Search

This manuscript serves to introduce The John A. Williams Human Skeletal (JAW) Collection, which is a donated skeletal collection consisting of individuals from the Body Donation Program at Western Carolina University. Full body donors decompose naturally at the Forensic Osteology Research Station (FOREST) before curation within the JAW Collection. As of 31 December 2021, the JAW Collection has 98 skeletal donors and 16 cremated donors. There are also nearly 40 donors within various stages of the decomposition and curation processes. The importance of a willed-body collection such as the JAW Collection is its ability to be utilized in educational efforts for both students and members of the public. Undergraduate students at Western Carolina University learn from our willed-body donors from the initial intake at FOREST through processing and curation within the Western Carolina Human Identification Lab (WCHIL). The JAW Collection also enables a thriving outreach program through continuing education efforts. Courses are offered throughout the year that would not be possible without a donated skeletal collection. Additionally, the FOREST and JAW Collection serve a larger community purpose by offering environmentally friendly alternatives to traditional burials for community members, demonstrating that these collections have a variety of purposes outside of academic research.

This paper develops a satellite account for the US health sector and measures productivity growth in health care for the elderly population between 1999 and 2012. We measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions. Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5 percent per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes. (JEL E01, H51, I10)

Objective To study the impact of hyperuricemia on clinical presentation, severity, and associated comorbidities of psoriatic arthritis (PsA). Methods Retrospective bicentric case–control study performed in Strasbourg and Colmar, France, from 2009 to 2019. Patients with PsA (according to ICD-10 coding) and at least one available serum urate (SU) measurement were included. Demographic, comorbidities, clinical, and radiographic data were collected. Hyperuricemia was defined as SU level ≥ 360 µmol/L. Results We included 242 patients: 73 (30.2%) had hyperuricemia and 15 (6.2%) met 2015 ACR/EULAR criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more frequently male (72.6% vs 39.1%, p = 1.6 × 10−6) with higher body mass index (30.9 vs 28.7 kg/m2, p = 0.015) and more comorbidities (Charlson comorbidity index: 2.6 vs 1.8, p = 0.005). PsA started at an older age (47.5 vs 43 years, p = 0.016) was more polyarticular (56.2% vs 41.9%, p = 0.049) than axial (9.6% vs 22.8%, p = 0.019) and more destructive (52.8% vs 37.4%, p = 0.032). PsA patients with joint destruction more frequently had hyperuricemia than did others (37.6% vs 25.8%, p = 0.047). Multivariable analysis confirmed the association of hyperuricemic PsA with peripheral joint involvement (odds ratio 2.98; 95% confidence interval 1.15–7.75; p = 0.025) and less good response to treatment (0.35; 0.15–0.87; p = 0.024). Conclusion Patients with hyperuricemic PsA show poorer response to PsA treatment and have more peripheral and destructive joint damage than normo-uricemic patients. Key Points• Gout and psoriatic arthritis (PsA) can co-exist in the same patient.• Monosodium urate crystals might have a deleterious impact on PsA.• Hyperuricemic PsA is more polyarticular, less frequently axial, and more destructive than normo-uricemic PsA.• PsA with hyperuricemia should lead to more personalized medicine.

Excess nutrients from agricultural settings contribute to surface water and groundwater impairment. Constructed wetlands have been widely used for water quality protection in various agricultural systems. We used a synthesis approach to document the performance of constructed wetlands for nutrient removal from a range of landscapes and geographic regions with the following objectives: (1) review the current use of constructed wetlands in agricultural applications, (2) summarize the nutrient removal efficiency of constructed wetlands, and (3) identify the geographic usage and costs associated with constructed wetlands. We reviewed over 130 publications and reports to characterize nutrient removal performance for the following types of agricultural effluents: cropland surface and subsurface drainage, and wastewater from livestock production, greenhouse, aquaculture, and hydroponic systems. Data from the reviewed studies indicate that constructed wetlands are efficient in protecting water quality in agricultural production settings. However, differences in constructed wetland characteristics reported by the studies suggest that standards are needed to ensure nutrient removal goals are met based on wetland design. Researchers should consider including basic performance parameters for constructed wetlands in published reports, including influent and effluent concentrations, hydraulic retention time, hydraulic loading rate, watershed to treatment wetland ratios, and plant species and relative cover. Future studies are needed to explore cost-benefit analyses to assess the feasibility and potential promotion of wetland incentive programs in various geographic regions and watershed nonpoint-source pollution goals for using these systems in agricultural settings. Keywords: Agricultural wastewater, Agricultural water quality, Aquaculture, Cropland runoff, Greenhouse, Hydroponic, Livestock, Review, Subsurface, Treatment wetland.

Information about an extensive set of health conditions on a well-defined sample of subjects is essential for assessing population health, gauging the impact of various policies, modeling costs, and studying health disparities. Unfortunately, there is no single data source that provides accurate information about health conditions. We combine information from several administrative and survey data sets to obtain model-based dummy variables for 107 health conditions (diseases, preventive measures, and screening for diseases) for elderly (age 65 and older) subjects in the Medicare Current Beneficiary Survey (MCBS) over the fourteen-year period, 1999–2012. The MCBS has prevalence of diseases assessed based on Medicare claims and provides detailed information on all health conditions but is prone to underestimation bias. The National Health and Nutrition Examination Survey (NHANES), on the other hand, collects self-reports and physical/laboratory measures only for a subset of the 107 health conditions. Neither source provides complete information, but we use them together to derive model-based corrected dummy variables in MCBS for the full range of existing health conditions using a missing data and measurement error model framework. We create multiply imputed dummy variables and use them to construct the prevalence rate and trend estimates. The broader goal, however, is to use these corrected or modeled dummy variables for a multitude of policy analysis, cost modeling, and analysis of other relationships either using them as predictors or as outcome variables.

Portable in situ ultraviolet-visual spectrometers, through high frequency water quality measurements, provide new insight into biogeochemical processes occurring within dynamic ecosystems. Nitrogen and carbon cycling were observed in two distinct wetland mesocosm environments during a two-year mesocosm study. Simulated drainage water was loaded into the mesocosms across seasons with target nitrate-N levels between 2.5 and 10 mg L−1. Nitrate-N and dissolved organic carbon concentrations in the water column were measured hourly with the spectrometer and calibrated with water quality grab samples. Prominent and unique diel cycles were observed in both nitrate-N and dissolved organic carbon readings from the spectrometer, which reveal biogeochemical processes in these systems are more complicated than typically considered in empirical models. Findings support the importance of utilizing high frequency monitoring to advance current knowledge of nitrogen and carbon processes occurring in treatment wetland ecosystems.

