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At Capitol Police Oversight Hearing Following the January 6th Insurrection, Chairwoman Klobuchar Highlights New Preparedness, Safety Efforts to Protect the Capitol
Klobuchar: “We owe it to these courageous officers to make sure they have the resources and support and the rules in place to do their jobs.”
WASHINGTON - U.S. Senator Amy Klobuchar (D-MN), Chairwoman of the Committee on Rules and Administration, chaired an oversight hearing of the U.S. Capitol Police (USCP) following the January 6th insurrection at the Capitol. Michael Bolton, Inspector General of the U.S. Capitol Police, testified at today’s hearing and spoke to the USCP’s efforts to improve preparedness and procedures to ensure the safety of those who work in and visit the Capitol.
Senator Klobuchar: Good morning. I call to order this hearing, which is the Rules Committee’s second oversight hearing of the United States Capitol Police following the January 6th attack on the Capitol.
As you know, Senator Blunt and I have led a series of hearings over improvements that must be made, changes that much be made, and we joined forces with Senators Peters and Portman of the Homeland Security Committee so that we had a more comprehensive look at the security failures on January 6th, which of course included mistakes at the top of the Capitol Police, mistakes of leadership within this building, and then mistakes on the side of the Defense Department and other agencies.
And so we are greatly appreciative of what Mr. Michael Bolton, the Inspector General for the Capitol Police, has done. I want to thank you for being here, Inspector Bolton. We welcome your wife, who is also with us today -- we will try not to ask her questions if you can’t answer them.
And I think you know the significance of this moment. We are here just over eleven months after the violent insurrection at the Capitol. Why? Because this Committee has responsibility of oversight of the police.
As we approach this year’s end, we will hear more today about the measures that have already been taken to improve the Capitol Police Department’s preparedness and operations, as well as the work that still needs to be done. You, Inspector General, put together a comprehensive list -- I remember Senator Blunt and I reviewing it as we prepared our own recommendations -- comprehensive list of over 100 recommendations. We consolidated some of those, came up with some of our own that, as I noted, were outside of the police department as well, and I think January 6th is a pretty good date to get the vast number of these things done, which we will be telling the Sergeant at Arms, both bodies, as well as the Capitol Police Chief. But we know progress has been made, and in the new year we will continue this discussion, as our first hearing will be with the new Capitol Police chief, and then we can get much more focused on the details of our own recommendations.
So in June -- the week before you testified, Mr. Bolton, before this Committee - we issued our bipartisan report with the Homeland Security Committee, as I noted, focused on the security, planning, and response failures of that day -- that unprecedented, horrific day.
Our report laid out key findings and recommendations, and importantly, as I noted, progress has been made in putting many of those recommendations in place.
We recommended that the Capitol Police produce a Department-wide operational plan for all large-scale events at the Capitol, and now those plans are standard procedure and have been used several times since then.
The Department has also worked to improve its handling of intelligence, including by making sure that information is shared with rank-and-file officers -- another of our recommendations.
We said that Congress should provide sufficient funding to support Capitol Police training and equipment requirements, as well as needed staffing levels, and in July President Biden signed our emergency funding legislation into law, which passed both houses of this Congress, to deliver resources to do just that. Significant resources in the supplemental budget that many of us on this Committee worked with Senator Leahy, who is a member of this Committee, as well as Senator Shelby, to make sure that these resources were included. Didn’t want to wait until year end; we wanted to get it done immediately. That legislation also provided funding for mental health support for officers, something I have strongly supported.
Another recommendation was for the Capitol Police Board to appoint a new police chief, which it did in July with the selection of Chief Manger. For the past several months, Chief Manger has worked to make needed changes and implement recommendations both from our report as well as from your Inspector General report, Mr. Bolton.
At our last hearing with you, you updated us on the review of Capitol Police policies and practices since the insurrection, including on the four reports you issued at that time. Since then, you have finished three more reports detailing issues that impacted the Department’s response to the events of January 6th, and you are finishing a final report outlining your findings and progress to address them.
Significantly, you have issued a total of 104 recommendations -- of which 30 have now been implemented -- in an effort to ensure that the Department is equipped to fulfill its mission. And it’s not as though work is not being done on the other recommendations -- as you know, they are in progress. And as I noted, we will have an ideal moment at the beginning of January to go back through, with the Chief himself, the work that needs to be done, the work that is done. And so this kind of alert to those working on these recommendations, not just, not just with the Capitol Police, but the other agencies as well. That they get their work done.
This work is crucial to improving the security of the Capitol -- and also to supporting the brave officers who served heroically in unimaginable circumstances. It was an honor to stand with some of those officers with Senator Blunt and their families as the President signed our bipartisan legislation to honor the heroes who defended our democracy with the Congressional Gold Medal.
We owe it to these courageous officers to make sure they have the resources and support and the rules in place to do their jobs. Since January 6th, anyone that walks around this Capitol, talk to officers, as I do, ask officers questions, see how they’re doing, you find out, one, that there has been some improvement in morale, which I think is really important. They lost so many of their fellow officers, including those who sadly died by suicide. But we also know from them there continues to be staff shortages. We have now put the money forward for that, but this police department, like many across the country, is facing staff shortages, and we must fill those jobs.
As our country moves forward, we know that there are many issues that merit serious consideration -- a major investigation which I support is going on, bipartisan investigation, in the House of Representatives, looking back at the root causes of what happened with recommendations. Our job today is to look at the security at the Capitol, and I look forward to discussing your findings, Inspector General Bolton, the progress that has been made in the Capitol Police Department in the past several months, and certainly the work that lies ahead, not only with the Capitol Police Department, but getting answers to the other issues we raised in our report, along with Senator Peters and Senator Portman with regard to the other agencies and how they work with the Capitol Police. Thank you very much, Mr. Bolton, and we look forward to hearing from you. I’ll turn it over to my friend and colleague, Senator Blunt.
