Background: Globalization and the potential for rapid spread of emerging infectious diseases have heightened the need for ongoing surveillance and early detection. The Global Public Health Intelligence Network (GPHIN) was established to increase situational awareness and capacity for the early detection of emerging public health events.Objective: To describe how the GPHIN has used Big Data as an effective early detection technique for infectious disease outbreaks worldwide and to identify potential future directions for the GPHIN.Findings: Every day the GPHIN analyzes over more than 20,000 online news reports (over 30,000 sources) in nine languages worldwide. A web-based program aggregates data based on an algorithm that provides potential signals of emerging public health events which are then reviewed by a multilingual, multidisciplinary team. An alert is sent out if a potential risk is identified. This process proved useful during the Severe Acute Respiratory Syndrome (SARS) outbreak and was adopted shortly after by a number of countries to meet new International Health Regulations that require each country to have the capacity for early detection and reporting. The GPHIN identified the early SARS outbreak in China, was credited with the first alert on MERS-CoV and has played a significant role in the monitoring of the Ebola outbreak in West Africa. Future developments are being considered to advance the GPHIN's capacity in light of other Big Data sources such as social media and its analytical capacity in terms of algorithm development. Conclusion:The GPHIN's early adoption of Big Data has increased global capacity to detect international infectious disease outbreaks and other public health events. Integration of additional Big Data sources and advances in analytical capacity could further strengthen the GPHIN's capability for timely detection and early warning.

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Few transplant programs use kidneys from donors with body weight (BW) < 10 kg. We hypothesized that pediatric en bloc transplants from donors with BW < 10 kg would provide similar transplant outcomes to larger grafts. All pediatric en bloc renal transplants performed at our center between 2001 and 2017 were reviewed (N = 28). Data were stratified by smaller (donor BW < 10 kg; n = 11) or larger donors (BW > 10 kg; n = 17). Renal volume was assessed during follow-up with ultrasound. Demographic characteristics were similar between the 2 groups of recipients. After mean follow-up of 44 months (smaller donors) and 124 months (larger donors), graft and patient outcomes were similar between groups. Serum creatinine at 1, 3, and 5 years was no different between groups. At 1 day posttransplant, mean total renal volume in the smaller donors was 28 ± 9 mm vs 45 ± 12 mm (P < .01). By 3 weeks, it was 53 ± 19 mm (smaller donors) versus 73 ± 19 mm (larger donors) (P = NS). Complication rates were similar between both groups with 1 case of venous thrombosis in the smaller group. With experience, outcomes are equivalent to those from larger pediatric donors.

Our results show that KIM-1 is a promising biomarker of subclinical AKI associated with hydronephrosis in urological patients. NGAL values were influenced by the presence of leukocyturia, limiting its usefulness in this population.

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ObjectivesTo evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys can improve long-term renal allograft function compared with static cold storage (CS). MethodsWe evaluated whether graft Doppler ultrasonography resistive indices improved with the use of HMP compared with CS preservation, and examined whether these improvements were predictive of long-term graft function. A total of 30 kidney transplants (15 pairs) were examined. One of the kidney pairs was placed on CS and transplanted first (CS group, n = 15). The other kidney of each pair was placed on HMP and transplanted after the CS group (HMP group, n = 15). Doppler ultrasonography was performed on days 1 and 7 after transplantation and resistive indices were evaluated. The estimated glomerular filtration rate (eGFR) was monitored for 24 months after transplantation. ResultsDespite longer cold ischaemia times, kidneys maintained with HMP had lower resistive indices (P = 0.005) with correspondingly higher eGFR throughout the follow-up. Subgroup analysis showed that the HMP-induced improvement in postoperative eGFR was greatest in kidneys obtained from donation after cardiac death (DCD), even at 2 years after transplantation (P = 0.008). ConclusionsHMP of transplant kidneys appears to improve vascular resistance after transplantation and has a positive impact on long-term allograft function compared with CS in the population of recipients of DCD kidneys.

with a high risk of recurrent stone disease undergo metabolic evaluation by any physician. 9 81% of patients interviewed would prefer to take prophylactic medication than undergo another stone episode, and 92% of respondents preferred medication to undergoing surgery. 10 Although patients indicate they would be interested in using medication to prevent future stones, compliance studies suggest otherwise. Close to 50% of patients prescribed pharmacological prevention were non-compliant, especially those on potassium citrate. 11 This data stresses the importance of a comprehensive metabolic assessment with implementaiton of individualized prevention strategies. With directed therapy and proper patient education, patient compliance and therapeutic success may be optimized.The economic burden of recurrent stone disease is also significant. Estimates of direct costs for patient care and the indirect costs related to lost work time exceed $5 billion USD. 12,13 Given the rising rates of obesity and diabetes and their association with stone formation, the cost of managing stone disease is expected to increase to 1.24 billion dollars yearly in the US by 2030. 14 This guideline is an update of the 2016 document and aims to identify patients at heightened risk of stone recurrence, to outline the required investigations to assess these patients, and to provide contemporary advice on dietary and medical interventions of proven benefit in the Canadian context. This current guideline addresses the evaluation and medical prophylaxis of upper urinary tract stones and not bladder stones. Literature reviewThe updated content included in this document is based on a review of the English language literature. A PubMed search was conducted encompassing the period from January 1, 2015 to July 1, 2021 to include the following terms: "nephrolithiasis", "urolithiasis", "kidney stone", "renal stone", or "urinary stone". In total, 11,640 article titles were reviewed and 293 were identified as potentially relevant for inclusion in the literature assessment for this guideline update. Management recommendations were modified if needed based on the most current literature since the last guideline was published in 2016. Studies were evaluated and recommendations made based on Oxford levels of evidence and grades of recommendation as per the CUA Guidelines Committee's directive. 15

Validated questionnaires and low urine output before transplantation may be used to identify patients at highest risk for LUTS after RTx. Identification of at risk patients would allow earlier initiation of treatment strategies to improve patient quality of life.