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This article presents a novel development of a very high-frequency (VHF) lightning interferometer system at National Atmospheric Research Laboratory, Gadanki (13.58°E,79.18°N). While similar systems have been developed in the past, this system distinguishes itself due to use of PXIe-based commercial-off-the-shelf (COTS) digitizers and controllers, offering the ease of configuration, scalability, and future upgradability. The system design comprises three broadband RF channels, a trigger generator, and a high-speed digitizer. The RF frontend incorporates discone antennas, bandpass filters, and low-noise amplifiers, ensuring efficient capture of lightning signals in the 20–80-MHz frequency band. The system addresses issues encountered during initial field experiments, such as frequent amplifier failures, by implementing voltage regulation closer to the amplifier. The signal acquisition system utilizes modular PXIe-based technology, enabling high bandwidth and throughput. The system employs two dual-channel Keysight M9203A PXIe digitizer cards mounted in a Keysight M9019A chassis, along with an embedded controller (Keysight M9037A) for seamless control and data acquisition. Its design and scalable architecture hold promise for future enhancements and upgrades. An example observation of a lightning flash recorded during the initial field deployment is presented. The detailed analysis of the flash showcases system’s capabilities in capturing the initiation, progression, and branching of lightning channels and identifying initial breakdown pulses (IBPs) and their characteristics.

We consider the problem of tracking the velocity profile of a target or phenomenon, which is distributed across its range, such as atmospheric wind velocity across altitudes from radar measurements. Typical pulsed radars apply spectral techniques on the matched filtered samples collected from the return echoes at each range bin. Both the true signal as well as the false targets can lead to prominent peaks in the spectral domain, and the recovery algorithms should identify the true profile across range bins. When the measurements in adjacent range bins are correlated, a dynamic program-based data association turns out to be highly suitable. This algorithm is popularly known as the Viterbi Data Association (VDA). While VDA has good performance when the true signal is present along with a small number of competing false spectral peaks in each range bin, poor SNRs from high altitude reflections may trigger several false peaks, considerably deteriorating the performance of the VDA. The main contribution of the current paper is in incorporating frequency domain subspace methods (in particular, Frequency selective ESPRIT) to iteratively refine the measurements such that the VDA can further improve the best-identified track so far. When data from multiple sensors are available, the proposed Iterative VDA (IVDA) algorithm can be further reinforced using multi-sensor fusion techniques, which we call the Reinforced IVDA. Both of the proposed algorithms demonstrate significant performance improvements in estimating target velocity at altitudes with low SNRs. In addition to simulations, the proposed algorithms are validated on field data collected from a Mesosphere Stratosphere Troposphere (MST) wind profiling radar.

Advocacy and policy change are powerful levers to improve quality of care and better support patients on home dialysis. While the kidney community increasingly recognizes the value of home dialysis as an option for patients who prioritize independence and flexibility, only a minority of patients dialyze at home in the United States. Complex system-level factors have restricted further growth in home dialysis modalities, including limited infrastructure, insufficient staff for patient education and training, patient-specific barriers, and suboptimal physician expertise. In this article, we outline trends in home dialysis use, review our evolving understanding of what constitutes high-quality care for the home dialysis population (as well as how this can be measured), and discuss policy and advocacy efforts that continue to shape the care of US patients and compare them with experiences in other countries. We conclude by discussing future directions for quality and advocacy efforts.

The Merit-based Incentive Payment System (MIPS) is a mandatory pay-for-performance program through the Centers for Medicare & Medicaid Services (CMS) that aims to incentivize high-quality care, promote continuous improvement, facilitate electronic exchange of information, and lower health care costs. Previous research has highlighted several limitations of the MIPS program in assessing nephrology care delivery, including administrative complexity, limited relevance to nephrology care, and inability to compare performance across nephrology practices, emphasizing the need for a more valid and meaningful quality assessment program. This article details the iterative consensus-building process used by the American Society of Nephrology Quality Committee from May 2020 to July 2022 to develop the Optimal Care for Kidney HealthMIPS Value Pathway (MVP). Two rounds of ranked-choice voting among Quality Committee members were used to select among nine quality metrics, 43 improvement activities, and three cost measures considered for inclusion in the MVP. Measure selection was iteratively refined in collaboration with the CMS MVP Development Team, and new MIPS measures were submitted through CMS's Measures Under Consideration process. The Optimal Care for Kidney HealthMVP was published in the 2023 Medicare Physician Fee Schedule Final Rule and includes measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The nephrology MVP aims to streamline measure selection in MIPS and serves as a case study of collaborative policymaking between a subspecialty professional organization and national regulatory agencies.

