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ABSTRACT Introduction Methods Results Conclusion The new ‘WHO Reporting System for Lung Cytopathology’ (2022) includes an ‘Insufficient’/‘Inadequate’/‘Non‐diagnostic’ category. Although they recommend that each laboratory should choose one term to report this diagnostic category, they do not recommend one term over the others. Our aim was to evaluate the use of these three terms in pulmonary FNACs among Spanish pathologists.A web‐based survey among Spanish pathologists using Google Forms was performed. It included 14 yes/no and multiple‐choice questions, the latter with an open‐text option where it was possible to give a different answer from the ones given. Some questions inquired about their daily practice routine whilst others proposed different cytological examples with the intention of knowing how they would report those particular cases.Twenty‐eight participants (18 cytopathologists, two general pathologists and seven residents) from 17 different Spanish hospitals completed the survey. Most of the respondents use more than one term of this diagnostic category, and there is a lack of reproducibility on the criteria to use one specific term.There is a need to clearly define this category to reduce variability between pathologists. [ABSTRACT FROM AUTHOR]

Background: Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID‐19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID‐19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico. Methods: We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits. Results: During the COVID‐19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre‐pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference. Conclusions: According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID‐19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers. [ABSTRACT FROM AUTHOR]

Risk of bias (RoB) assessment is essential to the systematic review methodology. The new version of the Cochrane RoB tool for randomized trials (RoB 2) was published in 2019 to address limitations identified since the first version of the tool was published in 2008 and to increase the reliability of assessments. This study analyzed the frequency of usage of the RoB 2 and the adequacy of reporting the RoB 2 assessments in non-Cochrane reviews published in 2020. This meta-research study included non-Cochrane systematic reviews of interventions published in 2020. For the reviews that used the RoB 2 tool, we analyzed the reporting of the RoB 2 assessment. Among 3880 included reviews, the Cochrane RoB 1 tool was the most frequently used (N = 2228; 57.4%), followed by the Cochrane RoB 2 tool (N = 267; 6.9%). From 267 reviews that reported using the RoB 2 tool, 213 (79.8%) actually used it. In 26 (12.2%) reviews, erroneous statements were used to indicate the RoB 2 assessment. Only 20 (9.4%) reviews presented a complete RoB 2 assessment with a detailed table of answers to all signaling questions. The judgment of risk of bias by the RoB 2 tool was not justified by a comment in 158 (74.2%) reviews. Only in 33 (14.5%) of reviews the judgment in all domains was justified in the accompanying comment. In most reviews (81.7%), the RoB was inadequately assessed at the study level. In conclusion, the majority of non-Cochrane reviews published in 2020 still used the Cochrane RoB 1 tool. Many reviews used the RoB 2 tool inadequately. Further studies about the uptake and the use of the RoB 2 tool are needed. [ABSTRACT FROM AUTHOR]

Tracking the state of biodiversity over time is critical to successful conservation, but conventional monitoring schemes tend to be insufficient to adequately quantify how species' abundances and distributions are changing. One solution to this issue is to leverage data generated by citizen scientists, who collect vast quantities of data at temporal and spatial scales that cannot be matched by most traditional monitoring methods. However, the quality of citizen science data can vary greatly. In this paper, we develop three metrics (inventory completeness, range completeness, spatial bias) to assess the adequacy of spatial observation data. We explore the adequacy of citizen science data at the species level for Australia's terrestrial native birds and then model these metrics against a suite of seven species traits (threat status, taxonomic uniqueness, body mass, average count, range size, species density, and human population density) to identify predictors of data adequacy. We find that citizen science data adequacy for Australian birds is increasing across two of our metrics (inventory completeness and range completeness), but not spatial bias, which has worsened over time. Relationships between the three metrics and seven traits we modelled were variable, with only two traits having consistently significant relationships across the three metrics. Our results suggest that although citizen science data adequacy has generally increased over time, there are still gaps in the spatial adequacy of citizen science for monitoring many Australian birds. Despite these gaps, citizen science can play an important role in biodiversity monitoring by providing valuable baseline data that may be supplemented by information collected through other methods. We believe the metrics presented here constitute an easily applied approach to assessing the utility of citizen science datasets for biodiversity analyses, allowing researchers to identify and prioritise regions or species with lower data adequacy that will benefit most from targeted monitoring efforts. Citizen science data are increasingly being used to monitor biodiversity, but datasets produced by citizen scientists come with a number of well‐recognised challenges. In this paper, we develop several metrics to assess the adequacy of spatial observation data from citizen science projects and explore these metrics at the species level for Australia's terrestrial birds. We find that data adequacy for most Australian birds is increasing, but several gaps still remain in the spatial coverage of citizen science data across the Australian continent. [ABSTRACT FROM AUTHOR]

Living wage (LW) is a concept that goes beyond that of national minimum wage (NMW), since it implies income adequacy to the wage earners and to his/her family members. It is coherent with the principle related to wages of the European Pillar of Social Rights (EPSR) namely the right of workers to fair wages, and the duty to ensure adequate minimum wages providing the satisfaction of the worker needs and of his/her family, which originated a proposal of the European Commission for a Directive on adequate minimum wages in the European Union. This article discusses the possibility of implementation of a LW policy in Portugal, a country with low average and median wages, a generous NMW relative to average and median wage, high earnings inequality and a polarised labour market. To be defensible, this policy should reach household income adequacy, be feasible regarding the labour and fiscal costs, and be socially acceptable regarding the change of earnings distribution. The discussion of this policy is made using EU‐SILC data and data from interviews with social partners involved in the national level social dialogue. We quantify and qualify some of the trade‐offs, simulating different values for core policy variables, centred on the worker as a wage earner, as a household member and as a citizen with social rights and fiscal duties, supported on an adequate normative estimation of a consensual Minimum Income Standard (MIS) for the Portuguese households. [ABSTRACT FROM AUTHOR]

With the explosive growth of online services, the Internet Data Center (IDC) has become an emerging load demand. The power consumption of IDCs are believed suitable for demand response (DR) purposes due to its temporal‐spatial flexibility properties. To what extent IDCs could be used as candidate DR resources to provide capacity support are dependent both on the technical property and the willingness of data end‐users. To address the above issue, this paper presents a methodological framework for quantifying the potential value of IDC‐based DR in distribution grids. To achieve this, the concept of capacity credit (CC) is introduced and extended into the IDC scenario. The proposed framework explicitly considered the impacts of uncertainty of user participation intention and the reliability of basic information in the DR process. A novel Z‐number based price elasticity uncertainty model is introduced, and a more realistic evaluation of IDC capacity credit is obtained. Finally, the effectiveness of the proposed model and method is illustrated on a modified IEEE‐33 node network, and the obtained results verify the significance of IDC‐based DR in enhancing the adequacy of supply in distribution grids. [ABSTRACT FROM AUTHOR]