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Long layovers are no fun, even if you get to hang out at the lounge. You can't work anymore, and you feel like you're just wasting life. Luckily, a number of major transit hubs are offering transfer passengers city tours designed to fill their waiting time. Many of them are free while one example here is affordably priced.
Changi Airport free heritage tour
Who can participate? Transit passengers with at least five hours before the connecting flight.
Visa requirement: Holders of passports issued by many countries enjoy visa-free status. Nationals of the Commonwealth of Independent States and Georgia who are on transit to or from a third country, with a confirmed onward air-ticket, enjoy a 96-hour visa free entry. Travellers with travel documents issued by China, India, Bangladesh, Egypt, Pakistan, Saudi Arabia, among others, are required to have a valid visa to enter Singapore. Click here for more information.
Duration: Two hours, four times daily. Tours start at 0900, 1130, 1430 and 1600.
Itinerary: The guided tour will introduce the Merlion Park, Colonial District, Central Business District and Chinatown or Little India.
Highlights: Participants have the chance to see the 165-metre tall Singapore Flyer, the iconic Esplanade and The Fountain of Wealth – the largest of its kind in the world.
How to enrol? Registration is at designated booths in Terminal 2, near transfer lounge E, or Terminal 3, next to transfer lounge B. You need to be there at least one hour before the tour starts.
Taiwan Taoyaun Airport free half-day tour
Who can participate? Transit passengers with seven to 24 hours to spare.
Visa requirement: Passport holders of 42 countries enjoy visa-exempt entry to Taiwan, for up to 30 or 90 days. Citizens from India, Thailand, the Philippines, Vietnam and Indonesia who hold a valid visa or permanent resident certificate issued by the US, Canada, Japan, U.K., Schengen Convention countries, Australia or New Zealand, and have never been employed in Taiwan as blue-collar migrant workers are also eligible for the tour, but they need to apply for visa-exempt entry with the National Immigration Agency beforehand. For more information, click here.
Duration: Five hours; departing daily at 0800 and 1330.
Itinerary: Morning tour brings participants to Sanxia and Zushi Temple and Yingge, while the afternoon tour includes visits to the Longshan Temple, Presidential Office Building, Chiang Kai-shek Memorial Hall, Martyrs' Shrine and Taipei 101.
Highlights: Yingge is famous for pottery with outlets featuring vases from Ming and Qing dynasties as well as the Yingge Ceramics Museum. The 508-metre Taipei 101 was the tallest building in the world from 2004 to 2010, when the Burj Khalifa in Dubai surpassed it. Longshan Temple is the oldest and most famous of its kind in Taipei.
How to enrol? You may call in advance to register or sign up at the tourist service centre at the arrival lobby. Note that there is no room for luggage on the bus and travellers are advised to store their luggage at the baggage storage counter before boarding the bus.
Seoul Incheon Airport free temple tour
Who can participate? Foreigners to Seoul. The airport does not specify how long a transit time one needs to join the tour and those interested need to judge for themselves.
Visa requirement: Visa exemption from 30 to 90 days for holders of passports issued by the US, Japan, Canada, New Zealand, UK, Thailand, Singapore, Malaysia, Macau, Taiwan, Hong Kong, Bangladesh and other countries with visa waiver agreement with South Korea. Residents from other countries require a transit visa to join the tour. Click here for more information.
Duration: One hour. Four tours daily, at 0900, 1100, 1300 and 1500.
Itinerary: Visit the Yonggungsa Temple by a coach with an English-speaking guide.
Highlights: The temple is famous for its 1,300 years old zelkova tree and a statue of the Buddha.
How to enrol? Apply for the tour at the transit tour booth on the second floor. Passengers may leave their luggage at the transit tour main desk between gate six and seven on the first floor after going through the immigration and customs.
Turkish Airlines free Istanbul city tour at Atatürk Airport
Who can participate? The airline's passengers with over six hours of transit time between 0900 and 1800.
Visa requirement: Travellers with a Hong Kong, Macau, Malaysia or New Zealand passport, or travel document issued by other exempt-visa countries can enter Turkey without a visa for 30 to 90 days. Travellers with passports issued by Australia, Canada, UAE, UK, US and more can obtain a three month-multiple entry visa at the Turkish border gates. Others are required to apply for visa at Turkish missions. For more information, click here.
Duration: "Six hours in Istanbul" starts daily at 0900 and 1200, while "one day in Istanbul" is nine hours long, beginning at 0900 every day.
Itinerary: "Six hours in Istanbul" includes visits to the Blue Mosque, German Fountain at Hippodrome Square, Serpentine Column, Obelisk of Theodosius, Hagia Sophia Museum or Topkapi Palace, and Underground Cistern. Breakfast and lunch are provided. "One day in Istanbul" includes two more items: shopping at the Spice Bazaar and a visit to New Mosque.
Highlights: The Blue Mosque is renowned for combining Byzantine elements with a traditional Islamic architecture, while the underground cistern built in 532AD offers a mystical ambiance. The Spice Bazaar is the second largest covered shopping complex in the city, after the Grand Bazaar. Prices here are more honest but bargaining is still advised.
How to enrol? After passport and custom control, sign up at the designated desk next to Starbucks in International Arrival Terminal.
Vigor Tours Hong Kong transit tour
Who can participate? Transit passengers with more than five hours to spare.
Visa requirement: Visa free period of 14 to 180 days available for nationals of Australia, UK, Canada, India, Indonesia, Japan, Korea, Malaysia, Philippines, Thailand, USA and more. Other travellers are required to have a visa to join the tour. For more information, click here.
Duration: Around five hours, starting daily at 0930.
Itinerary: The English guided-tour, onboard an air-conditioned tour bus, takes participants to the Tsing Ma Bridge, Tsim Sha Tsui Promenade, Avenue of Stars, Man Mo Temple and antiques shops along the Hollywood Road, as well as the sky100 Hong Kong Observation Deck at The International Commerce Centre – the city's tallest building. Also included are a Star Ferry ride and a journey on an Airport Express train back to the airport.
Highlights: Tsing Ma Bridge is the world’s longest road-and-rail suspension bridge, while the Star Ferry ride to Central presents an exquisite view of the iconic Victoria Harbour. The sky100 Hong Kong Observation Deck is the highest indoor observation deck in the city, offering a 360-degree bird’s-eye view of the city.
How to enrol?: Book the tour at the transit tour counter, opposite Arrivals Hall exit B. The tour costs HK$270 (US$35) per person, with all transportation expenses and admission fees included.

