Mixed shift rotations, sleep, burnout and well-being in professions similar to radiographers: A systematic review.

INTRODUCTION: Delivering 24 h healthcare requires rotational shift work from doctors and the medical imaging team, while contributing to safe and timely care of patients. Additional service pressure and staff shortfall leads to workload pressures, adjusted shift patterns and risk of burnout. Evidence should be sought to the effects of this work on staff. METHODS: This systematic review followed PRISMA reporting guidelines, using a convergent mixed methods approach according to Guidance from Joanna Briggs International. Quantitative trends and results were qualified in order to thematically analyse in conjunction with qualitative data and discussed together in context. Following initial searching, returned articles were screened by title and abstract. A team of 3 reviewers undertook blinded critical appraisal of those suitable, with quality assurance from a 4th team member. Papers passing a threshold of 75% on JBI appraisal tools were accepted for synthesis. Data extraction of appropriate articles retrieved was undertaken in parallel. RESULTS: Following screening and critical appraisal, 13 studies were returned focusing exclusively on Non Consultant Doctors. No studies investigated diagnostic radiographers. 85% (n = 11) reported negative association between shift work and the three themes of sleep/fatigue, burnout and wellbeing: including after the introduction of shift pattern control or adjusted shift patterns. The remainder showed no change, or any improvement nullified by countermeasures to maintain service delivery. CONCLUSION: Current working practices and shift plans in the target population showed detrimental effects on the participants - this can be suggested that Diagnostic Radiographers may suffer fatigue, burnout and poor mental health from stretched shift working patterns. IMPLICATIONS FOR PRACTICE: Further study into the effects of shift work on Diagnostic Radiographers and other allied health professionals is indicated - relating to the above themes in the context of errors and patient safety. Additional research into Non Consultant Doctors, shift work effects and the context of wider service delivery required; with suitable interventions and education to maximise understanding of legal working practices, monitoring and self-management of symptoms.

Case Report: COVID-19 Patient With Chief Complaint of Anosmia and Ageusia; a Unique Perspective on Atypical Symptomatology and Management in the Military.

A novel corona virus, severe acute respiratory syndrome coronavirus-2, found in Wuhan, China in December 2019 has since spread to multiple continents and has been implicated in thousands of deaths. This pandemic-causing virus has been initially described (corona virus disease 2019 [COVID-19]) with the presentation of fever, cough, and shortness of breath. The majority of studies published have been conducted on inpatient cases and a shortage of tests has encouraged screening only of patients with classic presentation. A positive COVID-19 case of a healthy military male, with the chief complaint of anosmia and ageusia, instigated local re-evaluation of the screening protocol for possible COVID-19 patients. Multiple studies in Europe have implicated anosmia and ageusia as symptoms associated with COVID-19, and subsequently, anosmia and ageusia have been added to Centers for Disease Control and Prevention screening guidelines as well. There should be a higher index of suspicion when evaluating a patient with high-risk activities, travel, and atypical symptoms. More studies need to be conducted with a healthy outpatient population to further understand this disease and decrease its impact.

CFTR is a tumor suppressor gene in murine and human intestinal cancer.

This corrects the article DOI: 10.1038/onc.2015.483.

Cystic Fibrosis Mice Develop Spontaneous Chronic Bordetella Airway Infections.

Chronic pulmonary disease and infection is the primary cause of morbidity and mortality in people with cystic fibrosis (CF). Though Pseudomonas aeruginosa, is most commonly found in the airways of individuals with CF, there is increasing appreciation for the diversity of the CF microbiome, including other taxa such as Bordetella. Here we describe the identification and impact of Bordetella pseudohinzii infection in CF mice, which previously have not been thought to develop spontaneous airway infections. We determined that CF mice are more susceptible to the B. pseudohinzii infections, and less able to resolve the infection than non-CF mice. Moreover, in both CF and non-CF mice, B. pseudohinzii infections lead to markedly reduced respiratory rates and a CF-specific immune response. These results establish the CF mouse model as an important tool for the study of CF-relevant infection and highlight the potential contribution of Bordetella to CF clinical pathology.

CFTR is a tumor suppressor gene in murine and human intestinal cancer.

CFTR, the cystic fibrosis (CF) gene, encodes for the CFTR protein that plays an essential role in anion regulation and tissue homeostasis of various epithelia. In the gastrointestinal (GI) tract CFTR promotes chloride and bicarbonate secretion, playing an essential role in ion and acid-base homeostasis. Cftr has been identified as a candidate driver gene for colorectal cancer (CRC) in several Sleeping Beauty DNA transposon-based forward genetic screens in mice. Further, recent epidemiological and clinical studies indicate that CF patients are at high risk for developing tumors in the colon. To investigate the effects of CFTR dysregulation on GI cancer, we generated Apc(Min) mice that carried an intestinal-specific knockout of Cftr. Our results indicate that Cftr is a tumor suppressor gene in the intestinal tract as Cftr mutant mice developed significantly more tumors in the colon and the entire small intestine. In Apc(+/+) mice aged to ~1 year, Cftr deficiency alone caused the development of intestinal tumors in >60% of mice. Colon organoid formation was significantly increased in organoids created from Cftr mutant mice compared with wild-type controls, suggesting a potential role of Cftr in regulating the intestinal stem cell compartment. Microarray data from the Cftr-deficient colon and the small intestine identified dysregulated genes that belong to groups of immune response, ion channel, intestinal stem cell and other growth signaling regulators. These associated clusters of genes were confirmed by pathway analysis using Ingenuity Pathway Analysis and gene set enrichment analysis (GSEA). We also conducted RNA Seq analysis of tumors from Apc(+/+) Cftr knockout mice and identified sets of genes dysregulated in tumors including altered Wnt ß-catenin target genes. Finally we analyzed expression of CFTR in early stage human CRC patients stratified by risk of recurrence and found that loss of expression of CFTR was significantly associated with poor disease-free survival.

Microscopy of nanoparticulate dispersions.

We present a critical review of the common methods for determining the dispersion state of nanoparticulate samples particularly in liquid media, including the determination of particle size and morphology; particle size distributions and polydispersity and equilibrium particle structure and chemistry. We highlight the potential contributions of both scanning probe and electron microscopies in this analysis which is of benefit in understanding nanoparticulate formulations and their behaviour applied across a very wide range of technologies and industry sectors.

Cascading costs of reproduction in female house wrens induced to lay larger clutches.

In many species, females produce fewer offspring than they are capable of rearing, possibly because increases in current reproductive effort come at the expense of a female's own survival and future reproduction. To test this, we induced female house wrens (Troglodytes aedon) to lay more eggs than they normally would and assessed the potential costs of increasing cumulative investment in the three main components of the avian breeding cycle - egg laying, incubation and nestling provisioning. Females with increased clutch sizes reared more offspring in the first brood than controls, but fledged a lower proportion of nestlings. Moreover, nestlings of experimental females were lighter than those of control females as brood size and prefledging mass were negatively correlated. In second broods of the season, when females were not manipulated, experimental females laid the same number of eggs as controls, but experienced an intraseasonal cost through reduced hatchling survival and a lower number of young fledged. Offspring of control and experimental females were equally likely to recruit to the breeding population, although control females produced more recruits per egg laid. The reproductive success of recruits from broods of experimental and control females did not differ. The manipulation also induced interseasonal costs to future reproduction, as experimental females had lower fecundity than controls when breeding at least 2 years after having their reproductive effort experimentally increased. Finally, females producing the modal clutch size of seven eggs in their first broods had the highest lifetime number of fledglings.

First Report of Cylindrocarpon sp. Associated with Root Rot Disease of Strawberry in North Carolina.

