Search

Background The aim of this study was to determine the long-term effect of increasing water intake in patients with autosomal dominant polycystic kidney disease (ADPKD) on longitudinal changes in health-related quality of life (HRQoL) in the setting of a clinical trial. Methods Self-completed HRQoL (using the KDQoL-SF, v.1.3 questionnaire) was assessed annually in participants of a 3-year randomized controlled clinical trial (n  = 187), allocated (1:1) either to increase water intake to reduce urine osmolality to ≤270 mosmol/kg (implemented by dietetic coaching, self-monitoring tools, text messaging) or continue usual water intake. Results Overall, 96% and 81.8% of participants (n  = 187) completed the questionnaire at the baseline and final study visits, respectively. At baseline, the physical component summary score (PCS) and mental component summary score (MCS) were similar in the two groups (P > 0.05) and the five dimensions with the lowest scores in both groups were: energy and fatigue; general and overall health; sleep; emotional well-being; and pain. Within each group, there were no longitudinal changes over time. At the final visit, the PCS was higher in the increased water intake group (51.3 ± 7.6, mean ± standard deviation) compared to the usual water intake group 48.8 ± 9.3; P = 0.037) whereas the MCS was numerically similar. The improvement in the PCS was due to higher sub-scale values for physical functioning and pain (both P < 0.05). By multivariate analysis, only baseline PCS and height-corrected total kidney volume were associated with the final PCS (P < 0.05). Conclusion HRQoL scores remained stable over a 3 year period, and were not adversely affected by the intervention to increase water intake. Future studies should evaluate the clinical significance of the higher PCS in the increased water intake group. [ABSTRACT FROM AUTHOR]

Breastfeeding is associated with reduced lifetime cardiometabolic risk, but little is known regarding the metabolic benefit in a subsequent pregnancy. The primary aim of this study was to investigate the association between breastfeeding duration and intensity and next pregnancy oral glucose tolerance test (OGTT) results. A retrospective cohort study was conducted from March 2020 to October 2022. All multiparous women who met inclusion criteria and gave birth during the study period were eligible for inclusion. Analysis was stratified by risk for gestational diabetes (GDM). High GDM risk criteria included previous GDM and BMI > 35 kg/m2. The association between breastfeeding duration and high-intensity breastfeeding (HIBF) and subsequent pregnancy OGTT were assessed with multivariate logistic models adjusted for statistically and clinically relevant covariables. There were 5374 multiparous participants who met the inclusion criteria for analysis. Of these, 61.7% had previously breastfed for >6 months, and 43.4% were at high risk for GDM. HIBF was associated with 47% reduced odds of an abnormal fasting glucose in a subsequent pregnancy OGTT (aOR 0.53; 95%CI 0.38–0.75; p < 0.01). There was no association between HIBF and other glucose results on the OGTT. Women who smoked were least likely to breastfeed at high intensity (aOR 0.31; 95%CI 0.21–0.47; p < 0.01). South Asian women had 65% higher odds of HIBF than women who identified as White/European (aOR 1.65; 1.36–2.00; p < 0.01). This study highlights the importance of exclusive breastfeeding to potentially reduce the prevalence of GDM and may also translate into long-term reduction of cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Objectives. Given the continuing COVID-19 pandemic and the associated prevention and control measures implemented, the psychological burden brought by the pandemic on citizens is expected to increase. This study is aimed at exploring the predictors of depressive symptoms among Hong Kong people during the epidemic, as well as factors that could potentially alleviate the negative effects of the epidemic. Methods. The third wave follow-up survey (December 2021 to January 2022) from a longitudinal prospective survey study conducted in Hong Kong was used for a cross-sectional analysis. The participants (n = 803) are adults aged 18 and above in Hong Kong. Logistic and linear regression were performed to test the predictors and moderating effects, respectively, with depression as the outcome variable. Results. With minimized confounding effects of demographic variables, higher levels of concern about infection, experience with COVID-19 infection and previous epidemics, hassles, and trust in authority increased the odds of being depressed, while a higher level of trust in medical professionals reduced the odds of depression. Moreover, greater trust in medical professionals, as a moderator, lessened the positive associations between the levels of depression and hassles and concern about infection. Conclusions. Even though the threats of COVID-19 seem to have lowered, this study shows that a few factors associated with the pandemic continue to threaten people's mental health. However, developing greater trust in medical experts may be an effective way to relieve psychological burden. [ABSTRACT FROM AUTHOR]

Objectives: Empirical evidence about the heightened risks of elder abuse and age discrimination during the COVID‐19 pandemic is scarce. This study aimed to track the changes in rates of both, and investigated their associated factors in the community‐dwelling older population in Hong Kong. Methods: In this two‐wave, cross‐sectional telephone survey, we interviewed a population‐based sample of individuals (≥55 years), and captured the situation of elder abuse and age discrimination before the COVID‐19 outbreak (n = 1209, Wave 1: October–December 2019) and during the pandemic (n = 891, Wave 2: December 2020–January 2021). Participants reported their experiences of different types of abuse and discrimination, financial health, subjective well‐being, satisfaction with environment, health and social services, and resilience. Results: Abuse was reported by 20.2% of the sample before the outbreak and 17.8% during the pandemic; while discrimination was reported by 24.6% and 29.8% at the two time points, respectively. A drop in physical abuse was observed, but it was accompanied by a rise in discrimination in the form of harassment or refusal of services. Findings of logistic regression analysis show that abuse during the pandemic was associated with younger age, poorer subjective well‐being, and lower resilience; while discrimination was associated with female gender, being married, and poorer subjective well‐being. Conclusions: Elder abuse and discrimination were prevalent across time points. The pandemic has highlighted the marginalization of older persons in our communities. There is an urgent need for development of effective interventions to end abuse and discrimination. Key points: The prevalence of elder abuse in Hong Kong dropped from 20.2% before the onset of the COVID‐19 pandemic to 17.8% during the pandemic.Older persons with younger age, poorer well‐being, and lower resilience were more likely to report elder abuse.The prevalence of age discrimination against older persons increased from 24.6% to 29.8% after the outbreak of the pandemic.Women, married individuals, and those with poorer well‐being were more likely to report age discrimination. [ABSTRACT FROM AUTHOR]

The city of Ohrid is one of the oldest settlements in the western Balkans, exceptionally rich with archeological, architectural, and cultural sites, which must be protected from damage during future earthquakes by proper retrofitting and strengthening of the old structures. To provide a sound basis for retrofitting work, in this paper, we describe the amplitudes of strong ground motion in Ohrid for a range of probabilities of being exceeded. We use the Uniform Hazard Method to compute the amplitudes of strong motion, and, in the calculations, we explicitly include the geological site conditions for all the maps we show. By noting the large jumps in the predicted strong motion amplitudes at sites along the contact between basement rock and sediments, we emphasize that the empirical scaling equations for strong motion amplitudes must include explicit dependence on the geological site conditions. [ABSTRACT FROM AUTHOR]

Background: The establishment of mental health facilities in the community has been hindered by opposition from local residents in Hong Kong. Through a comparative review, this study aimed to compare the issues related to the process of establishment of community-based mental health facilities between Hong Kong and selected overseas countries and regions. It will better inform the strategies and best practices that can be adopted for the establishment of mental health facilities in Hong Kong. Methods: Three electronic databases (PubMed, Scopus, and PsycINFO) were used to examine literature on nine jurisdictions in Asia and western societies from 2005 to 2019. In addition, we conducted a number of in-depth interviews with overseas experts to gain in-depth insights and clarify information that was unavailable or unclear. A total of 19,248 articles were identified through the initial search. 71 of them met the inclusion criteria. In addition, 20 articles about the establishment of other types of community facilities or sensitive facilities were identified from supplementary sources. Results: Most Western countries and Singapore have adopted regulations or laws to reduce public discrimination against particular groups, giving them corresponding human rights and legislating to demarcate the use of land in the community. Regions close to Hong Kong emphasize communication with community leaders to obtain support for sensitive services or facilities. Conclusions: Hong Kong may consider strengthening the land zoning ordinance in relation to community sensitive facilities, as well as increasing communication with the community and considering the possibility of locating facilities in government buildings. [ABSTRACT FROM AUTHOR]

