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Abstract Background Chronic kidney disease (CKD) is a devastating illness associated with increased mortality, reduced quality of life, impaired growth, neurocognitive impairment and psychosocial maladjustment in children. There is growing evidence of socioeconomic disparities in health outcomes among children with CKD. Patient navigators are trained non-medical personnel who assist patients with chronic conditions journey through the continuum of care and transit across different care settings. They help vulnerable and underserved populations to better understand their diagnosis, treatment options, and available resources, guide them through complex medical systems, and help them to overcome barriers to health care access. Given the complexity and chronicity of the disease process and concerns that current models of care may not adequately support the provision of high-level care in children with CKD from socioeconomically disadvantaged backgrounds, a patient navigator program may improve the provision of care and overall health of children with CKD. Methods The NAV-KIDS2 trial is a multi-centre, staggered entry, waitlisted randomised controlled trial assessing the health benefits and costs of a patient navigator program in children with CKD (stages 3–5, on dialysis, and with kidney transplants), who are of low socioeconomic backgrounds. Across 5 sites, 210 patients aged from 3 to 17 years will be randomised to immediate receipt of a patient navigator intervention for 24 weeks or waitlisting with standard care until receipt of a patient navigator at 24 weeks. The primary outcome is child self-rated health (SRH) 6-months after completion of the intervention. Other outcomes include utility-based quality of life, caregiver SRH, satisfaction with healthcare, progression of kidney dysfunction, other biomarkers, missed school days, hospitalisations and mortality. The trial also includes an economic evaluation and process evaluation, which will assess the cost-effectiveness, fidelity and barriers and enablers of implementing a patient navigator program in this setting. Discussion This study will provide clear evidence on the effectiveness and cost-effectiveness of a new intervention aiming to improve overall health and well-being for children with CKD from socioeconomically disadvantaged backgrounds, through a high quality, well-powered clinical trial. Trial registration Prospectively registered (12/07/2018) on the Australian New Zealand Clinical Trials Registry (ACTRN12618001152213).

Lotti Orwelius,1-4 Armando Teixeira-Pinto,2,5 Cristina Lobo,2 Altamiro Costa-Pereira,1,2 Cristina Granja,1,2,6,7 1Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; 2CINTESIS – Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; 3Department of Intensive Care, Linköping University, County Council of Östergötland, Linköping, Sweden; 4Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; 5Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; 6Department of Emergency and Intensive Care Medicine, Algarve Hospital Centre, Algarve, Portugal; 7Department of Biomedical Sciences and Medicine, University of Algarve, Algarve, Portugal Background: Decreased health-related quality of life (HRQoL) is a significant problem after an intensive care stay and is affected by several known factors such as age, sex, and previous health-state. The objective of this study was to assess the association between memory and self-reported perceived HRQoL of patients discharged from the intensive care unit (ICU). Methods: A prospective, multicenter study involving nine general ICUs in Portugal. All adult patients with a length of stay >48 hours were invited to participate in a 6-month follow-up after ICU discharge by answering a set of structured questionnaires, including EuroQol 5-Dimensions and ICU memory tool. Results: A total of 313 (52% of the eligible) patients agreed to enter the study. The median age of patients was 60 years old, 58% were males, the median Simplified Acute Physiology Score II (SAPS II) was 38, and the median length of stay was 8 days for ICU and 21 days for total hospital stay. Eighty-nine percent (n=276) of the admissions were emergencies. Seventy-eight percent (n=234) of the patients had memories associated with the ICU stay. Patients with no memories had 2.1 higher chances (P=0.011) of being in the bottom half of the HRQoL score (

