RR Donnelley (United States)

Mozambique introduced 10-valent-pneumococcal conjugate vaccine (PCV10) in 2013. We aimed to evaluate the indirect effect of PCV10 on invasive pneumococcal disease (IPD) and clinical severe pneumonia (CSP) in infants aged less than 10 weeks. Routine surveillance data for IPD and CSP among admitted infants less than 10 weeks of age were analyzed to compare IPD and CSP incidence using demographic surveillance data from pre- and post-PCV10 periods. IPD was defined as isolation of pneumococcus from blood or cerebrospinal fluid, and CSP according to World Health Organization criteria. The incidence of IPD and CSP among infants less than 10 weeks decreased by 87% [incidence rate ratio (IRR): 0.13; 95% confidence interval (CI): 0.02-0.95] from 283/100,000 in the pre-PCV to 36/100,000 children year at risk (CYAR) post-PCV, and by 62% (IRR: 0.38; 95% CI: 0.27-0.52) from 4100/100,000 pre-PCV to 1550/100,000 CYAR post-PCV periods, respectively. Vaccine-type IPD incidence declined by 92% (IRR: 0.18; 95% CI: 0.02-1.34) from 205/100,000 pre-PCV to 36/100,000 CYAR post-PCV, though the reduction was not statistically significant. The mortality rate due to IPD among infants less than 10 weeks declined from 47/100,000 CYAR in the pre-PCV to 0 in the post-PCV period. Mortality due to CSP declined by 29% (IRR: 0.71; 95% CI: 0.34-1.50), from 457/100,000 CYAR in the pre-PCV to 324/100,000 in the post-PCV periods. PCV10 introduction led to substantial declines in the incidence of IPD, CSP and associated mortality in infants too young to be vaccinated (less than 10 weeks) in Mozambique, suggesting indirect protection.

Dans cette contribution, je me propose d’analyser la figure du convive cynique dans la comédie grecque et latine. Les allusions aux manières de table cyniques sont présentes dans trois passages : le fragment 137 d’Eubule, le fragment 132 d’Antiphane et les vers 703-704 du Stichus de Plaute. L’analyse présente des difficultés méthodologiques : le genre littéraire de la comédie laisse présupposer une représentation déformée de la réalité et les problèmes d’ordre philologique liés aux fragments grecs transmis par Athénée sont nombreux. Cependant, cette étude présente un grand intérêt, surtout si nous songeons au fait qu’il s’agit de sources très anciennes, un cas exceptionnel dans le panorama des sources cyniques. La comédie corrobore ainsi le caractère ancien de beaucoup de traits de la figure du Cynique à banquet récurrents dans des textes plus récents et de nature différente : la frugalité et la rusticité dans le choix de la nourriture, des boissons, de la vaisselle et même de la position assumée pendant le banquet ; l’association à des figures marginales comme les parasites, les esclaves et les animaux ; et enfin le refus de la paideia traditionnelle, caractéristique indispensable du bon convive philosophe.

In this study, we investigated the separability of vanadium and tungsten from spent SCR (Selective Catalytic Reduction) catalyst leach solution by reduction of vanadium and solvent extraction using Alamine 336 and conducted experiments to optimize process conditions.It is difficult to separate vanadium and tungsten due to their similar chemical behavior, but tungsten can be selectively extracted from acidic solution when vanadium extraction is prevented by reducing anionic pentavalent vanadium to cationic tetravalent vanadium.The results showed that NaHSO 3 was most suitable as a reducing agent, and the extraction efficiency of vanadium decreased and the separation efficiency increased as the amount of reducing agent added, reaction time, and temperature increased.When reducing NaHSO 3 1.5 eq, 60 min, and 60, which are optimal conditions of reduction, vanadium and tungsten were effectively separated with vanadium extraction efficiency of 5.8%, tungsten extraction efficiency of 99%, and separation factor of vanadium and tungsten of 7,564.

