Spatial variations in aromatic hydrocarbon emission in a dust-rich galaxy.

Dust grains absorb half of the radiation emitted by stars throughout the history of the universe, re-emitting this energy at infrared wavelengths1-3. Polycyclic aromatic hydrocarbons (PAHs) are large organic molecules that trace millimetre-size dust grains and regulate the cooling of interstellar gas within galaxies4,5. Observations of PAH features in very distant galaxies have been difficult owing to the limited sensitivity and wavelength coverage of previous infrared telescopes6,7. Here we present James Webb Space Telescope observations that detect the 3.3 µm PAH feature in a galaxy observed less than 1.5 billion years after the Big Bang. The high equivalent width of the PAH feature indicates that star formation, rather than black hole accretion, dominates infrared emission throughout the galaxy. The light from PAH molecules, hot dust and large dust grains and stars are spatially distinct from one another, leading to order-of-magnitude variations in PAH equivalent width and ratio of PAH to total infrared luminosity across the galaxy. The spatial variations we observe suggest either a physical offset between PAHs and large dust grains or wide variations in the local ultraviolet radiation field. Our observations demonstrate that differences in emission from PAH molecules and large dust grains are a complex result of localized processes within early galaxies.

Performance of biochar mixed cement paste for removal of Cu, Pb and Zn from stormwater.

Using biochar as a partial replacement of Portland cement in cementitious materials is a promising solution to mitigate negative environmental impacts. However, current studies in available literature primarily focus on the mechanical properties of composites made with cementitious materials and biochar. Therefore, this paper reports the effects of the type of biochar, the percentage of biochar addition, and the particle size of the biochar on the removal efficiency of Cu, Pb, and Zn, as well as the effect of contact time on the removal efficiency of Cu, Pb, and Zn, along with the compressive strength. The peak intensities of OH-, CO32- and Calcium Silicate Hydrate (Ca-Si-H) peaks increase with increasing biochar addition levels, reflecting increased hydration product formation. The reduction of particle size of biochar causes the polymerization of the Ca-Si-H gel. However, no significant changes were observed in heavy metal removal, irrespective of the percentage of biochar addition, the particle size of biochar, or the type of biochar added to the cement paste. Adsorption capacities above 19 mg/g, 11 mg/g and 19 mg/g for Cu, Pb and Zn were recorded in all composites at an initial pH of 6.0. The Pseudo second order model best described the kinetics of the Cu, Pb, and Zn removal. The rate of adsorptive removal increases with the decrease in the density of the adsorbents. Over 40% of Cu and Zn were removed as carbonates and hydroxides through precipitation, whereas over 80% of Pb removal was via adsorption. Heavy metals bonded with OH-, CO32- and Ca-Si-H functional groups. The results demonstrate that biochar can be used as a cement replacement without negatively impacting heavy metal removal. However, neutralization of the high pH is needed before safe discharge.

Suppressing star formation in quiescent galaxies with supermassive black hole winds.

Quiescent galaxies with little or no ongoing star formation dominate the population of galaxies with masses above 2 × 10(10) times that of the Sun; the number of quiescent galaxies has increased by a factor of about 25 over the past ten billion years (refs 1-4). Once star formation has been shut down, perhaps during the quasar phase of rapid accretion onto a supermassive black hole, an unknown mechanism must remove or heat the gas that is subsequently accreted from either stellar mass loss or mergers and that would otherwise cool to form stars. Energy output from a black hole accreting at a low rate has been proposed, but observational evidence for this in the form of expanding hot gas shells is indirect and limited to radio galaxies at the centres of clusters, which are too rare to explain the vast majority of the quiescent population. Here we report bisymmetric emission features co-aligned with strong ionized-gas velocity gradients from which we infer the presence of centrally driven winds in typical quiescent galaxies that host low-luminosity active nuclei. These galaxies are surprisingly common, accounting for as much as ten per cent of the quiescent population with masses around 2 × 10(10) times that of the Sun. In a prototypical example, we calculate that the energy input from the galaxy's low-level active supermassive black hole is capable of driving the observed wind, which contains sufficient mechanical energy to heat ambient, cooler gas (also detected) and thereby suppress star formation.

