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Surface modification of thin film composite membrane by nanoporous titanate nanoparticles for improving combined organic and inorganic antifouling properties

Emadzadeh D, Ghanbari M, Lau WJ, Rahbari-Sisakht M, Rana D, Matsuura T, et al.

Mater Sci Eng C Mater Biol Appl, 2017 Jun 01;75:463-470.
PMID: 28415486 DOI: 10.1016/j.msec.2017.02.079

In this study, nanoporous titanate (NT) nanoparticle synthesized by the solvothermal method was used to modify polyamide layer of thin film composite membranes with the aim of improving membrane resistances against organic and inorganic fouling. Thin film nanocomposite membranes (NMs) were synthesized by adding mNTs (modified nanoparticles) into polyamide selective layer followed by characterization using different analytical instruments. The results of XPS and XRD confirmed the presence of mNTs in the polyamide layer of NMs, while FESEM, AFM, zeta potential and contact angle measurement further supported the changes in physical and chemical properties of the membrane surface upon mNTs incorporation. Results of fouling showed that NM1 (the membrane incorporated with 0.01w/v% mNTs) always demonstrated lower degree of flux decline compared to the control membrane when membranes were tested with organic, inorganic and multicomponent synthesized water, brackish water or seawater. Besides showing greater antifouling resistance, the NM also displayed significantly higher water flux compared to the control M membrane. The findings of this work confirmed the positive impact of mNTs in improving the properties of NM with respect to fouling mitigation and flux improvement.
Fulltext How Least Developed to Lower-Middle Income Countries Use Health Technology Assessment: A Scoping Review

Falkowski A, Ciminata G, Manca F, Bouttell J, Jaiswal N, Farhana Binti Kamaruzaman H, et al.

Pathog Glob Health, 2023 Mar;117(2):104-119.
PMID: 35950264 DOI: 10.1080/20477724.2022.2106108

Health Technology Assessment (HTA) is a multidisciplinary tool to inform healthcare decision-making. HTA has been implemented in high-income countries (HIC) for several decades but has only recently seen a growing investment in low- and middle-income countries. A scoping review was undertaken to define and compare the role of HTA in least developed and lower middle-income countries (LLMIC). MEDLINE and EMBASE databases were searched from January 2015 to August 2021. A matrix comprising categories on HTA objectives, methods, geographies, and partnerships was used for data extraction and synthesis to present our findings. The review identified 50 relevant articles. The matrix was populated and sub-divided into further categories as appropriate. We highlight topical aspects of HTA, including initiatives to overcome well-documented challenges around data and capacity development, and identify gaps in the research for consideration. Those areas we found to be under-studied or under-utilized included disinvestment, early HTA/implementation, system-level interventions, and cross-sectoral partnerships. We consider broad practical implications for decision-makers and researchers aiming to achieve greater interconnectedness between HTA and health systems and generate recommendations that LLMIC can use for HTA implementation. Whilst HIC may have led the way, LLMIC are increasingly beginning to develop HTA processes to assist in their healthcare decision-making. This review provides a forward-looking model that LLMIC can point to as a reference for their own implementation. We hope this can be seen as timely and useful contributions to optimize the impact of HTA in an era of investment and expansion and to encourage debate and implementation.
Fulltext Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia

Ramachandran R, Bhargava V, Jasuja S, Gallieni M, Jha V, Sahay M, et al.

J Vasc Access, 2022 Nov;23(6):849-860.
PMID: 33934667 DOI: 10.1177/11297298211011375

South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries.
Practice of dialysis access interventional nephrology procedures in the Asia-Pacific region: Getting lay of the land

Jasuja S, Gallieni M, Jha V, Vachharajani T, Bhalla AK, Tan J, et al.

Nephrology (Carlton), 2023 Dec;28(12):672-681.
PMID: 37697492 DOI: 10.1111/nep.14236

AIM: This cross-sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia-Pacific Region (APR), specifically related to dialysis access (DA).
METHODS: The Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia-Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey.
RESULTS: Twenty-one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access-related IN procedures, primarily the placement of non-tunnelled central catheters (n-TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico-legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel.
CONCLUSION: The practice of dialysis access-related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access-related IN is constrained by a lack of a skilled workforce and finances.