Baseline Definitions Research Articles

A Review of Life Cycle Assessment Methods to Inform the Scale‐Up of Carbon Dioxide Removal Interventions

ABSTRACTLife Cycle Assessment (LCA) methods are increasingly used for policy decision‐making in the context of identifying and scaling up sustainable carbon dioxide removal (CDR) interventions. This article critically reviews CDR LCA case‐studies through three key lenses relevant to policy decision‐making on sustainable CDR scale‐up, namely comparability across CDR assessments, assessment of the climatic merit of a CDR intervention, and consideration of wider CDR co‐benefits and impacts. Our results show that while providing valuable life cycle understanding, current practices utilize diverse methods, usually attributional in nature, which are CDR and time‐specific. As a result, they do not allow comprehensive cross‐comparison between CDRs, nor reveal the potential consequences of scaling up CDRs in the future. We suggest CDR LCA design requires clearer definitions of the study scope and goal, the use of more consistent functional units, greater comprehensiveness in system boundaries, and explicit baseline definitions. This would allow for robust assessments, facilitating comparison with other CDR methods, and better evidencing net climate benefits. The inventory should collect time‐dependent data on the full CDR life cycle and baseline, and report background assumptions. The impact assessment phase should evidence the climatic merits, co‐benefits, and trade‐offs potentially caused by the expanding CDR. Finally, to ensure a sustainable scale‐up of CDR, consequential analyses should be performed, and interpretation involves the comparison of all selected metrics and the permanence of carbon storage against a baseline scenario.

Emissions offset incentives, carbon storage and profit optimization for Australian timber plantations

This article evaluates additional carbon storage that becomes profitable over a range of carbon credit prices through Australian Emissions Reduction Fund (ERF) methods introduced in 2017 for timber plantations. We found prices of $20 and $50 CO2-eq t−1 motivated switching 4% and 29% of southern Australian case study estate stands from short-rotation E. globulus to long-rotation P. radiata, resulting in 10% and 48% more estate carbon storage. We found no uptake of not for harvest environmental plantings to be profitable, even at carbon prices of $100 CO2-eq t−1. This appears to be because of the relatively faster initial growth and carbon gain for long-rotation timber as compared to environmental planting species and the detail of baseline and comparison scenario definitions used in credit calculations. We also evaluated carbon storage versus profit trade-offs over the full set of technically possible and efficient estate management options to achieve abatement, greater than levels that maximize profit. Key conclusions from this analysis were that significant carbon storage increases even beyond what is profitable are possible for the case study estate at relatively little reduced profit opportunity cost for carbon prices of $20 CO2-eq t−1 and less. In contrast, managing all stands in the estate for the sole objective of improving carbon storage could nearly double carbon storage but result in a significant 27% profit reduction under a $20 CO2-eq t−1 carbon price scenario.

Energy Flows in Static and Programmable Catalysts

Programmable catalysts that change on the time scale of a catalytic cycle provide a new opportunity to control the flow of energy to reactants and products to promote faster and more selective chemistry. While traditional chemical manufacturing processes consume energy to achieve favorable reaction conditions, programmable catalysts aim to dynamically add or remove energy to catalytic cycles through perturbations of the catalytic surface via strain, charge, or light. These surface energy flows are quantified by the changes in adsorbate binding energy with time, and the overall efficiency relating energy inputs to catalytic performance is defined by the characteristics of the undulating catalytic surface. Understanding and quantifying energy flows in programmable catalysts provides baseline definitions and metrics for comparing dynamic conditions and identifying optimal catalytic performance for more efficient chemical manufacturing.

Investigating the trends in patient-reported outcomes pre-treatment and implications to efficacy analyses: A post-hoc analysis of a cancer clinical trial