Primary Nephrotic Syndrome and Risks of ESKD, Cardiovascular Events, and Death: The Kaiser Permanente Nephrotic Syndrome Study.

BACKGROUND: Little population-based data exist about adults with primary nephrotic syndrome. METHODS: To evaluate kidney, cardiovascular, and mortality outcomes in adults with primary nephrotic syndrome, we identified adults within an integrated health care delivery system (Kaiser Permanente Northern California) with nephrotic-range proteinuria or diagnosed nephrotic syndrome between 1996 and 2012. Nephrologists reviewed medical records for clinical presentation, laboratory findings, and biopsy results to confirm primary nephrotic syndrome and assigned etiology. We identified a 1:100 time-matched cohort of adults without diabetes, diagnosed nephrotic syndrome, or proteinuria as controls to compare rates of ESKD, cardiovascular outcomes, and death through 2014, using multivariable Cox regression. RESULTS: We confirmed 907 patients with primary nephrotic syndrome (655 definite and 252 presumed patients with FSGS [40%], membranous nephropathy [40%], and minimal change disease [20%]). Mean age was 49 years; 43% were women. Adults with primary nephrotic syndrome had higher adjusted rates of ESKD (adjusted hazard ratio [aHR], 19.63; 95% confidence interval [95% CI], 12.76 to 30.20), acute coronary syndrome (aHR, 2.58; 95% CI, 1.89 to 3.52), heart failure (aHR, 3.01; 95% CI, 2.16 to 4.19), ischemic stroke (aHR, 1.80; 95% CI, 1.06 to 3.05), venous thromboembolism (aHR, 2.56; 95% CI, 1.35 to 4.85), and death (aHR, 1.34; 95% CI, 1.09 to 1.64) versus controls. Excess ESKD risk was significantly higher for FSGS and membranous nephropathy than for presumed minimal change disease. The three etiologies of primary nephrotic syndrome did not differ significantly in terms of cardiovascular outcomes and death. CONCLUSIONS: Adults with primary nephrotic syndrome experience higher adjusted rates of ESKD, cardiovascular outcomes, and death, with significant variation by underlying etiology in the risk for developing ESKD.

Life cycle assessment and cost analysis of fly ash-rice husk ash blended alkali-activated concrete.

The utilization of industrial and agricultural by-products for the production of alkali activated concrete (AAC) has the potential to yield significant benefits towards sustainability goals. To be a viable material, the construction industry requires a construction material that achieves the requisite strength and the other property requirements as specified in codes and standards while demonstrating improved sustainability criteria. Fly ash and Rice Husk Ash (RHA) are abundantly available waste products, principally located in Asian countries. Currently, a significant proportion of these materials are disposed of in landfills, lagoons and rivers but offer potential to utilize in AAC. Hence, the identification of variables associated with fly ash and fly ah-RHA blended AAC by utilizing fly ash and RHA is vital. This study quantifies the environmental and economic factors by assessing the Greenhouse gas (GHG) emission, environmental impacts and benefits, and cost analysis of utilizing fly ash and RHA in AAC compared to Portland Cement (PC) concrete. Alkaline activator is a key component responsible for the highest GHG emission, cost and environmental impact amounts obtained for fly ash geopolymer and blended alkali-activated concrete compared with PC concrete. Alkali activators contribute to 74% of the total GHG emission, while heat curing contributed only 9% to the total GHG emission. The addition of 10% RHA to alkali-activated concrete showed a slight benefit for the analysis. Utilization of waste fly ash and RHA is responsible for providing significant benefits in terms of fresh and marine water ecotoxicity by avoiding waste disposal at the dumpsites, rivers, and storage lagoons.

Facile, Room-Temperature 17O Enrichment of Zeolite Frameworks Revealed by Solid-State NMR Spectroscopy.

