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Smallholder production is a significant contributor to rural livelihoods and rural economies in much of the developing world. Yet, there is evidence of increasing disengagement in some regions, including southern Africa. However, there has been little consideration of the rates and the livelihood, ecological and policy implications of such. In this paper we examine previous studies on rates of deactivation of crop fields by smallholders in the communal areas of South Africa, supported by repeat photo images and case study material. Together these various methods show that it is a widespread phenomenon occurring at variable rates. Over short periods deactivation of crop fields can be balanced through some reactivation or intensification of homegardens. But over longer periods there is a net decline in the area of fields cultivated in many areas, with corresponding increases in the area of fallow land which, through time, may undergo changes towards more natural vegetation. We review the drivers of this deactivation of field cropping, and then contemplate the possible socio-economic and ecological implications at local and national scales. We show that there are numerous and profound implications that require greater understanding and policy responses.

Liquefaction has always been intensely studied in parts of the world where earthquakes occur. However, the seismic activity is not the only possible cause of this phenomenon. It may in fact be triggered by some human activities, such as constructing and mining or by rail and road transport.

Spatial transcriptomics (ST) examines gene expression within its spatial context on tissue, linking morphology and function. Advances in ST resolution and throughput have led to an increase in scientific interest, notably in cancer research. This scoping study reviews the challenges and practical applications of ST, summarizing current methods, trends, and data analysis techniques for ST in neoplasm research. We analyzed 41 articles published by the end of 2023 alongside public data repositories. The findings indicate cancer biology is an important focus of ST research, with a rising number of studies each year. Visium (10x Genomics, Pleasanton, CA, USA) is the leading ST platform, and SCTransform from Seurat R library is the preferred method for data normalization and integration. Many studies incorporate additional data types like single-cell sequencing and immunohistochemistry. Common ST applications include discovering the composition and function of tumor tissues in the context of their heterogeneity, characterizing the tumor microenvironment, or identifying interactions between cells, including spatial patterns of expression and co-occurrence. However, nearly half of the studies lacked comprehensive data processing protocols, hindering their reproducibility. By recommending greater transparency in sharing analysis methods and adapting single-cell analysis techniques with caution, this review aims to improve the reproducibility and reliability of future studies in cancer research.

A renal angiomyolipoma (AML) is a rare, usually benign tumor consisting of smooth muscle cells, abnormal blood vessels, and fat tissue. Although AMLs are often asymptomatic, they can present with flank pain, hematuria, and a palpable mass in the abdomen. A significant complication involves rupture and hemorrhage into the retroperitoneal cavity, which can be life-threatening. The treatment approach has evolved from surgical removal to more conservative management, such as nephron-sparing embolization and mammalian target of rapamycin (mTOR) inhibitors for tuberous sclerosis complex (TSC)-associated AML. In March 2024, a 36-year-old female patient diagnosed with TSC was admitted to our department and underwent several endovascular embolizations after a life-threatening hemorrhage from a ruptured multilocular AML. The treatment was successful, with complete exclusion of the AMLs from circulation and without any complications during the postoperative period. This case emphasizes the effectiveness of selective arterial embolization using the Onyx liquid embolic system in managing AMLs and highlights the importance of preserving renal function. Methods used in AML diagnosis include ultrasound and computed tomography scans, with magnetic resonance imaging and biopsy recommended in difficult cases. Treatment depends on aspects such as tumor size, symptoms, and patient's general condition, with options ranging from active surveillance for small, asymptomatic AMLs to more invasive procedures for larger, symptomatic tumors. The main goal is to minimize symptoms and preserve renal function., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mach et al.)

Renal arteriovenous anomalies are uncommon. They are characterized by an abnormal vascular connection that usually bypasses the capillary bed. Most are acquired arteriovenous fistulas (AVF) while the rest are congenital or idiopathic arteriovenous malformations (AVM). AVF are usually caused by renal interventions, trauma, or neoplastic processes. They can lead to hypertension, heart failure, hematuria, and renal insufficiency. A 69-year-old woman presented with arrhythmia, tachycardia, mild ankle edema, and increasing fatigue. Right kidney color Doppler ultrasound confirmed the presence of a huge AVM with a blood flow of 9 L/minute and a dilated, 35 mm in diameter, right renal vein. Two months later, an attempt to embolize the AVM failed as the Amplatzer™ Vascular Plug II (Abbott Laboratories, Chicago, Illinois, United States) migrated to the pulmonary circulation and was later removed. Complete embolization was achieved by implanting two Amplatzer Vascular Plug IIs, various embolization coils, histoacryl glue, and lipiodol. Control angiography revealed significant stenosis in the right subclavian artery endovascular access, which was managed with BeGraft (Bentley InnoMed GmbH, Hechingen, Germany) and Zilver (Cook Group Incorporated, Bloomington, Indiana, United States) stents. The patient was discharged on the third postoperative day, all her symptoms resolved, and she reported eventual recovery. Three months later, the patient was operated on due to a 40x58 mm pseudoaneurysm at the right femoral access site. Thus, renal AVMs should be included as a potential alternative diagnosis for various symptoms such as hematuria and hypertension resistant to medication. Endovascular embolization is a less-invasive, safer, and more effective option than open surgery but has a risk of complications. Success requires fully occluding the shunted vessel, preventing embolic material migration, and preserving normal arterial branches. It depends on selecting adequate techniques and embolic materials individually, based on etiology and precise vascular anatomy assessment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mach et al.)