Nebraskan streams contribute excess nitrogen to the Mississippi/Atchafalaya River Basin and Gulf of Mexico, which results in major water-quality impairments. Reducing the amount of nitrogen (N) exported in these streams requires the use of best management practices (BMPs) within the landscape. However, proper BMP utilization has rarely been statistically connected to potential controls of N export within watersheds, particularly precipitation and soil characteristics. In this study, 19 watershed variables were evaluated in five categories (hydrological, physiographic, point sources, land use, and soil properties) to determine the characteristics that influenced variable nitrate nitrogen (NO3-N) concentrations in 17 Nebraska watersheds with known high NO3-N export rates. Each characteristic was derived from publicly-available datasets in an effort to develop a multiregional method. Of the 19 variables evaluated, 10 variables (developed, cropland, herbaceous, forest, excessively-drained soils, precipitation, base-flow index, slope, organic matter and point sources) were identified to statistically influence stream NO3-N concentrations. The 17 watersheds were divided into five subset groups using principal component analysis. Distributions of the 10 watershed variables were then used to determine the most applicable BMPs for NO3-N reductions for each stream subset: excessively drained with high baseflow index (Groups 1 and 2), dominantely row crop land usage with well-drained soils, higher precipitation, and an increased tendency for surface runoff concerns (Group 3), highly developed watersheds (Group 4), and single river dominated by wastewater treatment plant discharge (Group 5). Based on the most influential variables a variety of BMPs were recommended, including N fertilizer application management and accounting for N credit from mineralization and NO3-N in irrigation water (Groups 1 and 2), installation of riparian buffers and wetlands (Group 3), urban BMPs such as bioretention cells and permeable pavement (Group 4), and upgrades to the wastewater treatment plant (Group 5). This study provides an improved technique for facilitating watershed management by linking BMPs directly to the characteristics of each watershed to reduce current nitrate export.

Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population.In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbAOf 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbAThe Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX.National Institute of Diabetes and Digestive and Kidney Diseases.

Efforts to improve water quality of eutrophic ponds often involve implementing changes to watershed management practices to reduce external nutrient loads. While this is required for long-term recovery and prevention, eutrophic conditions are often sustained through the recycling of internal nutrients already present within the waterbody. In particular, internal phosphorus bound to organic material and adsorbed to sediment has the potential to delay lake recovery for decades. Thus, pond and watershed management techniques are needed that not only reduce external nutrient loading but also mitigate the effects of internal nutrients already present. Therefore, our objective was to demonstrate a biological and chemical approach to remove and sequester nutrients present and entering an urban retention pond. A novel biological and chemical management technique was designed by constructing a 37 m

Neonicotinoids have been the most commonly used insecticides since the early 1990s. Despite their efficacy in improving crop protection and management, these agrochemicals have gained recent attention for their negative impacts on non-target species such as honeybees and aquatic invertebrates. In recent years, neonicotinoids have been detected in rivers and streams across the world. Determining and predicting the exposure potential of neonicotinoids in surface water requires a thorough understanding of their fate and transport mechanisms. Therefore, our objective was to provide a comprehensive review of neonicotinoids with a focus on their fate and transport mechanisms to and within surface waters and their occurrence in waterways throughout the world. A better understanding of fate and transport mechanisms will enable researchers to accurately predict occurrence and persistence of insecticides entering surface waters and potential exposure to non-target organisms in agricultural intensive regions. This review has direct implications on how neonicotinoids are monitored and degraded in aquatic ecosystems. Further, an improved understanding of the fate and transport of neonicotinoids aide natural resource practitioners in the development and implementation of effective best management practices to reduce the potential impact and exposure of neonicotinoids in waterways and aquatic ecosystems.

Currently little is known of newer pesticide classes and their occurrence and persistence in recreational lakes. Therefore, the objectives of this study were to (1) assess average pesticide concentrations and loadings entering recreational lakes in three mixed land use watersheds throughout the growing season, (2) evaluate pesticide persistence longitudinally within the lakes, and (3) perform an ecotoxicity assessment. Six sampling campaigns were conducted at three lakes from April through October 2018 to measure the occurrence and persistence during pre, middle, and post growing season. Polar organic chemical integrative samplers (POCIS) were placed in streams near lake inlets and monthly samples were collected for analysis of twelve pesticides. Additional monthly grab water samples were taken at each POCIS location and at the midpoint and outlet of each lake. All pesticide samples were analyzed using liquid chromatography/tandem mass spectrometry (LC/MS/MS) and individual pesticide loading rates were determined. Occurrence and persistence of specific pesticides were significantly different between lakes in varying watershed land uses. Specifically, the recreational lake receiving predominately urban runoff had the highest load of pesticides, likely in the form of biocides, entering the waterbody. Concentrations of imidacloprid exceeded acute and chronic invertebrate levels for 11% and 61% of the sampling periods, respectively, with the recreational lake receiving predominately urban runoff having the most occurrences. Findings from this study are critical for preventing and mitigating potential effects of pesticides, specifically applied as biocides in urban landscapes, from entering and persisting in recreational lakes.

Estimating medical care productivity is a central economic challenge. This paper develops a satellite account for the US health sector that appropriately measures health care productivity and applies that to the elderly population between 1999 and 2012. The central output of the satellite account is health. The primary input is medical care; we also examine the impact of behavioral risk factors. Our empirical work measures the change in medical spending and health outcomes for a comprehensive set of 80 conditions. We estimate that medical care has positive productivity as a whole, with aggregate productivity growth of 9% over the time period. However, there is significant heterogeneity in productivity by condition. At the upper end, care for cardiovascular disease has been extremely productive. In contrast, care for people with mental illness and musculoskeletal conditions has been costly but not productive.

