Abstract
Background
Although the clinical benefit of obtaining a remission in proteinuria in nephrotic patients with focal segmental glomerulosclerosis (FSGS) is recognized, the long-term value of ...maintaining it and the impact of relapses on outcome are not well described.
Methods
We examined the impact of remissions and relapses on either a 50% decline in kidney function or end-stage kidney disease (combined event) using time-dependent and landmark analyses in a retrospective study of all patients from the Toronto Glomerulonephritis Registry with biopsy-proven FSGS, established nephrotic-range proteinuria and at least one remission.
Results
In the 203 FSGS individuals with a remission, 89 never relapsed and 114 experienced at least one relapse. The first recurrence was often followed by a repeating pattern of remission and relapse. The 10-year survival from a combined event was 15% higher in those with no relapse versus those with any relapse. This smaller than anticipated difference was related to the favourable outcome in individuals whose relapses quickly remitted. Relapsers who ultimately ended in remission (n = 46) versus in relapse (n = 68) experienced a 91% and 32% 7-year event survival (P < .001), respectively. Using time-varying survival analyses that considered all periods of remission and relapse in every patient and adjusting for each period's initial estimated glomerular filtration rate, the state of relapse was associated with a 2.17 (95% confidence interval 1.32–3.58; P = .002) greater risk of experiencing a combined event even in this FSGS remission cohort.
Conclusion
In FSGS, unless remissions are maintained and relapses avoided, long-term renal survival remains poor. Treatment strategies addressing remission duration remain poorly defined and should be an essential question in future trials.
Graphical Abstract
Graphical Abstract
Conventionally, the resilient modulus test is conducted in the laboratory under different moisture content in which matric suction is unknown during the test. To investigate the influence of the ...matric suction on the resilient modulus, this study integrated the suction-controlled testing system and developed a modified testing procedure for the resilient modulus test of unsaturated subgrade soils. Based on the axis-translation technique, two cohesive soils were tested to investigate the effect of matric suction on resilient modulus. In the modified testing procedure, in order to fulfill the equilibrium in matric suction, the number of load cycles at each loading sequence of the resilient modulus test (AASHTO T 292-91) needs to be increased significantly. Experimental data indicate that matric suctions measured in the specimen after consolidation and resilient modulus tests are consistent with the matric suctions deduced from the soil-water characteristic curve corresponding to the same moisture content. In general, the resilient modulus obtained by the suction-controlled resilient modulus test appears to be reasonable. The trends of resilient modulus obtained by the suction-controlled resilient modulus test are consistent with those obtained by the conventional resilient modulus test. However, the suction-controlled resilient modulus test provides better insights that can help in interpreting the test results.
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DOBA, FGGLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
While modeling approaches of evapotranspiration (λE) perform
reasonably well when evaluated at daily or monthly timescales, they can show systematic
deviations at the sub-daily timescale,
which ...results in potential biases in modeled λE to global climate
change. Here we decompose the diurnal variation of heat fluxes and
meteorological variables into their direct response to incoming solar
radiation (Rsd) and a phase shift to Rsd. We analyze data from an
eddy-covariance (EC) station at a temperate grassland site, which experienced a
pronounced summer drought. We employ three structurally different modeling
approaches of λE, which are used in remote sensing retrievals, and
quantify how well these models represent the observed diurnal cycle under
clear-sky conditions. We find that energy balance residual approaches, which
use the surface-to-air temperature gradient as input,
are able to reproduce the reduction of the phase lag from wet to dry conditions. However, approaches
which use the vapor pressure deficit (Da) as the driving gradient
(Penman–Monteith) show significant deviations from the observed phase lags,
which is found to depend on the parameterization of surface conductance to
water vapor. This is due to the typically strong phase lag of 2–3 h
of Da, while the observed phase lag of λE is only on the order of
15 min. In contrast, the temperature gradient shows phase differences in
agreement with the sensible heat flux and represents the wet–dry difference
rather well. We conclude that phase lags contain important information on
the different mechanisms of diurnal heat storage and exchange and, thus,
allow a process-based insight to improve the representation of
land–atmosphere (L–A) interactions in models.
Background:
Patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) are at risk of early death. This may be reduced by timely assessment and treatment.
Objectives:
The purpose of ...this study was to evaluate if Nurse-led Early Triage (NET) in the coronary care unit (CCU) can improve time to assessment and management of NSTE-ACS patients.
Methods:
Data on 79 consecutive chest pain patients admitted pre-NET to the acute admissions unit (AAU) and on 103 patients admitted in the first six months of the NET service in CCU, was re-examined and compared to subsequent data obtained on 92 patients admitted via NET five years later, in order to re-evaluate the service.
Results:
NET resulted in significant improvements in: the number of patients with chest pain who had their 12-lead electrocardiogram (ECG) performed within 10 min of admission (94% vs 32%, p<0.001); the number of high-risk NSTE-ACS patients prescribed clopidogrel (72% vs 42%, p<0.01); and the number being managed in CCU (82% vs 34%, p<0.01). Comparison of the NET service at five years with the pre-NET service demonstrated measurable benefits were sustained (p<0.01) for the same comparative end points. There were no significant differences in these end-points of time to ECG, clopidogrel prescription nor management in CCU for high-risk patients between the NET groups at six months and five years, demonstrating that current triage is as effective as when first introduced.
Conclusions:
This study demonstrated the positive impact of nurse-led early triage for NSTE-ACS patients and that initial benefits have been sustained.
This paper considers the max-min weighted signal-to-interference-plus-noise ratio (SINR) problem subject to multiple weighted-sum power constraints, where the weights can represent relative power ...costs of serving different users. First, we study the power control problem. We apply nonlinear Perron-Frobenius theory to derive closed-form expressions for the optimal value and solution and an iterative algorithm which converges geometrically fast to the optimal solution. Then, we use the structure of the closed-form solution to show that the problem can be decoupled into subproblems each involving only one power constraint. Next, we study the multiple-input-single-output (MISO) transmit beamforming and power control problem. We use uplink-downlink duality to show that this problem can be decoupled into subproblems each involving only one power constraint. We apply this decoupling result to derive an iterative subgradient projection algorithm for the problem.
Our purpose was to assess comparative female representation trends for trainees and full-time faculty in the academic radiation oncology and hematology oncology workforce of the United States over ...3 decades.
Simple linear regression models with year as the independent variable were used to determine changes in female percentage representation per year and associated 95% confidence intervals for trainees and full-time faculty in each specialty.
Peak representation was 48.4% (801/1654) in 2013 for hematology oncology trainees, 39.0% (585/1499) in 2014 for hematology oncology full-time faculty, 34.8% (202/581) in 2007 for radiation oncology trainees, and 27.7% (439/1584) in 2015 for radiation oncology full-time faculty. Representation significantly increased for trainees and full-time faculty in both specialties at approximately 1% per year for hematology oncology trainees and full-time faculty and 0.3% per year for radiation oncology trainees and full-time faculty. Compared with radiation oncology, the rates were 3.84 and 2.94 times greater for hematology oncology trainees and full-time faculty, respectively.
Despite increased female trainee and full-time faculty representation over time in the academic oncology physician workforce, radiation oncology is lagging behind hematology oncology, with trainees declining in recent years in radiation oncology; this suggests a de facto ceiling in female representation. Whether such issues as delayed or insufficient exposure, inadequate mentorship, or specialty competitiveness disparately affect female representation in radiation oncology compared to hematology oncology are underexplored and require continued investigation to ensure that the future oncologic physician workforce reflects the diversity of the population it serves.
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GEOZS, IJS, NUK, OILJ, UL, UM, UPUK
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