Search

Background: New Zealand (NZ) research into type 1 diabetes mellitus (T1DM) mortality can inform policy and future research. In this study we aimed to quantify the magnitude to which ethnicity and socioeconomic disparities influenced mortality at the population level among people with Type 1 diabetes (T1DM) in Auckland, New Zealand (NZ). Methods: The cohort data were derived from the primary care diabetes audit program the Diabetes Care Support Service (DCSS), and linked with national primary care, pharmaceutical claims, hospitalisation, and death registration databases. People with T1DM enrolled in DCSS between 1994–2018 were included. All-cause, premature, and cardiovascular mortalities were estimated by Poisson regression models with adjustment for population-level confounders. The mortality rates ratio (MRR) was standardized against the DCSS type 2 diabetes population. Mortality rates were compared by ethnic group (NZ European (NZE) and non-NZE) and socioeconomic deprivation quintile. The population attributable fraction (PAF) was estimated for ethnic and socioeconomic disparities by Cox regression adjusting for demographic, lifestyle, and clinical covariates. The adjusted slope index inequality (SII) and relative index of inequality (RII) were used to measure the socioeconomic disparity in mortalities. Results: Overall, 2395 people with T1DM (median age 34.6 years; 45% female; 69% NZE) were enrolled, among whom the all-cause, premature and CVD mortalities were 6.69 (95% confidence interval: 5.93–7.53), 3.30 (2.77–3.90) and 1.77 (1.39–2.23) per 1,000 person-years over 25 years. The overall MRR was 0.39 (0.34–0.45), 0.65 (0.52–0.80), and 0.31 (0.24–0.41) for all-cause, premature and CVD mortality, respectively. PAF attributable to ethnicity disparity was not significantly different for mortality. The adjusted PAF indicated that 25.74 (0.84–44.39)% of all-cause mortality, 25.88 (0.69–44.69)% of premature mortality, 55.89 (1.20–80.31)% of CVD mortality could be attributed to socioeconomic inequality. The SII was 8.04 (6.30–9.78), 4.81 (3.60–6.02), 2.70 (1.82–3.59) per 1,000 person-years and RII was 2.20 (1.94–2.46), 2.46 (2.09–2.82), and 2.53 (2.03–3.03) for all-cause, premature and CVD mortality, respectively. Conclusions: Our results suggest that socioeconomic disparities were responsible for a substantial proportion of all-cause, premature and CVD mortality in people with T1DM in Auckland, NZ. Reducing socioeconomic barriers to management and self-management would likely improve clinical outcomes. [ABSTRACT FROM AUTHOR]

This work examined the effects of seawater (SW) on the hydration of tricalcium aluminate (C3A) in C3A–gypsum and C3A–gypsum–Ca(OH)2 systems through the characterization of hydration heat release, the evolution of aqueous phase composition and hydration products with the hydration time. It was found that SW increased the dissolution driving force of C3A and solubility of gypsum, which accelerated the early hydration of C3A and the formation of ettringite (AFt), leading to a higher hydration degree of C3A at an early age compared with the deionized (DI) water–mixed pastes. After gypsum depletion to form AFt, and in the absence of Ca(OH)2, the formation of chloroaluminate hydrates was slower due to the insufficient Ca resulted in an accumulation of Al in solution. This would delay the subsequent transformation of AFt to monosulfate (SO4–AFm) and the formation of hydrogarnet (C3AH6), which would further reduce the hydration degree of the C3A at the later ages. However, in the presence of Ca(OH)2, the hydration degree of C3A–gypsum–Ca(OH)2 at later ages was increased, which was similar to that of the corresponding DI pastes. This can be inferred that the amount of Ca available in SW‐mixed cement concrete can affect the hydration degree of C3A in cement. [ABSTRACT FROM AUTHOR]

Reutilising waste glass powder (WGP) could be a promising alternative to supplementary cementitious materials (SCMs) because of its availability and carbon footprint reduction, especially in Hong Kong. However, concerns about the adverse effects on hydration and early strength have been raised and might limit concrete application. A wet grinding method was applied to convert WGP into ultra-fine particles, which could address these concerns and promote the application of WG as an alternative local SCM with a low carbon footprint. This study investigated the effect of wet grinding on WGP's physicochemical properties and how wet-ground WGP modified early hydration kinetics, mechanical performance, and microstructure of cement paste. The results indicated that ultra-fine WG was produced with the D 50 of 500 nm and modified surface composition. Unlike micro-sized WGP, introducing ultra-fine WGP increased the 1-d strength by 50% and the 28-d strength by 5% of cement paste. The improvement of early strength could be attributed to three reasons. Firstly, the dissolution of ultra-fine WGP increased pH in the pore solution of the cement paste, which accelerated the hydration of C 3 A and C 3 S and promoted the precipitation of ettringite and the formation of C-S-H. Secondly, the submicron particles provided nucleation sites for C-S-H precipitation and increased the pozzolanic reactivity. Lastly, ultra-fine WGP could also effectively fill the pores in the cement paste, leading to a denser microstructure. According to the result, the reactivity of WG could be enhanced through wet-grinding and finely ground WGP could substitute reactive but costly binders, such as cement and silica fume. • Ultra-fine WG with the D 50 of 500 nm was produced through wet-grinding treatment, which modified surface composition of WGP. • Unlike micro-sized WGP, ultra-fine WGP increased the 1-d strength by 50% and the 28-d strength by 5% of cement paste. • Increased pH in the pore solution, nucleation sites for C-S-H precipitation and denser microstructure improved early strength. [ABSTRACT FROM AUTHOR]