domain: geography


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THE HALF-DOLLAR GROWING SCARCER; Fewer Circulate as Output Dips and Hoarding Rises
Special to The New York Times ();
February 09, 1969,
, Section , Page 92, Column , words
WASHINGTON, Feb. 8 -- The half-dollar -- the largest and most comforting coin to jingle in American pockets and change purses -- is becoming increasingly scarce.

domain: news


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|Safety in glomerular numbers.|
|Jump to Full Text|
|PMID: 22532329 Owner: NLM Status: MEDLINE|
|A low nephron number is, according to Brenner's hyperfiltration hypothesis, associated with hypertension, glomerular damage and proteinuria, and starts a vicious cycle that ends in renal failure over the long term. Nephron endowment is set during foetal life, and there is no formation of nephrons after 34-36 weeks of gestation, indicating that many factors before that time-point may have an impact on kidney development and reduce nephron numbers. Such factors include maternal malnutrition, stress, diseases, such as diabetes, uteroplacental insufficiency, maternal and neonatal drugs and premature birth. However, other congenital anomalies, such as renal hypoplasia, unilateral renal agenesis or multicystic dysplastic kidney, may also lead to a reduced nephron endowment, with an increased risk for hypertension, renal dysfunction and the need for renal replacement therapy. This review focuses on the causes and consequences of a low nephron endowment and will illustrate why there is safety in glomerular numbers.|
|Michiel F Schreuder|
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|Type: Journal Article; Research Support, Non-U.S. Gov't; Review Date: 2012-04-25|
|Title: Pediatric nephrology (Berlin, Germany) Volume: 27 ISSN: 1432-198X ISO Abbreviation: Pediatr. Nephrol. Publication Date: 2012 Oct|
|Created Date: 2012-08-20 Completed Date: 2013-01-24 Revised Date: 2013-08-27|
Medline Journal Info:
|Nlm Unique ID: 8708728 Medline TA: Pediatr Nephrol Country: Germany|
|Languages: eng Pagination: 1881-7 Citation Subset: IM|
|Department of Pediatric Nephrology, 804, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
Glomerular Filtration Rate
Hypertension / etiology*, pathology, physiopathology
Kidney Diseases / etiology*, pathology, physiopathology
Kidney Glomerulus / abnormalities, embryology, pathology*, physiopathology
Proteinuria / etiology, pathology
|Pediatr Nephrol. 2013 Aug;28(8):1319
Journal ID (nlm-ta): Pediatr Nephrol
Journal ID (iso-abbrev): Pediatr. Nephrol
Publisher: Springer-Verlag, Berlin/Heidelberg
© The Author(s) 2012
Received Day: 6 Month: 2 Year: 2012
Revision Received Day: 14 Month: 3 Year: 2012
Accepted Day: 15 Month: 3 Year: 2012
Electronic publication date: Day: 25 Month: 4 Year: 2012
pmc-release publication date: Day: 25 Month: 4 Year: 2012
Print publication date: Month: 10 Year: 2012
Volume: 27 Issue: 10
First Page: 1881 Last Page: 1887
PubMed Id: 22532329
Publisher Id: 2169
|Safety in glomerular numbers|
|Michiel F. SchreuderAff1||
Address: +31-24-3614430 +31-24-3616428 email@example.com
|Department of Pediatric Nephrology, 804, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
With the hyperfiltration hypothesis, Brenner et al. showed that renal mass reduction results in glomerular alterations that may have adverse effects in the long run . The compensatory glomerular hyperfiltration is associated with glomerular hypertension and enlargement at first, followed by systemic hypertension, proteinuria and glomerulosclerosis. This starts a vicious cycle, with a further reduction in renal mass that results in an on-going decline in glomerular filtration rate (GFR) and may end in chronic kidney disease. The hyperfiltration hypothesis therefore indicates that there is safety in glomerular numbers. As this number is set during nephrogenesis, unrestricted kidney development resulting in nephron endowment is vital for future health. This review considers some of the environmental influences that have been shown to be important in determining nephron numbers and the long-term effects of reduced renal development (Fig. 1).
Nephrons are formed through the mutual induction of the ureteric bud and the metanephric mesenchyme. This process starts around the fourth to fifth week of gestation, and, more importantly, finishes around the 34–36th week of gestation . When complete, there is no possibility of forming new nephrons later in life, indicating that the nephron endowment an individual is born with will have to last his/her entire lifetime. After completion of nephrogenesis, an average of little under 1 million nephrons per kidney have been formed .
There are several ways in which kidney development goes off track, all of which lead to congenital anomalies of the kidney and urinary tract (CAKUT), ranging from renal agenesis to hypoplasia to dysplasia . Genetic but also environmental factors have been associated with the development CAKUT. For instance, a multicystic dysplastic kidney (MCDK) is more frequently seen in offspring from women with diabetes or following the use of certain anti-epileptic drugs during pregnancy, but is also associated with genetic mutations in genes such as HNF1beta . CAKUT is frequently identified during prenatal ultrasound screening. However, subtle alterations, such as a low nephron endowment, may not be picked up as it is not yet possible to count nephrons in vivo. This may well be achieved in the coming decade, as magnetic resonance imaging of individual glomeruli in vivo is within reach .
A so-called hypoplastic kidney, indicating a small size on ultrasound, is supposed to have a reduced number of nephrons. Even though studies have presented an association between nephron numbers and renal weight , only a small part (about 10 %) of the variation in nephron numbers is explained by a difference in renal size in adulthood (M.F. Schreuder, unpublished data). In addition, there is an almost tenfold variation in normal nephron numbers, ranging from a little over 200,000 to over 2.5 million nephrons per kidney . Some of this variation may be explained by genetic differences, and many environmental factors may influence final nephron numbers as well .
The relevance of the variation in nephron endowment is evident from the hyperfiltration hypothesis . And indeed, a low nephron number has been found in patients with hypertension referred to as “essential” hypertension. Keller and colleagues showed in a group of victims of motor vehicle accidents that the ones with hypertension had only about half the number of nephrons than their respective matched controls with normal blood pressure . Interestingly, there was no difference in the weight of the kidneys between the groups. In another study, Hughson et al. showed that there is an inverse relationship between nephron number and blood pressure, but only in Caucasians . No such association was found in African Americans, but a higher blood pressure persisted with a higher nephron number. The question remains as to why a normal nephron endowment in African Americans does not result in a normal blood pressure and illustrates that additional factors to nephron numbers determine blood pressure .
An obvious reason for a low total nephron number is found in individuals with a solitary functioning kidney (SFK)—for example, due to renal agenesis or aplasia, or in an MCDK. Even though there may be additional nephron formation in the congenital SFK, i.e. when the reduction in renal mass occurs before the termination of nephrogenesis , the total number will not reach the full potential and will result in glomerular hyperfiltration. In order to study the effects of glomerular hyperfiltration in humans, we designed the KIMONO study (Kidney of Monofunctional Origin)  and were able to show that one-third of children with an SFK at an age of just 10 years already show signs of renal injury, defined as hypertension, albuminuria or the use of renoprotective drugs. Using generalized estimating equations analysis, we found an increase in albuminuria, especially in patients with additional renal tract malformations, including reflux in the SFK . A decrease in GFR can also be seen starting from early teens. In fact, the GFR curve in patients with an SFK resembles the GFR curve in patients with diabetes and subsequent glomerular hyperfiltration . In diabetes, GFR is at first normal or somewhat increased, but as time goes by, microalbuminuria develops, and in a few more years this progresses to macroalbuminuria and the GFR starts to fall (Fig. 2). This ends in chronic kidney disease, and diabetes is in fact the leading cause for renal replacement therapy in adults .
