Early chronic kidney disease: diagnosis, management and models of care

Chronic kidney disease (CKD) is prevalent in many countries, and the costs associated with the care of patients with end-stage renal disease (ESRD) are estimated to exceed US$1 trillion globally. The clinical and economic rationale for the design of timely and appropriate health system responses to limit the progression of CKD to ESRD is clear. Clinical care might improve if early-stage CKD with risk of progression to ESRD is differentiated from early-stage CKD that is unlikely to advance. The diagnostic tests that are currently used for CKD exhibit key limitations; therefore, additional research is required to increase awareness of the risk factors for CKD progression. Systems modelling can be used to evaluate the impact of different care models on CKD outcomes and costs. The US Indian Health Service has demonstrated that an integrated, system-wide approach can produce notable benefits on cardiovascular and renal health outcomes. Economic and clinical improvements might, therefore, be possible if CKD is reconceptualized as a part of primary care. This Review discusses which early CKD interventions are appropriate, the optimum time to provide clinical care, and the most suitable model of care to adopt

Analysis of the population structure of a gorgonian forest (Placogorgia sp.) using a photogrammetric 3D modeling approach at Le Danois Bank, Cantabrian Sea

The presence of gorgonian forests and deep-sea sponge aggregations in the Le Danois Bank promoted its declaration as the “El Cachucho” Marine Protected Area (MPA) by the Spanish Ministry of Environment, and its inclusion in the Natura 2000 network. Both habitats are considered vulnerable, so follow-up surveys are being performed to monitor their conservation in compliance with the EU Habitats Directive. The use of a non-invasive methodology, which does not cause damage or alterations on benthic communities, is particularly necessary in vulnerable ecosystem studies and MPA monitoring. This study analyzed the assemblage structure of a Placogorgia sp. population using a 3D photogrammetry-based method. The study was carried out through the analysis of the video transects obtained at the Le Danois Bank, using the Politolana underwater towed vehicle during the July 2017 ECOMARG survey. Recent developments in specific software of photogrammetric image analysis allowed extracting valuable information from these video transects. Using the Pix4D Mapper Pro software, 3D point clouds were obtained, and the size and morphometry of yellow fan-shaped gorgonian population structure could be evaluated. Due to gorgonian's high structural complexity, the use of length (i.e. height) as the morphometric descriptor of the real size of the colonies is not appropriate. Instead of length, the fan surface area covered by each gorgonian colony was selected as a suitable parameter of size. The direct measurement of this parameter was possible through a complete 3D reconstruction of the gorgonian forest. A total of 426 colonies of Placogorgia sp. were digitalized to obtain surface measurements and fan spread orientation calculations in 3D models. The results show that gorgonian populations were mostly composed of a high proportion of small colonies (0–0.10 m2). The population structure distribution shows a high proportion (~27%) of recruits (0.5 m2). In 78% of the gorgonian colonies, facing angles were grouped inside the first quadrant (0°-90°), in accordance with the main current direction in this zone. Colony distribution and fan orientation inside the gorgonian forest can be used as data sources to improve monitoring and management programs of these unique habitats in MPAs

Spatial Analyses of Benthic Habitats to Define Coral Reef Ecosystem Regions and Potential Biogeographic Boundaries along a Latitudinal Gradient

Marine organism diversity typically attenuates latitudinally from tropical to colder climate regimes. Since the distribution of many marine species relates to certain habitats and depth regimes, mapping data provide valuable information in the absence of detailed ecological data that can be used to identify and spatially quantify smaller scale (10 s km) coral reef ecosystem regions and potential physical biogeographic barriers. This study focused on the southeast Florida coast due to a recognized, but understudied, tropical to subtropical biogeographic gradient. GIS spatial analyses were conducted on recent, accurate, shallow-water (0–30 m) benthic habitat maps to identify and quantify specific regions along the coast that were statistically distinct in the number and amount of major benthic habitat types. Habitat type and width were measured for 209 evenly-spaced cross-shelf transects. Evaluation of groupings from a cluster analysis at 75% similarity yielded five distinct regions. The number of benthic habitats and their area, width, distance from shore, distance from each other, and LIDAR depths were calculated in GIS and examined to determine regional statistical differences. The number of benthic habitats decreased with increasing latitude from 9 in the south to 4 in the north and many of the habitat metrics statistically differed between regions. Three potential biogeographic barriers were found at the Boca, Hillsboro, and Biscayne boundaries, where specific shallow-water habitats were absent further north; Middle Reef, Inner Reef, and oceanic seagrass beds respectively. The Bahamas Fault Zone boundary was also noted where changes in coastal morphologies occurred that could relate to subtle ecological changes. The analyses defined regions on a smaller scale more appropriate to regional management decisions, hence strengthening marine conservation planning with an objective, scientific foundation for decision making. They provide a framework for similar regional analyses elsewhere

Clinical pharmacology of cancer therapies in older adults

This abbreviated review outlines the physiologic changes associated with aging, and examines how these changes may affect the pharmacokinetics and pharmacodynamics of anticancer therapies. We also provide an overview of studies that have been conducted evaluating the pharmacology of anticancer therapies in older adults, and issue a call for further research

Vitalism in contemporary chiropractic: a help or a hinderance?

