Clinical review: Biomarkers of acute kidney injury: where are we now?

The recognition that acute kidney injury (AKI) is a significant independent risk factor for morbidity and mortality has resulted in a substantial number of publications over the past 5 years or more. In no small part these have, to a degree, highlighted the inadequacy of conventional markers of renal insufficiency in the acute setting. Much effort has been invested in the identification of early, specific AKI markers in order to aid early diagnosis of AKI and hopefully improve outcome. The search for a 'biomarker' of AKI has seen early promise replaced by a degree of pessimism due to the lack of a clear candidate molecule and variability of results. We outline the major studies described to date as well as discuss potential reasons for the discrepancies observed and suggest that evolution of the field may result in success with ultimately an improvement in patient outcomes

Segmentation and tracking of video objects for a content-based video indexing context

This paper examines the problem of segmentation and tracking of video objects for content-based information retrieval. Segmentation and tracking of video objects plays an important role in index creation and user request definition steps. The object is initially selected using a semi-automatic approach. For this purpose, a user-based selection is required to define roughly the object to be tracked. In this paper, we propose two different methods to allow an accurate contour definition from the user selection. The first one is based on an active contour model which progressively refines the selection by fitting the natural edges of the object while the second used a binary partition tree with aPeer ReviewedPostprint (published version

Some released prisoners cost municipalities millions by reoffending, but don’t have to

One major consequence of the rising prison populations seen in the past 30 years has been the growth in the number of prisoners released into American communities every year, many of whom go on to commit further crimes. These crimes come with a cost to society. Using New Jersey as a case study, Michael Ostermann & Joel M. Caplan estimate that reoffending within three years of release was valued by the public at almost $6 billion, with an average cost of$80,000 per offense. These costs were also concentrated in the state’s most economically and socially disadvantaged areas. In light of these findings, they argue that not only is incarceration ineffective in cutting the costs of crime, but that policymakers should focus their rehabilitation efforts on those they determine are most likely to re-offend

A History of the Improvement of Internet Protocols Over Satellites using ACTS

This paper outlines the main results of a number of ACTS experiments on the efficacy of using standard Internet protocols over long-delay satellite channels. These experiments have been jointly conducted by NASA\u27s Glenn Research Center and Ohio University over the last six years. The focus of our investigations has been the impact of long-delay networks with non-zero bit-error rates on the performance of the suite of Internet protocols. In particular, we have focused on the most widely used transport protocol, the Transmission Control Protocol (TCP), as well as several application layer protocols. This paper presents our main results, as well as references to more verbose discussions of our experiments

Prevention of acute kidney injury and protection of renal function in the intensive care unit : update 2017

Background: Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity. Objectives: To determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles. Method: A systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system. Results: We formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65-70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely. Conclusion: The results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes

Long-term economic outcomes

Objectives: This study aimed to provide a long-term cost comparison of patients using additional homeopathic treatment (homeopathy group) with patients using usual care (control group) over an observation period of 33 months. Methods: Health claims data from a large statutory health insurance company were analysed from both the societal perspective (primary outcome) and from the statutory health insurance perspective (secondary outcome). To compare costs between patient groups, homeopathy and control patients were matched in a 1:1 ratio using propensity scores. Predictor variables for the propensity scores included health care costs and both medical and demographic variables. Health care costs were analysed using an analysis of covariance, adjusted for baseline costs, between groups both across diagnoses and for specific diagnoses over a period of 33 months. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache. Results: Data from 21,939 patients in the homeopathy group (67.4% females) and 21,861 patients in the control group (67.2% females) were analysed. Health care costs over the 33 months were 12,414 EUR [95% CI 12,022–12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036–10,820] in the control group (p<0.0001). The largest cost differences were attributed to productivity losses (homeopathy: EUR 6,289 [6,118–6,460]; control: EUR 5,498 [5,326–5,670], p<0.0001) and outpatient costs (homeopathy: EUR 1,794 [1,770–1,818]; control: EUR 1,438 [1,414–1,462], p<0.0001). Although the costs of the two groups converged over time, cost differences remained over the full 33 months. For all diagnoses, homeopathy patients generated higher costs than control patients. Conclusion: The analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group