Background: The association of smoking with new‐onset cardiovascular disease, chronic lung disease, malignancy and mortality in dialysis is well‐known. The smoking prevalence and its association with clinical outcome was assessed. Methods: Multicentre cohort study using 'ANZDATA' Registry, 57 838 adults who commenced dialysis (>3 months) between 1990 and 2016 were included. Patients' demographics, initial dialysis modality, presence of comorbidities and smoking history are predictors. The primary outcome was all‐cause mortality. Secondary outcomes were smoking prevalence, cause‐specific mortality, non‐skin cancers, cardiovascular and chronic lung diseases. Results: Of the 57 838 patients, 56 512 (mean age of 58.9 ± 15.1 years, 40.1% female, 43% diabetic), had data on smoking history with 13.6% current, 40.7% former and 45.6% never smokers. Former and current smokers had 10% (HR 1.10; 95% CI: 1.08, 1.13) and 22%(HR 1.22; 95% CI: 1.18, 1.26) higher risk of all‐cause mortality. They were 13% (HR 1.13; 95% CI: 1.09, 1.18) and 23% (HR 1.23; 95% CI: 1.17, 1.29) for CVD mortality. Smoking was associated with higher mortality from respiratory failure (HR 1.59; 95% CI: 1.13, 2.23, p =.073 and HR 1.33; 95% CI: 1.01, 1.74, p =.042) for current and former smokers. Current and former smokers had higher risk for non‐skin cancer (HR 1.30; 95% CI: 1.19, 1.42 and HR 1.24; 95% CI: 1.17, 1.32). Smoking was associated with a higher rate of death from cancer (HR 1.26; 95% CI 1.19–1.33) and chronic lung disease (HR 1.48; 95% CI 1.15–1.92). Former and current smokers had a higher adjusted risk for de novo vascular disease (PVD, CVD), CAD (adjusted RR 1.1; 95% Cl: 1.09–1.12). Conclusions: In dialysis patients, smoking was associated with higher rates of all‐cause mortality, cardiovascular mortality, respiratory failure, chronic lung disease and malignancy along with higher risks of non‐skin cancers, de novo vascular disease and chronic lung disease. Summary at glance: Cigarette smoking is a very well‐known risk factor for mortality in dialysis patients. This is the first manuscript analysing hazardous effects of smoking by using the ANZDATA Registry. Besides well‐known negative impact on all‐cause mortality and chronic diseases, smoking trends in different age groups and time periods were reported in this study. This study underlines the negative impact of smoking in dialysis population. New guidelines and preventive measures should be designed according to different age groups. [ABSTRACT FROM AUTHOR]

Background: Cultural competence training plays an effective role in improving cultural competence for healthcare professionals, but cultural competence training was found to be insufficient in Hong Kong. Aim: This study aims to explore receptivity and readiness of Hong Kong healthcare professionals (nurses, occupational therapists (OTs), and physiotherapists (PTs)) towards cultural competence training. Methods: Twenty-three semi-structured interviews were conducted with 7 educators/trainers from tertiary institutions, 2 representatives of professional groups, and 14 managerial and frontline workers. Data were analysed using theoretical thematic analysis. Findings: Results show that nurses and PTs have lower levels of cultural competence than OTs owing to insufficient in-depth training and the nature of professional practice, and they expressed lower willingness to receive the training than OTs. However, the staff in these three professions encounter various challenges in serving ethnoculturally diverse groups. Therefore, barriers in receiving cultural competence training and best practice for providing cultural competence training were identified and discussed for these three professions. [ABSTRACT FROM AUTHOR]

Non‐adherence to medications is a critical challenge in the management of people with chronic kidney disease (CKD). This review explores the complexities of adherence in this population, the unique barriers and enablers of good adherence behaviours, and the role of emerging digital health technologies in bridging the gap between evidence‐based treatment plans and the real‐world standard of care. We present the current evidence supporting the use of digital health interventions among CKD populations, identifying the key research questions that remain unanswered, and providing practical strategies for clinicians to support medication adherence in a digital age. Summary at a glance: This manuscript reviews the current evidence for the use of digital health technologies to enhance medication adherence in chronic kidney disease populations. Practical strategies and considerations for integrating technologies into clinical practice are provided. [ABSTRACT FROM AUTHOR]

This qualitative evaluation study examined the impact of unstructured intervention on people with depression in a community mental health centre in Hong Kong. In the intervention, service users initiated groups and designed group activities by themselves, with social workers as facilitators. Semi‐structured interviews were conducted with service users enrolled in unstructured intervention, their family members, and service providers in 2019. Overall, 32 participants were recruited through purposive sampling. The results revealed that peer interactions helped participants to feel accepted and understood. Participants also acquired experience with emotional coping strategies and practised their interpersonal skills, and by learning new skills from peers, they were able to rebuild their self‐esteem and improve their relationships with friends and family. To cater to clients' different needs and concerns, unstructured activities should be diversified. Family and social functioning should also be emphasised in the development of unstructured intervention because the generic skills and knowledge acquired from unstructured activities with peers could help to enhance family relationships, self‐confidence, and the ability to manage issues related to working and socialising. [ABSTRACT FROM AUTHOR]

Background: There is little information available to inform the cost‐effectiveness of eHealth interventions in improving patient health outcomes. A trial‐based economic evaluation was undertaken aiming to inform the feasibility of conducting a mobile phone text messaging programme targeting dietary behaviours in people receiving haemodialysis. Methods: A trial‐based economic evaluation from a health system perspective of a 6‐month pilot randomised controlled trial was undertaken. One hundred and thirty patients receiving haemodialysis from six dialysis units across Sydney, Australia, were enrolled into the KIDNEYTEXT study. Usual care (inperson dietary counselling) was compared with usual care plus three semi‐personalised dietary mobile phone text messages per week over a 6‐month period. The outcomes of this economic evaluation included: cost of intervention, cost‐effectiveness and marginal effects on total costs. Results: The cost of developing and maintaining the KIDNEYTEXT intervention was US $110 per participant. Total costs were US $1418 higher in the usual care arm compared to the intervention arm. The incremental benefits for quality‐adjusted life adjusted years were 0.01 [95% confidence interval (CI) = −0.03 to 0.06] and dietary adherence (i.e., adherent to three or more dietary guidelines at 6 months) being 0.04 (95% CI = −0.15 to 0.24). The largest component of total costs was related to unplanned admissions to hospital. Conclusions: Mobile phone text messages targeting dietary behaviours may be cost saving, at the same time as maintaining similar or improved dietary behaviours. A larger trial with a longer follow‐up time is warranted. Highlights: Mobile phone text messaging is a low‐cost intervention.Mobile phone text messaging targeting dietary behaviours shows potential in being cost saving and resulting in similar or improved dietary behaviours.This simple text messaging intervention may be used as an additional tool to enhance patients' nutrition care.There may be a cost‐saving for dialysis units in using text messages, in addition to individualised dietary counselling. [ABSTRACT FROM AUTHOR]

