When the Earth trembles in the americas: the experience of haiti and chile 2010.

The response of the nephrological community to the Haiti and Chile earthquakes which occurred in the first months of 2010 is described. In Haiti, renal support was organized by the Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology (ISN) in close collaboration with Médecins Sans Frontières (MSF), and covered both patients with acute kidney injury (AKI) and patients with chronic kidney disease (CKD). The majority of AKI patients (19/27) suffered from crush syndrome and recovered their kidney function. The remaining 8 patients with AKI showed acute-to-chronic renal failure with very low recovery rates. The intervention of the RDRTF-ISN involved 25 volunteers of 9 nationalities, lasted exactly 2 months, and was characterized by major organizational difficulties and problems to create awareness among other rescue teams regarding the availability of dialysis possibilities. Part of the Haitian patients with AKI reached the Dominican Republic (DR) and received their therapy there. The nephrological community in the DR was able to cope with this extra patient load. In both Haiti and the DR, dialysis treatment was able to be prevented in at least 40 patients by screening and adequate fluid administration. Since laboratory facilities were destroyed in Port-au-Prince and were thus lacking during the first weeks of the intervention, the use from the very beginning on of a point-of-care device (i-STAT®) was very efficient for the detection of aberrant kidney function and electrolyte parameters. In Chile, nephrological problems were essentially related to difficulties delivering dialysis treatment to CKD patients, due to the damage to several units. This necessitated the reallocation of patients and the adaptation of their schedules. The problems could be handled by the local nephrologists. These observations illustrate that local and international preparedness might be life-saving if renal problems occur in earthquake circumstances

Industrial work placement in higher education: a study of civil engineering student engagement

For civil engineering undergraduates, the opportunity to spend a period of time in formal industrial work placement provides an invaluable learning experience. This paper reviews student engagement with short-term industrial placement and provides analysis of questionnaires (n=174) returned by undergraduates studying civil engineering at four Higher Education Institutes (HEI’s) in the West of Scotland. The data captures industrial placement statistics, employability skill-sets and presents brief testimonies from students. Whilst the journey to becoming a professional civil engineer is undoubtedly enhanced by short-term placement clear opportunities exist for HEI’s to affect and change existing pedagogical discourse. Commentary is likely to resonate beyond civil engineering and serve as a timely reminder of the need to re-invigorate academia / industry curriculum partnerships

Cognitive Performance in Midlife Type 2 Diabetes: Results form the ENBIND Study

Aims: To establish the impact of uncomplicated type 2 diabetes on cognitive and neuropsychological performance in midlife. Methods: We performed a cross-sectional study of middle-aged adults with uncomplicated type 2 diabetes and a cohort of healthy control participants. General cognition was assessed using the Montreal Cognitive Assessment test and neuropsychological assessment was undertaken using a detailed neuropsychological assessment battery. Results: A total of 152 participants (102 with type 2 diabetes and 50 controls) were recruited (mean age 52 ± 8 years, 51% women). Participants with midlife type 2 diabetes were more than twice as likely to make an error on the Montreal Cognitive Assessment test [incidence rate ratio 2.44 (95% CI 1.54 to 3.87); P \u3c 0.001]. Further, type 2 diabetes was also associated with significantly lower memory composite score [β: −0.20 (95% CI −0.39 to −0.01); P = 0.04] and paired associates learning score [β: = −1.97 (95% CI −3.51, −0.43); P = 0.01] on the neuropsychological assessment battery following adjustment for age, sex, BMI, educational attainment and hypercholesterolaemia. Conclusions: Even in midlife, type 2 diabetes was associated with small but statistically significant cognitive decrements. These statistically significant decrements, whilst not clinically significant in terms of objective cognitive impairment, may have important implications in selecting out individuals most at risk of later cognitive decline for potential preventative interventions in midlife

The forecasting of dynamical Ross River virus outbreaks: Victoria, Australia

Ross River virus (RRV) is Australia’s most epidemiologically important mosquito-borne disease.During RRV epidemics in the State of Victoria (such as 2010/11 and 2016/17) notifications canaccount for up to 30% of national RRV notifications. However, little is known about factors which canforecast RRV transmission in Victoria. We aimed to understand factors associated with RRVtransmission in epidemiologically important regions of Victoria and establish an early warningforecast system. We developed negative binomial regression models to forecast human RRVnotifications across 11 Local Government Areas (LGAs) using climatic, environmental, andoceanographic variables. Data were collected from July 2008 to June 2018. Data from July 2008 toJune 2012 were used as a training data set, while July 2012 to June 2018 were used as a testing dataset. Evapotranspiration and precipitation were found to be common factors for forecasting RRVnotifications across sites. Several site-specific factors were also important in forecasting RRVnotifications which varied between LGA. From the 11 LGAs examined, nine experienced an outbreakin 2011/12 of which the models for these sites were a good fit. All 11 LGAs experienced an outbreakin 2016/17, however only six LGAs could predict the outbreak using the same model. We documentsimilarities and differences in factors useful for forecasting RRV notifications across Victoria anddemonstrate that readily available and inexpensive climate and environmental data can be used to predict epidemic periods in some areas. Furthermore, we highlight in certain regions the complexityof RRV transmission where additional epidemiological information is needed to accurately predictRRV activity. Our findings have been applied to produce a Ross River virus Outbreak SurveillanceSystem (ROSS) to aid in public health decision making in Victoria

Should nutrient profile models be ‘category specific' or ‘across-the-board'? A comparison of the two systems using diets of British adults