BackgroundUncertainty around key elements of an appropriate patient-reported outcome (PRO) baseline assessment introduces trial-specific variation in oncology clinical trials with a poorly understood consequence on drug evaluation decisions. This research investigated the impact of multiple pre-treatment PRO assessments and timing of assessments in a clinical trial. MethodsA post-hoc analysis of a completed phase 3, open-label, randomized, parallel arm clinical trial in non-small cell lung cancer with two pre-treatment PRO assessments (screening and Week 1 Day 1 [W1D1]). Descriptive analyses, mixed models for repeated measures and time until definitive deterioration analyses were performed to estimate differences between treatment arms. Through model adjustments, different baseline specifications and assessment timing (pre/post-randomization) on W1D1 PROs were evaluated. ResultsPatients with both pre-treatment PRO assessments were included in the analysis (N = 535). Numerically small average change scores were observed between screening and W1D1 (mean change, 0–100 scale ranges): Chest pain (−0.94), Cough (−0.94), Dyspnea (1.27), Physical functioning (−1.19). Both pre-treatment assessments were moderately-highly correlated (r: 0.55–0.78) and no trend was found for deterioration or improvement during this period. Varying baseline definitions in the models produced slight differences in model fit but no impact on the between treatment group effect estimate. W1D1 PRO scores were not statistically influenced by assessment timing pre/post-randomization (p-values: 0.142–0.628). ConclusionFindings from this study question the need for multiple pre-treatment PRO assessments in oncology drug development trials and the degree of bias thought to be introduced through patient knowledge of treatment assignment. Implications for researchers are presented.

Defining Baseline Creatinine for Identification of AKI in Population-Based Laboratory Databases: A Danish Nationwide Cohort Study.

The baseline creatinine level is central in the Kidney Disease Improving Global Outcomes (KDIGO) criteria of AKI, but baseline creatinine is often inconsistently defined or unavailable in AKI research. We examined the rate, characteristics, and 30-day mortality of AKI in five AKI cohorts created using different definitions of baseline creatinine. This nationwide cohort study included all individuals aged ≥18 years in Denmark with a creatinine measurement in 2017. Applying the KDIGO criteria, we created four AKI cohorts using four different baseline definitions (most recent, mean, or median value of outpatient creatinine 365-368 days before, or median value 90-98 days before, if available, otherwise median value 365-391 days before) and one AKI cohort not using a baseline value. AKI rate and the distribution of age, sex, baseline creatinine, and comorbidity were described for each AKI cohort, and the 30-day all-cause mortality was estimated using the Kaplan-Meier method. The study included 2,095,850 adults with at least one creatinine measurement in 2017. The four different baseline definitions identified between 61,189 and 62,597 AKI episodes. The AKI rate in these four cohorts was 13-14 per 1000 person-years, and 30-day all-cause mortality was 17%-18%. The cohort created without using a baseline creatinine included 37,659 AKI episodes, corresponding to an AKI rate of 8.2 per 1000 person-years and a 30-day mortality of 23%. All five cohorts were similar regarding age, sex, and comorbidity. In a population-based setting with available outpatient baseline creatinine, different baseline creatinine definitions revealed comparable AKI cohorts, whereas the lack of a baseline creatinine when defining AKI led to a smaller AKI cohort with a higher mortality. These findings underscore the importance of availability and consistent use of an outpatient baseline creatinine, particulary in studies of community-acquired AKI.

Ambiguous definitions for baseline serum creatinine affect acute kidney diagnosis at the emergency department

BackgroundAcute kidney injury (AKI) incidence is increasing, however AKI is often missed at the emergency department (ED). AKI diagnosis depends on changes in kidney function by comparing a serum creatinine (SCr) measurement to a baseline value. However, it remains unclear to what extent different baseline values may affect AKI diagnosis at ED.MethodsRoutine care data from ED visits between 2012 and 2019 were extracted from the Utrecht Patient Oriented Database. We evaluated baseline definitions with criteria from the RIFLE, AKIN and KDIGO guidelines. We evaluated four baseline SCr definitions (lowest, most recent, mean, median), as well as five different time windows (up to 365 days prior to ED visit) to select a baseline and compared this to the first measured SCr at ED. As an outcome, we assessed AKI prevalence at ED.ResultsWe included 47,373 ED visits with both SCr-ED and SCr-BL available. Of these, 46,100 visits had a SCr-BL from the − 365/− 7 days time window. Apart from the lowest value, AKI prevalence remained similar for the other definitions when varying the time window. The lowest value with the − 365/− 7 time window resulted in the highest prevalence (21.4%). Importantly, applying the guidelines with all criteria resulted in major differences in prevalence ranging from 5.9 to 24.0%.ConclusionsAKI prevalence varies with the use of different baseline definitions in ED patients. Clinicians, as well as researchers and developers of automatic diagnostic tools should take these considerations into account when aiming to diagnose AKI in clinical and research settings.