BACKGROUND: The international system for reporting serous fluid cytopathology (TIS) recommends submitting at least 50‐75 mL of serous fluid to decrease false‐negative results. However, prior studies did not agree on specific volume requirements or consensus adequacy criteria. Our study aims to assess whether fluid volume affects the adequacy rate and to assess the minimum volume necessary for optimal adequacy in pleural and peritoneal fluids. METHODS: A total of 8530 serous fluid cytology cases were identified in the laboratory information system. Differences in mean fluid volume received in the laboratory were compared using an ANOVA Games‐Howell test based on TIS category. The percentage of malignant diagnoses across the volume ranges of 0 to 5 mL, 5 to 10 mL, 10 to 25 mL, 25 to 50 mL, 50 to 75 mL, 75 to 100 mL, 100 to 150 mL, 150 to 250 mL, 250 to 500 mL, 500 to 2000 mL was compared in pleural and peritoneal fluids using a chi‐square test, and a SiZer analysis was performed. RESULTS: Mean fluid volume in inadequate, atypical, and negative cases was significantly lower compared to positive cases. A SiZer analysis showed a positive relationship between the malignancy fraction of pleural and peritoneal fluids and fluid volume. The percentage of malignant diagnoses in pleural and peritoneal fluid samples increased significantly up to a volume range of 75‐100 mL. CONCLUSIONS: There is a significant relationship between fluid volume, adequacy and detection of malignancy in serous effusion cytopathology. The malignancy fraction increases with larger fluid volumes but at least 75‐100 mL of fluid should be submitted for optimal diagnosis of malignancy in pleural and peritoneal fluids.; [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound–guided tissue acquisition (EUS‐TA), especially endoscopic ultrasound–guided fine‐needle aspiration (EUS‐FNA), is the mainstay of tissue acquisition for the diagnosis of pancreatic ductal adenocarcinoma (PDAC). Recently, endoscopic ultrasound–guided fine‐needle biopsy (EUS‐FNB) using flexible biopsy needles has been used for patients with PDAC in an effort to increase diagnostic yields and biomarker testing. However, the role of EUS‐TA in biomarker testing for personalized therapy or precise chemotherapy for PDAC is not well established. Methods: PDAC cases with specimens acquired through concurrent EUS‐FNA and EUS‐FNB were identified retrospectively. Smears were prepared from EUS‐FNA sampling, and cell blocks (CBs) were prepared from EUS‐FNB sampling. Rapid onsite evaluation was conducted for all cases for diagnostic adequacy. The adequacy for biomarker testing, including next‐generation sequencing (NGS) and immunohistochemistry (IHC) assays, was evaluated, and cases with smears and CBs adequate for NGS were processed for targeted NGS. Results: There were 26 PDAC cases concurrently sampled by EUS‐FNA and EUS‐FNB. EUS‐FNA smears for all 26 cases and EUS‐FNB CBs for 20 cases (77%) were diagnostic for PDAC. Twenty‐one smears (81%) and 11 CBs (42%) were adequate for NGS. Nine cases with both smears and CBs adequate for NGS underwent NGS, which identified clinically significant gene mutation variants, including KRAS, TP53, and SMAD4 mutations. Conclusions: Both EUS‐FNA and EUS‐FNB can provide optimal material for targeted NGS for PDACs. In PDAC cases subjected to concurrent EUS‐FNA and EUS‐FNB, EUS‐FNA specimens had greater diagnostic yields and more adequate material for NGS than EUS‐FNB specimens, whereas EUS‐FNB was more suitable for IHC‐based biomarker testing. Samples acquired via either endoscopic ultrasound–guided fine‐needle aspiration or endoscopic ultrasound–guided fine‐needle biopsy are suitable for next‐generation sequencing testing, whereas endoscopic ultrasound–guided fine‐needle biopsy could provide material for immunohistochemistry‐based biomarker testing. [ABSTRACT FROM AUTHOR]

Hemodiafiltration (HDF) is not associated with lower mortality risk compared to standard hemodialysis (HD). However, there are many critical clinical outcomes in dialysis patients in addition to mortality; the impact of HDF on these other outcomes is not clear. This retrospective study included all patients referred to DaVita Clinics in the Kingdom of Saudi Arabia. High‐flux HD was the initial modality in all patients. Those who did not achieve adequacy targets or those with poorly controlled phosphorus were switched to postdilution HDF using 18 to 23 L exchange per treatment. Patients dialyzing with a central venous catheter, patients who dialyzed less than 90 days at DaVita, and those with interrupted HDF were excluded. Of the 1115 patients, 215 (19%) were on HDF and 900 on high‐flux HD; the median follow‐up was 6 months for all patients. The HDF group showed a significant reduction in serum phosphate (P <.001), a significant increase in serum calcium (P <.012) and a significant improvement in Kt/V (P <.0001). The HDF group had significantly higher hemoglobin levels than the HD group (P =.024), with a significant reduction in weekly erythropoiesis‐stimulating agent dose after starting HDF (P <.001). A modified protocol that included prolonged dialysis duration, larger‐sized dialyzer, faster blood flow rates, and adding hemofiltration fluid may be helpful in achieving the recommended targets. Thus, HDF can enable the achievement of adequate dialysis care in some patients. Randomized‐controlled clinical trials are necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: Fine needle aspiration cytology (FNAC) is a well‐established diagnostic procedure for head and neck masses not clearly originating from mucosal or cutaneous surfaces. We analysed head and neck masses evaluated over a 2‐year period, to assess the reliability of FNAC for the evaluation of malignancy. Methods: We enrolled all patients undergoing FNAC, from April 2013 to July 2015, in a single service of a large Italian university hospital. Relevant clinical data and ultrasonographic parameters of the lesions were recorded. We performed both conventional and thin‐prep smears. Clinical presentation, ultrasonographic features and final cytology diagnoses were analysed and correlated with histology. Results: The series included 301 lesions in 285 patients, with a single (94.4%) or two (5.6%) lesions. Only eight samples were considered non‐diagnostic/inadequate (2.6%). Among the cases, 139 FNAC (46.1%) underwent surgery. Cytological‐histological correspondence was found in 89% of the cases. Concerning malignancy, we documented less than 4% false positives and less than 2.5% false negatives, with 92.7% sensitivity and 94.6% specificity. Conclusion: FNAC diagnosis can be highly specific. Most importantly, it is highly reliable in assessing malignancy, thus defining the priority and guiding the management procedures. Fine needle aspiration cytology for non‐thyroid head and neck masses, when performed with ultrasound guidance and rapid on‐site evaluation, offers a high reliability in preliminarily assessing malignancy. Ultrasound‐guided fine needle aspiration cytology is a powerful tool in the hands of clinicians to determine the priority and guide further diagnostic work‐up. [ABSTRACT FROM AUTHOR]

Calcium intake is low in many countries, especially in low‐income countries. Our objective was to perform a simulation exercise on the impact, effectiveness, and safety of a flour fortification strategy using the Intake Modelling, Assessment, and Planning Program. Modeling of calcium fortification scenarios was performed with available dietary intake databases from Argentina, Bangladesh, Italy, the Lao People's Democratic Republic (Lao PDR), Uganda, Zambia, and the United States. This theoretical exercise showed that simulating a fortification with 156 mg of calcium per 100 g of flour would decrease the prevalence of low calcium intake, and less than 2% of the individuals would exceed the recommended calcium upper limit (UL) in Argentina, Italy, Uganda, and Zambia. Bangladesh and the Lao PDR showed little impact, as flour intake is uncommon. By contrast, in the United States, this strategy would lead to some population groups exceeding the UL. This exercise should be replicated and adapted to each country, taking into account the updated prevalence of calcium inadequacy, flour consumption, and technical compatibility between calcium and the flour‐type candidate for fortification. A fortification plan should consider the impact on all age groups to avoid the risk of exceeding the upper levels of calcium intake. [ABSTRACT FROM AUTHOR]

