Search

The present study investigates the transport of dilute bubbles by transitional flow in a joining, cross-flow-type T-junction channel geometry with Reynolds numbers at the outlet branch from Re3 = 600 to 1800 and an inlet volume flow rate ratio of 1. Bubbles with diameters between db = 400 and 600 µm are considered. The schematic pattern of the single-phase flow is introduced based on streakline dye visualizations. Complex 3D flow due to the narrow channel design dominates the recirculation area and flow instabilities become important with increasing Reynolds number, which can be observed by the fading of dye intensity. A numerical method is presented with unsteady boundary conditions based on laser Doppler velocimetry measurements. Bubble trajectories are obtained by an Euler-Lagrange approach. Using high-speed shadowgraphy method combined with image processing, bubble sizes were measured, and bubble trajectories were evaluated. Experimental bubble trajectories and numerically predicted bubble positions show good agreement for Re3 = 600, which is also the case with the dye visualization image. For higher Reynolds numbers, measurements of the bubble trajectories are reported and compared to dye visualization images. The increasing flow instabilities influence the bubble transport, resulting in large variations of bubble locations.

This paper hopes to show that, for Wallace Stevens, God and human imagination are closely identified. Moreover, the feeling of rightness, which for so long a time existed with the old religious idea of God, may be accessed once again. His notion of the “supreme fiction” will compare with Descartes’ “idea of the Infinite” as interpreted by Emmanuel Levinas. This epistemological reality, central to our being, can also become contemporary to our lives, in a way that the old religious idea of God can never again be. With access to this “right idea,” we may again find the sort of solace that we once found in old religious beliefs.

Chronic kidney disease (CKD) is a risk factor for premature cardiovascular disease. As kidney function declines, the presence of left ventricular abnormalities increases such that by the time kidney replacement therapy is required with dialysis or kidney transplantation, more than two-thirds of patients have left ventricular hypertrophy. Historically, much research in nephrology has focussed on the structural and functional aspects of cardiac disease in CKD, particularly using echocardiography to describe these abnormalities. There is a need to translate knowledge around these imaging findings to clinical outcomes such as unplanned hospital admission with heart failure and premature cardiovascular death. Left ventricular hypertrophy and cardiac fibrosis, which are common in CKD, predispose to the clinical syndrome of heart failure with preserved left ventricular ejection fraction (HFpEF). There is a bidirectional relationship between CKD and HFpEF, whereby CKD is a risk factor for HFpEF and CKD impacts outcomes for patients with HFpEF. There have been major improvements in outcomes for patients with heart failure and reduced left ventricular ejection fraction as a result of several large randomized controlled trials. Finding therapy for HFpEF has been more elusive, although recent data suggest that sodium-glucose cotransporter 2 inhibition offers a novel evidence-based class of therapy that improves outcomes in HFpEF. These observations have emerged as this class of drugs has also become the standard of care for many patients with proteinuric CKD, suggesting that there is now hope for addressing the combination of HFpEF and CKD in parallel. In this review we summarize the epidemiology, pathophysiology, diagnostic strategies and treatment of HFpEF with a focus on patients with CKD.

Titanium dioxide is a promising candidate for photoelectrochemical water splitting; however, its performance is limited due to the sluggish oxygen evolution reaction (OER). In this work, a hybrid nanomaterial was developed by combining ordered mesoporous TiO2 thin films with a cobalt oxo-phosphate OER catalyst (CoPi). We conducted a detailed structural and electrochemical characterization of the nanocomposite. We compared the performance of dense and mesoporous TiO2 films on different substrates as photoelectrodes for water splitting. The photoelectrodes exhibit high stability, reproducibility and cycling durability, with consistent photocurrent densities. Controlled amounts of CoPi were deposited on this matrix. Low loadings resulted in a 20% increase in photocurrent, whereas higher loadings suppressed the photocurrent. In this study, we demonstrate the importance of optimizing the co-catalyst loading based on the interaction between different components in a hybrid photoanode, with a focus on understanding the recombination pathways that appear when working with nanostructured semiconductors.

Purpose of review: \ud Recent advances in the world of glomerular diseases have largely focussed on remission induction with immune modulating therapy. It is well recognised that even with the best available treatments, patients with glomerular diseases may have an increased risk of progressive renal and cardiovascular disease.\ud \ud Recent findings: \ud The arrival of large trials looking at the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with chronic kidney disease (CKD) and diabetes or not has shifted the entire focus of current management and the shift needs to go further. This review summarises the background to these landmark trials and provides practical guidance for implementation of the results in a general nephrology clinic. In sub-group analyses of the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) clinical trial, SGLT2i improved renal outcomes in patients with immunoglobulin A (IgA) nephropathy highlighting the potential for this drug class in glomerular disease. We also discuss where the gaps in evidence are and where future trials in glomerular diseases, be they primary or secondary, should be focussed.\ud \ud Summary: \ud The renal community has never before had evidence of this strength upon which to base recommendations for patients with CKD and we should be grasping it with both hands.

