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Rationale & Objective: Estimates of the incidence of hyperkalemia in patients with chronic kidney disease (CKD) vary widely. Our objective was to estimate hyperkalemia incidence in patients with CKD from routine clinical care, including by level of kidney damage or function and among important patient subgroups. Study Design: Retrospective cohort study. Setting & Participants: 1,771,900 patients with stage 1-4 CKD identified from the US Optum De-Identified electronic health records database. Exposures or Predictors: Impaired kidney damage or function level at baseline based on urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), respectively, and selected patient subgroups. Outcomes: Hyperkalemia: 2 elevated serum potassium values (≥5.5 mmol/L) from the inpatient setting (2-24 hours apart) or outpatient setting (maximum 7 days apart), or 1 elevated serum potassium value plus pharmacotherapy initiation or hyperkalemia diagnosis (maximum 3 days apart). Analytical Approach: Incidence rates of hyperkalemia were calculated. Estimates were stratified by UACR and eGFR level at baseline and patient subgroups. Results: Over a mean follow-up of 3.9 years, the incidence of hyperkalemia was 3.37 events/100 person-years (95% confidence intervals, 3.36-3.38). Higher incidence rates were observed with increased UACR and lower eGFR. Highest rates were observed with UACR ≥3,500 (up to 19.1/100 person-years) irrespective of decreased eGFR level. High rates also occurred in patients with type 2 diabetes mellitus (T2DM, 5.43/100 person-years), heart failure (8.7/100 person-years), and those prescribed steroidal mineralocorticoid receptor antagonists (sMRAs, 7.7/100 person-years). Limitations: Potential misclassification of variables from possible medical coding errors; potential data incompleteness issues if patients received care at institutions not included in Optum. Conclusions: Hyperkalemia is a frequent occurrence in CKD, particularly in patients with T2DM, heart failure, or prescribed sMRAs, indicating the need for regular serum potassium and UACR monitoring in this patient population to help mitigate risk. Plain-Language Summary: People with chronic kidney disease (CKD) have a higher risk of illness, hospitalization, and death than those without CKD. Medicines that are commonly used to slow down CKD progression can sometimes lead to hyperkalemia, where levels of potassium in the blood are higher than normal and which can be potentially dangerous. Concerns about hyperkalemia have led some people with CKD to stop taking their medication. Our study of 1.7 million patients from the United States found that patients with severe kidney damage, as well as those with type 2 diabetes mellitus or heart failure, have a higher risk of hyperkalemia than other patients, indicating they are priority groups for having their potassium levels and level of kidney damage checked regularly.

Abstract In 2022, a severe outbreak of disease caused by clade 2.3.4.4b Highly Pathogenic Avian Influenza (HPAI) H5N1 virus resulted in unprecedented mortality among wild birds in eastern Canada. Tens of thousands of birds were reported sick or dead, prompting a comprehensive assessment of mortality spanning the breeding season between April 1 and September 30, 2022. Mortality reports were collated from federal, Indigenous, provincial, and municipal agencies, the Canadian Wildlife Health Cooperative, and other nongovernmental organizations, universities, and citizen science platforms. A scenario analysis was conducted to refine mortality estimates, accounting for potential double counts from multiple sources under a range of spatial and temporal overlaps. Correcting for double counting, HPAI is estimated to have caused 40,391 wild bird mortalities in eastern Canada during the spring and summer of 2022; however, this figure underestimates total mortality as it excludes unreported deaths on land and at sea. Seabirds and sea ducks, long‐lived species that are slow to recover from perturbations, accounted for 98.7% of estimated mortalities. Our study provides estimates of bird mortality, with Northern Gannets (Morus bassanus; 25,669), Common Murres (Uria aalge; 8133), and American Common Eiders (Somateria mollissima dresseri; 1894) exhibiting the highest mortality figures. We then compare these mortality estimates with recent population estimates and trends and make an initial assessment of whether biologically meaningful population‐level impacts are possible. Specifically, we focus on the Northern Gannet, a species that has suffered significant global mortality, and two harvested species, Common Murre and American Common Eider, to inform management decisions. Our analysis suggests population‐level impacts in eastern Canada are possible for Northern Gannets and American Common Eiders, but are unlikely for Common Murres. This study demonstrates a comprehensive approach to assessing mortality and underscores the urgent need for further research to understand the broader ecological ramifications of the HPAI outbreak on wild bird populations.