Background: The social unrest in the second half of 2019 in Hong Kong came with conflicts, confrontations, and violence which affected almost everyone in the city. The destruction and disruption of the urban facilities have undoubtedly had a significant impact on the lives and mental well-being of the public, and the older people are even more vulnerable. This study examined the impacts of the social unrest on the wellbeing of older people, an area that was seldomly addressed in the public discourse and literature.Methods: Narrative interviews were conducted to capture older people's lived experiences and ways of making sense of the unrest in Hong Kong. A total of 63 participants aged 60 and above was recruited through personal networks of the research team, and referrals by participants who took part in the interviews. Qualitative semi-structure interviews was conducted one on one via telephone.Results: Thirty-three male and 30 female participants took part in the interview. The number of participants from different risk zones affected by political unrest was comparable. Three themes were generated. Participants experienced challenges during the social unrest, including disturbance to family and social life, reduced incomes which affect quality of life, and difficulties in socializing with friends and accessing medical services. The social unrest caused emotional disturbance, giving rise to feelings of panic, fear, insomnia, depression, annoyance, and anger. Participants reported different coping strategies, ranging from moving to other places, to avoiding going to risky areas and watching news.Conclusion: Social unrest brings emotional distress to older people. In many cases, older people cope with challenges in different ways, whether active or passive. Social workers and other professionals should give more support to older people to encourage them to overcome their difficulties. The stakeholders' awareness of the problem and mental health promotion is required to alleviate the multiple layers of negative impacts. [ABSTRACT FROM AUTHOR]

We present seismic zoning maps of the National Capital Region (NCR) of India in terms of uniform hazard spectrum (UHS) amplitudes using three different attenuation equations to model the contributions of local earthquakes around the region and distant earthquakes in northwestern Himalaya (NWH) and Hindu Kush Subduction (HKS) sources. Our results show that the shape of design spectra must depend on the nature of contributing earthquake sources, their relative activity, the potential to create large magnitudes, and their geographical placement relative to the site selected for hazard computation. Our results also show that specifying strong motion amplitudes for use in engineering design by means of peak ground acceleration and a standard spectral shape may result in significant underestimation of intermediate and long‐period ground motions critical for buildings higher than four to five stories and hence should not be used. We present zoning maps for nine possible combinations of three different local geological site conditions (sediments, intermediate sites, and basement rock sites) and three different soil site conditions ("rock," stiff soil sites, and deep soil sites). One of these maps can be readily used to extract the UHS amplitudes of the pseudo relative velocity spectrum (PSV) at any site in the NCR by specifying the local geological site‐condition parameters from a high‐resolution surface geological map of the region and determining the local soil site conditions by experiments limited to the site alone. The paper also provides a geological map of NCR on a scale of 1:1 million for a rough idea of the local geological parameters for a site of interest. [ABSTRACT FROM AUTHOR]

Seismic activity parameters (a $a$ and b $b$ values in a Gutenbdataer–Richter relationship, maximum magnitude Mmax ${M}_{\max }$, and predominant focal depths H $H$) have been estimated for a grid of square cells of size 0.1° in latitudes and longitudes covering a large region bound by 24°−33°N and 72°−82°E to define input seismicity for microzoning of the Delhi metropolitan area. For this purpose, seven area types of seismic sources are first identified from a detailed seismotectonic evaluation of the region. Two of these sources form part of the Northwestern Himalaya and the remaining five encompass the intraplate area including and surrounding the National Capital Region. The seismic activity parameters are then estimated for each source zone by compiling a comprehensive catalog of 4483 past earthquakes with magnitudes of 2.0 or more covering the 1720–2020 period. All the grid cells in each source are initially assigned the same values of parameters b $b$, Mmax ${M}_{\max }$, and H $H$ as those for the source zone; whereas parameter a $a$ has been redefined for each grid cell using the cumulative occurrence rate of earthquakes above the minimum magnitude of completeness for the source zone. To account for possible uncertainties in past earthquake locations, values of the activity parameters thus assigned to all the grid cells in the region are spatially smoothed using an elliptical Gaussian kernel with a major axis along the predominant strike direction for the source zone of each grid cell. The grid cells across the source zone boundaries are also included in the smoothing process to normalize the effects of any subjectivity introduced in defining the source zone boundaries. Our estimations of seismic activity parameters thus obtained can be considered in the development of a robust and physically realistic seismicity model for practical engineering applications, which was made possible by our use of a sufficiently long duration of the earthquake catalog along with complete reporting of data up to magnitudes very close to the expected maximum magnitude in each source zone. We have also estimated the seismic activity parameters for the Hindu Kush subduction zone, which is then idealized by a point source. [ABSTRACT FROM AUTHOR]

We present seismic microzonation maps of New Delhi, India, using the probabilistic seismic hazard analysis (PSHA) method with input seismic activity parameters estimated in Part‐I of this two‐part paper. Our calculations required three different attenuation equations for amplitude scaling of strong ground motion from three principal contributing sources: the National Capital Region (NCR), Northwestern Himalaya (NWH), and the Hindu Kush subduction (HKS). We show that uniform hazard spectral (UHS) amplitudes are dominated only by the local seismicity in the NCR at high frequencies beyond about 2 Hz. For intermediate and long periods, UHS amplitudes are dominated by contributions from the NWH and HKS earthquakes. Our results show that specifying strong motion amplitudes for use in engineering design by means of peak ground acceleration can lead to serious errors for buildings higher than four to five stories and hence should not be used. Our results also show that the shape of design spectra must depend on the nature of contributing earthquake sources, their relative activity, potential to create large magnitudes, and geographical placement relative to the site of interest, and thus a standard design‐spectrum shape cannot satisfy all these requirements. We use local geological site condition parameters directly in all calculations and present hazard maps for three different soil site conditions ("rock," stiff soil sites, and deep soil sites). Thus, the user can extract the UHS amplitudes of pseudo relative velocity spectra at any site in the National Capital Territory by experimentally determining the local soil site conditions and then applying the corresponding maps shown in this paper. [ABSTRACT FROM AUTHOR]

Although there is a growing volume of research on violence against women, violence against older women has received little attention to date. Little is known about the experience of elder abuse, discrimination, loneliness, and health among older women, in particular in the era of COVID-19 when our lives have been changed drastically. Using two waves of survey data (N = 1,498), this study compared the estimates of elder abuse and age discrimination before and during the COVID-19 pandemic, examined their associations with physical and mental health, and explored the mediating effects of loneliness on the associations in two independent samples of older women in Hong Kong. Reductions in some forms of abuse and discrimination against older women during the pandemic were observed. Findings from regression analyses show that elder abuse and age discrimination were associated with poorer health, and these associations were mediated by loneliness. [ABSTRACT FROM AUTHOR]

Background: Prevalence of Fabry disease amongst Chronic Kidney Disease (CKD) patients on haemodialysis has been shown to be approximately 0.2%.Methods: We undertook a cross-sectional study employing a cascade screening strategy for Fabry Disease amongst 3000 adult, male and female patients affected by CKD stage 1-5D/T at public, specialty renal practices within participating Queensland Hospital and Health Services from October 2017 to August 2019. A multi-tiered FD screening strategy, utilising a combination of dried blood spot (DBS) enzymatic testing, and if low, then lyso-GB3 testing and DNA sequencing, was used.Results: Mean (SD) age was 64.0 (15.8) years (n = 2992), and 57.9% were male. Eight participants withrew out of the 3000 who consented. Of 2992 screened, 6 (0.20%) received a diagnosis of FD, 2902 (96.99%) did not have FD, and 84 (2.81%) received inconclusive results. Of the patients diagnosed with FD, mean age was 48.5 years; 5 were male (0.29%) and 1 was female (0.08%); 4 were on kidney replacement therapy (2 dialysis and 2 transplant); 3 were new diagnoses.Conclusions: Estimated overall FD prevalence was 0.20%. Screening of the broader CKD population may be beneficial in identifying cases of FD.Trial Registration: The aCQuiRE Study has been prospectively registered with the Queensland Health Database of Research Activity (DORA, https://dora.health.qld.gov.au ) as pj09946 (Registered 3rd July 2017). [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence for pre‐eclampsia prophylaxis with aspirin in women with pre‐existing diabetes mellitus (DM). Aims: To examine the evidence for aspirin in pre‐eclampsia prophylaxis in women with pre‐existing DM. Material and Methods: An electronic search using Ovid MEDLINE, Embase, CinicalTrials.gov and the Cochrane CENTRAL register of controlled trials through to February 2021 was performed. Reference lists of identified studies, previous review articles, clinical practice guidelines and government reports were manually searched. Randomised controlled trials (RCTs) of aspirin vs placebo for pre‐eclampsia prophylaxis were included. Articles were manually reviewed to determine if cohorts included women with DM. The systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Data from included trials were extracted independently by two authors who also independently assessed risk of bias as per the Cochrane Handbook criteria version 5.1.0. Data were analysed using Rev‐Man 5.4. Results: Forty RCTs were identified, of which 11 included a confirmed subset of women with DM; however, data were insufficient for meta‐analysis. Meta‐analysis of 930 women with DM, from individual patient data included in a systematic review and unpublished data from one of the 11 RCTs, showed a non‐significant difference in the outcome of pre‐eclampsia in participants treated with aspirin compared to placebo (odds ratio 0.58; 95% CI 0.20–1.71; P = 0.33). Conclusions: Pre‐eclampsia risk reduction with aspirin prophylaxis in women with pre‐existing DM may be similar to women without pre‐existing DM. However, randomised data within this meta‐analysis were insufficient, warranting the need for further studies within this high‐risk group of women. [ABSTRACT FROM AUTHOR]

