Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Nursesâ burnout and counterproductive work behavior in a Nigerian sample: The moderating role of emotional intelligence

This study examined the moderating role of EI in the relationship between burnout and CWB among 401 nurses drawn from various hospitals within South-eastern Nigeria. Three instruments were used for the collection of data, namely: Counterproductive Work Behaviour Checklist, Maslach Burnout Inventory, and Brief Emotional Intelligence scale. Moderated multiple regression results showed that emotional exhaustion, depersonalization, and personal accomplishment, positively predicted CWB. In addition, EI significantly and negatively predicted CWB. Results also showed that EI moderated the positive relationship between emotional exhaustion and CWB and between depersonalization and CWB such that the positive relationship between these two dimensions of burnout and CWB was stronger for nurses with low EI compared to those with high EI. The implications of the findings and limitations of the study were discussed. Keywords: Nurses, Burnout, Counterproductive work behaviour, Emotional intelligenc

Business-life balance and wellbeing: Exploring the lived experiences of women in a low-to-middle income country

Aim: With most studies on work-life balance focused on employees, this study sets out to explore the everyday living of business women who trade on petty goods and earn very little in a low-to-middle income country (LMIC). We explore their conceptions of balance, how they manage intersecting roles, and how they cope with daily hassles and stress to maintain wellbeing. Background: With the proportion of self-employed to employed people in Sub-Saharan LMICs being an inverse of the situation in Euro-American countries, there is a need to explore what balance could mean for the people in LMICs. Most studies in the work-life literature have explored how employees pursue balance and the various strategies that work for a specific group of people. Perhaps because work-life balance literature has largely sprung from advanced economies, little focus has been placed on how other societies, especially people in LMICs, navigate balance, given their unique milieu. Design: Adopting the reflective life-world approach, we inquire into the daily lives of women in very small businesses. Method: Twenty women who trade on a range of items and earn very little (gross daily sales of $0.41 to$62.98) were interviewed using a semi-structured guideline. Analysis was conducted using interpretative phenomenology. Result: Conceptions of balance for the women incorporated the notions of satisfactory progress across roles, proper time apportionment to roles, conditional balance as well as harmony and/or synchrony across roles—a slight difference from the popular understandings. Their conception of business life roles was deemed much more integral. Negative physical and psychological experiences impacting health and wellbeing, identified as culminating as a result of both roles, were commonplace but were typically considered a normal part of living. Engagements in extra-social roles appeared to have a double-edged effect. Placing the family first, time management, and prioritizing were some of the important measures of ensuring balance and wellbeing. Financial gains and personal satisfaction were top motivational reasons that kept the women committed to pursuing simultaneous roles. Conclusion: There is a strong overlap between what balance means for petty trading women and employees. However, the unique social platform offers a more communal perspective of issues in pursuing balance

Analysis of the influence of outdoor surface heat flux on the inlet water and the exhaust air temperature of the wetting pad of a direct evaporative cooling system

© 2023 Elsevier Ltd. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1016/j.applthermaleng.2023.120292The study investigates the interconnectivity between the inlet water temperature, wind flow rate, and storage water heat flux with the performance of biomass wetting pads in direct evaporative cooling under the external ambient condition of Sub-Saharan Africa. Thus, a standalone direct, evaporative cooling system with an upper water storage tank exposed to wind flow was locally developed and evaluated with jute, palm fruit mesocarp and wood charcoal as biomass cooling pad at three air velocities and constant pad thickness and three different air flow rates. The results indicated that increasing the heat flux around the water tank and decreasing the relative humidity of the inlet air through the wetting pad will lower both the inlet water and pad exhaust temperatures. The water demand was higher in palm fruit mesocarp fibre at airflow rates of 3 m/s, while at 4 and 4.5 m/s, it was higher in wood charcoal, and the value ranged from 9.64 × 10 −4 to 1.46 × 10 −3 kg/s. Except for jute fibre at 4 m/s, higher humidity difference or low cold room temperature did not translate to higher evaporative cooling effectiveness or efficiency. However, the lower inlet water temperature significantly affected the evaporative effectiveness. This shows the possibility of free moisture transfer into the cold room from the pad materials at increased air flow rates that helped boost the exhaust air's humidity. The average evaporative efficiency for the three pads ranged from 56.4 % to 80.96 %. The values for the enlargement coefficient ranged from 5 to 6.82, while the temperature thermal stress ranged from 24.37 to 28.66 °C.Peer reviewe