Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied \u201ccountry-specific\u201d factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a \u201cone-size-fits-all\u201d approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions

Non-AIDS defining cancers in the D:A:D Study-time trends and predictors of survival : a cohort study

BACKGROUND:Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.METHODS:Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.RESULTS:Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.CONCLUSIONS:The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC

Amazon river discharge estimated from TOPEX/Poseidon altimetry

This paper presents an application of the TOPEX/Poseidon (T/P)) satellite altimetry data to estimate river discharge at three sites along the Amazon River. We discuss the methodology to establish empirical relationships between satellite-derived water levels and daily estimations of river discharges based on rating Curves and in situ level measurements at gauging stations. Three sites are chosen: Martacapuru (Rivet- Solimoes), Jatuarana (nearby the confluence of the Solimoes and Rio Negro rivers) and Obidos (Amazon River). We then reconstruct the satellite-based river discharge over a 10-year time span (1992-2002). Comparison between satellite-derived and river discharge at the gauging stations shows that the T/P data can successfully be used for hydrological studies of large rivers, in providing in particular discharge estimates when in Situ data are not available

EDUCATIONAL PROGRAMMES OF THE CERVANTES INSTITUTE IN CHINA

The article analyses the problem of implementation of the Cervantes network Institute's activity in the People's Republic of China in the past decades. The spreading of the Institute's educational programmes aimed at the popularization of the Spanish language and culture among the people of the country who have nothing in common with the Spanish, what is more European, cultural heritage, has become the first priority task of the work of the Institute in the present-day epoch. The fact that there are no analogues of the Bologna process in the traditional Chinese region in East Asia and that China has complicated political relations with the neighboring countries, intensifies China's aspiration for developing cooperation in the educational sphere with the structures functioning on the global scale. That is why the establishment of active ties between the Cervantes Institute and the analogous Chinese structure, the Confucian Institute, Chinese universities and other educational establishments is going on at a rapid pace. At the same time many Chinese students begin to take a great interest in getting a secondary and a higher education in Spain. So, the Cervantes Institute becomes the first step for school leavers in learning the Spanish language and gaining basic knowledge about Spanish education. Chinese universities in their turn look at the Institute as an intermediary structure in their cooperation with the Spanish higher educational establishments. However, the Institute's activity in China differs from that in many European countries that is why the Institute's educational programmes originally aimed at the European standards are changed here, with the rules and standards of the Chinese educational system having been taken into account. Much prominence in this research is given to the analysis of the specific character of the Cervantes Institute's educational programmes in China. The authors point out existing problems in the work of the Institute in China and give some recommendations which in case of their implementation will enable the Institute to broaden its educational activity and enhance its role in intercultural communication in the Chinese society

Ground movement estimation in Yakutia using Dual-Pol InSAR TerraSAR-X data

International audienc

Synthesis of macrocyclic peptidomimetics: Via the Ugi-click-strategy

The Ugi-click-strategy was employed for the synthesis of 12-28 membered 1,2,3-triazole derived macrocyclic peptidomimetics. The Ugi reaction with acid components bearing acetylenic fragments and azidoisocyanides provided the corresponding peptidomimetics in up to 97% isolated yield. The subsequent CuAAC click reaction with these bifunctional substrates containing both acetylene and azide groups was investigated to reveal the influence of the structure of Ugi products on the direction of the click-cyclization. It was demonstrated that this approach allows efficient synthesis of either monomeric (12- and 13-membered) or dimeric (24-, 26- and 28-membered) macrocycles prepared in up to 85% yield. The scope and limitations of this method are discussed. © 2019 The Royal Society of Chemistry

The efficacy of prognosis and early diagnostics of fetal growth retardation [Эффективность прогнозировAния и рAнней диAгностики зAдержки ростA плодA]

The fetal growth retardation takes one of the leading places in the structure of perinatal morbidity and mortality. The frequency of this pregnancy complication in Russia is high – from 3% to 24% among full-term infants and from 18% to 46% among premature newborns. The article analyzes the capabilities of various diagnostic methods for predicting fetal growth retardation. The more indicators are included in the review the more effective is its reliability in the formation of risk groups for this pathology and more effective measures to prevent fetal growth retardation can be taken. © 2018 National Academy of Pediatric Science and Innovation. All rights reserved

Remote sensing of Siberian wetlands and peatlands

International audienc

Multi-satellite approach and in-situ observations to study hydrology of boreal wetlands

International audienc

Multi-satellite approach and in-situ observations to study hydrology of boreal wetlands

International audienc