Estimated GFR reporting is associated with decreased nonsteroidal anti-inflammatory drug prescribing and increased renal function

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used; however, they are also nephrotoxic with both acute and chronic effects on kidney function. Here we determined NSAID prescribing before and after estimated GFR (eGFR) reporting and evaluate renal function in patients who used NSAIDs but stopped these after their first eGFR report. A population-based longitudinal analysis using a record-linkage database was conducted with the GFR estimated using the four-variable equation from the MDRD study and analyzed by trend test, paired t-test, and logistic regression modeling. Prescriptions for NSAIDs significantly decreased from 39,459 to 35,415 after implementation of eGFR reporting from the second quarter of 2005 compared with the first quarter of 2007. Reporting eGFR was associated with reduced NSAID prescriptions (adjusted odds ratio, 0.78). NSAID prescription rates in the 6 months before April 2006 were 18.8, 15.4, and 7.0% in patients with CKD stages 3, 4, and 5 and 15.5, 10.7, and 6.3%, respectively, after eGFR reporting commenced. In patients who stopped NSAID treatment, eGFR significantly increased from 45.9 to 46.9, 23.9 to 27.1, and 12.4 to 26.4 ml/min per 1.73 m(2) in 1340 stage 3 patients, 162 stage 4 patients, and 9 stage 5 patients, respectively. Thus, NSAID prescribing decreased after the implementation of eGFR reporting, and there were significant improvements in estimated renal function in patients who stopped taking NSAIDs. Hence, eGFR reporting may result in safer prescribing

An inerter-equipped vibrating barrier for non-invasive motion control of seismically excited structures

The Vibrating Barrier (ViBa) is a large-scale oscillating mass-spring-damper unit contained in the ground and tuned to mitigate the motion of surrounding structures under earthquakeinduced ground shaking, without being directly in contact to them, through a structure-soilstructure interaction mechanism. Previous research showed that ViBa achieves significant seismic structural response reductions but, in doing so, it requires excessive vibrating mass, equal to the mass of the structure that aims to control or more, which hinders its practical applicability. This paper considers coupling ViBa with a grounded inerter acting as a mass amplifier to reduce ViBa mass/weight in suppressing seismically induced structural response. Attention is focused on structures amenable to modelling as single-degree-of freedom (SDOF) damped oscillators by establishing equations of motion of a 5-DOF dynamical system of a grounded inerter-equipped ViBa (IViBa) fused with a SDOF structure and accounting for soil structure interaction (SSI) effects due to soil compliance. Optimal closed-form H∞ and numerical H2 IViBa tuning are addressed minimizing the response of SDOF structure subject to harmonic resonant and to broadband/white base excitation, respectively. Numerical results pertaining to a small-scale physical ViBa prototype specimen are furnished quantifying the trade-off between IViBa mass and inertance considering non-rigid/compliant inerter-to-ground connectivity. Monotonic IViBa mass/weight reduction trend is found for fixed targeted structural performance under white stationary as well as colored non-stationary seismic excitation for increasing inertance and for sufficiently rigid inerter-to-ground connection. It is concluded that careful engineering design of the inerter-to-ground connection minimizing compliance is most critical in fully exploiting the beneficial effects of grounded inerter for mass/weight IViBa reduction facilitating, thus, its practical implementation

Emergent global patterns of ecosystem structure and function from a mechanistic general ecosystem model

Anthropogenic activities are causing widespread degradation of ecosystems worldwide, threatening the ecosystem services upon which all human life depends. Improved understanding of this degradation is urgently needed to improve avoidance and mitigation measures. One tool to assist these efforts is predictive models of ecosystem structure and function that are mechanistic: based on fundamental ecological principles. Here we present the first mechanistic General Ecosystem Model (GEM) of ecosystem structure and function that is both global and applies in all terrestrial and marine environments. Functional forms and parameter values were derived from the theoretical and empirical literature where possible. Simulations of the fate of all organisms with body masses between 10 µg and 150,000 kg (a range of 14 orders of magnitude) across the globe led to emergent properties at individual (e.g., growth rate), community (e.g., biomass turnover rates), ecosystem (e.g., trophic pyramids), and macroecological scales (e.g., global patterns of trophic structure) that are in general agreement with current data and theory. These properties emerged from our encoding of the biology of, and interactions among, individual organisms without any direct constraints on the properties themselves. Our results indicate that ecologists have gathered sufficient information to begin to build realistic, global, and mechanistic models of ecosystems, capable of predicting a diverse range of ecosystem properties and their response to human pressures

Disease progression in Plasmodium knowlesi malaria is linked to variation in invasion gene family members.

Emerging pathogens undermine initiatives to control the global health impact of infectious diseases. Zoonotic malaria is no exception. Plasmodium knowlesi, a malaria parasite of Southeast Asian macaques, has entered the human population. P. knowlesi, like Plasmodium falciparum, can reach high parasitaemia in human infections, and the World Health Organization guidelines for severe malaria list hyperparasitaemia among the measures of severe malaria in both infections. Not all patients with P. knowlesi infections develop hyperparasitaemia, and it is important to determine why. Between isolate variability in erythrocyte invasion, efficiency seems key. Here we investigate the idea that particular alleles of two P. knowlesi erythrocyte invasion genes, P. knowlesi normocyte binding protein Pknbpxa and Pknbpxb, influence parasitaemia and human disease progression. Pknbpxa and Pknbpxb reference DNA sequences were generated from five geographically and temporally distinct P. knowlesi patient isolates. Polymorphic regions of each gene (approximately 800 bp) were identified by haplotyping 147 patient isolates at each locus. Parasitaemia in the study cohort was associated with markers of disease severity including liver and renal dysfunction, haemoglobin, platelets and lactate, (r = ≥ 0.34, p =  <0.0001 for all). Seventy-five and 51 Pknbpxa and Pknbpxb haplotypes were resolved in 138 (94%) and 134 (92%) patient isolates respectively. The haplotypes formed twelve Pknbpxa and two Pknbpxb allelic groups. Patients infected with parasites with particular Pknbpxa and Pknbpxb alleles within the groups had significantly higher parasitaemia and other markers of disease severity. Our study strongly suggests that P. knowlesi invasion gene variants contribute to parasite virulence. We focused on two invasion genes, and we anticipate that additional virulent loci will be identified in pathogen genome-wide studies. The multiple sustained entries of this diverse pathogen into the human population must give cause for concern to malaria elimination strategists in the Southeast Asian region

Teaching Mindfulness to Teachers: a Systematic Review and Narrative Synthesis

School teachers report high levels of stress which impact on their engagement with pupils and effectiveness as a teacher. Early intervention or prevention approaches may support teachers to develop positive coping and reduce the experience and impact of stress. This article reviews research on one such approach: mindfulness-based interventions (MBIs) for school teachers. A systematic review and narrative synthesis were conducted for quantitative and qualitative studies that report the effects of MBIs for teachers of children aged 5– 18 years on symptoms of stress and emotion regulation and self-efficacy. Twelve independent publications were identified meeting the inclusion criteria and these gave a total of 13 samples. Quality appraisal of the identified articles was carried out. The effect sizes and proportion of significant findings are reported for relevant outcomes. The quality of the literature varied, with main strengths in reporting study details, and weaknesses including sample size considerations. A range of MBIs were employed across the literature, ranging in contact hours and aims. MBIs showed strongest promise for intermediary effects on teacher emotion regulation. The results of the review are discussed in the context of a model of teacher stress. Teacher social and emotional competence has implications for pupil wellbeing through teacher–pupil relationships and effective management of the classroom. The implications for practice and research are considered

Party mandates and the politics of attention:Party platforms, public priorities and the policy agenda in Britain

This paper develops an attention-based model of party mandates and policy agendas, where parties and governments are faced with an abundance of issues, and must divide their scarce attention across them. In government, parties must balance their desire to deliver on their electoral mandate (i.e. the “promissory agenda”) with a need to continuously adapt their policy priorities in response to changes in public concerns and to deal with unexpected events and the emergence of new problems (i.e. the “anticipatory agenda”). Parties elected to office also have incentives to respond to issues prioritized by the platforms of their rivals. To test this theory, time series cross-sectional models are used to investigate how the policy content of the legislative program of British government responds to governing and opposition party platforms, the executive agenda, issue priorities of the public and mass medi

Strategic Planning for Local Tourism Destinations: An Analysis of Tourism

This paper reports on a study of the planning practices of local tourism destinations. The tourism plans of 30 local tourism destinations in Queensland, Australia were analyzed to determine the extent to which sustainability principles, namely strategic planning and stakeholder participation, were integrated into the planning process. Utilizing a tourism planning process evaluation instrument developed by Simpson (2001), it was found that local tourism destinations are not integrating sustainability principles in their planning processes

The Evolution of Bat Vestibular Systems in the Face of Potential Antagonistic Selection Pressures for Flight and Echolocation

PMCID: PMC3634842This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

A Better-response Strategy for Self-interested Planning Agents

[EN] When self-interested agents plan individually, interactions that prevent them from executing their actions as planned may arise. In these coordination problems, game-theoretic planning can be used to enhance the agents¿ strategic behavior considering the interactions as part of the agents¿ utility. In this work, we define a general-sum game in which interactions such as conflicts and congestions are reflected in the agents¿ utility. We propose a better-response planning strategy that guarantees convergence to an equilibrium joint plan by imposing a tax to agents involved in conflicts. We apply our approach to a real-world problem in which agents are Electric Autonomous Vehicles (EAVs). The EAVs intend to find a joint plan that ensures their individual goals are achievable in a transportation scenario where congestion and conflicting situations may arise. Although the task is computationally hard, as we theoretically prove, the experimental results show that our approach outperforms similar approaches in both performance and solution quality.This work is supported by the GLASS project TIN2014-55637-C2-2-R of the Spanish MINECO and the Prometeo project II/2013/019 funded by the Valencian Government.Jordán, J.; Torreño Lerma, A.; De Weerdt, M.; Onaindia De La Rivaherrera, E. (2018). A Better-response Strategy for Self-interested Planning Agents. Applied Intelligence. 48(4):1020-1040. https://doi.org/10.1007/s10489-017-1046-5S10201040484Aghighi M, Bäckström C (2016) A multi-parameter complexity analysis of cost-optimal and net-benefit planning. In: Proceedings of the Twenty-Sixth International Conference on International Conference on Automated Planning and Scheduling. AAAI Press, London, pp 2–10Bercher P, Mattmüller R (2008) A planning graph heuristic for forward-chaining adversarial planning. 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Integration of decision support systems to improve decision support performance

Decision support system (DSS) is a well-established research and development area. Traditional isolated, stand-alone DSS has been recently facing new challenges. In order to improve the performance of DSS to meet the challenges, research has been actively carried out to develop integrated decision support systems (IDSS). This paper reviews the current research efforts with regard to the development of IDSS. The focus of the paper is on the integration aspect for IDSS through multiple perspectives, and the technologies that support this integration. More than 100 papers and software systems are discussed. Current research efforts and the development status of IDSS are explained, compared and classified. In addition, future trends and challenges in integration are outlined. The paper concludes that by addressing integration, better support will be provided to decision makers, with the expectation of both better decisions and improved decision making processes