Search Results (59)

In the absence of appropriate tools and a knowledge base for exploring high-grade metamorphic terrains, felsic gneiss complexes at granulite facies have long been considered barren and have remained undermapped and understudied. This was the case of the Bondy gneiss complex in the southwestern Grenville Province of Canada which consists of 1.39–1.35 Ga volcanic and plutonic rocks metamorphosed under granulite facies conditions at 1.19 Ga. Iron oxide–apatite and Cu-Ag-Au mineral occurrences occur among gneisses rich in biotite, cordierite, garnet, K-feldspar, orthopyroxene and/or sillimanite-rich gneisses, plagioclase-cordierite-orthopyroxene white gneisses, magnetite-garnet-rich gneisses, garnetites, hyperaluminous sillimanite-pyrite-quartz gneisses, phlogopite-sillimanite gneisses, and tourmalinites. Petrological and geochemical studies indicate that the precursors of these gneisses are altered volcanic and volcaniclastic rocks with attributes of pre-metamorphic Na, Ca-Fe, K-Fe, K, chloritic, argillic, phyllic, advanced argillic and skarn alteration. The nature of these hydrothermal rocks and the ore deposit model that best represents them are further investigated herein through lithogeochemistry. The lithofacies mineralized in Cu (±Au, Ag, Zn) are distinguished by the presence of garnet, magnetite and zircon, and exhibit pronounced enrichment in Fe, Mg, HREE and Zr relative to the least-altered rocks. In discrimination diagrams, the metamorphosed mineral system is demonstrated to exhibit the diagnostic attributes of, and is interpreted as, a metasomatic iron and alkali-calcic (MIAC) mineral system with iron oxide–apatite (IOA) and iron oxide copper–gold (IOCG) mineralization that evolves toward an epithermal cap. This contribution demonstrates that alteration facies diagnostic of MIAC systems and their IOCG and IOA mineralization remain diagnostic even after high-grade metamorphism. Exploration strategies can thus use the lithogeochemical footprint and the distribution and types of alteration facies observed as pathfinders for the facies-specific deposit types of MIAC systems. Full article

Detrital zircon (DZ) ages of Cretaceous sandstones in the United States contain critical spatial and temporal information on their sedimentary provenance and on the reorganization of drainage patterns. Herein, we report zircon U-Pb ages of sandstones from Lower Cretaceous and Upper Cretaceous formations of Arkansas. All Arkansas sandstones studied, except for those from the Upper Cretaceous Nacatoch Formation, display dominant Appalachian-Grenville DZ ages from among the Appalachian-Ouachita DZ grains that were studied. Our work shows that the sedimentary provenance of Arkansas sandstones started to change during the middle part of the Cretaceous. Notably, DZ grains from the Woodbine formation, which was deposited during the middle part of Cretaceous, show moderate contributions from Western Cordillera sources (275–55 Ma), and DZ grains from the Upper Cretaceous Nacatoch Formation exhibit dominant Western Cordillera sourcing. Our Arkansas-based DZ data suggest that the onset of DZ contribution of the Western Cordillera began at about 94 Ma, and the peak of the Western Cordillera source contribution occurred at about 73 Ma. Therefore, we can show that North American drainage reorganization with regard to Western Cordilleran DZ sourcing in Arkansas began during the time span 94–73 Ma, which is earlier than the previously reported onset of drainage reorganization with regard to Texas (i.e., 66–55 Ma). Full article

