Catheter-associated meatal pressure injuries (CAMPI) in patients with long-term urethral catheters-a cross-sectional study of 200 patients.

Background: Indwelling urethral catheters (IDC) are ubiquitous to healthcare settings, and are associated with many familiar risks like haematuria, infections, bladder spasms and stones. However, a less known complication is catheter-associated meatal pressure injury (CAMPI), especially in those with long-term IDCs. The objective of this study was to explore the prevalence, associated features and management of CAMPI in adults with a long-term IDC. Methods: A cross-sectional multi-centre study was undertaken of 200 adults with a long-term IDC across regional south-west Queensland, Australia between June 2019 to June 2021. The prevalence of CAMPI was determined by clinical examination, voluntary surveys completed by participants and documentation in medical records. Key IDC statistics included total duration of IDC, location of IDC changes, IDC size, type and fixation. Results: Out of 200 adults with a long-term IDC, 9% (18/200) had a CAMPI. There was a higher prevalence of male CAMPI (17/169, 10%) compared to female CAMPI (1/31, 3%). The median time to identification of a CAMPI after initial IDC insertion was 12 weeks (2-136 weeks), but occurred as soon as 2 weeks. CAMPI formation was associated with IDC changes in the community, impaired mobility and congestive cardiac failure (CCF). CAMPI were mostly treated by conservative means given the frailty of the population. Conclusions: Poor mobility, community-managed IDCs, and CCF were all found to have statistically significant associations with the development of CAMPI. CAMPI represents an important and underserved iatrogenic complication within urology practice, and greater awareness is needed to prevent it in vulnerable patients with long-term IDCs.

A multiscale accuracy assessment of moisture content predictions using time-lapse electrical resistivity tomography in mine tailings.

Accurate and large-scale assessment of volumetric water content (VWC) plays a critical role in mining waste monitoring to mitigate potential geotechnical and environmental risks. In recent years, time-lapse electrical resistivity tomography (TL-ERT) has emerged as a promising monitoring approach that can be used in combination with traditional invasive and point-measurements techniques to estimate VWC in mine tailings. Moreover, the bulk electrical conductivity (EC) imaged using TL-ERT can be converted into VWC in the field using petrophysical relationships calibrated in the laboratory. This study is the first to assess the scale effect on the accuracy of ERT-predicted VWC in tailings. Simultaneous and co-located monitoring of bulk EC and VWC are carried out in tailings at five different scales, in the laboratory and in the field. The hydrogeophysical datasets are used to calibrate a petrophysical model used to predict VWC from TL-ERT data. Overall, the accuracy of ERT-predicted VWC is [Formula: see text], and the petrophysical models determined at sample-scale in the laboratory remain valid at larger scales. Notably, the impact of temperature and pore water EC evolution plays a major role in VWC predictions at the field scale (tenfold reduction of accuracy) and, therefore, must be properly taken into account during the TL-ERT data processing using complementary hydrogeological sensors. Based on these results, we suggest that future studies using TL-ERT to predict VWC in mine tailings could use sample-scale laboratory apparatus similar to the electrical resistivity Tempe cell presented here to calibrate petrophysical models and carefully upscale them to field applications.

A Review on Applications of Time-Lapse Electrical Resistivity Tomography Over the Last 30 Years : Perspectives for Mining Waste Monitoring.

Mining operations generate large amounts of wastes which are usually stored into large-scale storage facilities which pose major environmental concerns and must be properly monitored to manage the risk of catastrophic failures and also to control the generation of contaminated mine drainage. In this context, non-invasive monitoring techniques such as time-lapse electrical resistivity tomography (TL-ERT) are promising since they provide large-scale subsurface information that complements surface observations (walkover, aerial photogrammetry or remote sensing) and traditional monitoring tools, which often sample a tiny proportion of the mining waste storage facilities. The purposes of this review are as follows: (i) to understand the current state of research on TL-ERT for various applications; (ii) to create a reference library for future research on TL-ERT and geoelectrical monitoring mining waste; and (iii) to identify promising areas of development and future research needs on this issue according to our experience. This review describes the theoretical basis of geoelectrical monitoring and provides an overview of TL-ERT applications and developments over the last 30 years from a database of over 650 case studies, not limited to mining operations (e.g., landslide, permafrost). In particular, the review focuses on the applications of ERT for mining waste characterization and monitoring and a database of 150 case studies is used to identify promising applications for long-term autonomous geoelectrical monitoring of the geotechnical and geochemical stability of mining wastes. Potential challenges that could emerge from a broader adoption of TL-ERT monitoring for mining wastes are discussed. The review also considers recent advances in instrumentation, data acquisition, processing and interpretation for long-term monitoring and draws future research perspectives and promising avenues which could help improve the design and accuracy of future geoelectric monitoring programs in mining wastes.

