KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a large population cohort

ACKNOWLEDGEMENTS We acknowledge the data management support of Grampian Data Safe Haven (DaSH) and the associated financial support of NHS Research Scotland, through NHS Grampian investment in the Grampian DaSH. S.S. is supported by a Clinical Research Training Fellowship from the Wellcome Trust (Ref 102729/Z/13/Z). We also acknowledge the support from The Farr Institute of Health Informatics Research. The Farr Institute is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates) and the Wellcome Trust (MRC Grant Nos: Scotland MR/K007017/1).

A distinctive clade B HIV type 1 is heterosexually transmitted in Trinidad and Tobago

HIV-1 transmission worldwide is predominantly associated with heterosexual activity, and non-clade B viruses account for the most spread. The HIV-1 epidemic in Trinidad/Tobago and the Caribbean shares many features with such heterosexual epidemics, including a prominent role for coincident sexually transmitted diseases. This study evaluates the molecular epidemiology of HIV-1 in Trinidad/Tobago during a period when abrupt transition from homosexual to heterosexual transmission occurred in the absence of injecting drug use, concomitant with a rapid rise in HIV-1 prevalence in the heterosexual population. Of 31 viral isolates studied during 1987–1995, all cluster with subtype B reference strains. In the analysis of full env genes from 22 early seroconverters, the Trinidad isolates constitute a significant subcluster within the B subtype. The Trinidad V3 consensus sequence differs by a single amino acid from the prototype B V3 consensus and demonstrates stability over the decade of this study. In the majority of isolates, the V3 loop of env contains a signature threonine deletion that marks the lineage of the Trinidad HIV-1 clade B epidemic from pre-1984. No phenotypic features, including syncitium induction, neutralization profiles, and chemokine receptor usage, distinguish this virus population from other subtype B viruses. Thus, although the subtype B HIV-1 viruses being transmitted in Trinidad are genetically distinguishable from other subtype B viruses, this is probably the result of a strong founder effect in a geographically circumscribed population rather than genetic selection for heterosexual transmission. These results demonstrate that canonical clade B HIV-1 can generate a typical heterosexual epidemic.

In vitro evolution of a highly replicating, doxycycline-dependent HIV for applications in vaccine studies

A major concern associated with the use of vaccines based on live-attenuated viruses is the possible and well documented reversion to pathogenic phenotypes. In the case of HIV, genomic deletions or mutations introduced to attenuate viral pathogenicity can be repaired by selection of compensating mutations. These events lead to increased virus replication rates and, eventually, disease progression. Because replication competence and degree of protection appear to be directly correlated, further attenuation of a vaccine virus may compromise the ability to elicit a protective immune response. Here, we describe an approach toward a safe attenuated HIV vaccine. The system is not based on permanent reduction of infectivity by alteration of important viral genomic sequences, but on strict control of replication through the insertion of the tetracycline (Tet) system in the HIV genome. Furthermore, extensive in vitro evolution was applied to the prototype Tet-controlled HIV to select for variants with optimized rather than diminished replication capacity. The final product of evolution has properties uniquely suited for use as a vaccine strain. The evolved virus is highly infectious, as opposed to a canonically attenuated virus. It replicates efficiently in T cell lines and in activated and unstimulated peripheral blood mononuclear cells. Most importantly, replication is strictly dependent on the nontoxic Tetanalogue doxycycline and can be turned on and off. These results suggest that this in vitro evolved, doxycycline-dependent HIV might represent a useful tool toward the development of a safer, live-attenuated HIV vaccine.

