Assessment and Management of Hypertension among Patients on Peritoneal Dialysis

Approximately 7%-10% of patients with ESKD worldwide undergo peritoneal dialysis (PD) as kidney replacement therapy. The continuous nature of this dialytic modality and the absence of acute shifts in pressure and volume parameters is an important differentiation between PD and in-center hemodialysis. However, the burden of hypertension and prognostic association of BP with mortality follow comparable patterns in both modalities. Although management of hypertension uses similar therapeutic principles, long-term preservation of residual diuresis and longevity of peritoneal membrane function require particular attention in the prescription of the appropriate dialysis regimen among those on PD. Dietary sodium restriction, appropriate use of icodextrin, and limited exposure of peritoneal membrane to bioincompatible solutions, as well as adaptation of the PD regimen to the peritoneal transport characteristics, are first-line therapeutic strategies to achieve adequate volume control with a potential long-term benefit on technique survival. Antihypertensive drug therapy is a second-line therapeutic approach, used when BP remains unresponsive to the above volume management strategies. In this article, we review the available evidence on epidemiology, diagnosis, and treatment of hypertension among patients on PD and discuss similarities and differences between PD and in-center hemodialysis. We conclude with a call for randomized trials aiming to elucidate several areas of uncertainty in management of hypertension in the PD population

Surprising simplicity in the modeling of dynamic granular intrusion

Granular intrusions, such as dynamic impact or wheel locomotion, are complex multiphase phenomena where the grains exhibit solid-like and fluid-like characteristics together with an ejected gas-like phase. Despite decades of modeling efforts, a unified description of the physics in such intrusions is as yet unknown. Here we show that a continuum model based on the simple notions of frictional flow and tension-free separation describes complex granular intrusions near free surfaces. This model captures dynamics in a variety of experiments including wheel locomotion, plate intrusions, and running legged robots. The model reveals that three effects (a static contribution and two dynamic ones) primarily give rise to intrusion forces in such scenarios. Identification of these effects enables the development of a further reduced-order technique (Dynamic Resistive Force Theory) for rapid modeling of granular locomotion of arbitrarily shaped intruders. The continuum-motivated strategy we propose for identifying physical mechanisms and corresponding reduced-order relations has potential use for a variety of other materials.Comment: 41 pages including supplementary document, 10 figures, and 8 vide

Analyzing Disproportionate Reaction via Comparative Multilingual Targeted Sentiment in Twitter

Global events such as terrorist attacks are commented upon in social media, such as Twitter, in different languages and from different parts of the world. Most prior studies have focused on monolingual sentiment analysis, and therefore excluded an extensive proportion of the Twitter userbase. In this paper, we perform a multilingual comparative sentiment analysis study on the terrorist attack in Paris, during November 2015. In particular, we look at targeted sentiment, investigating opinions on specific entities, not simply the general sentiment of each tweet. Given the potentially inflammatory and polarizing effect that these types of tweets may have on attitudes, we examine the sentiments expressed about different targets and explore whether disproportionate reaction was expressed about such targets across different languages. Specifically, we assess whether the sentiment for French speaking Twitter users during the Paris attack differs from English-speaking ones. We identify disproportionately negative attitudes in the English dataset over the French one towards some entities and, via a crowdsourcing experiment, illustrate that this also extends to forming an annotator bias

An Email Attachment is Worth a Thousand Words, or Is It?

There is an extensive body of research on Social Network Analysis (SNA) based on the email archive. The network used in the analysis is generally extracted either by capturing the email communication in From, To, Cc and Bcc email header fields or by the entities contained in the email message. In the latter case, the entities could be, for instance, the bag of words, url's, names, phones, etc. It could also include the textual content of attachments, for instance Microsoft Word documents, excel spreadsheets, or Adobe pdfs. The nodes in this network represent users and entities. The edges represent communication between users and relations to the entities. We suggest taking a different approach to the network extraction and use attachments shared between users as the edges. The motivation for this is two-fold. First, attachments represent the "intimacy" manifestation of the relation's strength. Second, the statistical analysis of private email archives that we collected and Enron email corpus shows that the attachments contribute in average around 80-90% to the archive's disk-space usage, which means that most of the data is presently ignored in the SNA of email archives. Consequently, we hypothesize that this approach might provide more insight into the social structure of the email archive. We extract the communication and shared attachments networks from Enron email corpus. We further analyze degree, betweenness, closeness, and eigenvector centrality measures in both networks and review the differences and what can be learned from them. We use nearest neighbor algorithm to generate similarity groups for five Enron employees. The groups are consistent with Enron's organizational chart, which validates our approach.Comment: 12 pages, 4 figures, 7 tables, IML'17, Liverpool, U

