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The rare earth element (REE) concentrations and the neodymium (Nd) and strontium (Sr) isotope compositions of the detrital fraction and authigenic Fe Mn oxyhydroxide coatings of marine sediments may provide valuable information for better understanding the pathways of weathering inputs and estuarine and coastal exchange processes on different time scales. Here, we present the REE concentrations and 143Nd/144Nd (expressed in epsilon units, εNd) and 87Sr/86Sr ratios of detrital and authigenic (leached Fe Mn oxyhydroxides) fractions from sediment core-top samples and of estuarine water samples collected in the Estuary and Gulf of St. Lawrence (EGSL) and continental shelf off southeastern Canada. The REE distribution patterns, εNd values, and 87Sr/86Sr isotopic values from the detrital fraction allow for the discrimination of sediment from continental sources in the EGSL. Sediments in the Baie des Chaleurs and on the continental shelf, which have εNd values ranging from −14.3 to −16, 87Sr/86Sr values ranging from 0.72708 to 0.71475, and low La/Yb and Gd/Yb ratios, are mainly supplied by the early Paleozoic Appalachian Mountains. In contrast, sediments in the Laurentian and Esquiman channels (εNd = −18.7 to −21.8, 87Sr/86Sr = 0.72068 to 0.72607, and high La/Yb and Gd/Yb ratios) come from the Grenvillian metamorphic rocks in the Canadian Shield, and surface sediments on the southern Labrador Shelf (εNd = −28.7, 87Sr/86Sr = 0.73062, and high La/Yb and Gd/Yb ratios) mainly originate from the Hudson Strait and Baffin Bay. The εNd values obtained from estuarine water samples and bulk sediment leachates are unradiogenic, with values ranging between −18.9 and − 21.7 and between −16.1 and − 27.2, respectively. Based on these results and the dissolved REE concentrations, we speculate that salt-induced coagulation of colloidal matter, dissolution of lithogenic sediments from the adjacent continents (notably from the erosion of the Grenville Province on the North Shore), bottom scavenging within the nepheloid layer, and brine rejection during sea ice formation significantly influence the distribution of REEs and the authigenic εNd signal throughout the water column in the EGSL. Overall, our results both underscore the fact that caution must be exercised when interpreting authigenic εNd records due to bottom water-mass mixing in estuarine and coastal marine environments and highlight the potential of REE and Nd Sr isotope compositions in investigating changes in sediment sources and transport pathways in the EGSL. • εNd, 87Sr/86Sr and REE records of estuarine waters and sediments are presented. • Detrital εNd, La/Yb and Gd/Yb allow for tracking changes in detrital provenance. • All εNd signals reflects unradiogenic isotopic signatures from the Canadian Shield. • Dissolution of the labile mineral phases influences the dissolved REE distribution. • Particle-scavenging and brine rejection redistribute REEs within the water column. [ABSTRACT FROM AUTHOR]

Summary: Background: Infection with Clostridium difficile is the primary infective cause of antibiotic-associated diarrhoea. We aimed to compare efficacy and safety of fidaxomicin and vancomycin to treat patients with C difficile infection in Europe, Canada, and the USA. Methods: In this multicentre, double-blind, randomised, non-inferiority trial, we enrolled patients from 45 sites in Europe and 41 sites in the USA and Canada between April 19, 2007, and Dec 11, 2009. Eligible patients were aged 16 years or older with acute, toxin-positive C difficile infection. Patients were randomly allocated (1:1) to receive oral fidaxomicin (200 mg every 12 h) or oral vancomycin (125 mg every 6 h) for 10 days. The primary endpoint was clinical cure, defined as resolution of diarrhoea and no further need for treatment. An interactive voice-response system and computer-generated randomisation schedule gave a randomisation number and medication kit number for each patient. Participants and investigators were masked to treatment allocation. Non-inferiority was prespecified with a margin of 10%. Modified intention-to-treat and per-protocol populations were analysed. This study is registered with ClinicalTrials.gov, number NCT00468728. Findings: Of 535 patients enrolled, 270 were assigned fidaxomicin and 265 vancomycin. After 26 patients were excluded, 509 were included in the modified intention-to-treat (mITT) population. 198 (91·7%) of 216 patients in the per-protocol population given fidaxomicin achieved clinical cure, compared with 213 (90·6%) of 235 given vancomycin, meeting the criterion for non-inferiority (one-sided 97·5% CI −4·3%). Non-inferiority was also shown for clinical cure in the mITT population, with 221 (87·7%) of 252 patients given fidaxomicin and 223 (86·8%) of 257 given vancomycin cured (one-sided 97·5% CI −4·9%). In most subgroup analyses of the primary endpoint in the mITT population, outcomes in the two treatment groups did not differ significantly; although patients receiving concomitant antibiotics for other infections had a higher cure rate with fidaxomicin (46 [90·2%] of 51) than with vancomycin (33 [73·3%] of 45; p=0·031). Occurrence of treatment-emergent adverse events did not differ between groups. 20 (7·6%) of 264 patients given at least one dose of fidaxomicin and 17 (6·5%) of 260 given vancomycin died. Interpretation: Fidaxomicin could be an alternative treatment for infection with C difficile, with similar efficacy and safety to vancomycin. Funding: Optimer Pharmaceuticals. [Copyright &y& Elsevier]

