Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring

To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis

Coastal Processes from Asbury Park to Manasquan, New Jersey

Source: https://erdc-library.erdc.dren.mil/jspui/This report describes a study of coastal processes along the Atlantic coast from Asbury Park to Manasquan, New Jersey. Numerical predictive models for storm surge, dune erosion, nearshore wave transformation, and shoreline response were used in conjunction with an intensive analysis of available physical data to assist in the design, evaluation, and implementation of comprehensive shore protection plans for this densely populated and heavily structured coastal region. the study was divided into four independent but interrelated areas: (a) deepwater wave climate analysis and nearshore wave transformation, (b) long-term shoreline response numerical modeling, (c) development of coastal stage-frequency relationships, and (d) numerical modeling of storm-induced dune erosion. The results, interrelations, and recommendations of these tasks are presented in the main body of the report together with guidance for the interpretation of the numerical model results. The statistics of the wave hindcast data base, along with graphical representations of the model results, are given in the appendices. Six proposed and four revised design alternatives were evaluated using the shoreline response model to predict the platforms evolution of the beach. Cross-shore responses of the proposed design alternatives were evaluated in a probabilistic manner using the dune erosion model in conjunction with the stage-frequency relationships

Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring

OBJECTIVES: To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. METHODS: This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection ((F/S)UTI) and renal scarring. RESULTS: Children with VUR had higher 2-year rates of recurrent (F/S)UTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent (F/S)UTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09–3.93]) and presence of renal scarring on the baseline (99m)Tc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22–6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent (F/S)UTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86–4.87]). CONCLUSIONS: VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD

Two-Dimensional Depth-Averaged Beach Evolution Modeling: Case Study of the Kizilirmak River Mouth, Turkey

This study presents an application of a two-dimensional beach evolution model to a shoreline change problem at the Kizilirmak River mouth, which has been facing severe coastal erosion problems for more than 20 years. The shoreline changes at the Kizilirmak River mouth have been thus far investigated by satellite images, physical model tests, and one-dimensional numerical models. The current study uses a two-dimensional depth-averaged numerical beach evolution model, developed based on existing methodologies. This model is mainly composed of four main submodels: a phase-averaged spectral wave transformation model, a two-dimensional depth-averaged numerical wave-induced circulation model, a sediment transport model, and a bottom evolution model. To validate and verify the numerical model, it is applied to several cases of laboratory experiments. Later, the model is applied to a shoreline change problem at the groin field to the east of the Kizilirmak River mouth at the Bafra alluvial plain. The results of the numerical model agree with the existing laboratory and field measurements

Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial

BackgroundHearing loss is associated with increased cognitive decline and incident dementia in older adults. We aimed to investigate whether a hearing intervention could reduce cognitive decline in cognitively healthy older adults with hearing loss.MethodsThe ACHIEVE study is a multicentre, parallel-group, unmasked, randomised controlled trial of adults aged 70–84 years with untreated hearing loss and without substantial cognitive impairment that took place at four community study sites across the USA. Participants were recruited from two study populations at each site: (1) older adults participating in a long-standing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) healthy de novo community volunteers. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed up every 6 months. The primary endpoint was 3-year change in a global cognition standardised factor score from a comprehensive neurocognitive battery. Analysis was by intention to treat. This trial was registered at ClinicalTrials.gov, NCT03243422.FindingsFrom Nov 9, 2017, to Oct 25, 2019, we screened 3004 participants for eligibility and randomly assigned 977 (32·5%; 238 [24%] from ARIC and 739 [76%] de novo). We randomly assigned 490 (50%) to the hearing intervention and 487 (50%) to the health education control. The cohort had a mean age of 76·8 years (SD 4·0), 523 (54%) were female, 454 (46%) were male, and most were White (n=858 [88%]). Participants from ARIC were older, had more risk factors for cognitive decline, and had lower baseline cognitive scores than those in the de novo cohort. In the primary analysis combining the ARIC and de novo cohorts, 3-year cognitive change (in SD units) was not significantly different between the hearing intervention and health education control groups (–0·200 [95% CI –0·256 to –0·144] in the hearing intervention group and –0·202 [–0·258 to –0·145] in the control group; difference 0·002 [–0·077 to 0·081]; p=0·96). However, a prespecified sensitivity analysis showed a significant difference in the effect of the hearing intervention on 3-year cognitive change between the ARIC and de novo cohorts (pinteraction=0·010). Other prespecified sensitivity analyses that varied analytical parameters used in the total cohort did not change the observed results. No significant adverse events attributed to the study were reported with either the hearing intervention or health education control.InterpretationThe hearing intervention did not reduce 3-year cognitive decline in the primary analysis of the total cohort. However, a prespecified sensitivity analysis showed that the effect differed between the two study populations that comprised the cohort. These findings suggest that a hearing intervention might reduce cognitive change over 3 years in populations of older adults at increased risk for cognitive decline but not in populations at decreased risk for cognitive decline