People spend increasing amounts of time at home, yet the indoor home environment remains understudied in terms of potential exposure to toxic trace metals. We evaluated trace metal (and metalloid) concentrations (As, Cu, Cr, Mn, Ni, Pb, and Zn) and health risks in indoor dust from homes from 35 countries, along with a suite of potentially contributory residential characteristics. The objective was to determine trace metal source inputs and home environment conditions associated with increasing exposure risk across a range of international communities. For all countries, enrichments compared to global crustal values were Zn > Pb > Cu > As > Cr > Ni; with the greatest health risk from Cr, followed by As > Pb > Mn > Cu > Ni > Zn. Three main indoor dust sources were identified, with a Pb–Zn–As factor related to legacy Pb sources, a Zn–Cu factor reflecting building materials, and a Mn factor indicative of natural soil sources. Increasing home age was associated with greater Pb and As concentrations (5.0 and 0.48 mg/kg per year of home age, respectively), as were peeling paint and garden access. Therefore, these factors form important considerations for the development of evidence-based management strategies to reduce potential risks posed by indoor house dust. Recent findings indicate neurocognitive effects from low concentrations of metal exposures; hence, an understanding of the home exposome is vital.

The scaling of Transformers has driven breakthrough capabilities for language models. At present, the largest large language models (LLMs) contain upwards of 100B parameters. Vision Transformers (ViT) have introduced the same architecture to image and video modelling, but these have not yet been successfully scaled to nearly the same degree; the largest dense ViT contains 4B parameters (Chen et al., 2022). We present a recipe for highly efficient and stable training of a 22B-parameter ViT (ViT-22B) and perform a wide variety of experiments on the resulting model. When evaluated on downstream tasks (often with a lightweight linear model on frozen features), ViT-22B demonstrates increasing performance with scale. We further observe other interesting benefits of scale, including an improved tradeoff between fairness and performance, state-of-the-art alignment to human visual perception in terms of shape/texture bias, and improved robustness. ViT-22B demonstrates the potential for "LLM-like" scaling in vision, and provides key steps towards getting there.

Supplemental material, sj-docx-1-eso-10.1177_23969873231173282 for Sex differences in associations between creatinine and cystatin C-based kidney function measures with stroke and major bleeding by Jennifer Susan Lees, Nicole L De La Mata, Michael K Sullivan, Melanie L Wyld, Brenda M Rosales, Rachel Cutting, James Alan Hedley, Elaine Rutherford, Patrick Barry Mark and Angela C Webster in European Stroke Journal

Scoping review protocol

Supplemental material, sj-docx-1-eso-10.1177_23969873231173282 for Sex differences in associations between creatinine and cystatin C-based kidney function measures with stroke and major bleeding by Jennifer Susan Lees, Nicole L De La Mata, Michael K Sullivan, Melanie L Wyld, Brenda M Rosales, Rachel Cutting, James Alan Hedley, Elaine Rutherford, Patrick Barry Mark and Angela C Webster in European Stroke Journal

Iron ores are principal input materials for iron and steel-making industries. Quality of iron ores is one of the critical parameters for formation of environmental pollutants related to the steel-making process. Dioxins are identified as one of the most toxic pollutants emitted during ironmaking, specifically during the sintering process. This study applied four types of iron ores and analyzed their moisture, density, particle size distribution and element concentrations to investigate their effect on the dioxin formation during sintering. Each type of iron ore was processed in a sinter pot grate. During each processing route, exhausted dust and generated sinter products were collected and subjected to PCDD/F and PCB analysis. Statistical analysis was applied to assess correlations between properties of iron ores and exhausted dioxin emissions, identifying key contributors to dioxin formation during sintering process. Results showed that Fe in iron ores was positively and significantly related to PCB 114 formation in dust and confirmed its co-catalytic effect on dioxin formation. Concentrations of Al, Ti and Cl in iron ores greatly increased PCDD/F and PCB emissions in the sintered products compared to dioxins in dust samples. The S levels and density of iron ores were highly related to the increasing PCDD/F and PCB emissions in both sinter and dust samples. By contrast, concentrations of Si in iron ores played a significant role in decreasing PCDD/F and PCB emissions in both sinter and dust samples. This study also confirmed the optimum size (

Despite ongoing concerns about trace metal and metalloid exposure risks from indoor dust, there has been limited research examining their sources and relationship to outdoor soils. Here we determine the concentrations and sources for potentially toxic trace metal and metalloids arsenic (As), chromium (Cr), copper (Cu), manganese (Mn), lead (Pb) and zinc (Zn) and their pathways into homes in Sydney, Australia, using home-matched indoor dust (n = 166), garden soil (n = 166), and road dust samples (n = 51). All trace metals were more elevated indoors versus their matched garden soil counterparts. Indoor Cu and Zn concentrations were significantly more enriched than outdoor media, indicating indoor sources were more relevant for these elements. By contrast, even though Pb was elevated in indoor dust, garden soil concentrations were correspondingly high, indicating it remains an important source and pathway for indoor contamination. Home attributes such as home age, construction materials, recent renovations and deteriorating exterior paint status correlated with high concentrations of paint-related As, Pb, Zn and metal sheeting-related Zn in garden soils and indoor dust of old homes (50 years). Significant correlations (p 0.05) between concentrations in road dust and garden soil Cu; concentrations of As and Zn in soil and indoor dust and Pb across all three media suggest common sources. Scanning electron microscopy (SEM) analysis of indoor dust samples (n = 6) showed that 57% of particles were derived from outdoor sources. Pb isotopic compositions of soil (n = 21) and indoor dust (n = 21) were moderately correlated, identifying the relevance of outdoor sources on indoor environments. This study illustrates the relationship, origin, and fate of trace metals moving from the surrounding environment, around and into homes, which is of value in understanding how to reduce potentially toxic trace metal exposure in the home environment.