This work examines the micromechanical properties of AFm phases formed in seawater and deionized water. As the interlayer SO 4 2− in the AFm phase is gradually replaced by Cl− in seawater, the basal spacing of the AFm crystal narrows, which promotes the packing density of nanocrystals and their indentation modulus and hardness, i.e. , Cl-AFm (Friedel's salt) > SO 4 -Cl-AFm (Kuzel's salt) > SO 4 -AFm (monosulphate). It is found that Friedel's salt formed in seawater feature multiple structural and compositional defects. First, the anions (Cl−, OH−, SO 4 2−) are bound in the interlayer of Friedel's salt, and the bound OH− contents have negative relations with the Cl− concentration in the seawater. Second, the incorporation of Mg ions in the Friedel's salt barely changes its micromechanical properties based on the experimental data and molecular dynamics simulations. Third, when portlandite is present in the seawater, some Ca vacancies would be formed in the Friedel's salt, which would decrease its Young's modulus significantly. This accounts for the decrease in the indentation modulus of Friedel's salt as observed in the experiments. These findings enable us to better understand and control the micromechanical properties of Cl-containing AFm phase formed in seawater-mixed cementitious materials. [ABSTRACT FROM AUTHOR]

• EOP is linked to a high risk of complications, technique failure, and death in PD patients. • Although some risk factors have been examined, no risk score has previously been derived to predict EOP. • A well-discriminated and calibrated risk score for EOP has been derived and validated. • As a tool, the score could identify high-risk patients for further intervention. Early onset peritonitis (EOP) increases the risk of clinical complications in patients initializing peritoneal dialysis (PD). This study aimed to develop and validate a risk prediction model for EOP among patients initializing PD. 3772 patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2015 were included. The main outcome, EOP, was defined as incident peritonitis occurring within 6 months of the initialization of PD. Multivariable logistic regression modeling was applied to derive the risk score. All accessible clinical measurements were screened as potential predictors. Assessment of the developed model in terms of model discrimination and calibration was performed using C statistics and a calibration slope, respectively, and validated internally through a bootstrapping (1000-fold) method to adjust for over-fitting. The absolute risk of EOP was 14.5%. Age, cardiac function measurements, serum electrolyte test items, lipid profiles, liver function test items, blood urea nitrogen, and white cell count were significant predictors of EOP in the final risk score. Good model discrimination, with C statistics above 0.70, and calibration of agreed observed and predicted risks were identified in the model. A prediction model that quantifies risks of EOP has been developed and validated. It is based on a small number of clinical metabolic measurements that are available for patients initializing PD in many developing countries, and could serve as a tool to screen the population at high risk of EOP. [ABSTRACT FROM AUTHOR]

Highlights • Using 10% WGP can effectively mitigate ASR of cement glass mortars. • 2% NS incorporation had limited effect on mitigating ASR of cement glass mortars. • The ASR mitigation effect of the hybrid NS and WGP was inferior to that with WGP. • The Na/Si and Ca/Si ratios of the ASR gel determined the mitigation effect. Abstract Swelling caused by alkali-silica reaction (ASR) in concrete is a deleterious behavior due to reactions between alkaline pore solution and amorphous or metastable forms of silica in aggregates. Generally, mitigation by using pozzolanic materials is commonly adopted. This study compared the effectiveness of a highly-reactive nano-SiO 2 (NS) and a slowly-reactive waste glass powder (WGP) on mitigating ASR of cement mortars prepared with crushed glass cullet as aggregates. The experimental results showed that incorporating 2% NS or 10% WGP or a hybrid of the two in the mortar can decrease the ASR expansion. Using WGP resulted in larger reduction in the ASR expansion than using NS. Meanwhile, there was an improvement of strength from 7 d to 28 d for the mortar prepared with WGP. The composition of reaction products containing the ASR gel formed in a simulated ASR condition and the macro-/micro-structure of the tested mortars were further analyzed. It was found that the reaction products formed with high ratios of Na/Si and Ca/Si were favorable in mitigating the ASR expansion. For the specimen prepared with WGP, the increase in the ratio of Ca/Si would increase the stiffness of the ASR gel, and a higher Na/Si ratio would help reduce the osmotic pressure. The findings from this study would be useful for the selection of pozzolans to mitigate the ASR effect when using crushed glass cullet as aggregates in cement mortars. [ABSTRACT FROM AUTHOR]

