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Background/aims: Despite evidence that preferential use of balanced/buffered fluids may improve outcomes compared with chloride-rich 0.9% saline, saline remains the most commonly used fluid for children with septic shock. We aim to determine if resuscitation with balanced/buffered fluids as part of usual care will improve outcomes, in part through reduced kidney injury and without an increase in adverse effects, compared to 0.9% saline for children with septic shock.Methods: The Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis (PRoMPT BOLUS) study is an international, open-label pragmatic interventional trial being conducted at > 40 sites in the USA, Canada, and Australia/New Zealand starting on August 25, 2020, and continuing for 5 years. Children > 6 months to < 18 years treated for suspected septic shock with abnormal perfusion in an emergency department will be randomized to receive either balanced/buffered crystalloids (intervention) or 0.9% saline (control) for initial resuscitation and maintenance fluids for up to 48 h. Eligible patients are enrolled and randomized using serially numbered, opaque envelopes concurrent with clinical care. Given the life-threatening nature of septic shock and narrow therapeutic window to start fluid resuscitation, patients may be enrolled under "exception from informed consent" in the USA or "deferred consent" in Canada and Australia/New Zealand. Other than fluid type, all decisions about timing, volume, and rate of fluid administration remain at the discretion of the treating clinicians. For pragmatic reasons, clinicians will not be blinded to study fluid type. Anticipated enrollment is 8800 patients. The primary outcome will be major adverse kidney events within 30 days (MAKE30), a composite of death, renal replacement therapy, and persistent kidney dysfunction. Additional effectiveness, safety, and biologic outcomes will also be analyzed.Discussion: PRoMPT BOLUS will provide high-quality evidence for the comparative effectiveness of buffered/balanced crystalloids versus 0.9% saline for the initial fluid management of children with suspected septic shock in emergency settings.Trial Registration: PRoMPT BOLUS was first registered at ClinicalTrials.gov ( NCT04102371 ) on September 25, 2019. Enrollment started on August 25, 2020. [ABSTRACT FROM AUTHOR]

• A generic framework is proposed for classifying freshwater and saline lake typology. • The framework leverages hydroclimate, remote sensing, and literature evidence. • The method is largely based on open-access data requiring no additional field measures. • Lake typology results in the Tibetan Plateau and Australia show promising accuracies. • The framework demonstrates potential for performing a global-scale lake classification. Separating saline and freshwater lakes is of immense importance for monitoring lentic ecosystems and assessing surface freshwater availability. However, conventional lake typology often relies on in situ salinity measurements, thus limiting the feasibility of a global application. To enable an effective workaround, we here propose and test a framework that classifies saline and freshwater lakes through systematic, integrated leveraging of hydrological, climatological, spectral, and literature evidence. In principle, saline lakes were sequentially identified if a lake is (1) located at the drainage terminal where salinity tends to build up as a result of lacking surface outflow (hydrological evidence), (2) distributed in an arid/semiarid climate with lacustrine evaporites visible from a high-resolution multispectral image (climatological and spectral evidence), or (3) documented to be (sub)saline or have measured salinity exceeding the maximum freshwater threshold (literature evidence). We applied the HydroSHEDS hydrography dataset, the Köppen-Geiger climate classification, and a large volume of spectral satellite images and literature to implement this framework. This framework was tested on the Tibetan Plateau using the Landsat-based, 30-m-resolution UCLA Circa-2015 global lake mask, and the result was benchmarked against the Chinese national lake survey. Our collected literature shows a 95% agreement between the lake types classified using hydrological, climatological, and spectral evidence alone and those documented in the literature. After further corrections based on the literature evidence, our final classification reached an overall accuracy of nearly 70% in terms of lake count and 94% in lake area, implying that the efficacy of our method tends to favor relatively large lakes. Given such promising accuracies, we further applied our framework to Australia, showcasing its effectiveness for lake typology classification without additional in situ surveys across the world's most saline continent. While our method, in theory, results in a conservative recognition of saline lakes and should not be considered a complete substitute for in situ surveys, the proposed framework demonstrates potential for performing global-scale freshwater and saline lake typology classification with reasonable accuracies, using only remote sensing images, open-source hydrography and climate data, and existing literature. [ABSTRACT FROM AUTHOR]