The expansion and transformation over time of dialysis therapies have been inexorably linked to the concept of adequacy. While initially the goal of dialysis was simple survival of patients until their next treatment, this changed with the publication of the National Cooperative Dialysis Study. It brought about a focus on defining adequate dialysis through measurements of the removal of small solutes, in particular urea. This spurred significant improvements in patient outcomes by standardizing therapy and providing benchmarks for each center to achieve. Over time, however, further research has found this narrow definition of adequacy to be insufficient to encompass the complexities of dialysis therapies. Factors such as residual kidney function (RKF), nutritional and volume status, and cardiovascular control all contribute to the outcomes for dialysis patients. We propose that an optimal definition of adequacy should not only focus on one factor but rather the interconnection and contribution to our patient's individual specific goals and their overall quality of life. [ABSTRACT FROM AUTHOR]

Background: Uveal melanoma is highly aggressive, and overall prognosis depends on mutation status. Fine‐needle aspiration biopsies (FNABs) play an important role in obtaining fresh tissue for cytologic diagnosis and molecular studies. It has been suggested that, although FNAB usually provides high diagnostic accuracy, there may be limited cellularity, which may compromise diagnostic potential for molecular studies. FNABs of uveal melanocytic lesions were evaluated to assess sample adequacy for both cytologic evaluation and next‐generation sequencing (NGS). Methods: The authors retrospectively evaluated 36 cases of melanocytic uveal lesions from 2015 to 2018. Samples were obtained by ophthalmologist‐performed FNAB and aliquoted for cytology and NGS. Various combinations of direct smears, liquid‐based cytology slides, cell blocks, and immunohistochemical stains for melanocytic markers were performed. All samples were tested for molecular alterations using hybrid‐capture–based NGS. Results: There was sufficient material for cytologic diagnosis in 33 of 36 cases (92%), for NGS testing in 30 of 36 cases (83%), and for both cytologic diagnosis and NGS testing in 28 of 36 cases (78%). Of 7 cases that were cytologically categorized as indeterminate or diagnosed as "atypical" or "nondiagnostic," NGS testing was sufficient and diagnostic for melanoma in 5 cases. Of the cases diagnosed as melanoma on pathology, 20 cases (87%) had concordant NGS testing results, 2 lacked molecular alterations, and 1 was insufficient for testing. Conclusions: FNA sampling of melanocytic uveal lesions is adequate for both cytologic diagnosis and NGS testing. In a subset of cases in which pathologic findings were indeterminate, NGS testing results were clarifying for diagnosis. In addition, specific molecular alterations identified can aid in evaluating prognosis and guide further management. Fine‐needle aspiration sampling of melanocytic uveal lesions is adequate for both cytologic diagnosis and next‐generation sequence testing, and specific molecular alterations identified can guide further management. In a subset of cases with indeterminate pathologic findings, next‐generation sequencing results are clarifying for diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Arterial graft physiology influences the long-term outcome of coronary artery bypass grafting (CABG). We studied factors that can affect the overall resistance to flow using internal mammary artery grafting to the left anterior descending artery.Methods: This was a prospective, nonrandomized observational study of 100 consecutive patients who underwent elective on-pump isolated or combined valve surgery and CABG. Coronary stenoses were assessed using conventional and quantitative coronary angiography assessment. The flow and pulsatility index (PI) of the grafts were assessed by transit-time flowmetry during cardioplegic arrest and at the end of the operation. Fractional polynomials were used to explore linearity, followed by multivariable regression analysis.Results: Univariate analysis demonstrated higher flows at the end of the operation in patients who had higher flows with the cross-clamp on (P < .001), in males (P = .004), in patients with a low PI at the end of the operation (P = .04), and in patients with a larger size of the recipient artery (P = .005). Multivariable regression analysis showed that the graft flow at the end of the operation was significantly associated with the mean flow with the cross-clamp on (P < .001), sex (P = .003), and PI at the end of the operation (P = .003). Concomitant valve surgery did not influence flows. Male patients had 18 mL/min higher flow.Conclusions: The graft flow at the end of the operation can be determined by the flow with the cross-clamp on, the PI with the cross-clamp off and coronary artery. We reported differences in the graft flows between sexes, and for first the time, we introduced the concepts of "adequate flow" and "resistance-to-forward-flow" for patent coronary grafts. [ABSTRACT FROM AUTHOR]

The intake of fiber‐rich foods during pregnancy has several health benefits to the pregnant woman including lowering the risks of diabetes, preeclampsia, and constipation. However, little is known about the content, daily intake levels, and adequacy of fiber among pregnant women in many low‐income settings. We aimed to identify common food items and determine adequacy of dietary fiber intake levels among pregnant women in rural Ethiopia. Dietary data were collected from a subsample (n = 55) of pregnant women enrolled to a larger prospective cohort study (n = 414). Dietary intake level was measured using repeated 24‐hr dietary recall method and weighing the total amount of daily food. Fiber content was determined using the Weende method supplemented by other sources.The mean [±SD] dietary fiber intake level was 25.89 [±5.09 mg/g] per day, which declined across pregnancy trimester from 26.01 [±9.18 mg/g] to 22.67 [±9.01 mg/g] and 24.56 [±9.98 mg/g] during the first, to second and third pregnancy trimesters, respectively. Boiled cereals and coffee contributed to nearly two‐thirds (63.2%) of the daily fiber intake, while the major bulk of daily food, enjera, contributed to less than a quarter (24.3%) of the fiber intake. Though dietary patterns favor diversified intake for fiber, the mean intake levels below the recommended levels and proportion of women getting adequate to the physiologic stages of pregnancy were inadequate compared to the standard. Mothers, in such community, could benefit from increasing overall intake of existing food to satisfy their fiber needs during pregnancy. [ABSTRACT FROM AUTHOR]

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Background: Previous studies have suggested that urine cytology adequacy may be related to both specimen volume and cellularity. Methods: The authors reviewed cytospin preparations from 314 urine specimens (162 voided and 152 instrumented specimens) found to have high‐grade urothelial carcinoma on biopsy. Results: The sensitivity of instrumented urine cytology was significantly higher than that of voided cytology (82% vs 25%; P < .001). The cellularity (at least 30 urothelial cells/10 high‐power fields [HPF]) of instrumented urine specimens also was significantly higher than that of voided specimens (57% vs 9%; P < .001). The sensitivity of voided urine cytology with a cellularity of 20 to 39 cells per 10 HPF was significantly higher than that of cases with <20 cells per 10 HPF (77% vs 19%; P < .001). The sensitivity decreased with higher cellularity for both types of specimens. The sensitivity of voided cases with a volume of at least 30 mL was higher than that of cases with a volume <30 mL, but this was not statistically significant (31% vs 17%; P = .07). Conclusions: The sensitivity of voided urine cytology for high‐grade urothelial carcinoma is significantly associated with urothelial cellularity but not specimen volume. Both the cellularity and sensitivity of voided urine specimens are less than that of instrumented specimens. [ABSTRACT FROM AUTHOR]

