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Abstract Patients with diabetes are susceptible to acute kidney injury (AKI) as compared to counterparts without diabetes. However, data on the long-term clinical outcome of AKI specifically in people with diabetes are still scarce. We sought to study risk factors for and adverse cardio-renal outcomes of AKI in multi-ethnic Southeast Asian people with type 2 diabetes. 1684 participants with type 2 diabetes from a regional hospital were followed an average of 4.2 (SD 2.0) years. Risks for end stage kidney disease (ESKD), major adverse cardiovascular events (MACE) and all-cause death after AKI were assessed by survival analyses. 219 participants experienced at least one AKI episode. Age, cardiovascular disease history, minor ethnicity, diuretics usage, HbA1c, baseline eGFR and albuminuria independently predicted risk for AKI with good discrimination. Compared to those without AKI, participants with any AKI episode had a significantly high risk for ESKD, MACE and all-cause death after adjustment for multiple risk factors including baseline eGFR and albuminuria. Even AKI defined by a mild serum creatinine elevation (0.3 mg/dL) was independently associated with a significantly high risk for premature death. Therefore, individuals with diabetes and any episode of AKI deserve intensive surveillance for cardio-renal dysfunction.

Abstract Background Diabetic kidney disease is an established risk factor for heart failure. However, the impact of incident heart failure on the subsequent risk of renal failure has not been systematically assessed in diabetic population. We sought to study the risk of progression to end stage kidney disease (ESKD) after incident heart failure in Asian patients with type 2 diabetes. Methods In this prospective cohort study, 1985 outpatients with type 2 diabetes from a regional hospital and a primary care facility in Singapore were followed for a median of 8.6 (interquartile range 6.2–9.6) years. ESKD was defined as a composite of progression to sustained eGFR below 15 ml/min/1.73m2, maintenance dialysis or renal death, whichever occurred first. Results 180 incident heart failure events and 181 incident ESKD events were identified during follow-up. Of 181 ESKD events, 38 (21%) occurred after incident heart failure. Compared to those did not progress to ESKD after incident heart failure (n = 142), participants who progressed to ESKD after heart failure occurrence were younger, had higher HbA1c and higher urine albumin-to-creatinine ratio at baseline. The excess risk of ESKD manifested immediately after heart failure occurrence, persisted for two years and was moderated thereafter. Cox regression suggested that, compared to counterparts with no heart failure event, participants with heart failure occurrence had 9.6 (95% CI 5.0- 18.3) fold increased risk for incident ESKD after adjustment for baseline cardio-renal risk factors including eGFR and albuminuria. It appeared that heart failure with preserved ejection fraction had a higher risk for ESKD as compared to those with reduced ejection fraction (adjusted HR 13.7 [6.3–29.5] versus 6.5 [2.3–18.6]). Conclusion Incident heart failure impinges a high risk for progression to ESKD in individuals with type 2 diabetes. Our data highlight the need for intensive surveillance of kidney function after incident heart failure, especially within the first two years after heart failure diagnosis.

Abstract Background Angiogenin, an enzyme belonging to the ribonucleases A superfamily, plays an important role in vascular biology. Here, we sought to study the association of plasma angiogenin and major adverse cardiovascular events (MACEs) in patients with type 2 diabetes (T2D). Methods This prospective study included 1083 T2D individuals recruited from a secondary hospital and a primary care facility. The primary outcome was a composite of four-point MACE (nonfatal myocardial infarction, stroke, unstable angina pectoris leading to hospitalization and cardiovascular death). Circulating angiogenin was measured by a proximity extension assay. Cox regression models were used to evaluate the association of baseline plasma angiogenin with the risk of MACE. Results During a median follow-up of 9.3 years, 109 (10%) MACE were identified. Plasma angiogenin was significantly higher in participants with MACE than in those without MACE (P

Circulating ceramide levels are dysregulated in kidney disease. However, their associations with rapid decline in kidney function (RDKF) and end-stage kidney disease (ESKD) in patients with type 2 diabetes (T2D) are unknown. In this prospective study of 1746 T2D participants, we examined the association of plasma ceramide Cer16:0, Cer18:0, Cer24:0, and Cer24:1 with RDKF, defined as an estimated glomerular filtration rate (eGFR) decline of 5 ml/min/1.73 m2 per year or greater, and ESKD defined as eGFR