Background: Integrated Community Centres for Mental Wellness (ICCMWs) provide district-based community support services for patients discharged from mental health facilities and other residents in Hong Kong. However, selecting locations for these community centres is challenging primarily because of community opposition, which has introduced barriers to responses to service users' interests and the operations of individual centres. This study examines public preferences for conflict resolution options, evaluates the feasibility of different consultation approaches, identifies effective methods for reducing public opposition and recommends possible approaches to public consultation and location selection. Methods: A total of 74 individual interviews were conducted with key informants, including government personnel, service operators, politicians, resident representatives, community activists and service users. These interviewees were asked about their knowledge, experiences and perspectives of centre location selection processes. Results: Interviews revealed that neighbourhood consultations for establishing community centres for mental wellness are time-consuming and did not yield a consensus of support from residents. In some instances, the government may decide to delay or withdraw location selection plans because of strong public opposition mainly because of bias and misunderstanding towards service users. However, the role of local politicians in mediating neighbourhood opinions and the government's determination in planning location selection are essential for successfully selecting ICCMW locations. Conclusion: Government departments should develop stronger collaboration to study target neighbourhoods and lobby stakeholders at earlier stages. Such investigations should involve identifying key stakeholders, the political and social dynamics of controversies and community demographics. A protocol specifying a time frame should be implemented to facilitate smooth and effective public consultation and community mental health service location selection processes. [ABSTRACT FROM AUTHOR]

This research examined understandings of cultural competence of social workers in Hong Kong, their needs and challenges in serving culturally diverse groups, and their willingness and receptivity to receive cultural competence training by using constructivist grounded theory. Individual qualitative interviews were conducted with thirteen frontline and managerial practitioners and educators in training institutions in the social work profession. Data were analysed by identifying major themes. The findings show that social workers in Hong Kong tend to encounter language barriers and various forms of cultural shocks in serving ethnoculturally diverse clients. The professional code of practice is not sufficient in promoting culturally competent practice and there are institutional barriers to the enhancement of cultural competence of the social services. Mainstream social work units are generally not well prepared to provide services to non-Chinese communities. In response to these obstacles, professional training should provide future Hong Kong social workers with opportunities to interact with ethnoculturally diverse communities through service-learning. To tackle institutional racism, leaders should have cultural awareness and promote culturally inclusive practices. Inclusion of staff members from diverse cultural backgrounds would increase the capacity of the organisations to better serve clients of diverse needs. Anti-racism training should be made as an essential professional development component for social work students, practicum students, practitioners and managers. [ABSTRACT FROM AUTHOR]

Aim: Dietary requirements for people on haemodialysis are complex and often poorly adhered to. Mobile phone text messaging offers a simple strategy to enhance current nutritional care. KIDNEYTEXT was a 6‐month pilot randomised controlled trial that evaluated the feasibility and impact of mobile phone text messages to alter participants' dietary behaviours. The aim of this study was to elicit the perspectives of people on haemodialysis regarding acceptability of mobile phone text messages targeting dietary behaviours. Methods: Semi‐structured interviews were conducted with participants in the intervention arm of the KIDNEYTEXT study. Participants were purposively sampled and interviews were conducted in‐person or over the phone. Transcripts were thematically analysed using principles of grounded theory. Results: Interviews were conducted with 25 participants. Four major themes were identified: building awareness (reinforcement of information, simple and comprehensible, guiding choices, accessible information enhancing motivation, gaining skills in management), valuing care (boosting self‐esteem, in‐person care bolstered by reminders), activating change (adjusting lifestyle, gaining control of electrolytes and fluid, striving to improve overall health), waning attention and motivation (lack of personalisation limiting change, maintaining the status quo, reverting back to old habits). Conclusions: Participants perceived that the KIDNEYTEXT intervention enabled participants to build on their knowledge through the dissemination of simple and actionable content. Participants appreciated frequent reminders of how to improve their diet and felt that this increased contact motivated them to alter some dietary behaviours. Future trials should consider strategies to enhance personalisation to further motivate dietary change. [ABSTRACT FROM AUTHOR]

Background: cDC1 is a subset of conventional DCs, whose most recognized function is cross-presentation to CD8+ T cells. We conducted this study to investigate the number and location of cDC1s in various human kidney diseases as well as their correlation with clinico-pathological features and CD8+ T cells. Methods: We analyzed 135 kidney biopsies samples. Kidney diseases included: acute tubular necrosis (ATN), acute interstitial nephritis (AIN), proliferative glomerulonephritis (GN) (IgA nephropathy, lupus nephritis, pauci-immune GN, anti-GBM disease), non-proliferative GN (minimal change disease, membranous nephropathy) and diabetic nephropathy. Indirect immunofluorescence staining was used to quantify cDC1s, CD1c+ DCs, and CD8+ T cells. Results: cDC1s were rarely present in normal kidneys. Their number increased significantly in ATN and proliferative GN, proportionally much more than CD1c+ DCs. cDC1s were mainly found in the interstitium, except in lupus nephritis, pauci-immune GN and anti-GBM disease, where they were prominent in glomeruli and peri-glomerular regions. The number of cDC1s correlated with disease severity in ATN, number of crescents in pauci-immune GN, interstitial fibrosis in IgA nephropathy and lupus nephritis, as well as prognosis in IgA nephropathy. The number of CD8+ T cells also increased significantly in these conditions and cDC1 number correlated with CD8+ T cell number in lupus nephritis and pauci-immune GN, with many of them closely co-localized. Conclusions: cDC1 number correlated with various clinic-pathological features and prognosis reflecting a possible role in these conditions. Their association with CD8+ T cells suggests a combined mechanism in keeping with the results in animal models. [ABSTRACT FROM AUTHOR]

Background: Fabry disease (FD) is a rare, lysosomal storage disorder caused by the absence or deficiency of the enzyme alpha-galactosidase A (α-Gal A) that leads to the abnormal accumulation of the lipid globotriaosylceramide (GB3) in a variety of cell types and tissues throughout the body. FD has an x-linked inheritance pattern. Previously thought to be only carriers, females can also experience FD symptomatology. Symptoms vary in type and severity from patient to patient and tend to increase in severity with age. FD symptoms are non-specific and may be shared with those of other diseases. Misdiagnoses and diagnostic delays are common, often resulting in progressive, irreversible tissue damage. The estimated prevalence of FD in the general population is 1:40,000 to 1:117,000 individuals. However, it is estimated that the prevalence of FD in the dialysis population is 0.12 to 0.7%. Little is known about the prevalence of FD in the broader Chronic Kidney Disease (CKD) population.Methods: This is an epidemiological study of the prevalence of FD in CKD patents identified from the public renal speciality practices in Queensland, Australia. A cascade approach to screening is being employed with dried blood spot testing for blood levels of alpha-galactosidase A (Alpha-Gal), with follow-up testing for patients with abnormal results by plasma levels of globotriaosylsphingosine (Lyso-GB3) for females and non-definitive cases in males. A diagnosis of FD is confirmed through genetic testing of the GLA gene in cases suspected of having FD based upon Alpha-Gal and Lyso-GB3 testing.Discussion: Expected outcomes of this study include more information about the prevalence of FD at all stages of CKD, including for both males and females. The study may also provide information about common characteristics of FD to assist with diagnosis and optimal management/treatment. Screening is also available for family members of diagnosed patients, with potential for early diagnosis of FD and intervention for those individuals.Trial Registration: Queensland Health Database of Research Activity (DORA, https://dora.health.qld.gov.au) pj09946 (Registered 3rd July 2017). [ABSTRACT FROM AUTHOR]

