Background In Central America, an epidemic of chronic kidney disease of unknown cause disproportionately affects young male agricultural workers. Study Design Longitudinal cohort study. Setting & ...Participants 284 sugarcane workers in 7 jobs were recruited from one company in northwestern Nicaragua. Blood and urine samples were collected before and near the end of the 6-month harvest season. Predictors Job category (cane cutter, seeder, seed cutter, agrichemical applicator, irrigator, driver, and factory worker); self-reported water and electrolyte solution intake. Outcomes & Measurements Changes in levels of urinary kidney injury biomarkers normalized to urine creatinine level, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), N -acetyl-β- d -glucosaminidase (NAG), and albumin; serum creatinine–based estimated glomerular filtration rate (eGFR). Results Mean eGFR was 113 mL/min/1.73 m2 and <5% of workers had albuminuria. Field workers had increases in NGAL and IL-18 levels that were 1.49 (95% CI, 1.06 to 2.09) and 1.61 (95% CI, 1.12 to 2.31) times as high, respectively, as in non–field workers. Cane cutters and irrigators had the greatest increases in NGAL levels during the harvest, whereas cane cutters and seeders had the greatest increases in IL-18 levels. Electrolyte solution consumption was associated with lower mean NGAL and NAG levels among cane cutters and lower mean IL-18 and NAG levels among seed cutters; however, there was no overall effect of hydration among all workers. On average, workers with the largest increases in NGAL and NAG levels during the harvest had declines in eGFRs of 4.6 (95% CI, 1.0 to 8.2) and 3.1 (95% CI, −0.6 to 6.7) mL/min/1.73 m2 , respectively. Limitations Surrogate exposure measure, loss to follow-up. Conclusions Results are consistent with the hypothesis that occupational heat stress and volume depletion may be associated with the development of kidney disease, and future studies should directly measure these occupational factors. The presence of urine tubular injury markers supports a tubulointerstitial disease that could occur with repeated tubular injury.
1. Along urbanised coastlines, urban infrastructure is increasingly becoming the dominant habitat. These structures are often poor surrogates for natural habitats, and a diversity of eco-engineering ...approaches have been trialled to enhance their biodiversity, with varying success. 2. We undertook a quantitative meta-analysis and qualitative review of 109 studies to compare the efficacy of common eco-engineering approaches (e.g. increasing texture, crevices, pits, holes, elevations and habitat-forming taxa) in enhancing the biodiversity of key functional groups of organisms, across a variety of habitat settings and spatial scales. 3. All interventions, with one exception, increased the abundance or number of species of one or more of the functional groups considered. Nevertheless, the magnitude of effect varied markedly among groups and habitat settings. In the intertidal, interventions that provided moisture and shade had the greatest effect on the richness of sessile and mobile organisms, while water-retaining features had the greatest effect on the richness of fish. In contrast, in the subtidal, small-scale depressions which provide refuge to new recruits from predators and other environmental Stressors such as waves, had higher abundances of sessile organisms while elevated structures had higher numbers and abundances of fish. The taxa that responded most positively to eco-engineering in the intertidal were those whose body size most closely matched the dimensions of the resulting intervention. 4. Synthesis and applications. The efficacy of eco-engineering interventions varies among habitat settings and functional groups. This indicates the importance of developing site-specific approaches that match the target taxa and dominant stressors. Furthermore, because different types of intervention are effective at enhancing different groups of organisms, ideally a range of approaches should be applied simultaneously to maximise niche diversity.
While photovoltaic (PV) renewable energy production has surged, concerns remain about whether or not PV power plants induce a "heat island" (PVHI) effect, much like the increase in ambient ...temperatures relative to wildlands generates an Urban Heat Island effect in cities. Transitions to PV plants alter the way that incoming energy is reflected back to the atmosphere or absorbed, stored, and reradiated because PV plants change the albedo, vegetation, and structure of the terrain. Prior work on the PVHI has been mostly theoretical or based upon simulated models. Furthermore, past empirical work has been limited in scope to a single biome. Because there are still large uncertainties surrounding the potential for a PHVI effect, we examined the PVHI empirically with experiments that spanned three biomes. We found temperatures over a PV plant were regularly 3-4 °C warmer than wildlands at night, which is in direct contrast to other studies based on models that suggested that PV systems should decrease ambient temperatures. Deducing the underlying cause and scale of the PVHI effect and identifying mitigation strategies are key in supporting decision-making regarding PV development, particularly in semiarid landscapes, which are among the most likely for large-scale PV installations.
While driving simulators are a valuable tool for assessing multiple dimensions of driving performance under relatively safe conditions, researchers and practitioners must be prepared for participants ...that suffer from simulator sickness. This paper describes multiple theories of motion sickness and presents a method for assessing and reacting to simulator sickness symptoms. Results showed that this method identified individuals who were unable to complete a driving simulator study due to simulator sickness with greater than 90% accuracy and that older participants had a greater likelihood of simulator sickness than younger participants. Possible explanations for increased symptoms experienced by older participants are discussed as well as implications for research ethics and simulator sickness prevention.