Cacao (Theobroma cacao L.) is a tropical tree species belonging to the Malvaceae, which originated in the lowland rainforests of the Amazon. It is a major agricultural commodity, which contributes towards the Gross Domestic Product of West African countries, where it accounts for about 70% of the world’s production. Understanding the genetic diversity of genetic resources in a country, especially for an introduced crop such as cacao, is crucial to their management and effective utilization. However, very little is known about the genetic structure of the cacao germplasm from Sierra Leone and Togo based on molecular information. We assembled cacao germplasm accessions (235 from Sierra Leone and 141 from Togo) from different seed gardens and farmers’ fields across the cacao-producing states/regions of these countries for genetic diversity and population structure studies based on single nucleotide polymorphism (SNP) markers using 20 highly informative and reproducible KASP–SNPs markers. Genetic diversity among these accessions was assessed with three complementary clustering methods, including model-based population structure, discriminant analysis of principal components (DAPC), and phylogenetic trees. STRUCTURE and DAPC exhibited some consistency in the allocation of accessions into subpopulations or groups, although some discrepancies in their groupings were noted. Hierarchical clustering analysis grouped all the individuals into two major groups, as well as several sub-clusters. We also conducted a network analysis to elucidate genetic relationships among cacao accessions from Sierra Leone and Togo. Analysis of molecular variance (AMOVA) revealed high genetic diversity (86%) within accessions. A high rate of mislabeling/duplicate genotype names was revealed in both countries, which may be attributed to errors from the sources of introduction, labeling errors, and lost labels. This preliminary study demonstrates the use of KASP–SNPs for fingerprinting that can help identify duplicate/mislabeled accessions and provide strong evidence for improving accuracy and efficiency in cacao germplasm management as well as the distribution of correct materials to farmers. Full article

Depression is a common mental illness that affects 5% of the adult population globally. The most common symptoms of depression are low mood, lack of pleasure from different activities, poor concentration, and reduced energy levels for an extended period, and it affects the emotions, behaviors, and overall well-being of an individual. The complex pathophysiology of depression presents challenges for current therapeutic options involving a biopsychosocial treatment plan. These treatments may have a delayed onset, low remission and response rates, and undesirable side effects. Researchers in nutrition and food science are increasingly addressing depression, which is a significant public health concern due to the association of depression with the increased incidence of cardiovascular diseases and premature mortality. Polyphenols present in our diet may significantly impact the prevention and treatment of depression. The primary mechanisms include reducing inflammation and oxidative stress, regulating monoamine neurotransmitter levels, and modulating the microbiota–gut–brain axis and hyperactivity of the hypothalamic–pituitary–adrenal (HPA) axis. This review summarizes recent advances in understanding the effects of dietary polyphenols on depression and explores the underlying mechanisms of these effects for the benefit of human health. It also highlights studies that are looking at clinical trials to help future researchers incorporate these substances into functional diets, nutritional supplements, or adjunctive therapy to prevent and treat depression. Full article

Introduction: COVID-19 vaccines were rapidly developed and deployed on a large scale during a global crisis. A range of deployment strategies were used globally to maximize vaccine uptake. In this scoping review, we identify and analyze the main healthcare system and policy factors that guided and influenced COVID-19 vaccination deployment and uptake globally. Materials and Methods: JBI guidelines, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and the population, concept, and context (PCC) framework were applied. Studies on individual COVID-19 vaccination factors, such as vaccine hesitancy, were excluded. The search was last conducted in May 2024 yielding 26,686 articles from PubMed, Embase, CINAHL, Scopus, and COVID-19 websites. A total of 47 articles and 3 guidance documents were included. The results of the thematic analysis were mapped to the Consolidated Framework for Implementation Research (CFIR). Results: The results found the following healthcare system and policy factors as integral to COVID-19 vaccination: types of vaccine products, healthcare workforce capacity, procurement strategies, distribution and cold-chain capacity, partnership, coordination, and leadership, information, communication, and registration strategies, delivery models, organizations, the existing health systems and policies on prioritization of at-risk groups and deployment plans. Discussion: Globally, COVID-19 vaccination programs responded to the pandemic by leveraging and reforming the existing healthcare systems, relying on strong leadership and global cooperation (such as the COVID-19 Vaccines Global Access Initiative). Deployment was enabled by effective communication and adoption of innovative technologies using data-driven policies to create high vaccine demand while overcoming limited vaccine supply and rapidly adapting to uncertainties. Full article