A new approach for room-temperature 17O enrichment of zeolites reveals a surprisingly dynamic and labile framework, where rapid and reversible bond breaking takes place. 17O NMR spectroscopy shows that although O sites in both framework Si-O-Al and Si-O-Si linkages are enriched simply on exposure to H217O(l), the enrichment of Si-O-Al species is more rapid, with a more uniform framework enrichment observed at longer durations. We demonstrate that this unexpected enrichment can be observed for two different framework topologies and for Na-exchanged (i.e., nonacidic) zeolites, as well as their protonic forms, confirming that the Brønsted acid proton is not necessary for isotopic exchange into the framework. This work not only offers new opportunities for structural characterization of these chemically and industrially important materials using NMR spectroscopy but suggests that further investigation of the rate and position of enrichment in zeolite frameworks could provide new insight into their chemical reactivity and their stability in aqueous-based applications such as ion exchange and catalysis.

A diver's dilemma - a case report on bronchopulmonary sequestration.

BACKGROUND: An asymptomatic SCUBA (Self-contained underwater breathing apparatus) diver was discovered to have an intralobar bronchopulmonary sequestration during routine pre-course screening. This is the first reported case of a diver who, having previously completed several recreational and military diving courses, was subsequently diagnosed with a congenital lung condition, possibly contraindicating diving. Presently, there is no available literature providing guidance on the diving fitness of patients with such a condition. CASE PRESENTATION: An asymptomatic 26-year-old male diver was nominated to attend an overseas naval diving course. Prior to this, he had been medically certified to participate in, and had successfully completed other military and recreational diving courses. He had also completed several hyperbaric dives up to a depth of 50 m and 45 recreational dives up to a depth of 30 m. He did not have a history of diving-related injuries or complications. He had never smoked and did not have any medical or congenital conditions, specifically recurrent respiratory infections. As part of pre-course screening requirements, a lateral Chest X-ray was performed, which revealed a left lower lobe pulmonary nodule. This was subsequently diagnosed as a cavitatory left lower lobe intralobar bronchopulmonary sequestration on Computed Tomography Thorax. The diver remains asymptomatic and well at the time of writing and has been accepted to participate in another overseas course involving only dry diving in a hyperbaric chamber, with no prerequisites for him to undergo surgery. CONCLUSION: Although bronchopulmonary sequestrations lack communication with the tracheobronchial tree, they may still contain pockets of air, even if not radiologically visible. This can be attributed to anomalous connections which link them to other bronchi, lung parenchyma and/or pores of Kohn. As such, there is a higher theoretical risk of pulmonary barotrauma during diving, leading to pneumothorax, pneumomediastinum, or cerebral arterial gas embolism. Taking these into consideration, the current clinical consensus is that bronchopulmonary sequestrations and all other air-containing lung parenchymal lesions should be regarded as contraindications to diving. Patients who have undergone definitive and uncomplicated surgical resection may be considered fit to dive.

High velocity dispersion in a rare grand-design spiral galaxy at redshift z = 2.18.

Although grand-design spiral galaxies are relatively common in the local Universe, only one has been spectroscopically confirmed to lie at redshift z > 2 (HDFX 28; z = 2.011); and it may prove to be a major merger that simply resembles a spiral in projection. The rarity of spirals has been explained as a result of disks being dynamically 'hot' at z > 2 (refs 2-5), which may instead favour the formation of commonly observed clumpy structures. Alternatively, current instrumentation may simply not be sensitive enough to detect spiral structures comparable to those in the modern Universe. At z < 2, the velocity dispersion of disks decreases, and spiral galaxies are more numerous by z ≈ 1 (refs 7, 13-15). Here we report observations of the grand-design spiral galaxy Q2343-BX442 at z = 2.18. Spectroscopy of ionized gas shows that the disk is dynamically hot, implying an uncertain origin for the spiral structure. The kinematics of the galaxy are consistent with a thick disk undergoing a minor merger, which can drive the formation of short-lived spiral structure. A duty cycle of <100 Myr for such tidally induced spiral structure in a hot massive disk is consistent with its rarity.

