Governing irrigation renewal in rural Australia

Irrigation renewal schemes are taking place globally for water conservation and gains in agricultural productivity, as competition for water resources increases. The publically-funded renewal of irrigation infrastructure is a key platform of water reform in Australia’s Murray-Darling Basin; it is considered by some to be a policy that contradicts market-based approaches. In this Australian study, we examine an irrigation renewal scheme in northern Victoria resulting from a large investment by the State and Federal Governments. The long historical development of infrastructure and institutions for irrigation in the region led to technological lock-in and exposure to international terms of trade and climate change. From interviews with water professionals involved in the region, three key themes were identified through an adapted grounded theory approach: (1) a lack of an appropriate platform for fostering community involvement in what was a large-scale investment of public money; (2) issues in the way that water losses and savings were calculated; and (3) contradictions in policies for water buyback and irrigation renewal that lead to some irrigators being disadvantaged. To better understand the situation, we also applied a theoretical lens based on social learning. We conclude that the framing of a water ‘crisis’ was used to the benefit of some irrigators in attracting large-scale investment of public funds for irrigation renewal. The proposed solution, a technologically-driven irrigation renewal scheme, was implemented at a pace that didn’t match the planning horizons for many, leading many to exit from irrigated agriculture. Systemic insights for the design and implementation of irrigation renewal schemes internationally are highlighted

Planning for electronic data interchange

A model of strategic implementation is developed as a possible solution to the inability of numerous US business organizations to effectively plan their electronic data interchange (EDI) systems. The model is developed based on an extensive analysis of the EDI systems of numerous US firms and illustrates the dynamics of such systems in reference to supplier-customer relationship, as influenced by corporate structure, marketing and distribution channels, and buyer power. Five generic business strategies are formulated using the EDI model. These are the strategy in which retail firms follow the lead by suppliers and customers, the strategy in which EDI's functions in the supply chain are expanded, the new products and services strategy, the tie-in strategy, and the time-based competition strategy

Balanced forced‐diuresis as a renal protective approach in cardiac surgery: Secondary outcomes of electrolyte changes

© 2021 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/jocs.15925Objectives Forced-diuresis during cardiopulmonary bypass (CPB) can be associated with significant electrolyte shifts. This study reports on the serum electrolyte changes during balanced forced-diuresis with the RenalGuard® system (RG) during CPB. Methods Patients at risk of acute kidney injury (AKI)—(history of diabetes &/or anaemia, e-GFR 20–60 ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore >5)—were randomized to either RG (study group) or managed as per current practice (control group). Results The use of RG reduced AKI rate (10% for RG and 20.9% in control, p = .03). Mean urine output was significantly higher in the RG group during surgery (2366 ± 877 ml vs. 765 ± 549 ml, p < .001). The serum potassium levels were maintained between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for the controls. Median potassium supplemental dose was 60 (0–220) mmol (RG group) as compared to 30 (0–190) mmol for control group over first 24 h (p < .001). On Day 1 post-op, there were no significant differences in the serum sodium, potassium, calcium, magnesium, phosphate, and chloride levels between the two groups. Otherwise, postoperative clinical recovery was also similar. Conclusions Balanced forced-diuresis with the RG reduced AKI rates after on-pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.This work was supported by a research grant from RenalGuard Solutions and by the National Institute of Healthcare Research (NIHR), Clinical Research Network, UK (Ref: NIHR CRN No 32769)Published onlin

Balanced forced-diuresis compared to control as a reno-protective approach in cardiac surgery: secondary outcome of a randomized controlled trial, assessment of neutrophil gelatinase-associated lipocalin levels