Combined heavy mineral analysis and detrital zircon geochronology have enabled us to track detritus supplied by the ancestral river systems draining the North American continent into the deep subsurface of the Gulf of Mexico, in both the coastal plain and the offshore deep water areas. During deposition of the Paleocene–Eocene Wilcox Group, sandstones in the western part of the area are interpreted as the products of the Rosita system derived via paleo-Rio Grande material, with a large component of sediment shed from the Western Cordillera. By contrast, samples from wells further east have high proportions of zircons derived from the Yavapai-Mazatzal Province and are attributed to the Rockdale system with sediment fed predominantly by the paleo-Colorado or paleo-Colorado-Brazos. There is evidence that sediment from the Rosita system occasionally extended into the central Gulf of Mexico, and, likewise, data indicate that the Rockdale system sporadically supplied sediment to the western part of the basin. During the Late Eocene of the central Gulf of Mexico (Yegua Formation) there was a distinct shift in provenance. The earlier Yegua sandstones have a large Grenville zircon component and are most likely to have had a paleo-Mississippi origin, whereas the later Yegua sandstones are dominated by zircons of Western Cordilleran origin, similar to Wilcox sandstones fed by the Rosita system via the paleo-Rio Grande. The switch from paleo-Mississippi to paleo-Rio Grande sourcing implies there was a major reorganisation of drainage patterns during the Late Eocene. Miocene sandstones in the deepwater Gulf of Mexico were principally sourced from the paleo-Mississippi, although the paleo-Red River is inferred to have contributed to the more westerly-located wells. Full article

Understanding risk factors for frailty, functional decline and incidence of adverse healthcare outcomes amongst community-dwelling older adults is important to plan population-level health and social care services. We examined variables associated with one-year risk of institutionalisation, hospitalisation and death among patients assessed in their own home by a community-based Aged Care Assessment Team (ACAT) in Western Australia. Frailty and risk were measured using the Clinical Frailty Scale (CFS) and Risk Instrument for Screening in the Community (RISC), respectively. Predictive accuracy was measured from the area under the curve (AUC). Data from 417 patients, median 82 ± 10 years, were included. At 12-month follow-up, 22.5% (n = 94) were institutionalised, 44.6% (n = 186) were hospitalised at least once and 9.8% (n = 41) had died. Frailty was common, median CFS score 6/9 ± 1, and significantly associated with institutionalisation (p = 0.001), hospitalisation (p = 0.007) and death (p < 0.001). Impaired activities of daily living (ADL) measured on the RISC had moderate correlation with admission to long-term care (r = 0.51) and significantly predicted institutionalisation (p < 0.001) and death (p = 0.01). The RISC had the highest accuracy for institutionalisation (AUC 0.76). The CFS and RISC had fair to good accuracy for mortality (AUC of 0.69 and 0.74, respectively), but neither accurately predicted hospitalisation. Home assessment of community-dwelling older patients by an ACAT in Western Australia revealed high levels of frailty, ADL impairment and incident adverse outcomes, suggesting that anticipatory care planning is imperative for these patients. Full article

The safe administration of solid oral dose forms in hospital inpatients with swallowing difficulties is challenging. The aim of this study was to establish the prevalence of difficulties in swallowing solid oral dose forms in acute hospital inpatients. A point prevalence study was completed at three time points. The following data were collected: the prevalence of swallowing difficulties, methods used to modify solid oral dose forms to facilitate administration, the appropriateness of the modification, and patient co-morbidities. The prevalence of acute hospital inpatients with swallowing difficulties was an average of 15.4% with a 95% CI [13.4, 17.6] across the three studies. On average, 9.6% of patients with swallowing difficulties had no enteral feeding tube in situ, with 6.0% of these patients receiving at least one modified medicine. The most common method of solid oral dose form modification was crushing, with an administration error rate of approximately 14.4%. The most common co-morbid condition in these patients was hypertension, with dysphagia appearing on the problem list of two (5.5%) acute hospital inpatients with swallowing difficulties. Inappropriate modifications to solid oral dose forms to facilitate administration can result in patient harm. A proactive approach, such as the use of a screening tool to identify acute hospital inpatients with swallowing difficulties, is required, to mitigate the risk of inappropriate modifications to medicines to overcome swallowing difficulties. Full article