Association of Oliguria With Acute Kidney Injury Diagnosis, Severity Assessment, and Mortality Among Patients With Critical Illness

The current definition and staging of acute kidney injury (AKI) considers alterations in serum creatinine (sCr) level and urinary output (UO). However, the relevance of oliguria-based criteria is disputed. To determine the contribution of oliguria, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, to AKI diagnosis, severity assessment, and short- and long-term outcomes. This cohort study included adult patients admitted to a multidisciplinary intensive care unit from January 1, 2010, to June 15, 2020. Patients receiving long-term dialysis and those who declined consent were excluded. Daily sCr level and hourly UO measurements along with sociodemographic characteristics and severity scores were extracted from electronic medical records. Long-term mortality was assessed by cross-referencing the database with the Swiss national death registry. The onset and severity of AKI according to the KDIGO classification was determined using UO and sCr criteria separately, and their agreement was assessed. Using a multivariable model accounting for baseline characteristics, severity scores, and sCr stages, the association of UO criteria with 90-day mortality was evaluated. Sensitivity analyses were conducted to assess how missing sCr, body weight, and UO values, as well as different sCr baseline definitions and imputations methods, would affect the main results. Among the 15 620 patients included in the study (10 330 men [66.1%] with a median age of 65 [IQR, 53-75] years, a median Simplified Acute Physiology Score II score of 40.0 [IQR, 30.0-53.0], and a median follow-up of 67.0 [IQR, 34.0-100.0] months), 12 143 (77.7%) fulfilled AKI criteria. Serum creatinine and UO criteria had poor agreement on AKI diagnosis and staging (Cohen weighted κ, 0.36; 95% CI, 0.35-0.37; P < .001). Compared with the isolated use of sCr criteria, consideration of UO criteria enabled identification of AKI in 5630 patients (36.0%). Those patients had a higher 90-day mortality than patients without AKI (724 of 5608 [12.9%] vs 288 of 3462 [8.3%]; P < .001). On multivariable analysis accounting for sCr stage, comorbidities, and illness severity, UO stages 2 and 3 were associated with a higher 90-day mortality (odds ratios, 2.4 [95% CI, 1.6-3.8; P < .001] and 6.2 [95% CI, 3.7-10.5; P < .001], respectively). These results remained significant in all sensitivity analyses. The findings of this cohort study suggest that oliguria lasting more than 12 hours (KDIGO stage 2 or 3) has major AKI diagnostic implications and is associated with outcomes irrespective of sCr elevations.

POS-061 THE IMPACT OF NEGLECTING URINARY OUTPUT WHEN DEFINING AKI IN PREDICTION MODELLING: A BIG DATA ANALYSIS

KDIGO criteria have improved standardization of AKI definition, but most published automated algorithms fail to include the urinary output (UO) criterium in their ground truth definition of AKI. UO is also associated with mortality, and ignoring this parameter in the AKI definition might thus not accurately reflect the risk associated with the label AKI. We classified KDIGO AKI stage≥2 using routinely collected ICU data to identify the impact of including UO or not in an automated AKI algorithm on estimates of AKI incidence and prognostic value. All patients admitted to an intensive care unit (ICU) in a tertiary care centre between 1/1/2013 and 31/12/2017 were prospectively included. We used different interpretations for the baseline of the serum creatinine (Screa) criterion, and/or the urinary output (UO) criterion (either a moving 12h time window or in each of its 12 constituent 1h blocks) to identify patients fulfilling KDIGO AKI stage≥2 diagnosis. As outcome, we assessed incidence of AKI and association with ICU mortality using state of the art statistics to avoid immortality bias. In 13,403 ICU admissions (62.2% male, age 60.8±16.8 years, SOFA at admission 7.0±4.1), incidence of KDIGO AKI stage≥2 varied from 4.3% to 19.3% for the different baseline definitions of the Screa criterion, and 14.1 to 34.3% for the two interpretations of the UO criteria (fig dashed columns). Cause-specific hazard ratios of ICU mortality for patients with versus without AKI diagnosis also ranged from 1.76 (95% CI: 1.47–2.10) to 2.38 (95% CI: 2.09–2.71) for the Screa criteria and from 3.00 (95%CI: 2.55-3.53) to 3.21 (95%CI: 2.80-3.69) for the two interpretations of the UO criteria (Fig plain columns). Neglecting urinary output when defining AKI according to KDIGO negatively impacts the sensitivity and prognostic value of the label AKI. Despite its higher incidence, AKI based on UO had a higher ICU based mortality risk than AKI based on any of the Screa criteria of KDIGO. Algorithms to detect or predict AKI should therefore include urinary output in their ground truth definition of AKI.