Aims: Cerebrovascular disease is one of more typical reasons for hospitalisation and re-hospitalisation in people with type 2 diabetes. We aimed to derive and externally validate two risk prediction algorithms for cerebrovascular hospitalisation and re-hospitalisation.Methods: Two independent cohorts were used to derive and externally validate the two risk scores. The development cohort comprises 4704 patients with type 2 diabetes registered in 18 general practices across Cambridgeshire. The validation cohort includes 1121 type 2 patients from a post-trial cohort data. Outcomes were cerebrovascular hospitalisation within two years and cerebrovascular re-hospitalisation within ninety days of the previous cerebrovascular hospitalisation. Logistic regression was applied to derive the two risk scores for cerebrovascular hospitalisation and re-hospitalisation from development cohort, which were externally validated in the validation cohort.Results: The incidence of cerebrovascular hospitalisation and re-hospitalisation was 3.76% and 1.46% in the development cohort, and 4.99% and 1.87% in the external validation cohort. Age, gender, body mass index, blood pressures, and lipid profiles were included in the final model. Model discrimination was similar in both cohorts, with all C-statistics > 0.70, and very good calibration of observed and predicted individual risks.Conclusion: Two new risk scores that quantify individual risks of cerebrovascular hospitalisation and re-hospitalisation have been well derived and externally validated. Both scores are on the basis of a few of clinical measurements that are commonly available for patients with type 2 diabetes in primary care settings and could work as tools to identify individuals at high risk of cerebrovascular hospitalisation and re-hospitalisation. [ABSTRACT FROM AUTHOR]

Background/Aims: During peritoneal equilibrium test (PET), intermediate measures of Dt/P (dialysate/plasma creatinine ratio), D0/P, D2/P and D4/P ratios might provide additional information regarding a patient’s cardiovascular mortality. We aimed to characterise heterogeneity of dialysate creatinine response patterns based on three ratios and compare cardiovascular mortality risks by response patterns. Methods: 3,477 patients initialising peritoneal dialysis (PD) between 2007-2015 were measured D0/P, D2/P and D4/P at baseline and 2-year cardiovascular mortality was defined as the primary outcome. Latent class mixed-effect models were fitted to identify distinct patterns of dialysate creatinine response. Multivariable Logistic regression model with adjustment of cardiometabolic factors were used to compare cardiovascular mortality by latent classes. Results: The 1st latent class including 36% of participants was characterised by consistently increasing and high Dt/P ratios both at 2-hour and 4-hour. The 2nd class including 61% of participants characterised by sharply increased ratio at 2-hour and slightly increased ratio at 4-hour. The 3rd class included 3% of participants with decreased ratio at 2-hour and increased ratio at 4-hour. Comparing the 1st class, the lower cardiovascular mortality risk was identified in the 2nd and 3rd class with adjusted odds ratio 0.65 (95% confidence interval: 0.62-0.69) and 0.48 (0.41-0.57), respectively. Conclusion: Patients with decreased Dt/P ratio between 0-hour and 2-hour and low ratios at 2-hour and 4-hour tend to have low cardiovascular mortality. Latent class analysis seems to be a promising method to reveal unidentified subgroups that do not fit into the risk category defined by Dt/P ratio at 4-hour. [ABSTRACT FROM AUTHOR]

The dispersion/distribution of nanoSiO 2 in cement-based materials is known as very influential on the property gain, but still remains a big problem that has not been well addressed. The aim of this work was trying to tailor the dispersion/distribution of nanoSiO 2 in cement-based materials with silica fume. Firstly, the surface of silica fume was amino-functionalized (AFSF) for adsorbing and dispersing nanoSiO 2 (NS), then the adsorption of NS on AFSF and its effects on the properties of fresh and hardened cement-based materials were studied. Results showed that the adsorption of NS on AFSF followed the Freundlich adsorption model, and a multi-layer adsorption characteristic were found. The adsorption of NS on AFSF helped increasing the fluidity of mortar, and mitigated the negative effects of nanoSiO 2 on the hydration and hardening properties of cement-based materials at late ages, resulting in an improved compressive strength, a higher degree of hydration of cement and a compacter microstructure at late ages than the pure AFSF-added sample, and a higher and comparable compressive strength than the control sample at the early and late age can be resulted. It can be suggested from this work that the dispersion/distribution of nanomaterial in cement-based materials with silica fume helps a better exploration of the nano-modification of cement-based materials and provide a new technique on producing nano-modified cement concrete, and work on making good absorption of nanomaterial on SCM is worth of further study. [ABSTRACT FROM AUTHOR]

This work investigated the influence of seawater on the growth rate, morphology, and properties of ettringite (AFt). The results showed that, in the absence of calcium hydroxide (CH), a part of the Mg ions in seawater preferentially formed Mg Al layered double hydroxide containing Cl− (Mg-Al-Cl LDH), which could accelerate the subsequent precipitation of AFt in seawater. However, in the presence of CH, some of the Mg ions in seawater formed brucite, and there was no significant acceleration for the precipitation of AFt in the seawater-CH solution, compared with the AFt formed in seawater without CH. Besides, in both cases with and without CH, some Mg ions in seawater could enter the sites of Ca in the AFt structure, leading to an unstable structure. This would cause a relatively lower packing density compared with the corresponding AFt samples synthesized in deionized (DI) water, further leading to a relatively lower mechanical property. When the Mg ions were excluded from seawater, the AFt samples synthesized seemed to have a relatively higher packing density compared with the corresponding AFt formed in DI water, resulting in a relatively higher mechanical property. This finding could lead to a better understanding of the degradation of the micromechanical properties of AFt in seawater-mixed cementitious materials caused by the Mg ions. [ABSTRACT FROM AUTHOR]