Case commentary on Foster v Jessen [2021] NIQB 56.

Diabetic kidney disease develops in about 40% of patients with diabetes and is the commonest cause of chronic kidney disease worldwide. Patients with chronic kidney disease, especially those with diabetes mellitus, are at high risk of both developing kidney failure and cardiovascular death. The use of renin-angiotensin system blockers to reduce the incidence of kidney failure in patients with diabetic kidney disease dates back to studies that are now 20 or more years old. During the last few years sodium-glucose co-transporter-2 inhibitors have shown beneficial renal effects in randomized trials. However, even in response to combined treatment with renin-angiotensin system blockers and sodium-glucose co-transporter-2 inhibitors, the renal residual risk remains high with kidney failure only deferred, but not avoided. The risk of cardiovascular death also remains high even with optimal current treatment. Steroidal mineralocorticoid receptor antagonists reduce albuminuria and surrogate markers of cardiovascular disease in patients already on optimal therapy. However, their use has been curtailed by the significant risk of hyperkalaemia. In The FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease (FIDELIO-DKD) study comparing the actions of the non-steroidal mineralocorticoid receptor antagonist finerenone with placebo, finerenone reduced the progression of diabetic kidney disease and the incidence of cardiovascular events with a relatively safe adverse event profile. This document presents in detail the available evidence on the cardioprotective and nephroprotective effects of mineralocorticoid receptor antagonists, analyses the potential mechanisms involved and discusses their potential future place in the treatment of patients with diabetic chronic kidney disease. Sin financiación 7.186 JCR (2021) Q1, 3/25 Transplantation 1.536 SJR (2021) Q1, 219/2489 Medicine (miscellaneous) No data IDR 2021 UEM

IoT applications vary considerably, but a core set of functional requirements typically remain the same.

Background: Bacteria colonizing the nasopharynx play a key role as gatekeepers of respiratory health. Yet, dynamics of early life nasopharyngeal (NP) bacterial profiles remain understudied in low-and-middle-income countries (LMICs), where children have a high prevalence of risk factors for lower respiratory tract infection. We investigated longitudinal changes in NP bacterial profiles, and associated exposures, among healthy infants from low-income households in South Africa.Methods: We used short fragment (V4 region) 16S rRNA gene amplicon sequencing to characterise NP bacterial profiles from 103 infants in a South African birth cohort, at monthly intervals from birth through the first 12 months of life and six-monthly thereafter until 30 months. Results:Corynebacterium and Staphylococcus were dominant colonizers at one month of life, however these were rapidly replaced by Moraxella- or Haemophilus-dominated profiles by four months. This succession was almost universal, and largely independent of a broad range of exposures Warm weather (summer), lower gestational age, maternal smoking, no day-care attendance, antibiotic exposure, or low height-for-age z score at 12 months were associated with higher alpha and beta diversity. Summer was also associated with higher relative abundances of Staphylococcus, Streptococcus, Neisseria or anaerobic gram-negative bacteria, whilst spring and winter were associated with higher relative abundances of Haemophilus or Corynebacterium, respectively. Maternal smoking was associated with higher relative abundances of Porphyromonas. Antibiotic therapy (or isoniazid prophylaxis for tuberculosis) was associated with higher relative abundance of anerobic taxa (Porphyromonas, Fusobacterium and Prevotella) and with lower relative abundances of health associated-taxa Corynebacterium and Dolosigranulum. HIV-exposure was associated with higher relative abundances of Klebsiella or Veillonella and lower relative abundances of an unclassified genus within the family Lachnospiraceae. Conclusions:In this intensively sampled cohort there was rapid and predictable replacement of early profiles dominated by health-associated Corynebacterium and Dolosigranulum with those dominated by Moraxella and Haemophilus, independent of exposures. Season and antibiotic exposure were key determinants of NP bacterial profiles. Understudied but highly prevalent exposures prevalent in LMICs, including maternal smoking and HIV-exposure, were associated with NP bacterial profiles.

This study explores the significant variation in test methods used to quantify microplastic release from the domestic laundry of textile fabrics. A wide review of the existing methods is made, with...

A study of 481 high school students who completed Teen Community Emergency Response Team (CERT) training using the Federal Emergency Management Agency CERT curriculum was conducted over a five-year period, with the objective of identifying the impacts of that training. Through both quantitative and qualitative data collection, the researcher found that a highly engaging emergency response curriculum has multiple positive impacts on teens completing the course. Those impacts include explicit knowledge and skills of emergency preparedness and response, college and career goal orientation enhancement, as well as enhancement to self-efficacy, self-confidence, self-esteem, and self-concept. Replicating such curricula and comprehensive training program at other secondary schools could have a very positive impact on the emergency preparedness and response capacity of communities where it is implemented.