HighlightsA floating treatment wetland design was evaluated for water quality improvements.Nitrate-N removal rates were quantified using spent coffee grounds as a carbon source.Nitrate-N removal rates increased throughout the growing season Abstract. The Midwestern U.S. is vulnerable to eutrophic conditions from high nutrient concentrations. Floating treatment wetlands (FTWs) are an innovative wetland design for nutrient removal from nonpoint sources and provide a unique treatment. The objectives of this project were to quantify nitrate removal in traditional and carbon-amended FTWs planted with Midwestern plant species during the establishment year. Three greenhouse experiments were conducted throughout the growing season using 18 mesocosms. Two vegetation designs were evaluated: rush species ( and ) and diverse species (, , , , , and ). Spent coffee grounds were applied to 9 of the 18 mesocosms as a carbon amendment. Nitrate-N removal increased during the establishment growing season in the FTW systems (Spring: 15.0% to 17.3%, Summer 1: 82.8% to 92.6%, Summer 2: 86.4% to 94.7%). Nitrate-N removal was also impacted by carbon amendments (FTW without amendment: 82.8% to 94.7%, FTW with amendment: 88.4% to 96.1%). Carbon additions were found to enhance denitrifying conditions even in the absence of FTWs (decreased dissolved oxygen, increased available organic carbon). Significant differences in nitrate-N removal were not observed between FTW vegetation designs. This study provides new insight on the impacts of the growing season, plant species, and carbon amendments on FTW nitrate-N removal performance during the establishment year. Keywords: Best management practices, Carbon amendment, Floating treatment wetlands, Nitrogen removal, Spent coffee grounds

Floating treatment wetlands are an innovative wetland design to passively improve water quality and remove pollutants from reservoirs with limited infrastructure modification or construction as compared to traditional treatment wetlands. However, design recommendations remain limited. Therefore, the objectives of this study were: 1. Determine nitrate-N removal rates in two floating treatment wetland vegetation designs entering a second growing season and 2. Evaluate nitrate-N removal performance in floating treatment wetland designs following the addition of two carbon amendments during the growing season. Three floating treatment wetland mesocosm experiments were conducted during the summer of 2019, where nitrate-N removal was evaluated. Two floating treatment wetland plant designs (Rush species and Diverse species) and three carbon conditions (no amendment, spent coffee grounds, and barley straw) were assessed in replicates of three. Floating treatment wetland vegetation design (Rush versus Diverse) was found to have significant (P

Introduction Les études vaccinales de grande ampleur et les registres apportent des résultats précieux mais souvent de manière retardée par rapport à l’urgence pandémique. Les perfusions de biologiques intraveineux en hôpital de jour (HDJ) permettent de garantir un recueil de données fiables en temps réel. C’est ainsi que nous avions mis en évidence le surrisque d’une forme grave de COVID-19 sous rituximab. Nous avons souhaité étudier l’impact des bDMARDs sur la réponse vaccinale humorale des patients suivis en HDJ. Patients et méthodes Nous avons étudié la réponse vaccinale après un schéma vaccinale complet, 2 ou 3 doses de vaccin, suivis en hôpital de jour dans 5 centres hospitaliers français et traités par un biomédicament intraveineux entre septembre 2019 et août 2021. Après information et consentement des patients, nous avons inclus ceux disposant ou acceptant de réaliser une sérologie anti-SARS-CoV-2. Les patients étaient considérés comme non-répondeurs si le taux d’anticorps détecté était inférieur au seuil de positivé du kit utilisé. Résultats Sur les 925 patients suivis en HDJ dans les 5 centres, les données préliminaires de 205 patients sont disponibles (148 F/57 H). L’âge médian était de 64 ans (Interquartile Range [IQR] 56–71). 25 étaient traités par tocilizumab (TCZ), 36 par abatacept (ABA), 53 par infliximab (IFX) et 91 par rituximab (RTX). 156 étaient traités pour une PR, 33 pour une spondyloarthrite et 16 pour une autre pathologie (connectivite n = 5, myosite n = 3, vascularite n = 2, arthrite juvénile idiopathique n = 2, autres n = 4). 25 patients étaient co-traités par corticoïdes, 126 par csDMARDs et 2 par d’autres immunossuppresseurs (aziathioprine). Trois quarts des patients traités par RTX ont débuté leur schéma vaccinal plus de 4 mois après leur dernier cycle de traitement. Un total de 23 patients avaient un antécédent de COVID-19 confirmé (par PCR ou sérologie). Un total de 169 patients ont été vaccinés par Pfizer, 16 par Astra-Zeneca, 14 par Moderna, 5 par Janssen et un par Astra-Zeneca puis Pfizer. Un total de 167 patients ont bénéficié d’une sérologie après 2 doses de vaccin (ou un schéma vaccinal complet en cas de COVID-19 préalable). Parmi eux, 28 (16,8 %) étaient non-répondeurs. Il n’y avait pas de différence en fonction de l’âge (p = 0,24) ou du sexe des patients (p = 0,51), du type de pathologie ou du co-traitement par corticoïdes ou csDMARD. La réponse vaccinale était différente en fonction du bDMARD utilisé (p = 0,0003) : aucun patient traité par IFX (0/42) n’était non-répondeur, un seul sous TCZ (1/25, 4 %) contre 25 % sous ABA (8/32) et 27,9 % sous RTX (19/68). Un total de 94 % des non répondeurs après 2 ou 3 doses de vaccin avaient été traités par RTX ou ABA. Chez les patients traités par rituximab, le délai entre la dernière perfusion et la première dose de vaccin était significativement plus courte chez les non-répondeurs (médiane 4,3 IQR [2,9–6,1] mois chez les non-répondeurs versus 8,4 IQR [5,7–14,5] chez les répondeurs, p = 0,0007). La diminution de réponse vaccinale post-ABA ou RTX étaient similaires après 3 doses de vaccin (56 patients), 25 % de non répondeurs sous ABA (1/4), 25 % sous RTX (10/40) contre 19 % sous IFX (9/11) et aucun sous TCZ (0/1). 18 des 56 patients ont bénéficié d’une sérologie après 2 doses et également après 3 doses de vaccin. 7 étaient non-répondeurs après 2 doses (6 RTX et 1 TCZ). Parmi eux, 5 sont restés non-répondeurs après leur 3e dose, tous traités par RTX. Conclusion L’ABA et le RTX altèrent la réponse vaccinale anti-SARS-CoV-2 : associés à 94 % des non-réponses vaccinales. La réponse vaccinale est altérée si un délai suffisant n’est pas respecté entre la perfusion de RTX, permettant une repopulation lymphocytaire B, et la vaccination.