Organic surface treatment agents, such as silanes, have been widely used for the improvement of the surface quality of cement-based materials, but their lower weather resistivity compared to the inorganic treatment agents is the main shortage. The tetraethyl orthosilicate (TEOS) silane was used for the surface treatment of hardened cement-based material by utilizing the inorganic in-situ hydrolysis product of SiO 2 . Effects and mechanisms of TEOS for surface treatment of hardened cement-based materials were investigated with a comparison study of the normally used inorganic concrete sealer sodium silicate, i.e., the water glass, and the water repellent methyltriethoxysilane (MT-silane). Compressive strength and mass transport property (water absorption rate or water vapor transport property) investigations suggested that the reported benefits of TEOS on hardened cementitious materials will not occur when it was applied onto the relatively young cement-based materials, and the properties could be worse than the sodium silicate- and MT-silane-treated samples, and the negative effect of TEOS on the hydration of cement at early age could be the reason as revealed by the hydration heat calorimetry tests. For the old cementitious material, the blocking of pores by the in-situ hydrolysis and condensation of TEOS, forming silica sol/gel, as well as its quick (comparable to that of sodium silicate) pozzolanic reaction with calcium hydroxide, forming additional calcium silicate hydrate, contribute to the improved surface quality. IR spectroscopic investigation showed that MT-silane react with calcium hydroxide, but in a slower rate than that of TEOS and sodium silicate, and no C-S-H gel can be formed, thus no densification of the structure could be resulted when using MT-silane. [ABSTRACT FROM AUTHOR]

Aims: To compare variations in metabolic target achievement by ethnicity (Europeans, Māori and Pasifika) among patients with type 2 diabetes (T2DM) in Auckland, New Zealand (NZ) between 1994 and 2013.Methods: 32,237 patients were enrolled. Adjusted marginal difference (European as reference) of systolic blood pressure (SBP), body mass index (BMI), HbA1c and total cholesterol, alongside the proportion achieving metabolic targets were estimated using multivariable mixed effect models at baseline, 1-, 2-, 3-, 4-, and 5-years, adjusted for covariates.Results: Compared with Europeans, Māori and Pasifika had continuously, significantly higher HbA1c (by 0.3% (+3.5 mmol/mol) and 0.6% (+6.8 mmol/mol) respectively and BMI (+1.5 and +0.3 kg/m2 respectively) but lower SBP (-1.8 and -3.4 mmHg respectively) and TG (-0.03 and -0.34 mmol/L respectively), and insignificantly TC (+0.004 and +0.01 respectively), by 5-years of follow-up. While 49% Europeans were within target HbA1c, this was achieved by only 30% Māori and 27% Pasifika. Conversely, 41% Europeans, 46% Māori and 59% Pasifika achieved the SBP target (all P < 0.0001).Conclusions: Managing hyperglycemia appears to be more challenging than treating hypertension and dyslipidemia among Māori and Pasifika. New anti-hyperglycemia treatments, addressing health literacy, socioeconomic and any cultural barriers to management and self-management are urgently needed to reduce these disparities. [ABSTRACT FROM AUTHOR]

This study explored the mechanism of the effect of seawater on tricalcium aluminate (C 3 A) hydration. The results showed that seawater retarded C 3 A hydration and reduced the reaction degree of C 3 A. The co-existence or ion pairing of Ca2+ and SO 4 2− onto the surface of C 3 A poisoning the reactive sites is the main reason for this retardation. Besides, the precipitation of Mg(OH) 2 on the surface of C 3 A would prolong the induction period for another 30 min and then consequently decrease the dissolution rate of C 3 A hydration. Trace amounts of MgSO 4 0 and Mg2+ present in the alkaline solution had little retardation effect. It was also found that Cl− would preferentially react with C 3 A to form Friedel's salt, rather than forming hydroxy-AFm as that in the C 3 A-deionized water paste. The direct formation of Friedel's salt resulted in an accumulation of Al3+ in solution, which would also hinder the subsequent dissolution of C 3 A. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: The lateral root of Aconitum has been popularly used in traditional Chinese medicine (TMC) known as Fuzi which is beneficial for the treatment of various diseases, such as rheumatism, painful joints, syncope and bronchial asthma. However, it has a potential carditoxicity with a relatively narrow margin of safety. Aim of the study: This paper was designed to explore the mechanisms of Fuzi's toxicity and find out potential tissue-specific biomarkers of toxic effects. Material and methods: A myocardial lipidomics based on ultraperformance lipid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UHPLC/Q-TOF MS) was developed to compare three cardiac lipid extraction methods and investigate the changes of lipids in mice heart of three different dosage groups. In addition, we concurrently inspected the biochemical parameters in plasma, observed the histology of the heart and recorded the electrocardiogram (ECG). Results: The cardiotoxicity of Fuzi was dose-dependent, and the high-dose group obviously manifested the heart damage in histology and a certain degree of arrhythmia. Significant changes of 14 lipid metabolites which primarily involved in phospholipid metabolism, sphingolipid metabolism, saturated fatty acid oxidation and unsaturated fatty acid peroxidation were identified and considered as the potential biomarkers of Fuzi toxicity. Conclusion: The lipidomics approach is helpful to search potential tissue-specific biomarkers and understand the underlying mechanisms of Fuzi toxicity on the heart. [Copyright &y& Elsevier]