This article uses a single male cohort microsimulation model to analyse the intra‐generational and distributional effects of a shift in Estonia from a defined benefit pay‐as‐you‐go (PAYG) pension system to a multi‐pillared system with a PAYG scheme with contribution‐based insurance components and a funded pension scheme. We contribute to the literature on microsimulation by showing how introducing contribution‐based insurance components and compulsory defined contribution (DC) schemes can increase pension inequality. Our results show that in the case of a high level of inequality in labour earnings and high long‐term unemployment rates, such as in Estonia, the introduction of a very strong link between contributions and future benefits leads to considerably higher inequality in pension incomes as measured by the Gini coefficient. Simulation results for Estonia suggest that inequality in old‐age pension incomes more than doubles when the reforms mature. In contrast, the inequality in replacement rates decreases. [ABSTRACT FROM AUTHOR]

For several decades, pension systems across the world have been undergoing reforms. The main reasons for this are demographic changes and increasing life expectancy. To make these reforms more effective and ensure that they are based on the best benchmarks, the European Union (EU) has introduced the Open Method of Coordination (OMC) in the field of pensions. This study investigates whether European pension systems have become more similar and convergent in terms of the three main objectives of the OMC: adequacy, sustainability, and modernization of pensions. Our methodology is based on multivariate statistical analysis, and employs synthetic indicators as well as agglomerative hierarchical clustering. We analyze 27 countries in the years 2005, 2010, and 2015. The article contributes to the existing literature on pension reforms through investigation of the convergence of EU pension systems in terms of the three OMC objectives, in order to evaluate the effectiveness of this public policy concept. Our approach differs from that generally found in the literature, especially in terms of the methodology employed. The results support the view that the OMC is not an effective means of making European pension systems more convergent and better in terms of adequacy, efficiency, and modernization. Any improvement in OMC performance in the field of pensions, even if observed, is not as significant as expected. [ABSTRACT FROM AUTHOR]

Hemodialysis for chronic renal failure was introduced and developed in Seattle, WA, in the 1960s. Using Kiil dialyzers, weekly dialysis time and frequency were established to be about 30 hours on 3 time weekly dialysis. This dialysis time and frequency was associated with 10% yearly mortality in the United States in 1970s. Later in 1970s, newer and more efficient dialyzers were developed and it was felt that dialysis time could be shortened. An additional incentive to shorten dialysis was felt to be lower cost and higher convenience. Additional support for shortening dialysis time was provided by a randomized prospective trial performed by National Cooperative Dialysis Study (NCDS). This study committed a Type II statistical error rejecting the time of dialysis as an important factor in determining the quality of dialysis. This study also provided the basis for the establishment of the Kt/Vurea index as a measure of dialysis adequacy. This index having been established in a sacrosanct randomized controlled trial (RCT), was readily accepted by the HD community, and led to shorter dialysis, and higher mortality in the United States. Kt/Vurea is a poor measure of dialysis quality because it combines three unrelated variables into a single formula. These variables influence the clinical status of the patient independent of each other. It is impossible to compensate short dialysis duration (t) with the increased clearance of urea (K), because the tolerance of ultrafiltration depends on the plasma‐refilling rate, which has nothing in common with urea clearance. Later, another RCT (the HEMO study) committed a Type III statistical error by asking the wrong research question, thus not yielding any valuable results. Fortunately, it did not lead to deterioration of dialysis outcomes in the United States. The third RCT in this field ("in‐center hemodialysis 6 times per week versus 3 times per week") did not bring forth any valuable results, but at least confirmed what was already known. The fourth such trial ("The effects of frequent nocturnal home hemodialysis") too did not show any positive results primarily due to significant subject recruitment issues leading to inappropriate selection of patients. Comparison of the value of peritoneal dialysis and HD in RCTs could not be completed because of recruitment problems. Randomized controlled trials have therefore failed to yield any meaningful information in the area of dose and or frequency of hemodialysis. [ABSTRACT FROM AUTHOR]

Objectives: To compare the adequacy of 23‐, 25‐, and 27‐gauge needles in the fine‐needle aspiration biopsy of thyroid nodules to develop guidelines for the collection of better specimens for cytologic diagnosis. Methods: This randomized prospective study included 156 consecutively enrolled patients with 156 nodules. Each nodule was aspirated with a needle of each size. The obtained specimens were analyzed independently by 2 cytopathologists, and adequacy rates were calculated. Results: In our investigation, there were no statistically significant differences among the adequacy rates achieved with 23‐, 25‐, and 27‐gauge needles (88.5%, 90.4%, and 89.7%, respectively; P > .05). The adequacy rates achieved with all 3 needle sizes in hyperechoic nodules were higher than those in hypoechoic samples (P < .05). Finally, no differences in adequacy for the different needle sizes were observed according to nodule size (P > .05). Conclusions: We conclude that fine‐needle aspiration biopsy with a 27‐gauge needle can aspirate an adequate specimen for cytopathologic diagnosis of thyroid nodules. The likelihood that inadequate materials will be obtained from hypoechoic nodules is higher than that for hyperechoic nodules. [ABSTRACT FROM AUTHOR]

Our understanding of the longitudinal relationship between generalized self-efficacy (GSE) and physical activity in children and youth is limited. The purpose of this study was to investigate the effect of GSE towards physical activity on sedentary behaviours and physical activity in school-aged children over time. A total of 2278 nine-year-old children (1120 girls and 1158 boys) were recruited at baseline and followed for seven waves of data collection from 2005 to 2008. All children completed questionnaires at each wave assessing their GSE (adequacy, predilection, and enjoyment), sedentary behaviours, free play, and organized activity. Mixed-effects models were used to estimate changes in physical activity and GSE within individuals over time, controlling for gender and motor ability. The results showed that participation in free play significantly increased over time, whereas organized activity significantly decreased over the same period. Children with high perceived adequacy and predilection had higher free play and organized activity participation relative to other children over time. However, the effect of perceived adequacy diminished over time, while the gaps between groups with different levels of predilection widened over time. While sedentary behaviours were lower over time in children with high predilection, these behaviours were consistently higher in children with high enjoyment. The differences in sedentary behaviours between groups increased over time for both predilection and enjoyment. This study highlights the importance of different components of GSE on physical activity participation. In addition, interventions targeting the enhancement of predilection may facilitate physical activity and reduce sedentary behaviours. [ABSTRACT FROM AUTHOR]

Abstract: The main objective of this article is to determine, based on internal data, replacement rates for a defined benefit pension system, with two aims: the adequacy of pensions – measured in terms of the expenditure of retirees – and the sustainability of the system. For this purpose two instruments are used: the internal rate of return, and techniques based on systems of notional accounts. These figures, derived from internal data, will serve, by comparison with the replacement rate of the system, to assess whether the system tends more towards adequacy or sustainability. The system studied is that of Spain. [ABSTRACT FROM AUTHOR]