La roca magica: Uses of natural zeolites in agriculture and industry

For nearly 200 years since their discovery in 1756, geologists considered the zeolite minerals to occur as fairly large crystals in the vugs and cavities of basalts and other traprock formations. Here, they were prized by mineral collectors, but their small abundance and polymineralic nature defied commercial exploitation. As the synthetic zeolite (molecular sieve) business began to take hold in the late 1950s, huge beds of zeolite-rich sediments, formed by the alteration of volcanic ash (glass) in lake and marine waters, were discovered in the western United States and elsewhere in the world. These beds were found to contain as much as 95% of a single zeolite; they were generally flat-lying and easily mined by surface methods. The properties of these low-cost natural materials mimicked those of many of their synthetic counterparts, and considerable effort has made since that time to develop applications for them based on their unique adsorption, cation-exchange, dehydration–rehydration, and catalytic properties. Natural zeolites (i.e., those found in volcanogenic sedimentary rocks) have been and are being used as building stone, as lightweight aggregate and pozzolans in cements and concretes, as filler in paper, in the take-up of Cs and Sr from nuclear waste and fallout, as soil amendments in agronomy and horticulture, in the removal of ammonia from municipal, industrial, and agricultural waste and drinking waters, as energy exchangers in solar refrigerators, as dietary supplements in animal diets, as consumer deodorizers, in pet litters, in taking up ammonia from animal manures, and as ammonia filters in kidney-dialysis units. From their use in construction during Roman times, to their role as hydroponic (zeoponic) substrate for growing plants on space missions, to their recent success in the healing of cuts and wounds, natural zeolites are now considered to be full-fledged mineral commodities, the use of which promise to expand even more in the future.

Self-renewal of primitive human hematopoietic cells (long-term-culture-initiating cells) in vitro and their expansion in defined medium.

A major goal of experimental and clinical hematology is the identification of mechanisms and conditions that support the expansion of transplantable hematopoietic stem cells. In normal marrow, such cells appear to be identical to (or represent a subset of) a population referred to as long-term-culture-initiating cells (LTC-ICs) so-named because of their ability to produce colony-forming cell (CFC) progeny for > or = 5 weeks when cocultured with stromal fibroblasts. Some expansion of LTC-ICs in vitro has recently been described, but identification of the factors required and whether LTC-IC self-renewal divisions are involved have remained unresolved issues. To address these issues, we examined the maintenance and/or generation of LTC-ICs from single CD34+ CD38- cells cultured for variable periods under different culture conditions. Analysis of the progeny obtained from cultures containing a feeder layer of murine fibroblasts engineered to produce steel factor, interleukin (IL)-3, and granulocyte colony-stimulating factor showed that approximately 20% of the input LTC-ICs (representing approximately 2% of the original CD34+ CD38- cells) executed self-renewal divisions within a 6-week period. Incubation of the same CD34+ CD38- starting populations as single cells in a defined (serum free) liquid medium supplemented with Flt-3 ligand, steel factor, IL-3, IL-6, granulocyte colony-stimulating factor, and nerve growth factor resulted in the proliferation of initial cells to produce clones of from 4 to 1000 cells within 10 days, approximately 40% of which included > or = 1 LTC-IC. In contrast, in similar cultures containing methylcellulose, input LTC-ICs appeared to persist but not divide. Overall the LTC-IC expansion in the liquid cultures was 30-fold in the first 10 days and 50-fold by the end of another 1-3 weeks. Documentation of human LTC-IC self-renewal in vitro and identification of defined conditions that permit their extensive and rapid amplification should facilitate analysis of the molecular mechanisms underlying these processes and their exploitation for a variety of therapeutic applications.

Management science, economics and finance: A connection

This paper provides a brief review of the connecting literature in management science, economics and finance, and discusses some research that is related to the three disciplines. Academics could develop theoretical models and subsequent econometric models to estimate the parameters in the associated models, and analyze some interesting issues in the three disciplines.

Spanish Nursing Students' Practical Experience of Computer Applications in Nursing

This study aimed to determine the level of computer practical experience in a sample of Spanish nursing students. Each student was given a Spanish language questionnaire, modified from an original used previously with medical students at the Medical School of North Carolina University (USA) and also at the Education Unit of Hospital General Universitario del Mar (Spain). The 10-item self-report questionnaire probed for information about practical experience with computers. A total of 126 students made up the sample. The majority were female (80.2%; n=101). The results showed that just over half (57.1%, n=72) of the students had used a computer game (three or more times before), and that only one third (37.3%, n=47) had the experience of using a word processing package. Moreover, other applications and IT-based facilities (e.g. statistical packages, e-mail, databases, CD-ROM searches, programming languages and computer-assisted learning) had never been used by the majority of students. The student nurses' practical experience was less than that reported for medical students in previous studies.