• S275 had a higher passivation rate at the first 1 h, afterwards, it became lower. • The lower Fe2+ oxides of S275 in the passive film showed poor protective property. • The higher donor density of S275 implied more point defects in the passive film. • The chloride threshold value of B500 was 4 times higher than that of S275. The corrosion behavior of two types of stirrups, a plain steel bar and a ribbed steel bar, were studied in this work. The results demonstrated that a better passive state was achieved on B500, which was due to a relatively higher concentration of Fe2+ oxides at the first 2 nm depths of the film, even though B500 film had relatively less FeO x contents, because Fe2+ oxides had a better protective property than Fe3+ oxides. Furthermore, the slightly lower donor density of B500 film in the M-S analysis results presented the much less point defect in the film, showing an increase in the anti-corrosion property of passive film. These contributed to a higher chloride threshold value of B500, 4 times higher than that of S275. Therefore, compared with S275, B500 stirrups could be more suitable for the application in the severe service environment. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance (IR) is increased among people with end-stage renal disease (ESRD). The Triglyceride glucose (TyG) index is a marker of IR and is also associated with the prognosis of cardiovascular disease among patients initiating peritoneal dialysis (PD). This study was aimed at examining the associations between TyG index and cardiovascular deaths in patients initiating PD. Methods and Results: Three thousand fifty-four patients initiating PD between 2007 and 2014 were included in a prospective cohort derived from Henan PD Registry, TyG index alongside other baseline characteristics were measured when ESRD patients initiated PD. Logistic regression adjusting for age, gender, and major cardiovascular risk factors estimated the association between TyG index and subsequent cardiovascular mortality within 2 years since the initiation of PD. Results: TyG index was positively associated with cardiovascular mortality: adjusted incidence rates ratio (95% CI) comparing the highest vs. lowest TyG index quartile was 2.32 (2.12–2.55) in all, 2.22 (2.01–2.46) in those with body mass index (BMI) <25 kg/m2, and 2.82 (2.24–3.54) in those with BMI ≥25 kg/m2, respectively. Linear dose-response relationships were revealed in all and by BMI. Conclusions: TyG index might be a prognostic factor in predicting cardiovascular mortality among patients initiating PD. [ABSTRACT FROM AUTHOR]

Background/Aims: Cerebrovascular disease (CeVD) is one of the leading causes of death in patients initialising peritoneal dialysis (PD). Currently there is no risk score to predict the future risk of CeVD on entry into PD. This study aimed to derive and validate a risk prediction model for CeVD mortality in 2 years after the initialisation of PD. Methods: All patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2014 were included. Multivariable logistic regression modelling was applied to derive the risk score. All accessible clinical measurements were screened as potential predictors. Internal validation through bootstrapping was applied to test the model performance. Results: The absolute risk of CeVD mortality was 2.9%. Systolic and diastolic blood pressure, total cholesterol, phosphate, and sodium concentrations were the strongest predictors of CeVD mortality in the final risk score. Good model discrimination with C statistics above 0.70 and calibration of agreed observed and predicted risks were identified in the model. Conclusion: The new risk score, developed and validated using clinical measurements that are accessible on entry into PD, could be used clinically to screen for patients at high risk of CeVD mortality. Such patients might benefit from therapies reducing the incidence of CeVD related events. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the association between the incident onset of T2DM and 5- and 10-year risks of CVD and HF in people with IGT identified in primary care in South and West Auckland, New Zealand (NZ) between 1994 and 2019. Methods: We compared CVD and HF risks in patients with IGT and with/without T2D newly diagnosed within the exposure window (1–5 years). Tapered matching and landmark analysis (to account for immortal bias) were used to control for potential effects of known confounders. Results: Among 26,794 patients enrolled with IGT, 845 had T2D newly diagnosed within 5 years from enrolment (landmark date) and 15,452 did not have T2D diagnosed. Patients progressing to T2D (vs. those not progressing) had a similar 5-year risk for CVD (hazard ratio 1.19; 95% CI 0.61–2.32) but significantly higher 10-year risk of CVD (2.45(1.40–4.29)), 5-year risk of HF (1.94(1.20–3.12)) and 10-year risk of HF (2.84(1.83–4.39). The association between the onset of T2D and risk of 10-year risk of CVD, 5-year and 10-year risk of HF was more likely among men, the socioeconomically deprived, those currently smoking, patients with higher metabolic measures and/or those with lower renal function. Patients of NZ European ethnicity had a lower 10-year risk of CVD. Conclusions: The study suggests that the diagnosis of T2D mediates the risk of CVD and HF in people with IGT. The development of risk scores to identify and better manage individuals with IGT at high risk of T2D is warranted. [ABSTRACT FROM AUTHOR]

Background/Aims: Traditional cardiovascular (CV) risk factors (RFs) and their management targets may not be applicable to specific medical subpopulations, particularly dialysis patients. This study aimed to evaluate the dose-response association between measurements of RFs, cardiovascular mortality, and potential metabolic targets among Chinese patients initializing peritoneal dialysis (PD). Methods: Risk-set sampling was applied to two population based 1: 10 case-control studies of incident PD patients, matched by age, sex and the year of initialisation of PD: a main sample (204 cases and 2,040 controls) and a replication sample (81 cases and 810 controls). The dose-response association between continuous measurements of CV RFs (blood pressure, fasting glucose, body mass index, total cholesterol, phosphate and ejection fraction) at baseline and the 2-year CV mortality were analyzed using conditional Logistic regression. The final threshold was chosen based upon a significant break in the regression coefficients and achievement of the minimum Bayesian information criterion (BIC). Results: A linear relationship was identified between fasting glucose and CV mortality. Non-linear associations between other measurements and CV mortality suggested potential metabolic treatment intensification thresholds as < 145/92mmHg for blood pressure, < 1.70mmol/L for phosphate, 24 kg/m2 for body mass index, 4.6mmol/L for total cholesterol, and > 60% for ejection fraction respectively. Conclusion: Our findings highlight the potential importance of more intensive glucose management, anti-hypertensive treatment and dietary management among PD patients. We recommend that the clinical relevance of these epidemiological associations be tested using randomized controlled trials of multifaceted interventions. [ABSTRACT FROM AUTHOR]

