The National Early Warning Score and its subcomponents recorded within ±24 hours of emergency medical admission are poor predictors of hospital-acquired acute kidney injury

YesBackground: Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. Aim: To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity.The Health Foundatio

Long‐term increases in shell thickness in Elliptio complanata (Bivalvia: Unionidae) in the freshwater tidal Hudson River

The shells of freshwater molluscs are highly plastic in response to environmental and ecological conditions, which can affect ecological interactions and ecosystem functioning.We tested for changes in relative shell thickness in the unionid bivalve Elliptio complanata in the freshwater tidal Hudson River over 1991–2017, a period of changing water chemistry and predation pressure.Shells of both juveniles (shells <20 mm long) and larger animals became substantially (c. 10%–25%) and significantly heavier (for a given shell length) over the study period. This parallels previously published results for the non‐native zebra mussel Dreissena polymorpha in the Hudson.Increased shell thickness during the study period could be explained by rising pH, alkalinity, and temperature, which increased calcite saturation and favoured the precipitation of calcium carbonate shells, as well as a response to greater predation by shell‐crushing predators.Because the factors that affect shell thickness (e.g. calcium carbonate saturation and presence and abundance of predators) are changing rapidly in many lakes and rivers, similar large changes in shell thickness may be occurring in fresh waters around the world, affecting ecological interactions and ecosystem functioning.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168269/1/fwb13723_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168269/2/fwb13723.pd

The SPINDLE Disruption-Tolerant Networking System ∗

program is developing technologies that enable access to information when stable end-to-end paths do not exist and network infrastructure access cannot be assured. DTN technology makes use of persistence within network nodes, along with the opportunistic use of mobility, to overcome disruptions to connectivity. In this paper, we describe the SPINDLE Disruption-Tolerant Networking system and related technology being developed at BBN under the DTN program. Using an open-source, standardsbased core with a plugin architecture and well-specified interfaces, we enable independent development and insertion of innovative DoD-relevant technology while allowing the core system to be refined and engineered within a COTS context. SPINDLE technology innovations include: (i) routing algorithms that work efficiently across a wide range of network disruption, (ii) a name-management architecture for DTNs that supports progressive resolution of intentional name attributes within the network (not at the source), including support for “queries as names ” and name-scheme translation, (iii) distributed caching, indexing, and retrieval approaches for disruptiontolerant content-based (rather than locator-based) access to information, and (iv) a declarative knowledge-based approach that integrates routing, intentional naming, policy-based resource management, and content-based access to information. We present preliminary results that show that the DTN approach outperforms traditional end-to-end approaches across a wide range of network disruption. I

Effect of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Biomarkers of Smoke Exposure: A Randomized Clinical Trial.

ImportanceThe optimal temporal approach for reducing nicotine to minimally or nonaddictive levels in all cigarettes sold in the United States has not been determined.ObjectivesTo determine the effects of immediate vs gradual reduction in nicotine content to very low levels and as compared with usual nicotine level cigarettes on biomarkers of toxicant exposure.Design, setting, and participantsA double-blind, randomized, parallel-design study with 2 weeks of baseline smoking and 20 weeks of intervention was conducted at 10 US sites. A volunteer sample of daily smokers with no intention to quit within 30 days was recruited between July 2014 and September 2016, with the last follow-up completed in March 2017.Interventions(1) Immediate reduction to 0.4 mg of nicotine per gram of tobacco cigarettes; (2) gradual reduction from 15.5 mg to 0.4 mg of nicotine per gram of tobacco cigarettes with 5 monthly dose changes; or (3) maintenance on 15.5 mg of nicotine per gram of tobacco cigarettes.Main outcomes and measuresBetween-group differences in 3 co-primary biomarkers of smoke toxicant exposure: breath carbon monoxide (CO), urine 3-hydroxypropylmercapturic acid (3-HPMA, metabolite of acrolein), and urine phenanthrene tetraol (PheT, indicator of polycyclic aromatic hydrocarbons) calculated as area under the concentration-time curve over the 20 weeks of intervention.ResultsAmong 1250 randomized participants (mean age, 45 years; 549 women [44%]; 958 [77%] completed the trial), significantly lower levels of exposure were observed in the immediate vs gradual reduction group for CO (mean difference, -4.06 parts per million [ppm] [95% CI, -4.89 to -3.23]; P &lt; .0055), 3-HPMA (ratio of geometric means, 0.83 [95% CI, 0.77 to 0.88]; P &lt; .0055), and PheT (ratio of geometric means, 0.88 [95% CI, 0.83 to 0.93]; P &lt; .0055). Significantly lower levels of exposure were observed in the immediate reduction vs control group for CO (mean difference, -3.38 [95% CI, -4.40 to -2.36]; P &lt; .0055), 3-HPMA (ratio of geometric means, 0.81 [95% CI, 0.75 to 0.88]; P &lt; .0055), and PheT (ratio of geometric means, 0.86 [95% CI, 0.81 to 0.92]; P &lt; .0055). No significant differences were observed between the gradual reduction vs control groups for CO (mean difference, 0.68 [95% CI, -0.31 to 1.67]; P = .18), 3-HPMA (ratio of geometric means, 0.98 [95% CI, 0.91 to 1.06]; P = .64), and PheT (ratio of geometric means, 0.98 [95% CI, 0.92 to 1.04]; P = .52).Conclusions and relevanceAmong smokers, immediate reduction of nicotine in cigarettes led to significantly greater decreases in biomarkers of smoke exposure across time compared with gradual reduction or a control group, with no significant differences between gradual reduction and control.Trial registrationclinicaltrials.gov Identifier: NCT02139930