Aircraft engines such as gas turbines and detonation engines have very important attention by the researchers in the last decades. However, using detonation engines for producing electrical and heat power was not researched efficiently. In this study, gas turbine and pulse detonation engines cogeneration systems were analyzed and compared by using first and second laws of thermodynamics and exergy analysis method. Three different cycles, namely, basic gas turbine, Zeldovich–von Neumann–Döring (ZND) detonation engine and steam injected regenerative ZND detonation engine cogeneration systems were investigated. The performance analyses and the advantage of these three cycles were obtained and discussed. The performance analyses were done for different compression ratios (r), and the combustion outlet temperatures and pressures, exergy efficiencies, specific fuel consumption, electrical efficiency, exergy fuel consumption, electrical heat rates and other performance parameters of the three cycles were obtained and discussed. It is found that gas turbine cogeneration systems have some advantages and disadvantages in some conditions than ZND cycle. The steam injected regenerative ZND detonation engine cogeneration systems can compete with the Brayton cycle cogeneration systems.

Cryogenics has an important influence on industry and science. In this study, optimum working conditions are obtained by applying exergy analysis and local optimization methods to two- and three-stage vapor compression cascade cryogenic cycle. The first and second laws of thermodynamics, exergy analysis, and local optimization methods are applied to the two- and three-stage cascade cryogenic cycle. By considering the needs and demands, it is possible to create new cycles by adding new devices and/or new stages to these cycles. The results of the optimum operating conditions are obtained for the two- and three-stage vapor compression cascade cryogenic cycle. It is seen that to achieve high COP values and high efficiency; it is necessary to reduce the compression ratio of the compressor as much as the fluid allows. For the two-stage cycle, the minimum total work required for cryogenic cooling is around P 7 = 2,400 kPa. The COP value is 0.30 between P 7 = 2,400 and 2,800 kPa, and the maximum exergy efficiency is obtained around 0.235. It is seen operating the first-stage compressor at high pressures increases the total losses of the entire cycle from 7,500 to 18,550 kW. The increase in total exergy losses is around 247%, and operating the first-stage compressor at high pressures increases the exergy efficiency of the entire cycle. The increase in total exergy efficiency is around 160%. When the second-stage compressor is operated at low pressure, the COP value increases by 2%, the exergy efficiency increases by 20%, and the exergy losses decrease by around 40%.

The purpose of this article is to evaluate four different gas turbine cogeneration cycles which are basic, absorption cooling, air heating and air fuel heating cogeneration cycles by using the most important six evaluation criteria for different excess air coefficient, different compression rates, and different compressor inlet air temperatures. These six evaluation criteria are electrical heat ratio, exergy efficiency, incremental heat rate, artificial thermal efficiency, fuel energy saving ratio, and specific fuel consumption. It is seen that the air-fuel heating cogeneration cycle is the most efficient among the cycles examined for a certain compressor compression ratio, followed by the air heating, basic, and absorption cooling cycles.

Energy in agriculture and in food production have vital importance that affect directly the cost and the quality of the products. Micro cogeneration plants are widely used in the World to produce heat and electricity at the same time in a same plant. The aim of this study, to analyze the performance of the production of power and heat for the food production process and the agricultural needs. For that reason, a basic cogeneration plant is taken to analyze the performance by using 1st and 2nd laws of thermodynamics and exergy analysis method. The electric-heat exergy rates, the energy and exergy efficiencies, the combustion chamber and the gas turbine outlet temperatures, the total electric and heat energies and exergies, and the specific works were calculated for various ambient temperatures and for various excess air rates of the basic cogeneration plants fueled with methane. The effects of the various ambient temperatures and the various excess air rates on the performance of the basic cogeneration plants were obtained, discussed and analyzed. For the best performance and for the best working conditions of the basic cogeneration plants in agriculture and food production process and food industry recommendations were done. It was found that, lower ambient temperatures give higher electric efficiency, but lower heat efficiency. However, an optimum excess air rates for the best performance was found at the value 2.3 of the excess air rates of the basic cogeneration plants fueled with methane.