Tracking the impacts of climate change on human health via indicators: lessons from the Lancet Countdown.

BACKGROUND: In the past decades, climate change has been impacting human lives and health via extreme weather and climate events and alterations in labour capacity, food security, and the prevalence and geographical distribution of infectious diseases across the globe. Climate change and health indicators (CCHIs) are workable tools designed to capture the complex set of interdependent interactions through which climate change is affecting human health. Since 2015, a novel sub-set of CCHIs, focusing on climate change impacts, exposures, and vulnerability indicators (CCIEVIs) has been developed, refined, and integrated by Working Group 1 of the "Lancet Countdown: Tracking Progress on Health and Climate Change", an international collaboration across disciplines that include climate, geography, epidemiology, occupation health, and economics. DISCUSSION: This research in practice article is a reflective narrative documenting how we have developed CCIEVIs as a discrete set of quantifiable indicators that are updated annually to provide the most recent picture of climate change's impacts on human health. In our experience, the main challenge was to define globally relevant indicators that also have local relevance and as such can support decision making across multiple spatial scales. We found a hazard, exposure, and vulnerability framework to be effective in this regard. We here describe how we used such a framework to define CCIEVIs based on both data availability and the indicators' relevance to climate change and human health. We also report on how CCIEVIs have been improved and added to, detailing the underlying data and methods, and in doing so provide the defining quality criteria for Lancet Countdown CCIEVIs. CONCLUSIONS: Our experience shows that CCIEVIs can effectively contribute to a world-wide monitoring system that aims to track, communicate, and harness evidence on climate-induced health impacts towards effective intervention strategies. An ongoing challenge is how to improve CCIEVIs so that the description of the linkages between climate change and human health can become more and more comprehensive.

Correlating heatwaves and relative humidity with suicide (fatal intentional self-harm).

Empirical evidence suggests that the effects of anthropogenic climate change, and heat in particular, could have a significant impact on mental health. This article investigates the correlation between heatwaves and/or relative humidity and suicide (fatal intentional self-harm) on a global scale. The covariance between heat/humidity and suicide was modelled using a negative binomial Poisson regression with data from 60 countries between 1979-2016. Statistically significant increases and decreases in suicide were found, as well as many cases with no significant correlation. We found that relative humidity showed a more significant correlation with suicide compared to heatwaves and that both younger age groups and women seemed to be more significantly affected by changes in humidity and heatwave counts in comparison with the rest of the population. Further research is needed to provide a larger and more consistent basis for epidemiological studies; to understand better the connections among heat, humidity and mental health; and to explore in more detail which population groups are particularly impacted and why.

A multi-centre survey reveals variations in the standard treatments and treatment modifications for head and neck cancer patients during Covid-19 pandemic.

BACKGROUND: The onset of the COVID-19 pandemic necessitated rapid changes to the practice of head and neck oncology in UK. There was a delay between the onset of the pandemic and the release of guidelines from cancer societies and networks, leading to a variable response of individual centres. This survey was conducted to assess the pre-Covid-19 pandemic standard of practice for head and neck oncology patients and the treatment modifications introduced during the first wave of the pandemic in UK. METHODOLOGY: The UK National Cancer Research Institute (NCRI) Head and Neck Clinical Studies Group initiated a multi-centre survey using questionnaire to investigate the effect on feeding tube practice, radiotherapy (RT) fractionation and volumes, use of chemotherapy in the neo-adjuvant, concurrent and palliative setting, the use of immunotherapy in the palliative setting, access to radiology and histopathology services, and availability of surgical procedures. RESULTS: 30 centres were approached across UK; 23 (76.7%) centres responded and were included in the survey. There were differences in the standard practices in feeding tube policy, RT dose and fractionation as well as concurrent chemotherapy use. 21 (91%) participating centres had at least one treatment modification. 15 (65%) centres initiated a change in radical RT; changing to either a hypofractionation or acceleration schedule. For post-operative RT 10 centres (43.5%) changed to a hypofractionation schedule. 12 (52.2%) centres stopped neo-adjuvant chemotherapy for all patients; 13 (56.5%) centres followed selective omission of chemotherapy in concurrent chemo-radiotherapy patients, 17 (73.9%) centres changed first-line chemotherapy treatment to pembrolizumab (following NHS England's interim guidance) and 8 (34.8%) centres stopped the treatment early or offered delays for patients that have been already on systemic treatment. The majority of centres did not have significant changes associated with surgery, radiology, histopathology and dental screening. CONCLUSION: There are variations in the standard of practice and treatment modifications for head and neck cancer patients during Covid-19 pandemic. A timely initiative is required to form a consensus on head and neck cancer management in the UK and other countries.

