Intensive care unit improves dialysis care quality while reducing costs.

Aims And Background: The current report details transition of outsourced conventional dialysis therapy in the ICU services to an in-house prolonged intermittent renal replacement therapy (PIRRT) service model as a quality improvement project using the Tablo Hemodialysis System, Outset Medical, Inc. The goals were aimed at maintaining or improving clinical outcomes, while also reducing dialysis-related nursing staff burden and dialysis-related treatment costs.

Methods: A descriptive comparative analysis was conducted of renal replacement therapy (RRT) of ≥6 hours in duration performed in the 1 year prior and 1 year after the ICU's in-house program launch using a PIRRT model including sequential 24-h treatments when medically necessary.

Pressure-Induced Amidine Formation via Side-Chain Polymerization in a Charge-Transfer Cocrystal.

Compression of small molecules can induce solid-state reactions that are difficult or impossible under conventional, solution-phase conditions. Of particular interest is the topochemical-like reaction of arenes to produce polymeric nanomaterials. However, high reaction onset pressures and poor selectivity remain significant challenges.

Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes.

Objective: To evaluate the fulfillment and validity of the kidney health evaluation for people with diabetes (KED) Healthcare Effectiveness Data Information Set (HEDIS) measure.

Patients And Methods: Optum Labs Data Warehouse (OLDW) was used to identify the nationally distributed US population aged 18 years and older, with diabetes, between January 1, 2017, and December 31, 2017. The OLDW includes deidentified medical, pharmacy, laboratory, and electronic health record (EHR) data.

Health care costs associated with unrecognized progression to late-stage kidney disease.

Objectives: Many individuals with chronic kidney disease (CKD) are undiagnosed or unaware of the disease and at risk of not receiving services to manage their condition and of "crashing" into dialysis. Past studies report higher health care costs among patients with delayed nephrology care and suboptimal dialysis initiation, but they are limited because they focused on patients undergoing dialysis and did not evaluate costs associated with unrecognized disease for patients "upstream," or patients with late-stage CKD. We compared costs for patients with unrecognized progression to late-stage (stages G4 and G5) CKD and end-stage kidney disease (ESKD) with costs for individuals with prior CKD recognition.

Synthesis and Post-Processing of Chemically Homogeneous Nanothreads from 2,5-Furandicarboxylic Acid.

Compared with conventional, solution-phase approaches, solid-state reaction methods can provide unique access to novel synthetic targets. Nanothreads-one-dimensional diamondoid polymers formed through the compression of small molecules-represent a new class of materials produced via solid-state reactions, however, the formation of chemically homogeneous products with targeted functionalization represents a persistent challenge. Through careful consideration of molecular precursor stacking geometry and functionalization, we report here the scalable synthesis of chemically homogeneous, functionalized nanothreads through the solid-state polymerization of 2,5-furandicarboxylic acid.

Glacial lake outburst floods threaten millions globally.

Glacial lake outburst floods (GLOFs) represent a major hazard and can result in significant loss of life. Globally, since 1990, the number and size of glacial lakes has grown rapidly along with downstream population, while socio-economic vulnerability has decreased. Nevertheless, contemporary exposure and vulnerability to GLOFs at the global scale has never been quantified.

Prevalence of use and characteristics of users of home-based medical care in Medicare Advantage.

Background/objectives: Home-based medical care (HBMC) is longitudinal medical care provided by physicians, advanced practice providers, and, often, inter-professional care teams to patients in their homes. Our objective is to determine the prevalence of HBMC among older adults (≥65) insured by a Medicare Advantage (MA) plan and compare characteristics of those who receive HBMC to those who do not.

Methods: Study used de-identified medical claims and enrollment records for MA beneficiaries during calendar years 2017 and 2018 linked with socioeconomic status data in the OptumLabs Data Warehouse.

Anemia Prevalence, Type, and Associated Risks in a Cohort of 5.0 Million Insured Patients in the United States by Level of Kidney Function.