Background: Recommendations regarding how many nodules to biopsy with thyroid fine-needle aspiration vary.Methods: The authors reviewed fine-needle aspiration specimens of 12,763 nodules from 10,506 patients and correlated them with the number of nodules biopsied.Results: Compared with patients in whom only a single nodule was biopsied, patients in whom multiple nodules were biopsied were found to be significantly younger, more likely female, and to have larger tumors, and those tumors were more often papillary (all P<.001). On fine-needle aspiration, patients who had multiple nodules biopsied were more often diagnosed with benign findings (P<.001), but usually had no significant difference in the risk of malignancy associated with any cytologic diagnosis. Performing biopsy in 3 nodules detected all carcinomas in the current series. Combining all cases in the literature demonstrated that performing only 3 biopsies in a patient with at least 4 suspicious nodules had a risk of malignancy of 1.2%.Conclusions: Biopsy of 3 different nodules in patients with multiple nodules appears to lower the risk of malignancy to that of a benign fine-needle aspiration specimen. Although exceptions can occur, cytologists may be able to improve the accuracy of their diagnoses by focusing predominantly on identifying papillary carcinoma after the first 2 nodules have been biopsied. Cancer Cytopathol 2017;125:848-53. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

In restructured power systems, the adequacy of the transmission network may be defined as the ability to meet reasonable demands by transmission of electricity (as stated by the Directive 2009/72/EC). The symmetric/constrained fuzzy power flow (CFPF) was recently proposed as a suitable tool to quantify that adequacy. In this paper, the use of the symmetric fuzzy power flow/CFPF is extended to support the decision process of investment in network components to accomplish a specific adequacy criteria. A technique based on dual variables, obtained from the linear formulation of the CFPF, is used. The importance of the duality information concerning the adequacy indices is explained. The proposed methodology is applied on IEEE 14 bus reliability test system to demonstrate its applicability. [ABSTRACT FROM AUTHOR]

Reportedly, citrate-based dialysis solution enables heparin dose tapering or even complete exclusion, particularly in postdilution hemodiafiltration (HDF). The aim of the study was to verify this strategy in predilution setting and to assess its short-term safety, efficacy, and biocompatibility. Ten regular hemodialysis patients were assigned to predilution HDF on acetate- and citrate-based dialysis solutions (0.8 mmol/l trisodium citrate) at random order. Acetate HDF was performed using routine dose of heparin while citrate HDF was heparin free. Plasma calcium, thrombin-antithrombin complexes (TAT), and citrate levels were measured at 0, 30, 60, 120, and 240 min. Following each session, a semiquantitative dialyzer clotting score (DCT 1-5) was assessed and HDF adequacy was determined as spKt/V. Statistical relevance was tested by ANOVA with p P < 0.05 held significant, data are given as means ± standard deviations. All sessions were accomplished successfully, premature termination or circuit re-setting was not necessary. However, DCT was significantly higher in citrate-HDF compared to acetate-HDF regimen (3.4 ± 0.65 and 1.8 ± 0.79, respectively, P = 0.002) as well as TAT generation rate (increase per session by factor 11.0 ± 8.43 and 2.1 ± 1.26, respectively, P = 0.004 between regimens). Ionized calcium declined only by the end of citrate-HDF (from 1.09 ± 0.086 to 0.99 ± 0.030 mmol/L, P = 0.002) yet without accompanying clinical symptoms. Systemic citrate levels increased along the citrate-HDF session but stayed an order of magnitude below concentrations needed to establish citrate anticoagulation (peak at 0.276 ± 0.112 mmol/L). Dialysis adequacy estimated by spKt/V was found lower in citrate-HDF vs. acetate-HDF (1.48 ± 0.163 and 1.58 ± 0.165, respectively, P = 0.006). Although predilution HDF using citrate-based dialysate is feasible without heparin, both dialysis adequacy and biocompatibility is significantly compromised. Therefore, this approach can be adopted for a single procedure but is not acceptable on a regular basis. [ABSTRACT FROM AUTHOR]

This article proposes a 'Swedish' type actuarial balance sheet (ABS) for a notional defined contribution (NDC) scheme with disability and minimum pension benefits. The proposed ABS splits the pension system in two parts: the pure NDC part and the redistributive part, which includes the assets and liabilities originating from non-contributory rights. The article contains a numerical example that sheds light on the real applicability of our proposal. The model has practical implications that could be of interest to policy-makers, given that it integrates actuarial and social aspects of public pensions and discloses the real cost of redistribution through minimum pensions. [ABSTRACT FROM AUTHOR]

Background: Adequacy criteria for thyroid fine-needle aspiration (FNA) recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBS) were developed with smears, but they are commonly applied to ThinPreps (TPs). This study evaluated adequacy in TPs at different diagnostic thresholds.Methods: All FNA procedures performed between 2010 and 2015 with matched surgical specimens were analyzed. Cell counts and cytological features were evaluated in all initially nondiagnostic (ND) cases. ND cases were reclassified into TBS categories by 2 pathologists, and the results were compared with surgical outcomes.Results: One hundred forty-six of the 151 cases initially classified as ND were available for review, and they had a mean cell count of 60.5 (standard deviation, 71.4). Interobserver agreement on the reclassification of ND cases was moderate (k = 0.57), and consensus yielded 48 ND cases (33%), 72 benign cases (49%), 24 cases of atypia of undetermined significance (16%), and 2 cases suspicious for malignancy (1%). Lowering the diagnostic threshold to any follicular cells yielded a sensitivity of 92%, a specificity of 60%, a positive predictive value of 59%, a negative predictive value of 92%, and a false-negative rate of 7.7%, whereas the values for the initially diagnostic cases were 93%, 58%, 59%, 93%, and 7.7%, respectively. Including cases with >60 cells but lacking 6 groups containing at least 10 cells did not affect test performance. Nuclear enlargement, pallor, grooves, and the presence of histiocytoid cells in initially ND FNA correlated with malignancy.Conclusions: In thyroid FNA examined with TP only, lowering the adequacy threshold and eliminating the requirement of 6 groups of at least 10 cells did not significantly affect test performance if cytological features associated with malignancy were absent. Cancer Cytopathol 2017;125:534-43. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

The use of minimally invasive procedures for diagnosis and treatment decisions means that very often cytological samples are the only material available for testing. Cytology has evolved from a strictly morphological approach to the routine use of immunohistochemistry. The advent of personalized medicine has increased the demand for molecular testing, making rapid on-site evaluation even more relevant. This article presents current rapid on-site evaluation practice patterns in different settings, with a special focus on the variety of professionals involved. Technological advances such as telepathology can help to alleviate distance constraints. This article also provides an overview of telecytopathology, describing challenges to its implementation and how to address them. Issues such as hardware, personnel training, communication, guidelines, validation, use, and future directions are highlighted. Cancer Cytopathol 2017;125(6 suppl):449-54. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

This article evaluates the pension policy pathways of the 11 former state socialist nations that have joined the European Union since 2004. Focusing primarily on the post-2004 period, the analysis discusses the most important measurable outcomes of these countries' pension reforms, in terms of poverty alleviation, pension adequacy and fiscal sustainability. Going beyond the quantifiable concepts, we also investigate the quality of the 11 countries' pension systems in terms of equity as well as efficiency, emphasizing the less conspicuous design errors present in these systems. Although these errors have received little attention to date, they may harm pension schemes along several dimensions, including their fiscal sustainability. [ABSTRACT FROM AUTHOR]

The article talks about the designs of marine protected areas, and mentions about movement patterns of coral reef fishes. Topics discussed include using of guidelines for improving the efficacy of an existing protected area network, achieving objectives for biodiversity conservation and fisheries management; and using variety of empirical methods such as acoustic telemetry, satellite tracking or underwater observations.