Dysregulation of histone deacetylases (HDACs) is closely associated with cancer development and progression. Here, we comprehensively analyzed the association between all HDAC family members and several clinicopathological and molecular traits of solid tumors across 22 distinct tumor types, focusing primarily on cancer stemness and immunity. To this end, we used publicly available TCGA data and several bioinformatic tools (i.e., GEPIA2, TISIDB, GSCA, Enrichr, GSEA). Our analyses revealed that class I and class II HDAC proteins are associated with distinct cancer phenotypes. The transcriptomic profiling indicated that class I HDAC members, including HDAC2, are positively associated with cancer stemness, while class IIA HDAC proteins, represented by HDAC7, show a negative correlation to cancer stem cell-like phenotypes in solid tumors. In contrast to tumors with high amounts of HDAC7 proteins, the transcriptome signatures of HDAC2-overexpressing cancers are significantly enriched with biological terms previously determined as stemness-associated genes. Moreover, high HDAC2-expressing tumors are depleted with immune-related processes, and HDAC2 expression correlates with tumor immunosuppressive microenvironments. On the contrary, HDAC7 upregulation is significantly associated with enhanced immune responses, followed by enriched infiltration of CD4+ and CD8+ T cells. This is the first comprehensive report demonstrating robust and versatile associations between specific HDAC family members, cancer dedifferentiation, and anti-tumor immune statuses in solid tumors.

The present study investigates the effects of the simultaneous use of two additives, an organosilane warm mix asphalt (WMA) agent and a grade-bumping polyolefin compound, on the conventional and high-temperature performance properties of a paving grade 50/70 bitumen and a polymer-modified 45/80-55 bitumen. The WMA agent and polyolefin additive were introduced to the binders at rates of up to 0.3% and 2%, respectively. The base asphalt binders and their blends with the additives were tested before and after aging in a rolling thin film oven test at a temperature of 143 °C. The effects of the investigated additives were found to be dependent on the type of base binder and its aging state. It was generally observed that the WMA additive decreased the performance of the asphalt binders and limited the effects of the other additive, which increased the high-temperature stiffness and non-recoverable compliance of the blends. This interaction amounted to as much as an approx. 20% decrease in high-temperature stiffness and non-recoverable compliance of the binders. The additives caused a small increase in the elasticity of the binders and improved their creep performance when measured in multiple stress creep recovery tests.

This paper presents the results of an analysis of the changes in the stiffness of asphalt binders modified with a bio-flux additive and subjected to the processes of foaming and short-term ageing. The purpose of the analyses was to determine changes in the rheological properties of asphalt binder as a result of technological processes characteristic of hot and warm mix asphalt technology. Three asphalt binders with similar penetration but varying degrees of polymer modification were tested: 50/70, 45/80-55 polymer-modified bitumen, and 45/80-80 highly modified bitumen. Tests were carried out on four groups of binders: original binders, foamed binders after 14 days of storage, non-foamed binders after Rolling Thin Film Oven Test (RTFOT) ageing, and foamed binders after 14 days of storage subjected to RTFOT ageing. The master curves of the complex shear modulus G* were analysed, and three indexes of binder stiffening were determined, characterising the investigated effects. The tests showed that some of the stiffening indices significantly depended on the degree of polymer modification and the content of the bio-flux additive. Moreover, it was found that the foaming process in the case of paving-grade bitumen and polymer-modified bitumen did not contribute to the additional stiffening of the binders.

The present paper investigates the viscoelastic stress-strain responses of laboratory and plant produced warm mix asphalt mixtures containing basalt fiber dispersed reinforcement. The investigated processes and mixture components were evaluated for their efficacy in producing highly performing asphalt mixtures with decreased mixing and compaction temperatures. Surface course asphalt concrete (AC-S 11 mm) and high modulus asphalt concrete (HMAC 22 mm) conventionally and using a warm mix asphalt technique with foamed bitumen and a bio-derived fluxing additive. The warm mixtures included lowered production temperature (by 10 °C) and lowered compaction temperatures (by 15 °C and 30 °C). The complex stiffness moduli of the mixtures were assessed under cyclic loading tests at combinations of four temperatures and five loading frequencies. It was found that the warm produced mixtures were characterized by lower dynamic moduli than the reference mixtures in the whole spectrum of loading conditions, however, the mixtures compacted at the 30 °C lower temperature performed better than the mixtures compacted at 15 °C lower temperature, specifically when highest testing temperatures are considered. The differences in the performance of plant and laboratory produced mixtures were ascertained to be nonsignificant. It was concluded that the differences in stiffness of hot mix and warm mixtures can be attributed to the inherent properties of foamed bitumen mixtures and that these differences should shrink in time.

The study investigated the effects of laboratory ageing on the fluxed and water-foamed asphalt binders in scope of Fourier transform infrared spectroscopic measurements of ageing indicators and changes in their chemical composition. The investigated binders included two paving grades, two polymer modified asphalt binders, and a highly modified asphalt binder. The bio-flux additive was produced from rapeseed methyl esters in an oxidation reaction in the presence of a metal catalyst and organic peroxide. The use of the bio-origin additive, in particular oil derivatives, was aimed at softening and better foaming of asphalt binders. This modification is possible due to the good mixability of vegetable oils with an asphalt binder, which gives a homogeneous product with reduced stiffness. The study involved the rolling thin film oven, short-term, and the pressure ageing vessel, long term, and ageing to induce oxidation on the evaluated asphalt binders. The addition of the bio-flux additive has significantly decreased the measured content of ketone compounds related to oxidation in both non-aged and aged asphalt binders, although this effect after ageing were far smaller in magnitude. Additionally, both ageing processes decreased significantly the absorbances in the ester spectral bands specific to the bio-flux additive. All mentioned effects were similar in magnitude in all tested asphalt binders.

