Mapping Thunder Sources by Inverting Acoustic and Electromagnetic Observations

We present a new method of locating current flow in lightning strikes by inversion of thunder recordings constrained by Lightning Mapping Array observations. First, radio frequency (RF) pulses are connected to reconstruct conductive channels created by leaders. Then, acoustic signals that would be produced by current flow through each channel are forward modeled. The recorded thunder is considered to consist of a weighted superposition of these acoustic signals. We calculate the posterior distribution of acoustic source energy for each channel with a Markov Chain Monte Carlo inversion that fits power envelopes of modeled and recorded thunder; these results show which parts of the flash carry current and produce thunder. We examine the effects of RF pulse location imprecision and atmospheric winds on quality of results and apply this method to several lightning flashes over the Magdalena Mountains in New Mexico, USA. This method will enable more detailed study of lightning phenomena by allowing researchers to map current flow in addition to leader propagation

Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Síndrome da Má-adaptação ao trabalho em turnos: uma abordagem ergonômica

O sistema de trabalho em turnos e noturno por ir contra a natureza humana, eminentemente diurna, traz prejuízos para a saúde do trabalhador tanto nos aspectos físicos e psíquicos, como emocionais e sociais. As manifestações agudas como insónia, excessiva sonolência durante o trabalho, distúrbios de humor, aumento de acidentes e problemas familiares e as manifestações crônicas como desordens do sono, doenças cardiovasculares e gastrointestinais, separação e divórcio, compõem os sinais e sintomas da Síndrome da Má-adaptação ao Trabalho em Turnos. O presente trabalho teve por objetivos analisar a Síndrome da Má-adaptação ao Trabalho em Turnos e o Trabalho Noturno e apresentar um estudo de caso onde através de questionários foram pesquisados aspectos de cronobiologia, variáveis biológicas e psicossociais relacionadas com o trabalho em turnos e noturno em uma empresa do setor cerâmico de Santa Catarina que utiliza o sistema de trabalho em turnos não rodiziantes. O estudo de caso revelou que em média 1 em cada 5 trabalhadores apresentaram pelo menos um dos sintomas de inadaptação ao trabalho em turnos e noturno e que pelo menos 10% dos trabalhadores manifestaram sintomatologia característica da Síndrome da Má-adaptação ao Trabalho em Turnos.<br>The shiftwork and nightwork system, for going against human nature, wich is eminently a day one, harms a worker's health from a physical, psychic, emotional and social point of view. Acute manifestations such as isomnia, excessive s/eepness during work hours, changes of humor, increased rates of accidents and family problems, as well as chronic manifestations assleep disorders, cardiovascular and gastrointestinal diseases, separation and divorce, make up signs and symptoms of Shiftwork Maladaptation Syndrome. This work sought to investigate Shiftwork Maladaptation Syndrome, and to analyze Night Work. By means of questionnaires, chronobiology aspects, biological and psicossocial variables have been researched such as related to shift and night work in a Santa Catarina enterprise working with ceramic products, where a non - rotatory shift work system is employed. The study of the case showed that 7 in 5 workers presented at least one of maladaptation symptoms when placed on shift and night work, and that at least 10% at workers exhibited symptomatology identified with shiftwork maladaptation syndrome