High-volume online hemodiafiltration (OL-HDF) has been associated with improved patient survival compared to conventional hemodialysis in recent trials, where the importance of convective volume (CV) in this benefit is noted. The purpose of this study was to determine the corporal composition parameters influencing the efficacy of CV in the removal of different molecular weight (MW) molecules. Demographic data, corporal composition parameters with bioimpedance spectroscopy, dialysis features and the reduction rates of different MW molecules in a four-hour OL-HDF session were collected in 61 patients. We observed a significant negative correlation of β2-microglobulin, cystatin-C, myoglobin and prolactin reduction rates with body surface area, weight, total body extracellular (ECW) and intracellular water (ICW), lean tissue mass and body cellular mass. The multivariable regression analysis identified ECW and ICW as the only corporal composition factors independently associated to the relative elimination of β2-microglobulin (Beta: -0.801 , P = 0.002 for ECW and Beta: -1.710 , P = 0.001 for ICW), cystatin-C (Beta: -0.656 , P = 0.010 for ECW and Beta: -1.511 , P = 0.004 for ICW) and myoglobin (Beta: -0.745 , P = 0.014 for ECW and Beta: -2.103 , P = 0.001 for ICW), in addition to CV. Prolactin reduction was only associated with ICW (Beta: -1.540 , P = 0.028). When adjusting CV with ECW and ICW, only the ratio CV/ECW was an independent predictor for higher elimination of β2-microglobulin, cystatin-C and myoglobin. The corporal composition parameters independently associated to the reduction of medium-sized molecules are the extracellular and intracellular water. The ratio 'convective volume/extracellular water' predicts higher efficacy of convective transport. Adjusting the convective volume to patient features could be useful to monitor the efficacy of OL-HDF and to prescribe individualized therapies. [ABSTRACT FROM AUTHOR]

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BACKGROUND Adequacy assessment for fine-needle aspiration procedures is a standard of care in large medical centers. Although the benefits of this approach include higher adequacy rates with fewer passes, it costs cytopathologist time and affects other clinical responsibilities. The objective of the current study was to evaluate the use of mobile video streaming (FaceTime) technology with the help of smartphone adapters attached to microscopes for remote adequacy assessment of cytologic samples. METHODS The study consisted of 2 phases: Phase 1 was a retrospective assessment of 25 samples by a primary pathologist with simultaneous streaming to a second pathologist using a smartphone (iPhone/iPad) FaceTime connection. Data on the adequacy of each sample and preliminary diagnoses were recorded. In phase 2, live cases were assessed prospectively by an onsite primary pathologist and by a remote pathologist using an iPhone/iPad-FaceTime connection. The testing phase involved prospective assessment of additional samples with a resident or cytotechnologist as the slide driver. RESULTS In phase 1, retrospective evaluation of 25 samples yielded considerable agreement (22 of 25 samples; 88%) between onsite and remote adequacy assessments. Three samples (12%) yielded results that did not agree, including 2 samples that were read as adequate in the onsite evaluation that were assessed as indeterminate using FaceTime. In phase 2 and in the testing phase, 14 samples exhibited considerable agreement on both adequacy and preliminary diagnosis (6 samples in phase 2 and 8 samples in the testing phase) and are currently available for reporting. Problems encountered include software version standardization, camera alignment, and (rarely) comprehension of the audio stream. CONCLUSIONS The current data indicate that iPhone/iPad FaceTime technology can be used to perform remote adequacy assessments of fine-needle aspirations and can help save valuable time for pathologists. Cancer Cytopathol 2016;124:213-220. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

This paper extends the symmetric/constrained fuzzy power flow models by including the potential correlations between nodal injections. Therefore, the extension of the model allows the specification of fuzzy generation and load values and of potential correlations between nodal injections. The enhanced version of the symmetric/constrained fuzzy power flow model is applied to the 30-bus IEEE test system. The results prove the importance of the inclusion of data correlations in the analysis of transmission system adequacy. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In this article the adequacy of social insurance benefits is addressed from the perspective of eight fundamental goals of social insurance. With respect to these goals, the legislated level of the benefit and other conditions represent tools to achieve adequate levels of benefits vis-à-vis contributory effort. The goals address income risks of various sorts: (i) income compensation; (ii) securing a decent standard of living; (iii) universality, implying simplicity and a high takeup of social rights; (iv) reducing income risk deriving from physical incapacity; (v) safeguarding insurability by balancing the expected payoff to the insured and the value of the contributions paid over the lifetime; (vi) intergenerational equity; (vii) containing work and savings disincentives; and (viii) risk reduction (prevention). A simple model serves to clarify what is needed to achieve benefit adequacy together with insurability and contribution adequacy. An example of income support in working age, based on Israeli data, illustrates the use of specific instruments to achieve a decent standard of living while containing economic disincentives. The example stresses the importance of synchronizing efforts with institutions outside the social insurance system. [ABSTRACT FROM AUTHOR]

BACKGROUND There is no widely accepted rapid on-site evaluation (ROSE) reporting system for endobronchial ultrasound-guided transbronchial needle aspiration. At the University of Arkansas for Medical Sciences, ROSE reporting was unstructured. The goal was to evaluate, compare, and improve upon 2 structured approaches proposed in the literature. METHODS One hundred eighteen consecutive nodal aspirates were retrospectively reviewed by a pathology resident and a staff cytopathologist, both of whom were blinded to the original unstructured readings. Each reviewer interpreted every specimen with 2 different structured criteria proposed in the literature: criteria from the University of Minnesota (the Minnesota [MN] criteria) and criteria from the North Shore Long Island Jewish Health System (the New York [NY] criteria). The data allowed a comparison of the original unstructured ROSE system with the MN and NY scoring schemes and the final diagnosis. RESULTS Original on-site adequacy (OSA) had been assessed at 96%. Three cases were false-adequate according to the original unstructured approach; these had been called adequate on site, but a subsequent slide review including cell blocks did not show definite nodal tissue. OSA dropped to 86% with the MN criteria and to 85% with the NY criteria. No false-adequate on-site diagnoses would have been rendered with the application of either structured criteria. There were no significant differences between the MN and NY criteria with respect to the determination of OSA. An assessment of ease of application favored the NY criteria. With respect to diagnostic categories, each of the systems (MN and NY) was felt to have a category of value not used by the other system. CONCLUSIONS A standardized intra- and inter-institutional system for ROSE reporting is needed. On the basis of comparative analyses and consensus, modifications to prior criteria have been proposed in the hope of approaching this goal. Cancer (Cancer Cytopathol) 2015;123:362-72. © 2015 American Cancer Society [ABSTRACT FROM AUTHOR]