Documentation of care preferences within 48 hours of admission to an intensive care unit (ICU) is a National Quality Forum-endorsed quality metric for older adults. Care preferences are poorly ...captured by administrative data.
Using deep natural language processing, our aim was to determine the rate of care preference documentation in free-text notes and to assess associated patient factors.
Retrospective review of notes by clinicians using a deep natural language processing to identify care preference documentation, including goals-of-care and treatment limitations, within 48 hours of ICU admission within five ICUs (medical, cardiac, surgery, trauma surgery, and cardiac surgery) for adults 75 years and older. Covariates included demographics, ICU type, sequential organ failure assessment score, and need for mechanical ventilation.
Deep natural language processing reviewed 11,575 clinician notes for 1350 ICU admissions. Median patient age was 84.0 years (interquartile range 78.0–88.4). Overall, 64.7% had documentation of care preferences. Patients with documentation were older (85 vs. 83 years; P < 0.001) and more often female (53.8% vs. 43.4%; P < 0.001). In adjusted analysis, rates of care preference documentation were higher for older patients, females, nonelective admissions, and admissions to the medical vs. the cardiac or surgical ICUs (all P ≤ 0.01).
Care preference documentation within 48 hours was absent in more than one-third of ICU admissions among patients aged 75 years and older and was more likely to occur in medical vs. cardiac or surgical ICUs.
Mesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America, affects young individuals working in physically strenuous occupations. Repeated episodes of ...work-related kidney injury may lead to CKD in this setting. We aimed to better understand the burden and natural history of acute kidney injury (AKI) in workers at risk for MeN.
Cross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with AKI.
326 sugarcane workers with normal preharvest serum creatinine (Scr) values and no history of CKD in an MeN hotspot in Nicaragua near the end of the harvest, and prospective follow-up of workers with AKI.
AKI during the harvest, as defined by Scr level increase ≥ 0.3mg/dL over baseline to a level ≥ 1.3mg/dL.
Kidney function trajectory and development of CKD over 12 months.
Linear regression models were used to analyze the association between job category and kidney function. For workers with AKI, the effect of time on Scr level was evaluated using linear mixed effects.
34 of 326 participants were found to have AKI, with a median late-harvest Scr level of 1.64mg/dL in the AKI group. Workers without AKI had a median Scr level of 0.88mg/dL. AKI was more common among cane cutters compared with other field workers. Participants with AKI had variable degrees of kidney function recovery, with median 6- and 12-month Scr values of 1.25 and 1.27mg/dL, respectively (P < 0.001 for each follow-up value compared to late-harvest Scr). When we compared workers’ kidney function before the AKI episode to their kidney function at last follow-up, 10 participants with AKI developed de novo estimated glomerular filtration rate < 60mL/min/1.73m2 and 11 had a >30% decrease in estimated glomerular filtration rate.
Follow-up limited to 1 year and some loss to follow-up in the prospective component of the study. Broad definition of AKI that includes both acute and subacute kidney injury.
In a group of sugarcane workers with normal preharvest kidney function, newly decreased kidney function developing during the harvest season was common. Of those with kidney injury, nearly half had established CKD 12 months later.
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Objectives
To determine if socioeconomic disadvantage impacts perioperative outcomes after tracheostomy.
Methods
We performed a retrospective case series of children who underwent tracheostomy. ...Children were divided into less and more disadvantaged groups based on their community's Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure. Primary outcomes were the length of stay, total cost, in‐hospital mortality, and 30‐day all‐cause readmission after tracheostomy placement. Length of stay was further analyzed using parametric survival analysis.
Results
A total of 239 patients met inclusion criteria, with 153 (64%) residing in more disadvantaged communities. Children from more disadvantaged communities were less likely to be White (42% vs. 26%, P = .009) and more likely to have Medicaid coverage (90% vs. 62%, P < .001). The two groups had similar medical complexity and comorbidities. The main outcome measures showed differences in median total length of stay (113 vs. 79 days, P = .04) and median total cost ($461 000 vs. $279 000, P = .01). Children with tracheostomies who were from more disadvantaged communities also had increased risk of prolonged hospitalizations (HR = 0.63, 95% CI = 0.48–0.83, P = .001). Readmissions, mortality rates, and quality of life scores were similar between groups.
Conclusions
Community disadvantage was associated with differences in hospitalization length and costs after pediatric tracheostomy placement. Further research should continue to describe how health disparities impact children's safe and efficient care with tracheostomies.
Level of Evidence
4 Laryngoscope, 131:2603–2609, 2021
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