Frailty is common among older hospital inpatients. While studies describe frailty prevalence in acute hospitals, it is usually based upon retrospective hospital-coded data or brief screening on admission rather than comprehensive geriatric assessment (CGA). Further, little is known about differences between pre-admission and current frailty status. Given this, we investigated the prevalence of pre-frailty and frailty among adult inpatients in a large university hospital after CGA. Of the 410 inpatients available, 398 were included in the study, with a median age of 70 years; 56% were male. The median length of stay (LOS) at review was 8 days. The point prevalence of frailty was 30% versus 14% for pre-frailty. The median Clinical Frailty Scale score pre-admission was 3/9, which was significantly lower than at review, which was 4/9 (p < 0.001). After adjusting for age and sex, frailty was associated with greater odds of prolonged LOS (odds ratio [OR] 1.7, p = 0.045), one-year mortality (OR 2.1, p = 0.006), and one-year institutionalisation (OR 9, p < 0.001) but not re-admission. Frailty was most prevalent on medical and orthopaedic wards. In conclusion, CGA is an important risk assessment for hospitalised patients. Frailty was highly prevalent and associated with poor healthcare outcomes. Frailty status appears to worsen significantly during admission, likely reflecting acute illness, and it may not reflect a patient’s true frailty level. The development of frailty clinical care pathways is recommended in order to address the poor prognosis associated with a diagnosis of frailty in this setting. Full article

Stroke due to atrial fibrillation (AF) is more common in older adults. Frailty is associated with AF. As little is known about the impact of frailty on cardioembolic stroke, we examined its association with important healthcare outcomes including mortality and functional outcome in stroke with AF. Data were collected from patients presenting consecutively to a regional university hospital to assess pre-admission frailty using the Clinical Frailty Scale (CFS) and function with the Modified Rankin Scale (mRS). Stroke severity was assessed on the National Institute of Health Stroke Scale (NIHSS). In total, 113 patients presenting between August 2014 and July 2016 were identified with cardioembolic stroke, median age 80 years; 60% were male. Their median NIHSS score was 6. The median pre-admission CFS score was 3; 26.5% scored ≥5/9, indicating frailty. The median pre-admission mRS scores increased significantly from 1 to 3 at discharge (p < 0.001). Frailty was associated with worse mRS scores at discharge, odds ratio 1.5, (p = 0.03). While no patients with frailty were suitable to avail of early supported discharge, 10% of those without frailty were (p = 0.02). There was no significant difference in 30-day mortality. Frailty is prevalent among patients with cardioembolic stroke due to AF and was associated with poorer functional outcomes. Although the numbers were small, these data suggest that brief frailty assessments are useful to risk-stratify patients with acute cardioembolic stroke. Frailty status on admission with stroke due to AF can help identify those more likely to have poorer outcomes, to benefit from intervention, to require prolonged rehabilitation, and to avail of ESD. Full article