Abstract Disclosure: J.E. Mosquera: None. X. Li: None. N. Maalouf: None. Background: Parathyroidectomy (PTX) is the only cure for primary hyperparathyroidism (PHPT). However, the impact of PTX on bone mineral density (BMD) is very variable. Methods: To assess the impact of demographic and clinical characteristics on BMD change post-PTX, we retrospectively reviewed charts of patients with biochemically proven PHPT and successful PTX between 2006 and 2022 at our institution and who had available pre- and post-PTX DXA scans. We extracted available demographic, clinical, and laboratory data including age, gender, race, body mass index, pre-PTX serum parathyroid hormone, calcium, phosphorus, alkaline phosphatase (Alkphos), 25-OH-vitamin D, and creatinine, 24-hour urine calcium, and use of bisphosphonates. The association between these parameters and BMD changes were assessed using univariate and multivariate models. Results: 121 patients (107 women) were included in this analysis. 35% were African American and 50% Hispanic. At PTX, mean (SD) age was 59 (12) years, BMI was 33 (7) kg/m2. 36% had osteopenia and 47% had osteoporosis on pre-PTX DXA. 6% of patients used BP before PTX and 3% used BP within one year of PTX. At year 1 post-PTX, median BMD (25th-75th percentile) change was +2.7% (-0.2% - +6.6%) at the lumbar spine (LS), +2.4% (-0.5% - +5.9%) at the femoral neck (FN), +2.8% (0.7% - +4.7%) at total hip (TH), and +0.1% (-3.6% - +3.0%) at the 1/3 radius. In univariate analyses, 1-year change in FN BMD was positively associated with highest pre-PTX serum calcium, PTH, and Alkphos, and negatively associated with age and serum creatinine. TH BMD change at 1 year was positively associated with highest pre-PTX PTH and Alkphos, and negatively associated with lowest T-score at baseline, age, and pre-PTX serum phosphorus, 25-OH-D and creatinine. LS BMD change at 1 year was positively associated with highest pre-PTX serum calcium and PTH, and negatively associated with lowest phosphorus pre-PTX. In multivariate analyses, younger age, highest pre-PTX serum calcium, and lowest BMD T-score pre-PTX were all independently and significantly associated with greater increase in post-PTX BMD at the FN, TH, and LS. Moreover, pre-PTX Alkphos was associated with greater BMD gain at the FN and TH, while female gender was associated with greater gain in LS BMD. Conclusions: In patients with PHPT who undergo curative PTX, variable BMD changes are observed at 1-year post-PTX. Younger age at PTX, higher serum calcium, and lower BMD pre-PTX are all associated with greater BMD gains post-PTX. These findings should be considered in the counseling of PHPT patients undergoing PTX. Presentation: Saturday, June 17, 2023

The relationship between arsenic exposure and all-cause mortality and the joint effects of arsenic exposure and smoking have been poorly described in previous studies. After 27 years of follow-up, a total of 1738 miners were included in the analysis. Different statistical methods were used to explore the relationship between arsenic exposure and smoking and the risk of all-cause mortality and various causes of death. A total of 694 deaths occurred during the 36,199.79 person-years of follow-up. Cancer was the leading cause of death, and arsenic-exposed workers had significantly higher mortality rates for all-cause, cancer, and cerebrovascular disease. All-cause, cancer, cerebrovascular disease, and respiratory disease increased with cumulative arsenic exposure. We demonstrated the negative effects of smoking and arsenic exposure on all-cause mortality. More effective actions should be taken to reduce arsenic exposure in miners.

