Cardiovascular morbidity and mortality after kidney transplantation

Kidney transplantation is the optimal treatment for patients with end stage renal disease (ESRD) who would otherwise require dialysis. Patients with ESRD are at dramatically increased cardiovascular (CV) risk compared to the general population. As well as improving quality of life, successful transplantation accords major benefits by reducing cardiovascular risk in these patients. Worldwide, cardiovascular disease remains the leading cause of death with a functioning graft and therefore is a leading cause of graft failure. This review focuses on the mechanisms underpinning excess cardiovascular morbidity and mortality and current evidence for improving cardiovascular risk in kidney transplant recipients. Conventional cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidaemia, and pre-existing ischaemic heart disease are all highly prevalent in this group. In addition, kidney transplant recipients exhibit a number of risk factors associated with pre-existing renal disease. Furthermore, complications specific to transplantation may ensue includingreduced graft function, side effects of immunosuppression and post transplantation diabetes mellitus. Strategies to improve cardiovascular outcomes post transplantation may include pharmacological intervention including lipid lowering or antihypertensive therapy, optimisation of graft function, lifestyle intervention and personalising immunosuppression to the individual patients risk profile

An experimental evaluation of the use of Δ13C as a proxy for palaeoatmospheric CO2

Understanding changes in atmospheric CO2 over geological time via the development of well constrained and tested proxies is of increasing importance within the Earth sciences. Recently a new proxy (identified as the C3 proxy) has been proposed that is based on the relationship between CO2 and carbon isotope discrimination (Δ13C) of plant leaf tissue. Initial work suggests that this proxy has the capacity to deliver accurate and potentially precise palaeo-CO2 reconstructions through geological time since the origins of vascular plants (∼450 Mya). However, the proposed model has yet to be fully validated through independent experiments. Using the model plant Arabidopsis thaliana exposed to different watering regimes and grown over a wide range of CO2 concentrations (380, 400, 760, 1000, 1200, 1500, 2000 and 3000ppm) relevant to plant evolution we provide an experimental framework that allows for such validation. Our experiments show that a wide variation in Δ13C as a function of water availability is independent of CO2 treatment. Validation of the C3 proxy was undertaken by comparing growth CO2 to estimates of CO2 derived from Δ13C. Our results show significant differences between predicted and observed CO2 across all CO2 treatments and water availabilities, with a strong under prediction of CO2 in experiments designed to simulate Cenozoic and Mesozoic atmospheric conditions (≥1500ppm). Further assessment of Δ13C to predict CO2 was undertaken using Monte Carlo error propagation. This suite of analysis revealed a lack of convergence between predicted and observed CO2. Collectively these findings suggest that the relationship between Δ13C and CO2 is poorly constrained. Consequently the use of Δ13C as a proxy to reconstruct palaeoatmospheric CO2 is of limited use as the estimates of CO2 are not accurate when compared to known growth conditions

Bat Mortality at Ontario Wind Farms Quantified and Compared Using Four Candidate Estimator Equations

Wind farm development is expanding globally. While wind energy is a low-cost option for new electricity supply, the impacts to wildlife populations, including bats (Chiroptera), are of ecological concern. To quantify these impacts, scientists have developed estimator equations to estimate bat mortality, which vary in assumptions related to correction factors. We compared the results of 4 estimators applied to post-construction monitoring data from Ontario, Canada, wind farms to evaluate the effects of field methods and correction factors on estimator consistency. To conduct our study, we obtained data from 21 wind farms between 2011 and 2017 for a total of 26 wind farm survey years, because some wind farms supplied fatality monitoring data in \u3e1 year, to estimate mortality. The Ontario Ministry of Natural Resources and Forestry estimator (OMNRF) tended to be highest, while the Huso, Schoenfeld-Erickson, and GenEst estimators produced similar results. Huso and Schoenfeld-Erickson estimates tended to fall within 95% confidence intervals for GenEst, while OMNRF estimates tended to be higher than the upper confidence interval for GenEst. The results from the OMNRF estimator were consistent with the other candidates when carcass persistence times were \u3e6.5 days but inconsistent when carcass persistence times were shorter. Our results demonstrated the degree to which mortality estimates can vary among estimators and highlight the need for a consistent estimator in comparative studies. We recommend GenEst for such studies, as this estimator can incorporate more inputs with flexibility to reflect site-specific field conditions and produces highly consistent results. Conversely, the OMNRF estimator produced consistently higher estimates than the other candidate estimators, and assumptions related to carcass persistence were regularly violated. We recommend that these limitations be acknowledged when interpreting results from this estimator and that its use be reconsidered when assumptions related to carcass persistence are not met