Con: Nutritional vitaminDreplacement in chronic kidney disease and end-stage renal disease

Insufficiency of 25-hydroxyvitamin D [25(OH)D] is highly prevalent among patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) and is a critical component in the pathogenesis of secondary hyperparathyroidism. Accordingly, current National Kidney Foundation—Kidney Disease Outcomes Quality Initiative and Kidney Disease: Improving Global Outcomes guidelines recommend the correction of hypovitaminosis D through nutritional vitamin D replacement as a first-step therapeutic approach targeting secondary hyperparathyroidism. In this Polar Views debate, we summarize the existing evidence, aiming to defend the position that nutritional vitamin D replacement is not evidence-based and should not be applied to patients with CKD. This position is supported by the following: (i) our meta-analysis of randomized controlled trials shows that whereas nutritional vitamin D significantly increases serum 25(OH)D levels relative to placebo, there is no evidence either in predialysis CKD or in ESRD that parathyroid hormone (PTH) is lowered; (ii) on the other hand, in randomized head-to-head comparisons, nutritional vitamin D is shown to be inferior to activated vitamin D analogs in reducing PTH levels; (iii) nutritional vitamin D is reported to exert minimal to no beneficial actions in a series of surrogate risk factors, including aortic stiffness, left ventricular mass index (LVMI), epoetin utilization and immune function among others; and (iv) there is no evidence to support a benefit of nutritional vitamin D on survival and other ‘hard’ clinical outcomes. Whereas nutritional vitamin D replacement may restore 25(OH)D concentration to near normal, the real target of treating vitamin D insufficiency is to treat secondary hyperparathyroidism, which is untouched by nutritional vitamin D. Furthermore, the pleotropic benefits of nutritional vitamin D remain to be proven. Thus, there is little, if any, benefit of nutritional vitamin D replacement in CKD

Ethnea -- an instance-based ethnicity classifier based on geo-coded author names in a large-scale bibliographic database

We present a nearest neighbor approach to ethnicity classification. Given an author name, all of its instances (or the most similar ones) in PubMed are identified and coupled with their respective country of affiliation, and then probabilistically mapped to a set of 26 predefined ethnicities. The dominant ethnicity (or pair of ethnicities) is assigned as the class. The predictions are also used to upgrade Genni (Smith, Singh, and Torvik, 2013) to provide ethnicity-specific gender predictions for cases like Italian vs. English Andrea, Turkish vs. Korean Bora, Israeli vs. Nordic Eli, and Slavic vs. Japanese Renko. Ethnea and Genni 2.0 are available at http://abel.lis.illinois.eduNIH P01AG039347NSF 1348742Ope

Blood pressure in hemodialysis: targets?

Purpose of review In the absence of ‘hard’ clinical-trial evidence to define optimal blood pressure (BP) targets and validate different BP measurement techniques, management of hypertension in hemodialysis is based on expert opinions. In this review, we provide a comparative evaluation of out-of-dialysis BP monitoring versus dialysis-unit BP recordings in diagnosing hypertension, guiding its management and prognosticating mortality risk. Recent findings Owing to their high variability and poor reproducibility, predialysis and postdialysis BP recordings provide inaccurate reflection of the actual BP load outside of dialysis. Contrary to the reverse association of peridialytic BP with mortality, elevated home and ambulatory BP provides a direct mortality signal. Out-of-dialysis BP monitoring, even when done in the clinic, is a reliable approach to manage hypertension in the dialysis unit. Whenever none of these measures are available, median intradialytic SBP can provide a better estimate of interdialytic BP levels compared with peridialytic BP measurements. Summary Although out-of-dialysis BP monitoring have better diagnostic accuracy and prognostic validity, randomized trials are needed to ascertain BP targets for managing hypertension in hemodialysis patients