The role of C-reactive protein (CRP) as a prognostic marker in COVID-19

Funding declaration This study received no specific funding. The study was partially supported through the NIHR Maudsley Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust in partnership with King's College London (BC)Peer reviewedPostprin

Clinician-facilitated physical activity intervention versus pulmonary rehabilitation for improving physical activity in COPD: a feasibility study

Pulmonary rehabilitation (PR) may not suit all individuals with chronic obstructive pulmonary disease (COPD) and may not result in increased physical activity. Higher levels of physical activity are associated with reduced mortality and morbidity. The aim of this study was to assess the feasibility of conducting a trial to investigate the effectiveness of a clinician-facilitated physical activity intervention (PAI) versus PR in improving physical activity in patients with COPD referred to PR. In this randomised controlled mixed methods feasibility study, all patients referred to PR who were eligible and willing were assessed at baseline and then randomised to the PAI or to PR. The assessments were repeated post-intervention and at 3-month follow-up. The main outcome was step count measured by Actigraph. Semi-structured interviews were conducted post-intervention. The N = 50 patients; mean (SD) age, 64.1(8.6) years, 24M were recruited and randomised; N = 23 (PAI) and n = 26 (PR): one patient was excluded from the analysis as that person did not meet the GOLD diagnostic criteria. Key feasibility criteria were met; recruitment was 11%, dropouts in PAI were 26% (n = 6) and 50% (n = 13/26) PR. Participants in both groups experienced a range of health benefits from their respective programmes. The PAI appears to be effective in increasing step counts in people with COPD: mean change (standard deviation) [confidence interval] for the PAI group was 972.0(3230.3)[–1080.3 to 3024.4], n = 12 and 4.3(662.7)[-440.9 to 449.5], n = 11 for the PR group. The PAI met all domains of fidelity. This study provides key information to inform a future-randomised controlled trial in physical activity

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism.

BACKGROUND: The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. METHODS: We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg if the body weight was <50 kg or the patient had coronary heart disease), with dose adjustment according to the thyrotropin level; 369 patients were assigned to receive placebo with mock dose adjustment. The two primary outcomes were the change in the Hypothyroid Symptoms score and Tiredness score on a thyroid-related quality-of-life questionnaire at 1 year (range of each scale is 0 to 100, with higher scores indicating more symptoms or tiredness, respectively; minimum clinically important difference, 9 points). RESULTS: The mean age of the patients was 74.4 years, and 396 patients (53.7%) were women. The mean (±SD) thyrotropin level was 6.40±2.01 mIU per liter at baseline; at 1 year, this level had decreased to 5.48 mIU per liter in the placebo group, as compared with 3.63 mIU per liter in the levothyroxine group (P<0.001), at a median dose of 50 μg. We found no differences in the mean change at 1 year in the Hypothyroid Symptoms score (0.2±15.3 in the placebo group and 0.2±14.4 in the levothyroxine group; between-group difference, 0.0; 95% confidence interval [CI], -2.0 to 2.1) or the Tiredness score (3.2±17.7 and 3.8±18.4, respectively; between-group difference, 0.4; 95% CI, -2.1 to 2.9). No beneficial effects of levothyroxine were seen on secondary-outcome measures. There was no significant excess of serious adverse events prespecified as being of special interest. CONCLUSIONS: Levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism. (Funded by European Union FP7 and others; TRUST ClinicalTrials.gov number, NCT01660126 .)

Contamination of the water supply to the town of Carolina, Mpumalanga, January 2012

Acid mine drainage has become a serious environmental concern in South Africa, particularly for the long-term sustainability of the country’s fresh water supply. Such concerns were dramatically highlighted in January 2012 when water in the Boesmanspruit Dam, which supplies the town of Carolina with potable water, underwent rapid deterioration following a large rainstorm event. A sudden drop in pH to 3.7, accompanied by elevated levels of iron, aluminium, manganese and sulphate rendered the water toxic and unsuitable for use. The problem remained unresolved for 7 months, provoking community protests and eventually court action against the Department of Water Affairs. Although evidence pointed to coal mining as the source of contamination, it was unclear how the dam became polluted so rapidly. We investigated the events surrounding the contamination of Carolina’s water supply, in an attempt to identify a possible cause and to assess whether the event has relevance for other dams in the Vaal River system. Chemical analyses of water samples revealed that the pollution originated from the Witrandspruit subcatchment where seepage from coal mines had accumulated in a wetland upstream of the dam. During an unusually heavy downpour, ponds holding polluted run-off from coal handling facilities overtopped and flushed the contents of the wetland into the Boesmanspruit Dam. While a recurrence of the event at Carolina is possible, major dams in the upper Vaal River catchment are unlikely to experience a similar catastrophic event. In the long term, pollution of these dams is likely to proceed gradually, as is currently occurring at the Middelburg and Witbank Dams

Controls On the Genesis, Sedimentary Architecture, and Preservation Potential of Dryland Alluvial Successions In Stable Continental Interiors:Insights from the Incising Modder River, South Africa

Interpretations of the allogenic and autogenic controls on dryland alluvial successions are commonly hampered by incomplete knowledge of the sedimentology of modern dryland river floodplains, in part because of the limited subsurface sediment exposures available in typically stable or aggrading riverine settings. Along many valleys in the South African interior, however, river incision and associated formation of “dongas” (gullies and badland-type settings) provides extensive exposures of Cenozoic alluvial successions, which enable assessment of the controls on their genesis, sedimentary architecture, and preservation potential. This paper focuses on the incised Modder River at Erfkroon, Free State, located ∼ 1480 km (river distance) inland from the Atlantic Ocean. At Erfkroon, numerous dongas have formed in an ∼ 15-m-thick alluvial succession deposited within a narrow (\u3c 500 m) valley carved predominantly in erodible, fine-grained sedimentary rocks (“shales”). Facies associations include channel deposits that vary in texture from sandy gravel to silty sand, and overbank deposits consisting predominantly of sandy mud to muddy sand that have varying degrees of pedogenic overprinting. Younger deposits are stacked upon, crosscut, or onlap older deposits, indicating a complex history of cut and fill. Changing assemblages of associated fossil fauna and archaeological artifacts, luminescence ages, and paleosol characteristics demonstrate net sediment accumulation over at least the last 42 ka under humid to arid climatic conditions. By contrast, the present-day situation of deep channel and donga incision into bedrock appears to represent a new phase of sediment evacuation and valley deepening. Comparison with other incising dryland rivers in the South African interior suggests that: 1) while phases of cut and fill are driven largely by climatic fluctuations, major phases of incision into bedrock are controlled by breaching of downstream resistant rock barriers; 2) long-term sediment preservation is limited in narrow valleys that are subject to extended periods of base-level stability followed by episodic, major incisional phases, but is greater along broader valleys where rivers are undergoing lateral migration and more progressive long-term incision. Study of incising rivers such as the Modder can yield important insights into the controls on alluvial successions in stable continental interiors beyond the range of sea-level changes, which may help with the interpretation of inland alluvial valleys preserved in the geological record