Urinary interleukin-18 does not predict acute kidney injury after adult cardiac surgery: a prospective observational cohort study

INTRODUCTION: Urinary interleukin-18 (IL-18) measured during the immediate postoperative period could be a promising predictor of acute kidney injury following adult cardiac surgery. METHODS: In a single-centre prospective observational cohort study, we enrolled 100 adult cardiac surgical patients undergoing cardiopulmonary bypass at a tertiary hospital. We measured the urinary concentration of IL-18 and creatinine preoperatively, on arrival in the intensive care unit, and 24 hours postoperatively. We assessed urinary IL-18 concentration and urinary IL-18/urinary creatinine ratio in relation to the postoperative development of acute kidney injury defined as an increase in serum creatinine of greater than 50% from preoperative to postoperative peak value within 48 hours after surgery. RESULTS: Twenty patients developed acute kidney injury. On arrival in the intensive care unit and at 24 hours postoperatively, urinary IL-18 (median [interquartile range]) was not different in patients who subsequently developed acute kidney injury compared with those who did not: on arrival in the intensive care unit (168 [717] versus 104 [256] pg/mL; P = 0.70) and at 24 hours (195 [483] versus 165 [246] pg/mL; P = 0.47). On arrival in the intensive care unit (area under the curve for the receiver operating characteristic curve [AUC-ROCC] 0.53, 95% confidence interval [CI] 0.38 to 0.68; P = 0.70) and at 24 hours postoperatively (AUC-ROCC 0.55, 95% CI 0.40 to 0.71; P = 0.48), urinary IL-18 was not better than chance in predicting acute kidney injury. All findings were confirmed when urinary IL-18 was adjusted for urinary creatinine. Urinary IL-18 correlated with duration of cardiopulmonary bypass (P < 0.001). CONCLUSION: In adults, early postoperative measurement of urinary IL-18 appears not to be valuable in identifying patients who develop acute kidney injury after cardiac surgery, but rather represents a nonspecific marker of cardiopulmonary bypass-associated systemic inflammation

Lessons from the Small Business Health Options Program: The SHOP Experience in California and Colorado

The Small Business Health Options Program (SHOP) got off to a slow start, with lower-than-expected enrollment and a public perception problem. This report examines California and Colorado's small-business marketplaces, which opened on schedule in October 2013. For business owners, employee choice was the most important reason cited for considering SHOP, with ease of administration a distant second. Several owners see SHOP as a viable alternative to the private exchanges now taking root among large and midsize employers. Interviews also revealed that business owners consider insurance brokers to be an important source of enrollment assistance. Those in the insurance and policy communities perceived small-business owners to be poorly informed about available tax credits; business owners disagreed, saying the credits were simply not key to their decision to elect SHOP. Potential growth areas for SHOP include developing alternative benefit designs, contracting with Medicaid plans, and offering ancillary products, such as wellness programs

Praxisforschungsnetzwerke - Eine explorative Studie mit Akteuren der ökologischen Landwirtschaft in Hessen

In der Praxisforschung werden LandwirtInnen als aktiv Handelnde in den Forschungsprozess eingebunden. LandwirtInnen, BeraterInnen und ForscherInnen gestalten Fragen und Inhalte gemeinsam. Dadurch entstehen Synergieeffekte, die Innovationen für eine nachhaltige Landwirtschaft hervorbringen. Durch langjährige Zusammenarbeit in Netzwerken kann erfolgsentscheidenes Vertrauen zwischen den Akteuren aufgebaut werden. In der vorliegenden Untersuchung wurden im April 2018 acht Akteure aus Hessen (LandwirtInnen, BeraterInnen und ForscherInnen) zur Praxisforschung in Hessen befragt. Hierzu wurde die Methode der Fokusgruppendiskussion genutzt. Die befragten Akteure nehmen eine Expertenstellung innerhalb ihrer Akteursgruppe ein. Die Analyse der Fokusgruppendiskussion zeigt, dass zur Zeit nur wenig Praxisforschung in Hessen betrieben wird und die Akteursgruppen schlecht untereinander vernetzt sind. Die Rahmenbedingungen für intensivere Zusammenarbeit sind sehr gut: Finanzmittel stehen zur Verfügung (Ökoaktionsplan), es gibt motivierte Akteure, es sind viele Universitäten ansässig und erfolgreiche EIP-Projekte bieten eine gute Ausgangsbasis. Um Praxisforschung im ökologischen Landbau in Hessen zu etablieren, werden AnsprechpartnerInnen und eine entsprechende Institutionalisierung benötigt. Die VÖL (Vereinigung Ökologischer Landbau in Hessen e.V.) bietet interessante Voraussetzungen für die Koordination eines Praxisforschungsnetzwerks. Die zur Zeit limitierte Versuchstechnik, eingeschränkte zeitliche Kapazitäten und räumliche Distanzen müssen dabei ebenso realistisch berücksichtigt werden wie eine faire Kostenverteilung

Comparing the implicit valuation of ecosystem services from nature-based solutions in performance-based green area indicators across three European cities

Performance-based green area indicators are increasingly used as policy instruments to promote nature-based solutions in urban property development. We explore the differences and parallels of three green area indicators: Berlin’s Biotope Area Factor (BAF), Stockholm’s Green Area Factor (GYF) and Oslo’s Blue Green Factor (BGF). As policy instruments they vary in their complexity and goals for green and blue structures. The urban planning literature devotes increasing attention to urban ecosystem services (ES) and its potential for utilitarian valuation including assigning preference weights, valuation and pricing of green and blue characteristics of urban development projects. Our comparison shows, however, that nature-based solutions in urban development projects in these three cities are largely planned, designed and implemented without using an explicit ES approach. Nevertheless, the choices of green structures and weighting of areas and structures in each city’s performance-based index constitute implicit valuation of bundles of ecosystem services. By investigating how the three indicator systems’ scores vary in parcel-scale development projects, we identify which ecosystem services each system implicitly promote and neglect. We discuss how variation in the systems’ complexity is the result of policy instrument design trade-offs between comprehensiveness and implementation costs. We argue that using physical proxies of performance in lieu of valuation of ecosystem services lowers site-specific information costs of green area indicators at property level. In the absence of an explicit ES approach, performance-based green area indicators in the three cities have been encouraging nature-based solutions in urban development without pricing of ecosystem services, without apologies. Policy design Green area points Blue-green factor Biotope factor Green space factor Ecosystem ServicesacceptedVersio

The Effect on Systemic and Pulmonary Circulations in the Resuscitation of Asphyxiated Newborn Piglets with 21%, 50% or 100% Oxygen

peer reviewe

On the proper reconstruction of complex dynamical systems spoilt by strong measurement noise

This article reports on a new approach to properly analyze time series of dynamical systems which are spoilt by the simultaneous presence of dynamical noise and measurement noise. It is shown that even strong external measurement noise as well as dynamical noise which is an intrinsic part of the dynamical process can be quantified correctly, solely on the basis of measured times series and proper data analysis. Finally real world data sets are presented pointing out the relevance of the new approach