Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis

OBJECTIVES: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant. DESIGN: Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722). SETTING: One hundred-fifty-three ICUs in 13 countries. PATIENTS: Altogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Continuous RRT was the initial RRT modality in 60.8% of patients in North America and 56.8% of patients in Europe, compared with 96.4% of patients in ANZ (p < 0.001). After adjustment for predefined baseline characteristics, compared with North American and European patients, those in ANZ were more likely to survive to ICU (p < 0.001) and hospital discharge (p < 0.001) and to 90 days (for ANZ vs. Europe: risk difference [RD], -11.3%; 95% CI, -17.7% to -4.8%; p < 0.001 and for ANZ vs. North America: RD, -10.3%; 95% CI, -17.5% to -3.1%; p = 0.007). CONCLUSIONS: Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions

Elastic scattering of 29 MeV negative pions from ²⁰⁸Pb

We have measured the differential cross section for 29 MeV negative pions elastically scattered from 208Pb. Range telescopes were used to detect the scattered pions. The data are compared with calculations of Rost. </jats:p

The variation of pionic X-ray intensity with atomic number

Pionic X-ray intensities have been measured for 57 elemental targets. For each transition, in addition to the broad maximum as a function of Z expected from the Auger effect and the strong absorption, local intensity maxima are observed near Z values of closed atomic shells. </jats:p

Optimizing plastics recycling networks

Plastic pollution is a serious sustainability issue facing the global community. Fragments of macroplastics and microplastics pollute terrestrial and aquatic ecosystems, while nanoplastics can also degrade air quality. The recent COVID-19 pandemic also exacerbated the problem. Large-scale commercial use of plastics recycling technologies is hindered by various socio-economic barriers. In particular, cross-contamination of mixed plastic streams is prevalent due to imperfect waste segregation. The concept of Plastics Recycling Networks is intro-duced to facilitate planning of reverse supply chains using optimization models. In this work, basic Linear Programming and Mixed-Integer Linear Programming models are developed for matching sources of waste plastic with plastic recycling plants within Plastics Recycling Networks. These models allocate streams while considering the ability of recycling plants to tolerate contaminants. Two illustrative case studies are analyzed to demonstrate the effectiveness of the models, and policy implications for mitigation of plastic pollution are dis-cussed. These models enable planning of networks with some tolerance for contaminants in plastic waste, and can be the basis for developing new variants to handle additional real world aspects

Optimizing plastics recycling networks

Plastic pollution is a serious sustainability issue facing the global community. Fragments of macroplastics and microplastics pollute terrestrial and aquatic ecosystems, while nanoplastics can also degrade air quality. The recent COVID-19 pandemic also exacerbated the problem. Large-scale commercial use of plastics recycling technologies is hindered by various socio-economic barriers. In particular, cross-contamination of mixed plastic streams is prevalent due to imperfect waste segregation. The concept of Plastics Recycling Networks is introduced to facilitate planning of reverse supply chains using optimization models. In this work, basic Linear Programming and Mixed-Integer Linear Programming models are developed for matching sources of waste plastic with plastic recycling plants within Plastics Recycling Networks. These models allocate streams while considering the ability of recycling plants to tolerate contaminants. Two illustrative case studies are analyzed to demonstrate the effectiveness of the models, and policy implications for mitigation of plastic pollution are discussed. These models enable planning of networks with some tolerance for contaminants in plastic waste, and can be the basis for developing new variants to handle additional real world aspects