Background: While many risk factors for preeclampsia, such as increased body mass index, advanced maternal age, chronic hypertension, diabetes, are now established in clinical practice, maternal lipid profile has not been included in the risk assessment for preeclampsia. We aim to characterize the serum levels of Total Cholesterol (TC), High density lipoprotein (HDL), Low density lipoprotein (LDL), Triglycerides (TG), Apolipoprotein A1, Apolipoprotein B and their ratios TC/HDL and ApoB/ApoA1 in the maternal and fetal circulations of normal pregnancy, preeclampsia (PE), fetal growth restriction (FGR) and PE + FGR.Methods: A prospective cross-sectional case control study was conducted measuring maternal and fetal lipid levels by enzymatic analysis and immune-turbidimetric enzymatic assays. FGR was defined by elevated umbilical artery Doppler resistance in association with estimated fetal weight < 10%. Kruskal Wallis non-parametric analysis of variance was used to test for homogeneity across the clinical groups for each of the variables, Mann-Whitney tests for pairwise comparisons and Spearman rank correlation were used to quantify gestational age-related changes.Results: (1) TG levels were elevated in maternal PE and cord blood PE + FGR groups compared to normal pregnancies. (2) A statistically significant elevation of fetal ApoB levels was observed in PE, FGR and PE + FGR compared to normal pregnancies. Apolipoprotein levels A1 and B were not different between maternal groups. (3) TC, HDL, LDL and TC/HDL levels did not show any significant gestational variation or between clinical groups in the maternal or fetal circulation.Conclusions: Elevation in maternal TG levels may have a role in the pathogenesis of PE. The implications of elevated maternal and fetal TG levels and elevated fetal Apolipoprotein B levels deserves further exploration of their role in long term cardiovascular risk in the mother as well as the offspring. [ABSTRACT FROM AUTHOR]

Background: The use of haemodiafiltration (HDF) for the management of patients with end‐stage kidney failure is increasing worldwide. Factors associated with HDF use have not been studied and may vary in different countries and jurisdictions. The aim of this study was to document the pattern of increase and variability in uptake of HDF in Australia and New Zealand, and to describe patient‐ and centre‐related factors associated with its use. Methods: Using the Australian and New Zealand Dialysis and Transplant Registry, all incident patients commencing haemodialysis (HD) between 2000 and 2014 were included. The primary outcome was HDF commencement over time, which was evaluated using multivariable logistic regression stratified by country. Results: Of 27 433 patients starting HD, 3339 (14.4%) of 23 194 patients in Australia and 810 (19.1%) of 4239 in New Zealand received HDF. HDF uptake increased over time in both countries but was more rapid in New Zealand than Australia. In Australia, HDF use was more likely in males (odds ratio (OR) 1.13, 95% confidence interval (CI) = 1.03–1.24, P = 0.009) and less likely with older age (reference <40 years; 40–54 years OR = 0.85; 95% CI = 0.72–0.99; 55–69 years OR = 0.79; 95% CI = 0.67–0.91; >70 years OR = 0.48; 95% CI = 0.41–0.56); higher body mass index (body mass index (BMI) < 18.5 kg/m2 OR = 0.62; 95% CI = 0.46–0.84; 18.5–29.9 kg/m2 reference; >30 kg/m2 OR = 1.46; 95% CI = 1.33–1.61), chronic lung disease (OR = 0.84; 95% CI = 0.76–0.94; P < 0.001), cerebrovascular disease (OR = 0.76; 95% CI = 0.67–0.85; P < 0.001) and peripheral vascular disease (OR = 0.77; 95% CI = 0.70–0.85; P < 0.001). No association was identified with race. In New Zealand, HDF use was more likely in Maori and Pacific Islanders (OR = 1.32; 95% CI = 1.05–1.66) and Asians (OR = 1.75; 95% CI = 1.15–2.68) compared to Caucasians, and less likely in males (OR = 0.76; 95% CI = 0.62–0.94; P = 0.01). No association was identified with BMI or co‐morbidities. In both countries, centres with a higher ratio of HD to peritoneal dialysis (PD) were more likely to prescribe HDF. Larger Australian centres were more likely to prescribe HDF (36–147 new patients/year OR = 26.75, 95% CI = 18.54–38.59; 17–35/year OR = 7.51, 95% CI = 5.35–10.55; 7–16/year OR = 3.00; 95% CI = 2.19–4.13; ≤6/year reference). Conclusion: Haemodiafiltration uptake is increasing, variable and associated with both patient and centre characteristics. Centre characteristics not explicitly captured elsewhere explained 36% of variability in HDF uptake in Australia and 48% in New Zealand. SUMMARY AT A GLANCE: The use of haemodiafiltration (HDF) for the management of patients with end‐stage renal disease is increasing worldwide. In this study of the pattern of HDF in Australia and New Zealand, the authors described that HDF uptake is increasing, variable and associated with both patient and centre characteristics. In particular, HDF uptake increase was more rapid in New Zealand than Australia, where HDF use in NZ was more likely in Maori and Pacific Islanders and Asians compared to Caucasians. [ABSTRACT FROM AUTHOR]

Objective: To determine the correlation between urinary and serum placental growth factor (PlGF) and investigate the predictive value as pregnancy progresses of urinary PlGF compared with serum PlGF, soluble fms-like tyrosine kinase 1 (sFLT-1), and the sFLT-1-to-PlGF ratio for the outcome of preeclampsia in women with preexisting diabetes.Research Design and Methods: A multicenter prospective cohort study was conducted of 158 women with preexisting insulin-requiring diabetes (41 with type 1 and 117 with type 2). Urinary PlGF and serum PlGF, sFLT-1, and the sFLT-1-to-PlGF ratio were assessed four times (14, 24, 30, and 36 weeks' gestation), and the association with the outcome of preeclampsia was investigated.Results: A correlation between urinary and serum PlGF was demonstrated from 24 weeks' gestation onward (P < 0.001). At all time points, those who developed preeclampsia had lower serum PlGF levels (P < 0.05), and receiver operating characteristic curves demonstrated that serum PlGF in this cohort performed better than the serum sFLT-1-to-PlGF ratio as a predictive test for preeclampsia. Preconception HbA1c ≥6.5% (48 mmol/mol) was an important discriminative predictor for preeclampsia (P = 0.01).Conclusions: This study prospectively describes the longitudinal changes in urinary PlGF alongside serum angiogenic markers throughout pregnancy in women with preexisting diabetes. We demonstrate correlation between urinary and serum PlGF and that in women with preexisting diabetes in pregnancy, serum PlGF is a better predictor of preeclampsia than the sFLT-1-to-PlGF ratio. [ABSTRACT FROM AUTHOR]