Mining activities at Duparquet in Western Quebec (Canada) have significantly affected the local environment and left behind significant amounts of metals. Monitoring this contamination is essential to infer its past and present impacts on environmental quality and to evaluate the resulting human exposure. In that context, we measured long time series of Pb concentrations and their corresponding stable isotope ratios in long-lived white cedars (Thuja occidentalis L.) growing at Duparquet Lake in order to evaluate potential time variations of the Pb environmental contamination as well as to identify the responsible source(s). Results show that before 1950, Pb at Duparquet is mostly terrigenous. Lead concentrations rapidly increase afterwards. A simultaneous shift to lower 206 Pb/ 207 Pb ratios identifies the smelting of Abitibi ores as the source of contamination. An isotope mass balance model evaluates at roughly 7.5-20%, 5-40%, 5-9% and <3% the Pb contributions from local smelters at distances of 3.6, 3.9, 7 and 9 km, respectively. The dispersion of the Pb contamination plume is possibly driven by the distance from the Beattie smelter. We finally estimated a delay of at least 13 years between atmospheric emissions from the Beattie smelting activities and the time they are recorded by tree rings. Ultimately, this study demonstrates that white cedar tree rings series provide reliable archives of past and present Pb atmospheric contamination., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: We examined frailty as a predictor of recovery in older adults hospitalized with influenza and acute respiratory illness., Methods: A total of 5011 patients aged ≥65 years were admitted to Canadian Serious Outcomes Surveillance Network hospitals during the 2011/2012, 2012/2013, and 2013/2014 influenza seasons. Frailty was measured using a previously validated frailty index (FI). Poor recovery was defined as death by 30 days postdischarge or an increase of more than 0.06 (≥2 persistent new health deficits) on the FI. Multivariable logistic regression controlled for age, sex, season, influenza diagnosis, and influenza vaccination status., Results: Mean age was 79.4 (standard deviation = 8.4) years; 53.1% were women. At baseline, 15.0% (n = 750) were nonfrail, 39.3% (n = 1971) were prefrail, 39.8% (n = 1995) were frail, and 5.9% (n = 295) were most frail. Poor recovery was experienced by 21.4%, 52.0% of whom had died. Frailty was associated with lower odds of recovery in all 3 seasons: 2011/2012 (odds ratio [OR] = 0.70; 95% confidence interval [CI], 0.59-0.84), 2012/2013 (OR = 0.72; 95% CI, 0.66-0.79), and 2013/2014 (OR = 0.75; 95% CI, 0.69-0.82); results varied by season, influenza status, vaccination status, and age., Conclusions: Increasing frailty is associated with lower odds of recovery, and persistent worsening frailty is an important adverse outcome of acute illness., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Concentrations of trace elements vary naturally between geological environments and as a result of emissions from anthropogenic activities. Habitat use strategy is an important determinant of trace element concentrations in tissues and eggs of wild birds. However, a scarcity of studies have documented the relationships between individual bird movements related to foraging activities and exposure to contaminants including trace elements. The objective of the present study was to investigate the influence of habitat use strategy, determined using GPS-based telemetry, on the liver concentrations of selected trace elements including rare earth elements (REEs) as well as lead (Pb) isotope ratios in an urban-adapted omnivorous bird, the ring-billed gull (Larus delawarensis). Male (n = 20) and female (n = 18) ring-billed gulls breeding near Montreal (QC, Canada) in one of the largest colony in North America were tracked using miniature GPS devices to characterize their movements over a 10-days period. The time spent foraging by both male and female gulls in landfills and wastewater basins positively correlated with liver Pb concentrations. A positive correlation was also found between the time spent foraging in agricultural fields and liver concentrations of yttrium (Y) in male and female ring-billed gulls. Heavy REE concentrations were significantly greater in female gull liver relative to those of males, although this was not associated with the time spent in any foraging habitats. Pb isotope ratios ( 208 Pb/ 206 Pb and 206 Pb/ 207 Pb) in the liver of male ring-billed gulls tended to be lower in individuals that foraged in landfills, thus indicating that they may have been exposed to different Pb sources relative to birds that visited other sites. This study provided valuable information on the potential sources of trace elements at the landscape level in free-ranging birds spanning urbanized environments., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The isotope ratios of strontium (Sr) and lead (Pb) in water derive from local geology and their isotopic signature can be linked to the age and type of underlying bedrocks and soils (if applicable), and are transferred up the food-chain. Both elements are transferred to human blood through diet and water, and some of it will ultimately be incorporated into the hair structure, making Sr and Pb isotopes interesting tools for tracing human mobility. In this study, we analyzed both the elemental concentration and isotope ratios of Sr and Pb from four different women of different ages to monitor their permanent relocation from central France to Eastern Canada during the summer 2012. For comparison, we also characterized bulk hair samples of sedentary individuals and local tap waters from their regions of origin and of settlement. Our results indicate that the 87Sr/86Sr and 206Pb/204Pb ratios are significantly modified by the change of environment, but also confirm that human hair compositions are impacted by other external factors (such as dust). Sr and Pb isotope systematics demonstrate their added value for detecting human mobility, but require further studies to better constrain the main sources and processes controlling their respective budgets in human hair for provenancing purposes., (Copyright © 2014 Forensic Science Society. Published by Elsevier Ireland Ltd. All rights reserved.)