How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study.

BACKGROUND: Chronic kidney disease (CKD) is a substantial cause of morbidity and mortality worldwide with disproportionate effects in sub-Saharan Africa (SSA). The optimal methods to estimate glomerular filtration rate (GFR) and therefore to determine the presence of CKD in SSA are uncertain. We plan to measure iohexol excretion to accurately determine GFR in Malawi, South Africa and Uganda. We will then assess the performance of existing equations to estimate GFR and determine whether a modified equation can better improve estimation of GFR in sub-Saharan Africa. METHODS: The African Research on Kidney Disease (ARK) study is a three-country study embedded within existing cohorts. We seek to enrol 3000 adults > 18 years based on baseline serum creatinine. Study procedures include questionnaires on socio-demographics and established risk factors for kidney disease along with anthropometry, body composition, blood pressure, blood chemistry and urine microscopy and albuminuria. We will measure GFR (mGFR) by plasma clearance of iohexol at 120, 180 and 240 min. We will compare eGFR determined by established equations with mGFR using Bland-Altman plots. We will use regression methods to estimate GFR and compare the newly derived model with existing equations. DISCUSSION: Through the ARK study, we aim to establish the optimal approach to estimate GFR in SSA. The study has the advantage of drawing participants from three countries, which will increase the applicability of the findings across the region. It is also embedded within established cohorts that have longitudinal information and serial measures that can be used to characterize kidney disease over a period of time. This will help to overcome the limitations of previous research, including small numbers, selected population sub-groups, and lack of data on proteinuria. The ARK collaboration provides an opportunity for close working partnerships across different centres, using standardized protocols and measurements, and shared bio-repositories. We plan to build on the collaboration for this study for future work on kidney disease in sub-Saharan Africa, and welcome additional partners from across the continent

Understanding kidney disease in rural central Uganda - Findings from a qualitative study.

As part of a multicentre study on kidney disease (ARK) undertaken in Malawi, South Africa and Uganda we undertook a social science component in Uganda to gather information on people's understandings and perceptions of a diagnosis of kidney dysfunction, treatment and treatment seeking. We recruited 46 people who had been given information about kidney dysfunction and had been found to have some, usually early, signs of mild impairment. Data were collected during two in-depth interviews. Most participants had heard of the condition, but half denied knowledge of the health status of their kidneys or receiving results of tests from the clinic team. This response may have been linked to a lack of symptoms, for those with early stage kidney dysfunction. The treatment people reported receiving caused some uncertainty about condition severity. This may be because several people were treated for other conditions (such as urinary tract infections) and did not require treatment specifically for kidney disease. In our study, participants assessed illness severity based on symptoms and treatment and compared with the progression of other conditions

Living donor liver transplant from an HIV-positive mother to her HIV-negative child : opening up new therapeutic options

OBJECTIVE : Transplant a liver from an HIV-positive mother to her HIV-negative child to save the child’s life. DESIGN : A unique case of living donor liver transplantation from an HIV-positive mother to her HIV-negative child in South Africa. Two aspects of this case are ground-breaking. First, it involves living donation by someone who is HIVpositive and second it involves controlled transplant of an organ from an HIV-positive donor into an HIV-negative recipient, with the potential to prevent infection in the recipient. METHODS : Standard surgical procedure for living donor liver transplantation at our centre was followed. HIV-prophylaxis was administered preoperatively. Extensive, ultrasensitive HIV testing, over and above standard diagnostic assays, was undertaken to investigate recipient serostatus and is ongoing. RESULTS : Both mother and child are well, over 1 year posttransplantation. HIV seroconversion in our recipient was detected with serological testing at day 43 posttransplant. However, a decline in HIV antibody titres approaching undetectable levels is now being observed. No plasma, or cell-associated HIV-1 DNA has been detected in the recipient at any time-point since transplant. CONCLUSION : This case potentially opens up a new living liver donor pool which might have clinical relevance in countries where there is a high burden of HIV and a limited number of deceased donor organs or limited access to transplantation. However, our recipient’s HIV status is equivocal at present and additional investigation regarding seroconversion events in this unique profile is ongoing.The South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa.http://journals.lww.com/aidsonlineam2019Medical Virolog

International consensus is needed on a core outcome set to advance the evidence of best practice in cancer prehabilitation services and research.