Metropolitan cities can serve as laboratories of sustainable development by experimenting with innovative sustainability programs while leveraging the advantages of metropolitan areas. With the importance of cities’ sustainability efforts, scholars have increasingly explored what factors motivate local governments to implement voluntary sustainability programs by focusing on internal government and community characteristics. However, what is missing in the previous discussion is whether city governments respond to sustainability efforts by other government entities, especially neighboring local governments. Drawing on institutional and policy diffusion theories, we analyzed the sustainability programs of 251 suburban cities in 66 metropolitan areas. We find that suburban cities are likely to consider sustainability efforts of central cities in the same metropolitan area when determining the extent to which they implement their sustainability programs. However, they are not necessarily responsive to sustainability efforts of nearby suburban cities. Our research sheds light on how local governments’ sustainability policy decisions are affected by their relationships with other local governments. It also provides policy implications for the important role of central cities in facilitating collective sustainability efforts in metropolitan areas.

The AATCC TM22-2014 spray test (similarly BS EN ISO 4920:2012) is widely used to determine the water repellency of textiles. Given the ongoing move towards non-fluorinated chemistries to provide water repellent finishes on textiles, modifications to the spray test are suggested to discriminate between those which initially demonstrate similar repellency and aid in assessment of performance within laboratory textile testing. An extended shower duration of 60 minutes or 120 minutes is recommended, with additional calculations to objectively quantify surface wetting. This increased test period demonstrated differences in performance between repellent finishes with a 1.37 g mass difference between fluorinated and non-fluorinated chemistries after 120 minutes. Further quantification of repellent performance, as set out in this study, would determine the performance of non-fluorinated durable water repellent (DWR) chemistries and suitability for end use.

In this work, an efficient model for simulating bubble dispersion and coalescence due to turbulence is developed in the Euler-Lagrange framework. The primary liquid phase is solved on the Euler grid with the RANS turbulence model. Bubble motion is computed with the force balance equations. One-way coupling between two phases is assumed and the framework is designed for the computation of disperse bubbly flows at low Eötvös number. The turbulent dispersion of the dispersed phase is reconstructed with the continuous random walk (CRW) model. Bubble-bubble collisions and coalescence are accounted for deterministically. To accelerate the time-consuming search for potential collision partners in dense bubbly flows, the sweep and prune algorithm is employed, which can be utilized in arbitrary mesh types and sizes. Validation against experiments of turbulent pipe flows demonstrates that the one-way coupled EL-CRW dispersion model can well reproduce the bubble distribution in a typical dense bubbly pipe flow. Good agreement of the bubble size distribution at the pipe outlet between the simulation and the experiment is obtained.

Background The United States Environmental Protection Agency (EPA) recently lowered residential floor and windowsill dust lead hazard standards, but maintained previous post-abatement clearance standards. We examined whether the discrepancy in these regulations places children at higher risk of lead poisoning. Methods In 250 children from Cincinnati, Ohio (2004-2008) living in homes built before 1978, we measured residential floor and windowsill dust lead loadings and blood lead concentrations at ages 1 and 2 years. Using linear regression with generalized estimating equations, we estimated covariate-adjusted associations of dust lead levels with blood lead concentrations and risk of lead poisoning. Results An increase in floor dust lead from 10 (revised dust lead hazard standard) to 40 μg/ft2 (post-abatement clearance standard) was associated with 26% higher (95% confidence interval (CI):15, 38) blood lead concentrations and 2.1 times the risk of blood lead concentrations ≥5 μg/dL (95% CI: 1.44, 3.06). Extrapolating our findings to US children age 1-5 years, we estimated that 6.9% (95% CI: 1.5, 17.2) of cases of blood lead concentrations ≥5 μg/dL are attributable to floor dust lead loadings between 10 and ≤40 μg/ft2. Conclusions The EPA's residential dust lead regulations place children at increased risk of lead poisoning. We recommend adopting more protective dust lead standards. Impact We determined whether children are at increased risk of lead poisoning with the 2019 EPA residential post-abatement lead clearance standards being higher than dust lead hazard standards.In this observational study, 2019 EPA dust lead clearance standards were associated with increased risk of lead poisoning compared to the revised dust lead hazard standard. Both EPA standards were associated with increased risk of lead poisoning compared to more stringent standards employed in our study.Extrapolating our findings to US children, the 2019 EPA dust lead clearance standards could place up to 36,700 children at risk of lead poisoning.

Misspecification in network autocorrelation models poses a challenge for parameter estimation, which is amplified by missing data. Model misspecification has been a focus of recent work in the statistics literature and new robust procedures have been developed, in particular cutting feedback. This paper shows how this helps in a misspecified network autocorrelation model. Where model misspecification is mild and the traits are fully observed, Bayesian imputation is routine. In settings with high missingness, Bayesian inference can fail, but a closely related cut model is robust. We illustrate this on a data set of graduate students using a Facebook-like messaging app.