Strawberry (Fragaria × ananassa Duchesne) is an economically important fruit crop in North Carolina for domestic consumption and export. In April 2012, outbreaks of a destructive root disease were observed in strawberry cv. Chandler in Buncombe, New Hanover, and Roman counties, North Carolina. Samples from Rowan (ID 13175) and Buncombe (ID 13193) counties submitted to the Plant Disease and Insect Clinic of the Department of Plant Pathology, North Carolina State University, exhibited yellowing and wilting of leaves and extensive root necrosis, and disease severity based on field symptoms ranged from 20 to 30%. To identify the pathogen, five small pieces of necrotic crown and root tissues were taken from each sample, surface disinfested for 1 min in a 1.5% sodium hypochlorite solution, and plated onto potato dextrose agar (PDA) with 0.5 g liter-1 of streptomycin sulfate. Colonies developing from the tissue samples were transferred to PDA. Colonies from both samples were identical, grew relatively slowly, and gradually turned yellowish to partially brownish. After about 7 days, abundant conidia were formed. These were hyaline, mostly straight with both ends rounded, predominantly three septate, and 40 to 50 × 5 to 10 µm. Based on morphological characteristics, these isolates were identified as a species of Cylindrocarpon (1) To confirm the original identification of the fungus as a species of Cylindrocarpon, genomic DNA of both isolates was extracted from mycelia using DNeasy Plant Mini Kit (Qiagen Inc., Valencia, CA) and analyzed using PCR (2). The internal transcribed spacers (ITS)1 and (ITS)2 flanking the 5.8S rRNA regions were amplified and sequenced using universal primers ITS1 (forward) and ITS4 (reverse). The sequences of the 421 bp (GenBank KC847090 and KC847091) of both isolates were identical. Furthermore, a BLASTn search of these sequences showed homology of 99% with the sequences of Cylidrocarpon species (AB369421.1, AM419069.1, AM419074.1, AY295332.1, JN031017.1, JN253505.1, and JQ886422.1), To fulfill Koch's postulates, inoculum of each isolate was prepared and adjusted to 1.5 × 107 conidia/ml using a hemacytometer. 'Chandler' strawberry plants were grown in 25-cm diameter plastic pots (one seedling per pot) in the greenhouse and five 6-week-old plants were injected with conidia of each isolate into the base of crown using a 5-ml syringe. The plants were covered with clear plastic for 24 h and left on the greenhouse bench with a 16-h photoperiod and 25/20°C day/night temperatures and assessed for disease development 14 days after inoculation. The inoculated plants exhibited wilting and root necrosis, consistent with the symptoms observed on strawberry plants in the field. Control plants treated with distilled water remained healthy. Isolations were made from the inoculated plants and the fungus used for inoculation was recovered from all plants. The morphology of these isolates was in agreement with published descriptions of Cylindrocarpon (1). To our knowledge, this is the first report of a Cylindrocarpon sp. causing crown and root rot on strawberry in North Carolina and effective disease management strategies need to be explored. References: (1) C. D. Booth. Mycol. Pap. (CMI) 104:1, 1996. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

Fungal Planet description sheets: 154-213.

Novel species of microfungi described in the present study include the following from South Africa: Camarosporium aloes, Phaeococcomyces aloes and Phoma aloes from Aloe, C. psoraleae, Diaporthe psoraleae and D. psoraleae-pinnatae from Psoralea, Colletotrichum euphorbiae from Euphorbia, Coniothyrium prosopidis and Peyronellaea prosopidis from Prosopis, Diaporthe cassines from Cassine, D. diospyricola from Diospyros, Diaporthe maytenicola from Maytenus, Harknessia proteae from Protea, Neofusicoccum ursorum and N. cryptoaustrale from Eucalyptus, Ochrocladosporium adansoniae from Adansonia, Pilidium pseudoconcavum from Greyia radlkoferi, Stagonospora pseudopaludosa from Phragmites and Toxicocladosporium ficiniae from Ficinia. Several species were also described from Thailand, namely: Chaetopsina pini and C. pinicola from Pinus spp., Myrmecridium thailandicum from reed litter, Passalora pseudotithoniae from Tithonia, Pallidocercospora ventilago from Ventilago, Pyricularia bothriochloae from Bothriochloa and Sphaerulina rhododendricola from Rhododendron. Novelties from Spain include Cladophialophora multiseptata, Knufia tsunedae and Pleuroascus rectipilus from soil and Cyphellophora catalaunica from river sediments. Species from the USA include Bipolaris drechsleri from Microstegium, Calonectria blephiliae from Blephilia, Kellermania macrospora (epitype) and K. pseudoyuccigena from Yucca. Three new species are described from Mexico, namely Neophaeosphaeria agaves and K. agaves from Agave and Phytophthora ipomoeae from Ipomoea. Other African species include Calonectria mossambicensis from Eucalyptus (Mozambique), Harzia cameroonensis from an unknown creeper (Cameroon), Mastigosporella anisophylleae from Anisophyllea (Zambia) and Teratosphaeria terminaliae from Terminalia (Zimbabwe). Species from Europe include Auxarthron longisporum from forest soil (Portugal), Discosia pseudoartocreas from Tilia (Austria), Paraconiothyrium polonense and P. lycopodinum from Lycopodium (Poland) and Stachybotrys oleronensis from Iris (France). Two species of Chrysosporium are described from Antarctica, namely C. magnasporum and C. oceanitesii. Finally, Licea xanthospora is described from Australia, Hypochnicium huinayensis from Chile and Custingophora blanchettei from Uruguay. Novel genera of Ascomycetes include Neomycosphaerella from Pseudopentameris macrantha (South Africa), and Paramycosphaerella from Brachystegia sp. (Zimbabwe). Novel hyphomycete genera include Pseudocatenomycopsis from Rothmannia (Zambia), Neopseudocercospora from Terminalia (Zambia) and Neodeightoniella from Phragmites (South Africa), while Dimorphiopsis from Brachystegia (Zambia) represents a novel coelomycetous genus. Furthermore, Alanphillipsia is introduced as a new genus in the Botryosphaeriaceae with four species, A. aloes, A. aloeigena and A. aloetica from Aloe spp. and A. euphorbiae from Euphorbia sp. (South Africa). A new combination is also proposed for Brachysporium torulosum (Deightoniella black tip of banana) as Corynespora torulosa. Morphological and culture characteristics along with ITS DNA barcodes are provided for all taxa.

Absence of the cystic fibrosis transmembrane regulator (Cftr) from myeloid-derived cells slows resolution of inflammation and infection.

The absence or reduction of CFTR function causes CF and results in a pulmonary milieu characterized by bacterial colonization and unresolved inflammation. The ineffectiveness at controlling infection by species such as Pseudomonas aeruginosa suggests defects in innate immunity. Macrophages, neutrophils, and DCs have all been shown to express CFTR mRNA but at low levels, raising the question of whether CFTR has a functional role in these cells. Bone marrow transplants between CF and non-CF mice suggest that these cells are inherently different; we confirm this observation using conditional inactivation of Cftr in myeloid-derived cells. Mice lacking Cftr in myeloid cells overtly appear indistinguishable from non-CF mice until challenged with bacteria instilled into the lungs and airways, at which point, they display survival and inflammatory profiles intermediate in severity as compared with CF mice. These studies demonstrate that Cftr is involved directly in myeloid cell function and imply that these cells contribute to the pathophysiological phenotype of the CF lung.

Childsmile: the national child oral health improvement programme in Scotland. Part 1: Establishment and development.

This paper is the first of two reviewing the Childsmile programme. It sets out to describe the development and implementation of this national oral health improvement programme for children in Scotland over its initial three-year period (January 2006 to December 2008) and into its second phase of development. It outlines the context in which the initiative was conceived, the initial development of its various components, and how monitoring and evaluation are shaping the delivery and direction of the programme.

Radically rethinking agriculture for the 21st century.

Population growth, arable land and fresh water limits, and climate change have profound implications for the ability of agriculture to meet this century's demands for food, feed, fiber, and fuel while reducing the environmental impact of their production. Success depends on the acceptance and use of contemporary molecular techniques, as well as the increasing development of farming systems that use saline water and integrate nutrient flows.

The cystic fibrosis transmembrane conductance regulator (Cftr) modulates the timing of puberty in mice.

BACKGROUND: Delayed puberty is common among individuals with cystic fibrosis (CF) and is usually attributed to chronic disease and/or poor nutrition. However, it has recently been recognised that pubertal delay can occur even in the setting of good nutritional and clinical status. This finding, along with evidence that Cftr is expressed in rat brain, human hypothalamus, and a gonadotropin releasing hormone secreting cell line, raises the possibility that some of the pubertal delay in CF could stem directly from alterations in Cftr function that affect the hypothalamic-pituitary-gonadal axis. METHODS: To examine this hypothesis, we investigated pubertal timing (as assessed by vaginal opening (VO)) in a mouse model of CF (Cftr(tm1Unc)) engineered to produce a truncated Cftr mRNA and referred to as S489X. Homozygous knockout, heterozygote, and wild type (WT) female mice were examined. RESULTS: As expected, the S489X-/S489X- knockout mice, which have chronic inflammation and gastrointestinal disease, grew more slowly and had later onset of puberty than WT animals. We anticipated that the S489X-/S489X+ heterozygotes, which have no clinical CF phenotype, might display an intermediate timing of puberty. Surprisingly, however, these mice had earlier VO than WT. These findings were confirmed in a second, independent model of CF engineered to generate the deltaF508 mutation in mice. Again, the homozygotes displayed later pubertal timing, while the heterozygotes displayed earlier VO than the WT animals. CONCLUSIONS: These data provide further evidence that Cftr can directly modulate the reproductive endocrine axis and raise the possibility that heterozygote mutation carriers may have a reproductive advantage.