Prehabilitation aims to optimise patients’ physical and psychological status before treatment. The types of outcomes measured to assess the impact of prehabilitation interventions vary across clinical research and service evaluation, limiting the ability to compare between studies and services and to pool data. An international workshop involving academic and clinical experts in cancer prehabilitation was convened in May 2022 at Sheffield Hallam University’s Advanced Wellbeing Research Centre, England. The workshop substantiated calls for a core outcome set to advance knowledge and understanding of best practice in cancer prehabilitation and to develop national and international databases to assess outcomes at a population level

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

How should regulators deal with entrenched company executives?

The regulatory framework for corporate governance, both in Australia and internationally, shifts between rules based regimes and principles based approach. The rules based regimes are typified by legislation that imposes mandated compliance based rules, such as the Sarbanes Oxley Act. Other regimes, such as Australia’s CLERP 9 and the ASX Corporate Governance Council’s principles, have opted for a disclosure approach. This paper examines these approaches in the context of the non-binding vote rule, which arguably combines aspects of both. The study’s methodology empirically considers evidence relating to actual voting patterns as well as case study examples of the non-binding vote’s effectiveness. Significantly, our analyses show that from its inception, the non-binding vote was effective in motivating management to change the remuneration package to one they perceived as more acceptable to shareholders and that the non-binding vote is an effective regime to manage CEO remuneration (and by extension) executive remuneration

Characterization of Aquarefined Micro/Nanoporous Lead Material

The process of aquarefining is an environmentally-friendly method for producing pure lead products that exhibit particularly low density. To observe the microstructures of these low-density forms of lead, scanning electron microscopy (SEM) was employed to examine aquarefined lead samples produced under three batches of processing conditions. Due to aquarefined lead\u27s tendency to collapse under its own weight, careful measures were taken during transport and handling to avoid damaging the samples. Three types of microstructures were observed and correlated to changes in processing conditions: octahedron crystallites, microscales, and dendrites. Energy-dispersive x-ray spectrometry (EDS) was used to quantify the amount of oxygen in each of these microstructures, as the type of lead microstructure appears to vary with the amount of oxygen present. For each batch of processing conditions, the density of the samples produced under those conditions was measured using the Archimedes method. The density of the samples ranged from 1.30 to 3.62 g/cm3, which is significantly less than that of conventional lead (11.30 g/cm3). The decrease in density appears to be due to the formation of thinner dendrites and of hydrogen-filled pores during the aquarefining process. From our results, lead and free acid concentrations were determined as the most critical factors in determining the microstructure of the aquarefined lead, with applied current and temperature of secondary importance

Continuity and Change: Exploring stylistic transitions in the anthropomorphic figures of the northwest Kimberley rock art assemblage and the varying contexts of rock art production

One of the largest concentrations of rock paintings in Australia is found in the rugged and remote Kimberley region in the northwest of the continent. A sequence of visually-distinctive figurative styles is likely to span periods of complex cultural change and major climatic events. However, the timing, nature and course of these changes are poorly understood. In order to redress these deficiencies, I investigated the relationships between continuity and change in the form and context of production of anthropomorphic figures in the rock art assemblage. Specifically, I identified the core characteristics of anthropomorphic figures in each of the established stylistic periods. I analysed the evidence cited by previous researchers to support notions of an abrupt discontinuity in the art assemblage between the Wararrajai Gwion and Painted Hand Periods. New chronological data was correlated with environmental evidence to establish the timing of cultural change and potential association of events with the Last Glacial Maximum. Factors that contributed to, or drove change were identified in order to develop an understanding of the social and economic lifeways in the northwest Kimberley through time