The article investigates the effects of chloride-rich intravenous fluid restriction on critically ill patients. Results show that after the intervention, severe metabolic acidosis and severe acidemia incidence decreased, but it also led to increased incidence of severe metabolic alkalosis and alkalemia. Data from a tertiary intensive care in Australia reveal that restricting chloride-rich fluids affects electrolyte and acid-base status and the choice of fluids modulates acid-base status.

In the arid regions of Australia, fine-grained slurried wastes produced during gold mining are typically disposed of in large storages using subaerial deposition. Management of the storage is often aimed at maximising the evaporative drying that occurs, thereby maximising the density achieved. Ore processing is conducted using groundwater that can have salinities that approach solution saturation. Precipitation of salts on the tailings surfaces during evaporation leads to the development of thin salt crusts that can significantly reduce the rate of evaporation. Quantification of the actual rate of evaporation from the drying tailings surfaces is important for assessing disposal strategies. Different methods of estimating evaporation were employed at mine sites in Western Australia (WA) to provide more information on the drying behaviour of saline tailings. These techniques are described and typical results from a saline tailings storage are presented. [Copyright &y& Elsevier]

This article describes models which can consider the interactions between plants, soils, water, irrigation practices, crop yields, and economics under shallow, saline groundwater conditions. Personal computing capability has now made it possible to develop a range of interactive modeling tools based on existing and new biophysical concepts. In view of the large number of available models, it is not possible to cover all modeling efforts in a single article. Hence, the discussion in this article is limited to farm and irrigation area scale salt, water, and groundwater management models. It provides an introduction to the SWAGMAN suite of models that have been used in Australia to determine sustainable cropping patterns under shallow, saline water table conditions. Salient features and applications of a detailed process based model (SWAGMAN Destiny), a lumped hydrologic economic model (SWAGMAN Farm) and a distributed biophysical model (SWAGSIM) are provided. [ABSTRACT FROM PUBLISHER]

Background: Knee osteoarthritis (OA) causes substantial pain, physical dysfunction and impaired quality of life. There is no cure for knee OA, and for some people, the disease may involve progressive symptomatic and structural deterioration over time. Platelet-rich plasma (PRP) is a therapeutic agent that aims to address underlying biological processes responsible for OA pathogenesis. As such, it has the potential to improve both symptoms and joint structure. The aim of this clinical trial is to determine whether a series of injections of PRP into the knee joint will lead to a significantly greater reduction in knee pain, and less loss of medial tibial cartilage volume over 12 months when compared to a series of placebo saline injections in people with knee OA., Methods: This will be a two-group, superiority, randomised, participant-, interventionist- and assessor-blinded, placebo-controlled trial. Two hundred and eighty-eight participants aged over 50 years with painful knee OA and mild to moderate structural change on x-ray (Kellgren and Lawrence grade 2 and 3) will be randomly allocated to receive either three PRP injections or three normal saline injections into the knee joint at weekly intervals. The primary outcomes will be 12-month change in average overall knee pain severity (numeric rating scale) and medial tibial cartilage volume (magnetic resonance imaging (MRI)). Secondary outcomes include additional measures of knee pain and other symptoms, function in daily living and sport and recreation, quality of life, participant-perceived global ratings of change, and other MRI structural outcomes including meniscal and cartilage morphology, synovitis, effusion, bone marrow lesions and cartilage defects. A range of additional measures will be recorded, and a separate health economic evaluation will be performed., Discussion: The findings from this study will help determine whether PRP improves both clinical and structural knee OA outcomes over 12 months when compared to a series of placebo saline injections., Trial Registration: Australian New Zealand Clinical Trials Registry reference: ACTRN12617000853347 . Prospectively registered 9th of June 2017.