Stabilization projects are increasingly used to mitigate the effects of anthropogenic streambank erosion, yet the effectiveness of stabilization has been insufficiently measured. Sound monitoring practices inform adjustments in implementation and maintenance, which improve engineered effectiveness. Thus, the objectives of this study were to: 1) measure streambank migration from in three reaches stabilized with wooden jetties following a major flooding event, and 2) quantify deposition around the jetties between pre-flood and post-flood. Streambank deposition was measured in 2019 with a River Surveyor and Global Positioning System (GPS). Bank erosion rates in Reaches 1, 2 and 3 were 0.41, 0.96 and 0.07 m2 m−1 yr−1, respectively, from pre-installation of wooden jetties. After streambanks in these reaches were stabilized, Reach 1 experienced 0.11 m2 m−1 yr−1 of erosion while Reaches 2 and 3 had 0.13 and 0.01 m2 m−1 yr−1 of deposition. Deposition increased in 2019 (1.61 and 0.81 m2 m−1) following a high magnitude flood. We utilized a new method for quantifying accumulated sediment in stream beds and banks. Our application of this new method demonstrates that jetties in the Cedar River have decreased streambank migration and increased sediment deposition at the point of implementation. The quantification of stream-sediment dynamics near jetties provides crucial information for stream-restoration design and decision-making, specifically for bioengineering design implementation.

Quantitative information about the fate of applied nitrate (NO 3 -N) in pulse-flow constructed wetlands is essential for designing wetland treatment systems and assessing their nitrogen removal services for agricultural and stormwater applications. Although many studies have documented NO 3 -N losses in wetlands, controlled experiments indicating the relative importance of different processes and N sinks are scarce. In the current study, 15 NO 3 -N isotope enrichment tracer experiments were conducted in wetland mesocosms of two different wetland soil types at two realistic agricultural NO 3 -N source loads. The 15 N label was traced from the source NO 3 -N into plant biomass, soil (including organic matter and ammonium), and N-gas constituents over 7–10 day study periods. All sinks responded positively to higher NO 3 -N loading. Plant uptake exceeded denitrification 2–3 fold in the low NO 3 -N loading experiments, while both fates were nearly equivalent in the high loading experiments. One to two years later, soils largely retained the assimilated tracer N, whereas plants had lost much of it. Results demonstrated that plant and microbial assimilation in the soil (temporary N sinks) can exceed denitrification (permanent N loss) in pulse-flow environments and must be considered by wetland designers and managers for optimizing nitrogen removal potential.

Wetland restoration is often conducted in Eastern U.S. coastal plain watersheds alongside agricultural lands that frequently export significant amounts of nitrogen in drainage water. Restoration plans that incorporate the addition of agricultural drainage water can simultaneously increase the success of achieving a target hydroperiod and reduce discharge of nitrogen to nearby surface water. The potential nitrogen removal effectiveness of two wetland restoration sites with such a restoration plan was evaluated in a two-year mesocosm study. Six large wetland mesocosms (3.5 m long × 0.9 m wide × 0.75 m deep) along with unplanted controls were used in this experiment. Three replicates of two soils that differed in organic matter and pH were planted with soft-stem bulrush (Schoenoplectus tabernaemontani) and allowed to develop in the two growing seasons prior to the study. Simulated drainage water was loaded into the mesocosms over eighteen batch studies across seasons with target nitrate-N levels between 2.5 to 10 mg L−1. Grab samples were collected from the water column and analyzed for nitrate-N, dissolved organic carbon, and chloride, along with other environmental parameters such as pH, water temperature, and soil redox. Seasonally, nitrogen and carbon within the wetland plants and soil were also measured. Multivariate statistical analyses were utilized to determine differences in nitrate-N reductions between treatments. Variables included carbon availability, temperature, antecedent moisture condition, nitrogen loading, and water pH. Contrary to the hypothesis that higher nitrate-N removal rates would be observed in the wetlands with higher organic matter, overall removal rates were higher in the wetland mesocosms containing Deloss soils (WET-Min) (maximum of 726 mg m−2 d−1) than those containing Scuppernong soil (WET-Org) (maximum of 496 mg m−2 d−1) and were dependent on daily NO3-N concentrations and season. Significant differences in NO3-N removal were found between seasons and soil types (α = 0.05), which helped to provide insight to the expected magnitude of nitrogen removal within these systems throughout the year, and potential mechanisms (i.e. denitrification vs. plant uptake) that will govern these removals.

Introduction Le risque evolutif de l’infection au nouveau coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], responsable de la maladie a coronavirus-2019 [COVID-19]) dans la population de patients atteints de rhumatismes inflammatoires chroniques (RIC) sous traitements immunomodulateurs (disease-modifying-anti-rheumatic drugs [DMARDs]) est incompletement connu. Cette population de patients immunodeprimes est consideree jusqu’a preuve du contraire comme une population a risque de formes severes de COVID-19. Cette etude a ete menee pour evaluer le degre de severite et l’issue de l’infection a SARS-CoV-2/COVID-19 chez les patients avec RIC exposes a des DMARDs, en pratique courante rhumatologique, au sein d’un des epicentres francais de la pandemie. Patients et methodes Nous avons mene entre mars et aout 2020 une etude observationnelle retrospective monocentrique aux hopitaux civils de Colmar (Alsace ; France) dediee a la collection des donnees des patients suivis pour un RIC ou une maladie auto-immune systemique qui ont developpe une infection a SARS-CoV-2, documentee par RT-PCR sur prelevements nasopharynges, ou de facon retrospective par la serologie (IgM/IgG diriges contre le SARS-CoV-2) et/ou sur la mise en evidence d’une pneumopathie bilaterale typique au scanner thoracique. Les caracteristiques cliniques des patients et les modalites d’immunomodulation (DMARDs conventionnels [csDMARDs], biologiques [bDMARDs] ou cibles [tsDMARDs]) ont ete collectees et analysees au regard de l’evolution benigne, moderee ou severe du COVID-19 et de l’issue de l’infection (guerison/deces). Resultats Un total de 19 patients, dont 9 polyarthrites rhumatoides, 6 spondyloarthrites, 2 syndromes de Sjogren primaire, 1 arterite a cellules geantes et 1 maladie de Still de l’adulte, ont ete confirmes par RT-PCR pour 10 patients (52,6 %), par serologie pour 8 patients (42,1 %) et sur la base d’un pattern compatible au scanner thoracique pour 1 patients (5,3 %). Sept patients (36,8 %) beneficiaient d’une association de traitements fonds combinant un csDMARDs avec un bDMARDs ou un tsDMARDs. Parmi les 15 patients sous csDMARDs (78,9 %), 11 etaient traites par methotrexate (MTX) (57,9 %), dont 2 en association a l’hydroxychloroquine (10,5 %), 3 recevaient du leflunomide (15,8 %), et 1 de l’azathioprine (5,3 %). Dix patients (52,6 %) etaient sous bDMARDs au debut des symptomes de COVID-19, dont 6 (31,6 %) sous anti-TNF alpha, 3 (15,8 %) sous anti-IL6R, tocilizumab et 1 patient (5,3 %) sous anti-CD20, rituximab. Une seule patiente (5,3 %) etait traitee par tsDMARD, baricitinib, en combinaison au MTX. Au total, 18 des 19 patients (94,7 %) analyses ont gueri sans sequelles. Parmi eux, 14 (73,7 %) ont developpe une forme benigne et 4 (21,1 %) une forme moderee necessitant une hospitalisation, mais sans transfert en soins intensifs. Une seule forme severe de COVID-19, compliquee de syndrome de detresse respiratoire aigue dont l’issue a ete fatale (5,3 %), a ete observee chez un patient de 83 ans, avec comorbidites cardiovasculaires, traite en monotherapie par anti-TNF alpha monoclonal (golimumab) pour une spondyloarthrite axiale. Conclusion Quelles que soient les modalites d’immunomodulation et le type de rhumatisme inflammatoire, le profil evolutif dans cette cohorte montre une predominance de formes benignes de COVID-19, avec guerison sans sequelles. L’âge et les comorbidites cardiovasculaires semblent dominer le pronostic, davantage que l’exposition a un traitement immunosuppresseur.