Exercise intolerance is a defining characteristic of heart failure with preserved ejection fraction (HFpEF). A marked rise in pulmonary capillary wedge pressure (PCWP) during exertion is pathognomonic for HFpEF and is thought to be a key cause of exercise intolerance. If true, acutely lowering PCWP should improve exercise capacity. To test this hypothesis, we evaluated peak exercise capacity with and without nitroglycerin to acutely lower PCWP during exercise in patients with HFpEF. Thirty patients with HFpEF (70±6 years of age; 63% female) underwent 2 bouts of upright, seated cycle exercise dosed with sublingual nitroglycerin or placebo control every 15 minutes in a single-blind, randomized, crossover design. PCWP (right heart catheterization), oxygen uptake (breath × breath gas exchange), and cardiac output (direct Fick) were assessed at rest, 20 Watts (W), and peak exercise during both placebo and nitroglycerin conditions. PCWP increased from 8±4 to 35±9 mm Hg from rest to peak exercise with placebo. With nitroglycerin, there was a graded decrease in PCWP compared with placebo at rest (-1±2 mm Hg), 20W (-5±5 mm Hg), and peak exercise (-7±6 mm Hg; drug × exercise stage P=0.004). Nitroglycerin did not affect oxygen uptake at rest, 20W, or peak (placebo, 1.34±0.48 versus nitroglycerin, 1.32±0.46 L/min; drug × exercise P=0.984). Compared with placebo, nitroglycerin lowered stroke volume at rest (-8±13 mL) and 20W (-7±11 mL), but not peak exercise (0±10 mL). Sublingual nitroglycerin lowered PCWP during submaximal and maximal exercise. Despite reduction in PCWP, peak oxygen uptake was not changed. These results suggest that acute reductions in PCWP are insufficient to improve exercise capacity, and further argue that high PCWP during exercise is not by itself a limiting factor for exercise performance in patients with HFpEF. URL: https://www. gov; Unique identifier: NCT04068844.

Abstract. While modern wind turbines have become by far the largest rotating machines on Earth with further upscaling planned for the future, a renewed interest in small wind turbines (SWTs) is fostering energy transition and smart grid development. Small machines have traditionally not received the same level of aerodynamic refinement as their larger counterparts, resulting in lower efficiency, lower capacity factors, and therefore a higher cost of energy. In an effort to reduce this gap, research programs are developing worldwide. With this background, the scope of the present study is 2-fold. In the first part of this paper, an overview of the current status of the technology is presented in terms of technical maturity, diffusion, and cost. The second part of the study proposes five grand challenges that are thought to be key to fostering the development of small wind turbine technology in the near future, i.e. (1) improving energy conversion of modern SWTs through better design and control, especially in the case of turbulent wind; (2) better predicting long-term turbine performance with limited resource measurements and proving reliability; (3) improving the economic viability of small wind energy; (4) facilitating the contribution of SWTs to the energy demand and electrical system integration; (5) fostering engagement, social acceptance, and deployment for global distributed wind markets. To tackle these challenges, a series of unknowns and gaps are first identified and discussed. Based on them, improvement areas are suggested, for which 10 key enabling actions are finally proposed.

Multiple substance use is a common but underrecognized problem in patients on opioid agonist treatment (OAT). Co-occurring substance misuse is associated with poor clinical and psychosocial outcomes. We aimed ( a ) to determine the effect of screening and brief intervention (SBI) for substance misuse in people on OAT and (b) to qualitatively summarize the implementation of SBI. We performed a systematic review of clinical trials on the efficacy of SBI for alcohol and drug misuse in participants on OAT. We searched 5 electronic databases and included published studies and unpublished trials. We measured the standardized mean difference in substance risk scores before and after intervention. We also estimated the standardized mean difference in alcohol consumption per day before and after intervention. We included a total of 8 studies; 5 of these were included in the meta-analysis, and all were reviewed for narrative synthesis. We observed a significant change in the pre-post brief intervention substance risk scores with a medium effect size (Hedges g = 0.752, 95% confidence interval, 0.405-1.099). Sensitivity analyses with different pretest-posttest correlations did not change our result. Modest effects of SBI were found in reducing both alcohol and illicit drug risk scores, and among the population on methadone and buprenorphine treatment. We also observed a significant decrease in alcohol consumption per day 3 months after SBI. Studies showed a limited and incomplete screening for substance misuse and delivery of brief intervention in OAT settings. Screening and brief intervention may be a potential treatment for co-occurring substance misuse among patients on OAT.