Lower emissions and better performances in food production also affect the cost, the environmental effects, and the quality of the products of the agriculture and food industry. The aim of this study is to investigate and to analyze the exergetic performance of the production of heat exergy and power, to reuse waste heat and to give optimum reaction and to adapt to changing demands of the food production process and agriculture. Because of those reasons, an air fuel preheated (recuperative) cogeneration plant is taken to analyze the exergetic performance and working conditions by using exergy analysis and 1st and 2nd laws of thermodynamics. Energy and exergy efficiencies, combustion chamber and gas-turbine outlet temperatures, electric-heat exergy rates, specific works, and total electric and heat energies and exergies are calculated by taking various environmental temperatures and various excess air coefficient. Effects of the environmental temperatures and the excess air coefficient on the exergetic performance of the recuperative cogeneration plants were calculated, obtained, and discussed. For the best exergetic performance and working conditions, some recommendations were done for agriculture and for the food production process. In that study, it is found that, the recuperative cogeneration plants can obtain and give the best solutions and can adapt to changing demands of heat and electric rates. Also, it was found that, lower ambient temperatures give better electric efficiency, but lower heat exergy and electric rates. However, higher excess air coefficient increases the performance of the recuperative (air fuel preheated) cogeneration plants.

Energy cost and consumption are increasing, so that efficiency becomes more important, from the production to the end users. Energy reserves are limited; increasing demand and environmental concerns make efficiency important. To provide cost-effective and clean power generation, gas turbines and cogeneration are becoming the key technology that must be researched and developed. Three different cogeneration cycles are analyzed by using first and second laws of thermodynamics and exergy analysis method. The three cycles are basic, air heated, and fuel air heated cycles. The performance analysis of the devices such as turbine, recuperator, combustion chamber, compressor, and heat exchanger for the whole cycle is obtained and discussed. For different excess air rates, compression ratios (r), and ambient (inlet air) temperatures, the Z factor (ratio of lost exergy to useful exergy), specific fuel consumption, and specific work and other performance parameters of the devices were obtained and discussed. It is found that excess air rates have the most effect on the performance of the three cycles.

Introduction: sigmoid volvulus is responsible for 50-75% of large bowel obstructions worldwide. Objective: to characterise the patients treated surgically for sigmoid volvulus at the "Joaquín Albarrán" Clinical Surgical Hospital during the period January-December 2019. Methods: an observational, descriptive, cross-sectional, descriptive study was carried out in 19 patients treated surgically for sigmoid volvulus. The following variables were studied: age, sex, clinical manifestations, surgical procedure performed, complications and time of evolution of the disease. Results: patients over 60 years of age and male sex constituted 79 % of the total number of patients. All 19 patients manifested pain, abdominal distension and tympanism, while vomiting occurred in 16 cases. The most commonly used surgical procedure was termino-terminal resection and anastomosis. Some type of complication occurred in 57,9 % of the patients, with surgical site infection being the most frequent. The average complication occurred in patients with approximately 3 days of evolution. Conclusions: in patients over 60 years of age, male, treated for mechanical bowel occlusion, the cause was sigmoid volvulus, where pain, abdominal distension and tympanism were common clinical manifestations. The predominant type of operation was sigmoidectomy plus primary anastomosis; the most frequent postoperative complication was surgical site infection and most complications occurred within the first 3 days.

