Health and economic impact of the pneumococcal conjugate vaccine in hindering antimicrobial resistance in China

Antimicrobial resistance (AMR) poses a serious threat to global public health. However, vaccinations have been largely undervalued as a method to hinder AMR progression. This study examined the AMR impact of increasing pneumococcal conjugate vaccine (PCV) coverage in China. China has one of the world’s highest rates of antibiotic use and low PCV coverage. We developed an agent-based DREAMR (Dynamic Representation of the Economics of AMR) model to examine the health and economic benefits of slowing AMR against commonly used antibiotics. We simulated PCV coverage, pneumococcal infections, antibiotic use, and AMR accumulation. Four antibiotics to treat pneumococcal diseases (penicillin, amoxicillin, third-generation cephalosporins, and meropenem) were modeled with antibiotic utilization, pharmacokinetics, and pharmacodynamics factored into predicting AMR accumulation. Three PCV coverage scenarios were simulated over 5 y: 1) status quo with no change in coverage, 2) scaled coverage increase to 99% in 5 y, and 3) accelerated coverage increase to 85% over 2 y followed by 3 y to reach 99% coverage. Compared to the status quo, we found that AMR against penicillin, amoxicillin, and third-generation cephalosporins was significantly reduced by 6.6%, 10.9%, and 9.8% in the scaled scenario and by 10.5%, 17.0%, and 15.4% in the accelerated scenario. Cumulative costs due to AMR, including direct and indirect costs to patients and caretakers, were reduced by $371 million in the scaled and $586 million in the accelerated scenarios compared to the status quo. AMR-reducing benefits of vaccines are essential to quantify in order to drive appropriate investment.

Worldwide version-controlled database of glacier thickness observations

Although worldwide inventories of glacier area have been coordinated internationally for several decades, a similar effort for glacier ice thicknesses was only initiated in 2013. Here, we present the third version of the Glacier Thickness Database (GlaThiDa v3), which includes 3 854 279 thickness measurements distributed over roughly 3000 glaciers worldwide. Overall, 14 % of global glacier area is now within 1 km of a thickness measurement (located on the same glacier) – a significant improvement over GlaThiDa v2, which covered only 6 % of global glacier area and only 1100 glaciers. Improvements in measurement coverage increase the robustness of numerical interpolations and model extrapolations, resulting in better estimates of regional to global glacier volumes and their potential contributions to sea-level rise. In this paper, we summarize the sources and compilation of glacier thickness data and the spatial and temporal coverage of the resulting database. In addition, we detail our use of open-source metadata formats and software tools to describe the data, validate the data format and content against this metadata description, and track changes to the data following modern data management best practices. Archived versions of GlaThiDa are available from the World Glacier Monitoring Service (e.g., v3.1.0, from which this paper was generated: https://doi.org/10.5904/wgms-glathida-2020-10; GlaThiDa Consortium, 2020), while the development version is available on GitLab (https://gitlab.com/wgms/glathida, last access: 9 November 2020).

Can Existing Improvements of Water, Sanitation, and Hygiene (WASH) in Urban Slums Reduce the Burden of Typhoid Fever in These Settings?

Background Sustained investments in water, sanitation, and hygiene (WASH) have lagged in resource-poor settings; incremental WASH improvements may, nonetheless, prevent diseases such as typhoid in disease-endemic populations. Methods Using prospective data from a large cohort in urban Kolkata, India, we evaluated whether baseline WASH variables predicted typhoid risk in a training subpopulation (n = 28 470). We applied a machine learning algorithm to the training subset to create a composite, dichotomous (good, not good) WASH variable based on 4 variables, and evaluated sensitivity and specificity of this variable in a validation subset (n = 28 470). We evaluated in Cox regression models whether residents of “good” WASH households experienced a lower typhoid risk after controlling for potential confounders. We constructed virtual clusters (radius 50 m) surrounding each household to evaluate whether a prevalence of good WASH practices modified the typhoid risk in central household members. Results Good WASH practices were associated with protection in analyses of all households (hazard ratio [HR] = 0.57; 95% confidence interval [CI], .37–.90; P = .015). This protection was evident in persons ≥5 years old at baseline (HR = 0.47; 95% CI, .34–.93; P = .005) and was suggestive, though not statistically significant, in younger age groups (HR = 0.61; 95% CI, .27–1.38; P = .235). The level of surrounding household good WASH coverage was also associated with protection (HR = 0.988; 95% CI, .979–.996; P = .004, for each percent coverage increase). However, collinearity between household WASH and WASH coverage prevented an assessment of their independent predictive contributions. Conclusions In this typhoid-endemic setting, natural variation in household WASH was associated with typhoid risk. If replicated elsewhere, these findings suggest that WASH improvements may enhance typhoid control, short of major infrastructural investments.