Ex-vivo normothermic perfusion (EVNP) is an emerging strategy in kidney preservation that enables resuscitation and viability assessment under pseudo-physiological conditions prior to transplantation. The optimal perfusate composition and duration, however, remain undefined. A systematic literature search (Embase; Medline; Scopus; and BIOSIS Previews) was conducted. We identified 1,811 unique articles dating from January 1956 to July 2021, from which 24 studies were deemed eligible for qualitative analysis. The perfusate commonly used in clinical practice consisted of leukocyte-depleted, packed red blood cells suspended in Ringer’s lactate solution with Mannitol, dexamethasone, heparin, sodium bicarbonate and a specific nutrient solution supplemented with insulin, glucose, multivitamins and vasodilators. There is increasing support in preclinical studies for non-blood cell-based perfusates, including Steen solution, synthetic haem-based oxygen carriers and acellular perfusates with supraphysiological carbogen mixtures that support adequate oxygenation whilst also enabling gradual rewarming. Extended durations of perfusion (up to 24 h) were also feasible in animal models. Direct comparison between studies was not possible due to study heterogeneity. Current evidence demonstrates safety with the aforementioned widely used protocol, however, extracellular base solutions with adequate oxygenation, supplemented with nutrient and metabolic substrates, show promise by providing a suitable environment for prolonged preservation and resuscitation.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021231381, identifier PROSPERO 2021 CRD42021231381

IntroductionHypertension is one of the leading causes of morbidity and mortality worldwide, and has been associated with target organ damage. Effects of hypertension on the auditory system are varied and requires further investigation. This study aimed to investigate the association between hypertension and auditory deficits (hearing loss and tinnitus).MethodsThis study employed a cross-sectional study including 106 (54.7% female) hypertensive adults aged 18–55 years, and 92 (52.2% female) non-hypertensive sex- and age-matched adults residing in South Africa. A data extraction sheet was used to obtain hypertension information from participants' medical files, and to subjectively obtain tinnitus status and characteristics among participants. Participants' hearing sensitivity—including extended high frequencies (EHF)—were measured using a diagnostic audiometer. The χ2 test determined the difference in auditory deficit prevalence between the study groups. Logistic regression was used to identify predictor variables associated with auditory deficits in the hypertensive group.ResultsA hearing loss prevalence of 37.4% among hypertensive adults compared to 14.1% among the non-hypertensive group (P = 0.000, χ2 = 14.00) was found. The EHF pure-tone average among the hypertensive group was 44.1 ± 19.2 dB HL, and 20.0 ± 18.3 dB HL among the control group. Bilateral mild sensorineural hearing loss was the most common type of hearing loss among hypertensive adults. A higher prevalence of tinnitus (41.5%) was found in the hypertensive group compared to the control group (22.8%) (P = 0.008, χ2 = 7.09). In this study, 30.3% of hypertensive adults had tinnitus without hearing loss compared to 17.7% non-hypertensive adults. Factors associated with hearing loss included being between 50 and 55 years [adjusted Odds Ratio (AOR) = 3.35; 95% Confidence Interval (CI): 1.32–8.50; P = 0.011], having grade 2 hypertension (AOR = 4.18; 95% CI: 1.02–17.10; P = 0.048), and being on antihypertensive medication (AOR = 3.18; 95% CI: 1.02–9.87; P = 0.045). Tinnitus was associated with grade 3 hypertension (AOR = 3.90; 95% CI: 1.12–12.64; P = 0.033).ConclusionsOur study showed that hypertensive adults had a higher proportion of hearing loss and tinnitus compared to non-hypertensive adults. Findings suggest an association between hypertension and auditory deficits, demonstrating a need for integration of hearing healthcare services for hypertension management.

Additional file 1

INTRODUCTION: Arteriovenous fistulae (AVF) are the 'gold standard' vascular access for haemodialysis. Universal usage is limited, however, by a high early failure rate. Several small, single-centre studies have demonstrated better early patency rates for AVF created under regional anaesthesia (RA) compared with local anaesthesia (LA). The mechanistic hypothesis is that the sympathetic blockade associated with RA causes vasodilatation and increased blood flow through the new AVF. Despite this, considerable variation in practice exists in the UK. A high-quality, adequately powered, multicentre randomised controlled trial (RCT) is required to definitively inform practice. METHODS AND ANALYSIS: The Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study is a multicentre, observer-blinded RCT comparing primary radiocephalic/brachiocephalic AVF created under regional versus LA. The primary outcome is primary unassisted AVF patency at 1 year. Access-specific (eg, stenosis/thrombosis), patient-specific (including health-related quality of life) and safety secondary outcomes will be evaluated. Health economic analysis will also be undertaken. ETHICS AND DISSEMINATION: The ACCess study has been approved by the West of Scotland Research and ethics committee number 3 (20/WS/0178). Results will be published in open-access peer-reviewed journals within 12 months of completion of the trial. We will also present our findings at key national and international renal and anaesthetic meetings, and support dissemination of trial outcomes via renal patient groups. TRIAL REGISTRATION NUMBER: ISRCTN14153938. SPONSOR: NHS Greater Glasgow and Clyde GN19RE456, Protocol V.1.3 (8 May 2021), REC/IRAS ID: 290482.