Established therapeutic interventions effectively mitigate the risk and progression of chronic kidney disease (CKD). Countries and regions have a compelling need for organizational structures that enable early identification of people with CKD who can benefit from these proven interventions. We report the current global status of CKD detection programs.

Chronic kidney disease (CKD) causes substantial global morbidity and increases cardiovascular and all-cause mortality. Unlike other chronic diseases with established strategies for screening, there has been no consensus on whether health systems and governments should prioritize early identification and intervention for CKD. Guidelines on evaluating and managing early CKD are available but have not been universally adopted in the absence of incentives or quality measures for prioritizing CKD care. The burden of CKD falls disproportionately upon persons with lower socioeconomic status, who have a higher prevalence of CKD, limited access to treatment, and poorer outcomes. Therefore, identifying and treating CKD at the earliest stages is an equity imperative. In 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a controversies conference entitled “Early Identification and Intervention in CKD.” Participants identified strategies for screening, risk stratification, and treatment for early CKD and the key health system and economic factors for implementing these processes. A consensus emerged that CKD screening coupled with risk stratification and treatment should be implemented immediately for high-risk persons and that this should ideally occur in primary or community care settings with tailoring to the local context.

The cGMP-dependent protein kinase in Plasmodium falciparum(PfPKG) plays multiple roles in the life cycle of the parasite. As a result, this enzyme is a potential target for new antimalarial agents. Existing inhbitors, while potent and active in malaria models are not optimal. This communication describes initial optimization of a structurally distinct class of PfPKG inhibitors.

Prion diseases are fatal neurodegenerative disorders that can be transmitted via contact with infective tissue. Variability in hospital safety policies related to prion disease may place health-care workers at risk. We sought to assess variability of safety policies related to prion disease for neurosurgical procedures and lumbar punctures among neurological institutions in the United States. We e-mailed neurologists associated with 2016 US News and World Report“Top 50” Neurology & Neurosurgery Institutions to request hospital policies regarding safety precautions related to prion disease. For institutional surgical policies, the main outcome was concordance with each of the 8 specific precautions described in World Health Organization (WHO) guidelines published in 1999. No similar guidelines are available for lumbar puncture, so themes were identified and quantified among the lumbar puncture policies we collected. Of the 51 institutions contacted, there were 38 responses. Two institutions did not have relevant policies and 3 institutions declined to share their policies, yielding 33 institutional policies for review. Of these, 85% had a surgical policy and 54% had a lumbar puncture policy. Concordance with all 8 specific precautions described in the WHO guidelines was found in 14% of surgical policies. Lumbar puncture policies demonstrated variability in methods of waste disposal and decontamination procedures. There is significant variability in policies regarding safety precautions in patients with suspected prion disease. We advocate for the formation of national or international committees to examine this issue, set new guidelines, and foster implementation at the level of individual institutions.

The endoscopic step-up approach in the management of Necrotizing Pancreatitis involves sequential steps of intervention at different time points in the clinical course of the disease. EUS-guided drainage of WON is the first step of the Endoscopic step-up approach. LAMS are preferred over plastic stents for safe and effective drainage due to their wide calibre. LAMS also provide a conduit for subsequent endoscopic interventions. Successive steps in the endoscopic step-up approach include DEN &/or irrigation using NCT in symptomatic patients, primarily based on necrotic debris characteristics. The recently proposed primary DEN is based on the premise that it requires fewer re-interventions with reduced hospital stay and cost. However,judicious selection of strategy is warranted as primary DEN poses several challenges. Minimally invasive percutaneous radiological &/or surgical drainage are considered when endoscopic drainage is not feasible or successful.

Providing high-quality patient-centered care is the central mission of dialysis facilities. Assessing quality and patient-centeredness of dialysis care is necessary for continuous dialysis facility improvement. Based predominantly on readily measured items, current quality measures in dialysis care emphasize biochemical and utilization outcomes, with very few patient-reported items. Additionally, current metrics often do not account for patient preferences and may compromise patient-centered care by limiting the ability of providers to individualize care targets, such as dialysis adequacy, based on patient priorities rather than a fixed numerical target. Developing, implementing, and maintaining a quality program using readily quantifiable data while also allowing for individualization of care targets that emphasize the goals of patients and their care partners provided the motivation for a September 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care. Workshop participants focused on 4 questions: (1) What are the outcomes that are most important to patients and their care partners? (2) How can social determinants of health be accounted for in quality measures? (3) How can individualized care be effectively addressed in population-level quality programs? (4) What are the optimal means for collecting valid and robust patient-reported outcome data? Workshop participants identified numerous gaps within the current quality system and favored a conceptually broader, but not larger, quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors. Workshop participants also identified a need for new, low-burden tools to assess patient goals and priorities.