Chronic kidney disease after liver, cardiac, lung, heart–lung, and hematopoietic stem cell transplant

Patient survival after cardiac, liver, and hematopoietic stem cell transplant (HSCT) is improving; however, this survival is limited by substantial pretransplant and treatment-related toxicities. A major cause of morbidity and mortality after transplant is chronic kidney disease (CKD). Although the majority of CKD after transplant is attributed to the use of calcineurin inhibitors, various other conditions such as thrombotic microangiopathy, nephrotic syndrome, and focal segmental glomerulosclerosis have been described. Though the immunosuppression used for each of the transplant types, cardiac, liver and HSCT is similar, the risk factors for developing CKD and the CKD severity described in patients after transplant vary. As the indications for transplant and the long-term survival improves for these children, so will the burden of CKD. Nephrologists should be involved early in the pretransplant workup of these patients. Transplant physicians and nephrologists will need to work together to identify those patients at risk of developing CKD early to prevent its development and progression to end-stage renal disease

Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data

Background: Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. Methods: Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. Results: Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63–3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19–1.74), p < 0.001); history of transfusion (1.48(1.13–1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21–1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47–0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47–0.76), p < 0.001); younger-age (1.07 (1.03–1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46–0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23–2.44) and 1.46(1.18–1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. Conclusions: Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. Trial registration: ISRCTN ISRCTN84086586. Keywords: Severe anaemia, Readmissio

Radiocarbon evidence that carbon from the Deepwater Horizon spill entered the planktonic food web of the Gulf of Mexico

The Deepwater Horizon (Macondo) oil spill released large volumes of oil and gas of distinct carbon isotopic composition to the northern Gulf of Mexico, allowing Graham et al (2010 Environ. Res. Lett. 5 045301) to use stable carbon isotopes (δ ^13 C) to infer the introduction of spilled oil into the planktonic food web. Surface ocean organic production and measured oil are separated by 5–7‰ in stable carbon isotope (δ ^13 C) space, while in radiocarbon (Δ ^14 C) space these two potential sources are separated by more than 1000‰. Thus radiocarbon isotopes provide a more sensitive tracer by which to infer possible introduction of Macondo oil into the food web. We measured Δ ^14 C and δ ^13 C in plankton collected from within 100 km of the spill site as well as in coastal and offshore DIC (dissolved inorganic carbon or ΣCO _2 ) to constrain surface production values. On average, plankton values were depleted in ^14 C relative to surface DIC, and we found a significant linear correlation between Δ ^14 C and δ ^13 C in plankton. Cumulatively, these results are consistent with the hypothesis that carbon released from the Deepwater Horizon spill contributed to the offshore planktonic food web. Our results support the findings of Graham et al (2010 Environ. Res. Lett. 5 045301), but we infer that methane input may be important

Roads and landslides in Nepal: How development affects environmental risk

10.5194/nhess-18-3203-2018Natural Hazards and Earth System Sciences18123203-321

Analysis of Reactivity Temperature Coefficient for Light Water Moderated HEU-UAl 4 and LEU-UO 2 Lattices of MNSR

Abstract: Analysis of the Reactivity Temperature Coefficient (RTC) of the Ghana Research Reactor-1 using the reference HEU-UAl 4 and then the LEU-UO 2 fuel currently being developed under the RETR programme was carried out to determine the Fuel Temperature Coefficient (FTC) and Moderator Temperature Coefficient (MTC) using SCUBA, a locally developed FORTRAN 95 code. The contribution of each isotope present in the fuel cell to RTC was determined by analyzing the temperature effect on the thermal fission factor (η) and the thermal utilization factor (f). The average values of the core RTC for the temperature range of 15 o C to 140 o C at the beginning of life of the core were observed to be -0.70×10 -4 and -2.061×10 -4 for the HEU-UAl 4 and the LEU-UO 2 respectively

An open-label, dose-ranging study of Rolontis, a novel long-acting myeloid growth factor, in breast cancer

This randomized, open-label, active-controlled study investigated the safety and efficacy of three doses of Rolontis (eflapegrastim), a novel, long-acting myeloid growth factor, versus pegfilgrastim in breast cancer patients being treated with docetaxel and cyclophosphamide (TC). The primary efficacy endpoint was duration of severe neutropenia (DSN) during the first cycle of treatment. Patients who were candidates for adjuvant/neoadjuvant TC chemotherapy were eligible for participation. TC was administered on Day 1, followed by 45, 135, or 270 µg/kg Rolontis or 6 mg pegfilgrastim on Day 2. Complete blood counts were monitored daily when the absolute neutrophil count (ANC) fell to &lt; 1.5 × 10 9 /L. Up to four cycles of TC were investigated. The difference in DSN (time from ANC &lt; 0.5 × 10 9 /L to ANC recovery =2.0 × 10 9 /L) between the Rolontis and pegfilgrastim groups was -0.28 days (confidence interval [CI]: -0.56, -0.06) at 270 µg/kg, 0.14 days (CI: -0.28, 0.64) at 135 µg/kg, and 0.72 days (CI: 0.19, 1.27) at 45 µg/kg. Noninferiority to pegfilgrastim was demonstrated at 135 µg/kg (P = 0.002) and 270 µg/kg (P &lt; .001), with superiority demonstrated at 270 µg/kg (0.03 days; P = 0.023). The most common treatment-related adverse events (AEs) were bone pain, myalgia, arthralgia, back pain, and elevated white blood cell counts, with similar incidences across groups. All doses of Rolontis were well tolerated, and no new or significant treatment-related toxicities were observed. In Cycle 1, Rolontis demonstrated noninferiority at the 135 µg/kg dose and statistical superiority in DSN at the 270 µg/kg dose when compared to pegfilgrastim

Randomized phase 2, open-label, dose-ranging study of a novel, long-acting G-CSF (SPI-2012) or pegfilgrastim for the management of neutropenia in patients with breast cancer (BC) treated with (Neo) adjuvant chemotherapy with docetaxel + cyclophosphamide (TC)

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