Comparative analysis of constructive solutions for thermal insulation by using computer applications in building rehabilitation in Mediterranean climate. The Spanish case

The new Spanish legislation in Energy Saving, similar to European regulation, provides new technical requirements to adequate technical solutions used in integral rehabilitation of existing buildings. The aim of this paper is to present, analyze and discuss the main thermal insulation constructive solutions best suited to a Mediterranean climate, and conclude on their suitability under the legislation in Energy Saving. The proposed methodology is based on the most usual constructive solutions in integral rehabilitation of buildings by analyzing their outstanding design features, by studying its construction details and then by applying the software provided by the Spanish legislation of energy efficiency in buildings. The results of the study evaluate and classify several solutions for façade rehabilitation according to energy efficiency criteria and their suitability for this type of weather, verifying the necessity of using software applications in energy saving for the proper design of constructive solutions in building rehabilitation.

Tight-Binding Approximations in 1D and 2D Coupled-Cavity Photonic Crystal Structures

Light confinement and controlling an optical field has numerous applications in the field of telecommunications for optical signals processing. When the wavelength of the electromagnetic field is on the order of the period of a photonic microstructure, the field undergoes reflection, refraction, and coherent scattering. This produces photonic bandgaps, forbidden frequency regions or spectral stop bands where light cannot exist. Dielectric perturbations that break the perfect periodicity of these structures produce what is analogous to an impurity state in the bandgap of a semiconductor. The defect modes that exist at discrete frequencies within the photonic bandgap are spatially localized about the cavity-defects in the photonic crystal. In this thesis the properties of two tight-binding approximations (TBAs) are investigated in one-dimensional and two-dimensional coupled-cavity photonic crystal structures We require an efficient and simple approach that ensures the continuity of the electromagnetic field across dielectric interfaces in complex structures. In this thesis we develop \textrm{E} -- and \textrm{D} --TBAs to calculate the modes in finite 1D and 2D two-defect coupled-cavity photonic crystal structures. In the \textrm{E} -- and \textrm{D} --TBAs we expand the coupled-cavity \overrightarrow{E} --modes in terms of the individual \overrightarrow{E} -- and \overrightarrow{D} --modes, respectively. We investigate the dependence of the defect modes, their frequencies and quality factors on the relative placement of the defects in the photonic crystal structures. We then elucidate the differences between the two TBA formulations, and describe the conditions under which these formulations may be more robust when encountering a dielectric perturbation. Our 1D analysis showed that the 1D modes were sensitive to the structure geometry. The antisymmetric \textrm{D} mode amplitudes show that the \textrm{D} --TBA did not capture the correct (tangential \overrightarrow{E} --field) boundary conditions. However, the \textrm{D} --TBA did not yield significantly poorer results compared to the \textrm{E} --TBA. Our 2D analysis reveals that the \textrm{E} -- and \textrm{D} --TBAs produced nearly identical mode profiles for every structure. Plots of the relative difference between the \textrm{E} and \textrm{D} mode amplitudes show that the \textrm{D} --TBA did capture the correct (normal \overrightarrow{E} --field) boundary conditions. We found that the 2D TBA CC mode calculations were 125-150 times faster than an FDTD calculation for the same two-defect PCS. Notwithstanding this efficiency, the appropriateness of either TBA was found to depend on the geometry of the structure and the mode(s), i.e. whether or not the mode has a large normal or tangential component.

Portugal. In economics, we call it conflict of interest! CEPS Commentary, 12 April 2013

Faced with limited options for coming up with the funds needed to pay off the next instalment on its bailout loan, Portugal is advised in this Commentary by economist Leonor Coutinho to trim the number of public sector employees, in combination with an increase in public sector working hours, among the lowest in Europe. In her view, these measures will have the best long-term implications both in terms of fiscal sustainability and of labour productivity, and may finally allow the country to resume the catching-up process that has been stalled since the start of EMU.

Trends in incidences and risk factors for hepatocellular carcinoma and other liver events in HIV and hepatitis C virus co-infected individuals from 2001 to 2014: a multi-cohort study.

