Early Ultrasound Surveillance of Newly-Created Hemodialysis Arteriovenous Fistula

Introduction: We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomised controlled trial (RCT) evaluation of ultrasounddirected salvage intervention. Methods: Consenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF non-maturation identified by logistic regression modelling. Results: Of 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF non-maturation could be optimally modelled from the week four ultrasound parameters alone, but with only moderate positive predictive values (wrist, 60.6% (95% CI 43.9 – 77.3); elbow, 66.7% (48.9 - 84.4)). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modelling of the early ultrasound characteristics could also predict primary patency failure at 6 months, but that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data. Conclusions: Early ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

Corporate social responsibility and stakeholder engagement in Ghana’s mining sector: a case study of Newmont Ahafo mines

AbstractEven though the concept of Corporate Social Responsibility (CSR) has been applauded for several decades, the concept of stakeholder engagement is relatively new to the Ghanaian mining sector. This study investigates the CSR process of an extractive company and examines how stakeholders are engaged in CSR. Using purposive and snowball sampling in identifying its respondents, data was gathered through interviewing 21 selected respondents from various stakeholder groups and documents such as sustainability annual reports were analyzed. It was discovered that Newmont Ahafo Mines has consistently had a prominent CSR drive in Ghana for several years and stakeholder involvement in CSR is important for implementing relevant CSR programs. Findings of this study contribute to the building of empirical reference which will serve as guidelines for management practitioners dealing with stakeholder relations and CSR in Ghana’s mining sector. Therefore, it is recommended that the mining sector put immense effort in engaging various stakeholders in their CSR initiatives.</jats:p

Corporate social responsibility and stakeholder engagement in Ghana's mining sector: A case study of Newmont Ahafo mines

Even though the concept of Corporate Social Responsibility (CSR) has been applauded for several decades, the concept of stakeholder engagement is relatively new to the Ghanaian mining sector. This study investigates the CSR process of an extractive company and examines how stakeholders are engaged in CSR. Using purposive and snowball sampling in identifying its respondents, data was gathered through interviewing 21 selected respondents from various stakeholder groups and documents such as sustainability annual reports were analyzed. It was discovered that Newmont Ahafo Mines has consistently had a prominent CSR drive in Ghana for several years and stakeholder involvement in CSR is important for implementing relevant CSR programs. Findings of this study contribute to the building of empirical reference which will serve as guidelines for management practitioners dealing with stakeholder relations and CSR in Ghana's mining sector. Therefore, it is recommended that the mining sector put immense effort in engaging various stakeholders in their CSR initiatives

Corporate Social Responsibility (CSR): Motivations and challenges of a Multinational Enterprise (MNE) subsidiary's engagement with host communities in Ghana

This paper aims to explore the motivations and challenges of engaging host communities in CSR practices within the context of Newmont Ahafo Mines (NAM), a subsidiary of a Multinational Mining Enterprise (MNE) operating in Ghana's mining sector. This paper draws insights from stakeholder theory and interviews conducted with internal stakeholders (management and employees) and stakeholders in host communities (traditional rulers and community members). The findings indicate that effective decision-making, gaining legitimacy, cost savings, management of risks, and accountability are some of the perceived motivations of NAM's stakeholder engagement in CSR. Nonetheless, the most critical challenges to NAM in improving stakeholder engagement in CSR practices are the lack of community members' support in CSR projects, communities' high expectations of NAM on development projects and over-dependency on NAM on the part of host communities. Therefore, it is reasonable for MNEs in emerging economies to attune engagement practices to the host community's context. This will enable CSR practices and policies to fully exploit the latent benefits of CSR in the mining sector

Corporate Social Responsibility (CSR): motivations and challenges of a Multinational Enterprise (MNE) subsidiary’s engagement with host communities in Ghana

AbstractThis paper aims to explore the motivations and challenges of engaging host communities in CSR practices within the context of Newmont Ahafo Mines (NAM), a subsidiary of a Multinational Mining Enterprise (MNE) operating in Ghana’s mining sector. This paper draws insights from stakeholder theory and interviews conducted with internal stakeholders (management and employees) and stakeholders in host communities (traditional rulers and community members). The findings indicate that effective decision-making, gaining legitimacy, cost savings, management of risks, and accountability are some of the perceived motivations of NAM’s stakeholder engagement in CSR. Nonetheless, the most critical challenges to NAM in improving stakeholder engagement in CSR practices are the lack of community members’ support in CSR projects, communities’ high expectations of NAM on development projects and over-dependency on NAM on the part of host communities. Therefore, it is reasonable for MNEs in emerging economies to attune engagement practices to the host community’s context. This will enable CSR practices and policies to fully exploit the latent benefits of CSR in the mining sector.</jats:p

Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study

Introduction Arteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for achieving dialysis of the prevalent dialysis population via permanent access (as opposed to a central venous catheter). This is partly due to the relatively poor maturation rate of newly created fistulas, with as many as 50% of fistulas failing to mature.The Surveillance Of arterioveNous fistulAe using ultRasound study will examine whether a protocolised programme of Doppler ultrasound (US) surveillance can identify, early after creation, potentially correctable problems in those AVFs that subsequently fail to mature.Methods and analysis This is a multicentre observational study that will assess newly created AVFs by Doppler US performed at 2, 4, 6 and 10 weeks after creation. The primary outcome measure will be primary fistula patency at week 10. Secondary outcome measures include: successful use of the fistula; clinical suitability for dialysis; creation of new fistula or radiological salvage; fistula thrombosis; secondary fistula patency rate and patient acceptability.Ethics and dissemination The study has been approved by the Cambridgeshire and Hertfordshire Research Ethics Committee and by the Health Research Authority (REC 18/EE/0234). The results generated from this work will be published as open access, within 3 years of trial commencement. We will also present our findings at key national/international renal meetings, as well as support volunteers at renal patient groups to disseminate the trial outcome.Trial registration number ISRCTN3603387

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo