Evaluation of Daily Low-Dose Prednisolone During Upper Respiratory Tract Infection to Prevent Relapse in Children With Relapsing Steroid-Sensitive Nephrotic Syndrome: The PREDNOS 2 Randomized Clinical Trial

Importance: In children with corticosteroid-sensitive nephrotic syndrome, many relapses are triggered by upper respiratory tract infections. Four small studies found that administration of daily low-dose prednisolone for 5 to 7 days at the time of an upper respiratory tract infection reduced the risk of relapse, but the generalizability of their findings is limited by location of the studies and selection of study population. / Objective: To investigate the use of daily low-dose prednisolone for the treatment of upper respiratory tract infection-related relapses. / Design, Setting, and Participants: This double-blind, placebo-controlled randomized clinical trial (Prednisolone in Nephrotic Syndrome [PREDNOS] 2) evaluated 365 children with relapsing steroid-sensitive nephrotic syndrome with and without background immunosuppressive treatment at 122 pediatric departments in the UK from February 1, 2013, to January 31, 2020. Data from the modified intention-to-treat population were analyzed from July 1, 2020, to December 31, 2020. / Interventions: At the start of an upper respiratory tract infection, children received 6 days of prednisolone, 15 mg/m2 daily, or matching placebo preparation. Those already taking alternate-day prednisolone rounded their daily dose using trial medication to the equivalent of 15 mg/m2 daily or their alternate-day dose, whichever was greater. / Main Outcomes and Measures: The primary outcome was the incidence of first upper respiratory tract infection-related relapse. Secondary outcomes included overall rate of relapse, changes in background immunosuppressive treatment, cumulative dose of prednisolone, rates of serious adverse events, incidence of corticosteroid adverse effects, and quality of life. / Results: The modified intention-to-treat analysis population comprised 271 children (mean [SD] age, 7.6 [3.5] years; 174 [64.2%] male), with 134 in the prednisolone arm and 137 in the placebo arm. The number of patients experiencing an upper respiratory tract infection-related relapse was 56 of 131 (42.7%) in the prednisolone arm and 58 of 131 (44.3%) in the placebo arm (adjusted risk difference, -0.02; 95% CI, -0.14 to 0.10; P = .70). No evidence was found that the treatment effect differed according to background immunosuppressive treatment. No significant differences were found in secondary outcomes between the treatment arms. A post hoc subgroup analysis assessing the primary outcome in 54 children of South Asian ethnicity (risk ratio, 0.66; 95% CI, 0.40-1.10) vs 208 children of other ethnicity (risk ratio, 1.11; 95% CI, 0.81-1.54) found no difference in efficacy of intervention in those of South Asian ethnicity (test for interaction P = .09). / Conclusions and Relevance: The results of PREDNOS 2 suggest that administering 6 days of daily low-dose prednisolone at the time of an upper respiratory tract infection does not reduce the risk of relapse of nephrotic syndrome in children in the UK. Further work is needed to investigate interethnic differences in treatment response. / Trial Registration: isrctn.org / Identifier: ISRCTN10900733; EudraCT 2012-003476-39

Population Structure and Modern Human Origins

This paper reviews statistical methods for inferring population his-tory from mitochondrial mismatch distributions and extends them to the case of geographically structured populations. Inference is based on a geographically structured version of the coalescent algorithm that allows for temporal variation in population size, in the number of subdivisions, and in the rate of migration between subdivisions. Confidence regions are inferred under several models of population history. If the pattern in mitochondrial DNA reflects population growth rather than selection, then the confidence regions reject the multiregional hypothesis of modern human origins more strongly than has previously been possible. They do not reject the replacement hypothesis

Life Cycle Management of Infrastructures

By definition, life cycle management (LCM) is a framework “of concepts, techniques, and procedures to address environmental, economic, technological, and social aspects of products and organizations in order to achieve continuous ‘sustainable’ improvement from a life cycle perspective” (Hunkeler et al.\ua02001). Thus, LCM theoretically integrates all sustainability dimensions, and strives to provide a holistic perspective. It also assists in the efficient and effective use of constrained natural and financial resources to reduce negative impacts on society (Sonnemann and Leeuw\ua02006; Adibi et al.\ua02015). The LCM of infrastructures is the adaptation of product life cycle management (PLM) as techniques to the design, construction, and management of infrastructures. Infrastructure life cycle management requires accurate and extensive information that might be generated through different kinds of intelligent and connected information workflows, such as building information modeling (BIM)

Mapping the Paediatric Quality of Life Inventory (PedsQL™) Generic Core Scales onto the Child Health Utility Index–9 Dimension (CHU-9D) Score for Economic Evaluation in Children