And just as diabetic nephropathy ends in renal failure, so may renal function in children with a congenital SFK. A recent long-term follow-up study on patients with several congenital renal tract anomalies showed that 20–40 % of patients with an SFK are in renal failure by the age of 30 years . Unfortunately, there are several methodological issues in these studies that may have had an impact on this poor outcome, such as the small group size, the retrospective collection of data, the presence of additional renal tract anomalies and the likeliness of selection bias as some patients were identified based on the presence of hypertension and/or proteinuria. As this is currently the only study to present data on long-term renal survival in such patient cohorts, it is difficult to estimate true risks for renal failure in individuals with SFK. The least that can be concluded is that a solitary functioning kidney is not always a benign condition without any sequelae and that some patients may end up in renal failure.
Such statements have long been questioned, as most kidney donors are considered to be in good health, even after long-term follow-up . In fact, life expectancy among kidney donors is no different from that of the general population, even though some signs of renal injury do occur in these donors, with an increased incidence of hypertension and proteinuria reported in one long-term study . One might argue that a lower incidence could be expected as kidney donors are screened intensively prior to donation and will therefore represent a relatively healthy segment of the population. The absence of a difference in the incidence of hypertension or end-stage renal disease may, in that view, even be considered another sign of hyperfiltration injury.
However, there are fundamental differences between starting life with one kidney and losing or donating one as an adult. One of the main differences can be found in the degree of glomerular hyperfiltration. Animal studies have shown that nephrectomy during the final stages of kidney development results in a doubling of glomerular hyperfiltration when compared to nephrectomy in early adulthood . As glomerular hyperfiltration is the key to future renal damage , this may account for the differences between a congenital and acquired SFK.
Unfortunately, it is currently impossible to predict which individuals with an SFK will suffer from long-erm sequelae. The aim of the KIMONO study is to be able to allow for a differentiation in hyperfiltration injury risk. However, until such predictions have proven to be useful, follow-up of all individuals with a SFK is warranted .
As nephrogenesis takes place entirely before term birth, intrauterine growth restriction is the most widely studied environmental phenomenon influencing renal development . Professor David Barker was one of the first to describe the association between a low birth weight and later cardiovascular deaths . This was followed by an abundance of studies that showed increased risk for diabetes, stroke and hypertension as well . The former Barker hypothesis, now entitled the Developmental Origins of Health and Disease (DOHaD), states that foetal and early postnatal influences or hits program organs and organ systems. This programming effect may have short-term benefits, but results in malfunction in the long run.
In addition to diabetes and cardiovascular events, perinatal programming has been shown to have an effect on the kidney. A lower birth weight, as a marker of restricted intrauterine growth, is associated with a reduced number of nephrons: about 250,000 nephrons fewer are formed when the birth weight is 1 kg lower . Such a decrease in nephron endowment results in an increased risk of renal failure . A recent meta-analysis showed that a low birth weight is associated with a 75 % higher risk of albuminuria, low GFR and chronic kidney disease . Even though the combination of the Barker and Brenner hypotheses offers an explanation for this association, no definitive proof has been found that a low nephron endowment per se causes increased risk for hypertension or renal injury.
Many animal models have been used to study such associations between nephron number, cardiovascular function, renal function and low birth weight . Some of these models, for instance uterine artery ligation, are based on placental dysfunction, which is the main cause of low birth weight in developed countries. Other models have focussed on nutritional programming, for instance through protein restriction of pregnant animals or restriction in total food intake. These latter models have been used the most widely and have shown similar results: a lower nephron number, with higher blood pressure, more albuminuria and glomerulosclerosis and chronic kidney disease in the long run . In fact, a low protein diet fed to pregnant mice drastically reduces the life span of their offspring by an average of 200 days .
A human cohort extensively studied for the effects of caloric restriction during pregnancy has been the Dutch Hunger Winter cohort: in the occupied region of the Netherlands, daily rations varied between 400 and 800 calories in the winter of 1944–45, a massive shortage during a specific time frame of pregnancy . All offspring showed altered glucose handling later in life, but the ones exposed to growth restriction during the periods of conception or early gestation specifically showed an increased risk of hypertension and doubled rates of coronary heart disease. The fastest rate of nephrogenesis is during mid-gestation, and those exposed to the famine during that time showed a threefold higher incidence of albuminuria as adults . A recent famine study in Africa has confirmed these results, even at an earlier age . These studies show that caloric restriction is a highly important environmental factor that still affects a large part of the population worldwide. In addition to macronutrient restrictions, deficits in micronutrients have also been shown to negatively influence kidney development, such as vitamin A , sodium , iron , and zinc .
Another common condition that affects kidney development is diabetes: dysregulation of glucose is found in one in six pregnancies according to recent criteria of the International Association of Diabetes and Pregnancy Study Groups (IADSPG) . Many consequences of diabetes for renal development have been identified, both in extreme glucose concentrations as well as with just slight alterations. First, nephron endowment is decreased. In an animal study, this reduction was found to be approximately 40 % . Increased apoptosis was described via activation of the intrarenal renin–angiotensin system (RAS) and NF-kappaB and p53 signalling, as well as the generation of reactive oxygen species. Functionally, there is a reduced renal reserve, more albuminuria and higher blood pressure, which can be prevented by abolishing hyperglycaemia during nephrogenesis with insulin . This study illustrates the importance of strict screening for gestational diabetes for future renal health of the offspring.
Maternal diabetes is also associated with CAKUT and with a three-fold increased risk of renal agenesis and dysplasia . It should, however, be noted that familial mutations of HNF1beta were not studied in this study. Mutations in HNF1beta are well known to be associated with renal cysts and diabetes syndrome, which may link maternal diabetes with renal defects in offspring, such as an MCDK .
Another environmental factor influencing kidney development is the use of medication by the pregnant mother . Some drugs have been shown to influence renal development, but there is still much research needed to elucidate the effects of the majority of medications on nephrogenesis. One drug that has been studied in more detail is dexamethasone. Normally, a foetus is protected from high levels of maternal steroids through inactivation in the placenta by 11 beta-hydroxysteroid dehydrogenase 2 (11beta-HSD2) . Synthetic steroids circumvent this metabolism, thereby passing through the placenta and promoting the secretion of surfactant in the foetal lung. Unfortunately, negative effects on the kidney are found as well, and many animal studies have shown lower nephron numbers, with hypertension in the long run . The effects of maternal malnutrition and stress may act through this same pathway, as malnutrition has been shown to result in a reduced expression and activity of placental 11beta-HSD2 .