Systematic review of outcomes and endpoints in acute migraine clinical trials.

Background/ObjectiveTo review the acute migraine clinical trial literature and provide a summary of the endpoints and outcomes used in such trials.MethodA systematic literature review, following a prespecified (but unregistered) protocol developed to adhere to recommendations of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, was conducted to understand endpoints and outcomes used in acute migraine clinical trials. Predefined terms were searched in PubMed to locate clinical trials assessing acute migraine treatments. Final database search was conducted on October 28, 2019. Identified publications were reviewed against established inclusion and exclusion criteria to determine eligibility. Data related to general trial design characteristics, sample characteristics, and outcomes and endpoints reported in each publication were extracted from eligible publications. Descriptive summaries of design features, sample characteristics, and the endpoints and outcomes employed across publications were constructed. Outcomes are presented within four broad categories: (a) pain‐related outcomes (pain relief, pain freedom, etc.), (b) associated symptoms (nausea, photophobia, etc.), (c) disability/impairment/impact, (d) patient‐reported outcome measures (PROMs, general health and migraine/headache‐specific). Endpoint types were categorized within three broad categories: (a) change from baseline, (b) fixed timepoint, and (c) responder definitions (e.g., 50% reduction). This review focuses on a subset of recent (1998 or later) randomized and blinded publications evaluating drugs or medical devices.ResultsOf 1567 publications found through the initial search and reference section reviews, 705 met criteria and were included for data extraction. Inter‐rater agreement kappas for the descriptive variables extracted had an average kappa estimate of 0.86. The more recent, randomized and blinded pharmaceutical and medical device article subset includes 451 publications (451/705, 63.9%). The outcomes and endpoints varied substantially across trials, ranging from pain relief or freedom, freedom from or relief of migraine‐associated symptoms, use of acute or rescue medication, and various other PROMs, including measures of satisfaction and quality of life. Within the recent randomized and blinded article subset, most articles examined ≥1 pain‐related outcome (430/451, 95.3%). Of the publications that examined pain, outcomes most often used were pain relief (310/430, 72.1%), pain freedom (279/430, 64.9%), and headache recurrence (202/43,051, 47.0%) or rescue medication use (278/430, 64.9%). Associated symptoms such as nausea, photophobia, and phonophobia were more frequently measured (299/451, 66.3%) compared to most bothersome associated symptom (16/451, 3.5%), as it is a new addition to regulatory guidance. Over one‐third of eligible publications examined disability/impairment (186/451, 41.2%) or ≥1 PROM (159/451, 35.3%). The definition of the endpoints used (e.g., change from baseline, fixed timepoint comparisons, categorization of “responders” to treatment based on wide variety of “responder definitions”) also differed substantially across publications.ConclusionAcute migraine clinical trials exhibit a large amount of variability in outcomes and endpoints used, in addition to the variability in how outcomes and endpoints were used from trial‐to‐trial. There were some common elements across trials that align with guidance from the International Headache Society, the Food and Drug Administration and other regulatory agencies (e.g., assessing pain and associated symptoms, 2‐hour post‐treatment). Other aspects of acute migraine clinical trial design did not follow guidance. For example, multi‐item PROMs intended to measure constructs (e.g., scales) are rarely used, the use of pain‐related outcomes is inconsistent, some associated symptom assessments are idiosyncratic, and the timing of the assessment of primary endpoints is variable. The development of a core set of outcomes and endpoints for acute migraine clinical trials that are patient‐centered and statistically robust could improve the conduct of individual trials, facilitate cross‐trial comparisons, and better support informed treatment decisions by healthcare professionals and patients.

