Challenges and opportunities in late-stage chronic kidney disease

There is increasing recognition that chronic diseases are a major challenge for health delivery systems and treasuries. These are highly prevalent and costly diseases and frequency is expected to increase greatly as the population of many countries ages. Chronic kidney disease (CKD) has not received the same attention as other chronic diseases such as congestive heart failure; yet, the prevalence and costs of CKD are substantial. Greater recognition and support for CKD may require that the disease no longer be viewed as one continuous disease state. Early CKD stages require less complex care and generate lower costs. In contrast, late-stage CKD is every bit as complex and costly as other major chronic diseases. Health authorities may not recognize and fund CKD care appropriately until late-stage CKD is defined clearly as separate and distinct from earlier stages of disease. In this review, we describe the burden of chronic diseases, consider the challenges and barriers and propose processes to improve late-stage CKD care. In particular, we recommend the need for improved continuity of care, enhanced use of information technology, multidisciplinary care, timely referral to nephrologists, protocol use and improved patient engagement

Medication discrepancies in late-stage chronic kidney disease.

Background: Late-stage chronic kidney disease (LS-CKD) can be defined by glomerular filtration rate (GFR) 0-30 mL/min. It is a period of risk for medication discrepancies because of frequent hospitalizations, fragmented medical care, inadequate communication and polypharmacy. In this study, we sought to characterize medication discrepancies in LS-CKD. Methods: We analyzed all patients enrolled in Northwell Health\u27s Healthy Transitions in LS-CKD program. All patients had estimated GFR 0-30 mL/min, not on dialysis. Medications were reviewed by a nurse at a home visit. Patients\u27 medication usage and practice were compared with nephrologists\u27 medication lists, and discrepancies were characterized. Patients were categorized as having either no discrepancies or one or more. Associations between patient characteristics and number of medication discrepancies were evaluated by chi-square or Fisher\u27s exact test for categorical variables, and two-sample Results: Seven hundred and thirteen patients with a median age of 70 (interquartile range 58-79) years were studied. There were 392 patients (55.0% of the study population) with at least one medication discrepancy. The therapeutic classes of medications with most frequently occurring medication discrepancies were cardiovascular, vitamins, bone and mineral disease agents, diuretics, analgesics and diabetes medications. In multivariable analysis, factors associated with higher risk of discrepancies were congestive heart failure [odds ratio (OR) 2.13; 95% confidence interval (CI) 1.44-3.16; P = 0.0002] and number of medications (OR 1.29; 95% CI 1.21-1.37; P \u3c 0.0001). Conclusions: Medication discrepancies are common in LS-CKD, affect the majority of patients and include high-risk medication classes. Congestive heart failure and total number of medications are independently associated with greater risk for multiple drug discrepancies. The frequency of medication discrepancies indicates a need for great care in medication management of these patients

Acute kidney injury in patients hospitalized with COVID-19

© 2020 International Society of Nephrology The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation. Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 694 died (35%), 519 (26%) were discharged and 780 (39%) were still hospitalized. AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis

Employers’ Perception on the Antecedents of Graduate Employability for the Information Technology Sector

This chapter aims to analyze the perceptions of the employers in the Information Technology (IT) sector in India on the antecedents of graduate employability. With an increased emphasis on Organizational flexibility in today’s volatile and complex Business environment, the employability of the workforce has gained crucial significance. Flexibility has been acknowledged as a predictor of Organizational performance (Sushil, Global J Flex Syst Manag 16(4):309–311, 2015) and its Strategic driver (Sharma et al., Global J Flex Syst Manag 11(3):51–68, 2010). Flexible strategies and business plan often demand the need to scale up the quality of manpower or shift the required skill set to swiftly adapt to the Market changes accordingly. This Flexibility is not confined to the quantity of manpower only but also encompasses the quality of skills deployed by the manpower (Srivastava, Global J Flex Syst Manag 17(1):105–108, 2016). Therefore, it is imperative for the potential Job seeker to understand and continuously adapt to the changing knowledge and skill requirements of the employers to develop and maintain their employability. The employers in this dynamic sector demand a range of knowledge, skills, and other attributes from potential job seekers. However, the graduates passing out of Higher Education Institutions fail to meet these expectations of the employers. Therefore, the sector is struggling with the challenges of talent crunch and qualitative demand–Demand–supply mismatch of manpower. The identification of factors that influence graduate employability is based on literature review. This chapter is empirical and examines the perceptions of the employers on the factors that impact employability and validates the association between the research constructs. Opinion surveys are used to elicit responses from a sample of 236 respondents, i.e., Technical/HR personnel at the middle-level/upper middle-level management positions spanning across 71 reputed IT companies in India. These respondents are actively involved in the staffing of graduates seeking Technical jobs in IT sector. The perception of these employers has been investigated using bivariate and multivariate analysis techniques. The key insights drawn in this chapter enable potential job seekers to clearly understand the employer demands in the IT sector and equip themselves with the required knowledge and skills. This also contributes to enhancing the manpower Flexibility in organizations. The chapter has significant implications for the policy-makers and key stakeholders to bridge the Employability gap in this sector

Manejo de insetos polinizadores adotado por produtores de canola do Rio Grande do Sul e do Paraná.

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Visitantes florais e potenciais polinizadores da cultura da macieira.

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The gender gap in brazilian entomology: an analysis of the academic scenario.

Although women are about half of world's population, they are underrepresented in many sectors including academia and the research scenario in general. Gender gap in Entomology has been pointed out in other publications; however, data for Brazil has never been demonstrated. Here we provide a diagnosis for the Brazilian Entomology scenario in order to contribute to propositions towards disentangling the gender gap in general. We analyzed scientometric data for Brazilian Entomology focusing on gender disparity and on personal perceptions related to the gender gap through an online questionnaire. We detected a pervasive gender bias in which the scissor-shaped curve is the most representative effect of it: women were the majority in lower degree stages but the minority in higher degree stages (permanent positions and positions of prestige and power). We also observed mentorship bias and discussed these results in light of intersectionality and the COVID-19 pandemic. Gender differences were perceived differently by the questionnaire respondents considering age, gender, and parenting. With this data and analyses, we have provided elements to stimulate and support change to a healthier and more equitable academic space

Brazilian female researchers do not publish less despite an academic structure that deepens sex gap.

In the 21st century, we still need to talk about gender inequality in science. Even with the sharp growth of studies on this theme over the last decades, we are still trying to convince our peers that diversity matters and, if embraced, makes better science. Part of this draw- back can be related to the need for data to support effective proposals to change the aca- demic scenario. In order to close some of those gaps, we here analyze 1) the profile of Brazilian researchers based on production, impact, and membership to the Brazilian Acad- emy of Sciences, 2) participation in the Editorial boards of Brazilian journals dedicated to Entomology, and, 3) the academic scenario of Brazilian Entomology focusing on the sex of the first and last authors in peer-reviewed international publications related to Entomology. We aimed to provide a deeper look on the Brazilian Entomology scenario and to expand the amount of data availability to stimulate and foster a mind-change in the current academic structure. We performed scientometric searches and analysis using different platforms and found that the number and impact of the publications by female researchers, as observed by relative numbers, are not less than that of males. Despite that, female researchers are less represented at the Brazilian Academy of Sciences and editorial boards, reinforcing the lack of women recognition in science. Thus, we observe that some narratives related to the productivity gap can be misleading to a perpetuation of our internal and structural biases. We here expanded data from a previous paper where we scrutinized the Brazilian Entomol- ogy scenario and discussed the patches and systems that maintain gender gap in science