Caring for adults with congenital heart disease in a regional setting.

OBJECTIVE: The number of adults with congenital heart disease has increased with improvements in surgical and medical management, posing a challenge for regional and rural settings, which might have difficulties accessing specialised professionals with congenital heart disease services. This study aims to ascertain the demographics and management of adults with congenital heart disease seen by a cardiology practice in regional Australia to better understand the needs of regional adults with congenital heart disease. DESIGN: A descriptive study using data from clinical notes collected between April 2013 and April 2016. SETTING: A private cardiology practice in Coffs Harbour, New South Wales. The practice has a treating cardiologist, senior sonographer, visiting cardiothoracic surgeon and visiting paediatric cardiologist. PARTICIPANTS: One-hundred-and-one adults with congenital heart disease (age: 16-88 years; 55 women). MAIN OUTCOME MEASURES: Congenital heart disease defect, lesion severity, referral reason, past surgery, pulmonary hypertension, cardiac surgery during the study, mortality, adherence with follow-up plans and specialist referral. RESULTS: Sixty-six patients had simple congenital heart disease, 24 had congenital heart disease of moderate complexity and 11 had congenital heart disease of great complexity. Most were referred for surveillance, seven were referred due to pregnancy and eight were new diagnoses. Six patients died, nine had cardiac operations and five were treated for pulmonary arterial hypertension. Overall adherence to the treating cardiologist's follow-up plans was 84%. All patients with congenital heart disease of great complexity were referred to congenital heart disease specialists. CONCLUSION: A substantial number of patients had complex pathology, new diagnoses or required surgery, highlighting the importance of developing integrated services with the close support of outside specialists in managing adults with congenital heart disease in regional settings.

Effect of Pseudomonas fluorescens on Buried Steel Pipeline Corrosion.

Buried steel infrastructure can be a source of iron ions for bacterial species, leading to microbiologically influenced corrosion (MIC). Localized corrosion of pipelines due to MIC is one of the key failure mechanisms of buried steel pipelines. In order to better understand the mechanisms of localized corrosion in soil, semisolid agar has been developed as an analogue for soil. Here, Pseudomonas fluorescens has been introduced to the system to understand how bacteria interact with steel. Through electrochemical testing including open circuit potentials, potentiodynamic scans, anodic potential holds, and electrochemical impedance spectroscopy it has been shown that P. fluorescens increases the rate of corrosion. Time for oxide and biofilms to develop was shown to not impact on the rate of corrosion but did alter the consistency of biofilm present and the viability of P. fluorescens following electrochemical testing. The proposed mechanism for increased corrosion rates of carbon steel involves the interactions of pyoverdine with the steel, preventing the formation of a cohesive passive layer, after initial cell attachment, followed by the formation of a metal concentration gradient on the steel surface.

ZBP-89 regulates expression of tryptophan hydroxylase I and mucosal defense against Salmonella typhimurium in mice.