Internet of Things as System of Systems: A Review of Methodologies, Frameworks, Platforms, and Tools

The Internet of Things (IoT) is the latest example of the System of Systems (SoS), demanding for both innovative and evolutionary approaches to tame its multifaceted aspects. Over the years, different IoT methodologies, frameworks, platforms, and tools have been proposed by industry and academia, but the jumbled abundance of such development products have resulted into a high (and disheartening) entry-barrier to IoT system engineering. In this survey, we steer IoT developers by: 1) providing baseline definitions to identify the most suitable class of development products—methodologies, frameworks, platforms, and tools–for their purposes and 2) reviewing seventy relevant products through a comparative and practical approach, based on general SoS engineering features revised in the light of main IoT systems desiderata (i.e., interoperability, scalability, smartness, and autonomy). Indeed, we aim to lessen the confusion related to IoT methodologies, frameworks, platforms, and tools as well as to freeze their current state, for eventually easing the approach towards IoT system engineering.

Incidence and Risk Factors for Acute and Chronic Kidney Injury after Adult Cord Blood Transplantation.

Although cord blood transplantation (CBT) extends allograft access, patient comorbidities, chemoradiation, and nephrotoxic medications all contribute to acute kidney injury (AKI) risk. We analyzed AKI in adult myeloablative CBT recipients who underwent transplantation from 2006 to 2017 for hematologic malignancies using cyclosporine A (CSA)/mycophenolate mofetil immunosuppression. Maximum grades of AKI were calculated using Kidney Disease: Improving Global Outcomes (grade 1, 1.5 to <2-fold; grade 2, 2 to <3-fold; or grade 3, ≥3-fold over baseline) definitions. In total, 153 patients (median 51 years [range, 23-65], 114/153 [75%] acute leukemia, 27/153 [18%] African, 88/153 [58%] cytomegalovirus seropositive, median age-adjusted hematopoietic cell comorbidity index 3 [range, 0-9], median pretransplant albumin 4.0 g/dL [range, 2.6-5.2]) underwent transplantation. The day 100 cumulative incidence of grade 1-3 AKI was 83% (95% confidence interval [CI], 77%-89%) (predominantly grade 2, median onset 40 days, range 0 to 96), and grade 2-3 AKI incidence was 54% (95% CI, 46%-62%) (median onset 43 days, range 0 to 96). Mean CSA level preceding AKI onset was high (360 ng/mL, target range 300-350). In multivariate analysis, African ancestry, addition of haploidentical CD34+ cells, low day -7 albumin, critical illness/intensive care admission, and nephrotoxic drug exposure (predominantly CSA and/or foscarnet) were associated with AKI. In a day 100 landmark analysis, 6% of patients with no prior AKI had chronic kidney disease (CKD) at 2 years versus 43% with prior grade 1 and 38% with prior grade 2-3 AKI (overall P= .02). Adult CBT recipients are at significant AKI risk, and AKI is associated with increased risk of CKD. Prevention strategies, early recognition, and prompt intervention are critical to mitigate kidney injury.

The smartphone generation of community radio listeners: Is FM sustainable?

Abstract This article examines the current environment of audio transmission services in the UK with particular regard to the community radio sector. Community radio stations in the UK are having to consider the extent to which their audiences choose to listen on an FM analogue signal and whether this is sustainable for them. The number of new platforms that a listener is using to access audio programming now includes DAB, SSDAB, TV carriers and online services. There are also developments to the actual receivers that may be used, in particular the use of smartphones to listen via online Wi-Fi or 4G. Currently there are no plans for an FM turn off in the UK and a hybrid system of transmission and reception is the most likely outcome for the foreseeable future. The consequences of this environment for the broadcasters, the listeners and the audio content are discussed in turn. A sample group of twelve community radio stations have been studied to assess current practices. This group are the remaining stations from the original Access Pilot community radio stations that went on air in 2002 and so are the oldest and most established of the UK stations. This article provides baseline definitions where relevant and uses recent data from national audience research, regulatory and other bodies to assess what people are listening to and how, along with examples from public service and commercial radio, as well as community radio.