HighlightsWe provide context and perspectives on articles in the Wetland Ecosystem Resilience collection.Insights gained on wetland resilience to sea-level rise and climate change, land use and drainage, and nutrients. Abstract. The objective of this article is to introduce a collection of articles that explore current research and scientific thought on wetland ecosystem resilience. The collection contains articles on wetland resilience to climate change, agricultural land use-driven change, and recreational land use, along with evaluations of wetland resilience through high-resolution monitoring and modeling tools. Wetland settings in the U.S. span tidal marshes and coastal plain non-riverine wetlands in North Carolina, prairie potholes in Iowa, Appalachian floodplain wetlands, and floating treatment wetlands in the Midwest. The studies in this collection found vertical accretion rates of 0.7 to 4.0 mm year-1 in a tidal marsh, a wide range of potential wetland hydroperiod responses to climate change, substantial decreases in inundation period, crop yield, and surface-water nitrate (but increases in phosphorus) in artificially drained potholes, and nitrate removal in carbon-amended floating treatment wetlands. Further work is needed to better understand how to design and enhance wetland systems in agricultural regions, better preserve wetland ecosystem services in areas affected by land use and climate change, and provide technical standards for the wide range of designs currently used for wetland treatment systems. Keywords: Agricultural wetlands, Resiliency, Temporal data, Treatment wetlands, Water chemistry, Water quality, Water treatment

Accurate prediction of Escherichia coli contamination in surface waters is challenging due to considerable uncertainty in the physical, chemical and biological variables that control E. coli occurrence and sources in surface waters. This study proposes a novel approach by integrating hydro-climatic variables as well as animal density and grazing pattern in the feature selection modeling phase to increase E. coli prediction accuracy for two cascading dams at the US Meat Animal Research Center (USMARC), Nebraska. Predictive models were developed using regression techniques and an artificial neural network (ANN). Two adaptive neuro-fuzzy inference system (ANFIS) structures including subtractive clustering and fuzzy c-means (FCM) clustering were also used to develop models for predicting E. coli. The performances of the predictive models were evaluated and compared using root mean squared log error (RMSLE). Cross-validation and model performance results indicated that although the majority of models predicted E. coli accurately, ANFIS models resulted in fewer errors compared to the other models. The ANFIS models have the potential to be used to predict E. coli concentration for intervention plans and monitoring programs for cascading dams, and to implement effective best management practices for grazing and irrigation during the growing season.

To understand the cost burden of medical care it is essential to partition medical spending into conditions. Two broad strategies have been used to measure disease-specific spending. The first attributes each medical claim to the condition that physicians list as its cause. The second decomposes total spending for a person over a year to their cumulative set of health conditions. Traditionally, this has been done through regression analysis. This paper has two contributions. First, we develop a new cost attribution method to attribute spending to conditions using a more flexible attribution approach, based on propensity score analysis. Second, we compare the propensity score approach to the claims-based approach and the regression approach in a common set of beneficiaries age 65 and older in the 2009 Medicare Current Beneficiary Survey. Our estimates show that the three methods have important differences in spending allocation and that the propensity score model likely offers the best theoretical and empirical combination.

There is a need to evaluate high surface nitrate concentrations across agricultural watersheds, both spatially and temporally, to increase understanding of source and timing of nitrogen loads in streams and rivers. Bazile Creek is a high-nitrate stream originating in the agriculturally intensive Bazile Groundwater Management Area of Eastern Nebraska, USA. It is a gaining stream that receives groundwater with high nitrate concentrations originating from nonpoint sources. The objective of this study was to determine spatial and temporal variability of baseflow nitrate concentrations in Bazile Creek and its tributaries and to relate this variability to watershed characteristics. Surface-water nitrate samples were collected monthly from July 2018 through September 2019 from nine sites in the watershed and were analyzed for nitrate concentration. Average surface water nitrate-N concentrations within the watershed ranged from 2.7 to 15 mg L−1 and were significantly different between the sites (p

Excess nutrients and herbicides remain two major causes of waterbody impairment globally. In an attempt to better understand pollutant sources in the Big Sandy Creek Watershed (BSCW) and the prospects for successful remediation, a program was initiated to assist agricultural producers with the implementation of best management practices (BMPs). The objectives were to (1) simulate BMPs within hotspots to determine reductions in pollutant loads and (2) to determine if water-quality standards are met at the watershed outlet. Regression-based load estimator (LOADEST) was used for determining sediment, nutrient and atrazine loads, while artificial neural networks (ANN) were used for determining E. coli concentrations. With respect to reducing sediment, total nitrogen and total phosphorus loads at hotspots with individual BMPs, implementing grassed waterways resulted in average reductions of 97%, 53% and 65% respectively if implemented all over the hotspots. Although reducing atrazine application rate by 50% in all hotspots was the most effective BMP for reducing atrazine concentrations (21%) at the gauging station 06883940, this reduction was still six times higher than the target concentration. Similarly, with grassed waterways established in all hotspots, the 64% reduction in E. coli concentration was not enough to meet the target at the gauging station. With scaled-down acreage based on the proposed implementation plan, filter strip led to more pollutant reductions at the targeted hotspots. Overall, a combination of filter strip, grassed waterway and atrazine rate reduction will most likely yield measureable improvement both in the hotspots (&gt, 20% reduction in sediment, total nitrogen and total phosphorus pollution) and at the gauging station. Despite the model&rsquo, s uncertainties, the results showed a possibility of using Soil and Water Assessment Tool (SWAT) to assess the effectiveness of various BMPs in agricultural watersheds.