BACKGROUND & AIMS: ZBP-89 (also ZNF148 or Zfp148) is a butyrate-inducible zinc finger transcription factor that binds to GC-rich DNA elements. Deletion of the N-terminal domain is sufficient to increase mucosal susceptibility to chemical injury and inflammation. We investigated whether conditional deletion of ZBP-89 from the intestinal and colonic epithelium of mice increases their susceptibility to pathogens such as Salmonella typhimurium. METHODS: We generated mice with a conditional null allele of Zfp148 (ZBP-89(FL/FL)) using homologous recombination to flank Zfp148 with LoxP sites (ZBP-89(FL/FL)), and then bred the resulting mice with those that express VillinCre. We used microarray analysis to compare gene expression patterns in colonic mucosa between ZBP-89(ΔInt) and C57BL/6 wild-type mice (controls). Mice were gavaged with 2 isogenic strains of S. typhimurium after administration of streptomycin. RESULTS: Microarray analysis revealed that the colonic mucosa of ZBP-89(ΔInt) mice had reduced levels of tryptophan hydroxylase 1 (Tph1) messenger RNA, encoding the rate-limiting enzyme in enterochromaffin cell serotonin (5-hydroxytryptamine [5HT]) biosynthesis. DNA affinity precipitation demonstrated direct binding of ZBP-89 to the mouse Tph1 promoter, which was required for its basal and butyrate-inducible expression. ZBP-89(ΔInt) mice did not increase mucosal levels of 5HT in response to S. typhimurium infection, and succumbed to the infection 2 days before control mice. The ΔhilA isogenic mutant of S. typhimurium lacks this butyrate-regulated locus and stimulated, rather than suppressed, expression of Tph1 approximately 50-fold in control, but not ZBP-89(ΔInt), mice, correlating with fecal levels of butyrate. CONCLUSIONS: ZBP-89 is required for butyrate-induced expression of the Tph1 gene and subsequent production of 5HT in response to bacterial infection in mice. Reductions in epithelial ZBP-89 increase susceptibility to colitis and sepsis after infection with S. typhimurium, partly because of reduced induction of 5HT production in response to butyrate and decreased secretion of antimicrobial peptides.

Mushrooms and Health Summit proceedings.

The Mushroom Council convened the Mushrooms and Health Summit in Washington, DC, on 9-10 September 2013. The proceedings are synthesized in this article. Although mushrooms have long been regarded as health-promoting foods, research specific to their role in a healthful diet and in health promotion has advanced in the past decade. The earliest mushroom cultivation was documented in China, which remains among the top global mushroom producers, along with the United States, Italy, The Netherlands, and Poland. Although considered a vegetable in dietary advice, mushrooms are fungi, set apart by vitamin B-12 in very low quantity but in the same form found in meat, ergosterol converted with UV light to vitamin D2, and conjugated linoleic acid. Mushrooms are a rare source of ergothioneine as well as selenium, fiber, and several other vitamins and minerals. Some preclinical and clinical studies suggest impacts of mushrooms on cognition, weight management, oral health, and cancer risk. Preliminary evidence suggests that mushrooms may support healthy immune and inflammatory responses through interaction with the gut microbiota, enhancing development of adaptive immunity, and improved immune cell functionality. In addition to imparting direct nutritional and health benefits, analysis of U.S. food intake survey data reveals that mushrooms are associated with higher dietary quality. Also, early sensory research suggests that mushrooms blended with meats and lower sodium dishes are well liked and may help to reduce intakes of red meat and salt without compromising taste. As research progresses on the specific health effects of mushrooms, there is a need for effective communication efforts to leverage mushrooms to improve overall dietary quality.

Sociodemographic and clinical factors influencing serum potassium concentration: A retrospective cohort study.

Background: Self-care is crucial for maintaining the health and quality of life of individuals undergoing physical examinations, especially those with abnormal test results because they are at a higher risk of experiencing worse outcomes. However, there is currently a lack of comprehensive literature on the impact of sociodemographic and clinical factors on self-care practices related to serum potassium concentration among individuals undergoing physical examinations. Therefore, this study aimed to explore the sociodemographic and clinical factors influencing serum potassium concentration. Methods: Data from 43,151 individuals who underwent physical examinations were retrospectively collected in January, April, July, and October of 2019-2021. The serum potassium concentrations of these individuals were compared based on sex, age, and residential area. Additionally, the whole cohort and a subset of 6698 individuals with available occupational information were included to analyze the sociodemographic factors associated with serum potassium concentration using logistic regression analysis. Furthermore, a propensity score matching approach was employed to match 642 individuals with abnormal serum potassium concentrations to 642 with normal serum potassium concentrations. Pearson's correlation analysis was subsequently used to investigate the clinical factors contributing to abnormalities in serum potassium concentration. Results: High temperatures; older age; male sex; living in the southern part of the city; and chemical, communication system, and transportation occupations were associated with a higher likelihood of experiencing abnormal serum potassium concentrations. Individuals with abnormal serum potassium concentrations had a higher prevalence of underlying diseases. Compared with the hypokalemia group, the hyperkalemia group exhibited a higher incidence of diabetes and cardiovascular disease. In the hyperkalemia group, serum potassium concentration positively correlated with serum creatinine concentration and negatively correlated with the estimated glomerular filtration rate (eGFR). In contrast, in the hypokalemia group, serum potassium concentration negatively correlated with creatinine concentrations, blood glucose concentration, and systolic and diastolic blood pressure, and positively correlated with eGFR. Conclusions: Sociodemographic and clinical factors can affect blood potassium concentration. During daily self-care, it is essential for individuals with abnormal potassium concentrations to avoid exposure to relevant sociodemographic risk factors and seek medical attention as soon as possible to screen for diseases, such as hypertension, cardiovascular disease, and diabetes.