Paleoclimatological Context and Reference Level of the 2°C and 1.5°C Paris Agreement Long-Term Temperature Limits

The Paris Agreement adopted in December 2015 during the COP21 conference stipulates that the increase in the global average temperature is to be kept well below 2°C above “pre-industrial levels” and that efforts are pursued to limit the temperature increase to 1.5°C above “pre-industrial levels”. In order to further increase public acceptance of these limits it is important to transparently place the target levels and their baselines in a paleoclimatic context of the past 150,000 years (Last Interglacial, LIG) and in particular of the last 10,000 years (Holocene; Present Interglacial, PIG). Intense paleoclimatological research of the past decade has firmed up that pre-industrial temperatures have been highly variable which needs to be reflected in the pre-industrial climate baseline definitions. The currently used reference level 1850-1900 represents the end of the Little Ice Age (LIA).The LIA represents the coldest phase of the last 10,000 years when mean temperatures deviated strongly negatively from the Holocene average and which therefore are hard to justify as a representative pre-industrial baseline. The temperature level reached during the interval 1940-1970 may serve as a better reference level as it appears to roughly correspond to the average pre-industrial temperature of the past two millennia. Placing the climate limits in an enlarged paleoclimatic context will help to demonstrate that the chosen climate targets are valid and represent dangerous extremes of the known natural range of Holocene temperature variability.

Impact of Different Baseline Definitions on The Incidence of Relevant Outcomes Associated with Cancer Following An Advanced Non-Small Cell Lung Cancer (NSCLC) Diagnosis

Impact of Different Baseline Definitions on The Incidence of Relevant Outcomes Associated with Cancer Following An Advanced Non-Small Cell Lung Cancer (NSCLC) Diagnosis

Kernel Analog Forecasting of Tropical Intraseasonal Oscillations

Abstract This paper presents the results of forecasting the Madden–Julian oscillation (MJO) and boreal summer intraseasonal oscillation (BSISO) through the use of satellite-obtained global brightness temperature data with a recently developed nonparametric empirical method. This new method, referred to as kernel analog forecasting, adopts specific indices extracted using the technique of nonlinear Laplacian spectral analysis as baseline definitions of the intraseasonal oscillations of interest, which are then extended into forecasts through an iterated weighted averaging scheme that exploits the predictability inherent to those indices. The pattern correlation of the forecasts produced in this manner remains above 0.6 for 50 days for both the MJO and BSISO when 23 yr of training data are used and 37 days for the MJO when 9 yr of data are used.

Heating & current drive efficiencies, TBR and RAMI considerations for DEMO

The heating & current drive (H&CD) systems in a DEMOnstration fusion power plant are one of the major energy consumers. Due to its high demand in electrical energy the H&CD efficiency optimization is an important goal in the DEMO development.The H&CD power for DEMO, based on physics scenarios for the different plasma phases, is needed for plasma initiation phases (incl. breakdown), current ramp-up, heating to H-mode, burn control, controlled current ramp-down, MHD control and other functions. Plasma control will need significant installed H&CD power, though not continuously used.Previously, in the DEMO1 2015 baseline definitions, optimistic forecasted H&CD efficiencies had been assumed in the corresponding system code (i.e. PROCESS) module. Realizing that there is a high uncertainty in the assumptions the efficiencies have been modified and the impact on the DEMO power plant and basic tokamak configuration are discussed in this article.A comparison of the various H&CD systems NBI (Neutral Beam Injection), Electron Cyclotron (EC), Ion Cyclotron (IC) in terms of impact on Tritium Breeding Ratio (TBR) due to various openings for the H&CD front end components in the breeding blanket (BB) is presented.For increasing the reliability as major features the power per system unit and the redundancy are identified leading to a new proposal for clusters for EC and modular ion-sources for NB.

Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study.