The present paper investigates the effects of simultaneous mechanical foaming using water and fluxing with a bio-derived agent on the properties of three distinct asphalt binders: 50/70 paving-grade bitumen, 45/80-55 polymer-modified bitumen, and 45/80-80 highly modified asphalt binder. The testing involved classical tests for assessing binder consistency (penetration at 25 °C, ring and ball softening point, Fraass breaking point, and dynamic viscosity) as well as performance tests (high and low Superpave critical temperatures and multiple stress creep recovery). The tests included assessment directly after asphalt binder foaming and were repeated after a 14-day period. It was shown that bitumen foaming had only short-term effects on the asphalt binders, which did not persist in the repeated tests after 14 days. The fluxing agent that was utilized caused significant changes in the consistency of all asphalt binders. The changes in the performance characteristics of the 50/70 and 45/80-55 binders were severe and amounted to a significant decrease in high-temperature performance of these binders. On the other hand, an improvement in all performance characteristics in the case of the 45/80-80 asphalt binder was observed as a result of the applied processes, particularly when measured 14 days after foaming. This study shows that the simultaneous use of foaming and the fluxing additive decreased the dynamic viscosity of the 45/80-80 binder, while improving its properties relating the pavement performance.

Background: Arabic-speaking refugees are the largest group of refugees arriving in the United States since 2008, yet little is known about their rates of healthcare access, utilization, and satisfaction after the end of the Refugee Medical Assistance (RMA) period., Methods: This study was a cross-sectional observational study. From January to December 2019, a household survey was conducted of newly arrived Arabic-speaking refugees in Connecticut between 2016 and 2018. Households were interviewed in Arabic either in person or over the phone by one of five researchers. Descriptive statistics were generated for information collected on demographics, prevalence of chronic conditions, patterns of health seeking behavior, insurance status and patient satisfaction using the Patient Satisfaction Questionnaire (PSQ-18)., Results: Sixty-five households responded to the survey representing 295 Arabic-speaking refugees - of which 141 (48%) were children. Forty-seven households (72%) reported 142 chronic medical conditions among 295 individuals, 62 persons (21%) needed daily medication, 285 (97%) persons were insured. Median patient satisfaction was > 4.0 out of 5 for 6 of 7 domains of the PSQ-18 but wide variation (scores from 1.0 - 5.0)., Conclusion: Arabic-speaking refugees in Connecticut participating in this study were young. The majority remained insured after their Refugee Medical Assistance lapsed. They expressed median high satisfaction with health services but with wide variation. Inaccessibility of health services in Arabic and difficulty obtaining medications remain areas in need of improvement., (© 2022. The Author(s).)

The paper presents the results of exploratory research on the use of reclaimed cement concrete in cold-recycled mixes with foamed bitumen. Because reclaimed cement concrete, unlike natural aggregates, is expected to have a residue of the non-hydrated cement covering the aggregate grains, which may result in a secondary cementation process after its application in a road base, this avenue was explored by tracking the time evolution of the compressive strength of the final material. The tests were performed using two mixtures, i.e., a reference mixture and a mixture containing 25% reclaimed cement concrete. The mixtures containing reclaimed cement concrete were characterized by increased uniaxial compressive strengths after each curing period (3, 4, 7, 14 and 28 days)-by 11.5 kPa on average and e.g., 498 kPa vs. 506 kPa after 28 days. The obtained differences between the mixtures were not found to be statistically significant. The small effects of the incorporation of reclaimed cement concrete were attributed to the time passed typically between the demolition and new pavement construction and to the presence of a second binding material-bitumen.

Vertical Flow Treatment Wetland (VF-TW) systems achieve high efficiencies in terms of carbon related parameters removals from domestic wastewaters. Nitrogen removal is also efficient but optimisations are still needed. This article reports and discusses experimental data collected from 24-h monitoring campaigns of 29 full-scale VF-TWs, having different configurations and operation time up to 13 years. All monitored systems gathered 1 or 2 stage(s) of unsaturated or partially saturated VF-TW. Additionally, some of those included an aerobic biological Tricking Filter (TF) prior to TW stage(s). Results firstly showed that the implementation of a TF improved TSS, COD and BOD 5 removal rates in the monitored systems. Regarding nitrogen removal, the association of TF with one stage of partially saturated vertical TW was found to achieve around 79% of nitrification in average and up to 92% in some cases. In the configurations where TF was associated to 2 successive stages of TW, almost all total nitrogen removal by nitrification/denitrification was achieved at the outlet of the first-stage TW. The contribution of the second-stage TW in denitrification was found very low due to limited availability of organic carbon to support heterotrophic denitrification. Specific solutions to enhance the contribution of the second stage in the denitrification process are discussed., (Copyright © 2021. Published by Elsevier Ltd.)

The presented study explores the effects of decreased temperatures utilized in rolling thin-film oven (RTFOT) laboratory short-term ageing of asphalt binders based on 35/50- and 50/70-penetration paving-grade bitumen. Additionally, the effects of three additives used with these binders at different concentrations are evaluated: liquid anti-stripping agent, liquid warm-mix additive, and solid warm-mix additive. The resulting asphalt binders were subjected to basic (penetration at 25 °C, softening point, dynamic viscosity) and functional high-temperature characterization (G*/sin(δ), high critical temperature, non-recoverable creep compliance). It was found that the decreased short-term ageing temperatures may detrimentally impact the high-temperature grade of bituminous binders, but this effect can be mitigated by the use of appropriate additives. What is more, it was found that bituminous binders may respond differently to the aforementioned factors. Based on the results, it is advised that asphalt binders intended for use in warm-mix asphalts should be thoroughly tested to appropriately simulate the mixture production process and its effects.