Assessing the Influence of Banana Leaf Ash as Pozzolanic Material for the Production of Green Concrete: A Mechanical and Microstructural Evaluation.

This paper reports an investigation of the mechanical and microscopic properties of partially replaced banana leaf ash (BLA) concrete. In this research, the cement was partially replaced by BLA in two phases: Phase A (0%, 5%, 10%, 15%, 20%, 25% and 30%) and Phase B (0%, 10%, 20% and 30%). The consequence of partially replacing cement with BLA in concrete was investigated by the application of a range of tests, namely X-ray fluorescence (XRF), compressive strength, splitting tensile strength, flexure strength, ultrasonic pulse velocity and scanning electron microscopy (SEM) analysis. The properties were then correlated with the properties of a standard 100% Portland cement concrete of similar strength. The XRF result of the BLA identified a composition with 48.93% SiO2 and 3.48% Al2O3, which indicates that the material potentially possesses pozzolanic properties. The mechanical properties of the partially replaced BLA concrete noted minor strength loss, approximately 5% with 20% partial replacement. The nondestructive testing data showed enhanced performance up to 20% partial replacement, with ultrasonic pulse values above 3500 m/s. The scanning electron microscopy analysis illustrated that the morphology of BLA specimens contained increased microcracks compared with the control. The decrease in strength observed is attributed to the fibrous composition of the BLA. The mechanical, nondestructive testing and microscopic results highlight the potential to utilize BLA as a partial replacement for cement as a pozzolanic material in concrete at up to 20% by weight of cement.

Creatine and Resistance Training: A Combined Approach to Attenuate Doxorubicin-Induced Cardiotoxicity.

Doxorubicin (DOX), a potent chemotherapy agent, useful in the treatment of solid tumors, lymphomas, and leukemias, is limited by its potentially lethal cardiotoxicity. However, exercise has been consistently shown to mitigate the side effects of DOX, including cardiotoxicity. To date, most studies examining the relationship between exercise and DOX-induced cardiotoxicity have focused on aerobic exercise, with very few examining the role of anerobic activity. Therefore, this investigation explored the potential of creatine (CR) and resistance training (RT) in preserving cardiac health during DOX therapy. Male Sprague-Dawley rats were grouped into RT, RT + CR, sedentary (SED), and SED + CR, with each division further branching into saline (SAL) or DOX-treated subsets post-10 weeks of RT or SED activity. RT comprised progressive training utilizing specialized cages for bipedal stance feeding. CR-treated groups ingested water mixed with 1% CR monohydrate and 5% dextrose, while control animals received 5% dextrose. At week 10, DOX was administered (2 mg/kg/week) over 4-weeks to an 8 mg/kg cumulative dose. Cardiac function post-DOX treatment was assessed via transthoracic echocardiography. Left ventricular diameter during diastole was lower in DOX + CR, RT + DOX, and RT + CR + DOX compared to SED + DOX (p < 0.05). Additionally, cardiac mass was significantly greater in RT + CR + DOX SED + DOX animals (p < 0.05). These results suggest RT and CR supplementation, separately and in combination, could attenuate some measures of DOX-induced cardiotoxicity and may offer a cost-effective way to complement cancer treatments and enhance patient outcomes. More investigations are essential to better understand CR's prolonged effects during DOX therapy and its clinical implications.