Background: Evidence on the health benefits of occupational physical activity (OPA) is inconclusive. We examined the associations of baseline OPA and OPA changes with all-cause, cardiovascular disease (CVD), and cancer mortality and survival times. Methods: This study included prospective and longitudinal data from the MJ Cohort, comprising adults over 18 years recruited in 1998–2016, 349,248 adults (177,314 women) with baseline OPA, of whom 105,715 (52,503 women) had 2 OPA measures at 6.3 ± 4.2 years (mean ± SD) apart. Exposures were baseline OPA, OPA changes, and baseline leisure-time physical activity. Results: Over a mean mortality follow-up of 16.2 ± 5.5 years for men and 16.4 ± 5.4 years for women, 11,696 deaths (2033 of CVD and 4631 of cancer causes) in men and 8980 deaths (1475 of CVD and 3689 of cancer causes) in women occurred. Combined moderately heavy/heavy baseline OPA was beneficially associated with all-cause mortality in men (multivariable-adjusted hazard ratio (HR) = 0.93, 95% confidence interval (95%CI): 0.89–0.98 compared to light OPA) and women (HR = 0.86, 95%CI: 0.79–0.93). Over a mean mortality follow-up of 12.5 ± 4.6 years for men and 12.6 ± 4.6 years for women, OPA decreases in men were detrimentally associated (HR = 1.16, 95%CI: 1.01–1.33) with all-cause mortality, while OPA increases in women were beneficially (HR = 0.83, 95%CI: 0.70–0.97) associated with the same outcome. Baseline or changes in OPA showed no associations with CVD or cancer mortality. Conclusion: Higher baseline OPA was beneficially associated with all-cause mortality risk in both men and women. Our longitudinal OPA analyses partly confirmed the prospective findings, with some discordance between sex groups.

Background. Recurrent glomerulonephritis (GN) is an important cause of allograft loss after transplantation when GN is the primary cause of kidney failure. Retransplantation after allograft loss from recurrent disease requires careful consideration. We aimed to determine the probability of relisting and the risk of allograft loss after retransplantation in recipients with prior allograft loss from recurrent GN. Methods. Using data from the Australia and New Zealand Dialysis and Transplant Registry and multivariable Cox modeling, we compared the probability of waitlisting and allograft loss after second transplantation between those with and without prior allograft loss from recurrent disease. Results. Of 3276 patients who received a second kidney transplant, 179 (5%) lost their first allograft from recurrent GN. Between 2006 and 2021, 1524 patients with failed first allografts (6% with recurrent GN, 45% with primary GN but no disease recurrence) were relisted for transplantation. Compared with patients without primary GN, the adjusted hazard ratios (95% confidence intervals) for relisting in patients with primary GN, with and without disease recurrence, were 1.09 (0.88-1.34) and 1.16 (1.05-1.29), respectively. The respective adjusted hazard ratios for allograft loss after repeat transplantation were 0.77 (0.59-1) and 1.02 (0.9-1.16). Of the 81 patients who received a second allograft after losing their first allograft to GN recurrence, 18 patients (22%) also lost their second allograft because of recurrent GN. Conclusions. Patients with prior allograft loss from GN recurrence were not disadvantaged, with comparable waitlist potential and allograft outcome after repeat transplantation. However, >20% of those with prior allograft loss from disease recurrence also lost their second allografts from recurrent disease.

Abstract Objective To describe the feeding characteristics and growth of children with prenatal exposure to Zika virus (ZIKV) from birth to 48 months. Design Using data from the prospective Microcephaly Epidemic Research Group Pediatric Cohort (MERG-PC), children without microcephaly born to mothers with evidence of ZIKV infection during pregnancy (ZIKV-exposed children without microcephaly) and children with Zika-related microcephaly were compared using repeated cross-sectional analyses within the following age strata: birth; 1 to 12; 13 to 24; 25 to 36; and 37 to 48 months. The groups were compared in relation to prematurity, birth weight, breastfeeding, alternative feeding routes, dysphagia and anthropometric profiles based on the World Health Organization Anthro z-scores (weight-length/height, weight-age, length/height-age and BMI-age). Results The first assessment included 248 children, 77 (31.05%) with microcephaly and 171 (68.95%) without microcephaly. The final assessment was performed on 86 children. Prematurity was 2.35 times higher and low birth weight was 3.49 times higher in children with microcephaly. The frequency of breastfeeding was high (> 80%) in both groups. On discharge from the maternity hospital, the frequency of children requiring alternative feeding route in both groups was less than 5%. After 12 months of age, children with microcephaly required alternative feeding route more often than children without microcephaly. In children with microcephaly, the z-score of all growth indicators was lower than in children without microcephaly. Conclusions Children with Zika-related microcephaly were more frequently premature and low birth weight and remained with nutritional parameters, i.e., weight-for-age, weight-for-length/height and length/height-for-age below those of the children without microcephaly.

