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The 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimation of glomerular filtration rate (GFR) lower values for Black individuals relative to previous equations, which may change medication eligibility or trigger the need to reevaluate dosing decisions. Major drug classes such as antibiotics, antidiabetic medications, cardiovascular agents, medications for the treatment of psychiatric illness, and chemotherapy drugs all have estimated GFR thresholds for prescribing eligibility. However, the use of strict thresholds for medication eligibility should be heavily scrutinized, and individualized comprehensive approaches should be used for patients on the cusps of these thresholds.

Real-time estimation of patient cardiovascular states, including cardiac output and systemic vascular resistance, is necessary for personalized hemodynamic monitoring and management. Highly invasive measurements enable reliable estimation of these states but increase patient risk. Prior methods using minimally invasive measurements reduce patient risk but have produced unreliable estimates limited due to trade-offs in accuracy and time resolution. Our objective was to develop an approach to estimate cardiac output and systemic vascular resistance with both a high time resolution and high accuracy from minimally invasive measurements. Using the two-element Windkessel model, we formulated a state-space method to estimate a dynamic time constant – the product of systemic vascular resistance and compliance – from arterial blood pressure measurements. From this time constant, we derived proportional estimates of systemic vascular resistance and cardiac output. We then validated our method with a swine cardiovascular dataset. Our estimates produced using arterial blood pressure measurements not only closely align with those using highly invasive measurements, but also closely align when derived from three separate locations on the arterial tree. Moreover, our estimates predictably change in response to standard cardiovascular drugs. Overall, our approach produces reliable, real-time estimates of cardiovascular states crucial for monitoring and control of the cardiovascular system.

Peer support is a promising intervention to mitigate post-ICU disability, however there is a paucity of rigorously designed studies.

We use the radar equation along with in situ observations of Bragg-resonant ocean waves to estimate the scattering patch area for each radial velocity observation from a direction finding high frequency (HF) radar operating at 13 Mhz. Estimated areas for range cells 2–10 (3–15 km) vary from less than 1 km$^{2}$ to more than 10 km$^{2}$, with a mean of 2.5 km$^{2}$ and standard deviation of 2.3 km$^{2}$. Assuming a 1.8 km effective range cell width, and given the known ranges, these are approximately equivalent to a mean angular width of 8.5$^\text{o}$, and a standard deviation of 10.0$^{\circ }$. The scattering patch areas follow a Weibull distribution, with scale and shape parameters 2.5 and 1.2. Patch area uncertainties, expressed as a percentage of the patch area, average 36%, with most below 50%. Knowledge of the scattering patch area could allow improved data combining methods (e.g., appropriate weighting or variable resolution totals), and improve the ability of HF radar networks to resolve small scale flows and eddies. Understanding the scattering patch size may also contribute to improved HF radar-based observations of coastal winds, as it plays a role in the relationship between wind speed and backscattered power.

Solid-state electrolytes, particularly polymer/ceramic composite electrolytes, are emerging as promising candidates for lithium-ion batteries due to their high ionic conductivity and mechanical flexibility. The interfaces that arise between the inorganic and organic materials in these composites play a crucial role in ion transport mechanisms. While lithium ions are proposed to diffuse across or parallel to the interface, few studies have directly examined the quantitative impact of these pathways on ion transport and little is known about how they affect the overall conductivity. Here, we present an atomistic study of lithium-ion (Li+) transport across well-defined polymer–argyrodite interfaces. We present a force field for polymer–argyrodite interfacial systems, and we carry out molecular dynamics and enhanced sampling simulations of several composite systems, including poly(ethylene oxide) (PEO)/Li6PS5Cl, hydrogenated nitrile butadiene rubber (HNBR)/Li6PS5Cl, and poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP)/Li6PS5Cl. For the materials considered here, Li-ion exhibits a preference for the ceramic material, as revealed by free energy differences for Li-ion between the inorganic and the organic polymer phase in excess of 13 kBT. The relative free energy profiles of Li-ion for different polymeric materials exhibit similar shapes, but their magnitude depends on the strength of interaction between the polymers and Li-ion: the greater the interaction between the polymer and Li-ions, the smaller the free energy difference between the inorganic and organic materials. The influence of the interface is felt over a range of approximately 1.5 nm, after which the behavior of Li-ion in the polymer is comparable to that in the bulk. Near the interface, Li-ion transport primarily occurs parallel to the interfacial plane, and ion mobility is considerably slower near the interface itself, consistent with the reduced segmental mobility of the polymer in the vicinity of the ceramic material. These findings provide insights into ionic complexation and transport mechanisms in composite systems, and will help improve design of improved solid electrolyte systems.