• Seawater affects the fresh and physical properties of UHPC due to the accelerated hydration and modified microstructure. • Seawater exacerbated both the autogenous and drying shrinkage of UHPC. • The pozzolanic reactivity of silica fume was enhanced, leading to higher compressive strength and autogenous shrinkage of seawater UHPC. • Unlike normal concrete, seawater increased the autogenous shrinkage of UHPC. In addition, no Friedel's salt and brucite were observed in seawater UHPC but in normal concrete. Due to the shortage of fresh water, the use of seawater in concrete production could alleviate the demand for the limited resource. To promote the use of seawater in ultra-high-performance concrete (UHPC), the effects of seawater on the hardening process and the corresponding relationship between the macroscopic performance and hydration, pozzolanic reaction, and microstructure of hydration products were investigated. Earlier setting times, higher early but lower later compressive strength and higher shrinkage of UHPC were observed. The modified performance was not only attributed to the presence of seawater accelerating the early hydration but also due to the change of microstructure and C-S-H structure. Better early strength and exacerbated shrinkage were associated with the slightly reduced porosity but refined pore structure, while lower later-age compressive strength in the seawater group was related to coarser microstructure and shorter mean chain length (MCL) and lower polymerisation of C-S-H. In addition, the pozzolanic reactivity of silica fume was enhanced, which would also contribute to the increased early compressive strength and exacerbated shrinkage of UHPC. It should be noted that no Friedel's salt and brucite were observed in the seawater UHPC. Moreover, although the incorporation of fly ash (PFA) was able to compensate for the adverse effects of seawater on compressive strength and autogenous shrinkage of UHPC, the exacerbated drying shrinkage was still a concern even when fly ash was present. [ABSTRACT FROM AUTHOR]

Ca(OH) 2 (CH) is a critical constituent that influences the durability of cement-based materials. By taking the advantages of the in situ hydrolysis of tetraethoxysilane, TEOS, and the in situ consumption of CH at the surface of hardened cement-based material, this work studied the effects of TEOS-treatment on the CH-related durability, i.e., the calcium-leaching and sulfate-attack resistivity. Results suggested that TEOS can penetrate into hardened cement-based material more easily than water. Thermogravimetric analysis showed that TEOS consumed CH on the surface of hardened cement-based material, resulting in a gradient distribution of CH, and benefited the CH-related durability. The loss of compressive strength of mortar samples suffering decalcification was reduced by TEOS-treatment, and the lower Ca-leaching of the TEOS-treated sample introduced by the reduction of CH content and the polymerization of C-S-H gel (shown by NMR results) could be two of the critical reasons. XRD results showed that the formation of the gypsum on the surface of cement-based material that cured in Na 2 SO 4 solution could be reduced by the in situ consumption of CH of TEOS, which benefited the reduction of the loss of the compressive strength in the corrosive environment. It can be deduced from this study that the in situ consumption of CH of TEOS on the surface of hardened cement-based material would favor the improvement of the durability, showing its potential for surface-treatment of hardened cement-based material. [ABSTRACT FROM AUTHOR]

Microplastics (MPs) and per- and polyfluoroalkyl substances (PFASs) have drawn great attention as emerging threats to aquatic ecosystems. Although the literature to study the MPs and PFASs alone has grown significantly, our knowledge of the overlap and interactions between the two contaminations is scarce due to the unawareness of it. Actually, numerous human activities can simultaneously release MPs and PFASs, and the co-sources of the two are common, meaning that they have a greater potential for interactions. The direct interaction lies in the PFASs adsorption by MPs in water with integrated mechanisms including electrostatic and hydrophobic interactions, plus many influence factors. In addition, the existence and transportation of MPs and PFASs in the aquatic environment have been identified. MPs and PFASs can be ingested by aquatic organisms and cause more serious combined toxicity than exposure alone. Finally, curbing strategies of MPs and PFASs are overviewed. Wastewater treatment plants (WWTPs) can be an effective place to remove MPs from wastewater, while they are also an important point source of MPs pollution in water bodies. Although adsorption has proven to be a successful curbing method for PFASs, more technological advancements are required for field application. It is expected that this review can help revealing the unheeded relationship and interaction between MPs and PFASs in aquatic environments, thus assisting the further investigations of both MPs and PFASs as a whole. [Display omitted] • Sources/co-sources of MPs and PFASs are common, but neglected. • Sorption behaviour of PFASs on MPs is complex and is influenced by many factors. • The transportation of the two from the perspective of mutual influence is reviewed. • The recent removal strategies of MPs and PFASs from water are summarized. [ABSTRACT FROM AUTHOR]