© 2021 The Authors. Published by Springer Nature. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/s13019-021-01620-wBackground: Neutrophil gelatinase-associated lipocalin (NGAL) is a recognised biomarker for acute kidney injury (AKI).This study investigated the impact of balanced forced-diuresis using RenalGuard® system (RG), in reducing acute kidney injury (AKI) rates and the associated NGAL levels (6-h post-CPB plasma level) post adult cardiac surgery with cardiopulmonary bypass (CPB). Methods: Patients included in the study were at high-risk for AKI post cardiac surgery, namely history of diabetes and/or anaemia, e-GFR 20–60 ml/min/1.73 m2, Logistic EuroScore > 5, anticipated CPB time > 120 min. Patients were randomized to either RG (n = 110) or managed as per current practice (control = 110). RIFLE-defined AKI rate (based on serum creatinine level increase) within first 3 days of surgery and 6-h post CPB NGAL levels were the primary and secondary end-points. Results: Pre and intra-operative characteristics between the two groups were similar (p > 0.05) including the pre-op NGAL levels, the oxygen delivery (ecDO2i) and the carbon dioxide production (ecVCO2i) during CPB. Patients in the RG group had a significantly lower post-operative RIFLE-defined AKI rate compared to control (10% (11/110) v/s 20.9% (23/110), p = 0.03). Overall, median 6-h post CPB NGAL levels in patients with AKI were significantly higher than those who did not develop AKI (211 vs 150 ng/ml, p < 0.001). Patients managed by balanced forced-diuresis had lower post-operative NGAL levels (146 vs 178 ng/ml, p = 0.09). Using previously reported NGAL cut-off level for AKI (142 ng/ml), binary logistic regression analysis confirmed a beneficial effect of the RG system, with an increased risk of AKI of 2.2 times in the control group (OR 2.2, 95% CI 1.14–4.27, p = 0.02). Conclusions: Overall, the 6-h post-CPB plasma NGAL levels were significantly higher in patients who developed AKI. Patients managed with the novel approach of balanced forced-diuresis, provided by the RenalGuard® system, had a lower AKI rate and lower NGAL levels indicating a lesser degree of renal tissue injury. Trial registration ClinicalTrials.gov website, NCT02974946, https://clinicaltrials.gov/ct2/show/NCT02974946.This work was supported by a research grant from RenalGuard Solutions and by the National Institute of Healthcare Research (NIHR), Clinical Research Network, UK [Ref: NIHR CRN No. 32769].Accepted versio

Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial

© 2020 The Authors. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1093/ejcts/ezaa395OBJECTIVES Our goal was to investigate the efficacy of balanced forced diuresis in reducing the rate of acute kidney injury (AKI) in cardiac surgical patients requiring cardiopulmonary bypass (CPB), using the RenalGuard® (RG) system. METHODS Patients at risk of developing AKI (history of diabetes and/or anaemia; estimated glomerular filtration rate 20–60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5) were randomized to the RG system group (n = 110) or managed according to current practice (control = 110). The primary end point was the development of AKI within the first 3 postoperative days as defined by the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) criteria. RESULTS There were no significant differences in preoperative and intraoperative characteristics between the 2 groups. Postoperative AKI rates were significantly lower in the RG system group compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025]. This effect persisted even after controlling for a number of potential confounders (odds ratio 2.82, 95% confidence interval 1.20–6.60; P = 0.017) when assessed by binary logistic regression analysis. The mean volumes of urine produced during surgery and within the first 24 h postoperatively were significantly higher in the RG system group (P < 0.001). There were no significant differences in the incidence of blood transfusions, atrial fibrillation and infections and in the median duration of intensive care unit stays between the groups. The number needed to treat with the RG system to prevent AKI was 9 patients (95% confidence interval 6.0–19.2). CONCLUSIONS In patients at risk for AKI who had cardiac surgery with CPB, the RS RG system significantly reduced the incidence of AKI and can be used safely and reproducibly. Larger studies are required to confirm cost benefits.This work was supported by RenalGuard Solutions; and National Institute of Healthcare Research (NIHR), Clinical Research Network, UK [Ref: NIHR CRN No 32769].Published onlin