Introduction: The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is based on the central components of the Mediterranean and DASH diets and emphasizes foods that may provide a neuro-cognitive benefit. To date, no study has investigated adherence to the MIND diet and indices of cardiac remodeling. We hypothesized that adherence to the MIND diet may have a favorable impact on indices of cardiac remodeling. Methods: Multivariable linear regression related the MIND diet score to echocardiographic indices of cardiac remodeling in 2569 Framingham Offspring cohort participants (mean age, 67 years; 55% women). The MIND diet score contains 15 components, each with a maximum score of 1 (max score =15). We averaged MIND diet scores across 2-4 exam cycles. Primary and secondary echocardiographic measures are in Table 1 . Simple models (model 1) were adjusted for age, sex, and total energy intake, and additional models (model 2) were further adjusted for BMI, smoking, total/high-density lipoprotein cholesterol (TC-HDL) ratio, heart rate, diabetes, systolic blood pressure, and use of anti-hypertensive medication. Results: Participants had a mean (±SD) cumulative MIND diet score of 6.9 (± 1.7). The cumulative MIND diet score was significantly associated with favorable measures of E/e’, GLS, GCS, and MAPSE in model 1 ( Table 1 ). Associations between the MIND diet score and echocardiographic measures were attenuated and became non-significant in model 2 ( Table 1 ). A higher MIND diet score was associated with lower levels of several clinical risk factors including BMI (β±SE (p value): -0.01±0.002 (<.0001)), TC-HDL ratio (-0.05±0.01 (0.0002)), heart rate (-0.83±0.12 (<.0001)), with lower odds of diabetes (OR [95% CI]: 0.88 [0.82, 0.94]), and use of anti-hypertensive medication (0.94 [0.90, 0.99]). Conclusions: Favorable associations between cumulative adherence to the MIND diet and echocardiographic indices are likely mediated by the favorable impact of adherence to the MIND diet on clinical risk factors.

Objective: Adherence to the Mediterranean- DASH for Neurodegenerative Delay (MIND) diet has previously been associated with cognitive decline and dementia. To our knowledge, no prior study has investigated the association between the MIND diet and measures of brain volume, silent brain infarcts (SBIs) or brain atrophy. Methods: We aimed to evaluate, cross-sectionally and longitudinally, whether consumption of a diet consist with the MIND diet was associated with larger brain volumes, fewer SBIs and fewer atrophy in the community-based Framinham Heart Study. We included 1,904 participants (mean age 69 (SD, 9)) who completed a brain MRI and a validated food frequency questionnaire (FFQ). The MIND diet consists of 10 healthy and five unhealthy components (range: 0-15). A cumulative MIND diet score was calculated by averaging across three FFQs (exams 5 (1991-1995), 6 (1995-1998), and 7 (1998-2001)). From the total study population, 86 % completed all three FFQs. Brain MRI was performed proximal to exam 7 and again after a mean of 7 years (SD, 1.1) (n=1,317). Total brain volume (TBV), hippocampal volume (HPV), white matter hyperintensity volume (WMHV), expressed as a percentage of total cranial volume, and presence of SBIs were assessed from MRI scans. We used multivariable linear (TBV, HPV and WMHV) and logistic (SBIs) regressions for the cross-sectional analyses, and we analyzed the annualized change of TBV and HPV as atrophy measures using multivariable linear regression. Results: In cross-sectional analyses, higher MIND diet scores were significantly associated with larger TBV (β±SE, +0.09±0.04; p=0.03) after adjustment for basic demographic factors, total daily energy intake, and APOE e4 allele status, but was not associated with HPV (+0.001±0.001; p=0.09), WMHV (-0.01±0.01; p=0.27), SBIs (OR (95%CI), +1.01, 0.92:1.10; p=0.61) or atrophy (TBV, -0.001±0.01; p=0.88; HPV, -0.0003±0.001; p=0.62). After additional adjustments for cardiovascular risk factors the association with TBV was attenuated (+0.05±0.04; p=0.17). Significant interactions were observed for HPV by APOE ε4 status and BMI in the basic model. After stratification by APOE ε4 status, higher MIND diet scores were significantly associated with higher HPV among APOE ε4 non-carriers (+0.002±0.001; p=0.01) but not carriers (n=412). After stratification by BMI, higher adherence to the MIND diet was associated with larger HPV among participants with a BMI above 25 (+0.002±0.001; p=0.01), but not among participants with a BMI below 25. Conclusions: Higher adherence to the MIND diet was not independently associated with brain volume measures, SBIs or brain atrophy in our community cohort as the associations appeared to be mediated by cardiovascular risk factors. In addition, we observed that adherence to the diet was associated with larger brain volume measures in sub groups. Replication is needed to confirm our findings.