This work investigated the strength degradation mechanisms of seawater ordinary Portland cement (OPC) pastes. Two types of specimens were prepared ((i) OSD sample (i.e. OPC was mixed with seawater, and then cured in deionized (DI) water) and (ii) ODD sample (i.e. OPC was mixed with DI water, and then cured in DI water, as the reference system)). The use of seawater in preparing OPC pastes effectively increased the hydration rate and early-age mechanical strength, but lowered the mechanical strength at the later age. The higher hydration degree and larger amounts of carbonates with a smaller crystal size enabled the seawater OPC pastes to exhibit a higher early-age mechanical strength, increasing by 13.0%–17.0% compared with the DI water OPC pastes. While the formation of Friedel's salt and the formation of calcium-silicate-hydrate (C-S-H) gel with a lower polymerization degree and mean molecular chain length resulted in the deterioration of the pore structure and negatively affected the later-age strength development of the seawater OPC paste, decreasing by 5.8%–11.9% compared with the DI water OPC pastes. [ABSTRACT FROM AUTHOR]

Supersulfated cement (SSC) is a traditional low-carbon cement, but its slow hydration and strength development has limited its practical applications. Nano silica (NS) was used to activate the hydration of SSC by taking advantage of its ability to regulate silicate and aluminate reactions. The mechanical performance of various mixes was determined, as a function of sulfation degree and NS addition, as pore structure, phase assemblage, hydration degree, and microstructure. Results showed that NS improves the hydration degree of slag, densifies the microstructure, and significantly increases both early- and late-age compressive strength. The enhancement was attributed to its effects on the hydration of slag in SSC: delaying ettringite formation, but promoting C-(A)-S-H precipitation, reducing microporosity. This study reveals the critical role of the regulation of hydration kinetics of silicate and aluminate in controlling the performance of SSC as NS does. [ABSTRACT FROM AUTHOR]

Background Studies have reported that pharmacologic interventions with candesartan or ramipril could reduce the risk of hypertension among prehypertensive subjects free of clinical cardiovascular disease (CVD), however, the cost-effectiveness and long-term cardiovascular risk of drug treatment among these population is unclear. Method A Markov state-transition model was developed to simulate a hypothetical cohort of Chinese adults with high-range prehypertension (130–139/85–89 mm Hg) but without CVD. Data on the incidence of CVD and hypertension was obtained from corresponding risk equations. Utility and disease-related costs were obtained from published literatures. Robustness and uncertainty was evaluated using deterministic and probabilistic sensitivity analyses. Results Compared with placebo, drug treatment resulted in delaying the development of hypertension by nearly 12 years and reducing the absolute incidence of hypertension by 32.01% over lifetime. The cumulative incidence of coronary heart disease, stroke and heart failure were reduced and survival was improved from 28.46 to 28.80 years. The average incremental cost effectiveness ratio for drug treatment was $12,994 per quality-adjusted life-year and the value was mostly sensitive to the effect size of treatment and age starting treatment. At a willingness-to-pay threshold of > 3 × China gross domestic product per capita in 2014, there was a 30.48% chance that drug treatment would remain cost-effective and a low chance of being cost-effective if relative risk of treatment on hypertension was larger than 0.64. Conclusion Drug treatment for prehypertension may help stem the current epidemic of hypertension among Chinese adults free of CVD, which may in turn reduce CVD complications and potentially be cost effective. [ABSTRACT FROM AUTHOR]

Objective Restricted pulmonary function is found among people with diabetes. This study aimed to investigate the dose-response relationship between pulmonary function measurements [forced expiratory volume in one second ( FEV1) and forced vital capacity ( FVC)] and risk of metabolic syndrome ( MS)/type 2 diabetes. Methods A total of 1454 adults in rural Victoria, Australia, and 5824 adults in Nanjing, China, from randomly selected households provided clinical history, oral glucose tolerance test, lipids, anthropometric, blood pressure and spirometric measurements. MS was defined by International Diabetes Federation criteria. Adjusted odds ratios for MS and type 2 diabetes with lung capacity measurements were estimated using logistic regression. Dose-response relationships were explored using the restricted cubic spline models. Results There was a nonlinear relationship between FEV1 and the risk of type 2 diabetes and MS (both P < 0·0001) in both the Australian and Chinese populations. The FEV1 associated with the lowest risk of type 2 diabetes and MS was above 2·70 l (95% CI: 2·68 to 2·72 l and 2·65 to 2·76 l in Chinese and Australian populations, respectively). The discrimination of the model could be significantly improved using the FEV1 threshold in both the Australian and Chinese populations. Conclusions In both the Australian and Chinese populations, the risk of type 2 diabetes and MS is lowest with a FEV1 of 2·65-2·76 l. This might be used in clinical practice in different countries as a prompt to screen for type 2 diabetes and MS in patients with obstructive lung disease and to ensure there was no abnormal glucose metabolism before the commencement of steroids if indicated. [ABSTRACT FROM AUTHOR]

