COMBUSTION AND LEACHING BEHAVIOR OF TRACE ELEMENTS IN LIGNITE AND COMBUSTION BY-PRODUCTS FROM THE MUĞLA BASIN, SW TURKEY

The Muğla Basin is one of the most well-documented coal basins of Anatolia, SW Turkey. Previous studies mainly focused on coal geology, as well as on the environmental impacts from trace elements emitted into the atmosphere during coal combustion. However, the environmental impacts from coal utilization also include groundwater contamination from hazardous trace elements leached from exposed lignite stockpiles or ash disposal dumps. In the present study a comparative assessment of the combustion, as well as the leaching behaviour of trace elements from sixteen lignite, fly ash and bottom ash samples under various pH conditions is attempted. The samples were picked up from three regions in the Muğla Basin, namely, these of Yeniköy, Kemerköy and Yatağan. Proximate and ultimate analyses were performed on all samples. Quantitative mineralogical analysis was carried out using a Rietveld-based full pattern fitting technique. The elements Ag, As, B, Ba, Be, Co, Cr, Cu, Fe, Ga, Hf, Li, Mn, Mo, Ni, Pb, Sr, U, V and Zn were grouped according to their volatility during combustion and their leachability in the various types of samples. The pH of the leaching agent little affected the leaching trends of most elements and the mode of occurrence proved to be the major factor controlling primarily combustion and to a lesser extent leaching. The elements were classified into 7 classes with increasing environmental significance with Mo, Sr and V being the most potentially hazardous trace elements in the Muğla region

ENVIRONMENTAL – HYDROGEOLOGICAL INVESTIGATIONS ON THE CLAY DEPOSITS IN THE BROAD AREA OF MESOLOGGI – AITOLIKO LAGOONS

A hydrogeological study took place in the broader area of Mesologgi – Aitoliko lagoons (West Greece) aiming at the investigation of a) the hydrogeological conditions of the area as well as the surface and groundwater influences on the quality of the clay deposits found in the lagoons and b) the properties of the clay in order to be identified as “therapeutic peloids”. Due to their location, the clay deposits could be influenced and possibly polluted from the surface waters. The aquifer of the unconsolidated formations presents low hydraulic conductivity, while the carbonate aquifer is bounded from the foregoing aquifer and therefore the possibility of clay pollution from the groundwater is very limited. pH of the sediments showing neutral and alkaline values, limits the mobility of some pollutants. Seawater affects some of the clay samples, which present high electrical conductivity. Iron and manganese show also high concentrations, while some of trace elements such as Cd, Hg, Hf, Be, Ag present concentrations under the detection limit. Most of the organic material of the clay consists of humus and therefore they could be suitable for fangotherapy

Troponin elevation pattern and subsequent cardiac and non-cardiac outcomes: Implementing the Fourth Universal Definition of Myocardial Infarction and high-sensitivity troponin at a population level

Background: The Fourth Universal Definition of Myocardial Infarction (MI) differentiates MI from myocardial injury. We characterised the temporal course of cardiac and non-cardiac outcomes associated with MI, acute and chronic myocardial injury. Methods: We included all patients presenting to public emergency departments in South Australia between June 2011–Sept 2019. Episodes of care (EOCs) were classified into 5 groups based on high-sensitivity troponin-T (hs-cTnT) and diagnostic codes: 1) Acute MI [rise/fall in hs-cTnT and primary diagnosis of acute coronary syndrome], 2) Acute myocardial injury with coronary artery disease (CAD) [rise/fall in hs-cTnT and diagnosis of CAD], 3) Acute myocardial injury without CAD [rise/fall in hs-cTnT without diagnosis of CAD], 4) Chronic myocardial injury [elevated hs-cTnT without rise/fall], and 5) No myocardial injury. Multivariable flexible parametric models were used to characterize the temporal hazard of death, MI, heart failure (HF), and ventricular arrhythmia. Results: 372,310 EOCs (218,878 individuals) were included: acute MI (19,052 [5.12%]), acute myocardial injury with CAD (6,928 [1.86%]), acute myocardial injury without CAD (32,231 [8.66%]), chronic myocardial injury (55,056 [14.79%]), and no myocardial injury (259,043 [69.58%]). We observed an early hazard of MI and HF after acute MI and acute myocardial injury with CAD. In contrast, subsequent MI risk was lower and more constant in patients with acute injury without CAD or chronic injury. All patterns of myocardial injury were associated with significantly higher risk of all-cause mortality and ventricular arrhythmia. Conclusions: Different patterns of myocardial injury were associated with divergent profiles of subsequent cardiac and non-cardiac risk. The therapeutic approach and modifiability of such excess risks require further research

Impacts of high sensitivity troponin T reporting on care and outcomes in clinical practice:Interactions between low troponin concentrations and participant sex within two randomized clinical trials