Introduction: Arteriovenous fistulae (AVF) are the ���gold standard��� vascular access for haemodialysis. Universal usage is limited, however, by a high early failure rate. Several small, single-centre studies have demonstrated better early patency rates for AVF created under regional anaesthesia (RA) compared with local anaesthesia (LA). The mechanistic hypothesis is that the sympathetic blockade associated with RA causes vasodilatation and increased blood flow through the new AVF. Despite this, considerable variation in practice exists in the UK. A high-quality, adequately powered, multicentre randomised controlled trial (RCT) is required to definitively inform practice. Methods and analysis: The Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study is a multicentre, observer-blinded RCT comparing primary radiocephalic/brachiocephalic AVF created under regional versus LA. The primary outcome is primary unassisted AVF patency at 1 year. Access-specific (eg, stenosis/thrombosis), patient-specific (including health-related quality of life) and safety secondary outcomes will be evaluated. Health economic analysis will also be undertaken. Ethics and dissemination: The ACCess study has been approved by the West of Scotland Research and ethics committee number 3 (20/WS/0178). Results will be published in open-access peer-reviewed journals within 12 months of completion of the trial. We will also present our findings at key national and international renal and anaesthetic meetings, and support dissemination of trial outcomes via renal patient groups. Trial registration number: ISRCTN14153938. Sponsor: NHS Greater Glasgow and Clyde GN19RE456, Protocol V.1.3 (8 May 2021), REC/IRAS ID: 290482.

Prostate cancer is characterised by significant global disparity; mortality rates in Sub-Saharan Africa are double to quadruple those in Eurasia1. Hypothesising unknown interplay between genetic and non-genetic factors, tumour genome profiling envisages contributing mutational processes2,3. Through whole-genome sequencing of treatment-naïve prostate cancer from 183 ethnically/globally distinct patients (African versus European), we generate the largest cancer genomics resource for Sub-Saharan Africa. Identifying ~2 million somatic variants, Africans carried the greatest burden. We describe a new molecular taxonomy using all mutational types and ethno-geographic identifiers, including Asian. Defined as Global Mutational Subtypes (GMS) A–D, although Africans presented within all subtypes, we found GMS-B to be ‘African-specific’ and GMS-D ‘African-predominant’, including Admixed and European Africans. Conversely, Europeans from Australia, Africa and Brazil predominated within ‘mutationally-quiet’ and ethnically/globally ‘universal’ GMS-A, while European Australians shared a higher mutational burden with Africans in GMS-C. GMS predicts clinical outcomes; reconstructing cancer timelines suggests four evolutionary trajectories with different mutation rates (GMS-A, low 0.968/year versus D, highest 1.315/year). Our data suggest both common genetic factors across extant populations and regional environmental factors contributing to carcinogenesis, analogous to gene-environment interaction defined here as a different effect of an environmental surrounding in persons with different ancestries or vice versa. We anticipate GMS acting as a proxy to intrinsic and extrinsic mutational processes in cancers, promoting global inclusion in landmark studies.

Background:\ud Acute kidney disease (AKD) is a proposed definition for acute kidney injury (AKI) lasting 7 days or longer. Little has been reported regarding characteristics of patients with AKD and their short- and long-term outcomes. We describe the epidemiology and risk factors for AKD and outcomes following AKD.\ud \ud Methods:\ud This retrospective observational cohort study identified patients aged 16 or older admitted to the Glasgow Royal Infirmary and Queen Elizabeth University Hospital intensive care units (ICUs) in Scotland between 1st July 2015 and 30th June 2018. Baseline serum creatinine and subsequent values were used to identify patients with de-novo kidney injury (DNKI). Patients with recovery prior to day 7 were classified as AKI; recovery at day 7 or beyond was classified as AKD. Outcomes were in-hospital and long-term mortality, and proportion of major adverse kidney events (MAKEs). Multivariable logistic regression was used to identify risk factors for AKD. A Cox proportional hazards model was used to identify factors associated with long-term outcomes.\ud \ud Findings:\ud Of the 5,334 patients admitted to ICU who were assessed for DNKI, 1,620 (30·4%) suffered DNKI and of these, 403 (24·9%) met AKD criteria; 984 (60·7%) were male and the median age was 60·0 (IQR=48·0–72·0). Male sex, sepsis and lower baseline estimated glomerular filtration rate (eGFR) were associated with development of AKD. In-ICU (16·1%vs6·2%) and in-hospital (26·1%vs11·6%) mortality rates were significantly higher in AKD patients than AKI patients. Long-term survival was not different for AKD patients (HR=1·16; p-value=0·261) but AKD was associated with subsequent MAKEs (OR=1·25).\ud \ud Interpretation:\ud One in four ICU patients with DNKI met AKD criteria. These patients had an increased risk of short-term mortality and long-term MAKEs. Whilst the trend for long-term survival was lower, this was not significantly different from shorter-term AKI patients. Patients with AKD during their ICU stay should be identified to initiate interventions to reduce risk of future MAKEs.\ud \ud Funding:\ud No funding was associated with this study.