A wide variety of antibiotics and other pharmaceuticals are used in livestock production systems and residues passed to the environment, often unmetabolized, after use and excretion. Antibiotic residues may be transported from manure-treated soils via runoff and are also capable of reaching surface and groundwater systems through a variety of pathways. The occurrence and persistence of antibiotics in the environment is a concern due to the potential for ecological effects and proliferation of environmental antibiotic resistance in pathogenic organisms. In the present study, the occurrence and seasonal variation of 24 commonly-used veterinary antibiotics was evaluated in surface water adjacent to several livestock production systems using Polar Organic Chemical Integrative Samplers (POCIS). Uptake rates for all compounds, nine of which have not been previously reported, were measured in the laboratory to permit estimation of changes in the time-weighted average (TWA) antibiotic concentrations during exposure. The antibiotics detected in POCIS extracts included sulfadimethoxine, sulfamethoxazole, trimethoprim, sulfamerazine, sulfadiazine, lincomycin, erythromycin, erythromycin anhydro- and monensin. The maximum TWA concentration belonged to sulfadiazine (25 ng/L) in the August–September sampling period and coincided with the highest number of precipitation events. With the exception of monensin that showed an increase in concentration over the stream path, none of the detected antibiotics were prescribed to livestock at the facility. The detection of antibiotics not prescribed by the facility may be attributable to the environmental persistence of previously used antibiotics, transfer by wind from other nearby livestock production sites or industrial uses, and/or the natural production of some antibiotics.

Understanding the value of medical care requires comparing cost changes with changes in health outcomes. Aggregate cost changes are known in detail, but changes in the health of people have not been comparably measured, nor has research related changes in spending to changes in population health. We compare change in medical expenditures by disease with changes in quality-adjusted life expectancy (QALE) by disease over time in the Medicare population. Data come from the 1999 and 2012 Medicare Current Beneficiary Survey (MCBS), an ongoing study of Medicare beneficiaries. We collapse the large group of medical conditions imputed in the MCBS to a more succinct 26 categories. To estimate changes in health by disease, we use propensity score models to attribute mortality and health related quality-of-life (HRQOL) to each disease. We account for both changing disease prevalence and changes in the impairment associated with different diseases. QALE increased for 16 of the 26 conditions, with the greatest improvements for heart disease (0.4 years), cardiovascular risk factors (hypertension, hyperlipidemia, diabetes; 0.3 years) and digestive conditions (0.2 years), and the greatest declines for mental health conditions (-0.14 years), and dementia (-0.26 years). Comparing these changes with changes in expenditures by disease points to conditions for which investment has yielded improvement in quality as well as length of life (stroke, ischemic heart disease) and those for which investment has been less successful in improving population health (dementia, mental health). Results can inform further in-depth study of disease treatment cost-effectiveness and policies that guide treatment decisions.

The adult hippocampus hosts a population of neural stem and progenitor cells (NSPCs) that proliferates throughout the mammalian life span. To date, the new neurons derived from NSPCs have been the primary measure of their functional relevance. However, recent studies show that undifferentiated cells may shape their environment through secreted growth factors. Whether endogenous adult NSPCs secrete functionally relevant growth factors remains unclear. We show that adult hippocampal NSPCs secrete surprisingly large quantities of the essential growth factor VEGF in vitro and in vivo. This self-derived VEGF is functionally relevant for maintaining the neurogenic niche as inducible, NSPC-specific loss of VEGF results in impaired stem cell maintenance despite the presence of VEGF produced from other niche cell types. These findings reveal adult hippocampal NSPCs as an unanticipated source of an essential growth factor and imply an exciting functional role for adult brain NSPCs as secretory cells.

The authors wish to make the following corrections to this paper [1]:(1): The author name “Francois Birgand” should be Francois Birgand.(2): Reference 38 should be the following:Birgand, F.; Aveni-Deforge, K.; Smith, B.; Maxwell, B.M.; Horstman, M.; Gerling, A.B.; Carey, C.C.First report of a novel multiplexer pumping system coupled to a water quality probe to collect hightemporal frequency in situ water chemistry measurements at multiple sites. Limnol. Oceanogr. Methods

Recent pathogenic Escherichia coli contamination of fresh vegetables that originated from irrigation water has increased awareness and importance of identifying sources of E. coli entering agroecosystems. However, inadequate methods for accurately predicting E. coli occurrence and sources in waterways continue to limit the identification of appropriate and effective prevention and treatment practices. Therefore, the primary objectives of this study were to: (1) Determine the concentration of E. coli during storm events in a hydrologic controlled stream situated in a livestock research operation that is located in the Central Flyway for avian migration in the United States. Great Plains; and (2) Identify trends between E. coli concentrations, grazing rotations, and avian migration patterns. The study sampled five rainfall events (three summer and two fall) to measure E. coli concentrations throughout storm events. A combination of cattle density and waterfowl migration patterns were found to significantly impact E. coli concentrations in the stream. Cattle density had a significant impact during the summer season (p .0001), while waterfowl density had a significant impact on E. coli concentrations during the fall (p = .0422). The downstream reservoir had exceedance probabilities above the Environmental Protection Agency freshwater criteria 85% of the growing season following rainfall events. Based on these findings, implementation of best management practices for reducing E. coli concentrations during the growing season and testing of irrigation water prior to application are recommended.