Improvement of heavy metal removal from urban runoff using modified pervious concrete.

Heavy metals are one of the major chemical pollutant groups in urban runoff. The application of porous concrete is a potential alternative to conventional runoff management systems with the ability to remove heavy metals. Hence, a thorough understanding of the heavy metal removal mechanisms and constraints of conventional porous concrete opens a path for the development of effective modifications. This review critically discusses the major contributors in ordinary porous concrete which supports heavy metal removal. The effects of initial concentration, contact time and competing ions on heavy metal removal using porous concrete are also discussed. Additionally, the effect of decalcification, atmospheric carbonation, acid influent on heavy metal removal is reviewed. The major drawback of porous concrete is the high pH (>8.5) of the effluent water, decalcification of the porous concrete and leaching of adsorbed pollutants. Overall, the addition of adsorbent materials to the porous concrete increases removal efficiencies (7% - 65% increase) without neutralizing the effluent pH. Meanwhile, the addition of Reduced Graphene Oxide is successful in reducing the leachability of the removed heavy metals. The addition of pozzolanic materials can lower the effluent pH while maintaining similar removal efficiencies to unmodified porous concrete. Therefore, developing a novel method of neutralizing the effluent pH must be prioritized in future studies. Additionally, the toxicity that can occur due to the abrasion of modified porous concrete requires study in future research. Further, advanced characterization methods should be used in future studies to understand the mechanisms of removal via the modified porous concrete materials.

Performance of Reinforced Foam and Geopolymer Concretes against Prolonged Exposures to Chloride in a Normal Environment.

The utilization of sustainable cement replacement materials in concrete can control the emission of carbon dioxide and greenhouse gases in the construction industry, thus contributing significantly to the environment, society, and the global economy. Various types of sustainable concrete including geopolymer concrete are tested for their efficacy for construction in laboratories. However, the performance and longevity of sustainable concrete for civil engineering applications in corrosive environments are still debatable. This paper aims to investigate the performance of the reinforced geopolymer (GPC) and foam concretes (FC) against corrosive chloride exposure. Two long term key parameters, i.e., corrosion rate and mechanical performance of reinforcing steel in geopolymer and foam concrete were assessed to evaluate their performance against chloride attack. For experiments, reinforced GPC and FC specimens, each admixed with 3 and 5% chlorides, were kept at varying temperatures and humidity levels in the environmental chambers. The corrosion rates of the reinforced geopolymer and foam concrete specimens were also compared with control specimens after 803 days and the tensile strength of the corroded reinforcing steel was also determined. Moreover, the long term efficacy of repaired patches (810 days), in a chloride-rich surrounding environment utilizing FC and GPC, was investigated. The results suggested greater performance of FC compared to GPC under standard environmental conditions. However, the simulated patch repair with GPC showed better resistance against chloride attack compared to FC. The research also undertook the fractographical examination of the surfaces of the reinforcement exposed to 5% admixed chloride and develops models for the corrosion rates of foam concrete as a function of the corrosion rates of geopolymer concrete and chloride content. A correlation model for the corrosion rates of FC and GPC was also developed. The findings of the current research and the model developed are novel and contribute to the knowledge of long term degradation science of geopolymers and form concrete materials. Furthermore, the findings and methodology of the current research have practical significance in the construction and repair industry for determining the remaining service life for any reinforced and steel infrastructure.

Dialysis therapy and mortality in older adults with heart failure and advanced chronic kidney disease: A high-dimensional propensity-matched cohort study.