Another group of drugs that can have a major impact on renal development are the angiotensin converting enzyme inhibitors and angiotensin receptor blockers, as the RAS is essential for kidney development . Gross disturbance of the RAS may mimic mutations of the RAS genes and result in renal tubular dysgenesis with a reduced number of tubular sections and dedifferentiated tubuli . Another consequence of perinatal angiotensin blockade may just be a lower nephron number, with all its sequelae .
Postnatal drug administration to the prematurely born neonate may have similar effects. Being born before the 36th week of gestation indicates that nephrogenesis has not yet ceased and will continue after birth. Any drug administered to a prematurely born neonate therefore has the potential to disturb normal nephrogenesis, especially before 28 weeks of gestation. Widely used drugs in such infants are antibiotics, such as aminoglycosides, non-steroidal anti-inflammatory drugs for closure of a patent ductus arteriosus and diuretics. All of these drugs have been shown to potentially hamper nephrogenesis (for an overview, see ).
In addition to drugs, the majority of premature neonates do not grow well during the first weeks after birth, leading to extra-uterine growth restriction . This has similar effects on the kidney as intrauterine growth restriction as it leads to a reduction in nephron endowment . Whether it is due to the kidney or to other organ systems that are altered after premature birth, a high proportion of hypertension is found: a Dutch follow-up study of premature offspring at the age of 19 years showed that half had a blood pressure in the prehypertensive or hypertensive range .
The consequences of a suboptimal intrauterine environment for tubular function have been studied in less detail than have the glomerular consequences. Most attention has been on sodium transporters, as a possible explanation for hypertension after low birth weight was hypothesized to be caused by altered renal sodium handling. In fact, an upregulation of NKCC2 was found after protein restriction, leading to increased renal sodium retention . Other tubular transport systems have been shown to be altered as well, including a defect in tubular phosphate transport . Maternal low protein diet in rats, as a model for intrauterine growth restriction, has been shown to lead to increased urinary calcium excretion , whereas magnesium transport was not affected .
Maternal malnutrition, stress or diseases such as diabetes, uteroplacental insufficiency, maternal and neonatal drugs and premature birth with growth restriction are environmental factors with the potential to hamper kidney development. This may result in gross anomalies, such as renal agenesis or multicystic dysplasia, but most effects are more subtle and lead to a reduction in nephron endowment. Starting life with a reduced nephron endowment starts a vicious cycle that leads to hyperfiltration, hypertension and/or glomerular damage with albuminuria, and may end in chronic kidney disease. Acknowledging these health risks and following up on patients longitudinally is essential to reduce the associated risks. In addition, more research is needed to evaluate factors that may hamper nephrogenesis and study the pathways that are involved in this programming, all aimed at preventing exposure to such factors or limiting the negative effects by studying rescue therapies. Until science has developed that far, patients should be offered structured follow-up to find and treat risk factors for future health.
- Development of in vivo imaging of glomeruli may allow for the individual determination of nephron numbers, and thereby the study of the consequences of a low nephron endowment
- Studies into the effects of medications administered during nephrogenesis, either in pregnant women or in prematurely born neonates, will allow for the prevention of low nephron endowment and associated long-term sequelae
- Further unravelling of the molecular regulation of kidney development may allow for the identification of key (growth) factors that can be used as a rescue therapy when kidney development is hampered.
- A low nephron endowment leads to glomerular hyperfiltration, associated with hypertension, glomerular damage and proteinuria, and starts a vicious cycle that ends in renal failure in the long run.
- Nephron endowment is influenced by genetic and environmental factors, such as maternal malnutrition, stress or diseases, such as diabetes, uteroplacental insufficiency, maternal and neonatal drugs and premature birth.
- A solitary functioning kidney is an example of low nephron endowment and is associated with hyperfiltration injury in up to one-third of patients, and may result in end-stage renal disease.
- Which factor is the best marker to predict nephron number in a 22-year-old adult?
- Renal size on ultrasound
- Birth weight and gestational age
- Blood pressure level
- Glomerular filtration rate
- Level of proteinuria
- Which statement(s) are true concerning nephron numbers?
- On average, a little under 1 million nephrons per kidney are formed, with a small inter-individual range.
- Nephrons are only formed during gestation.
- Both genetic as well as many environmental factors are important in determining final nephron endowment.
- All three answers are correct.
- A patient with a congenital solitary functioning kidney…
- Has a condition that warrants a relatively infrequent but long-term follow-up.
- Can be safely discharged from follow-up when check-ups at the age of 2 years are normal.
- Should be checked until the age of 10 years, as no long-term sequelae have been noted after that.
- Has sufficient renal reserve capacity to go through life without any expected renal consequences, just as has been shown for large numbers of kidney donors.
- Drug use during kidney development…
- is safe, unless noted differently in the package leaflet.
- may have a wide variety of consequences.
- should always be prevented.
- should be subject of more research.
- (b) + (d)
- The effect of gestational diabetes on nephrogenesis…
- is characterized by renal hypoplasia and/or dysplasia.
- may be found within the “normal” range of glucose levels.
- may be explained by a genetic mutation in HNF1beta, which is associated with Maturity Onset Diabetes of the Young (MODY) and renal hypodysplasia.
- all of the above.
2. c. (Neonates born before termination of nephrogenesis, i.e. prematurely, will show postnatal formation of nephrons, even though this will be at a reduced level)
MFS is supported by the Dutch Kidney Foundation (KJPB.08.06).
This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
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[Figure ID: Fig1]
Integration of causes and consequences of low nephron endowment due to programming of kidney development (upper) leading to glomerular hyperfiltration (lower). MCDK Multicystic dysplastic kidney, IUGR intrauterine growth restriction, GFR glomerular filtration rate, ESRD end-stage renal disease
[Figure ID: Fig2]
Different potential courses of albuminuria and glomerular filtration rare (GFR) in individuals with a congenital solitary functioning kidney, based on an integration of data from previous studies [13, 14, 16]. GFR (solid lines) may mature to normal two-kidney values (90–120 ml/min/1.73 m2) and gradually decrease during adulthood, with a gradual increase in albuminuria (dashed lines) into the microalbuminuria (30–300 mg/24 h) or macroalbuminuria (>300 mg/24 h) range. However, renal function may deteriorate much faster and lead to albuminuria in the first decade of life  and end-stage renal disease in early adulthood
Keywords: Keywords Kidney development, Glomerular hyperfiltration, Nephron endowment, Solitary functioning kidney, Intrauterine growth restriction, Prematurity.
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domain: medical


