Renal biopsy: it is time for pragmatism and consensus.

To obtain truly informed consent, we must be able to advise our patients accurately about the relative risk and benefit of any treatment plan. Percutaneous renal biopsy remains the gold standard investigation in the evaluation of intrinsic renal disease. There have been significant improvements in practice over the past decades with regards to percutaneous renal biopsy. Across centres, we appear now to have reached agreement on many aspects of this procedure, such as the need for blood pressure control, avoidance of coagulopathy, use of spring-loaded needles under direct imaging guidance and a need to monitor for complications. The authors from Rush University Medical Centre provide reassurance that renal biopsy in the modern era remains a safe procedure with a low rate of significant bleeding. There remain areas of divergence in practice that may have unintended and deleterious consequences: administration of desmopressin and discontinuation of aspirin, for example, both carry a risk of thrombosis. It is our opinion that it is time to reach consensus on our interpretation of the available data and to draw up guidelines to standardize our biopsy practice internationally

Computational Study Of Molecular Hydrogen In Zeolite Na-A. II. Density Of Rotational States And Inelastic Neutron Scattering Spectra

Part I of this series [J. Chem. Phys. 111, 7599 (1999)] describes a simulation of H(2) adsorbed within zeolite Na-A in which a block Lanczos procedure is used to generate the first several (9) rotational eigenstates of H(2), modeled as a rigid rotor, and equilibrated at a given temperature via Monte Carlo sampling. Here, we show that rotational states are strongly perturbed by the electrostatic fields in the solid. Wave functions and densities of rotational energy states are presented. Simulated neutron spectra are compared with inelastic neutron scattering data. Comparisons are made with IR spectra in which rotational levels may appear due to rovibrational coupling. (C) 2001 American Institute of Physics

Microstructure mixing observations and finescale parameterizations in the Beaufort Sea

Author Posting. © American Meteorological Society, 2021. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 51(1), (2021): 19-35, https://doi.org/10.1175/JPO-D-19-0233.1.In the Beaufort Sea in September of 2015, concurrent mooring and microstructure observations were used to assess dissipation rates in the vicinity of 72°35′N, 145°1′W. Microstructure measurements from a free-falling profiler survey showed very low [O(10−10) W kg−1] turbulent kinetic energy dissipation rates ε. A finescale parameterization based on both shear and strain measurements was applied to estimate the ratio of shear to strain Rω and ε at the mooring location, and a strain-based parameterization was applied to the microstructure survey (which occurred approximately 100 km away from the mooring site) for direct comparison with microstructure results. The finescale parameterization worked well, with discrepancies ranging from a factor of 1–2.5 depending on depth. The largest discrepancies occurred at depths with high shear. Mean Rω was 17, and Rω showed high variability with values ranging from 3 to 50 over 8 days. Observed ε was slightly elevated (factor of 2–3 compared with a later survey of 11 profiles taken over 3 h) from 25 to 125 m following a wind event which occurred at the beginning of the mooring deployment, reaching a maximum of ε= 6 × 10−10 W kg−1 at 30-m depth. Velocity signals associated with near-inertial waves (NIWs) were observed at depths greater than 200 m, where the Atlantic Water mass represents a reservoir of oceanic heat. However, no evidence of elevated ε or heat fluxes was observed in association with NIWs at these depths in either the microstructure survey or the finescale parameterization estimates.This work was supported by NSF Grants PLR 14-56705 and PLR-1303791 and by NSF Graduate Research Fellowship Grant DGE-1650112

Beyond CRAAP: Critical Thinking in the Age of Fake News

In this age of fake news, clickbait, and alternative facts, how can we equip students to find the truth? While fake news is not a new concept, its ubiquity has made it increasingly difficult to distinguish between what is real and what is fabricated. Library professionals have long been in the business of teaching critical thinking and source evaluation. How can we leverage this knowledge to teach students to be confident information consumers and creators? This session will review online learning content created by librarians at Brock University, including a media literacy tutorial for students in the Teacher Education program, and an online workshop on identifying fake news and critically evaluating news information. We will explore the importance of teaching media literacy and critical thinking skills, outline strategies for moving beyond the checklist approach to evaluating information, and share successes, challenges and next steps

Risk factors for bleeding complications after nephrologist-performed native renal biopsy

Background: Bleeding is a recognized complication of native percutaneous renal biopsy. This study aimed to describe the incidence of major bleeding after biopsy in a single centre over a 15-year period and examine factors associated with major bleeding. Methods: We identified consecutive adult patients undergoing ultrasound-guided native renal biopsy in the Glasgow Renal and Transplant Unit from 2000 to 2014. From the electronic patient record, we collected data pertaining to biopsy indication, pre- and post-biopsy laboratory measurements, prescribed medication and diagnosis. Aspirin was routinely continued. We defined major bleeding post-biopsy as the need for blood transfusion, surgical or radiological intervention or death. Binary logistic regression analysis was used to assess factors associated with increased risk of major bleeding. Results: There were 2563 patients who underwent native renal biopsy (1499 elective, 1064 emergency). The average age of patients was 57 (SD 17) years and 57.4% were male. Overall, the rate of major bleeding was 2.2%. In all, 46 patients required transfusion (1.8%), 9 patients underwent embolization (0.4%), no patient required nephrectomy and 1 patient died as a result of a significant late retroperitoneal bleed. Major bleeding was more common in those undergoing emergency compared with elective renal biopsy (3.4 versus 1.1%; P < 0.001). Aspirin was being taken at the time of biopsy in 327 of 1509 patients, with no significant increase in the risk of major bleeding (P = 0.93). Body mass index (BMI) data were available for 546 patients, with no increased risk of major bleeding in 207 patients classified as obese (BMI >30). Conclusions: The risk of major bleeding following native renal biopsy in the modern era is low. Complications are more common when biopsy is conducted as an emergency, which has implications for obtaining informed consent. Our data support the strategy of not stopping aspirin before renal biopsy