Cancer is a significant disease that poses a major threat to human health. Image-guided cancer therapy refers to a series of medical procedures that use imaging technology to precisely locate and treat cancer. Combining the dual characteristics of medical images and functional nanomaterial (NM) drug carriers, various integrated diagnosis and treatment probes have been developed for in vivo dynamic monitoring and therapeutic effect evaluation of drugs based on medical imaging. Copper (Cu)-based NMs have emerged as valuable products of nanotechnology due to their unique physicochemical properties, which are influenced by factors, such as size, shape, and surface properties. In the field of imaging, Cu-based NMs offer a combination of desirable characteristics, including fluorescence emission, contrast enhancement, and radiolabeling stability. These properties form the foundation for a wide range of imaging modalities. In addition, Cu-based NMs can be used as a carrier for diagnostic or therapeutic drugs and the synergistic effect of multiple therapeutic modalities can be realized by doping multiple transition metals into the heterostructures. These properties have become an important basis for imaging-guided therapy with Cu-based NMs. In this review we introduce biocompatible Cu-based NMs for image-guided cancer therapy and provide an overview of the promising outcomes in biomedical research.

IntroductionPatients with glomerular disease experience symptoms that impair their physical and mental health while managing their treatments, diet, appointments and monitoring general and specific indicators of health and their illness. We sought to describe the perspectives of patients and their care partners on self-management in glomerular disease.MethodsWe conducted 16 focus groups involving adult patients with glomerular disease (n = 101) and their care partners (n = 34) in Australia, Hong Kong, the United Kingdom, and United States. Transcripts were analyzed thematically.ResultsWe identified the following 4 themes: empowered in autonomy (gaining confidence through understanding, taking ownership of disease and treatment, learning a positive health approach); overwhelmed by compounding treatment burdens (financially undermined and depleted, demoralized by side effects and harms, frustrated by fragmented and inflexible care, fear of possible drug harms); striving for stability and normalcy (making personal sacrifices, maximizing life participation, attentiveness to bodily signs, avoiding precarious health states, integrating medicines into routines); and necessity of health-sustaining relationships (buoyed by social support, fulfilling meaningful responsibilities, sharing and normalizing experiences, seeking a trusting and respectful alliance).ConclusionPatients with glomerular disease and their care partners value their capacity for autonomy and disease ownership, stability of their health, and relationships that support self-management. Strategies directed at strengthening these factors may increase self-efficacy and improve the care and outcomes for patients with glomerular disease.

Abstract Background The study of length of stay (LOS) outliers is important for the management and financing of hospitals. Our aim was to study variables associated with high LOS outliers and their evolution over time. Methods We used hospital administrative data from inpatient episodes in public acute care hospitals in the Portuguese National Health Service (NHS), with discharges between years 2000 and 2009, together with some hospital characteristics. The dependent variable, LOS outliers, was calculated for each diagnosis related group (DRG) using a trim point defined for each year by the geometric mean plus two standard deviations. Hospitals were classified on the basis of administrative, economic and teaching characteristics. We also studied the influence of comorbidities and readmissions. Logistic regression models, including a multivariable logistic regression, were used in the analysis. All the logistic regressions were fitted using generalized estimating equations (GEE). Results In near nine million inpatient episodes analysed we found a proportion of 3.9% high LOS outliers, accounting for 19.2% of total inpatient days. The number of hospital patient discharges increased between years 2000 and 2005 and slightly decreased after that. The proportion of outliers ranged between the lowest value of 3.6% (in years 2001 and 2002) and the highest value of 4.3% in 2009. Teaching hospitals with over 1,000 beds have significantly more outliers than other hospitals, even after adjustment to readmissions and several patient characteristics. Conclusions In the last years both average LOS and high LOS outliers are increasing in Portuguese NHS hospitals. As high LOS outliers represent an important proportion in the total inpatient days, this should be seen as an important alert for the management of hospitals and for national health policies. As expected, age, type of admission, and hospital type were significantly associated with high LOS outliers. The proportion of high outliers does not seem to be related to their financial coverage; they should be studied in order to highlight areas for further investigation. The increasing complexity of both hospitals and patients may be the single most important determinant of high LOS outliers and must therefore be taken into account by health managers when considering hospital costs.

