Environmentally sustainable design guide for haemodialysis facilities: An Australian and New Zealand society of Nephrology initiative.

Haemodialysis facilities have a large environmental impact due to high energy, water and consumable usage by haemodialysis equipment. As climate change and natural resource scarcity escalate, all the while the number of people requiring dialysis increases, there is an urgent need for dialysis facilities that meet care needs while minimising environmental impact. To address this, the Australian and New Zealand Society of Nephrology engaged an environmental sustainability consulting practise to develop a best practise guide for the environmentally sustainable design and operation of haemodialysis facilities. Four opportunity areas were considered, namely energy, water, waste and resource recovery, and additional sustainability. A total of 28 environmental improvement initiatives were identified. The majority (n = 23) were general measures that could be applied across all healthcare settings, while five were specific to haemodialysis facilities. Recommendations were made regarding specific measures that should be undertaken and/or standards that must be met to achieve the intent of each initiative. These were stratified to enable their application to both existing dialysis facilities and new builds. The lifecycle stage of a haemodialysis facility to which each initiative applied was highlighted, as was its potential impact. This guide provides a tailored and comprehensive resource for the kidney care community to enable the integration of best practise sustainability considerations into both existing and new facilities. If broadly implemented, it has the potential to markedly improve the environmental impact of haemodialysis provision.

Functional Connectivity Changes on Resting-State fMRI after Mild Traumatic Brain Injury: A Systematic Review.

BACKGROUND: Mild traumatic brain injury is theorized to cause widespread functional changes to the brain. Resting-state fMRI may be able to measure functional connectivity changes after traumatic brain injury, but resting-state fMRI studies are heterogeneous, using numerous techniques to study ROIs across various resting-state networks. PURPOSE: We systematically reviewed the literature to ascertain whether adult patients who have experienced mild traumatic brain injury show consistent functional connectivity changes on resting-state -fMRI, compared with healthy patients. DATA SOURCES: We used 5 databases (PubMed, EMBASE, Cochrane Central, Scopus, Web of Science). STUDY SELECTION: Five databases (PubMed, EMBASE, Cochrane Central, Scopus, and Web of Science) were searched for research published since 2010. Search strategies used keywords of "functional MR imaging" and "mild traumatic brain injury" as well as related terms. All results were screened at the abstract and title levels by 4 reviewers according to predefined inclusion and exclusion criteria. For full-text inclusion, each study was evaluated independently by 2 reviewers, with discordant screening settled by consensus. DATA ANALYSIS: Data regarding article characteristics, cohort demographics, fMRI scan parameters, data analysis processing software, atlas used, data characteristics, and statistical analysis information were extracted. DATA SYNTHESIS: Across 66 studies, 80 areas were analyzed 239 times for at least 1 time point, most commonly using independent component analysis. The most analyzed areas and networks were the whole brain, the default mode network, and the salience network. Reported functional connectivity changes varied, though there may be a slight trend toward decreased whole-brain functional connectivity within 1 month of traumatic brain injury and there may be differences based on the time since injury. LIMITATIONS: Studies of military, sports-related traumatic brain injury, and pediatric patients were excluded. Due to the high number of relevant studies and data heterogeneity, we could not be as granular in the analysis as we would have liked. CONCLUSIONS: Reported functional connectivity changes varied, even within the same region and network, at least partially reflecting differences in technical parameters, preprocessing software, and analysis methods as well as probable differences in individual injury. There is a need for novel rs-fMRI techniques that better capture subject-specific functional connectivity changes.

Terminal Ileum Lipoma Causing Ileocolic Intussusception: A Case Report and Literature Review.

Adult intussusception is much rarer than pediatric intussusception and usually occurs secondary to a pathological lead point, most frequently neoplasm. Terminal ileum lipomas are an infrequent cause of adult ileocolic intussusception but can be seen together with the intussusception on initial imaging evaluation, which can guide appropriate diagnosis and management. We describe a case of a 42-year-old man presenting with 12 hours of severe right lower quadrant pain. CT of the abdomen and pelvis demonstrated an ileocolic intussusception with fat-density lesions within the intussusception as well as in the distal ileum. The patient went to the operating room for laparoscopic ileocolic resection, during which ileo-ileal and ileocolic intussusceptions were identified in the terminal ileum and multiple fatty masses were palpated in the terminal ileum and cecum. Following ileocecectomy, surgical pathology confirmed terminal ileum with intussusception associated with multiple submucosal lipomas. We also review the literature for cases of ileocolic intussusception caused by terminal ileum lipomas. Patients presented with both acute and chronic symptoms, and while CT was the most common modality used for diagnosis, ultrasound and colonoscopy were also able to identify the intussusception. Although the intussusception was initially reduced in two patients, all patients ultimately underwent surgical resection.