Background Chronic kidney disease (CKD) is a global public health problem, which lacks effective treatment. Previously, we have shown that CD103+ dendritic cells (DCs) are pathogenic in adriamycin nephropathy (AN), a model of human focal segmental glomerulosclerosis (FSGS). Fms-like tyrosine kinase 3 (Flt3) is a receptor that is expressed with high specificity on tissue resident CD103+ DCs. Methods To test the effect on CD103+ DCs and kidney injury of inhibition of Flt3, we used a selective Flt3 inhibitor (AC220) to treat mice with AN. Results Human CD141+ DCs, homologous to murine CD103+ DCs, were significantly increased in patients with FSGS. The number of kidney CD103+ DCs, but not CD103− DCs or plasmacytoid DCs, was significantly decreased in AN mice after AC220 administration. Treatment with AC220 significantly improved kidney function and reduced kidney injury and fibrosis in AN mice. AC220-treated AN mice had decreased levels of inflammatory cytokines and chemokines, tumor necrosis factor-α, interleukin (IL)-1β, IL-6, CCL2 and CCL5 and reduced kidney infiltration of CD4 T cells and CD8 T cells. The protective effect of AC220 was associated with its suppression of CD103+ DCs-mediated CD8 T cell proliferation and activation in AN mice. Conclusion Flt3 inhibitor AC220 effectively reduced kidney injury in AN mice, suggesting that this inhibitor might be a useful pharmaceutical agent to treat CKD. [ABSTRACT FROM AUTHOR]

Aim: To correlate plasma and urinary soluble fms‐like tyrosine kinase 1 (sFlt‐1) and placental growth factor (PIGF) in preeclampsia (PE) and fetal growth restriction (FGR) and assess the performance in detecting established disease. Methods: A cross‐sectional case–control study recruited 26–40 weeks gestation pregnancies into four clinical groups: normal pregnancy, PE, PE + FGR, and FGR. enzyme‐linked immunosorbent assay (ELISA) measurements of urinary and plasma sFlt‐1 and PlGF levels were performed. Urinary levels of sFlt‐1 and PIGF were normalized to creatinine. Spearman's rank correlation was used to assess the association between plasma and urinary levels of sFlt‐1 and PIGF, and receiver operating characteristic graphs were used to quantify the performance of each individual marker and their ratios in predicting normal versus pathological pregnancies affected by preeclampsia and/or FGR. Results: There was a significant correlation between plasma PlGF and urinary PlGF (r = 0.718, P < 0.001) in all groups. In the pathological groups, plasma sFlt‐1 and urinary sFlt‐1 as well as plasma sFlt‐1: PIGF ratio and urinary sFlt‐1: PlGF ratio were higher, but plasma PIGF and urinary PlGF were lower when compared to normal pregnancy. Plasma PIGF and plasma sFlt‐1: PlGF ratio was comparable in performance to urinary PlGF and urinary sFlt‐1: PIGF ratio for the diagnosis of preeclampsia and/or FGR. Conclusion: Urinary PIGF can be used as an alternative to circulating biomarkers in preeclampsia and FGR. Plasma sFlt‐1, PlGF and sFlt‐1: PlGF ratio as well as urinary PIGF and sFlt‐1: PlGF ratio can be used to differentiate between normal pregnancy and pregnancies complicated by preeclampsia and FGR. [ABSTRACT FROM AUTHOR]

Aims: (1) To determine incidence and reasons for transfer from maintenance haemodialysis (HD) to peritoneal dialysis (PD); (2) To compare mortality of HD patients transferred to PD with those who initiated and remained on PD. Methods: A 1:2 matched cohort of ANZDATA included patients dialyzing over 3 months dividing into 2 groups. Group A (HD to PD) was compared to group B (initiated and remained on PD) and matched PD group (Group C). We compared mortality by total time on dialysis regardless of modality. Results: Of 20 882 patients, there were 911 in group A. The transfer rate from HD to PD was 5%, 6.7% and 7.4% at 1,4 and 8 years, respectively. Median time before switching of patients in Group A was 5.9 (4.0–10.9) months. The commonest reported reason for transfer was patient preference (63.8%). Mortality was significantly worse in Group A if dialysis vintage was ≤6 months and from 12–24 months (P < 0.05), whereas there was no difference in mortality if dialysis vintage was 6–12 months or ≥ 24 months (P = 0.073 and P = 0.153, respectively). Overall, mortality of patients in group A was higher than that in group B after adjusting for age, race, chronic lung disease, peripheral vascular disease, cerebrovascular disease, diabetes, haemoglobin and phosphate (hazard ratio = 1.335, 95% confidence interval = 1.172–1.520). Conclusion: Haemodialysis patients transferred to PD had higher mortality than those initiated on PD, strengthening the case for PD first policy. SUMMARY AT A GLANCE: In this matched cohort analysis, patients who were started on peritoneal dialysis had better survival than patients who were transferred from haemodialysis to peritoneal dialysis, even though the average time of conversion was around 6 months after dialysis and the major reason of conversion was patient preference. These findings lend support to the PD‐first policy. [ABSTRACT FROM AUTHOR]

Introduction Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis. Methods and analysis Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken. Ethics and dissemination The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee--Westmead. Results will be presented at scientific meetings and published in peerreviewed publications. [ABSTRACT FROM AUTHOR]

Background: There is little available data on fetal monocyte phenotype and function. A prospective cross-sectional pilot study was conducted to describe the cord blood monocyte subset phenotype in preeclampsia (PE) and fetal growth restriction (FGR) as compared to normal pregnancy and maternal circulation. Methods: Maternal and cord blood samples from 27 pregnancies were collected at delivery from normal pregnancy, PE, FGR and PE + FGR. The distribution of fetal monocyte subtypes was characterized by CD14 and CD16 expression using flow cytometry and compared for each clinical group using a classification of classical, intermediate and non-classical subsets. Results: The intermediate monocytes were the dominant monocyte subset in the cord blood of PE and PE + FGR with an increase in the combined inflammatory monocyte subsets intermediate and non-classical in PE compared to normal pregnancy. The non-classical monocyte subset proportion was elevated in all pathological groups PE, FGR and PE + FGR. A significant reduction in the non-classical monocyte subset was observed in the cord blood of the normal pregnancy group as compared to the maternal circulation. Conclusion: This study describes for the first time in the fetal circulation, dominant monocyte intermediate subsets and increased inflammatory subsets in PE as well as increased non-classical subsets in PE and FGR compared to normal pregnancy. [ABSTRACT FROM AUTHOR]

The scattering and reflection of SH waves by a slope on an elastic wedged space is investigated. A series solution is obtained by using the wave function expansion method. The slope on a wedged space is divided into two subregions by an artificial, auxiliary circular arc. The wave fields with unknown complex coefficients within each sub-region are derived. Applying Graf addition theorem, the scattered waves in the sub-regions are expressed in a global coordinate system. Fourier transform is adopted to derive a consistent form of standing waves in the inner region using the orthogonality of the cosine functions. The boundary-valued problem is solved by stress and displacement continuity along the artificial, auxiliary arc to obtain the unknown complex coefficients. Parametric studies are next performed to investigate how the topography from the slope on the wedged space will affect the scattering and diffraction, and hence the amplification and de-amplification of the SH waves. Numerical results show that the surface motions on the slope of the wedged space is influenced greatly by the topography. Amplification of the surface motions near the slope vertex is significant. The corresponding phases along the wedged space surfaces are consistent with the direction that the SH waves are propagating. [ABSTRACT FROM AUTHOR]

Background It is unclear if haemodiafiltration improves patient survival compared with standard haemodialysis. Observational studies have tended to show benefit with haemodiafiltration, while meta-analyses have not provided definitive proof of superiority. Methods Using data from the Australia and New Zealand Dialysis and Transplant Registry, this binational inception cohort study compared all adult patients who commenced haemodialysis in Australia and New Zealand between 2000 and 2014. The primary outcome was all-cause mortality. Cardiovascular mortality was the secondary outcome. Outcomes were measured from the first haemodialysis treatment and were examined using multivariable Cox regression analyses. Patients were censored at permanent discontinuation of haemodialysis or at 31 December 2014. Analyses were stratified by country. Results The study included 26 961 patients (4110 haemodiafiltration, 22 851 standard haemodialysis; 22 774 Australia, 4187 New Zealand) with a median follow-up of 5.31 (interquartile range 2.87–8.36) years. Median age was 62 years, 61% were male, 71% were Caucasian. Compared with standard haemodialysis, haemodiafiltration was associated with a significantly lower risk of all-cause mortality [adjusted hazard ratio (HR) for Australia 0.79, 95% confidence interval (95% CI) 0.72–0.87; adjusted HR for New Zealand 0.88, 95% CI 0.78–1.00]. In Australian patients, there was also an association between haemodiafiltration and reduced cardiovascular mortality (adjusted HR 0.78, 95% CI 0.64–0.95). Conclusion Haemodiafiltration was associated with superior survival across patient subgroups of age, sex and comorbidity. [ABSTRACT FROM AUTHOR]