Author(s): Chandana Guha [sup.1] [sup.2] , Rabia Khalid [sup.1] [sup.2] , Anita van Zwieten [sup.1] [sup.2] , Anna Francis [sup.3] , Carmel M. Hawley [sup.4] [sup.5] [sup.6] , Allison Jauré [...], Background Children with chronic kidney disease (CKD) require multidisciplinary care to meet their complex healthcare needs. Patient navigators are trained non-medical personnel who assist patients and caregivers to overcome barriers to accessing health services through care coordination. This trial aims to determine the effectiveness of a patient navigator program in children with CKD. Methods The NAVKIDS.sup.2 trial is a multi-center, waitlisted, randomized controlled trial of patient navigators in children with CKD conducted at five sites across Australia. Children (0-16 years) with CKD from low socioeconomic status rural or remote areas were randomized to an intervention group or a waitlisted control group (to receive intervention after 6 months). The study primary and secondary endpoints include the self-rated health (SRH) (primary), and utility-based quality of life, progression of kidney dysfunction of the child, SRH, and satisfaction with healthcare of the caregiver at 6 months post-randomization. Results The trial completed recruitment in October 2021 with expected completion of follow-up by October 2022. There were 162 patients enrolled with 80 and 82 patients randomized to the immediate intervention and waitlisted groups, respectively. Fifty-eight (36%) participants were from regional/remote areas, with a median (IQR) age of 9.5 (5.0, 13.0) years, 46% were of European Australian ethnicity, and 65% were male. A total of 109 children (67%) had CKD stages 1-5, 42 (26%) were transplant recipients, and 11 (7%) were receiving dialysis. Conclusion The NAVKIDS.sup.2 trial is designed to evaluate the effectiveness of patient navigation in children with CKD from families experiencing socioeconomic disadvantage. Graphical abstract

Calibrating optical sensors has become a priority to maintain data quality and ensure consistency among sensors from different agencies. Achieving and monitoring radiometric calibration often involves the identification of temporally stable targets on the Earth’s surface. Although some locations across North Africa have traditionally been used as primary targets for calibration purposes, it is crucial to explore alternative options to account for potential changes in these sites over time. This study conducted a global assessment of pixel-level temporal stability using Landsat 8 OLI data, with the primary goal of identifying regions suitable for global radiometric calibration efforts. This work followed a two-stage approach, including the testing and selection of an effective combination of statistical tests to differentiate between temporally stable and unstable pixels and the generation of a worldwide mosaic of temporally stable pixels through a per-pixel statistical analysis employing a combination of Spearman’s rho and Pettitt’s test for assessing long-term trends and detecting change points. Notably, comparing the temporal mean top-of-atmosphere (TOA) reflectance before and after applying the generated temporal filter to a site with documented unstable pixels revealed a substantial reduction in mean variation, up to 6%. In addition, slopes observed in the pre-filter mean TOA reflectance, ranging between −0.002 and −0.005, became zero or near-zero and statistically insignificant after the temporal filter was applied, demonstrating a reduction in total uncertainties by 3 to 4%. These findings evidence the potential of this work, placing it as a potential foundation in the continuous search to identify additional targets for global radiometric calibration efforts.

Primary cutaneous anaplastic large-cell lymphoma (C-ALCL) is a rare subtype of non-Hodgkin lymphoma, CD30 positive that does not exhibit extracutaneous manifestations at the time of diagnosis. The emergence of solitary papules or nodules, on the trunk and extremities, characterizes the disease. This case reports a 58-year-old female who presented with a rapidly enlarging nodule on her right calf. The biopsy revealed a malignant neoplasm of large cells. The morphological features, combined with the immunohistochemical profile, revealed a CD30-positive and anaplastic lymphoma kinase-negative lymphoproliferative disorder, consistent with C-ALCL. Shortly after the first excision, new lesions manifested in violaceous papules and nodules, and a new biopsy was performed, confirming the initial diagnosis. The patient underwent radiotherapy for 4 weeks and the lesions regressed but recurred about a year after. The patient is currently under treatment. The main goal is to emphasize the importance of considering this diagnosis as a possibility in large-cell cutaneous lymphomas.