Background: The Paediatric Quality of Life Inventory (PedsQL™) questionnaire is a widely used, generic instrument designed for measuring health-related quality of life (HRQoL); however, it is not preference-based and therefore not suitable for cost–utility analysis. The Child Health Utility Index–9 Dimension (CHU-9D), however, is a preference-based instrument that has been primarily developed to support cost–utility analysis. Objective: This paper presents a method for estimating CHU-9D index scores from responses to the PedsQL™ using data from a randomised controlled trial of prednisolone therapy for treatment of childhood corticosteroid-sensitive nephrotic syndrome. Methods: HRQoL data were collected from children at randomisation, week 16, and months 12, 18, 24, 36 and 48. Observations on children aged 5 years and older were pooled across all data collection timepoints and were then randomised into an estimation (n = 279) and validation (n = 284) sample. A number of models were developed using the estimation data before internal validation. The best model was chosen using multi-stage selection criteria. Results: Most of the models developed accurately predicted the CHU-9D mean index score. The best performing model was a generalised linear model (mean absolute error = 0.0408; mean square error = 0.0035). The proportion of index scores deviating from the observed scores by 13 years) or patient groups with particularly poor quality of life. ISRCTN Registry No: 1664524

Assessing the potential of yield improvements, through process scrap reduction, for energy and CO<inf>2</inf> abatement in the steel and aluminium sectors

Targets to cut 2050 CO2 emissions in the steel and aluminium sectors by 50%, whilst demand is expected to double, cannot be met by energy efficiency measures alone, so options that reduce total demand for liquid metal production must also be considered. Such reductions could occur through reduced demand for final goods (for instance by life extension), reduced demand for material use in each product (for instance by lightweight design) or reduced demand for material to make existing products. The last option, improving the yield of manufacturing processes from liquid metal to final product, is attractive in being invisible to the final customer, but has had little attention to date. Accordingly this paper aims to provide an estimate of the potential to make existing products with less liquid metal production. Yield ratios have been measured for five case study products, through a series of detailed factory visits, along each supply chain. The results of these studies, presented on graphs of cumulative energy against yield, demonstrate how the embodied energy in final products may be up to 15 times greater than the energy required to make liquid metal, due to yield losses. A top-down evaluation of the global flows of steel and aluminium showed that 26% of liquid steel and 41% of liquid aluminium produced does not make it into final products, but is diverted as process scrap and recycled. Reducing scrap substitutes production by recycling and could reduce total energy use by 17% and 6% and total CO 2 emissions by 16% and 7% for the steel and aluminium industries respectively, using forming and fabrication energy values from the case studies. The abatement potential of process scrap elimination is similar in magnitude to worldwide implementation of best available standards of energy efficiency and demonstrates how decreasing the recycled content may sometimes result in emission reductions. Evidence from the case studies suggests that whilst most companies are aware of their own yield ratios, few, if any, are fully aware of cumulative losses along their whole supply chain. Addressing yield losses requires this awareness to motivate collaborative approaches to improvement. © 2011 Elsevier B.V. All rights reserved

Options for achieving a 50% cut in industrial carbon emissions by 2050.

Carbon emissions from industry are dominated by production of goods in steel, cement plastic, paper, and aluminum. Demand for these materials is anticipated to double at least by 2050, by which time global carbon emissions must be reduced by at least 50%. To evaluate the challenge of meeting this target the global flows of these materials and their associated emissions are projected to 2050 under five technical scenarios. A reference scenario includes all existing and emerging efficiency measures but cannot provide sufficient reduction. The application of carbon sequestration to primary production proves to be sufficient only for cement The emissions target can always be met by reducing demand, for instance through product life extension, material substitution, or "light-weighting". Reusing components shows significant potential particularly within construction. Radical process innovation may also be possible. The results show that the first two strategies, based on increasing primary production, cannot achieve the required emissions reductions, so should be balanced by the vigorous pursuit of material efficiency to allow provision of increased material services with reduced primary production

The roles of energy and material efficiency in meeting steel industry CO2 targets.

Identifying strategies for reducing greenhouse gas emissions from steel production requires a comprehensive model of the sector but previous work has either failed to consider the whole supply chain or considered only a subset of possible abatement options. In this work, a global mass flow analysis is combined with process emissions intensities to allow forecasts of future steel sector emissions under all abatement options. Scenario analysis shows that global capacity for primary steel production is already near to a peak and that if sectoral emissions are to be reduced by 50% by 2050, the last required blast furnace will be built by 2020. Emissions reduction targets cannot be met by energy and emissions efficiency alone, but deploying material efficiency provides sufficient extra abatement potential