Background/Objectives: Nutrient profile models have the potential to help promote healthier diets. Some models treat all foods equally (across-the-board), some consider different categories of food separately (category specific). This paper assesses whether across-the-board or category-specific nutrient profile models are more appropriate tools for improving diets. Subjects/Methods: Adult respondents to a British dietary survey were split into four groups using a diet quality index. Fifteen food categories were identified. A nutrient profile model provided a measure of the healthiness of all foods consumed. The four diet quality groups were compared for differences in (a) the calories consumed from each food category and (b) the healthiness of foods consumed in each category. Evidence of a healthier diet quality groups consuming more of healthy food categories than unhealthy diet quality groups supported the adoption of across-the-board nutrient profile models. Evidence of healthier diet quality groups consuming healthier versions of foods within food categories supported adoption of category-specific nutrient profile models. Results: A significantly greater percentage of the healthiest diet quality group's diet consisted of fruit and vegetables (21 vs 16%), fish (3 vs 2%) and breakfast cereals (7 vs 2%), and significantly less meat and meat products (7 vs 14%) than the least healthy diet quality group. The foods from the meat, dairy and cereals categories consumed by the healthy diet quality groups were healthier versions than those consumed by the unhealthy diet quality groups. Conclusions: All other things being equal, nutrient profile models designed to promote an achievable healthy diet should be category specific but with a limited number of categories. However models which use large number of categories are unhelpful for promoting a healthy diet

Magnesium lactate in the treatment of Gitelman syndrome: patient-reported outcomes.

BACKGROUND: Gitelman syndrome (GS) is a rare recessively inherited renal tubulopathy associated with renal potassium (K) and magnesium (Mg) loss. It requires lifelong K and Mg supplementation at high doses that are at best unpalatable and at worst, intolerable. In particular, gastrointestinal side effects often limit full therapeutic usage. METHODS: We report here the analysis of a cohort of 28 adult patients with genetically proven GS who attend our specialist tubular disorders clinic, in whom we initiated the use of a modified-release Mg preparation (slow-release Mg lactate) and who were surveyed by questionnaire. RESULTS: Twenty-five patients (89%) preferred the new treatment regimen. Of these 25, 17 (68%) regarded their symptom burden as improved and seven reported no worsening. Of the 25 who were not Mg-treatment naïve, 13 (59%) patients reported fewer side effects, 7 (32%) described them as the same and only 2 (9%) considered side effects to be worse. Five were able to increase their dose without ill-effect. Overall, biochemistry improved in 91% of the 23 patients switched from therapy with other preparations who chose to continue the modified-release Mg preparation. Eleven (48%) improved both their Mg and K mean levels, 3 (13%) improved Mg levels only and in 7 cases (30%), K levels alone rose. CONCLUSIONS: Patient-reported and biochemical outcomes using modified-release Mg supplements were very favourable, and patient choice should play a large part in choosing Mg supplements with GS patients.This work was supported by the Wellcome Trust and the NIHR Cambridge Biomedical Research Centre, and contains data that were presented in abstract form at ASN Kidney week 2014.This is the final version of the article. It first appeared from Oxford University Press via https://doi.org/10.1093/ndt/gfw01

Seeking safety beyond refuge : the impact of immigration and citizenship policy upon refugees in the UK

Western states are concerned about maintaining and securing national borders. Across Europe, one response has been to implement restrictive asylum regimes that prevent ‘bogus’ applicants and grant refuge only to the ‘deserving’. Alongside these concerns, states are eager to encourage socially cohesive communities. One recent tool adopted by the UK government has been citizenship policy, including English language/life in the UK tests and citizenship ceremonies. By drawing upon in-depth interviews with refugees in Scotland (UK), this paper explores the impact of the current asylum regime and citizenship policies from the perspective of individual voices that are often absent from wider debates. It explores how temporary refugee status impacts upon individuals’ everyday lives including employment and education, and impacts upon children. The data also question the reasons for refugees deciding to become British citizens (or not) and highlight instrumental reasons alongside less tangible factors such as gaining a sense of security. Taking the discussion forward, the study explores some unintended consequences of immigration and citizenship policies in the UK. The research suggests that not only do restrictive asylum policies negatively impact upon refugees and their integration but also serve to elevate fear and uncertainty, which can unintentionally spur individuals to seek naturalisation

Optimising predictive modelling of Ross River virus using meteorological variables

Background:Statistical models are regularly used in the forecasting and surveillance of infectious diseases to guide public health. Variable selection assists in determining factors associated with disease transmission, however, often overlooked in this process is the evaluation and suitability of the statistical model used in forecasting disease transmission and outbreaks. Here we aim to evaluate several modelling methods to optimise predictive modelling of Ross River virus (RRV) disease notifications and outbreaks in epidemiological important regions of Victoria and Western Australia.Methodology/Principal findings:We developed several statistical methods using meteorological and RRV surveillance data from July 2000 until June 2018 in Victoria and from July 1991 until June 2018 in Western Australia. Models were developed for 11 Local Government Areas (LGAs) in Victoria and seven LGAs in Western Australia. We found generalised additive models and generalised boosted regression models, and generalised additive models and negative binomial models to be the best fit models when predicting RRV outbreaks and notifications, respectively. No association was found with a model’s ability to predict RRV notifications in LGAs with greater RRV activity, or for outbreak predictions to have a higher accuracy in LGAs with greater RRV notifications. Moreover, we assessed the use of factor analysis to generate independent variables used in predictive modelling. In the majority of LGAs, this method did not result in better model predictive performance.Conclusions/Significance:We demonstrate that models which are developed and used for predicting disease notifications may not be suitable for predicting disease outbreaks, or vice versa. Furthermore, poor predictive performance in modelling disease transmissions may be the result of inappropriate model selection methods. Our findings provide approaches and methods to facilitate the selection of the best fit statistical model for predicting mosquito-borne disease notifications and outbreaks used for disease surveillance