Application of the 2017 KDIGO Guideline for the Evaluation and Care of Living Kidney Donors to Clinical Practice

The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 “Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors” was developed to assist medical professionals who evaluate living kidney donor candidates and provide care before, during, and after donation. This guideline Work Group concluded that a comprehensive approach to donor candidate risk assessment should replace eligibility decisions on the basis of assessments of single risk factors in isolation. To address all issues important to living donors in a pragmatic and comprehensive guideline, many of the guideline recommendations were on the basis of expert consensus opinion even when no direct evidence was available. To advance available evidence, original data analyses were also undertaken to produce a “proof-of-concept” risk projection model for kidney failure. This was done to illustrate how the community can advance a new quantitative framework of risk that considers each candidate’s profile of demographic and health characteristics. A public review by stakeholders and subject matter experts as well as industry and professional organizations informed the final formulation of the guideline. This review highlights the guideline framework, key concepts, and recommendations, and uses five patient scenarios and 12 guideline statements to illustrate how the guideline can be applied to support living donor evaluation and care in clinical practice.

Multiple hazards under future UK Climate Projections

<p>When two or more extreme weather events occur either simultaneously or in close succession, there may be more severe societal and economic impacts than when extreme hazards occur alone. Impacts may also cascade across different sectors of society or amplify impacts in another sector. Perturbed parameter ensemble simulations of projections to 2080 have been generated at the UK Met Office to cover the UK at high spatial (12 km or 2.2 km) and temporal resolution (daily or sub-daily) resolution as part of the “UK Climate Projections”. We use the regional 12 km model simulations at daily resolution to consider how the frequency, duration and spatial extent of multiple extreme hazard events in the UK changes over the 21<sup>st </sup>century. We will show case studies of multiple extreme hazard pairings that pose a risk to UK sectors, for example, the risk of hot and dry weather to agricultural harvests. By working with stakeholders that have a good understanding of their vulnerabilities and exposure, we consider multiple extreme events in a risk projection framework. This work is funded under the Strategic Priority Fund for UK Climate Resilience.</p>

Projection of land and ecosystem degradation for preventing risk of natural capital decline in Tibet plateau.

<p>Numerous methodologies are available so far measuring trends of land (LD) and ecosystem degradation (ED) with spatially explicit manner. Yet the delineation of spatial and temporal covariance between LD and ED remains challenging which limited the effectiveness of future conservation decision making for preventing risks of LD and ED simultaneously, especially in cold and drought areas because of high cost of restoration. Here, we produced the spatial networks for managing and restoring LD and ED based on the risk projection of LD and ED in Tibet plateau under human exploitation pressure and climate change. Firstly, we simulated 10 indicators for LD and ED separately by monthly interval from 2000 to 2015 to capture the current trends of LD and ED. Secondly, resilience, resistant, and risk exposure have been assessed to connect the vegetation traits, threaten factors and their reflections. Thirdly, by the exploration of relationship between LD and ED and their impact factors, we projected risks for both of them using 12 scenarios from different climate and land use change combinations identifying the key area of preventing LD and ED spatially. Finally, an effectiveness analysis has been processed ordering results under each scenarios leaded to the decline of nature capital for providing alternative strategies of regional land and ecosystem management. By our research, we found that LD and ED in Tibetan plateau have similar pattern of dynamic, while ED shows more significant correlation with climate change due to stronger intrinsic resilience in front of stressors. In opposites, once serious land degradation occurs, it is hardly being recovered by increasing of precipitation and temperature. Based on the relationship analysis, we modeled LE and ED risks under various potential scenarios suggesting that at least 100,000km2 area needed to human intervention for restoration. These suggested sites covered the worst 60% areas of both LD and ED producing 12.5 billion USD  dollars revenue from the maintenance of key regulating ecosystem services.</p>

Informed dimension reduction of clinically-related genome-wide association summary data characterises cross-trait axes of genetic risk

Integration of genome-wide association study (GWAS) data has been used to generate new hypotheses of biological mechanism, aetiological relationships between traits, or test causality of one factor for another. However, such approaches have typically been limited to pairwise comparisons of traits. We propose a generally applicable method, that exploits ideas from Bayesian genetic fine mapping to define a “lens” that focuses relevant variants before dimension reduction of a set of related GWAS summary statistics. We applied this technique to immune-mediated diseases, deriving 13 components which summarise the multidimensional patterns of genetic risk. Projection of independent datasets demonstrated the specificity and accuracy of our reduced dimension basis, enabled us to functionally characterise individual components, identify disease-discriminating components and suggest novel associations in rare diseases where classical GWAS approaches are challenging. Our approach summarises the genetic architectures underlying any range of aetiologically-related traits in fewer dimensions, facilitating more nuanced multidimensional comparative analyses.

Early Detection of Baby-Rain-Cell Aloft in a Severe Storm and Risk Projection for Urban Flash Flood

In July 2008, five people were killed by a tragic flash flood caused by a local torrential heavy rainfall in a short time in Toga River. From this tragic accident, we realized that a system which can detect hazardous rain-cells in the earlier stage is strongly needed and would provide an additional 5 to 10 min for evacuation. By analyzing this event, we verified that a first radar echo aloft, by volume scan observation, is a practical and important sign for early warning of flash flood, and we named a first echo as a “baby-rain-cell” of Guerrilla-heavy rainfall. Also, we found a vertical vorticity criterion for identifying hazardous rain-cells and developed a heavy rainfall prediction system that has the important feature of not missing any hazardous rain-cell. Being able to detect heavy rainfall by 23.6 min on average before it reaches the ground, this system is implemented in XRAIN in the Kinki area. Additionally, to resolve the relationship between baby-rain-cell growth and vorticity behavior, we carried out an analysis of vorticity inside baby-rain-cells and verified that a pair of positive and negative vertical vortex tubes as well as an updraft between them existed in a rain-cell in the early stage.