Rationale & Objective: Anemia is common in chronic kidney disease (CKD); although anemia is associated with adverse outcomes, the available treatments are not ideal. We characterized the burden, risk factors for, and risks associated with anemia by estimated glomerular filtration rate (eGFR) and hemoglobin level.

Study Design: Cross-sectional and prospective cohort study.

Missing Care: the Initial Impact of the COVID-19 Pandemic on CKD Care Delivery.

Background: Chronic kidney disease (CKD) is a common condition with adverse health outcomes addressable by early disease management. The impact of the COVID-19 pandemic on care utilization for the CKD population is unknown.

Objective: To examine pandemic CKD care and identify factors associated with a high care deficit.

Association of Rosuvastatin Use with Risk of Hematuria and Proteinuria.

Background: Despite reports of hematuria and proteinuria with rosuvastatin use at the time of its approval by the US Food and Drug Association (FDA), little postmarketing surveillance exists to assess real-world risk. Current labeling suggests dose reduction (maximum daily dose of 10 mg) for patients with severe CKD.

Methods: Using deidentified electronic health record data, we analyzed 152,101 and 795,799 new users of rosuvastatin and atorvastatin, respectively, from 2011 to 2019.

Investigating H Adsorption in Isostructural Metal-Organic Frameworks M-CUK-1 (M = Co and Mg) through Experimental and Theoretical Studies.

A combined experimental and theoretical study of H adsorption was carried out in Co-CUK-1 and Mg-CUK-1, two isostructural metal-organic frameworks (MOFs) that consist of M ions (M = Co and Mg) coordinated to pyridine-2,4-dicarboxylate (pdc) and OH ligands. These MOFs possess saturated metal centers in distorted octahedral environments and narrow pore sizes and display high chemical and thermal stability. Previous experimental studies revealed that Co-CUK-1 exhibits a H uptake of 183 cm g at 77 K/1.

Solid-State Pathway Control via Reaction-Directing Heteroatoms: Ordered Pyridazine Nanothreads through Selective Cycloaddition.

Nanothreads are one-dimensional nanomaterials composed of a primarily sp hydrocarbon backbone, typically formed through the compression of small molecules to high pressures. Although nanothreads have been synthesized from a range of precursors, controlling reaction pathways to produce atomically precise materials remains a difficult challenge. Here, we show how heteroatoms within precursors can serve as "thread-directing" groups by selecting for specific cycloaddition reaction pathways.

Magnetism and Luminescence of a MOF with Linear Mn Nodes Derived from an Emissive Terthiophene-Based Imidazole Linker.

A new terthiophene-based imidazole luminophore 5,5'-(1-thieno[3,4-d]imidazole-4,6-diyl)bis(thiophene-2-carboxylic acid) (TIBTCH, ) was synthesized in one step from previously reported 4,6-di(thiophen-2-yl)-1-thieno[3,4-d]imidazole (DTTI, ), and their photophysical properties were studied and compared accordingly. Under solvothermal conditions, reacting with Mn(OAc) yielded a new three-dimensional metal-organic framework (MOF, ) which was structurally defined by single-crystal X-ray diffraction. In , all Mn(II) ions octahedrally bind to carboxylate- atoms to form a linear Mn secondary building unit (SBU) that contains three distinct coordination modes.

A massive rock and ice avalanche caused the 2021 disaster at Chamoli, Indian Himalaya.

On 7 February 2021, a catastrophic mass flow descended the Ronti Gad, Rishiganga, and Dhauliganga valleys in Chamoli, Uttarakhand, India, causing widespread devastation and severely damaging two hydropower projects. More than 200 people were killed or are missing. Our analysis of satellite imagery, seismic records, numerical model results, and eyewitness videos reveals that ~27 × 10 cubic meters of rock and glacier ice collapsed from the steep north face of Ronti Peak.

The Serious Illness Population: Ascertainment via Electronic Health Record or Claims Data.

Context: Palliative care can improve the lives of people with serious illness, yet clear operational definitions of this population do not exist. Prior efforts to identify this population have not focused on Medicare Advantage (MA) and commercial health plan enrollees.