Pulsed power generators create high-energy-density conditions by rapidly delivering an immense pulse of electrical current to a compact imploding load. Accurately measuring the shape and amplitude of this load current pulse is essential to understanding the behavior of all pulsed power experiments. At the Z Pulsed Power Facility, the closest-in load current measurements are provided by velocimetry techniques such as VISAR (velocity interferometer system for any reflector) and PDV (photonic Doppler velocimetry). Here, fiber-coupled interferometers measure the velocity history of an exploding metallic flyer plate that is embedded in the vertical walls of the current return can. The flyer plate is driven outward by the magnetic pressure from the load current such that magnetohydrodynamic modeling can be used to determine the load current waveform from the measured velocity history. In this paper, we present the first load current velocimetry measurements to be made from the horizontal top flyer plate that carries current radially inward from the return can to the load. These spatially resolved measurements, which span R=5–9 mm, are enabled by a transformative new velocimetry diagnostic—a line-imaging velocity interferometer called Z Line VISAR (ZLV)—whose optical performance overcomes the measurement challenges presented by the steep velocity gradients encountered on the top flyer plate. To validate ZLV’s capabilities, a 14-MA, 100-ns experiment was conducted to losslessly couple current up the return can and radially inward across the top flyer plate. Comparisons between the ZLV data obtained from this experiment and two-dimensional magnetohydrodynamic simulations driven with the current measured on the return can indicate that the current delivery across the top flyer plate is indeed lossless to within the few-percent uncertainty of the ZLV data. Given that the current coupling is lossless, the experimental results are used to demonstrate that one-dimensional current unfold techniques can be applied to generate a radially resolved load current map from the ZLV velocity data. This analysis provides a template for how to use the ZLV diagnostic to determine the efficacy of current delivery in future experiments where losses may occur in close proximity to the load.

Abstract Background Pulse wave velocity (PWV), central pulse pressure and augmentation index are arterial stiffness- related hemodynamic parameters but their associations with renal outcome are still controversial. We hereby aim to study, 1) which hemodynamic parameter is independently associated with progressive chronic kidney disease (CKD), 2) the association of 3-year change in PWV with CKD progression and, 3) the additive predictive value of PWV for progressive CKD. Methods Carotid- femoral PWV, central pulse pressure and augmentation index were measured in 1444 participants with type 2 diabetes at baseline and 3 years apart. Progressive CKD was defined as confirmed eGFR decline 40% or greater. Results In the follow-up, 102 participants experienced progressive CKD. All 3 hemodynamic parameters were significantly associated with progressive CKD In univariable analysis. However, only PWV remained statistically significant after adjustment for known clinical risk factors and the other 2 hemodynamic parameters (OR 1.14 [95% CI 1.01–1.29] per m/s increment). One m/s regression (decrement) in PWV in the 3-year follow-up was associated with 26% lower adjusted- risk of progressive CKD (OR 0.74, 95% CI 0.56–0.97). Adding PWV onto traditional risk factor- based model significantly improved classification (net reclassification improvement 0.25, 95% CI 0.05–0.45, P = 0.01) and positive prediction rate (24.5 to 32.3%). Conclusions Of 3 arterial stiffness- related hemodynamic parameters, only PWV is independently associated with progressive CKD. PWV may be a potential intervention target to mitigate risk of CKD progression and also a biomarker to improve risk-stratification of adverse renal outcome in individuals with type 2 diabetes.

Abstract Background Haptoglobin (Hp) is an abundant plasma protein with anti-oxidant properties. Hp polymorphism is associated with cardio-metabolic dysfunction but the allele conferring risk of developing acute myocardial infarction (AMI) in type 2 diabetes (T2D) patients is unclear. This study aimed to investigate the association of Hp phenotype (Hp 1-1, 2-1 and 2-2) with incident AMI in Chinese T2D patients. Methods This prospective study included Chinese T2D participants from the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D) and Diabetic Nephropathy (DN) cohorts. Information on incidence of non-fatal AMI was collected by data linkage with the Singapore Myocardial Infarction Registry. Hp phenotype was determined using enzyme-linked immunosorbent assay. Cox proportional hazards regression models were used to evaluate the association of Hp phenotype with incident AMI, adjusted for traditional risk factors separately in two cohorts, then meta-analysed. Results In total, 2324 Chinese participants (SMART2D; N = 1034, mean age [SD] of 59 [11]) and (DN: N = 1290, mean age [SD] of 58 [12]) were included in this study. There were total of 30 (56 events per 10,000 patient-years) and 99 (128 events per 10,000 patient-years) AMI events in SMART2D and DN cohorts respectively. In meta-analysis, presence of Hp 1 allele conferred 43% (hazard ratio [HR] = 1.43 [95% CI 1.10–1.87], P = 0.008, Phet = 0.413) increased risk of incident AMI, independent of age, sex, smoking, body mass index, HbA1c, diabetes duration, lipids, hypertension, renal function and usage of insulin and RAS antagonist. In adjusted model, compared to Hp 2-2 groups, individuals with Hp 1-1 (HR = 2.18 [95% CI 1.19–3.76], P = 0.010, Phet = 0.193) and Hp 2-1 (HR = 1.45 [95% CI 0.98–2.14], P = 0.065, Phet = 0.576) were at a higher risk of incident AMI. Moreover, compared to Hp 2-2 groups, non-Hp 2-2 groups (Hp 1-1 and Hp 2-1) were at 55% increased risk of incident AMI (HR = 1.55 [95% CI 1.07–2.24], P = 0.021, Phet = 0.940). Conclusions Hp 1-1 phenotype was associated with increased risk of incident AMI, independent of traditional risk factors, in Chinese patients with T2D. Hp phenotyping may allow for identification of T2D individuals at higher risk for onset of AMI. However, further studies are needed to understand the underlying mechanism between Hp alleles and risk for AMI.