Background: The impacts of high sensitivity cardiac troponin (hs-cTn) reporting on downstream interventions amongst suspected acute coronary syndrome (ACS) in the emergency department (ED), especially amongst those with newly identified hs-cTn elevations and in consideration of well-established sex-related disparities, has not been critically evaluated to date. This investigation explores the impact of hs-cTnT reporting on care and outcomes, particularly by participant sex. Methods: Two similarly ED-based randomized controlled trials conducted between July 2011 to March 2013 (n = 1988) and August 2015 to April 2019 (n = 3378) were comparatively evaluated. Clinical outcomes were adjudicated to the Fourth Universal Definition of MI. Changes in practice were assessed at 30 days, and death or MI were explored to 12 months. Results: The HS-Troponin study demonstrated no difference in death or MI with unmasking amongst those with hs-cTnT &lt;30 ng/L, whereas the RAPID TnT study demonstrated a significantly higher rate. In RAPID TnT, there was significant increase in death or MI associated with unmasking for females with hs-cTnT &lt;30 ng/L (masked: 11[1.5%], unmasked: 25[3.4%],HR: 2.27,95%C.I.:1.87–2.77,P &lt; 0.001). Less cardiac stress testing with unmasking amongst those &lt;30 ng/L was observed in males in both studies, which was significant in RAPID TnT (masked: 92[12.0%], unmasked: 55[7.0%], P = 0.008). In RAPID TnT, significantly higher rates of angiography in males were observed with unmasking, with no such changes amongst females &lt;30 ng/L (masked: 28[3.7%], unmasked: 51[6.5%],P = 0.01). Conclusion: Compared with males, there were no evident impacts on downstream practices for females with unmasking in RAPID TnT, likely representing missed opportunities to reduce late death or MI.</p

Impacts of high sensitivity troponin T reporting on care and outcomes in clinical practice:Interactions between low troponin concentrations and participant sex within two randomized clinical trials

Background: The impacts of high sensitivity cardiac troponin (hs-cTn) reporting on downstream interventions amongst suspected acute coronary syndrome (ACS) in the emergency department (ED), especially amongst those with newly identified hs-cTn elevations and in consideration of well-established sex-related disparities, has not been critically evaluated to date. This investigation explores the impact of hs-cTnT reporting on care and outcomes, particularly by participant sex. Methods: Two similarly ED-based randomized controlled trials conducted between July 2011 to March 2013 (n = 1988) and August 2015 to April 2019 (n = 3378) were comparatively evaluated. Clinical outcomes were adjudicated to the Fourth Universal Definition of MI. Changes in practice were assessed at 30 days, and death or MI were explored to 12 months. Results: The HS-Troponin study demonstrated no difference in death or MI with unmasking amongst those with hs-cTnT &lt;30 ng/L, whereas the RAPID TnT study demonstrated a significantly higher rate. In RAPID TnT, there was significant increase in death or MI associated with unmasking for females with hs-cTnT &lt;30 ng/L (masked: 11[1.5%], unmasked: 25[3.4%],HR: 2.27,95%C.I.:1.87–2.77,P &lt; 0.001). Less cardiac stress testing with unmasking amongst those &lt;30 ng/L was observed in males in both studies, which was significant in RAPID TnT (masked: 92[12.0%], unmasked: 55[7.0%], P = 0.008). In RAPID TnT, significantly higher rates of angiography in males were observed with unmasking, with no such changes amongst females &lt;30 ng/L (masked: 28[3.7%], unmasked: 51[6.5%],P = 0.01). Conclusion: Compared with males, there were no evident impacts on downstream practices for females with unmasking in RAPID TnT, likely representing missed opportunities to reduce late death or MI.</p

Cost effectiveness of a 1-hour high-sensitivity troponin-T protocol: an analysis of the RAPID-TnT trial

Background: To understand the economic impact of an accelerated 0/1-hour high-sensitivity troponin-T (hs-cTnT) protocol. Objective: To conduct a patient-level economic analysis of the RAPID-TnT randomised trial in patients presenting with suspected acute coronary syndrome (ACS). Methods: An economic evaluation was conducted with 3265 patients randomised to either the 0/1-hour hs-cTnT protocol (n = 1634) or the conventional 0/3-hour standard-of-care protocol (n = 1631) with costs reported in Australian dollars. The primary clinical outcome was all-cause mortality or new/recurrent myocardial infarction. Results: Over 12-months, mean per patient costs were numerically higher in the 0/1-hour arm compared to the conventional 0/3-hour arm (by $472.49/patient, 95$-1,380.15 to $2,325.13, P = 0.617) with no statistically significant difference in primary outcome (0/1-hour: 62/1634 [3.8$891.22/patient, 95 %CI: $-96.07 to 1,878.50, P = 0.077). Restricting the analysis to patients with hs-cTnT concentrations ≤ 29 ng/L, mean per patient cost remained numerically higher in the 0/1-hour arm (by$152.44/patient, 95 %CI:$-1,793.11 to$2,097.99, P = 0.988), whilst the reduction in ED LOS was more pronounced (by 0.70 h/patient, 95 %CI: 0.45–0.95, P < 0.001). Conclusions: There were no differences in resource utilization between the 0/1-hour hs-cTnT protocol versus the conventional 0/3-hour protocol for the assessment of suspected ACS, despite improved initial ED efficiency. Further refinements in strategies to improve clinical outcomes and subsequent management efficiency are needed.Ming-yu Anthony Chuang Emmanuel S. Gnanamanickam, Jonathan Karnon, Kristina Lambrakis, Matthew Horsfall, Andrew Blyth ... et al