text:
Millions of rural Mexican citi
Top stories from DAWNS Digest
Huge Setback for Gay Rights in Africa
Saharawi Voice compiles the “stories from the forgotten people of Africa's last colony”, with the aim of conveying a sense of daily life in Western Sahara and the hardships of living in an occupied territory.
In Egypt’s restive Sinai Peninsula,
The UN-backed effort to wipe polio off the face of the earth reached has reached a major milestone.
The concept of task shifting is not a new one.
It was a visit by Danish journalists, who organized a two-day workshop on audio podcasting at the Paro Co
It’s hard to believe that Afghanist
In early November, you might have seen headlines such as this one, from the Washington Post: “U.S.
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domain: design


text: Even though it almost feels like a cliché to be thinking about what I am thankful for on this Thanksgiving day I am still doing it. It has been both the hardest and the best last couple years for me. The best in the sense that I have begun to really understand who I am and what I want to do and meeting the love of my life while also the worst couple years while coming to terms with my anxiety that has tried to hold me back. I am extremely grateful for the friends, family, and my boyfriend for having my back and letting me be me. I feel as though I had to really fall hard in order to realize what I wanted and have that motivation to grow and become better and stronger. I feel proud to finally be in a better place in my life where I am able to work a job I love an feel more confident while doing so. This is still a work in progress for me, but I am in the right direction. I also feel proud of choices I am making now such as trying to build a healthier lifestyle with a balance of work and play. I am trying to build exercise more into my life now while also incorporating my love of adventure and seeing new places. I feel blessed to have the people I have in my life and want to continue to make time for them as well as myself and I am excited to see just how much I will have grown by the time next Thanksgiving comes around.

domain: psychology


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text:
LSU QB with starting experience entering NCAA transfer portal
LSU’s quarterback battle appears to be down to two. TJ Finley is entering the transfer portal, he confirmed to Jacques Doucet of WAFB 9.
A former Ponchatoula standout, Finley signed in LSU’s 2020 recruiting class. As a true freshman, Finley started five games for the Tigers. He was 80-of-140 passing for 5 touchdowns and 5 interceptions.
Finley impressed in his debut against South Carolina, going 17-of-21 for 265 yards and 2 touchdowns, along with a rushing TD. He struggled mightily, however, against Texas A&M in his fourth game when he was 9-of-25 passing for 118 yards and 2 INTs. Finley’s final appearance was a 14-of-28 outing with a TD pass against Alabama.
Entering the transfer portal does not bind a player to leave the school but Finley appears to be set on continuing his college football career elsewhere.
“I plan on taking a few trips to other schools before deciding where I will be attending,” Finley told Doucet.
Finley appeared to be No. 3 in LSU’s quarterback battle with Myles Brennan, last year’s starter before a season-ending injury, and Max Johnson, who led the Tigers to wins over Florida and Ole Miss, ahead of Finley.


Shahid and Priyanka travel cattle class for film promotions
Shahid Kapoor and Priyanka Chopra have been spotted travelling economy class on domestic flights
The duo is all over the place for the promotion of their upcoming film. So they feel it is easier as their staff is with them. Not all domestic airlines and routes have business class, no? So they actually have been forced to do it.


text:
Believe it or not, Calvinism is making a comeback. Due in part, I’m sure, to the fact that this year marks the 500th birthday of John Calvin, the secular media has taken notice that there is a resurgence of interest in Calvinism specifically amongst younger Evangelicals. In fact, a couple months ago Time Magazine listed Calvinism as one of the top 10 ideas changing the world in 2009.
The latest article on Calvinism’s comeback comes from Lakeland, Florida:
This month, followers of Calvin are celebrating the 500th anniversary of his birth and hope that his theology, which may be growing in popularity among a new generation of evangelical pastors, can be rescued from its bad reputation.
Calvin’s influence is more widely felt than is generally realized, both in churches and in American life. Portions of our ideas about democracy and capitalism can be traced to him, and even his ideas about human nature, which run counter to optimistic self-help trends, may make more sense in a period of economic and political turmoil.
You can read the rest of this article here (notice that Coral Ridge gets a mention).