The process of water-based foaming of bitumen produces binders that can be incorporated in cold recycled asphalt mixes and pavement upper structural layers made of half-warm mix asphalt prepared at 100-130 °C. During the foaming process, cold water and air act on hot bitumen (160-170 °C), which results in the explosive vaporization of water leading to changes in the binder structure. The impact of foaming on the properties of bitumen 70/100 was evaluated by investigating the binder characteristics before and after foaming. Determination of two foaming parameters, maximum expansion and half-life, was followed by measurements of penetration at 25 °C, softening point, Fraass breaking point, and dynamic viscosity at 60, 90, and 135 °C. Rheological and low-temperature tests were also performed before and after foaming bitumen 70/100. The Bending Beam Rheometer method was applied to determine the low temperature stiffness modulus. A DHR-2 rheometer was used to determine the dynamic modulus and phase angle of the tested binder. The Black and master curves before and after foaming were plotted in the 2S2P1D model and the model parameters were analysed. Analysis of the test results confirmed the effects of the foaming process on the basic, low-temperature, and rheological characteristics of the bitumen.

This study explores the effects of foaming on three selected bituminous binders: 50/70 paving grade bitumen, 45/80-55 polymer modified bitumen and 45/80-80 HiMA binder. The first part of the investigations included the evaluation of the foaming performance in terms of foaming temperature and foaming water content with the utilization of desirability functions and based on the equality of maximum expansion ratio and bitumen foam half-life. The second part of the study investigated the effects of foaming on the chemical structure of the binders using Fourier-transform infrared spectroscopy. The results of the spectroscopic measurements permitted calculation of structural indices specific to functional groups associated with bitumen oxidation, as well as those indicative of elastomeric modification. The results have shown that the different types of bitumen exhibited different foaming characteristics, which was most evident in bitumen foam half-lives, with the HiMA binder performing the best. The spectrometric measurements did not show any significant effects of foaming on the chemical structure of the evaluated binders related to oxidative stress, neither were any major changes in the PmB-specific regions found.

Background: Mobile devices are gaining a rising number of users in all countries around the globe. Novel solutions to diagnose patients with out-of-hospital onset of arrhythmic symptoms can be easily used to record such events, but the effectiveness of these devices remain unknown., Methods: In a group of 100 consecutive patients of an academic cardiology care center (mean age 68 ± 14.2 years, males: 66%) a standard 12-lead electrocardiogram (ECG) and a Kardia Mobile (KM) record were registered. Both versions were assessed by three independant groups of physicians., Results: The analysis of comparisons for standard ECG and KM records showed that the latter is of lower quality (p < 0.001). It was non-inferior for detection of atrial fibrillation and atrial flutter, showed weaker rhythm detection in pacemaker stimulation (p = 0.008), and was superior in sinus rhythm detection (p = 0.02), though. The sensitivity of KM to detect pathological Q-wave was low compared to specificity (20.6% vs. 93.7%, respectively, p < 0.001). Basic intervals measured by the KM device, namely PQ, RR, and QT were significantly different (shorter) than those observed in the standard ECG method (160 ms vs. 180 ms [p < 0.001], 853 ms vs. 880 ms [p = 0.03] and 393 ms vs. 400 ms [p < 0.001], respectively)., Conclusions: Initial and indicative value of atrial fibrillation and atrial flutter detection in KM is comparable to results achieved in standard ECG. KM was superior in detection of sinus rhythm than eye-ball evaluation of 12-lead ECG. Though, the PQ and QT intervals were shorter in KM as compared to 12-lead ECG. Clinical value needs to be verified in large studies, though.

