S-S MTDs.
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BACKGROUND: A double-blind, randomized controlled trial was carried out to study the effects of statins on matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in areas of peak and low abdominal aortic aneurysm (AAA) wall stress. METHODS: A total of 40 patients undergoing elective open AAA repair were randomized to receive either atorvastatin 80 mg (n = 20) or placebo (n = 20) for 4 weeks preoperatively. Finite element analysis was used to determine AAA wall stress distribution. Full thickness aortic samples were obtained at surgery from areas of low and peak wall stress, snap-frozen, and stored at -80°C for subsequent MMP-2, -8, and -9 and TIMP-1 and -2 analyses. Statistical analysis was performed using SPSS 16.0 (SPSS Inc, Chicago, IL). RESULTS: Both groups were well matched (p > 0.05) regarding age, gender, comorbidities, and duration of hospital stay. There were no statistically significant differences in levels of MMPs and TIMPs between the statin and placebo group and between areas of low and peak AAA wall stress. CONCLUSION: The short-term use of statins is not associated in reducing levels of MMP 2, 8, and 9 and TIMP-1 and -2 in areas of low and peak wall stress in patients with AAA.
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Aorta Abdominal/efectos de los fármacos , Aneurisma de la Aorta Abdominal/tratamiento farmacológico , Ácidos Heptanoicos/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Metaloproteinasas de la Matriz/metabolismo , Pirroles/administración & dosificación , Inhibidores Tisulares de Metaloproteinasas/metabolismo , Procedimientos Quirúrgicos Vasculares , Anciano , Anciano de 80 o más Años , Aorta Abdominal/enzimología , Aorta Abdominal/patología , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/enzimología , Aneurisma de la Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/cirugía , Atorvastatina , Distribución de Chi-Cuadrado , Método Doble Ciego , Esquema de Medicación , Procedimientos Quirúrgicos Electivos , Inglaterra , Femenino , Análisis de Elementos Finitos , Humanos , Masculino , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 8 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/metabolismo , Persona de Mediana Edad , Efecto Placebo , Cuidados Preoperatorios , Estrés Mecánico , Factores de Tiempo , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Inhibidor Tisular de Metaloproteinasa-2/metabolismo , Resultado del TratamientoRESUMEN
PURPOSE: To compare articulated and nonarticulated early walking aids (EWAs) for clinical and quality-of-life outcomes in transtibial amputees. METHODS: Patients undergoing lower limb amputation in a tertiary-care vascular surgical unit were screened over a 4-year period. Recruited patients were randomized to receive articulated amputee mobility aid (AMA) or nonarticulated pneumatic postamputation mobility aid (PPAMA) during early rehabilitation. Primary (10-meter walking velocity) and secondary clinical (number and duration of physiotherapy treatments during EWA/prosthesis use) and quality-of-life (SF-36) outcome measures were recorded at five standardized assessment visits. Inter-group and intra-group analyses were performed. RESULTS: Two hundred seventy-two patients were screened and 29 transtibial amputees (median age, 56 years) were recruited (14/treatment arm). No significant difference was seen in demographics and comorbidities at baseline. Inter-group analysis: Median 10-meter walking velocity was significantly (Mann-Whitney, P = .020) faster in the PPAMA group (0.245 m/s, interquartile range [IQR] 0.218-0.402 m/s) compared with the AMA group (0.165 m/s; IQR, 0.118-0.265 m/s) at visit 1. However, there was no difference between the groups at any other visit. Similarly, the number of treatments using EWA was significantly (P = .045) lower in the PPAMA group (5.0; IQR, 3.5-8.0) compared with the AMA group (6.0; IQR, 6.0-10.5). No difference was observed between the groups in duration of physiotherapy or SF-36 domain and summary scores. Intra-group analysis: Both treatment groups showed significant improvement in 10-meter walking velocity (Friedman test; AMA P = .001; PPAMA P = .007); however, other clinical outcomes did not show any statistically significant improvement. Only physical function domain of SF-36 demonstrated significant improvement (Friedman test; AMA P = .037; PPAMA P = .029). CONCLUSIONS: There is no difference in clinical and QOL outcomes between articulated and nonarticulated EWAs in rehabilitation of transtibial amputees.
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Amputación Quirúrgica/rehabilitación , Miembros Artificiales , Pierna/cirugía , Adulto , Anciano , Ambulación Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modalidades de Fisioterapia , Diseño de Prótesis , Calidad de Vida , Tibia , CaminataRESUMEN
OBJECTIVES: To establish the relationship between quality of life (QOL) index scores and clinical indicators of lower limb ischemia. METHODS: One hundred seventy-eight patients (108 men, median age 70 years) with femoropopliteal lesions suitable for angioplasty were recruited. Assessments were performed prior to and at 1, 3, 6, and 12 months following intervention (angioplasty and/or supervised exercise program). Clinical indicators of lower limb ischemia (treadmill walking distances, ankle pressures), generic (SF36, EuroQol), and disease-specific (Kings College VascuQol) quality of life questionnaires were analyzed. Correlation analysis was performed for index scores (SF-6D, EQ-5D, VascuQol) and individual domain scores using nonparametric tests. RESULTS: All clinical indicators of lower limb ischemia and quality of life index scores showed a statistically significant improvement as result of intervention (Friedman test, P < .001). Both generic QOL index scores (SF-6D, EQ-5D) showed moderate but statistically significant correlation (Spearman's rank correlation, P < .001) with treadmill walking distances (SF-6D r = 0.533, EQ-5D r = 0.500) and weak but significant correlation to resting and postexercise ankle-brachial pressure index (SF-6D r = 0.253, EuroQol r = 0.214). Disease-specific index scores (VascuQol) showed similar moderate correlation to treadmill walking distances (r = 0.584, P < .001) and weak but statistically significant correlation with resting and postexercise ABPI (r = 0.377, P < .001). All index scores showed strong and statistically significant (P< .001) correlation with patient-reported walking distance (SF-6D r = 0.604, EQ-5D r = 0.511, VascuQol r = 0.769). All domains of SF36 showed similar correlation with clinical indicators except general health. The strongest correlation was seen with treadmill walking distances in the domains of physical function (r = 0.538) and bodily pain (r = 0.524). CONCLUSION: All generic and disease-specific QOL scores show statistically significant improvement with angioplasty and/or supervised exercise in patients with claudication due to femoropopliteal atherosclerosis. However, the degree of improvement seen in clinical indicators of lower limb ischemia is not reflected in these scores. These findings support the use of composite outcome measures with mandatory, independent assessment of QOL as an independent outcome measure in intervention studies in these patients.