In this study, complete Sacral Spina Bifida Occulta (SSBO) and Lumbosacral Transitional Vertebrae (LSTV) with their various subtypes based on the Castellvi classification were appraised in a South African population sample. Adult human skeletons representing the three largest South African population groups, namely South African African, South African of Mixed Ancestry; South African of European descent; both biological sexes; and age range between 21 and 90 years at death were evaluated for both spinal anomalies.The number of preselected skeletons (n = 1798) from the largest collection in Africa of modern human skeletons (N = 2630) provided a strong representative South African sample. The observational study looked at lumbar and sacral vertebrae in each skeleton and any anomalous features were captured in an Excel spreadsheet.Complete SSBO with no LSTV was observed in eight subjects (8/1798; 0.44 %), while incomplete SSBO was observed in one subject (1/1798; 0.06 %), and one individual (1/1798; 0.06 %) exhibiting complete SSBO with LSTV (Type IIIB, Castellvi classification). No significant differences were observed when comparing the prevalence of the LSTV with SSBO in the male and female groups of the different population affinity groups. The number of individuals with SSBO was found in more South African Africans than in the other population groups with no significant difference between groups.This research revealed the simultaneous presence of two morphological anomalies (SSBO and LSTV) at the same vertebral segment that could result in low back pain. Variant morphology awareness is crucial for clinicians across all modalities to prevent misdiagnosis, leading to better treatment plans, and avoiding injury.

ABSTRACT Following the detection of novel highly pathogenic avian influenza virus (HPAIV) H5N1 clade 2.3.4.4b in Newfoundland, Canada, in late 2021, avian influenza virus (AIV) surveillance in wild birds was scaled up across Canada. Herein, we present the results of Canada’s Interagency Surveillance Program for Avian Influenza in Wild Birds during the first year (November 2021–November 2022) following the incursions of HPAIV from Eurasia. The key objectives of the surveillance program were to (i) identify the presence, distribution, and spread of HPAIV and other AIVs; (ii) identify wild bird morbidity and mortality associated with HPAIV; (iii) identify the range of wild bird species infected by HPAIV; and (iv) genetically characterize detected AIV. A total of 6,246 sick and dead wild birds were tested, of which 27.4% were HPAIV positive across 12 taxonomic orders and 80 species. Geographically, HPAIV detections occurred in all Canadian provinces and territories, with the highest numbers in the Atlantic and Central Flyways. Temporally, peak detections differed across flyways, though the national peak occurred in April 2022. In an additional 11,295 asymptomatic harvested or live-captured wild birds, 5.2% were HPAIV positive across 3 taxonomic orders and 19 species. Whole-genome sequencing identified HPAIV of Eurasian origin as most prevalent in the Atlantic Flyway, along with multiple reassortants of mixed Eurasian and North American origins distributed across Canada, with moderate structuring at the flyway scale. Wild birds were victims and reservoirs of HPAIV H5N1 2.3.4.4b, underscoring the importance of surveillance encompassing samples from sick and dead, as well as live and harvested birds, to provide insights into the dynamics and potential impacts of the HPAIV H5N1 outbreak. This dramatic shift in the presence and distribution of HPAIV in wild birds in Canada highlights a need for sustained investment in wild bird surveillance and collaboration across interagency partners.IMPORTANCEWe present the results of Canada’s Interagency Surveillance Program for Avian Influenza in Wild Birds in the year following the first detection of highly pathogenic avian influenza virus (HPAIV) H5N1 on the continent. The surveillance program tested over 17,000 wild birds, both sick and apparently healthy, which revealed spatiotemporal and taxonomic patterns in HPAIV prevalence and mortality across Canada. The significant shift in the presence and distribution of HPAIV in Canada’s wild birds underscores the need for sustained investment in wild bird surveillance and collaboration across One Health partners.