This paper presents an advanced characterization of the organic fraction of the top deposit layer collected in a French vertical flow treatment wetland (first stage) in operation in Brazil (two units with different organic deposit layer accumulation times), and compares the results with those obtained from studies in France. The organic and inorganic constituents of the samples collected were analysed by biological, chemical and thermochemical methods. The unit with the organic deposit with longer accumulation time (almost 10 years) was characterized as a mature one (organic matter - OM: 51.3 and 52.7%, thermal index - R TGA : 0.79 and 0.85, humification index - HI: 0.61 and 1.16, respectively for the depths of 0-5 cm and 5-10 cm). The unit with the deposit organic with less than three years of accumulation also presented characteristics of a mature deposit (OM: 61.2%, R TGA : 0.79, HI: 1.01 for the depth of 0-5 cm), indicating a rapid mineralization of the deposit under the existing subtropical environment. Despite several differences in term of conception, hydraulic and mass loading rates and accumulation rates, the characteristics of the OM of Brazilian deposits were found to be quite similar to the French ones., 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: New protocols of pulmonary veins isolation (PVI) result in easier and more efficient procedure performance. Ablation index (AI) is the novel tool which helps to achieve transmural lesions during catheter ablation. However, benefit of this protocol in the reduction of myocardial injury is still not known., Purpose: The aim of the study was to compare myocardial injury during catheter ablation using standard and AI protocol., Methods: To the analysis we included 24 patients with paroxysmal atrial fibrillation, who underwent radiofrequency catheter PVI using CARTO system (Biosense Webster, Inc). In all patients cardiac troponin I (cTnI) levels were assessed before and 24 hours after the procedure. In 12 patients PVI was performed using continuous applications (dragging technique) and in 12 patients during PVI ablation AI protocol was implemented. To unify analyzed groups, we excluded patients with additional ablation lines (including line separating ipsilateral pulmonary veins)., Results: In analyzed group mean age was 59.3 ± 7.7 years and 18 (75%) patients were male. There were no differences in the clinical characteristic between both subgroups. Trend in shorter total x-ray time was observed in AI group compared with dragging group (8.6 ± 5.4 vs. 5.3 ± 3.2 min.; P  = .093) with no differences in total procedure time (146.3 ± 28.9 vs. 153.2 ± 37.1 min.; P  = .616). Twenty-four hours after the PVI procedure cTnI levels were significantly lower in AI group than in dragging group (1.984 ± 0.644 vs. 3.369 ± 1.818 ng/mL; P  = .026), with no difference in mean baseline cTnI levels (0.004 ± 0.006 vs. 0.015 ± 0.032 ng/mL; P  = .304)., Conclusion: Presented study revealed that compared with standard, continuous applications, AI protocol implementation results in reduction of myocardial injury during catheter PVI in patients with paroxysmal atrial fibrillation., Competing Interests: The local institutional review board of Medical University of Warsaw approved trial on October 6, 2016 (number KB/143/2016), and the trial was registered at the ClinicalTrials.gov on July 26, 2016 (identifier: NCT02844959). All the other authors report that they have no relationships to disclose that are relevant to the contents of this paper., (© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Objectives: Adoption of emergency department (ED) initiation of buprenorphine (BUP) for opioid use disorder (OUD) into routine emergency care has been slow, partly due to clinicians' unfamiliarity with this practice and perceptions that it is complicated and time-consuming. To address these barriers and guide emergency clinicians through the process of BUP initiation, we implemented a user-centered computerized clinical decision support system (CDS). This study was conducted to assess the feasibility of implementation and to evaluate the preliminary efficacy of the intervention to increase the rate of ED-initiated BUP., Methods: An interrupted time series study was conducted in an urban, academic ED from April 2018 to February 2019 (preimplementation phase), March 2019 to August 2019 (implementation phase), and September 2019 to December 2019 (maintenance phase) to study the effect of the intervention on adult ED patients identified by a validated electronic health record (EHR)-based computable phenotype consisting of structured data consistent with potential cases of OUD who would benefit from BUP treatment. The intervention offers flexible CDS for identification of OUD, assessment of opioid withdrawal, and motivation of readiness to start treatment and automates EHR activities related to ED initiation of BUP (including documentation, orders, prescribing, and referral). The primary outcome was the rate of ED-initiated BUP. Secondary outcomes were launch of the intervention, prescription for naloxone at ED discharge, and referral for ongoing addiction treatment., Results: Of the 141,041 unique patients presenting to the ED over the preimplementation and implementation phases (i.e., the phases used in primary analysis), 906 (574 preimplementation and 332 implementation) met OUD phenotype and inclusion criteria. The rate of BUP initiation increased from 3.5% (20/574) in the preimplementation phase to 6.6% (22/332) in the implementation phase (p = 0.03). After the temporal trend of the number of physician's with X-waiver training and other covariates were adjusted for, the relative risk of BUP initiation rate was 2.73 (95% confidence interval [CI] = 0.62 to 12.0, p = 0.18). Similarly, the number of unique attendings who initiated BUP increased modestly 7/53 (13.0%) to 13/57 (22.8%, p = 0.10) after offering just-in-time training during the implementation period. The rate of naloxone prescribed at discharge also increased (6.5% preimplementation and 11.5% implementation; p < 0.01). The intervention received a system usability scale score of 82.0 (95% CI = 76.7 to 87.2)., Conclusion: Implementation of user-centered CDS at a single ED was feasible, acceptable, and associated with increased rates of ED-initiated BUP and naloxone prescribing in patients with OUD and a doubling of the number of unique physicians adopting the practice. We have implemented this intervention across several health systems in an ongoing trial to assess its effectiveness, scalability, and generalizability., (© 2020 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine (SAEM).)

Trophic magnification factors (TMFs, i.e., the average change in the log-concentration of a pollutant per trophic level) have been extensively assessed for the so-called persistent organic pollutants, especially organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs), which are biomagnified along the food web. In contrast, trophic dilution was documented for pollutants with a high metabolic conversion rate, such as phthalate plasticizers and polycyclic aromatic hydrocarbons (PAHs). However, the fate of their metabolites across the food web has been rarely investigated. In this comparative study, the trophodynamics of 104 micropollutants and 25 of their metabolites were investigated in a freshwater food web from the urban Orge River, France. Trophic levels were determined using stable isotopes. Pyrethroid pesticides and their metabolites were not detected. As predicted, PCBs and OCPs biomagnified (TMF >1), while all chlorinated paraffins (CPs), PAHs, and phthalates underwent a trophic dilution (TMF <1). TMFs significantly decreased with a metabolic transformation rate and increased with hydrophobicity. The levels of PAH or phthalate metabolites were not significantly correlated with trophic levels or underwent a trophic dilution. This study highlighted that the relative contribution of metabolite levels in TMF values calculated for both parent compound and its metabolite(s) is weak compared to TMF values of the parent compound only in a riverine food web.