Aim: Monocytes are likely to play a significant role in the pathogenesis of preeclampsia (PE) and intrauterine fetal growth restriction (IUGR), given their role in homeostasis and tissue repair. Our aim was to study the gestational changes in monocytes in normal pregnancy and to determine whether monocyte subsets and phenotype are altered in pregnancy complications, such as PE and IUGR. Methods: A prospective cross‐sectional case–control study was conducted. Pregnant women between 24 and 40 weeks of gestation (n = 54) were recruited and classified into four clinical groups of normal pregnancy, PE, IUGR and PE + IUGR. The maternal monocyte subsets classical, intermediate and nonclassical were compared for each clinical group. Monocyte polarization towards M1 (inflammatory) and M2 (repair) phenotypes was assessed by surface expression of CD86 and CD163 ratio, using flow cytometry. Results: The classical monocytes were reduced and intermediate monocyte elevated compared to normal pregnancy in PE, IUGR and PE + IUGR in gestations <37 weeks and IUGR in 26–40 weeks. CD163 expression was increased and CD86/CD163 ratio decreased in IUGR compared to normal pregnancy for all subsets. Nonclassical monocyte counts and CD163 expression increased with advancing gestation in normal pregnancy. Conclusion: These results show for the first time, a shift towards increased intermediate maternal monocyte subtype in IUGR and in preterm PE as well as skewing of maternal peripheral monocytes (all subsets) towards M2 phenotype in pregnancies complicated by IUGR. [ABSTRACT FROM AUTHOR]

An indirect boundary element method (IBEM) is developed to study the dynamic impedance functions (stiffness coefficients) of a rigid strip foundation embedded in a multi-layered viscoelastic transversely isotropic (TI) half-space. The proposed IBEM using half-space Green’s functions of distributed loads as fundamental solutions have the merits of fictitious loads being directly applied on the real boundaries without the problem of singularity and of the discretization effort restricted to local boundaries. In addition, the accuracy of the proposed method is not affected by the thickness of the discrete TI layers, as the exact dynamic stiffness matrix is employed. The presented algorithm is verified via comparisons with published results for the isotropic medium. By taking a rigid strip foundation embedded in a homogeneous half-space, a single-layered half-space, and a multi-layered half-space as examples, the effects of material anisotropy, frequency of excitation, and soil layer on the impedance functions are studied in detail. Numerical results show that impedance functions for the TI medium can be significantly different from those of the isotropic case. The variation of TI parameters alters the dynamic characteristics of the TI layered site, which in turn alters the dynamic interaction between the soil and foundation. In addition, the soil sedimentary sequence also has a remarkable influence on the impedance functions. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study is to determine whether peritoneal membrane transport status (MTS) is associated with peritonitis or poor peritoneal dialysis‐related outcomes. Methods: This retrospective cohort study analysed data of incident adult patients on peritoneal dialysis in Western Sydney between 1 October 2003 and 31 December 2012. Only patients who underwent peritoneal equilibration and adequacy tests within 6 months of commencement were included. Kaplan–Meier survival curves for time until first peritonitis and time until composite endpoint of peritonitis, death or technique failure, censored for transplant, were constructed. Results: About 397 patients, mean age 58.8(+/−2SD29) years, body mass index (BMI) 26.6(+/−5) kg/m2 and serum albumin 35.4(+/−5) g/L were included. About 59.2% had high/high‐average peritoneal MTS; 45.8% were past and current smokers; 51.9% developed at least one episode of peritonitis; 7.6% changed to haemodialysis; 6.3% underwent transplantation; 8.8% died; and 25.4% remained free of the aforementioned events over a mean follow‐up period of 22.5 months (range 0–115 months). Peritoneal MTS was not associated with time to first peritonitis (p = 0.67) or composite endpoint of peritonitis, death or technique failure (p = 0.12). Smoking and hypoalbuminaemia independently predicted time to first peritonitis. Past and current smokers had a hazard ratio of 1.38 (95% CI 1.03–1.86) for shorter time to first peritonitis, significant after adjustment for serum albumin (p = 0.033). Serum albumin <32 g/L had a hazard ratio of 1.74 (95% CI 1.13–2.67) for shorter time to first peritonitis, significant after adjusting for smoking (p = 0.012). Conclusion: Smoking and hypoalbuminaemia, but not MTS, were associated with shorter time to first peritonitis and composite endpoint of peritonitis, death and technique failure. [ABSTRACT FROM AUTHOR]

Studies disrupting the chemokine pathway CX3CL1 (fractalkine)/ CX3CR1 have shown decreased atherosclerosis in animal models but the techniques used to interrupt the pathway have not been easily translatable into human trials. DNA vaccination potentially overcomes the translational difficulties. We evaluated the effect of a DNA vaccine, targeted to CX3CR1, on atherosclerosis in a murine model and examined possible mechanisms of action. DNA vaccination against CX3CR1, enhanced by dendritic cell targeting using DEC-205 single chain variable region fragment (scFv), was performed in 8 week old ApoE-/- mice, fed a normal chow diet. High levels of anti-CX3CR1 antibodies were induced in vaccinated mice. There were no apparent adverse reactions to the vaccine. Arterial vessels of 34 week old mice were examined histologically for atherosclerotic plaque size, macrophage infiltration, smooth muscle cell infiltration and lipid deposition. Vaccinated mice had significantly reduced atherosclerotic plaque in the brachiocephalic artery. There was less macrophage infiltration but no significant change to the macrophage phenotype in the plaques. There was less lipid deposition in the lesions, but there was no effect on smooth muscle cell migration. Targeted DNA vaccination to CX3CR1 was well tolerated, induced a strong immune response and resulted in attenuated atherosclerotic lesions with reduced macrophage infiltration. DNA vaccination against chemokine pathways potentially offers a potential therapeutic option for the treatment of atherosclerosis. [ABSTRACT FROM AUTHOR]

Cell therapy using macrophages requires large amounts of cells, which are difficult to collect from patients. Patients undergoing peritoneal dialysis (PD) discard huge numbers of peritoneal macrophages in dialysate daily. Macrophages can be modulated to become regulatory macrophages, which have shown great promise as a therapeutic strategy in experimental kidney disease and human kidney transplantation. This study aimed to examine the potential of using peritoneal macrophages (PMs) from peritoneal dialysate to treat kidney disease. Monocytes/macrophages accounted for >40% of total peritoneal leukocytes in both patients and mice undergoing PD. PMs from patients and mice undergoing PD were more mature than peripheral monocytes/macrophages, as shown by low expression of C-C motif chemokine receptor 2 (CCR2) and morphological changes during in vitro culture. PMs from patients and mice undergoing PD displayed normal macrophage function and could be modulated into a regulatory (M2) phenotype. In vivo, adoptive transfer of peritoneal M2 macrophages derived from PD mice effectively protected against kidney injury in mice with adriamycin nephropathy (AN). Importantly, the transfused peritoneal M2 macrophages maintained their M2 phenotype in kidney of AN mice. In conclusion, PMs derived from patients and mice undergoing PD exhibited conventional macrophage features. Peritoneal M2 macrophages derived from PD mice are able to reduce kidney injury in AN, suggesting that peritoneal macrophages from patients undergoing PD may have the potential for clinical therapeutic application. [ABSTRACT FROM AUTHOR]