Guidelines have recommended single pool Kt/ V > 1.2 as the minimum dose for chronic hemodialysis ( HD) patients on thrice weekly HD. The Dialysis Outcomes and Practice Patterns Study ( DOPPS) has shown that 'low Kt/ V' (<1.2) is more prevalent in Japan than many other countries, though survival is longer in Japan. We examined trends in low Kt/ V, dialysis practices associated with low Kt/ V, and associations between Kt/ V and mortality overall and by gender in Japanese dialysis patients. We analyzed 5784 HD patients from Japan DOPPS (1999-2011), restricted to patients dialyzing for >1 year and receiving thrice weekly dialysis. Logistic regression models estimated the relationships of patient characteristics with Kt/ V. Logistic models also were used to estimate the proportion of low Kt/ V cases attributable to various treatment practices. Multivariable Cox regression was used to estimate the associations of low Kt/ V, blood flow rate ( BFR), and treatment time ( TT), with all-cause mortality. From 1999 to 2009, the prevalence of low Kt/ V declined in men (37-27%) and women (15-10%). BFR <200 mL/min, TT <240 minutes, and dialyzate flow rate ( DFR) < 500 mL/min were common (35, 13, and 19% of patients, respectively) and strongly associated with low Kt/ V. Fifteen percent of low Kt/ V cases were attributable to BFR <200 and 13% to TT <240, compared to only 3% for DFR <500. Lower Kt/ V was associated with elevated mortality, more so among women (hazard ratio [ HR] = 1.13 per 0.1 lower Kt/ V, 95% CI: 1.07-1.20) than among men ( HR = 1.06 per 0.1 lower Kt/ V, 95% CI: 1.00-1.12). The relatively large proportion of low Kt/ V cases in Japanese facilities may potentially be reduced 30% by increasing BFR to 200 mL/min and TT to 4 hours thrice weekly in HD patients. Associations of low Kt/ V with elevated mortality suggest that modification of these practices may further improve survival for Japanese HD patients. [ABSTRACT FROM AUTHOR]

SUMMARY Background The National Kidney Foundation-Dialysis Outcomes Quality Initiative (KDOQI) guidelines and the Renal Association recommend the use of either Kt/V or urea reduction ratio (URR) to measure haemodialysis adequacy. Objectives To determine the methods used to measure paediatric haemodialysis adequacy and to assess consistency between calculations of single pool Kt/V (spKt/V) and URR. Design A service evaluation was conducted to establish current practices in measuring dialysis adequacy. A prospective longitudinal study was conducted to compare spKt/V and URR. Participants Thirty-two children were recruited consisting of 13 males and 19 females in five paediatric dialysis centres. Results Inconsistencies were reported of the method of post-urea sampling with 4 of the 10 centres using the KDOQI recommended sampling method. Five dialysis centres reported using URR and five reported using spKt/V. There were substantial differences between the two measures. Using URR suggested that up to 44% of children did not receive adequate dialysis, whereas measurement by spKt/V suggested no more than 6% of the same dialysis sessions were not adequate. Conclusion One standard measure should be used to assess dialysis adequacy in paediatric centres in England. KDOQI guidelines were not consistently followed in obtaining a post-urea blood sample and this procedure should be standardised. [ABSTRACT FROM AUTHOR]

A. G. Siebers, J. A. W. M. van der Laak, R. Huberts-Manders, J. E. M. Vedder and J. Bulten Accurate assessment of cell density in low cellular liquid-based cervical cytology Objective: Scant cellularity is the most important source of unsatisfactory liquid-based cytology. Although still being debated, low cellularity is thought to compromise the detection of squamous lesions. Thus, reliable assessment of cellularity is essential. The aim of the present study was to determine the cellularity range for ThinPrep® slides of low cellularity and to establish the most accurate cell-counting protocol. Methods: A series of 60 ThinPrep cases representing the full spectrum of adequate, 'satisfactory but limited by' (SBLB) and unsatisfactory reports were included. Two cell-counting protocols with three different magnifications, using ×10, ×20 and ×40 objectives, were evaluated and related to the true cellularity, together with a reassessment of the degree of adequacy originally reported. The cell-counting protocol that showed the highest correlation coefficient was considered the most accurate. Results: Based on seven (re)assessments a majority score for adequacy was established. There were 42 cases with a majority score 'unsatisfactory' or 'SBLB' (low cellularity) of which 41 contained fewer than 20 000 squamous cells; and 18 cases with a majority score 'satisfactory' of which one had fewer than 20 000 cells. The cell-counting protocol that showed the significantly highest correlation with the reference standard was the Stichting Kwaliteitsbewaking Medische Laboratoriumdiagnostiek (SKML) protocol with a ×10 objective. Conclusions: ThinPrep slides reported as unsatisfactory or SBLB were shown to contain fewer than 20 000 squamous cells. The most accurate protocol for estimating the cellularity of these slides was cell counting in five non-adjacent microscope fields along the horizontal axis and five along the vertical axis of the slide with a ×10 objective and applying a correction factor of 1.24× to correct for underestimation of the true cellularity. [ABSTRACT FROM AUTHOR]

Aim Percutaneous renal biopsy ( PRB) remains the gold standard for the diagnosis of renal disease; however, the tissue yield which relates to the optimal needle size used for native-kidney biopsies has not been clearly established. Our study compares the sample adequacy and complication rates using 16 gauge ( G) and 18 gauge ( G) automatic needles on native kidney PRB. Methods A retrospective analysis was performed of native-kidney biopsies at two centres, one exclusively using 16 G and the other exclusively using 18 G needles. All samples were assessed by a single centralized pathology service. We compared patient characteristics, indications, diagnoses, adequacy of tissue samples, and complications. Results A total of 934 native-kidney biopsies were performed with real time ultrasound guidance: 753 with Bard Max Core 16 G × 16 cm needles, and 181 with Bard Magnum 18 G × 20 cm needles. The median (range) of total glomeruli count per biopsy was higher in the 16 G group compared with the 18 G group (19 (0-66) vs 12 (0-35), P < 0.001), despite having fewer cores per biopsy (2 (0-4) vs 3 (1-4), P < 0.001). The 16 G group provided a greater proportion of adequate biopsy samples (94.7% vs 89.4%, P = 0.001). There was no significant difference in the frequency of total complications between the 16 G and 18 G groups (3.7% vs 2.2%, P = 0.49). Conclusion This retrospective study demonstrates 16 G needles provide more glomeruli, more diagnostically adequate renal tissue, with fewer cores without a significant increase in complications compared with 18 G needles. Based on these observations, 16 G needles should be considered as the first line option in native-kidney PRB. [ABSTRACT FROM AUTHOR]

The adoption of the International Labour Organization Recommendation concerning national floors of social protection, 2012 ( No. 202) highlights the global importance of the extension of social security coverage. To maximize the positive impacts of coverage extension, not only should benefits and services be provided to the widest number of people and cover the greatest number of risks, but benefits have to be adequate. Whilst not without challenges, the level of coverage can be defined and measured. However, the definition of what is an adequate benefit is often less clear and has often relied on the use of one measure - the replacement ratio - to determine the relative adequacy of cash benefits. Given the multiple aims of social security systems, the use of a broader measure of adequacy that goes beyond cash benefit levels is not only more appropriate but necessary. In a context where financial constraints are arguably greater than ever, this article looks at the importance of adequacy and why such a broader consideration is required to measure the other aspects of benefit and service provision. It highlights how such a multivariable analysis could be constructed and the challenges of doing so. By attempting to measure if other goals of benefit provision are met - including quality of service, labour market aims, security of benefits and interaction with other stakeholders - the article seeks to contribute to widening the debate. [ABSTRACT FROM AUTHOR]