Re-examination of Peltaster fructicola, a member of the apple sooty blotch complex.

Peltaster fructicola is one of several fungi that causes sooty blotch on apple. Johnson et al (1996, 1997) correctly described P. fructicola but illustrated two different fungi. One is P. fructicola and the other is an unidentified ascomycete. In this paper, P. fructicola is more completely described and accurately illustrated.

Measuring forces with the AFM: polymeric surfaces in liquids.

This review links together for the first time both the practicalities of force measurement and the work carried out to date on force detection between polymeric surfaces in liquids using the atomic force microscope (AFM). Also included is some of the recent work that has been carried out between surfactant surfaces and biologically coated surfaces with the AFM. The emphasis in this review is on the practical issues involved with force measurement between these types of surfaces, and the similarities and irregularities between the observed types of forces measured. Comparison is made between AFM and surface force apparatus (SFA) measurements, as there is a much longer history of work with the latter. Results indicate that forces between the surfaces reviewed here are a complicated mixture of steric-type repulsion, conformational behaviour on separation and long-range attraction, which is often ascribed to 'hydrophobic' forces. The origin of this latter force remains uncertain, despite its almost ubiquitous appearance in force measurements with these types of surfaces.

Experimental evidence that changes in oocyte growth influence meiotic chromosome segregation.

BACKGROUND: It is well known that the fidelity of meiotic chromosome segregation is greatly reduced with increasing maternal age in humans. More recently, direct studies of human oocytes have demonstrated a striking age-related increase in oocytes exhibiting gross disturbances in chromosome alignment on the meiotic spindle. This abnormality, termed congression failure, has been postulated to be causally related to human non-disjunction and to result from subtle alterations in folliculogenesis that develop with advancing reproductive age. METHODS: Immunofluorescence staining, conventional cytogenetic analysis and spectral karyotyping of oocytes from mouse models were used to investigate the hypothesis that changes in the regulation of folliculogenesis induce meiotic defects. RESULTS: Mutations that affect oocyte growth were found to increase the frequency of congression failure at first meiotic metaphase. Importantly, increased congression failure was correlated with meiotic non-disjunction, suggesting a cause-and-effect relationship. CONCLUSIONS: Our findings support the hypothesis that congression failure results from disturbances in the complex interplay of signals regulating folliculogenesis and that these changes subtly alter the late stages of oocyte growth, increasing the risk of a non-disjunction error. These findings have important implications for human aneuploidy, since they suggest that it may be possible to develop prophylactic treatments for reducing the risk of age-related aneuploidy.

First Report of Stigmina lautii in the United States.