Reconsidering the Role of the Digital in Global Production Networks

Global production networks (GPN) has become a key framework in conceptualising linkages, power and structure in globalised production. However, this framework has been less successful in integrating the influence of digital information and ICTs in production, and this problematic in a world where relationships and power are increasingly mediated by digital information flows and resources. We thus look to adapt the GPN framework to allow more substantive analysis of ‘the digital’. Primarily this is done through a theoretical analysis of the three core categories of the GPN framework - embeddedness, value and networks – to highlight how these categories can better integrate a more dynamic and contested conceptualisation of the digital. Illustrations from research on the digitalization of tea sector GPNs in East Africa highlight how these theoretical advances provide new insights on the digital and its expanding role in economic production

Complete revascularization with multivessel PCI for myocardial infarction

BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P=0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P=0.62 and P=0.27 for interaction for the first and second coprimary outcomes, respectively). CONCLUSIONS Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479. opens in new tab.

A catalogue of Triticum monococcum genes encoding toxic and immunogenic peptides for celiac disease patients

The celiac disease (CD) is an inflammatory condition characterized by injury to the lining of the small-intestine on exposure to the gluten of wheat, barley and rye. The involvement of gluten in the CD syndrome has been studied in detail in bread wheat, where a set of “toxic” and “immunogenic” peptides has been defined. For wheat diploid species, information on CD epitopes is poor. In the present paper, we have adopted a genomic approach in order to understand the potential CD danger represented by storage proteins in diploid wheat and sequenced a sufficiently large number of cDNA clones related to storage protein genes of Triticum monococcum. Four bona fide toxic peptides and 13 immunogenic peptides were found. All the classes of storage proteins were shown to contain harmful sequences. The major conclusion is that einkorn has the full potential to induce the CD syndrome, as already evident for polyploid wheats. In addition, a complete overview of the storage protein gene arsenal in T. monococcum is provided, including a full-length HMW x-type sequence and two partial HMW y-type sequences

Monocyte subsets in heart failure

Introduction: Monocytes play important roles in inflammation, thrombosis, angiogenesis and tissue repair and may contribute to the pathophysiology of heart failure (HF). Functional diversity is likely to stem from the presence of three distinct monocyte subsets, defined by flow cytometry (FC) as CD14++CD16-CCR2+ (Mon1), CD14++CD16+CCR2+ (Mon2) and CD14+CD16++CCR2- (Mon3). The aims of this thesis were to study the following parameters in patients with ischaemic HF: 1) monocyte subset numbers, 2) monocyte subset expression of surface receptors for inflammation, angiogenesis, cell adhesion molecules (CAM) and tissue repair, 3) cross-talk between monocytes and platelets in the formation of monocyte-platelet aggregates (MPAs). Methods: Monocyte subsets were analysed by FC on venous blood samples at baseline in 51 patients admitted with acute HF (AHF), 42 with stable HF (SHF), 44 with stable coronary artery disease (CAD) without HF and 40 healthy controls (HC). Plasma levels of inflammatory cytokines were also measured by flow cytometric bead array technology. In AHF, additional longitudinal samples were taken at discharge and 3 months. Results: Compared to CAD controls, patients with SHF had higher counts of Mon2 and MPAs associated with Mon2, alongside increased expression of inflammatory markers and CAM receptors on Mon2. Compared to SHF, those with AHF had higher counts of Mon1, Mon2 and MPAs associated with Mon1 and Mon2. Patients with AHF also had increased expression of angiogenic receptors on Mon1 and increased expression of angiogenic receptors, scavenger receptors and CAM receptors on Mon2. After adjusting for confounders, counts of Mon2, MPAs associated with Mon2 and expression of VCAM-1R on Mon2 were associated with clinical outcomes in AHF. Conclusions: Differences in monocyte subset numbers and cell surface receptor expression are seen in patients with HF. Mon2 appears to have a prognostic role in patients with AHF, however larger studies are required to confirm these findings