Objective To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Design Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. Setting 21 haemodialysis centres across Australia. Participants 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. Results Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). Conclusions Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient- clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis. [ABSTRACT FROM AUTHOR]

This paper is the second of the two papers, discussing the rocking and resultant component of rotations, with the torsional components of motions presented earlier in the first paper for the case of out-of-plane SH waves excitation on a semi-parabolic canyon. The rotational motions are gaining importance in recent years in the field of strong-motion seismology and earthquake engineering. Many previous papers on out-of-plane SH waves excitation presented the associated torsion rotational motions, when in fact there is also a rocking rotational component of motions. Both the rocking and torsion rotational motions, in as much as the translational motions, had shown to play an important role in structural responses, even though rotations are not incorporated into building design codes at present. Studying the rotational motions can thus help to a better understanding of the behavior of surface topographies that are in the vicinity of structures in the event of seismic excitation. This paper included, besides the additional rocking motions, also the resultant rotational motions combining torsion and rocking. [ABSTRACT FROM PUBLISHER]

The surface displacement amplitudes excited by out-of-plane SH waves on and around a semi-parabolic canyon had solution that was introduced over twenty years ago. In 2015, such solution was updated to much (5 times) higher frequencies, using a transformation involving the Wronskian. The same excitations also introduce rotations on and around the parabolic canyon. This article is the first of two that discuss the torsional component of rotations, with the rocking components discussed in the subsequent article. The rotational amplitudes of motions, as much as the displacement amplitudes, play an important role in studying the surface responses of structures, and can lead to a better understanding of the behavior of surface topographies in the event of seismic excitation. [ABSTRACT FROM PUBLISHER]

Objective: To investigate the association of falling insulin requirements (FIR) among women with preexisting diabetes with adverse obstetric outcomes and maternal biomarkers longitudinally in pregnancy.Research Design and Methods: A multicenter prospective cohort study of 158 women (41 with type 1 diabetes and 117 with type 2 diabetes) was conducted. Women with FIR of ≥15% from the peak total daily dose after 20 weeks' gestation were considered case subjects (n = 32). The primary outcome was a composite of clinical markers of placental dysfunction (preeclampsia, small for gestational age [≤5th centile], stillbirth, premature delivery [<30 weeks], and placental abruption). Maternal circulating angiogenic markers (placental growth factor [PlGF] and soluble fms-like tyrosine kinase 1 [sFlt-1]), placental hormones (human placental lactogen, progesterone, and tumor necrosis factor-α), HbA1c, and creatinine were studied serially during pregnancy.Results: FIR ≥15% were associated with an increased risk of the composite primary outcome (odds ratio [OR] 4.38 [95% CI 1.9-10.3]; P < 0.001), preeclampsia (OR 6.76 [95% CI 2.7-16.7]; P < 0.001), and was more common among women with type 1 diabetes (36.6 vs. 14.5%; P = 0.002). Creatinine was modestly elevated among women with FIR ≥15%; however, there was no difference in HbA1c. The ratio of sFlt-1 to PlGF was significantly higher among women with FIR at 25, 30, and 36 weeks, with differences maintained in the subgroup that developed preeclampsia. There was no difference in placental hormones between the groups.Conclusions: This is the first prospective study to associate FIR with altered expression of placental antiangiogenic factors and preeclampsia. FIR are an important clinical sign, among women with preexisting diabetes, that should alert the clinician to investigate underlying placental dysfunction. [ABSTRACT FROM AUTHOR]

Background: Endothelial cells are known to contribute to kidney fibrosis via endothelial-mesenchymal transition (EndoMT). Matrix metalloproteinase 9 (MMP-9) is known to be profibrotic. However, whether MMP-9 contributes to kidney fibrosis via EndoMT is unknown. Methods: Primary mouse renal peritubular endothelial cells (MRPECs) were isolated and treated by recombinant human transforming growth factor beta 1 (rhTGF-β1) with or without MMP-9 inhibitor or by recombinant human MMP-9 (rhMMP- 9) alone. Kidney fibrosis was induced by unilateral ureteral obstruction (UUO) in MMP-9 knockout (KO) and wide-type (WT) control mice. The effects of MMP-9 on EndoMT of MRPECs and kidney fibrosis were examined. Results: We showed that MRPECs underwent EndoMT after rhTGF-β1 treatment or in UUO kidney as evidenced by decreased expression of endothelial markers, vascular endothelial cadherin (VE-cadherin) and CD31, and increased levels of mesenchymal markers, a-smooth muscle actin (a-SMA) and vimentin. The expression of fibrosis markers was also upregulated significantly after rhTGF-β1 treatment in MRPECs. The EndoMT and fibrosis markers were significantly less in rhTGF-β1-treated MMP-9 KO MRPECs, whereas MMP-9 alone was sufficient to induce EndoMT in MRPECs. UUO kidney ofMMP-9 KO mice showed significantly less interstitial fibrosis and EndoMT in MRPECs. Notch signaling shown by Notch intracellular domain (NICD) was increased, while Notch-1 was decreased in rhTGF-β1-treated MRPECs of MMP-9WT but notMMP-9 KO mice. Inhibition ofMMP-9 or Notch signaling prevented rhTGF-β1- or rhMMP-9-induced a-SMA and NICD upregulation in MRPECs. UUO kidney of MMP-9 KOmice had less staining of Notch signaling transcription factor Hey-1 in VE-cadherin-positive MRPECs than WT controls. Conclusions: Our results demonstrate that MMP-9-dependent Notch signaling plays an important role in kidney fibrosis through EndoMT ofMRPECs. [ABSTRACT FROM AUTHOR]

Introduction: The Revised Cardiac Risk Index (RCRI) is a popular classification system to estimate patients' risk of postoperative cardiac complications based on preoperative risk factors. Renal impairment, defined as serum creatinine >2.0 mg/dL (177 µmol/L), is a component of the RCRI. The estimated glomerular filtration rate has become accepted as a more accurate indicator of renal function. We will externally validate the RCRI in a modern cohort of patients undergoing non-cardiac surgery and update its renal component. Methods and analysis: The Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study is an international prospective cohort study. In this prespecified secondary analysis of VISION, we will test the risk estimation performance of the RCRI in ~34 000 participants who underwent elective non-cardiac surgery between 2007 and 2013 from 29 hospitals in 15 countries. Using data from the first 20 000 eligible participants (the derivation set), we will derive an optimal threshold for dichotomising preoperative renal function quantified using the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) glomerular filtration rate estimating equation in a manner that preserves the original structure of the RCRI. We will also develop a continuous risk estimating equation integrating age and CKD-Epi with existing RCRI risk factors. In the remaining (approximately) 14 000 participants, we will compare the risk estimation for cardiac complications of the original RCRI to this modified version. Cardiac complications will include 30-day non-fatal myocardial infarction, non-fatal cardiac arrest and death due to cardiac causes. We have examined an early sample to estimate the number of events and the distribution of predictors and missing data, but have not seen the validation data at the time of writing. Ethics and dissemination: The research ethics board at each site approved the VISION protocol prior to recruitment. We will publish our results and make our models available online at http://www.perioperativerisk.com. Trial registration number: ClinicalTrials.gov NCT00512109. [ABSTRACT FROM AUTHOR]

This article examines the issue of parental self-efficacy in guiding and supervising children to use mobile devices in Hong Kong. Data were collected from a sample of 1,561 students and 1,233 of their parents. Multiple hierarchical regression analyses showed that the frequency with which parents adopted involvement as a parenting method and the frequency of minor parent–child conflicts triggered by parental supervision were significantly associated with parental self-efficacy in supervising children to use mobile devices. Findings suggest that support for parents to adopt involvement methods more frequently and better manage parent–child conflicts are crucial in enhancing their self-efficacy. [ABSTRACT FROM PUBLISHER]