Bladder perivascular epithelioid cell tumour and tuberous sclerosis complex: a rare association.

Bladder perivascular epithelioid cell tumours (PEComas) associated with tuberous sclerosis complex (TSC) are rare, with only one other case report in the literature to date. We present our case of a bladder PEComa in a young adult female with TSC arising de novo. Histopathology showed features in keeping with an angiomyolipoma and confirmatory immunohistochemical stains were positive for both melanocytic and smooth muscle markers. She was well at the 6-month follow-up post-surgical resection. Given the rarity of such lesions in the bladder, we discuss the diagnostic and prognostic challenges, clinical implications and a brief review of the literature to date.

The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises.

TRANSLATIONS: For the Chinese, French, German, and Spanish translations of the abstract see Supplementary Materials section.

Computationally scalable geospatial network and routing analysis through multi-level spatial clustering.

Network analysis finds natural applications in geospatial information systems for a range of applications, notably for thermal grids, which are important for decarbonising thermal energy supply. These analyses are required to operate over a large range of geographic scales. This is a challenge for existing approaches, which face computational scaling challenges with the large datasets now available, such as building and road network data for an entire country. This work presents a system for geospatial modelling of thermal networks including their routing through the existing road network and calculation of flows through the network. This is in contrast to previous thermal network analysis work which could only work with simplified aggregated data.•We apply multi-level spatial clustering which enables parallelisation of work sets.•We develop algorithms and data processing pipelines for calculating network routing.•We use cluster-level caching to enable rapid evaluation of model variants.

Integrated hydrogeophysical modelling and data assimilation for geoelectrical leak detection.

Time-lapse electrical resistivity tomography (ERT) measurements provide indirectobservations of hydrological processes in the Earth's shallow subsurface at high spatial and temporal resolution. ERT has been used in the past decades to detect leaks and monitor the evolution of associated contaminant plumes. Specifically, inverted resistivity images allow visualization of the dynamic changes in the structure of the plume. However, existing methods do not allow the direct estimation of leak parameters (e.g. leak rate, location, etc.) and their uncertainties. We propose an ensemble-based data assimilation framework that evaluates proposed hydrological models against observed time-lapse ERT measurements without directly inverting for the resistivities. Each proposed hydrological model is run through the parallel coupled hydro-geophysical simulation code PFLOTRAN-E4D to obtain simulated ERT measurements. The ensemble of model proposals is then updated using an iterative ensemble smoother. We demonstrate the proposed framework on synthetic and field ERT data from controlled tracer injection experiments. Our results show that the approach allows joint identification of contaminant source location, initial release time, and solute loading from the cross-borehole time-lapse ERT data, alongside with an assessment of uncertainties in these estimates. We demonstrate a reduction in site-wide uncertainty by comparing the prior and posterior plume mass discharges at a selected image plane. This framework is particularly attractive to sites that have previously undergone extensive geological investigation (e.g., nuclear sites). It is well suited to complement ERT imaging and we discuss practical issues in its application to field problems.

Ertapenem for osteoarticular infections in obese patients: a pharmacokinetic study of plasma and bone concentrations.

PURPOSE: Ertapenem is used off-label to treat osteoarticular infections but there are few pharmacokinetic (PK) data to guide optimal dosing strategies in patients who may be obese with multiple co-morbidities including diabetes and peripheral vascular disease. METHODS: Participants undergoing lower limb amputation or elective joint arthroplasty received a dose of intravenous ertapenem prior to surgery. Eight plasma samples were collected over 24 h, together with at least one bone sample per patient. Ertapenem concentrations in plasma and bone were measured using liquid-chromatography/mass-spectroscopy and analysed using non-linear mixed effects PK modelling. RESULTS: Plasma and bone concentrations were obtained from 10 participants. The final population PK model showed that a fat free body mass was the most appropriate body size adjustment. Ertapenem diffused rapidly into bone but concentrations throughout the 24 h dosing period were on average 40-fold higher in plasma, corresponding to a bone to plasma ratio of 0.025, and highly variable between individuals. Simulations demonstrated a high probability of target attainment (PTA) for free plasma concentrations when the minimum inhibitory concentrations (MIC) were ≤ 0.25 mg/L. By contrast, at MICs of 0.5 mg/L and ≥ 1 mg/L, the fractions of patients attaining this target was ~ 80% and 40%, respectively. In bone, the PTA was ≤ 45% when the MIC was ≥ 0.25 mg/L. CONCLUSION: Local bone and free plasma concentrations appear adequate for osteoarticular infections where Enterobacteriaceae are the main causative pathogens, but for Staphylococcus aureus and other bacteria, conventional dosing may lead to inadequate PTA.