Lipoprotein(a) (Lp[a]) is an low-density lipoprotein (LDL)-like particle in which apolipoprotein (apo) B is covalently bound to a plasminogen-like molecule called apo(a). A High level of Lp(a) has been demonstrated to be an independent, causal, and prevalent risk factor for atherosclerotic cardiovascular disease (ASCVD), as well as aortic valve disease, through mechanisms that promote atherogenesis, inflammation, and thrombosis. With reliable and accessible assays, Lp(a) level has been established to be associated linearly with the risk for ASCVD. The 2021 Canadian Cardiovascular Society Dyslipidemia Guidelines recommend measuring an Lp(a) level once in a person’s lifetime as part of the initial lipid screening. The aim of this review is to provide an update and overview of the utility and application of Lp(a) level in the assessment and treatment of adults at risk for ASCVD, consistent with this guideline recommendation. Résumé: La lipoprotéine(a), ou Lp(a), est une lipoprotéine de basse densité dans laquelle l’apolipoprotéine B est liée de manière covalente à une molécule semblable au plasminogène, l’apolipoprotéine(a). On a démontré qu’un taux élevé de Lp(a) est un facteur de risque indépendant, causal et fréquent d’athérosclérose cardiovasculaire (ASCV) et de valvulopathie aortique, en raison de mécanismes qui favorisent l’athérogénèse, l’inflammation et la thrombose. Des épreuves fiables et accessibles ont permis d’établir que le taux de Lp(a) était associé de façon linéaire à un risque d’ASCV. Dans ses lignes directrices de 2021 sur la prise en charge de la dyslipidémie, la Société cardiovasculaire du Canada recommande de mesurer le taux de Lp(a) une fois au cours de la vie d’une personne, dans le cadre du dépistage initial des lipides. Le présent article vise à fournir une mise à jour et un compte rendu de l’utilité et de l’application du taux de Lp(a) dans l’évaluation et le traitement des adultes présentant un risque d’ASCV, conformément à cette recommandation issue des lignes directrices.

Background: Occipitalisation is the most prevalent congenital abnormality at the craniovertebral junction; however, it is rare in the general population. There is a paucity of literature on osteological prevalence studies within the South African Black and broader African populations. This study aimed to establish baseline data for the prevalence of occipitalisation in the South African Black population group. Methods: One thousand two hundred thirteen skulls from a South African Black population were initially sampled, and after exclusion criteria were applied, the sample was reduced to 1119 skulls (male 766; female 353). A morphological description of the skulls that exhibited occipitalisation was included in this study. Results: Occipitalisation was observed in three skulls (3/1119; 0.27 %); two of the skulls were female (2/353; 0.57 %), and one was male (1/766; 0.13 %). The three occipitalised skulls exhibited fusion in three areas of the atlas: the anterior arch, lateral masses, and transverse processes. No skulls exhibited posterior arch fusion of the atlas. Conclusion: This study established a baseline prevalence of occipitalisation in the South African Black population at 0.27 % and found no significant association between sex and occipitalisation (p = 0.236). This study highlights the need for further studies in the other African population affinity groups.

Abstract Hierarchically porous, high‐surface‐area silica materials are excellent candidates for multiple applications like catalysis and environmental remediation. Shaping these materials with additive manufacturing (AM) techniques, like robocasting, could enable their use with the benefit of on‐demand, customized shaping and maximizing performance. Herein, ordered mesoporous silica COK‐12 slurries were robocasted into monoliths, containing different ratios of uncalcined COK‐12 and sodium bentonite (0–25 wt.%). The rheology of the mixed slurries is characterized by lower flow indexes (0.69 vs. 0.32) and higher yield stresses (96 vs. 259 Pa) compared to pure COK‐12 ones. Monoliths were printed in woodpile structures and calcined at 600°C. Micro‐CT measurements showed a linear shrinkage of 25% after calcination. Mechanical characterization showed increased uniaxial strength (0.20 ± 0.07 to 1.0 ± 0.3 MPa) with increasing binder/solids ratio from 13 to 25%. The amorphous, mesoporous structure of COK‐12 was retained. The structures exhibited open porosities of 52 ± 4% and showed higher specific mesopore volumes, and increased average mesopore size (6 vs. 8 nm) compared to COK‐12. Small‐angle x‐ray scattering analysis revealed an increased lattice parameter (10.3 vs. 11.0 nm) and reduced wall thickness (3.1 nm vs. 4.1 nm) of the COK‐12 in the monoliths. These properties indicate suitability for their application as porous supports and adsorbents.