Figari F, Matsaganis M, Sutherland H. Are European social safety nets tight enough? Coverage and adequacy of Minimum Income schemes in 14 EU countries This study explored and compared the effectiveness of Minimum Income (MI) schemes for persons of working age in the European Union (EU). Using the European microsimulation model EUROMOD, we estimated indicators of coverage and adequacy of MI schemes in 14 EU countries. In terms of coverage, we found that in several countries, some individuals are ineligible for MI even when they fall below a poverty line set at 40 per cent of median income. With respect to adequacy, we show that in certain countries, a large fraction of those entitled to MI remain at very low levels of income even when MI benefit is added. Overall, our findings suggest that MI schemes in Europe remain divergent, and that their clustering may be more complex than has hitherto been allowed for. Key Practitioner Message:• The ability of European welfare states to fight poverty is a key policy question, especially at times of crisis;• Adequacy and coverage of Minimum Income schemes are crucial aspects of the answer;• Microsimulation allows us to separate the effectiveness of MI schemes 'by design', from issues of benefit administration, targeting errors and so forth. [ABSTRACT FROM AUTHOR]

Aim Recent efforts to apply the principles of systematic conservation planning to freshwater ecosystems have focused on the special connected nature of these systems as a way to ensure adequacy (long-term maintenance of biodiversity). Connectivity is important in maintaining biodiversity and key ecological processes in freshwater environments and is of special relevance for conservation planning in these systems. However, freshwater conservation planning has focused on longitudinal connectivity requirements within riverine ecosystems, while other habitats, such as floodplain wetlands or lakes and connections among them, have been overlooked. Here, we address this gap by incorporating a new component of connectivity in addition to the traditional longitudinal measure. Location Northern Australia. Methods We integrate lateral connections between freshwater areas (e.g. lakes and wetlands) that are not directly connected by the river network and the longitudinal upstream-downstream connections. We demonstrate how this can be used to incorporate ecological requirements of some water-dependent taxa that can move across drainage divides, such as waterbirds. Results When applied together, the different connectivity rules allow the identification of priority areas that contain whole lakes or wetlands, their closest neighbours whenever possible, and the upstream/downstream reaches of rivers that flow into or from them. This would facilitate longitudinal and lateral movements of biota while minimizing the influence of disturbances potentially received from upstream or downstream reaches. Main conclusions This new approach to defining and applying different connectivity rules can help improve the adequacy of freshwater-protected areas by enhancing movements of biodiversity within priority areas. The integration of multiple connectivity needs can also serve as a bridge to integrate freshwater and terrestrial conservation planning. [ABSTRACT FROM AUTHOR]

The acquisition or designation of new protected areas is usually based on criteria for representation of different ecosystems or land-cover classes, and it is unclear how well- threatened species are conserved within protected-area networks. Here, we assessed how Australia's terrestrial protected-area system (89 million ha, 11. 6% of the continent) overlaps with the geographic distributions of threatened species and compared this overlap against a model that randomly placed protected areas across the continent and a spatially efficient model that placed protected areas across the continent to maximize threatened species' representation within the protected-area estate. We defined the minimum area needed to conserve each species on the basis of the species' range size. We found that although the current configuration of protected areas met targets for representation of a given percentage of species' ranges better than a random selection of areas, 166 (12. 6%) threatened species occurred entirely outside protected areas and target levels of protection were met for only 259 (19. 6%) species. Critically endangered species were among those with the least protection; 12 (21. 1%) species occurred entirely outside protected areas. Reptiles and plants were the most poorly represented taxonomic groups, and amphibians the best represented. Spatial prioritization analyses revealed that an efficient protected-area system of the same size as the current protected-area system (11. 6% of the area of Australia) could meet representation targets for 1272 (93. 3%) threatened species. Moreover, the results of these prioritization analyses showed that by protecting 17. 8% of Australia, all threatened species could reach target levels of representation, assuming all current protected areas are retained. Although this amount of area theoretically could be protected, existing land uses and the finite resources available for conservation mean land acquisition may not be possible or even effective for the recovery of threatened species. The optimal use of resources must balance acquisition of new protected areas, where processes that threaten native species are mitigated by the change in ownership or on-ground management jurisdiction, and management of threatened species inside and outside the existing protected-area system. [ABSTRACT FROM AUTHOR]

Nelson K. Social assistance and minimum income benefits in old and new EU democracies Int J Soc Welfare 2010: 19: 367–378 © 2009 The Author, Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. In this article, social assistance developments are analysed in a large number of European Union (EU) member states, including European transition countries and the new democracies of southern Europe. The empirical analysis is based on the unique and recently established SaMip Dataset, which provides social assistance benefit levels for 27 countries from 1990 to 2005. It is shown that social assistance benefits have had a less favourable development than that of unemployment provision. Hardly any of the investigated countries provide social assistance benefits above the EU near-poverty threshold. Social assistance benefit levels have not converged in Europe. Instead, divergence can be observed, which is due mainly to lagging developments in eastern and southern Europe. [ABSTRACT FROM AUTHOR]

The article explores the incorporation of ecological and evolutionary processes into conservation planning assessments in Australia. It discusses how biodiversity is generated by a number of ecological and evolutionary processes. It focuses on the novel incorporation of processes with traditional framework of a comprehensive sample of biodiversity to identify spatial priorities. It is stated that priority areas that considered ecological and evolutionary processes were more connected along vegetated waterways.

The basics of targeting, writing, adjusting, and monitoring a hemodialysis prescription are reviewed for patients being dialyzed 3 or 4 times a week. K/DOQI 2006 adequacy guidelines and practice recommendations are reviewed, and a practical method using a variety of nomograms is suggested to monitor and adjust the desired level of Kt/V. [ABSTRACT FROM AUTHOR]

Objective: Large loop excision of the transformation zone (LLETZ) has become standard of care in the management of cervical squamous neoplasia and with cone biopsy glandular intraepithelial neoplasia. Controversy remains about the long-term effects of this traumatic procedure. The aim of this study was to count and compare the number of endocervical glandular cell groups in pre- and post-LLETZ cervical preparations using liquid-based cytology to establish a cyto-morphological correlate of destruction of the transformation zone. Methods: The cytology/histology correlation audit records of the Cytopathology Department of St Luke’s Hospital in 2003 and early 2004 were used to select patients with a cytological diagnosis of high grade dyskaryosis followed by LLETZ. Only those cases with post-LLETZ cytological follow-up were selected. Cases using conventional smears were excluded. One hundred and twenty slides (60 pairs of slides) in total were retrieved. The cases underwent review and all groups of >3 glandular cells in each slide were counted by AM while blinded as to whether smears were pre- or post-LLETZ. Medians were compared using a Mann–Whitney U-test. Results: The median number of groups of endocervical glandular cells of the pre-treatment group was 5.5 and of the post-treatment group was 2.0. There were significantly fewer endocervical glandular cell groups in the post-LLETZ population ( P = 0.03). Conclusions: The number of endocervical glandular groups in cervical cytological preparations decreases significantly following LLETZ procedure. This suggests that cytological follow-up may not be as useful in glandular neoplasia cases. Few or absent glandular cell groups in post-LLETZ preparations may have implications for adequacy assessment. [ABSTRACT FROM AUTHOR]

Hemodialysis is accepted as standard therapy for end-stage renal failure but despite four decades of experience the morbidity and mortality associated with the treatment remains unacceptably high. Quality of dialysis is traditionally measured with reference to urea clearance but it is becoming increasingly apparent that other solutes across the range of molecular size are also important. More prolonged or more frequent therapy may improve dialysis delivery and enhance survival in patients with end-stage renal disease. [ABSTRACT FROM AUTHOR]