Background: Chiropractic emerged in 1895 and was promoted as a viable health care substitute in direct competition with the medical profession. This was an era when there was a belief that one cause and one cure for all disease would be discovered. The chiropractic version was a theory that most diseases were caused by subluxated (slightly displaced) vertebrae interfering with “nerve vibrations” (a supernatural, vital force) and could be cured by adjusting (repositioning) vertebrae, thereby removing the interference with the body’s inherent capacity to heal. DD Palmer, the originator of chiropractic, established chiropractic based on vitalistic principles. Anecdotally, the authors have observed that many chiropractors who overtly claim to be “vitalists” cannot define the term. Therefore, we sought the origins of vitalism and to examine its effects on chiropractic today. Discussion: Vitalism arose out of human curiosity around the biggest questions: Where do we come from? What is life? For some, life was derived from an unknown and unknowable vital force. For others, a vital force was a placeholder, a piece of knowledge not yet grasped but attainable. Developments in science have demonstrated there is no longer a need to invoke vitalistic entities as either explanations or hypotheses for biological phenomena. Nevertheless, vitalism remains within chiropractic. In this examination of vitalism within chiropractic we explore the history of vitalism, vitalism within chiropractic and whether a vitalistic ideology is compatible with the legal and ethical requirements for registered health care professionals such as chiropractors. Conclusion: Vitalism has had many meanings throughout the centuries of recorded history. Though only vaguely defined by chiropractors, vitalism, as a representation of supernatural force and therefore an untestable hypothesis, sits at the heart of the divisions within chiropractic and acts as an impediment to chiropractic legitimacy, cultural authority and integration into mainstream health care

Targeted prostate cancer screening in BRCA1 and BRCA2 mutation carriers: Results from the initial screening round of the IMPACT study

Background Men with germline breast cancer 1, early onset (BRCA1) or breast cancer 2, early onset (BRCA2) gene mutations have a higher risk of developing prostate cancer (PCa) than noncarriers. IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1/2 mutation carriers and controls) is an international consortium of 62 centres in 20 countries evaluating the use of targeted PCa screening in men with BRCA1/2 mutations. Objective To report the first year\u27s screening results for all men at enrolment in the study. Design, setting and participants We recruited men aged 40-69 yr with germline BRCA1/2 mutations and a control group of men who have tested negative for a pathogenic BRCA1 or BRCA2 mutation known to be present in their families. All men underwent prostate-specific antigen (PSA) testing at enrolment, and those men with PSA >3 ng/ml were offered prostate biopsy. Outcome measurements and statistical analysis PSA levels, PCa incidence, and tumour characteristics were evaluated. The Fisher exact test was used to compare the number of PCa cases among groups and the differences among disease types. Results and limitations We recruited 2481 men (791 BRCA1 carriers, 531 BRCA1 controls; 731 BRCA2 carriers, 428 BRCA2 controls). A total of 199 men (8%) presented with PSA >3.0 ng/ml, 162 biopsies were performed, and 59 PCas were diagnosed (18 BRCA1 carriers, 10 BRCA1 controls; 24 BRCA2 carriers, 7 BRCA2 controls); 66% of the tumours were classified as intermediate- or high-risk disease. The positive predictive value (PPV) for biopsy using a PSA threshold of 3.0 ng/ml in BRCA2 mutation carriers was 48% - double the PPV reported in population screening studies. A significant difference in detecting intermediate- or high-risk disease was observed in BRCA2 carriers. Ninety-five percent of the men were white, thus the results cannot be generalised to all ethnic groups. Conclusions The IMPACT screening network will be useful for targeted PCa screening studies in men with germline genetic risk variants as they are discovered. These preliminary results support the use of targeted PSA screening based on BRCA genotype and show that this screening yields a high proportion of aggressive disease. Patient summary In this report, we demonstrate that germline genetic markers can be used to identify men at higher risk of prostate cancer. Targeting screening at these men resulted in the identification of tumours that were more likely to require treatment. \ua9 2014 European Association of Urology

Knowing pedagogical praxis in twenty-first century education

There are always perennial and critical questions to be asked about the nature, conduct and study of education. Who is it for? What is its purpose? Is it just? How does it happen? How does one educate? What is education? Such questions lead us into the complex territory of interrelated educational practices involving student learning, teaching, leading, professional learning and development and researching. This chapter seeks to answer a more fundamental question for educators about pedagogical practice posed by Stephen Kemmis: in whose interests are we acting? To do this, we take the lead from decades of influential work by Kemmis and his commitment to a praxis-oriented view of pedagogy, research and education. For him, praxis in education, although differently understood in different historical and educational traditions, concerns a more deliberative, moral, ethical and virtuous conceptualisation of pedagogical practice. It sets aside a more simplistic view of praxis as action by tying it intimately to the notion of phronēsis, a concept that accounts for practical wisdom and the recognition that practical action in the here-and-now (in everyday life, in educational settings) has consequences and so is part of history-making. Thus, the chapter re(in)states the promises of education by considering what is pedagogical praxis, what is required for pedagogical praxis and why should educators be concerned with pedagogical praxis in contemporary times