Impact of prior CKD management in a renal care network on early outcomes in incident dialysis patients: a prospective observational study

Abstract Background Effective therapeutic strategies are available to prevent adverse outcomes in patients with chronic kidney disease (CKD) but their clinical results are hindered by unplanned implementation. Coordination of care emerges as a suitable way to improve patient outcomes. In this study, we evaluated the effect of planned and coordinated patient management within a dedicated renal care network comparatively to standard renal care delivered in nephrology departments of teaching hospitals. Methods This observational matched cohort study included 40 patients with CKD stage 4–5 in the network group as compared with a control group of 120 patients matched for age, sex and diabetic status. Main outcome was a composite endpoint of death from cardiovascular cause and cardiovascular events during the first year after dialysis initiation. Results There was no difference between the two groups neither for the primary outcome (40% vs 41%) nor for the occurrence of death from cardiovascular cause or cardiovascular events. Whereas the proportion of patients requiring at least one hospitalization was identical (83.3% vs 75%), network patients experienced less individual hospitalizations than control patients (2.3±2.0 vs 1.6±1.7) during the year before dialysis start. Patients of the network group had a slower renal function decline (7.7±2.5 vs 4.9±1.1 ml/min/1,73m2 per year; p=0.04). Conclusions In this limited series of patients, we were unable to demonstrate a significant impact of the coordinated renal care provided in the network on early cardiovascular events in incident dialysis patients. However, during the predialysis period, there were less hospitalizations and a slower slope of renal function decrease. </jats:sec

Modeling E. coli Tumbles by Rotational Diffusion. Implications for Chemotaxis

The bacterium Escherichia coli in suspension in a liquid medium swims by a succession of runs and tumbles, effectively describing a random walk. The tumbles randomize incompletely, i.e. with a directional persistence, the orientation taken by the bacterium. Here, we model these tumbles by an active rotational diffusion process characterized by a diffusion coefficient and a diffusion time. In homogeneous media, this description accounts well for the experimental reorientations. In shallow gradients of nutrients, tumbles are still described by a unique rotational diffusion coefficient. Together with an increase in the run length, these tumbles significantly contribute to the net chemotactic drift via a modulation of their duration as a function of the direction of the preceding run. Finally, we discuss the limits of this model in propagating concentration waves characterized by steep gradients. In that case, the effective rotational diffusion coefficient itself varies with the direction of the preceding run. We propose that this effect is related to the number of flagella involved in the reorientation process

“Liaisons dangereuses”: The invasive red-vented bulbul ( Pycnonotus cafer ), a disperser of exotic plant species in New Caledonia

International audienceThe biodiversity hotspot of New Caledonia hosts high levels of endemism (74% of flora) that is threatened increasingly by climate change, habitat reduction, and inva-sive species. The fruit-eating red-vented bulbul (Pycnonotus cafer) is currently invading the main island of the archipelago, and its recent dispersal out of urbanized habitats raises questions about its potential to disperse noxious plant seeds along urban corridors and beyond. Indeed, the red-vented bulbul is considered a vector of several introduced plant species in its alien range including Miconia calvescens, Lantana camara, and Schinus terebinthifolius. We conducted a quantitative assessment of the bulbul's fruits consumption by analyzing the gut contents of shot birds. We estimated gut passage times for four species of fruit found in gut contents (S. terebin-thifolius, Myrtastrum rufopunctatum, Passiflora suberosa, and Ficus prolixa) and tested the effects of bird digestion on seed germination rates for two species. Finally, we monitored the movements of individual VHF radio-tagged red-vented bulbuls. All of the consumed fruit species we identified here have red fleshy diaspore, including fruit of the shrub M. rufopunctatum that occurred frequently (9.6%) in bulbul gut samples. Median gut passage times were short (15-41 min), corresponding to short-distance seed transportation (77-92 m). The effect of gut passage was positive for the germination of the invasive S. terebinthifolius and negative for the endemic M. ru-fopunctatum, suggesting a potential bias in the contribution to the dispersal toward alien species. This study provides the first integrated assessment of mechanisms involved in the seed dispersal effectiveness of this high-concern invasive bird species that is expected to face similar plant communities in most of its alien range in tropical islands. More generally, our results enhance knowledge of synergies between non-native frugivores and plant species dispersal

DECADIESE: a new method to assess buildings’ sustainable value through functional performance and externalities integration

International audienceAmbitious building retrofits to improve energy performance are often hardly justified by energy savings only. Indeed the return on investment to divide energy consumption of a building by two is more than 25 years, which often discourage investors. Energy efficiency thus needs to be considered differently to be economically justified. That is why a new methodology called DECADIESE has been developed by a consortium of major companies from the French building sector and academic partners. Broader than an energy efficiency focus only, DECADIESE aims at capturing the sustainable value of a building with an original focus beyond the scope of classical analytic methods, by extending the perimeter of associated stakeholders in order to allow ambitious building projects. DECADIESE considers an extended value of a building by incorporating economic, social and environmental aspects through externalities elicitation and integration with a multi-stakeholders point of view, but also by recentering the value created by a building around the benefits brought to its users through a functional approach. The methodology is built around a structured process involving multiple stakeholders (such as building owner, building owner assistant, engineering contractor, potential users and neighbours…) that contribute to feed the different modules of an experimental tool, finally aggregated in cost-benefits indicators. This paper focuses on the functional part of this model. On the one hand, buildings costs are first broken down into usage functions following a process inspired from value engineering standards. Usage functions costs offer a new vision of costs breakdown for a building, which highlights possible mismatches between functional objectives for users and associated amounts of money. On the other hand, the functional performance of the building is assessed thanks to a grid composed of 95 qualitative and quantitative criteria. Those elementary scores are then aggregated in 7 usage functions scores thanks to a fuzzy logic model based on building experts rules. Once those elements identified, DECADIESE proposes to a project owner a new vision of its project and the ability to compare building variants. DECADIESE has been experimentally applied on several case studies. Results show a good relevance of results and reveal a high interest of building sector actors. Next steps are underway to make the methodology more reliable and usable by building sector actors

Corporate climate ratings: Assessing divergence from scientific expectations

International audienc

Corporate Climate Ratings: Assessing Divergence from Scientific Expectations

Private investment and consumption choices serve as a major driver to push companies to cut their greenhouse gas emissions and prepare for climate change. Sustainability scores, labels and rankings have helped guide these decisions since the 1990s, but are now coming under increasing scholarly criticism. In this context, we performed a systematic review of this criticism and tested the findings against current climate performance assessment tools. Our approach includes a comprehensive literature review, an inventory of climate-related scores, labels and ranking providers and their offerings, and an assessment of scores against best-in-class practices for each issue. We find the concerns raised in the scientific literature are related to the accuracy, reliability, and fairness of the tools, and whether they are effective in driving corporate action. Tool providers were found to use a diversity of business models, methodologies, and definitions of corporate climate performance. Despite some variability across tools and concerns, we find tools remain generally opaque and poorly aligned with scientific expectations. While corporate climate performance systems typically address indirect impacts and industry and size specificities; they rarely use standardized, verified inputs, and transparent, science-based weightings. Investors, corporations, and researchers can use our results to inform their choice of information providers, and regulators might take interest in the snapshot we provide on the maturity of the corporate climate performance measurement market. This paper aims to initiate improvements in the design of sustainability information systems