In June 1999, a specimen of blue spruce (Picea pungens) from Avery County, North Carolina, exhibiting symptoms of needle blight was submitted to the Plant Disease and Insect Clinic at North Carolina State University. A fungus sporulating profusely on symptomatic needles was identified as Stigmina lautii. Since then, three additional specimens have been received-on blue spruce from Ashe County, on Norway spruce (P. abies) from Avery County, and on Picea sp. from Cherokee County. These counties are all in western North Carolina but are not contiguous, indicating that the fungus is probably widespread in the western part of the state. S. lautii was described by Sutton (2) in 1973 on black spruce (P. mariana) and white spruce (P. glauca) collected from various locations in Manitoba and Saskatchewan, Canada. The only other reference found to the fungus is a specimen collected in British Columbia, Canada, on P. glauca in 1972 (2). The morphology of the North Carolina specimens of S. lautii is essentially as described by Sutton. The dark brown, superficial, flattened sporodochia are developed only through stomata. Sporodochia are found both on symptomatic needles as well as on adjacent green needles. Conidiophores arise only laterally from the lower, outer cells of the sporodochium, and are macronematous, mononematous, brown, smooth, unbranched, 1 to 2 septate, and 10 to 20 × 4 to 6 µm. Conidiogenous cells are brown, monoblastic, integrated, terminal, percurrent with 3 to 4 annelations, and 6 to 12 × 4 to 5 µm. Conidia are pale brown, cylindrical to fusiform, often curved, thick walled, verrucose, 5 to 8 distoseptate, and 25 to 45 × 5 to 6 µm. Superficially, the sporodochia of S. lautii might be confused with pycnidia of Rhizosphaera kalkhoffii, which also arise through stomata. The latter fungus also is associated with a needle blight of Picea spp. in western North Carolina. Both fungi were present on one specimen examined. Currently, no information is available on the pathogenicity of S. lautii, but its association with typical needle blight symptoms and the known pathogenicity of other Stigmina spp. on conifers make it likely that the fungus is pathogenic to spruce. To my knowledge, this is the first report of S. lautii in the United States, and P. pungens and P. abies represent new host records for the fungus. Specimens BPI 747910 and 840959, have been deposited in the herbarium of the National Fungus Collections, Beltsville, MD. References: (1) J. H. Ginns. Page 158 in: Compendium of Plant Disease and Decay Fungi in Canada 1960-1980. Agric. Can. Publ. 1813, 1986. (2) B. C. Sutton. Mycol. Pap. 132:113, 1973.

Use of rapamycin in a transplant patient who developed cyclosporin neurotoxicity.

We describe the case of a paediatric kidney transplant patient who developed cyclosporin neurotoxicity on day 7 post-transplant. Consequently, her cyclosporin was stopped and she was commenced on rapamycin. Over the next 3 weeks her creatinine remained elevated and she had several episodes of biopsy proven rejection, despite increasing the initial dose of rapamycin by tenfold. Her whole blood rapamycin levels also remained well below the target range of 10-20 ng/ml. On day 38 post-transplant, the decision was made to add tacrolimus to her immunosuppression. At the same time, phenytoin, which had been commenced during her episode of cyclosporin neurotoxicity, was withdrawn. After this point her rapamycin blood levels rapidly increased to within the therapeutic range and she improved clinically. We propose that phenytoin, as a p450 cytochrome enzyme inducer, increased the metabolism of rapamycin in this patient and hence decreased the initial therapeutic effectiveness of this drug.

Coordinating the segregation of sister chromatids during the first meiotic division: evidence for sexual dimorphism.

Errors during the first meiotic division are common in our species, but virtually all occur during female meiosis. The reason why oogenesis is more error prone than spermatogenesis remains unknown. Normal segregation of homologous chromosomes at the first meiotic division (MI) requires coordinated behavior of the sister chromatids of each homolog. Failure of sister kinetochores to act cooperatively at MI, or precocious sister chromatid segregation (PSCS), has been postulated to be a major contributor to human nondisjunction. To investigate the factors that influence PSCS we utilized the XO mouse, since the chromatids of the single X chromosome frequently segregate at MI, and the propensity for PSCS is influenced by genetic background. Our studies demonstrate that the strain-specific differences in PSCS are due to the actions of an autosomal trans-acting factor or factors. Since components of the synaptonemal complex are thought to play a role in centromere cohesion and kinetochore orientation, we evaluated the behavior of the X chromosome at prophase to determine if this factor influenced the propensity of the chromosome for self-synapsis. We were unable to directly correlate synaptic differences with subsequent segregation behavior. However, unexpectedly, we uncovered a sexual dimorphism that may partially explain sex-specific differences in the fidelity of meiotic chromosome segregation. Specifically, in the male remnants of the synaptonemal complex remain associated with the centromeres until anaphase of the second meiotic division (MII), whereas in the female, all traces of synaptonemal complex (SC) protein components are lost from the chromosomes before the onset of the first meiotic division. This finding suggests a sex-specific difference in the components used to correctly segregate chromosomes during meiosis, and may provide a reason for the high error frequency during female meiosis.

Vascular access for hemodialysis: an indepth review.

A multi-disciplinary approach to vascular access planning, early preoperative surgical assessment and increased use of vascular imaging for surveillance, specialist service and pharmacological prevention of intimal hyperplasia will lead to improved patency rates for both autologous AVF and synthetic grafts.