Few studies have reported the differential outcomes of Small Incision Lenticule Extraction (SMILE) on myopic astigmatism. Given this, we examined the effectiveness of SMILE for up to one year, comparing with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism, conducting a retrospective review of patients who underwent correction of myopic astigmatism using the 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec) at two refractive clinics in Poland between 2016–2017. Patients were aged ≥21 with stable refractive errors between −0.5 and −10.0 diopter (D) with astigmatism up to 5D. The mean age of the 209 patients (355 eyes) available was 32 years; 58.4% were female. Of these, 247 had WTR, 62 oblique, and 46 ATR astigmatism. The mean pre-operative spherical equivalent (SE) was −5.4 ± 2.57D and the cylinder −1.7 ± 1.0D. The mean SE for WTR reduced from −5.60 ± 2.37D to −0.31 ± 0.67D at 2 months and −0.38 ± 0.70D at 12 months; the mean cylinder improved from −1.90 ± 1.10D to −0.31 ± 0.39D and −0.36 ± 0.43D, respectively. Eyes with oblique astigmatism also improved from a mean SE of −5.8 ± 3.4 D to −0.82 ± 1.50D and −0.69 ± 1.15D and a cylinder of −1.4 ± 0.73D to −0.17 ± 0.33D at 2 months and −0.1 ± 0.32D at 12. For ATR, the mean SE improved from −4.0 ± 1.8D to −0.08 ± 0.22D and −0.04 ± 0.12D; and the mean cylinder from −1.25 ± 0.53 to −0.02 ± 0.09D −0.08 ± 0.21D at 2 and 12 months, respectively. There were statistically significant improvements in SE, manifest sphere and cylinder refraction, and UDVA and CDVA scores for each cylinder type at 2 months with ATR cylinders having better outcomes. Although missing data limited interpretation at one year, differences were maintained. The magnitude of error calculations suggests that WTR was more prone to under-correction, particularly for high astigmatism (>1.5D). SMILE for myopic astigmatism reliably corrects SE, irrespective of the subtype of astigmatism. Full article

Quantifying and identifying the introduction of metal in ore deposits that have experienced multiple overprinting hydrothermal events remains an elusive yet essential goal in metallogenic studies. Here, we constrain the origin of Co in the Idaho Cobalt Belt (ICB) that experienced two distinct metal-rich events that introduced Co and Cu. We performed a detailed petrographic study of sulfide ore at Iron Creek in the ICB, in concert with the quantification of trace metal element concentrations and copper isotope values to identify the introduction of Co in the system. The pyrite displays various degrees of alteration, with the highest Co concentrations (up to 6 wt.%) in less-altered pyrite grains (e.g., sharp edges, absence of altered boundaries and fissures) and highest δ⁶⁵Cu isotope value. The most-altered pyrite grains (e.g., corroded grains, round and altered boundaries) have lower Co contents and lower δ⁶⁵Cu isotope values that match the copper isotope values of the chalcopyrite. The least-altered pyrite shows a narrow δ⁶⁵Cu range between −0.39‰ to −0.58‰. In contrast, the most-altered pyrite grains are isotopically depleted, showing a δ⁶⁵Cu range from −1.35‰ to −0.90‰. Chalcopyrite shows a δ⁶⁵Cu range between −1.07‰ and −0.77‰. We interpret, from the Cu isotope compositions and Co concentrations in pyrite, that the Co was originally introduced into the siliciclastic host rock package in a Mesoproterozoic SEDEX environment. The heavier Cu was then preferentially leached in a second event, resulting in isotopically lighter Cu in the altered pyrite. Remobilization of the SEDEX cobalt was likely associated with CO₂-rich metamorphic fluids present in the region during the Mesoproterozoic East Kootenay orogeny, the late Mesoproterozoic Grenville orogeny, and the Late Jurassic to Late Cretaceous Cordilleran orogeny. Full article

