Developing an integrated clinical decision support system for the early identification and management of kidney disease-building cross-sectoral partnerships.

BACKGROUND: The burden of chronic conditions is growing in Australia with people in remote areas experiencing high rates of disease, especially kidney disease. Health care in remote areas of the Northern Territory (NT) is complicated by a mobile population, high staff turnover, poor communication between health services and complex comorbid health conditions requiring multidisciplinary care. AIM: This paper aims to describe the collaborative process between research, government and non-government health services to develop an integrated clinical decision support system to improve patient care. METHODS: Building on established partnerships in the government and Aboriginal Community-Controlled Health Service (ACCHS) sectors, we developed a novel digital clinical decision support system for people at risk of developing kidney disease (due to hypertension, diabetes, cardiovascular disease) or with kidney disease. A cross-organisational and multidisciplinary Steering Committee has overseen the design, development and implementation stages. Further, the system's design and functionality were strongly informed by experts (Clinical Reference Group and Technical Working Group), health service providers, and end-user feedback through a formative evaluation. RESULTS: We established data sharing agreements with 11 ACCHS to link patient level data with 56 government primary health services and six hospitals. Electronic Health Record (EHR) data, based on agreed criteria, is automatically and securely transferred from 15 existing EHR platforms. Through clinician-determined algorithms, the system assists clinicians to diagnose, monitor and provide guideline-based care for individuals, as well as service-level risk stratification and alerts for clinically significant events. CONCLUSION: Disconnected health services and separate EHRs result in information gaps and a health and safety risk, particularly for patients who access multiple health services. However, barriers to clinical data sharing between health services still exist. In this first phase, we report how robust partnerships and effective governance processes can overcome these barriers to support clinical decision making and contribute to holistic care.

Advanced Electrolyte Formula for Robust Operation of Vanadium Redox Flow Batteries at Elevated Temperatures.

Insufficient thermal stability of vanadium redox flow battery (VRFB) electrolytes at elevated temperatures (>40 °C) remains a challenge in the development and commercialization of this technology, which otherwise presents a broad range of technological advantages for the long-term storage of intermittent renewable energy. Herein, a new concept of combined additives is presented, which significantly increases thermal stability of the battery, enabling safe operation to the highest temperature (50 °C) tested to date. This is achieved by combining two chemically distinct additives-inorganic ammonium phosphate and polyvinylpyrrolidone (PVP) surfactant, which collectively decelerate both protonation and agglomeration of the oxo-vanadium species in solution and thereby significantly suppress detrimental formation of precipitates. Specifically, the precipitation rate is reduced by nearly 75% under static conditions at 50° C. This improvement is reflected in the robust operation of a complete VRFB device for over 300 h of continuous operation at 50 °C, achieving an impressive 83% voltage efficiency at 100 mA cm-2 current density, with no precipitation detected in either the electrode/flow-frame or electrolyte tank.

Equilibrium and Dynamic Absorption of Electrolyte Species in Cation/Anion Exchange Membranes of Vanadium Redox Flow Batteries.

Vanadium redox flow batteries (VRFBs) rely on ion exchange membranes (IEMs) to separate the positive and negative compartments while maintaining electrical neutrality of the cell, by allowing the transport of ionic charge carriers. Cation exchange membranes (CEMs) and anion exchange membranes (AEMs), the two principal types of IEM, have both been employed in VRFBs. The performance of these IEMs can be influenced by the absorption of species from the electrolyte. In this study, a typical commercial CEM (Nafion 117) and AEM (FAP 450), were examined with respect to vanadium uptake, after exposure to electrolyte at different states of charge. The two types of membrane were found to behave very differently, with the AEM showing very high selectivity for VV , which resulted in a significant increase in area-specific resistivity. In contrast, the CEM absorbed VII more strongly than vanadium in other oxidation states. These findings are essential for the development of an effective membrane for VRFB applications.

Preparation of CoNi high surface area porous foams by substrate controlled electrodeposition.

We demonstrate that nanofabrication of 3D dendritic CoNi alloy foams with an open porous structure can be achieved by electrodeposition onto a single-crystalline Cu(111) substrate at ambient conditions. The very low wettability of this substrate caused by its low surface energy allows tailoring the CoNi deposit morphology. This is concluded from a comparison of polycrystalline Cu substrates with single-crystalline ones of different orientations. The advantages of the present CoNi alloy foams are low internal stresses and good mechanical stability on the substrate. In a second step, by comparing the catalytic properties of the achieved foam with those of CoNi layers obtained on polycrystalline Cu substrates, it is shown that the morphology of the CoNi layers has a decisive influence on the kinetics of the surface redox reaction. The higher reaction rate makes the open foam suitable as catalyst for oxygen evolution in electrolysers. The reversibility of the redox process provides great potential for the achieved porous layers to be used as positive material in alkaline batteries.

Determinants of summiting success and acute mountain sickness on Mt Kilimanjaro (5895 m).

OBJECTIVE: To determine the incidence of acute mountain sickness (AMS), the frequency of summiting success, and the factors that affect these in trekkers on Kilimanjaro, one of the world's most summitted high-altitude peaks. METHODS: The study group comprised 312 trekkers attempting Mt Kilimanjaro summit by the Marango Route. Trekkers ascended over 4 or 5 days along a fixed ascent profile, stopping at 3 huts on ascent (2700 m, 3700 m, and 4700 m) before attempting the summit. Researchers were stationed at each hut for 16 days. Each night we measured heart rate, respiratory rate, blood pressure, oxygen saturation, and Lake Louise Score. We recorded the highest altitude that trekkers reached on the mountain. RESULTS: Of 181 complete sets of data, 111 (61%) trekkers reached the summit, and 139 (77%) developed AMS. Physiological results were not related to summit success. The incidence of AMS and summiting success were similar in those on the 4- or 5-day route. Trekkers on the 5-day route who used acetazolamide were less likely to develop AMS and more likely to summit than were those not taking acetazolamide (P = <.05); this difference was not present with trekkers on the 4-day route. CONCLUSIONS: The risk of developing AMS is high on Mt Kilimanjaro. Although taking an extra day to acclimatize with the use of acetazolamide did provide some protection against AMS, ideally trekkers need a more gradual route profile for climbing this mountain.

The effect of angiotensin-converting enzyme genotype on acute mountain sickness and summit success in trekkers attempting the summit of Mt. Kilimanjaro (5,895 m).

The I-allele rather than the D-allele of the human angiotensin converting enzyme (ACE) gene has been associated with high-altitude mountaineering success. We investigated whether the I-allele was associated with summit success, and also with AMS development, in altitude-naïve trekkers. Subjects ascended from 1,860 m to the summit over 4 days (n = 34, 'direct-profile') or 5 days (n = 82, 'slower-profile'). Proportionally more II direct-profile subjects were successful than ID or DD, although the difference was not significant (100% of II subjects, 52% ID and 43% DD, P = 0.09). There was no difference in success amongst subjects on the slower-profile (50% II, 45% ID and 58% DD, P = 0.54). There was a non-significant trend for increasing AMS scores in ID/DD subjects. Amongst tourist trekkers on Mt. Kilimanjaro the I-allele is not associated with summit success. No evidence is found to support an association between ACE genotype and AMS development.