This study compared the activation of the clavicular, sternocostal and abdominal heads of the pectoralis major (PM) and the long portion of the triceps brachii during the execution of the bench press with several inclinations, grip types, and grip widths. Thirteen healthy men with more than a year of resistance training experience participated in this study. The subjects performed 6 repetitions of various variations of the bench press at angles of -15°, 0° and 30° with grip width of 100% and 200% of their biacromial width in both pronation and supination with a load equivalent of their respective 12RM for each movement. EMG, bar acceleration and shoulder angle were recorded during each repetition. Activation of the clavicular head of the PM was, compared to a wide pronation at 0°, significantly higher at a close pronation at 0°and 30°; during a close supination at 30° and during a wide supination at 30°. Activation of the sternocostal head of the PM was, during a wide pronation at 0°, significantly higher than during a close supination at 0°, 30° and -15°; during a wide supination at 30; during a wide supination at 0° and 30° and at close pronation at 30° and -15°. Activation of the abdominal head of the PM was significantly better with wide pronation at -15° and 0° compared to all positions at 30°. Triceps brachii were better solicited during close pronation at 0° and -15° compared to supinated grip at 0° and 30°. Results from this study show that the bench press exercise performed with a wide pronation grip at 0° can maximize the activation of the three heads of the PM.

This study analyzes the effects of N fertilizer application rates on profitability of growing switchgrass and using the feedstock in a pyrolysis biorefinery facility to create a source of sustainable aviation fuel (SAF) supply in Tennessee. Switchgrass (Panicum virgatum L.) is a perennial bunchgrass native to North America with traits suitable for biofuel and co-product production. Previous chemical analysis has shown that ash content in switchgrass is related to the amount of nitrogen applied to the field, while at the biorefinery level, the percentage ash content reduces the biorefinery fuel output. To obtain optimal nitrogen (N) application rates for the switchgrass producers and the biorefinery, a two-part analysis is employed. First, a partial budgeting profitability analysis is conducted for this cropping enterprise at the farm-gate level without considering downstream implications of biomass quality, i.e., ash content. Second, the effects of higher ash content as a percentage of the feedstock on biorefinery output are analyzed. Results show farm-gate profit is maximized when N fertilizer is applied at 111 kg/ha, while as a result of increased production levels and decreased percentage ash content, biorefinery profit is maximized when N is applied at 157 kg/ha. Lower ash could lead to premium prices paid to switchgrass producers if higher quality feedstock were to be demanded as part of an integrated biofuel industry.

Music is a tool physical education (PE) teachers can use to help motivate students to greater physical activity (PA) rates during class activities. Music research in the PE context has found music to increase PA rates in the junior high school context (Brewer et al., 2016), that music increases the enjoyment of the PE experience for students (Barney et al., 2016) and can serve as a distraction during certain workouts (Higginson et al., 2019). This study aimed to examine the effects of music on physical activity rates (steps taken and time in activity) via pedometers of junior high school students in basketball gameplay. For this study, 270 junior high school students (157 males and 113 females) from eight intact seventh-, eighth-, and ninth-grade classes participated. The male and female participants attended different schools. Generally, it was found that the female participants were more active than their male counterparts when music was playing. These results and others illustrate music's effect on junior high school student PA rates., Introduction Music can be a powerful tool for increasing a person's physical activity. For example, college students' who listened to their personal music devices perceived that they worked harder and [...]