Background Type 2 Diabetes (T2DM) affects different populations disproportionately including in New Zealand (NZ), where long-term temporal trends in cause-specific clinical outcomes between Māori, European and Pacific people remain unclear. Methods Data from patients with T2DM, aged 35-84 years enrolled 1994-2018 in a NZ primary care audit programme (the Diabetes Care Support Service) were linked with national death registration, hospitalisation, pharmaceutical claims and primary care databases. Cause-specific death and hospitalisation rates were adjusted for gender, age, smoking, obesity, social-economic status and time periods by age-period-cohort models. Results Overall, 79,912 (50.6% female, mean-age 56±15 years, median follow-up 9.7 years) patients with T2DM were enrolled. For Europeans vs Māori, adjusted incidence rates ratio (IRR) and absolute risk difference /1000 person-years were 1.96 (95% CI: 1.80- 2.14) and 22.85 (19.93-25.77) for all-cause mortality, 1.93 (1.63-2.29) and 6.97 (5.14-8.80) for cardiovascular (CVD) mortality, 1.64 (1.40-1.93) and 3.08 (2.25-3.92) for cancer mortality, 1.26 (1.25-1.28) and 42.70 (41.32-44.08) for CVD hospitalisation, 1.31 (1.28-1.34) and 44.76 (42.37-47.15) for cancer hospitalisation, 2.05 (1.96-2.14) and 31.44 (29.67-33.21) for end-stage renal disease (ESRD) hospitalisation. Pacific rates were significantly less than Māori, but higher than Europeans for ESRD (IRR:1.59 (1.52-1.67)) and CVD (1.09 (1.07-1.10)) hospitalisation. Conclusions Poorer health outcomes have persisted among Māori and Pacific people with T2DM for >20 years. New policies supporting more intensive management of T2DM are urgently needed. Differences in outcomes between Māori and Pacific people warrant further research. Key messages Outcome disparities have persisted among Māori and Pacific people with T2DM for >20 years. [ABSTRACT FROM AUTHOR]

Hospitalization has been higher among New Zealand (NZ) Māori and Pasifika than Europeans with type 2 diabetes (T2DM) for >20 years. We compared their metabolic profiles as possible drivers behind the worse outcomes. Methods: We identified four 5-year cohorts incorporating 15498 Europeans, 6445 Māori 10294 Pasifika with T2DM enrolled in 1994, 1999, 2004, 2009, to a primary care audit program. Systolic blood pressure (SBP), body mass index (BMI), HbA1c, albumin creatinine ratio (ACR), total cholesterol (TC), and triglyceride were measured at baseline, 1, 2, 3, 4 and 5-years. Mean and mean-difference (reference= European) were estimated at each time-point, with adjustment for age, gender, smoking, SE status, diabetes duration, key meds and the other measures. Multiple imputation with chained equation tackled missing values. Multivariable mixed effects modelling was used to model the repeated measurements. Results: Compared with Europeans, Māori (black) and Pasifika (grey) had higher HbA1c, ACR, and lower SBP at each time-point and within each cohort. Fig 1 shows the adjusted mean (95%CI) differences. Conclusions: NZ Māori/Pasifika under primary care management have better SBP and lipids, but worse glycemia than Europeans. This could partly explain the worse Māori/Pasifika outcomes and suggests that glycemic management is more challenging than BP/lipid management for primary care. Disclosure: D. Simmons: None. D. Yu: None. R. G. Cutfield: None. B. J. Orr-walker: None. Z. Zhao: None. Y. Cai: None. C. Hotu: None. J. Baker: None. U. L. Osuagwu: None. Funding: Counties Manukau Health; Middlemore Foundation [ABSTRACT FROM AUTHOR]

• A large asymmetric confluence with complex confluent configurations was investigated. • The pollutants at the confluence displayed significant spatiotemporal variability. • The severe polluted tributary seriously affected the water quality at the confluence. • The discharge ratio is the controlling factor that affects the mixing process. Previous studies of confluences have mainly concentrated on their hydrodynamic characteristics and morphological dynamics. However, the increasing environmental pollution in rivers has resulted in abrupt variations in water quality at confluences, thus affecting the ecosystems in river networks. Therefore, more attention should be paid to the pollutant distribution and mixing processes at confluences. In this study, several field experiments on pollutant concentrations were conducted at a large asymmetric confluence with a discordant bed and wide-shallow channel in northern China, where a heavily polluted tributary known as the Fen River joins the Yellow River. The results displayed that the heavily polluted tributary seriously affected the water quality at the confluence, especially in the downstream channel near the tributary. The contaminations at the confluence present a relatively strong temporal variability. The organic matter and dissolved oxygen show a similar seasonal variability with each other whereas ammonia nitrogen and total phosphorus are also similar to each other, but they have a different variability from the first group. These pollutants mostly demonstrated the same spatial distribution characteristics, with large horizontal concentration differences at the confluence. The standard deviation of the cross-sectional concentration gradually decreased with the downstream mixing of contaminants. Nonetheless, under conventional hydrological conditions, these contaminants were not completely mixed through a length of 27 river widths. Compared with a concordant bed, this discordant confluence exhibited a relatively fast mixing rate. The key factor affecting the mixing process at the confluence was the discharge ratio. Exceptionally, during the irrigation period (March–April), owing to the extremely low discharge of the tributary, the main stream flowed backward into the tributary, which enhanced the mixing motion to constitute an approximately full mixing regime at the mouth of the tributary. These results are of great importance in understanding the degree of contamination, spatiotemporal distribution and mixing dynamics of characteristic pollutants at complex river confluences. [ABSTRACT FROM AUTHOR]