A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy.

Background: Patients who start renal replacement therapy (RRT) for End-Stage Kidney Disease (ESKD) without having had timely access to specialist renal services have poor outcomes. At one NHS Trust in England, a community-wide CKD management system has led to a decline in the incident rate of RRT and the lowest percentage of patients presenting within 90 days of starting RRT in the UK. We describe the protocol for a quality improvement project to scale up and evaluate this innovation.

Constraints on the magnitude and rate of CO2 dissolution at Bravo Dome natural gas field.

The injection of carbon dioxide (CO2) captured at large point sources into deep saline aquifers can significantly reduce anthropogenic CO2 emissions from fossil fuels. Dissolution of the injected CO2 into the formation brine is a trapping mechanism that helps to ensure the long-term security of geological CO2 storage. We use thermochronology to estimate the timing of CO2 emplacement at Bravo Dome, a large natural CO2 field at a depth of 700 m in New Mexico.

Meteorite Kr in Earth's mantle suggests a late accretionary source for the atmosphere.

Noble gas isotopes are key tracers of both the origin of volatiles found within planets and the processes that control their eventual distribution between planetary interiors and atmospheres. Here, we report the discovery of primordial Kr in samples derived from Earth's mantle and show it to be consistent with a meteorite or fractionated solar nebula source. The high-precision Kr and Xe isotope data together suggest that Earth's interior acquired its volatiles from accretionary material similar to average carbonaceous chondrites and that the noble gases in Earth's atmosphere and oceans are dominantly derived from later volatile capture rather than impact degassing or outgassing of the solid Earth during its main accretionary stage.

Solubility trapping in formation water as dominant CO(2) sink in natural gas fields.

Injecting CO(2) into deep geological strata is proposed as a safe and economically favourable means of storing CO(2) captured from industrial point sources. It is difficult, however, to assess the long-term consequences of CO(2) flooding in the subsurface from decadal observations of existing disposal sites. Both the site design and long-term safety modelling critically depend on how and where CO(2) will be stored in the site over its lifetime.

Neon isotopes constrain convection and volatile origin in the Earth's mantle.

Identifying the origin of primordial volatiles in the Earth's mantle provides a critical test between models that advocate magma-ocean equilibration with an early massive solar-nebula atmosphere and those that require subduction of volatiles implanted in late accreting material. Here we show that neon isotopes in the convecting mantle, resolved in magmatic CO2 well gases, are consistent with a volatile source related to solar corpuscular irradiation of accreting material. This contrasts with recent results that indicated a solar-nebula origin for neon in mantle plume material, which is thought to be sampling the deep mantle.

US-style commissioning. Raising Arizona.

Strategic health authorities can learn a lot about strategic vision from Arizona's healthcare cost containment system. The Arizona commissioners have greater power than primary care trusts to push through new and more effective models of community care. Commissioner/provider relations can be fraught as health plans hold out for big discounts.

A new Olympus assay for the determination of ceruloplasmin.

Ceruloplasmin's main clinical importance is in the diagnosis of Wilson's disease, where plasma ceruloplasmin concentration is reduced. Increased levels are particularly notable in diseases of the reticuloendothelial system such as Hodgkin's disease as well as during pregnancy or use of contraceptive pills. This paper describes a new Olympus assay OSR6164 for the determination of ceruloplasmin on the Olympus AU640E, AU400E and AU2700 analytical systems.