To describe staff and family members' opinions about closed‐circuit television (CCTV) in communal and private areas of residential aged care facilities (RACF), and to investigate how this relates to perceptions of care quality. A cross‐sectional survey was developed to capture perceptions of CCTV's influence on care quality, and acceptable locations for CCTV placement. Data were recorded as ordinal‐scale and open responses. Non‐parametric tests of association were conducted. The survey was completed by 81 staff and 74 family members. Both staff and family were satisfied with care quality and safety, irrespective of CCTV use. More family members were in favour of CCTV in both public and private areas, compared to staff who favoured public areas. Staff and family assumed there was real‐time monitoring, leading to a belief that CCTV monitoring would improve safety and prevent falls and abuse. Concerns were raised that CCTV could be used instead of improving staff‐to‐resident ratios and interaction. Overall, participants supported the use of CCTV more in public than in private areas and believed it reveals and prevents poor care. There was no association between CCTV use and satisfaction with care. Closed‐circuit television can have positive impacts if all stakeholders are involved in implementation.

Conventional radio frequency (RF) transmitters frequently necessitate a pair of high-resolution, high-speed digital-to-analog converters (DACs) to ensure a specific level of linearity in wireless communication systems. Nevertheless, the high-resolution DACs escalate power consumption and area requirements and intensify the need for heat dissipation mechanisms. This brief presents a direct digital synthesis (DDS) transmitter using a pair of RF DACs with just 2 bits of resolution. The DDS transmitter, which uses a proposed digital pulse-width modulation signal with dithering, is resistant to power amplifier (PA) nonlinearity. Tested with 5G uplink signals and a pair of nonlinear PAs at 836.5 MHz, the transmitter could pass the stringent spectral requirements for 5G applications without using any digital predistortion or calibration techniques.

Coughing is a respiratory behavior that plays a crucial role in protecting the respiratory system. Here we show that the nucleus of the solitary tract (NTS) in mice contains heterogenous neuronal populations that differentially control breathing. Within these subtypes, activation of tachykinin 1 (Tac1)-expressing neurons triggers specific respiratory behaviors that, as revealed by our detailed characterization, are cough-like behaviors. Chemogenetic silencing or genetic ablation of Tac1 neurons inhibits cough-like behaviors induced by tussive challenges. These Tac1 neurons receive synaptic inputs from the bronchopulmonary chemosensory and mechanosensory neurons in the vagal ganglion and coordinate medullary regions to control distinct aspects of cough-like defensive behaviors. We propose that these Tac1 neurons in the NTS are a key component of the airway–vagal–brain neural circuit that controls cough-like defensive behaviors in mice and that they coordinate the downstream modular circuits to elicit the sequential motor pattern of forceful expiratory responses.

Couched in work on territory, discourse and symbolic power, this paper examines how dominant representations and classifications of settlement types are produced by overlapping political, media and academic discourses through an investigation of the ‘post-industrial town.’ The 2016 referendum on European Union (EU) membership and the 2019 General Election thrust England’s deindustrializing towns into the foreground. Viewed as the primary settlement type of the ‘Brexit heartlands’ and the ‘Red Wall’, descriptions, encodings and classifications of the ‘post-industrial town’ have proliferated across media, academic and political discourses. Following, the article draws on Critical Discourse Studies to trace the emergence of the ‘post-industrial town’ as a territorial production. I argue that the ‘post-industrial town’ has been produced by discursive and socio-technical practices invoking symbolic imaginaries of how places look, who lives there and their practices. In the case of ‘post-industrial towns’, a dominant symbolic production has emerged of an older, white, working-class, non-cosmopolitan and socially conservative type of settlement. Moreover, discursive and symbolic territorial productions have led to (un)wilful misrepresentation and misrecognition as places ‘on-the-ground’ are brought into political strategizing and discourse.

In recent decades, there has been a growing interest in fully automated methods for tackling complex optimization problems across various fields. Active learning (AL) and its variant, assisted active learning (AAL), incorporating guidance or assistance from external sources into the learning process, play key roles in this automation by enabling the autonomous selection of optimal experimental conditions to efficiently explore the problem space. These approaches are particularly valuable in situations wherein experimentation is costly or time-consuming. This study explores the application of AAL in model-based method development (MD) for liquid chromatography (LC) by using Bayesian statistics to incorporate historical data and analyte information for the generation of initial retention models. The process involves updating the model parameters based on new experiments, coupled with an active data selection method to choose the most informative experiment to run in a subsequent step. This iterative process balances model exploitation and experimental exploration until a satisfactory separation is achieved. The effectiveness of this approach is demonstrated via two practical examples, resulting in optimized separations in a limited number of experiments by optimizing the gradient slope. It is shown that the ability of AAL to leverage past knowledge and compound information to improve accuracy and reduce experimental runs offers a flexible alternative approach to fixed design methods.