Why Newcastle must swoop for PL midfielder available in the summer
By Derek Smithson
Newcastle should seriously consider a move for midfielder Lucas Leiva, who is available on a free transfer in the summer as his contract at Liverpool expires.
The 30-year-old is set to see his 10-year spell at Anfield come to an end and he had made 346 appearances for the Merseyside club, becoming a fan favourite in the process.
Rafael Benitez was the manager who bought the Brazilian for Liverpool back in 2007 and the current Newcastle boss should seriously consider a reunion at St James’ Park.
The Magpies are looking to strengthen their squad as they return to the Premier League next season, with the club clinching the Championship title.
They are going to need experienced top-flight players that can help their squad and Liverpool ace Lucas certainly has the know-how to improve them.
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He is a defensive midfielder by trade, but can also be used as an emergency defender.
Lucas proved this season under Jurgen Klopp that he still has top qualities by making 31 senior appearances and he is very efficient at winning the ball back for his side.
A potential Lucas-Jonjo Shelvey combination in the centre of the park sounds like an interesting proposition and one that could definitely compete in the Premier League.
The midfielder undoubtably has the quality still to do a job in the top flight and Newcastle could make a fantastic addition by picking him up for free.
They are likely to have to pay him big wages, but the north-east club have given Benitez big financial backing and no transfer fee should sweeten the deal.
In other Newcastle transfer news, they are planning a £4million move for a Serie A goalkeeper.


text:
|Title of book:||The Future Makers: Australian wines for the 21st century|
|Publisher:||Hardie Grant Books|
|ISBN||978 1 74066 661 9|
This is a really good and enlightening read.
Physically the book is sensorially retro, with a sweet-earthy feel and smell, though it doesn’t say it’s been printed on any sort of ethically sourced paper, which probably means it hasn’t. It’s all attractive touchy-feely earthy tones and matt-finish pictures, which gives the whole thing something of a natural feel. And given that improving sustainability is a thread through the book, such a presentation is no surprise.
Allen succinctly sets the climate change scene as a partial motivating force for the ‘new Australian viticulture’ before delving into the main thrust of the book – terroir – and the producers who work to embrace and express it.
For 30 years and more the Aussies have diss-ed this French word, which has no encompassing translation, but means, pretty much, a combination of the land, the soil, the vines, the climate, the weather, (wo)man’s husbandry and stewardship, which results in wines that taste of where they’re grown. A sense of place. It’s wryly ironic, then, that the paradigm shift in Aussie viticulture which Allen explores involves the adoption of the terroir mantra, and more sustainable ways of growing grapes. But about time, frankly; Australia has hugely diverse vineyard regions.
The lion’s share of the book is devoted to discussing these new, and some well-established but evolving, pioneers. Allen brings them alive on the page, with pithy passages from the horses’ mouths. In this big section, interspersed among the producer listing, and on buff-coloured pages for ease of reference, are some detailed texts of the more prominent personalities for whatever classic, iconoclastic, fanatic, romantic reasons. For example, Michael Dhillon of Bindi is on these pages, as are the likes of Phillip Jones of Bass Phillip, Ron and Emily Laughton of Jasper Hill, Julian Castagna of Castagna and Peter Gago of Penfolds to name a few.
On other pages, highlighted in a greener hue, are small essays on wine industry developments such as Australia’s fortified wines, biodynamics, packaging and Tassie bubblies etc. It would have been good to have had a list of these anecdotal essays in the contents, but that’s the tiniest of gripes. The featured producers are all emboldened in the index.
The timing of the book could be a fillip for the Australian industry as it moves away from its old image of bargain basement ‘sunshine in a bottle’ wines to something more regional, more individual, more distinctive and distinguished.
As an aside, for UK readers to buy some of these wines, there may have to be an equivalent paradigm shift of shopping habits to indie merchants.

domain: library


text:
Large-eared Pied Bats were discovered in the 1960s. Little is known about them.
Large-eared Pied Bats roost in caves, mines and unused bird nests.
Large-eared Pied Bats roost together in small groups during spring and summer and hibernate in colder months.
Feeding and diet
Large-eared Pied Bats are thought to feed on small flying insects.
Large-eared Pied Bats are vulnerable to disturbance from human visitors to cave roosts, destruction of caves by mining, and loss of feeding habitat by clearing for agriculture and housing estates.

domain: biology


text:
"We have just received a notification from China that 20 investors will surely attend the investment forum in Kupang," Consul of the Chinese Consulate General in Denpasar, Bali, Li Changda stated on Thursday, November 14, 2019.
Besides Chinese investors, tens of businessmen from the provinces of East Nusa Tenggara, West Nusa Tenggara, and Bali will congregate for the investment forum.
"Some 200 participants comprising entrepreneurs and trade officials will attend the investment forum," the Chinese offcial revealed.
According to him, the Chinese investors partaking in the forum are successful businessmen engaged in the fields of construction, energy, electricity, logistics, fishery, agriculture, husbandry and others.
He is upbeat about the forum leading to the inking of mutually beneficial cooperation agreements between Chinese investors and their Indonesian counterparts. (Antara)