UNLABELLED: There is growing interest in engineering Pseudomonas putida KT2440 as a microbial chassis for the conversion of renewable and waste-based feedstocks, and metabolic engineering of P. putida relies on the understanding of the functional relationships between genes. In this work, independent component analysis (ICA) was applied to a compendium of existing fitness data from randomly barcoded transposon insertion sequencing (RB-TnSeq) of P. putida KT2440 grown in 179 unique experimental conditions. ICA identified 84 independent groups of genes, which we call fModules (functional modules), where gene members displayed shared functional influence in a specific cellular process. This machine learning-based approach both successfully recapitulated previously characterized functional relationships and established hitherto unknown associations between genes. Selected gene members from fModules for hydroxycinnamate metabolism and stress resistance, acetyl coenzyme A assimilation, and nitrogen metabolism were validated with engineered mutants of P. putida. Additionally, functional gene clusters from ICA of RB-TnSeq data sets were compared with regulatory gene clusters from prior ICA of RNAseq data sets to draw connections between gene regulation and function. Because ICA profiles the functional role of several distinct gene networks simultaneously, it can reduce the time required to annotate gene function relative to manual curation of RB-TnSeq data sets. IMPORTANCE: This study demonstrates a rapid, automated approach for elucidating functional modules within complex genetic networks. While Pseudomonas putida randomly barcoded transposon insertion sequencing data were used as a proof of concept, this approach is applicable to any organism with existing functional genomics data sets and may serve as a useful tool for many valuable applications, such as guiding metabolic engineering efforts in other microbes or understanding functional relationships between virulence-associated genes in pathogenic microbes. Furthermore, this work demonstrates that comparison of data obtained from independent component analysis of transcriptomics and gene fitness datasets can elucidate regulatory-functional relationships between genes, which may have utility in a variety of applications, such as metabolic modeling, strain engineering, or identification of antimicrobial drug targets.

Introduction: The assessment of person-environment congruence is important in vocational and career guidance. The aims of this study were to obtain descriptive statistics for the congruence between realistic, investigative, artistic, social, enterprising, and conventional (RIASEC) vocational interests and occupational aspirations, and to relate congruence scores to vocational self-efficacy and the Big Five personality traits in a sample of high school students. Method: The participants were 274 second- and third-year high school students from Cajeme (Sonora, Mexico). The Self-Directed Search (SDS), the Vocational Self-Efficacy Scale and the Global Personality Assessment Scale were administered. Congruence was measured using the Iachan and C indexes. Descriptive statistics and percentile rankings of congruence scores were obtained. To explore the association between variables, partial correlation and hierarchical multiple regression analyses were performed. Results: Female students obtained higher mean scores on the two congruence indexes than male students; however, the difference was only significant for the Iachan index. The Big Five personality traits in the aggregate explained significant amounts of variability in congruence scores, with small to moderate effect sizes. Openness to experience was the only significant predictor. Self-efficacy dimensions were not significantly associated with congruence scores. Discussion or Conclusion: The results provide information in the line of research on the relationships between the congruence construct with the Big Five-factors of personality and vocational self-efficacy. The study has practical implications in vocational assessment and guidance; the descriptive statistics for the two congruence indexes (Iachan and C) will allow more valid interpretations of the scores of this construct in populations with characteristics similar to those of the sample.

Drawing from a variety of conceptual and theoretical frameworks, this article provides a summary of decades of research into a university-district partnership that in multiple ways could be considered a systemic success. It describes the practices and processes of how two sectors of the broader physical education system (i.e., in-school physical education and teacher education) have complemented each other in the pursuit of the ongoing workforce development of physical education professionals. Physical education professionals belonging to the participating school district and teacher preparation program have sustained a working partnership based on sound professional learning community (PLC) principles (e.g., ongoing professional development, collaborative teaming, common vision, mission, and language, strong support from the central office) long before PLCs became fixtures in districts and schools. Indeed, this partnership could, in many respects, be described as a PLC before its time. This article highlights the partnership's early days and several features that have supported its success and longevity. It also offers supporting evidence from the perspectives of the students, parents, and teachers who have been associated with this partnership.