BACKGROUND  While liver-related deaths in HIV and hepatitis C virus (HCV) co-infected individuals have declined over the last decade, hepatocellular carcinoma (HCC) may have increased. We described the epidemiology of HCC and other liver events in a multi-cohort collaboration of HIV/HCV co-infected individuals. METHODS  We studied all HCV antibody-positive adults with HIV in the EuroSIDA Study, the Southern Alberta Clinic Cohort, the Canadian Co-infection Cohort, and the Swiss HIV Cohort Study from 2001 to 2014. We calculated the incidence of HCC and other liver events (defined as liver-related deaths or decompensations, excluding HCC) and used Poisson regression to estimate incidence rate ratios. RESULTS  Our study comprised 7,229 HIV/HCV co-infected individuals (68% male, 90% white). During follow-up, 72 cases of HCC and 375 other liver events occurred, yielding incidence rates of 1.6 (95% confidence interval (CI): 1.3, 2.0) and 8.6 (95% CI: 7.8, 9.5) cases per 1,000 person-years of follow-up, respectively. The rate of HCC increased 11% per calendar year (95% CI: 4%, 19%) and decreased 4% for other liver events (95% CI: 2%, 7%), but only the latter remained statistically significant after adjustment for potential confounders. High age, cirrhosis, and low current CD4 cell count were associated with a higher incidence of both HCC and other liver events. CONCLUSIONS  In HIV/HCV co-infected individuals, the crude incidence of HCC increased from 2001 to 2014, while other liver events declined. Individuals with cirrhosis or low current CD4 cell count are at highest risk of developing HCC or other liver events.

Essays on coordination problems in economics

No estudo da economia, há diversas situações em que a propensão de um indivíduo a tomar determinada ação é crescente na quantidade de outras pessoas que este indivíduo acredita que tomarão a mesma ação. Esse tipo de complementaridade estratégica geralmente leva à existência de múltiplos equilíbrios. Além disso, o resultado atingido pelas decisões decentralizadas dos agentes pode ser ineficiente, deixando espaço para intervenções de política econômica. Esta tese estuda diferentes ambientes em que a coordenação entre indivíduos é importante. O primeiro capítulo analisa como a manipulação de informação e a divulgação de informação afetam a coordenação entre investidores e o bem-estar em um modelo de corridas bancárias. No modelo, há uma autoridade reguladora que não pode se comprometer a revelar a verdadeira situação do setor bancário. O regulador observa informações idiossincráticas dos bancos (através de um stress test, por exemplo) e escolhe se revela essa informação para o público ou se divulga somente um relatório agregado sobre a saúde do sistema financeiro como um todo. O relatório agregado pode ser distorcido a um custo – um custo mais elevado significa maior credibilidade do regulador. Os investidores estão cientes dos incentivos do regulador a esconder más notícias do mercado, mas a manipulação de informação pode, ainda assim, ser efetiva. Se a credibilidade do regulador não for muito baixa, a política de divulgação de informação é estado-contingente, e existe sempre um conjunto de estados em que há manipulação de informação em equilíbrio. Se a credibilidade for suficientemente baixa, porém, o regulador opta por transparência total dos resultados banco-específicos, caso em que somente os bancos mais sólidos sobrevivem. Uma política de opacidade levaria a uma crise bancária sistêmica, independentemente do estado. O nível de credibilidade que maximiza o bem-estar agregado do ponto de vista ex ante é interior. O segundo e o terceiro capítulos estudam problemas de coordenação dinâmicos. O segundo capítulo analisa o bem-estar em um ambiente em que agentes recebem oportunidades aleatórias para migrar entre duas redes. Os resultados mostram que sempre que a rede de pior qualidade (intrínseca) prevalece, isto é eficiente. Na verdade, um planejador central estaria ainda mais inclinado a escolher a rede de pior qualidade. Em equilíbrio, pode haver mudanças ineficientes que ampliem a rede de qualidade superior. Quando indivíduos escolhem entre dois padrões ou redes com níveis de qualidade diferentes, se todos os indivíduos fizessem escolhas simultâneas, a solução eficiente seria que todos adotassem a rede de melhor qualidade. No entanto, quando há fricções e os agentes tomam decisões escalonadas, a solução eficiente difere ix do senso comum. O terceiro capítulo analisa um problema de coordenação dinâmico com decisões escalonadas em que os agentes são heterogêneos ex ante. No modelo, existe um único equilíbrio, caracterizado por thresholds que determinam as escolhas para cada tipo de agente. Apesar da heterogeneidade nos payoffs, há bastante conformidade nas ações individuais em equilíbrio. Os thresholds de diferentes tipos de agentes coincidem parcialmente contanto que exista um conjunto de crenças arbitrário que justifique esta conformidade. No entanto, as estratégias de equilíbrio de diferentes tipos nunca coincidem totalmente. Além disso, a conformidade não é ineficiente. A solução eficiente apresentaria estratégias ainda mais similares para tipos distintos em comparação com o equilíbrio decentralizado.

The status of flue gas desulfurization applications in the United States : a technological assessment : highlights : [a staff report of the Bureau of Power /

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