Blood lead (Pb) poisoning remains a global concern, particularly for children in their early developmental years. Broken Hill is Australia's oldest operating silver-zinc-lead mine. In this study, we utilized recent advances in machine learning to assess multiple algorithms and identify the most optimal model for predicting childhood blood Pb levels (BLL) using Broken Hill children's (

The purpose of conducting this LCA was to calculate the potential environmental impacts of the repurposing of John Lawrie Tubulars products sourced from North Sea Oil and Gas fields and to compare repurposed steel tubulars to those made from prime steel1throughout their lifecycle. The analysis includes multiple environmental characterization indicators associated with the material processing, on-site operations, and supply chain. The benefits of repurposed tubulars are consistently beneficial across all environmental indicators when compared to prime steel tubulars. The life cycle analysis results show that for every tonne of steel tubular repurposed there is a 97.21% saving of carbon emissions over a prime steel seamless equivalent and is 97.78% for welded steel tubulars (cradle to gate). Further characterization analysis (cradle to site) showed that distribution presented the highest impact (47%) with materials (26%) and material transportation (15%). The average delivery in the UK adds 56.53kgCO2eto John Lawrie's tubular steel giving a cradle to delivery at the customers gate of 118.53kgCO2eper tonne2. The combined material and distribution carbon footprint of repurposed tubular products (cradle to site) has ~6% of the impact of those made from prime steel. With growing pressure on the construction industry amongst others to be more resource efficient, and to lower embodied carbon, material reuse strategies are critical to meet targets. Considering the potential of the results for environmental impact reduction there is the need to further develop and promote the application of repurposed steel tubulars. This data can be used to demonstrate the environmental impacts and benefits of refurbished tubulars and supports the efficacy of environmental claims and contribution to circular economy. With both the construction and energy industries focused on finding innovative ways in which to reduce their emissions and support the Scottish and UK Governments in bringing all greenhouse gas emissions (GHG) to net zero by 2050, this study details one way these industries can help drive the changes required.

Chronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment.

Background Inflammation is a hallmark of prostate cancer (PCa), yet no pathogenic agent has been identified. Men from Africa are at increased risk for both aggressive prostate disease and infection. We hypothesize that pathogenic microbes may be contributing, at least in part, to high‐risk PCa presentation within Africa and in turn the observed ethnic disparity. Methods Here we reveal through metagenomic analysis of host‐derived whole‐genome sequencing data, the microbial content within prostate tumor tissue from 22 men. What is unique about this study is that patients were separated by ethnicity, African vs European, and environments, Africa vs Australia. Results We identified 23 common bacterial genera between the African, Australian, and Chinese prostate tumor samples, while nonbacterial microbes were notably absent. While the most abundant genera across all samples included: Escherichia, Propionibacterium, and Pseudomonas, the core prostate tumor microbiota was enriched for Proteobacteria. We observed a significant increase in the richness of the bacterial communities within the African vs Australian samples (t = 4.6‐5.5; P = .0004‐.001), largely driven by eight predominant genera. Considering core human gut microbiota, African prostate tissue samples appear enriched for Escherichia and Acidovorax, with an abundance of Eubacterium associated with host tumor hypermutation. Conclusions Our study provides suggestive evidence for the presence of a core, bacteria‐rich, prostate microbiome. While unable to exclude for fecal contamination, the observed increased bacterial content and richness within the African vs non‐African samples, together with elevated tumor mutational burden, suggests the possibility that bacterially‐driven oncogenic transformation within the prostate microenvironment may be contributing to aggressive disease presentation in Africa.

Background The androgen‐regulated gene TMPRSS2 to the ETS transcription factor gene ERG fusion is the most common genomic alteration acquired during prostate tumorigenesis and biased toward men of European ancestry. In contrast, African American men present with more advanced disease, yet their tumors are less likely to acquire TMPRSS2‐ERG. Data for Africa is scarce. Methods RNA was made available for genomic analyses from 181 prostate tissue biopsy cores from Black South African men, 94 with and 87 without pathological evidence for prostate cancer. Reverse transcription polymerase chain reaction was used to screen for the TMPRSS2‐ERG fusion, while transcript junction coordinates and isoform frequencies, including novel gene fusions, were determined using targeted RNA sequencing. Results Here we report a frequency of 13% for TMPRSS2‐ERG in tumors from Black South Africans. Present in 12/94 positive versus 1/87 cancer negative prostate tissue cores, this suggests a 92.62% predictivity for a positive cancer diagnosis (P = 0.0031). At a frequency of almost half that reported for African Americans and roughly a quarter of that reported for men of European ancestry, acquisition of TMPRSS2‐ERG appears to be inversely associated with aggressive prostate cancer. Further support was provided by linking the presence of TMPRSS2‐ERG to low‐grade disease in younger patients (P = 0.0466), with higher expressing distal ERG fusion junction coordinates. Conclusions Only the second study of its kind for the African continent, we support a link between TMPRSS2‐ERG status and prostate cancer racial health disparity beyond the borders of the United States. We call for urgent evaluation of androgen deprivation therapy within Africa.