The aim of this systematic review was to identify and critically appraise the available evidence regarding solid oral dosage forms (SODFs), e.g., tablets, and challenges regarding the oral administration of medicine to inpatients in a variety of healthcare settings such as (1) hospitals, (2) nursing homes and (3) long-term stay units (LTSUs). A literature search was undertaken in September 2021 and repeated in June 2023 in the following databases: PubMed, EMBASE, CINAHL, Scopus, Web of Science, The Cochrane Library, PsycINFO and ProQuest. A Microsoft Excel^® spreadsheet was devised to collate the following data from each eligible study: study author and year, country, number of participants, title, duration (follow-up period), study design, inclusion and exclusion criteria, method and data collection, relevant outcomes, and key findings. A total of 3023 records were identified, with 12 articles being included in the final systematic review. Seven of the twelve studies reported on the prevalence of difficulties swallowing SODFs, which varied from 10–34.2%. Nine of the twelve studies reported the methods used to manipulate SODFs, with the most reported method being tablet crushing. Given the prevalence of swallowing difficulties and the subsequent crushing of medicines in response to this, it is evident that concerns should be raised regarding the potential for a medication administration error to occur. Full article

Early identification of frailty can prevent functional decline. Although multiple frailty screens exist for use in Emergency Departments (EDs), few are validated against diagnostic standards such as comprehensive geriatric assessment. To examine the diagnostic accuracy of ED screens for frailty, scientific databases were searched for prospective diagnostic accuracy test studies from January 2000 to September 2022. Studies were assessed for risk of bias using QUADAS-C. Psychometric properties were extracted and analysed using R. Six studies involving 1,663 participants describing seven frailty screening instruments (PRISMA-7, CFS, VIP, FRESH, BPQ, TRST, and ISAR), representing 13 unique data points, were included. The mean age of participants ranged from 76 to 86 years. The proportion that was female ranged from 45 to 60%. The pooled prevalence rate of frailty was high at 59%. The pooled estimate for sensitivity was 0.85 (95% CI: 0.76–0.91) versus 0.77 (95% CI: 0.62–0.88) for specificity. Pooled accuracy based on area under the ROC curve was 0.89 (95% CI: 0.86–0.90). Although few studies were found, limiting the ability to conduct a meta-analysis of individual instruments, available frailty screens can accurately diagnose frailty in older adults attending the ED. As specificity was comparatively low, additional assessment may be required to identify those requiring inpatient management or onward community referral. Further study is therefore required. Full article

Background: Many women with early-stage breast cancer are predicted to be at sufficiently low risk for recurrence that they may forego chemotherapy. Nevertheless, some low-risk women will experience a local recurrence, and for them the risk of death increases significantly thereafter. The utility of initiating chemotherapy at the time of local recurrence has not been adequately addressed. The purpose of this study is to identify, in a hospital-based series of patients with early-stage breast cancer who were not treated with chemotherapy, those factors which predict death post local recurrence. Methods: We identified 135 women who were diagnosed with early-stage breast cancer (node-negative, <5 cm) and who did not receive chemotherapy at diagnosis and who developed a local recurrence. They were diagnosed between 1987 and 2000 and treated at Women’s College Hospital. For each patient, we abstracted information on the initial cancer (age at diagnosis, tumour size, tumour grade, ER status, PR status, HER2 status, lympho-vascular invasion, type of surgery, use of radiotherapy, tamoxifen and chemotherapy), the time from initial diagnosis to local recurrence and treatment at recurrence. The Kaplan–Meier method was used to estimate the ten-year actuarial risk of breast cancer death post recurrence. A Cox proportional hazards model was used to estimate multivariate hazard ratios for the various factors. Results: Among the 135 women in the cohort, the mean time from initial diagnosis to local recurrence was 7.8 years (range: 0.3 to 22.6 years). A total of 38 of the 135 women (28.1%) died of breast cancer a mean of 5.3 years after experiencing the local recurrence (range: 0.3 to 17 years). The ten-year breast cancer survival post local recurrence was 71% and the 15-year survival was 65%. In a multivariate analysis, it was found that factors that were significantly associated with death after local recurrence were (1) PR-negative status, (2) young age at diagnosis (<40 years) and (3) time to local recurrence less than 2 years. Nine percent of women received chemotherapy at the time of local recurrence. Conclusions: For breast cancer patients with a low baseline risk of mortality, the risk of death after an isolated local recurrence is substantial. Systemic treatment at the time of local recurrence needs further study. Full article