Lowering LDL cholesterol reduces the risk of developing atherosclerotic events in CKD, but the effects of such treatment on progression of kidney disease remain uncertain. Here, 6245 participants with CKD (not on dialysis) were randomly assigned to simvastatin (20 mg) plus ezetimibe (10 mg) daily or matching placebo. The main prespecified renal outcome was ESRD (defined as the initiation of maintenance dialysis or kidney transplantation). During 4.8 years of follow-up, allocation to simvastatin plus ezetimibe resulted in an average LDL cholesterol difference (SEM) of 0.96 (0.02) mmol/L compared with placebo. There was a nonsignificant 3% reduction in the incidence of ESRD (1057 [33.9%] Exploratory analyses also showed no significant effect on the rate of change in eGFR. Lowering LDL cholesterol by 1 mmol/L did not slow kidney disease progression within 5 years in a wide range of patients with CKD.
This pilot study suggests that older patients trained to dialyse at home using PD or HD are highly satisfied with the nephrology service - even when living remote from the nephrology unit. Home-based dialysis is possible in older patients with levels of comorbidity and disease severity as serious as elsewhere.
Between 2015 and 2050 world population is projected to increase by nearly 2.5 billion, rising from 7.3 billion to an estimated 9.8 billion. The vast majority of that projected increase-an estimated 97 percent-will occur in the developing world. Demography is not destiny, but population growth in the developing world is a challengemultiplier. In recent decades, notable gains have been made in reducing the incidence of hunger and poverty in the world, but progress has been slow in countries with high fertility rates. The nations with the fastest growing populations tend to rank high on global indices of hunger, poverty, environmental degradation, and fragility; and many of these countries face enormous obstacles to economic development in the form of climate change, regional or ethnic conflict, or water scarcity. Most of these countries also have large numbers of unemployed young people between the ages of 15-24, a demographic factor that can contribute to, or exacerbate, political instability and conflict. Unless fertility rates in these countries fall faster than currently anticipated by demographers, many of these countries face an uncertain future. Lack of progress in improving living conditions in these countries could lead to greater political instability and conflict and increase the growing number of refugees and internally displaced persons in the world.
Ubiquitous satellite communications are in a leading position for bridging the digital divide. Fulfilling such a mission will require satellite services on par with fibre services, both in bandwidth and cost. Achieving such a performance requires a new generation of communications payloads powered by large-scale processors, enabling a dynamic allocation of hundreds of beams with a total capacity beyond 1 Tbit s
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. The fact that the scale of the processor is proportional to the wavelength of its signals has made photonics a key technology for its implementation. However, one last challenge hinders the introduction of photonics: while large-scale processors demand a modular implementation, coherency among signals must be preserved using simple methods. Here, we demonstrate a coherent photonic-aided receiver meeting such demands. This work shows that a modular and coherent photonic-aided payload is feasible, making way to an extensive introduction of photonics in next generation communications satellites.
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