Sustainably achieving the goal of global food security is one of the greatest challenges of the 21st century. The current food system is failing to meet the needs of people, and at the same time, is having far-reaching impacts on the environment and undermining human well-being in other important ways. It is increasingly apparent that a deep transformation in the way we produce and consume food is needed in order to ensure a more just and sustainable future. This paper uses the concept of regime shifts to understand key drivers and innovations underlying past disruptions in the food system and to explore how they may help us think about desirable future changes and how we might leverage them. We combine two perspectives on regime shifts-one derived from natural sciences and the other from social sciences-to propose an interpretation of food regimes that draws on innovation theory. We use this conceptualization to discuss three examples of innovations that we argue helped enable critical regime shifts in the global food system in the past: the Haber-Bosch process of nitrogen fixation, the rise of the supermarket, and the call for more transparency in the food system to reconnect consumers with their food. This paper concludes with an exploration of why this combination of conceptual understandings is important across the Global North/ Global South divide, and proposes a new sustainability regime where transformative change is spearheaded by a variety of social-ecological innovations.

Hot-mix asphalt (HMA) remains the predominant material for pavement surfacing. Mixing is performed at about 180 °C, depending on the bitumen used. Environmental concerns in terms of emissions and energy demand are fostering new sustainable technologies in road construction. Warm-mix asphalt (WMA) and half-warm-mix asphalt (HWMA) mixtures meet current expectations in that they are produced at lower temperatures, 100-130 °C, ensured by foaming the bitumen with water. The extent of temperature reduction requires that the mixture has adequate moisture and frost resistance, which is particularly important in countries that have a low-temperature climate. Asphalt concrete AC 8 S with 50/70-grade foamed bitumen modified with 0.6 wt.% surface-active agent (SAA) was used in the tests. To provide the AC mixture with the required resistance to climatic factors (water, temperature below 0), hydrated lime was added at 0, 15, 30, and 45 wt.% as limestone filler replacement. The influence of the hydrated lime addition on the air void content and resistance to moisture and frost damage was investigated according to the WT-2 2014 methodology based on EN 12697-12: 2008 and to the modified AASHTO T283 method. The optimum content of hydrated lime for filler replacement was determined through statistical analysis of the test results. With the optimum hydrated lime replacement of 30%, the required level of moisture and frost resistance of HWMA concrete with foamed bitumen is achieved. The results of this study confirmed the suitability of HWMA concrete with foamed bitumen for application in road construction practice.

The paper aimed at assessing the feasibility of using natural zeolites as a mineral filler substitute for asphalt mixtures produced at around 120 °C temperatures with a water foamed binder and compacted at 100 °C. The tests utilized the AC 16 asphalt concrete mixture intended for the binder and base course with the mineral filler fraction amounting to 4% by wt. comprising limestone dust and zeolites (when added). A reference hot mix and warm mix with foamed bitumen were compared to two mixes with zeolites, with one containing 0.4% of a water-modified (20% moisture content) zeolite and the second containing 1.0% of natural air-dried zeolite. The investigations included: assessment of campactability using a gyratory compactor, air void content, indirect tensile strength before and after conditioning with one freeze-thaw cycle, and the resulting resistance to moisture and frost damage. The mixtures with zeolites exhibited decreased compactability when compared to reference mixes, which the Marshall samples confirmed. The mechanical properties have also deteriorated in zeolite-bearing mixtures, which was partially accounted to the decreased compaction level. It was concluded that the temperature of the mixture production was too low for the zeolite water to significantly improve the compactablity of the asphalt mixture and its mechanical parameters.

Background: The aim of the study was to compare clinical characteristics of real-life atrial fibrillation (AF) patients with populations included in randomized clinical trials (ROCKET AF and RE-LY)., Methods: The analysis included 3528 patients who are participants of the ongoing, multicentre, retrospective CRAFT study. The study is registered in ClinicalTrials.gov: NCT02987062. The study is based on a retrospective analysis of hospital records of AF patients treated with vitamin K antagonists (VKAs) (acenocoumarol, warfarin) and non-vitamin K oral anticoagulants (NOACs) (dabigatran, rivaroxaban). CHADS2 score was used for risk of stroke stratification., Results: VKA was prescribed in 1973 (56.0%), while NOAC in 1549 (44.0%), including dabigatran - 504 (14.3%) and rivaroxaban - 1051 (29.8%), of the 3528 patients. VKA patients in the CRAFT study were at significantly lower risk of stroke (CHADS2 1.9 ± 1.3), compared with the VKA population from the RE-LY (2.1 ± 1.1) and the ROCKET-AF (3.5 ± 1.0). Patients in the CRAFT study treated with NOAC (CHADS2 for patients on dabigatran 150 mg - 1.3 ± 1.2 and on rivaroxaban - 2.2 ± 1.4) had lower risk than patients from the RE-LY (2.2 ± 1.2) and the ROCKET AF (3.5 ± 0.9)., Conclusions: Real-world patients had a lower risk of stroke than patients included in the RE-LY and ROCKET AF trials.