Approximately half of the annual carbon fixation on Earth occurs in the surface ocean through the photosynthetic activities of phytoplankton such as the ubiquitous picocyanobacterium Prochlorococcus. Ecologically distinct subpopulations (or ecotypes) of Prochlorococcus are central conduits of organic substrates into the ocean microbiome, thus playing important roles in surface ocean production. We measured the chemical profile of three cultured ecotype strains, observing striking differences among them that have implications for the likely chemical impact of Prochlorococcus subpopulations on their surroundings in the wild. Subpopulations differ in abundance along gradients of temperature, light, and nutrient concentrations, suggesting that these chemical differences could affect carbon cycling in different ocean strata and should be considered in models of Prochlorococcus physiology and marine carbon dynamics.

Diabetic retinopathy (DR) is a leading cause of vision-loss globally among type 2 diabetes (T2DM) patients. Information on the economic burden of DR in Singapore is limited. We aim to identify the total annual direct medical costs of DR at different stages, and to examine factors influencing the costs. Four hundreds and seventy T2DM patients who attended the Diabetes Centre in a secondary hospital in Singapore in 2011-2014 were included. Digital color fundus photographs were assessed for DR in a masked fashion. Retinopathy severity was further categorized into non-proliferative DR (NPDR), including mild, moderate and severe NPDR, and proliferative DR (PDR). Medical costs were assessed using hospital administrative data. DR was diagnosed in 172 (39.5%) patients, including 51 mild, 62 moderate and 18 severe NPDR, and 41 PDR. The median cost in DR [2012.0 (1111.2-4192.3)] was significantly higher than that in non-DR patients [1158.1 (724.1-1838.9)] (p

Objective – The accessibility of non-traditional resources presents ongoing challenges for users and librarians. This study investigates methods for optimizing metadata and the placement of search results to enhance the discoverability of these resources within library systems. Researchers conducted A/B testing to compare two features of Ex Libris Primo: the Resource Recommender and Discovery Import Profiles. The objective was to enhance user access to a broader range of informational assets beyond conventional collections. This study posed the research question: Is inclusion in the results list (Discovery Import Profiles) or are visually appealing advertisement-style cards above results (Resource Recommender) a more effective method for discovery of non-traditional library resources? Methods – Researchers identified four key resource types for testing: librarians, frequently asked questions (FAQs), databases, and research guides. An A/B test was conducted with each resource presented in the Discovery Import Profiles and Resource Recommender formats. Following the A/B test, a combined C test was conducted to validate findings. Results – The ad-style cards achieved higher engagement rates, particularly for databases and FAQs, while research guides performed better when embedded directly in search results. This study highlights the strengths and limitations of each method. Databases and FAQs benefited from the visual prominence of the ad-style cards, while research guides were more discoverable within search results. However, minimal engagement with librarians as a resource type across both methods suggests the need for improved tagging and metadata strategies. Conclusion – Findings underscore the importance of institution-specific research and localized assessments to ensure effective implementation of discovery strategies. This study provides a useful method for libraries aiming to enhance the discoverability of their non-traditional resources, ultimately improving user access and satisfaction.

Background: Class III obesity, formerly known as morbid obesity, is a known risk factor for chronic kidney diseases. Due to outdated information suggesting that morbid obesity is a contraindication for kidney biopsy and the misconception that proteinuria in obese patients is solely related to hyperfiltration, necessiating only conservative treatment, the vast majority of primary glomerulonephritis in these patients remains undiagnosed and untreated. Here, the clinical characteristics, treatments and results of patients who had class III obesity and needed a kidney biopsy are presented. Methods: Two hundred thirty-one native kidney biopsies conducted between 2015 and 2021 were retrospectively reviewed, identifying 12 patients with a body mass index ≥40 kg/m2 . Results: Ten patients presented with nephrotic syndrome, 8 of these patients underwent immunosuppressive therapy. Membranous nephropathy and focal segmental glomerulosclerosis were the most common diagnoses. Seven patients went into remission during follow-up. Our results indicated that class III obesity alone is not a detrimental morbidity when it comes to diagnosing and treating glomerular diseases. Conclusion: If a primary glomerulonephritis is diagnosed through a safe biopsy procedure, there is no reason to avoid considering immunosuppressive therapy for these patients.