Chronic kidney disease is a persistent chronic health condition commonly seen in pediatric nephrology programs. Our study aims to evaluate the sensitivity of the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric instrument to indicators of disease severity and activity in pediatric chronic kidney disease. This cross sectional study included 233 children 8–17 years old, with chronic kidney disease from 16 participating institutions in North America. Disease activity indicators, including hospitalization in the previous 6 months, edema, and number of medications consumed daily, as well as disease severity indicators of kidney function and coexisting medical conditions were captured. PROMIS domains, including depression, anxiety, social-peer relationships, pain interference, fatigue, mobility, and upper extremity function, were administered via web-based questionnaires. Absolute effect sizes (AES) were generated to demonstrate the impact of disease on domain scores. Four children were excluded because of missing glomerular filtration rate (GFR) estimations. Of the 229 children included in the final analysis, 221 completed the entire PROMIS questionnaire. Unadjusted PROMIS domains were responsive to chronic kidney disease activity indicators and number of coexisting conditions. PROMIS domain scores were worse in the presence of recent hospitalizations (depression AES 0.33, anxiety AES 0.42, pain interference AES 0.46, fatigue AES 0.50, mobility AES 0.49), edema (depression AES 0.50, anxiety AES 0.60, pain interference AES 0.77, mobility AES 0.54) and coexisting medical conditions (social peer-relationships AES 0.66, fatigue AES 0.83, mobility AES 0.60, upper extremity function AES 0.48). The PROMIS pediatric domains of depression, anxiety, social-peer relationships, pain interference, and mobility were sensitive to the clinical status of children with chronic kidney disease in this multi-center cross sectional study. We demonstrated that a number of important clinical characteristics including recent history of hospitalization and edema, affected patient perceptions of depression, anxiety, pain interference, fatigue and mobility. The PROMIS instruments provide a potentially valuable tool to study the impact of chronic kidney disease. Additional studies will be required to assess responsiveness in PROMIS score with changes in disease status over time.

Atrazine, one of the most widely used herbicides in the world, threatens human health along with terrestrial and aquatic biota. Recent reports have found atrazine in drinking water to be associated with increased birth defects and incidences of Non-Hodgkin's Lymphoma, with higher levels of significance from exposure to both atrazine and nitrate-N. The Midwest region of the United States, which includes Nebraska, is one of the leading regions for high nitrate-N concentrations and agrochemicals, including atrazine, in surface waters. Therefore, the objective of this study was to provide a case study for completing an environmental risk analysis for the potential exposure of atrazine and nitrate-N to ecosystems and humans through interaction with surface waters using two approaches: (1) Identify watersheds across Nebraska that were at risk for exceeding atrazine and nitrate-N maximum contaminant limits (MCLs) in surface water; and (2) Determine the specific times of year where risks were greatest. Factors were then analyzed using Geographic Information System (GIS) software to identify areas of high risk. Impairments for both nitrate-N and atrazine in the surface water were found predominately during the early growing season in the southeastern region of Nebraska, in watershed areas with the highest amount of corn production and annual precipitation. Further, the methodology developed in this study has the potential for application in regions with higher dependency on surface water to determine multiple agrochemical load influxes from upstream regions and evaluate other surface water contaminants during the same time periods.

As health care financing, organization, and delivery innovations proliferate, the need for comprehensive, detailed data on medical spending has never been more apparent. This study builds on previous work to provide a more comprehensive accounting of medical spending at the individual level than has been done in the past. We account for spending by the entire population: the civilian, non-institutionalized population that is the subject of past studies, as well as high medical spenders, the institutionalized, the incarcerated, and active-duty military personnel. We use within-imputation and other adjustments to build a micro dataset and reconcile survey data based on our estimate of medical spending to the National Health Expenditure Accounts (NHEA). The micro dataset we build can be used for more detailed policy evaluations that more closely reflect true national personal health expenditure at the individual level.

To evaluate inpatient health care utilization for children with systemic lupus erythematosus (SLE) with and without kidney disease.The Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 2000, 2003, and 2006 was used for this analysis. SLE hospitalizations from the 2006 cohort were identified and classified as those with versus without kidney involvement by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Analyses were performed to examine determinants of hospitalization charges and changes in charges over time.In the US, 7,390 SLE-related pediatric hospitalizations generated $267 million in total charges in 2006. Of these, 4,193 discharges had kidney involvement. The average hospitalization charge was greater for SLE patients with kidney involvement compared to those without kidney involvement ($43,100 versus $28,500; P0.0001). In multivariate analysis, kidney involvement remained a significant predictor of hospitalization charges, independent of demographic and hospital characteristics (P0.0001). SLE-associated acute kidney failure, transplant, and end-stage kidney disease resulted in greater hospitalization charges than SLE without kidney involvement by $74,900 (P0.0001), $32,700 (P = 0.0002), and $27,400 (P0.0001), respectively.In the US,7,000 hospitalizations occurred in 2006 among children with SLE, with nearly 57% demonstrating kidney involvement. Kidney involvement is a major determinant of hospitalization charges for these children. This study represents one of the first large-scale assessments of in-hospital health care utilization by children with SLE.

The objective of this study was to evaluate the water quality benefits provided by a buffer enrolled in the North Carolina Conservation Reserve Enhancement Program (NC CREP). A 5-year study was conducted on two distinct buffer sections along the same stream to evaluate the hydrology and attenuation of groundwater nitrate (NO 3 − -N) entering from nearby agricultural fields. The average buffer widths were 60 m (Section 1, upstream) and 45 m (Section 2, downstream). Three transects of groundwater monitoring well nests within each buffer zone were installed to monitor water quality and water table depths for 5 years. Mean groundwater NO 3 − -N concentrations at the 1.5 m depth decreased from 4.5 mg L −1 to 1.7 mg L −1 and from 12.9 mg L −1 to 1.4 mg L −1 in buffer Sections 1 and 2 respectively. These differences were significant in both buffer sections ( α = 0.05), but the wider Section 1 received significantly less NO 3 − -N than did Section 2 ( P 3 − -N loads were reduced by 0.003 kg m −2 yr −1 (76% reduction) at the 1.5 m depth, while in Section 2 these loads were reduced by 0.02 kg m −2 yr −1 (94% reduction) and 0.04 kg m −2 yr −1 (86% reduction) at the 1.5 m and 3 m depths, respectively. Topography, water table and redox measurements, nitrate to chloride ratios, and deep groundwater cation analyses, indicated both sections were suitable for denitrification to proceed. However, the position of the wider Section 1 buffer in the landscape limited the amount of NO 3 − -N contaminated groundwater that entered from the agricultural fields, and thus could have been designed to be narrower. The effectiveness of NO 3 − -N reduction in riparian buffer systems is dependent on multiple landscape and biogeochemical factors and not buffer width alone. Findings provide design guidance for conservation buffer program managers as related to the influence of buffer landscape position on groundwater nitrate reduction.