This report focuses in particular on a specific project hosted by two distinguished academic centers in Brazil, namely University of São Paulo and the Federal University of Santa Catarina, to explore Amerindian kinship networks and ‘gift’ circulation, by a team of anthropologists and computer scientists from Brazil, Argentina and Peru.

BackgroundWhile peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients' and caregivers' perspectives on the meaning and role of patient empowerment in PD.MethodsAdult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed.ResultsWe identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen).ConclusionsUnderstanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD.

The emerging new learning scenarios made possible by the rapid dissemination of adaptive digital technologies are deeply changing higher education processes. They provide educators and learners with new opportunities for transforming their educational practices. encouraging learning innovation and challenging traditional teaching methods. This transformation is particularly significant in how learning achievement is measured, assessed, and certified. The use of learning analytics and adaptive digital technologies not only contribute to consolidate an assessment for learning approach as call for it. In the face of this challenge, educators must speedily adapt their practices to ensure that they are effectively using digital tools to support this new assessment culture. In the framework of the Erasmus+ project PROF-XXI, a Massive Open Online Course (MOOC) entitled "The 21st Century Teacher: Learning to Teach with Digital Technologies" was designed and delivered to facilitate teachers’ access to good practices in this field. The MOOC included four modules covering various aspects of digital education and was designed taking as a reference the competences defined in the DigCompEdu framework. It was delivered on an Open edX instance. A total of 5,660 participants, mainly from Latin America, took this course in two cohorts, with 681 participants completing it. In this paper we describe the experience of designing a learning module specifically dedicated to digital assessment innovation for this MOOC, The aim was to inspire educational change and promote a more sustainable approach to assessment for learning based on the PrACT framework. The main results of this experience are presented and discussed, as well as lessons learnt.

Cancer transmission from deceased donors is an exceedingly rare but potentially fatal complication in transplant recipients. We aimed to quantify the likelihood of non-utilization of kidneys for transplantation from donors with a prior cancer history. We included all intended and actual deceased donors in Australia and New Zealand between 1989 and 2017. Association between prior cancer history and non-utilization of donor kidneys was examined using adjusted logistic regression. Of 9,485 deceased donors, 345 (4%) had a prior cancer history. Of 345 donors with a prior cancer history, 197 (57%) were utilized for transplantation. Donor characteristics of age, sex and comorbidities were similar between utilized and non-utilized donors with prior cancer. The time from cancer to organ donation was similar between utilized and non-utilized donors, irrespective of cancer subtypes. Donors with a prior cancer history were less likely to be utilized [adjusted OR (95% CI) 2.29 (1.68–3.13)] than donors without prior cancer. Of all actual donors, the adjusted OR for non-utilization among those with prior cancer was 2.36 (1.58–3.53). Non-melanoma skin cancer was the most frequent prior cancer type for utilized and non-utilized potential donors. Donors with prior cancers were less likely to be utilized for transplantation, with no discernible differences in cancer characteristics between utilized and non-utilized donors.

This paper presents the initial vicarious radiometric calibration results for Landsat 9 OLI using a combination of ground-based techniques and test sites located in Nevada, California, and South Dakota, USA. The field data collection methods include the traditional reflectance-based approach and the automated Radiometric Calibration Test Site (RadCaTS). The results for top-of-atmosphere spectral radiance show an average ratio (OLI/ground measurements) of 1.03, 1.01, 1.00, 1.02, 1.02, 1.01, 0.98, and 1.01 for Landsat 9 OLI bands 1–8, which is within the design specification of ±5% for spectral radiance. The results for top-of-atmosphere reflectance show an average ratio (OLI/ground measurements) of 0.99, 0.99, 1.00, 1.02, 1.01, 1.02, 1.00, and 1.00 for Landsat 9 OLI bands 1–8, which is within the design specification of ±3% for top-of-atmosphere reflectance.