Background: The HEARTSafe Communities program promotes community efforts to improve systems for treating sudden cardiac arrest (SCA). The study hypothesis was that the rates of SCA survival to admission, discharge, and discharge with CPC score 1 or 2 are higher in HEARTSafe-designated communities than non-designated communities in Connecticut, USA. Secondary outcomes included bystander CPR and AED application., Methods: The state Office of EMS supplied a list of towns that are HEARTSafe-designated, and dates of designation. The Cardiac Arrest Registry to Enhance Survival provided data for all SCA from 2013 to 2017 in the 70 participating towns. For each SCA, it was determined whether the town was HEARTSafe-designated at the time., Results: Of 2922 SCA cases, 1569 (54%) occurred in towns that were HEARTSafe-designated. Patients in designated towns were 1.15 times more likely to have AEDs applied by bystanders, and 1.15 times more likely to have CPR started by bystanders, than were patients in non-designated towns, but these differences were not significance (p = 0.66 and 0.28). The likelihood of surviving to admission was 1.33 times higher (p = 0.02) in designated towns. The likelihood of surviving to discharge was 1.33 times higher, and of surviving to discharge with CPC 1 or 2 was 1.4 times higher, but these differences were not significant (p = 0.17 and 0.13)., Conclusion: SCA survival rates do not differ between HEARTSafe and non-HEARTSafe communities in Connecticut. SCA patients in HEARTSafe communities are no more likely to receive bystander AED application or bystander CPR., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Buprenorphine (BUP) can safely and effectively reduce craving, overdose, and mortality rates in people with opioid use disorder (OUD). However, adoption of ED-initiation of BUP has been slow partly due to physician perception this practice is too complex and disruptive. We report progress of the ongoing EMBED ( EMergency department-initiated BuprenorphinE for opioid use Disorder) project. This project is a five-year collaboration across five healthcare systems with the goal to develop, integrate, study, and disseminate user-centered Clinical Decision Support (CDS) to promote the adoption of Emergency Department (ED)-initiation of buprenorphine/naloxone (BUP) into routine emergency care. Soon to enter its third year, the project has already completed multiple milestones to achieve its goals including (1) user-centered design of the CDS prototype, (2) integration of the CDS into an automated electronic health record (EHR) workflow, (3) data coordination including derivation and validation of an EHR-based computable phenotype, (4) meeting all ethical and regulatory requirements to achieve a waiver of informed consent, (5) pilot testing of the intervention at a single site, and (6) launching a parallel group-randomized 18-month pragmatic trial in 20 EDs across 5 healthcare systems. Pilot testing of the intervention in a single ED was associated with increased rates of ED-initiated BUP and naloxone prescribing and a doubling of the number of unique physicians adopting the practice. The ongoing multi-center pragmatic trial will assess the intervention's effectiveness, scalability, and generalizability with a goal to shift the emergency care paradigm for OUD towards early identification and treatment., Trial Registration: Clinicaltrials.gov # NCT03658642., Competing Interests: CONFLICTS OF INTEREST The authors have no financial conflicts or competing interests to disclose.

The present work examined the trophic transfer of perfluoroalkyl and polyfluoroalkyl substances (PFASs) in a typical urban river (Orge River, near Paris, France), and aimed to investigate the potential contribution of precursors to the biomagnification of perfluoroalkyl acids (PFAAs). Sixteen PFAAs, twelve of their precursors (pre-PFAAs targeted ) and two fluorinated alternatives to long-chain PFASs were analyzed in water, sediments and biota (including biofilm, invertebrates and fish). Twenty two compounds were detected in biological samples (2.0-147 ng g -1 wet weight), perfluorooctane sulfonate (PFOS) and C 12 -C 14 perfluoroalkyl carboxylates (PFCAs) being predominant while ∑pre-PFAAs targeted contributed to 1-18% of ∑PFASs. Trophic magnification factors (TMFs) were >1 (i.e. denoting biomagnification) for C 9 -C 14 PFCAs, C 7 -C 10 perfluoroalkyl sulfonates (PFSAs) and several pre-PFAAs (e.g. 8 : 2 and 10 : 2 fluorotelomer sulfonates). The significant decrease in ∑pre-PFCAs/∑PFCAs concentration ratio with trophic level suggested a likely contribution of selected precursors to the biomagnification of PFCAs through biotransformation, while this was less obvious for PFOS. The total oxidizable precursor assay, applied for the first time to sediment and biota, revealed the presence of substantial proportions of extractable unknown pre-PFAAs in all samples (i.e. 15-80% of ∑PFASs upon oxidation). This proportion significantly decreased from sediments to invertebrates and fish, thereby pointing to the biotransformation of unattributed pre-PFAAs in the trophic web, which likely contributes to the biomagnification of some PFAAs (i.e. C 9 -C 12 PFCAs and C 7 -C 10 PFSAs).

To ensure the standard properties of half-warm asphalt (HWA) mixes produced with foamed bitumen, the binder needs to have the best possible characteristics. One way to attain this is to modify the bitumen before it is foamed. The 50/70 penetration bitumen used in this study, was modified with a surface active agent (SAA) at different rates (0.2%, 0.4%, and 0.6% by wt.). The effect of the modifier on the bitumen properties (penetration, softening point, the Fraass breaking point, dynamic viscosity at 60 °C, 90 °C, and 135 °C) and on the binder foaming parameters (expansion ratio - ER, half-life - HL, foam index - FI) was investigated and the optimum quantity of foaming water was determined. Statistical analysis of the results showed that the addition of 0.6% SAA had the most beneficial effect on the set of 50/70 bitumen standard properties and foaming characteristics.

Congestive heart failure (CHF) and atrial fibrillation (AF) frequently coexist and are associated with increased risk of cardiovascular events.To compare baseline characteristics, comorbidities and pharmacotherapy in AF patients with concomitant CHF to those without CHF.The study included 3506 real-life AF patients with (37.1%) and without CHF - participants of the multicentre, retrospective MultiCenter expeRience in AFib patients Treated with OAC (CRAFT) trial (NCT02987062).All patients were treated with non-vitamin K antagonist oral anticoagulants (NOAC) or vitamin K antagonists (VKA). The frequency of NOAC among patients with and without CHF was 45.6% and 43.2%, respectively (P = .17). Patients with CHF were older (73.3 vs 64.7 years, P <.001), less likely to be women (37.4% vs 42%, P = .007), had higher CHA2DS2-VASc score (3.8 ± 1.7 vs 2.6 ± 1.8, P <.001), more often had permanent AF (53.0% vs 13.4%, P <.001), chronic obstructive pulmonary disease (16.7% vs 4.9%, P <.001), coronary artery disease (64.3% vs 29.8%, P <.001), peripheral vascular disease (65.3% vs 31.4%, P <.001), chronic kidney disease (43.1% vs 10.0%, P <.001), liver fibrosis (5.7% vs 2.6%, P <.001), neoplasm (9.6% vs 7.3%, P = .05), history of composite of stroke, transient ischemic attack or systemic embolization (16.2% vs 10.7%, P <.001), pacemaker (27.4% vs 22.1%, P = .004), implantable cardioverter-defibrillator (22.7% vs 0.8%, P <.001) or transaortic valve implantation (4.0% vs 0.8%, P <.001), cardiac resynchronization therapy (8.7% vs 0.3%, P <.001), composite of kidney transplantation, hemodialysis or creatinine level > 2.26 mg/dL (3.6% vs 0.8%, P <.001) and had less often hypertension (69.4% vs 72.5%, P = .05).Patients with AF and CHF had a higher thromboembolic risk and had more concomitant diseases.

INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia with a significant risk of morbidity and mortality. Non-vitamin K antagonist oral anticoagulants are the first‑line drugs in stroke prevention in patients with AF. Oral anticoagulant (OAC) therapy may differ between medical centers. OBJECTIVES We compared the clinical characteristics of AF patients treated with OAC in a district and an academic hospital. PATIENTS AND METHODS We analyzed 3528 patients from the multicenter retrospective CRAFT study: 2666 patients from the academic hospital and 862 patients from the district hospital. Their baseline clinical characteristics were compared. RESULTS Patients treated in the district hospital were older (mean [SD] age, 73.9 [10.3] years vs 66.0 [13.4] years; P <0.001) and more likely female (49.1% vs 37.4%; P <0.001). Patients treated in the academic hospital more frequently had paroxysmal AF, while those in the district hospital, permanent AF. The latter group was also more likely to have comorbidities and a higher frequency of previous bleeding episodes or anemia. The groups did not differ regarding kidney function. In both groups, patients were significantly more likely to be on rivaroxaban than on dabigatran. The group treated in the district hospital were at higher risk of thromboembolic events than the other gruop (mean [SD] CHA2DS2VASc score, 4.6 [1.7] vs 3.05 [2.0]; P <0.001), as well as of hemorrhagic events (mean [SD] HASBLED score, 0.6 [0.7] vs 0.4 [0.6]; P <0.001). CONCLUSIONS Patients with AF treated with OACs in the district and academic hospitals have different clinical characteristics. Patients treated in the district hospital were older, had more comorbidities, more frequently had permanent AF, and were at higher risk of thromboembolic and bleeding events than patients treated in the academic hospital.

Background: The first-line drugs for the treatment of non-valvular atrial fibrillation (AF) are non-vitamin K antagonist oral anticoagulants (NOACs), which are preferred over vitamin K antagonists (VKAs). There is some evidence that there are dis-crepancies between everyday clinical practice and the guidelines., Aim: The study aimed to compare the characteristics of patients on VKAs, dabigatran, and rivaroxaban in everyday practice (i.e. baseline characteristics, drug doses, risk factors for bleeding and thromboembolic events). Additionally, we assessed the frequency of prescription of different oral anticoagulants (OACs) in recent years., Methods: This study consisted of data from the multicentre CRAFT (MultiCentre expeRience in AFib patients Treated with OAC) study (NCT02987062). This was a retrospective analysis of hospital records of AF patients (hospitalised in the years 2011-2016) treated with VKAs (acenocoumarol, warfarin) and NOACs (dabigatran, rivaroxaban). A total of 3528 patients with non-valvular AF were enrolled in the CRAFT study., Results: The total cohort consisted of 1973 patients on VKA, 504 patients on dabigatran, and 1051 patients on rivaroxaban. Patients on rivaroxaban were older (70.5 ± 13.1 years) and more often female (47.9%), compared with those on VKAs (67.0 ± 12.8 years, p < 0.001; 35.5%, p < 0.001) and on dabigatran (66.0 ± 13.9 years, p < 0.001; 38.9%, p = 0.001). Among NOACs, patients with persistent and permanent AF were more likely to receive rivaroxaban (54.7% and 73.4%, re-spectively) than dabigatran (45.3%, p < 0.001 and 26.6%, p = 0.002, respectively). Patients on rivaroxaban had higher risk of thromboembolic events (CHA2DS2VASc 3.9 ± 2.0, CHADS2 2.2 ± 1.4) than those on VKAs (3.3 ± 2.0, 1.9 ± 1.3) and on dabigatran (3.1 ± 2.0, 1.8 ± 1.3). Patients on rivaroxaban had also a higher rate of prior major bleeding (11.2%) than those on VKAs (6.7%, p < 0.001) and on dabigatran (7.3%, p = 0.02). Patients on lower doses of dabigatran and rivaroxaban had a significantly higher risk of thromboembolic and bleeding events. Use of VKAs in the year 2011 was reported in over 96% of patients on OACs, but this proportion decreased to 34.6% in 2016. In the last analysed year (2016) AF patients were treated mainly with NOACs - dabigatran (24.2%) and rivaroxaban (41.3%)., Conclusions: The prescription of VKAs declined significantly after the introduction of NOACs. Patients treated with different OACs demonstrated a distinct baseline clinical profile. The highest risk of thromboembolic events and incidence of major bleedings was observed in patients on rivaroxaban, in comparison to patients on VKAs and dabigatran. Among NOACs, patients treated with lower doses of dabigatran and rivaroxaban were older and had a significantly higher risk of thromboembolic and bleeding events.