Determinants of Item Nonresponse to Web and Mail Respondents in Three Address-Based Mixed-Mode Surveys of the General Public

This study describes acquisition of knowledge and motor skill in bladder training (BT) and pelvic floor muscle training (PFMT) and adherence following a behavioral modification program (BMP). Essentially continent (0-5 episodes in past year) community-dwelling older women (n = 359) were randomized to treatment (n = 164), a 2-h group education session supplemented by one brief individualized session of approximately 10 min, or control (n = 195), no instruction, and followed for 12 months. Knowledge, motor skill, and adherence to the BMP were documented. Changes in pelvic muscle function and voiding interval were used to validate self-reported adherence. Following group instruction, mean BT and PFMT knowledge was 90 and 86%, respectively; 68% demonstrated correct PFMT technique without additional instruction, 29% required brief instruction, and 3% were unable to learn PFMT technique. Adherence ranged from 63 to 82% for PFMT and 58 to 67% for BT. Group instruction supplemented with brief individual instruction as needed is an effective teaching method for BT and PFMT.

The objective of the study was to determine the kinetic model that best fit observed nitrate removal rates at the mesocosm scale in order to determine ideal loading rates for two future wetland restorations slated to receive pulse flow agricultural drainage water. Four nitrate removal models were investigated: zero order, first order decay, efficiency loss, and Monod. Wetland mesocosms were constructed using the primary soil type (in triplicate) at each of the future wetland restoration sites. Eighteen mesocosm experiments were conducted over two years across seasons. Simulated drainage water was loaded into wetlands as batches, with target nitrate-N levels typically observed in agricultural drainage water (between 2.5 and 10 mg L−1). Nitrate-N removal observed during the experiments provided the basis for calibration and validation of the models. When the predictive strength of each of the four models was assessed, results indicated that the efficiency loss and first order decay models provided the strongest agreement between predicted and measured NO3-N removal rates, and the fit between the two models were comparable. Since the predictive power of these two models were similar, the less complicated first order decay model appeared to be the best choice in predicting appropriate loading rates for the future full-scale wetland restorations.

Background and objectivesNephrotic syndrome (NS) represents a common disease in pediatric nephrology typified by a relapsing and remitting course and characterized by the presence of edema that can significantly affect the health-related quality of life in children and adolescents. The PROMIS pediatric measures were constructed to be publically available, efficient, precise, and valid across a variety of diseases to assess patient reports of symptoms and quality of life. This study was designed to evaluate the ability of children and adolescents with NS to complete the PROMIS assessment via computer and to initiate validity assessments of the short forms and full item banks in pediatric NS. Successful measurement of patient reported outcomes will contribute to our understanding of the impact of NS on children and adolescents.DesignThis cross-sectional study included 151 children and adolescents 8-17 years old with NS from 16 participating institutions in North America. The children completed the PROMIS pediatric depression, anxiety, social-peer relationships, pain interference, fatigue, mobility and upper extremity functioning measures using a web-based interface. Responses were compared between patients experiencing active NS (n = 53) defined by the presence of edema and patients with inactive NS (n = 96) defined by the absence of edema.ResultsAll 151 children and adolescents were successfully able to complete the PROMIS assessment via computer. As hypothesized, the children and adolescents with active NS were significantly different on 4 self-reported measures (anxiety, pain interference, fatigue, and mobility). Depression, peer relationships, and upper extremity functioning were not different between children with active vs. inactive NS. Multivariate analysis showed that the PROMIS instruments remained sensitive to NS disease activity after adjusting for demographic characteristics.ConclusionsChildren and adolescents with NS were able to successfully complete the PROMIS instrument using a web-based interface. The computer based pediatric PROMIS measurement effectively discriminated between children and adolescents with active and inactive NS. The domain scores found in this study are consistent with previous reports investigating the health-related quality of life in children and adolescents with NS. This study establishes known-group validity and feasibility for PROMIS pediatric measures in children and adolescents with NS.

The objective of this study was to evaluate the healthcare utilization of hospitalized children with hypertension. The Healthcare Cost and Utilization Project Kids' Inpatient Database, years 1997, 2000, 2003, and 2006, was used to identify hypertension hospitalizations. We examined the association of patient and hospital characteristics on hypertension charges. Data from each cohort year were used to analyze trends in charges. We found that 71282 pediatric hypertension hospitalizations generated $3.1 billion in total charges from 1997 to 2006. Approximately 68% were 10 to 18 years old, 55% were boys, and 47% were white. Six percent of claims with a diagnosis code for hypertension also had a diagnosis code for end-stage renal disease or renal transplant. The frequency of hypertension discharges increased over time ( P =0.02 for each of age groups 2–9 years and 2–18 years; P =0.03 for age group 10–18 years), as well as the fraction of inpatient charges attributed to hypertension ( P P P =0.03, respectively). During the 10-year study period, the frequency of hypertension-associated hospitalizations was increasing across all of the age groups, and the fraction of charges related to hypertension was also increasing. The coexisting condition of end-stage renal disease resulted in a significant increase in healthcare charges.

Background The impact of recent guidelines for early detection and prevention of chronic kidney disease (CKD) on patient awareness of disease and factors that might be associated with awareness have not been well described. Methods Awareness rates were assessed in 2992 adults (age, ≥20 years) with CKD stages 1 to 4 from a nationally representative, cross-sectional survey (National Health and Nutrition Examination Survey 1999-2004). Awareness of CKD was defined by an answer of yes to “Have you ever been told you have weak or failing kidneys?” Potential predictors of awareness included demographics, access to care, and clinical and lifestyle factors, which were assessed by standardized interviewer-administered questionnaires and physical examinations. We examined independent associations of patient characteristics with awareness in those with CKD stage 3 (n = 1314) over 6 years using multivariable logistic regression. Results Awareness improved over time in those with CKD stage 3 only (4.7% [95% confidence interval {CI}, 2.6%-8.5%], 8.9% [95% CI, 7.1%-11.2%], and 9.2% [95% CI, 6.1%-13.8%] for 1999-2000, 2001-2002, and 2003-2004, respectively; P = .04, adjusted for age, sex, and race). Having proteinuria (odds ratio, 3.04 [95% CI, 1.62-5.70]), diabetes (OR, 2.19 [95% CI, 1.03-4.64]), and hypertension (OR, 2.92 [95% CI, 1.57-5.42]) and being male (OR, 2.06 [95% CI, 1.15-3.69]) were all statistically significantly associated with greater awareness among persons with CKD stage 3 after adjustment. Chronic kidney disease awareness increased almost 2-fold for those with CKD stage 3 over recent years but remains low. Persons with risk factors for CKD (proteinuria, diabetes, hypertension, and male sex) were more likely to be aware of their stage 3 disease. Conclusion Renewed and innovative efforts should be made to increase CKD awareness among patients and health care providers.