Crystalline monolayers prevalent in nature and technology possess elusive elastic properties with important implications in fundamental physics, biology, and nanotechnology. Leveraging the recently discovered shape transitions of oil-in-water emulsion droplets, upon which these droplets adopt cylindrical shapes and elongate, we investigate the elastic characteristics of the crystalline monolayers covering their interfaces. To unravel the conditions governing Euler buckling and Brazier kink formation in these cylindrical tubular interfacial crystals, we strain the elongating cylindrical droplets within confining microfluidic wells. Our experiments unveil a nonclassical relation between the Young’s modulus and the bending modulus of these crystals. Intriguingly, this relation varies with the radius of the cylindrical crystal, presenting a nonclassical mechanism for tuning of elasticity in nanotechnology applications.

•Randomized controlled trials of non-pharmacological interventions following concussion demonstrate moderate to good completeness.•Missing key components, particularly modifications, motivational strategies, and qualified supervisor limit accurate replication.•Reporting completeness has improved since Template for Intervention Description and Replication and Consensus on Exercise Reporting Template publication.•Publication in highly cited journals and low risk of bias do not guarantee reporting completeness.

Critical care survivors experience multiple care transitions, with no formal follow-up care pathway.

Aim:To explore general practitioners’ (GPs) views on implementing pharmacogenomic testing in Australian general practice.Methods:Semi-structured interviews were conducted with nine GPs in Australia, recruited from primary care networks. Interviews were analyzed using thematic analysis. Themes were mapped onto the Consolidated Framework for Implementation Research domains.Results:Barriers to implementation included lack of knowledge, education, standardized pharmacogenomic reports and national clinical guidelines and financial inaccessibility. Facilitators included positive exposure to pharmacogenomics, peer influences, interdisciplinary collaboration and proven clinical utility. Current uptake was minimal; however, GPs shared positive perceptions of clinical use.Conclusion:Recommendations for successful implementation include building and disseminating clinical evidence, developing national guidelines and standardized reports, incorporation into formal education and increasing financial accessibility.

Le programme d’accompagnement du retour à domicile (PRADO) BPCO permet l’organisation du parcours de soins des patients après hospitalisation pour exacerbation de BPCO. Cette étude visait à évaluer son impact médicoéconomique.

People with low socioeconomic status are disproportionately affected by kidney failure, and their adverse outcomes may stem from unmet health-related social needs. This study explored hemodialysis patient perspectives on health-related social needs and recommendations for intervention.

Asteroids with diameters less than about 5 km have complex histories because they are small enough for radiative torques (that is, YORP, short for the Yarkovsky–O’Keefe–Radzievskii–Paddack effect)1to be a notable factor in their evolution2. (152830) Dinkinesh is a small asteroid orbiting the Sun near the inner edge of the main asteroid belt with a heliocentric semimajor axis of 2.19 au; its S-type spectrum3,4is typical of bodies in this part of the main belt5. Here we report observations by the Lucy spacecraft6,7as it passed within 431 km of Dinkinesh. Lucy revealed Dinkinesh, which has an effective diameter of only 720 m, to be unexpectedly complex. Of particular note is the presence of a prominent longitudinal trough overlain by a substantial equatorial ridge and the discovery of the first confirmed contact binary satellite, now named (152830) Dinkinesh I Selam. Selam consists of two near-equal-sized lobes with diameters of 210 m and 230 m. It orbits Dinkinesh at a distance of 3.1 km with an orbital period of about 52.7 h and is tidally locked. The dynamical state, angular momentum and geomorphologic observations of the system lead us to infer that the ridge and trough of Dinkinesh are probably the result of mass failure resulting from spin-up by YORP followed by the partial reaccretion of the shed material. Selam probably accreted from material shed by this event.

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes1,2and molecular mechanisms that are often specific to cell type3,4. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (P< 5 × 10−8) that map to 611 loci, of which 145 loci are, to our knowledge, previously unreported. We define eight non-overlapping clusters of T2D signals that are characterized by distinct profiles of cardiometabolic trait associations. These clusters are differentially enriched for cell-type-specific regions of open chromatin, including pancreatic islets, adipocytes, endothelial cells and enteroendocrine cells. We build cluster-specific partitioned polygenic scores5in a further 279,552 individuals of diverse ancestry, including 30,288 cases of T2D, and test their association with T2D-related vascular outcomes. Cluster-specific partitioned polygenic scores are associated with coronary artery disease, peripheral artery disease and end-stage diabetic nephropathy across ancestry groups, highlighting the importance of obesity-related processes in the development of vascular outcomes. Our findings show the value of integrating multi-ancestry genome-wide association study data with single-cell epigenomics to disentangle the aetiological heterogeneity that drives the development and progression of T2D. This might offer a route to optimize global access to genetically informed diabetes care.