BACKGROUND: Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, and the combination is linked to poor outcomes, but limited data exist to guide optimal management. We evaluated the outcome of dialysis therapy in older patients with HF and advanced CKD. METHODS: We examined adults aged ≥70 years with HF and eGFR ≤20 ml/min/1.73 m2 between 2008-2012 and no prior renal replacement therapy, cancer, cirrhosis or organ transplant. We identified patients who initiated chronic dialysis through 2013 and matched patients who did not initiate dialysis on age, gender, diabetes status, being alive on dialysis initiation date, and a high-dimensional propensity score for starting dialysis. Deaths were identified through 2013. We used Cox regression to evaluate the association of chronic dialysis and all-cause death. RESULTS: Among 348 adults with HF and advanced CKD who initiated dialysis and 947 matched patients who did not start dialysis, mean age was 80±5 years, 51% were women and 33% were Black. The crude rate of death was high overall but lower in those initiating vs. not initiating chronic dialysis (26.1 vs. 32.1 per 100 person-years, respectively, P = 0.02). In multivariable analysis, dialysis was associated with a 33% (95% Confidence Interval:17-46%) lower adjusted rate of death compared with not initiating dialysis. CONCLUSIONS: Among older adults with HF and advanced CKD, dialysis initiation was associated with lower mortality, but absolute rates of death were very high in both groups. Randomized trials should evaluate net outcomes of dialysis vs. conservative management on length and quality of life in this high-risk population.

The initial 18 months of the first multi-disciplinary regional Pulmonary Arterial Hypertension Clinic in Australia.

OBJECTIVE: To report the initial 18 months experience of the first multi-disciplinary regional Pulmonary Arterial Hypertension (PAH) Clinic in Australia. DESIGN: Prospective cohort study. SETTING: Community setting on the mid-north coast of New South Wales. PARTICIPANTS: A total of 47 patients (mean age±standard error of the mean: 71.8±1.8 years; male/female ratio 13/34). MAIN OUTCOME MEASURES: Diagnosis of PAH, exclusion of other causes of pulmonary hypertension, commencement of PAH-specific pharmacotherapy. RESULTS: Twenty-three (49%) patients were discharged back to their GP with pulmonary hypertension from a combination of ischaemic heart and/or lung disease. Three (6%) patients died from connective tissue disease (CTD)-related PAH with one death (2%) from ischaemic heart disease. Five (11%) patients remain on treatment (n=2, Bosentan for congenital heart disease-related PAH; n=1 Bosentan for CTD-related PAH; and n=1 Bosentan and n=1 Sildenafil for primary PAH). Fifteen (32%) patients have ongoing review for PAH related to CTD (n=11), carcinoid (n=1) and uncertain cause (n=3). CONCLUSION: Patients with CTD-related PAH have a poor prognosis. PAH should be considered in anyone with dyspnoea without obvious features of cardiac or pulmonary disease, especially in the setting of a CTD. Regional population centres are under-resourced with PAH specialty medical services. We have sought to address this by establishment of the first regional multi-disciplinary PAH Clinic in Australia.

Novel Analytical Method for Mix Design and Performance Prediction of High Calcium Fly Ash Geopolymer Concrete.

Despite extensive in-depth research into high calcium fly ash geopolymer concretes and a number of proposed methods to calculate the mix proportions, no universally applicable method to determine the mix proportions has been developed. This paper uses an artificial neural network (ANN) machine learning toolbox in a MATLAB programming environment together with a Bayesian regularization algorithm, the Levenberg-Marquardt algorithm and a scaled conjugate gradient algorithm to attain a specified target compressive strength at 28 days. The relationship between the four key parameters, namely water/solid ratio, alkaline activator/binder ratio, Na2SiO3/NaOH ratio and NaOH molarity, and the compressive strength of geopolymer concrete is determined. The geopolymer concrete mix proportions based on the ANN algorithm model and contour plots developed were experimentally validated. Thus, the proposed method can be used to determine mix designs for high calcium fly ash geopolymer concrete in the range 25-45 MPa at 28 days. In addition, the design equations developed using the statistical regression model provide an insight to predict tensile strength and elastic modulus for a given compressive strength.