The role of prediabetes as a risk factor for hyperfiltration and albuminuria in persons who do not develop diabetes is unclear. The lack of evidence is mainly due to the difficulty of accurately assessing the glomerular filtration rate (GFR) in the near-normal range of GFR. We investigated whether prediabetes is an independent risk factor for glomerular hyperfiltration and high-normal urinary albumin-creatinine ratio (ACR) using measured GFR (mGFR) rather than estimated GFR. Prospective cohort study based on the Renal Iohexol Clearance Survey in Tromsø 6(RENIS-T6) and the RENIS Follow-Up Study. Median observation time was 5.6 years. A representative sample of 1,261 persons without diabetes mellitus (DM) from the general population aged 50 to 62 years. Prediabetes defined by fasting glucose and hemoglobin A1c according to levels suggested by the American Diabetes Association (preDMADA) and the International Expert Committee of 2009 (preDMIEC). Change in mGFR; hyperfiltration defined as mGFR>90th percentile adjusted for age, sex, weight, and height; and high-normal ACR (>10mg/g) at follow-up. GFR was measured with iohexol clearance. Baseline fasting glucose, hemoglobin A1c, and both definitions of prediabetes were predictors of higher mGFR at follow-up and lower annual mGFR decline in multivariable-adjusted regression analyses. Participants with preDMIEC had an OR for hyperfiltration of 1.95 (95% CI, 1.20-3.17) and for high-normal ACR of 1.83 (95% CI, 1.04-3.22) at follow-up. We adjusted for cardiovascular risk factors including ambulatory blood pressure at baseline and change in use of antihypertensive medication between baseline and follow-up. Only middle-aged white patients participated. There is no consensus on how to define glomerular hyperfiltration. Our findings imply an independent role of prediabetes in the development of glomerular hyperfiltration and albuminuria. Prediabetes might be a target for early treatment to prevent chronic kidney disease in chronic hyperglycemia.

Knowledge, Theory and Practice in Knowledge Management: Betweeen Associative Pattering and Context-Rich Action

Embedded throughout this paper you will find the diversity of opinions that correlates to the diversity of theories, frameworks, case studies and stories that are related to the field of Knowledge Management (KM). We begin by introducing the Sampler Research Call approach and the 13 KM academics and practitioners working in different parts of the world who answered the call. We then provide baseline definitions and briefly explore the process of knowledge creation within the human mind/brain. After a brief (and vastly incomplete) introduction to KM literature at the turn of the Century, the frameworks of Sampler Call participants are introduced, and two early frameworks that achieved almost cult status—the Data-Information-Knowledge-Wisdom (DIKW) continuum and the SECI (socialization, externalization, combination and internalization) model—are explored through the eyes of Sampler Call participants. We then introduce the results of the KMTL (Knowledge Management Thought Leader) Study, which suggest theories consistent with the richness and diversity of thought interwoven throughout this paper. The field of KM is introduced as a complex adaptive system with many possibilities and opportunities. Finally, we share summary thoughts, urging us as KM academics and practitioners to find the balance between the conscious awareness/understanding of higher-order patterns and the actions we take; between the need for overarching theory and the experiential freedom necessary to address context-rich situations.

Standardized Definitions and Clinical Endpoints in Trials Investigating Endovascular Repair of Aortic Dissections

Endovascular therapy is a rapidly expanding option for the treatment of patients with aortic dissection (AD) and various studies have been published. These trials, however, are often difficult to interpret and compare because they do not utilize uniform clinical endpoint definitions. The DEFINE Group is a collaborative effort of an ad hoc multidisciplinary team from various specialties involved in AD therapy in Europe and the United States. DEFINE's goal was to arrive at a broad based consensus for baseline and endpoint definitions in trials for endovascular therapy of various vascular pathologies. In this project, which started in December 2006, the individual team members reviewed the existing pertinent literature. Following this, a series of telephone conferences and face-to-face meetings were held to agree upon definitions. Input was also obtained from regulatory (United States Food and Drug Administration) and industry (device manufacturers with an interest in peripheral endovascular revascularization) stakeholders, respectively. These efforts resulted in the present document containing proposed baseline and endpoint definitions for clinical and morphological outcomes. Although the consensus has inevitably included certain arbitrary consensus choices and compromises, adherence to these proposed standard definitions would provide consistency across future trials, thereby facilitating evaluation of clinical effectiveness and safety of various endovascular revascularization techniques. This current document is based on a broad based consensus involving relevant stakeholders from the medical community, industry and regulatory bodies. It is proposed that the consensus document may have value for study design of future clinical trials in endovascular AD therapy as well as for regulatory purposes.

The ACEF score as predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention

Acute kidney injury (AKI) is an important complication of iodinated contrast media administration [ [1] McCullough P.A. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008; 51: 1419-1428 Abstract Full Text Full Text PDF PubMed Scopus (762) Google Scholar ]. It particularly occurs after coronary procedures; the reported incidence may be as high as 50%, depending on populations, baseline risk factors and definitions [ [2] Bartorelli A.L. Marenzi G. Contrast-induced nephropathy. J Interv Cardiol. 2008; 21: 74-85 Crossref PubMed Scopus (89) Google Scholar ].