domain: economics


text:
Then provide us a sampling of your writing. We would like you to write 3 rooms of a dungeon, no map required. Include a short introduction, 3-4 sentences in length. The dungeon rooms should contain mechanical elements, like magic items, traps, etc., so we can evaluate your technical writing skills as well as your prose. Your work will not be owned or retained by AAW Games and will only be used to evaluate your skills.
Send the aforementioned sample of your writing to firstname.lastname@example.org or, better yet: join the AAW Games Discord and get to know us and our community of friends and fans at http://bit.ly/AAWGames then DM your work to Thilo @Endzeitgeist
Please note, we tend to get a lot of applicants so if you don’t hear back from us, it means it wasn’t a good fit. That said, don’t hesitate to try again next time we put out a call of this nature.
We look forward to working with you!
Douglas Niles, a legendary name for those who hail from the days of AD&D and TSR. A man whose legacy spans from the very first Forgotten Realms novels to the creation of the Dragonlance world, Doug is a New York Times Best-Seller and his work has been read and utilized by countless roleplayers. Doug is also well known for creating the groundbreaking Dungeoneer’s Survival Guide (TSR, 1986) with legends Gary Gygax and David C. Sutherland III, a book which detailed exploration of the subterranean world, a realm which was previously only hinted at and briefly explored in a few select modules. The Dungeoneer’s Survival Guide finally gave DMs the ability to craft their own adventures and full campaigns in the Underdark.
Now, 35 years after the Dungeoneer’s Survival Guide was published by TSR, Douglas Niles returns, alongside Thilo Graf (Endzeitgeist) and Stephen Yeardley, to bring you the Survivalist’s Guide to Spelunking.
The Survivalist’s Guide to Spelunking is designed for use with D&D 5e but has enough information about the strange and alien underground world to be of use for anyone looking for a good survival guide to enhance their adventures into the depths of the earth.
In the section below is the inside scoop, the back of book text, from the Survivalist’s Guide to Spelunking, for your esteemed edification. The Survivalist’s Guide to Spelunking Kickstarter goes live on March 3rd, 2021 and you don’t want to miss being a part of this legendary occasion to pay homage to one of the greats with an exciting “sequel” to the Dungeoneer’s Survival Guide, lavishly crafted for both D&D players & DMs.
The legendary dwarven delver Dugmore Dumple is back from retirement! Following on from his seminal guide for dungeoneers, Dugmore now takes you through crystalline caverns, fungal jungles and the maze-like passages of his home beneath the surface, even skirting the upper regions of Hel itself.
Survival in the Underworld is no mean feat, but this massive tome contains all you need to exist and endure, nay, prosper in and profit from the lightless realms below. Dugmore’s sage advice, carefully balanced by seasoned traveler and guide Fin Starling, provides all the tools you require to enhance your experience while exploring the fabled caverns and tunnels below the surface.

domain: hobby


Zero degrees, zero limits! Light, strong and smart as well as the M-zero standard versions, being suitable for very low latitude areas till 0°, it is the perfect instrument for the travelling astronomy.
From 0° till 70° mount
Avalon Instruments introduce the M-zero for low latitude areas till 0°. Light weight, small dimensions the M-zero LHQ comes with four range degrees available:
1 - 0° - 15°
2 - 15° - 45°
3 - 30° - 55°
4 - 55° - 70°
The M-zero LHQ is the perfect mount for low latitude area and travelling astronomy.
NOTE: The Alt/az configuration is not available in the M-zero LHQ mount.
6 dec arm positions on the RA axis available
As well as the M-zero standard versions, the M-zero LHQ allow to move the DEC arm up and down on the RA axis in 6 different positions on depending on the user setup, to allow a fine balancing by using the less counterweight possible, in most cases, with less than 1 kg/2.2 lb counterweight.
Double Telescope Setup
Thanks to the Dual-DEC system or by assembling the optional X-guider accessory, it is possible to mount a second telescope in the opposite side of the declination axis. Considering this capability it is possible to use a great range of optics starting from a small (4-5 kg/8.8-11 lb) refractor up to a double setup with a total weight of 12-13 kg/26.4-28.6 lb, obtaining performances so good to get it over the need of a bigger mount.
Thanks to StarGO GoToControl System the M-Zero can be controlled by smartphone and tablet via Bluetooth or WiFi connection.
The virtually zero maintenance, the long lasting materials used and the possibility to easily update the StarGO firmware and software allow the M-zero to be always ready to use, up to date, competitive and extremely reliable!
Light and Strong
Made entirely from anodized aluminum, worked using 5 axes CNC machines.
The mount weights only 6 kg/13.2 lb and, combined with the new T-Pod 90 tripod, reaches a total weight of 12 kg/26.4 lb.
Technology and Innovation
The top quality manufacturing level, the Fast-Reverse Belt Drive System with zero backlash and the StarGO GoTo control system allow excellent performance in the photographic use, with guided long exposure images (see our suggested PHD2 guide parameters table), even while using very long focal length telescopes.
THE POLAR ALIGNMENT can be performed by using the polar scope mounted on the RA body that can be rotated to the upper position for a comfortable adjustment of the Polar Alignment.
The standard kit for the polar alignment is provided with the following components:
2. Support stand provided of scope fixing knobs and dovetail attack with fixing grip knob.
3. Illuminator cap provided of red LED and connection cable to the StarGO.
- Mount Head
- T-pod 90 (Aluminum tripod)
- Transport bag
- Counterweight shaft and 0.5 kg Counterweight
- StarGO Board and Keypad
- Polar scope with support
- Power Supply 15V/4 A
- Warranty, Testing Certificates & Declaration of Conformity
- Allen wrench
- Tripod plate and screws for fixing the mount to the tripod
- USB flash drive with manuals and software
- Ra/Dec motor cables
- M-zero Dual Dec adapter
|Type||Equatorial Single-Arm mount|
|Weight||10,1 kg/22,2 lb|
|Capacity||8 kg/17.6 lb (one telescope) - 13 kg/28.6 lb (double telescopes setup)|
||All belts drive system based on four stages reducer. All the movements are on ball bearings. No maintenance and no backlash system. Pulleys made with special polymer fiberglass charged and high precision toothed belts.|
|Construction Material||Anodized aluminium, worked out from single blocks with high precision 5 axis CNC machines|
|Polar Finder||Celestron model|
|GOTO system||StarGO GoTo Control System WiFi version|
|Counterweight||0.5 kg/1.1 lb|
|Scope plate||Vixen style|
|Warranty||2 years from the purchase date, extended to 5 years for the transmission system|
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Worcester Co. approves Inlet dredging partnership
WORCESTER Co., MD – The Ocean City Inlet can be considered the lifeline of Worcester County. All year long, boats use the Inlet, but recently, some boats have had trouble getting through, because Mother Nature has filled part of the Inlet back up with sand.
Recently, a large boat got stuck in the Ocean City Inlet, causing thousands of dollars in damages. We’re told the vessel was stuck for about 7 hours, signifying a need to make the inlet deeper.
At a recent meeting, Worcester County Commissioners approved a Project Partnership Agreement with the Department of the Army and the Maryland Department of Natural Resources.
This partnership will help the federal government to increase the depth of the Inlet to 16 feet. We’re told the material that is dredged up from the Inlet will be used for the Assateague Island Restoration Project.
The Project Partnership Agreement is just the next step in getting the Inlet dredged.
We’re told the agreement has not yet been finalized, as the Army Corps of Engineers still needs to give the final approval.
They are expected to give that approval sometime in the next week.