Principal infinity-bundles - General theory

The theory of principal bundles makes sense in any infinity-topos, such as that of topological, of smooth, or of otherwise geometric infinity-groupoids/infinity-stacks, and more generally in slices of these. It provides a natural geometric model for structured higher nonabelian cohomology and controls general fiber bundles in terms of associated bundles. For suitable choices of structure infinity-group G these G-principal infinity-bundles reproduce the theories of ordinary principal bundles, of bundle gerbes/principal 2-bundles and of bundle 2-gerbes and generalize these to their further higher and equivariant analogs. The induced associated infinity-bundles subsume the notions of gerbes and higher gerbes in the literature. We discuss here this general theory of principal infinity-bundles, intimately related to the axioms of Giraud, Toen-Vezzosi, Rezk and Lurie that characterize infinity-toposes. We show a natural equivalence between principal infinity-bundles and intrinsic nonabelian cocycles, implying the classification of principal infinity-bundles by nonabelian sheaf hyper-cohomology. We observe that the theory of geometric fiber infinity-bundles associated to principal infinity-bundles subsumes a theory of infinity-gerbes and of twisted infinity-bundles, with twists deriving from local coefficient infinity-bundles, which we define, relate to extensions of principal infinity-bundles and show to be classified by a corresponding notion of twisted cohomology, identified with the cohomology of a corresponding slice infinity-topos. In a companion article [NSSb] we discuss explicit presentations of this theory in categories of simplicial (pre)sheaves by hyper-Cech cohomology and by simplicial weakly-principal bundles; and in [NSSc] we discuss various examples and applications of the theory.Comment: 46 pages, published versio

Effect of left atrial and ventricular abnormalities on renal transplant recipient outcome—a single-center study

Background: Premature cardiovascular (CV) death is the commonest cause of death in renal transplant recipients. Abnormalities of left ventricular (LV) structure (collectively termed uremic cardiomyopathy) and left atrial (LA) dilation, a marker of fluid status and diastolic function, are risk factors for reduced survival in patients with end stage renal disease (ESRD). In the present analysis, we studied the impact of pre-transplant LA and LV abnormalities on survival after successful renal transplantation (RT).<p></p> Methods: One hundred nineteen renal transplant recipients (first transplant, deceased donors) underwent cardiovascular MRI (CMR) as part of CV screening prior to inclusion on the waiting list. Data regarding transplant function and patient survival after transplantation were collected.<p></p> Results: Median post-transplant follow-up was 4.3 years (interquartile range (IQR) 1.9, 6.2). During the post-transplant period, 13 patients returned to dialysis after graft failure and 23 patients died with a functioning graft. Survival analyses, censoring for patients returning to dialysis, showed that pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced survival after transplantation. Multivariate Cox regression analyses demonstrated that longer waiting time, poorer transplant function, presence of LV hypertrophy and higher LA volume on screening CMR and female sex were independent predictors of death in patients with a functioning transplant.<p></p> Conclusions: Presence of LVH and higher LA volume are significant, independent predictors of death in patients who are wait-listed and proceed with renal transplantation.<p></p> METHODS: One hundred nineteen renal transplant recipients (first transplant, deceased donors) underwent cardiovascular MRI (CMR) as part of CV screening prior to inclusion on the waiting list. Data regarding transplant function and patient survival after transplantation were collected.<p></p> RESULTS: Median post-transplant follow-up was 4.3 years (interquartile range (IQR) 1.9, 6.2). During the post-transplant period, 13 patients returned to dialysis after graft failure and 23 patients died with a functioning graft. Survival analyses, censoring for patients returning to dialysis, showed that pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced survival after transplantation. Multivariate Cox regression analyses demonstrated that longer waiting time, poorer transplant function, presence of LV hypertrophy and higher LA volume on screening CMR and female sex were independent predictors of death in patients with a functioning transplant.<p></p> CONCLUSIONS: Presence of LVH and higher LA volume are significant, independent predictors of death in patients who are wait-listed and proceed with renal transplantation

Research to improve the design of driven pile foundations in chalk: the ALPACA project

Large numbers of offshore wind turbines, near-shore bridges and port facilities are supported by driven piles. The design and installation of such piles is often problematic in Chalk, a low-density, porous, weak carbonate rock, which is present under large areas of NW Europe. There is little guidance available to designers on driveability, axial capacity, the lateral pile resistance which dominates offshore wind turbine monopile behaviour, or on how piles can sustain axial or lateral cyclic loading. This paper describes the ALPACA project which involves comprehensive field testing at a low-to-medium density chalk research test site. The project is developing new design guidance through comprehensive field testing and analysis combined with in-situ testing campaigns and advanced static-and-cyclic laboratory testing on high quality block and rotary core samples

Shock Compression of Simulated Adobe

A series of plate impact experiments were conducted to investigate the shock response of a simulant for adobe, a traditional form of building material widely used around the world. Air dried bricks were sourced from the London brick company, dry machined and impacted at a range of velocities in a single stage gas gun. The shock Hugoniot was determined (Us =2.26up+0.37) as well as release information. The material was found to behave in a manner which was similar to that of loose sand and considerably less stiff than a weak porous sandstone. The effect of any cementing of the grains was examined by shocking powdered samples contained within a cell arrangement.The research was funded by the Defence Science and Technology Laboratory (part of UK MoD) under the Weapons Science and Technology Centre