This international scale study measured the prevalence of indoor microplastics (MPs) in deposited dust in 108 homes from 29 countries over a 1-month period. Dust borne MPs shape, colour, and length were determined using microscopy and the composition measured using μFTIR. Human health exposure and risk was assessed along with residential factors associated with MPs via a participant questionnaire. Samples were categorised according to each country's gross national income (GNI). Synthetic polymers dominated in low income (LI) (39%) and high income (HI) (46%) while natural fibres were the most prevalent in medium income (MI) (43%) countries. Composition and statistical analysis showed that the main sources of MPs and dust were predominantly from indoor sources. Across all GNI countries, greater vacuuming frequency was associated with lower MPs loading. High income country samples returned higher proportions of polyamides and polyester fibres, whereas in LI countries polyurethane was the most prominent MPs fibre. Exposure modelling showed infants (0-2 years) were exposed to the highest MPs dose through inhalation (4.5 × 10

Increased interest in backyard food production has drawn attention to the risks associated with urban trace element contamination, in particular lead (Pb) that was used in abundance in Pb-based paints and gasoline. Here we examine the sources, pathways and risks associated with environmental Pb in urban gardens, domestic chickens and their eggs. A suite of other trace element concentrations (including As, Cd, Cr, Cu, Hg, Mn, Ni, Pb, Zn) are reported from the sampled matrices. Sixty-nine domestic chickens from 55 Sydney urban gardens were sampled along with potential sources (feed, soil, water), blood Pb concentrations and corresponding concentrations in eggs. Age of the sampled chickens and house age was also collected. Commercial eggs (n = 9) from free range farms were analysed for comparative purposes. Study outcomes were modelled using the large Australian VegeSafe garden soil database (20,000 samples) to predict which areas of inner-city Sydney, Melbourne and Brisbane are likely to have soil Pb concentrations unsuitable for keeping backyard chickens. Soil Pb concentrations was a strong predictor of chicken blood and egg Pb (p=0.00001). Almost 1 in 2 (n = 31/69) chickens had blood Pb levels20 μg/dL, the level at which adverse effects may be observed. Older homes were correlated with higher chicken blood Pb (p = 0.00002) and egg Pb (p = 0.005), and younger chickens (12 months old) had greater Pb concentrations, likely due to increased Pb uptake during early life development. Two key findings arose from the study data: (i) in order to retain chicken blood Pb below 20 μg/dL, soil Pb needs to be 166 mg/kg; (ii) to retain egg Pb 100 μg/kg (i.e. a food safety benchmark value), soil Pb needs to be 117 mg/kg. These concentrations are significantly lower than the soil Pb guideline of 300 mg/kg for residential gardens. This research supports the conclusion that a large number of inner-city homes may not be suitable for keeping chickens and that further work regarding production and consumption of domestic food is warranted.

Twenty-one grades 6-12 students were interviewed to learn about their experiences participating in a fully synchronous virtual learning environment at a public charter school in California, USA. Students take seven 50-minute classes four days a week and seven 30-minute classes the fifth weekday using the Zoom platform and Google Classroom. One-third of participants were students with disabilities, one-third English language learners, and one-third possessed neither designation. This study identifies several themes regarding the benefits and drawbacks of an entirely synchronous learning experience for secondary students. The participants make recommendations for their general education, special education, and English language development teachers, including strategies to engage secondary students more effectively, assessment suggestions, curriculum design ideas, advice about organizing Google Classrooms in ways that are supportive of student needs, and exhortations about what teachers should not do when planning and implementing synchronous online learning.

IntroductionPerfluoroalkyl and polyfluoroalkyl substances (PFAS) are a diverse group of compounds that have been used in hundreds of industrial applications and consumer products including aqueous film-forming foam (AFFF) for many years. Multiple national and international health and environmental agencies have accepted that PFAS exposures are associated with numerous adverse health effects. Australian firefighters have been shown to have elevated levels of PFAS in their blood, specifically perfluorooctane sulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS), due to the historical use of AFFF. While PFAS concentrations decline over time once the source of exposure has been removed, their potential adverse health effects are such that it would be prudent to develop an intervention to lower levels at a faster rate than occurs via natural elimination rates.Methods and analysisThis is a randomised controlled trial of current and former Australian firefighters in the Metropolitan Fire Brigade/Fire Rescue Victoria, and contractors, with previous occupational exposure to PFAS and baseline elevated PFOS levels. The study is investigating whether whole blood donation every 12 weeks or plasma donation every 6 weeks will significantly reduce PFAS levels, compared with a control group. We have used covariate-adaptive randomisation to balance participants’ sex and blood PFAS levels between the three groups and would consider a 25% reduction in serum PFOS and PFHxS levels to be potentially clinically significant after 12 months of whole blood or plasma donation. A secondary analysis of health biomarkers is being made of changes between screening and week 52 in all three groups.Ethics and disseminationThis trial has been approved by Macquarie University Human Research Ethics Committee (reference number: 3855), final protocol V.2 dated 12 June 2019. Study results will be disseminated via peer-reviewed publications and presentations at conferences.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000204145).