Objectives: We aimed to operationalize our conceptual definition of serious illness to identify those with serious medical conditions (SMC) among commercial insurance and MA enrollees, and to compare the populations identified through electronic health record (EHR) or claims data sources.

Estimating Kidney Failure Risk Using Electronic Medical Records.

Background: The four-variable kidney failure risk equation (KFRE) is a well-validated tool for patients with GFR <60 ml/min per 1.73 m and incorporates age, sex, GFR, and urine albumin-creatinine ratio (ACR) to forecast individual risk of kidney failure. Implementing the KFRE in electronic medical records is challenging, however, due to low ACR testing in clinical practice.

The FDA Metformin Label Change and Racial and Sex Disparities in Metformin Prescription among Patients with CKD.

Background: In 2016, the Food and Drug Administration (FDA) changed labeling regarding metformin contraindications in patients with diabetes and CKD from using serum creatinine-based thresholds to using eGFR-based thresholds. Because race and sex affect serum creatinine levels independently of GFR, the earlier creatinine-based contraindication may have inadvertently caused racial and sex disparities in metformin prescription among patients with low eGFR.

Methods: In an analysis of 15,946 Black and White primary care patients with diabetes and eGFR≥30 ml/min per 1.

Growth and Break-Up of Methanogenic Granules Suggests Mechanisms for Biofilm and Community Development.

Methanogenic sludge granules are densely packed, small, spherical biofilms found in anaerobic digesters used to treat industrial wastewaters, where they underpin efficient organic waste conversion and biogas production. Each granule theoretically houses representative microorganisms from all of the trophic groups implicated in the successive and interdependent reactions of the anaerobic digestion (AD) process. Information on exactly how methanogenic granules develop, and their eventual fate will be important for precision management of environmental biotechnologies.

Association between cancer-specific adverse event triggers and mortality: A validation study.

Background: As there are few validated measures of patient safety in clinical oncology, creating an efficient measurement instrument would create significant value. Accordingly, we sought to assess the validity of a novel patient safety measure by examining the association of oncology-specific triggers and mortality using administrative claims data.

Methods: We examined a retrospective cohort of 322 887 adult cancer patients enrolled in commercial or Medicare Advantage products for one year after an initial diagnosis of breast, colorectal, lung, or prostate cancer in 2008-2014.

Reversible Solid-State Isomerism of Azobenzene-Loaded Large-Pore Isoreticular Mg-CUK-1.

A large-pore version of Mg-CUK-1, a water-stable metal-organic framework (MOF) with 1-D channels, was synthesized in basic water. Mg-CUK-1L has a BET surface area of 2896 m g and shows stark selectivity for CO sorption over N, O, H, and CH. It displays reversible, multistep gated sorption of CO below 0.

In situ formation and solid-state oxidation of a triselenane NSeN-pincer MOF.

Controlled partial decomposition of 2-selenonicotinic acid in the presence of Co2+ or Ni2+ resulted in the in situ formation of an unusual MOF based on triselenane ligands (RSeSeSeR) coordinated to M2+ centers as NSeN-pincers. Post-synthetic oxidation by treatment with aqueous H2O2 facilitates its solid-state conversion into a RSeO2- molecular coordination complex, which was tracked via powder X-ray diffraction studies and by single-crystal structural resolution of the final product.

Developing a cancer-specific trigger tool to identify treatment-related adverse events using administrative data.

Background: As there are few validated tools to identify treatment-related adverse events across cancer care settings, we sought to develop oncology-specific "triggers" to flag potential adverse events among cancer patients using claims data.

Methods: 322 887 adult patients undergoing an initial course of cancer-directed therapy for breast, colorectal, lung, or prostate cancer from 2008 to 2014 were drawn from a large commercial claims database. We defined 16 oncology-specific triggers using diagnosis and procedure codes.

What's Happening at Home: A Claims-based Approach to Better Understand Home Clinical Care Received by Older Adults.

Background: Home clinical care (HCC) includes home-based medical care (HBMC-medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over 7 million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC.

Objective: To describe HCC received by older adults using claims data within the OptumLabs Data Warehouse.