Abstract Alleviating symptom burden in patients with myeloproliferative neoplasms (MPNs) is imperative to achieving optimal management. Research remains to elucidate the relationship between the JAK2V617F (Janus kinase 2) mutation present in many MPN patients, and the symptomatology they experience. This retrospective study analysed data collected from MPN patients included in the Myeloproliferative Neoplasms: An In‐depth Case–Control (MOSAICC) pilot study. The MPN Symptom Assessment Form was administered, and median symptom scores were compared between JAK2V617F‐positive and JAK2V617F‐negative groups. Multivariate logistic regression analysis adjusted for confounding variables. Overall, 106 MPN patients participated: 65.1% were JAK2V617F positive, 30.2% were JAK2V617F negative and 4.7% had an unknown status. Multivariate analysis revealed a low symptom burden for early satiety (p

Introduction: Cerebrospinal fluid (CSF) fistulas are a rare phenomenon, that can lead to life-threatening complications if left untreated. Presenting as rhinorrhea or otorrhea, they can be difficult to diagnose due to admixture of other bodily fluids. Typically, CSF fistulas develop after trauma, but in rare instances, they can be diagnosed in patients with a neoplastic lesion. Objective: To discuss several steps in diagnosing CSF fistulas. Patient: A fifty-year-old female with an intra-osseous temporal bone meningioma. Interventions: For diagnosing CSF admixture in fluids, two tests are looked into: beta-2 transferrin (β2T) and beta-trace protein (βTP) testing. Conclusion: Testing for βTP is a highly sensitive, quick and non-invasive method to assess CSF admixture in middle ear effusion. Because of its lower cost, faster results and easy sample collection, βTP testing has in our clinic replaced β2T testing. The current case illustrates a rare etiology of a CSF fistula, where β2T testing presumably showed false-negative results and βTP testing showed true-positive results.

Characterizing metabolically active microorganisms using RNA-based methods is a crucial tool for monitoring and mitigating operational issues, such as oil biodegradation and biocorrosion of pipelines in the oil and gas industry. Our review, a pioneering study, addresses the main methods used to preserve, isolate, and sequence RNA from oilfield samples and describes the most abundant metabolically active genera studied. Using the MEDLINE/PubMed, PubMed Central, Scopus, and Web of Science databases, 2.561 potentially eligible records were identified. After screening, 20 studies were included in our review, underscoring the scarcity of studies related to the subject. Data were extracted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). These studies evaluated different samples, including produced water (PW), injection water (IW), solid deposits (SD), oil (OIL), and oily sludge (OS) collected from oilfields located in Australia, China, India, Mexico, and the United Arab Emirates. Environmental samples accounted for 55% of the studies, while enriched cultures and microbial consortia represented 35% and 15% of studies, respectively. PW was the most frequently studied sample, comprising 72% of all samples. Filtration and centrifugation were the only processes employed to concentrate the biomass present in samples. For RNA preservation, the most used method was a solution composed of 95:5 v/v ethanol/TRIzol, while for RNA isolation, the TRIzol reagent was the most cited. The Sanger sequencing method was used in all studies evaluating functional genes (alkB, dsrA, aprA, assA, and mcrA), and the Next-Generation Sequencing (NGS) method was employed in studies for sequencing transcripts of the 16S rRNA gene and metatranscriptomes. Pseudomonas (16S rRNA = PW: 2%; IW: 8%; metatranscriptome = PW: 20%) and Acinetobacter (16S rRNA = PW: 1%; IW: 4%; metatranscriptome = PW: 17%) were the most abundant genera. This study outlined the primary methods employed in researching metabolically active microorganisms. These data provide a foundation for future research. However, it is essential to note that we cannot yet determine the most effective method. We hope that this study will inspire further research related to the standardization of RNA preservation, extraction, and sequencing methods and significantly contribute to our understanding of active microbial communities in oilfields.