Evaluation of prognostic factors affecting root coverage in patients before planned orthodontic treatment

During orthodontic dental arch expansion, especially in cases of teeth with gingival recessions, further loss of soft tissues and progression of recession might be observed. <b>Aim.</b> The aim of this study was to evaluate determinants of root coverage, increase in the width of keratinised tissue and gingival thickness after soft tissue augmentation procedures in patients before planned orthodontic treatment. <b>Material and methods.</b> 16 patients with the mean age of 28.18 (±6.58) years with 122 type I and II gingival recessions were enrolled in the study. Total, 32 soft tissue augmentation procedures with a coronally advanced flap (CAF) and tunnel technique (TUN) together with a connective tissue graft (CTG) were performed. The clinical and aesthetic parameters were assessed at baseline and 6 months postoperatively. <b>Results.</b> CAF was performed more often in upper teeth and type I gingival recession, in contrast to TUN. The mean percentage root coverage on CAF sides was 98.48%, while on TUN sides it was 81.71%. Complete root coverage was achieved in 87.3% and 61.2% of gingival recessions, respectively. A multivariate linear regression showed that the amount of root coverage was significantly affected by baseline recession height (GR), recession type, type and position of a tooth and surgical modality. The increase in the width of keratinised tissue (WKT) was related to the baseline width of keratinised tissue, type and position of a tooth, whereas the increase in gingival thickness (GT) was associated with baseline gingival thickness, tooth position and gender. Best aesthetics was observed on the TUN sides. <b>Conclusions.</b> Baseline characteristics of a surgical site (GR, WKT, GT), recession type, position and type of a tooth, and treatment modality may be helpful in the prognosis of recession coverage, increase in the width of keratinised tissue and gingival thickness in orthodontic patients.

Invitation coverage and participation in Italian cervical, breast and colorectal cancer screening programmes

Objectives In Italy, regional governments organize cervical, breast and colorectal cancer screening programmes, but there are difficulties in regularly inviting all the target populations and participation remains low. We analysed the determinants associated with invitation coverage of and participation in these programmes. Methods We used data on screening programmes from annual Ministry of Health surveys, 1999–2012 for cervical, 1999–2011 for breast and 2005–2011 for colorectal cancer. For recent years, we linked these data to the results of the national routine survey on preventive behaviours to evaluate the effect of spontaneous screening at Province level. Invitation and participation relative risk were calculated using Generalized Linear Models. Results There is a strong decreasing trend in invitation coverage and participation in screening programmes from North to South Italy. In metropolitan areas, both invitation coverage (rate ratio 0.35–0.96) and participation (rate ratio 0.63–0.88) are lower. An inverse association exists between spontaneous screening and both screening invitation coverage (1–3% decrease in invitation coverage per 1% spontaneous coverage increase) and participation (2% decrease in participation per 1% spontaneous coverage increase) for the three programmes. High recall rate has a negative effect on invitation coverage in the next round for breast cancer (1% decrease in invitation per 1% recall increase). Conclusions Organizational and cultural changes are needed to better implement cancer screening in southern Italy.

The growth behavior of graphene on iron-trichloride-solution-soaked copper substrates in a low pressure chemical vapor deposition

A copper substrate soaking-treatment with FeCl3 solution is introduced to significantly reduce the initial graphene nucleation density (up to 6-fold from 0.29 to 0.05 μm−2), and the overall graphene coverage increase-rate is successfully increased.