Background: For patients with atrial fibrillation who have an ischemic stroke or transient ischemic attack (TIA) despite taking direct oral anticoagulants (DOACs), the optimal strategy for ongoing anticoagulation is unknown. Methods: Using provincial administrative databases in Alberta, Canada, we compared anticoagulant use before/after the breakthrough stroke/TIA and assessed recurrence of stroke/TIA or bleeding, with consideration of medication adherence. Adherence was defined as the proportion of days covered (PDC) being ≥ 80%. Results: Among 985 patients, the median age was 80 years (interquartile range 13), with a mean CHADS2 score of 1.7± 1 prior to the index event. Patients were followed for a median of 643 days (interquartile range 836). Following the index stroke/TIA event, 623 patients (63%) filled a prescription for the same DOAC regimen, 83 (8%) filled a prescription for a different dose, 155 (16%) switched DOAC agents, 51 (5%) switched to warfarin, and 73 (7%) filled no oral anticoagulant prescription. Patients who kept the same regimen more commonly had TIA index events (59%); patients who changed dose or drug more often had stroke index events (55%-78%). During follow-up, 135 (14%) had stroke/TIA recurrence, and 46 (5%) had bleeding; rates of each did not differ between prescribing patterns. Post-index event, the proportion of patients with a proportion of days covered ≥ 80% improved from 55% to 80%. Conclusions: Although most maintained the same DOAC regimen after stroke/TIA, rates of recurrent stroke/TIA and bleeding were similar across prescribing patterns. Stroke/TIA severity may have influenced prescribing practices. DOAC prescription adherence improved poststroke/TIA and signals an opportunity for optimization in patients with atrial fibrillation. Résumé: Contexte: Chez les patients atteints de fibrillation auriculaire qui subissent un accident vasculaire cérébral (AVC) ischémique ou un accident ischémique transitoire (AIT) malgré la prise d’anticoagulants oraux directe (AOD), la stratégie optimale pour la poursuite de l’anticoagulation est inconnue. Méthodologie: À partir des bases de données administratives provinciales en Alberta, au Canada, nous avons comparé l’utilisation d’anticoagulants avant/après l’AVC/AIT survenu pendant l’anticoagulothérapie et avons évalué la récurrence d’un AVC/AIT ou d’un saignement, en tenant compte de l’adhésion au traitement médicamenteux. L’adhésion a été définie comme une proportion de jours couverts (PJC) de 80 % ou plus. Résultats: Chez 985 patients, l’âge médian était de 80 ans (écart interquartile de 13) et le score CHADS2 moyen, de 1,7 ± 1 avant l’événement de référence. Les patients ont été suivis pendant une médiane de 643 jours (écart interquartile de 836). Après l’AVC/AIT de référence, 623 patients (63 %) ont fait exécuter une ordonnance du même schéma d’AOD, 83 (8 %) ont fait exécuter une ordonnance d’une dose différente, 155 (16 %) sont passés à d’autres AOD, 51 (5 %) sont passés à la warfarine et 73 (7 %) n’ont fait exécuter aucune ordonnance d’anticoagulant oral. Chez les patients qui ont continué à recevoir le même schéma, la plupart (59 %) avaient eu un AIT comme événement de référence; chez les patients qui ont changé de dose ou de médicament, la plupart (55 à 78 %) avaient eu un AVC comme événement de référence. Durant le suivi, 135 (14 %) ont connu un AVC/AIT récurrent et 46 (5 %) ont présenté un saignement; les taux de chaque manifestation ont été similaires pour les différents schémas de prescription. Après l’événement de référence, le pourcentage de patients ayant une PJC ≥ 80 % a augmenté, passant de 55 à 80 %. Conclusions: Malgré le maintien du même schéma d’AOD chez la plupart des patients après l’AVC/AIT, les taux d’AVC/AIT récurrent et de saignement ont été similaires avec tous les schémas de prescription. La gravité d’un AVC/AIT pourrait avoir influencé les pratiques de prescription. L’adhésion aux AOD prescrits s’est améliorée après un AVC/AIT et témoigne d’une possibilité d’optimisation chez les patients atteints de fibrillation auriculaire.