Patient-Related Barriers to Timely Dialysis Access Preparation: A Qualitative Study of the Perspectives of Patients, Family Members, and Health Care Providers

Rational & Objective A key aspect of smooth transition to dialysis is the timely creation of a permanent access. Despite early referral to kidney care, initiation onto dialysis is still suboptimal for many patients, which has clinical and cost implications. This study aimed to explore perspectives of various stakeholders on barriers to timely access creation. Study Design Qualitative study. Setting & Participants Semi-structured interviews with 96 participants (response rate, 67%), including patients with stage 4 chronic kidney disease (n = 30), new hemodialysis patients with (n = 18) and without (n = 20) permanent access (arteriovenous fistula), family members (n = 19), and kidney health care providers (n = 9). Analytical Approach Thematic analysis. Results Patients reported differential levels of behavioral activation toward access creation: avoidance/denial, wait and see, or active intention. 6 core themes were identified: (1) lack of symptoms, (2) dialysis fear and practical concerns (exaggerated fear, pain, cost, lifestyle disruptions, work-related concerns, burdening their families), (3) evaluating value against costs/risks of access creation (benefits, threat of operation, viability, prompt for early initiation), (4) preference for alternatives, (5) social influences (hearsay, family involvement, experiences of others), and (6) health care provider interactions (mistrust, interpersonal tension, lack of clarity on information). Themes were common to all groups, whereas nuanced perspectives of family members and health care providers were noted in some subthemes. Limitations Response bias. Conclusions Individual, interpersonal, and psychosocial factors compromise dialysis preparation and contribute to suboptimal dialysis initiation. Our findings support the need for interventions to improve patient and family engagement and address emotional concerns and misperceptions about preparing for dialysis

A hierarchical key pre-distribution scheme for fog networks

Security in fog computing is multi-faceted, and one particular challenge is establishing a secure communication channel between fog nodes and end devices. This emphasizes the importance of designing efficient and secret key distribution scheme to facilitate fog nodes and end devices to establish secure communication channels. Existing secure key distribution schemes designed for hierarchical networks may be deployable in fog computing, but they incur high computational and communication overheads and thus consume significant memory. In this paper, we propose a novel hierarchical key pre-distribution scheme based on “Residual Design” for fog networks. The proposed key distribution scheme is designed to minimize storage overhead and memory consumption, while increasing network scalability. The scheme is also designed to be secure against node capture attacks. We demonstrate that in an equal-size network, our scheme achieves around 84% improvement in terms of node storage overhead, and around 96% improvement in terms of network scalability. Our research paves the way for building an efficient key management framework for secure communication within the hierarchical network of fog nodes and end devices. KEYWORDS: Fog Computing, Key distribution, Hierarchical Networks

Dynamics of axial separation in long rotating drums

We propose a continuum description for the axial separation of granular materials in a long rotating drum. The model, operating with two local variables, concentration difference and the dynamic angle of repose, describes both initial transient traveling wave dynamics and long-term segregation of the binary mixture. Segregation proceeds through ultra-slow logarithmic coarsening.Comment: 4 pages, 3 Postscript figures; submitted to PR

Chemical Raman Enhancement of Organic Adsorbates on Metal Surfaces

Using a combination of first-principles theory and experiments, we provide a quantitative explanation for chemical contributions to surface-enhanced Raman spectroscopy for a well-studied organic molecule, benzene thiol, chemisorbed on planar Au(111) surfaces. With density functional theory calculations of the static Raman tensor, we demonstrate and quantify a strong mode-dependent modification of benzene thiol Raman spectra by Au substrates. Raman active modes with the largest enhancements result from stronger contributions from Au to their electron-vibron coupling, as quantified through a deformation potential, a well-defined property of each vibrational mode. A straightforward and general analysis is introduced that allows extraction of chemical enhancement from experiments for specific vibrational modes; measured values are in excellent agreement with our calculations.Comment: 5 pages, 4 figures and Supplementary material included as ancillary fil

An Explicit Bound for Dynamical Localisation in an Interacting Many-Body System

We characterise and study dynamical localisation of a finite interacting quantum many-body system. We present explicit bounds on the disorder strength required for the onset of localisation of the dynamics of arbitrary ensemble of sites of the XYZ spin-1/2 model. We obtain these results using a novel form of the fractional moment criterion, which we establish, together with a generalisation of the self-avoiding walk representation of the system Green's functions, called path-sums. These techniques are not specific to the XYZ model and hold in a much more general setting. We further present bounds for two observable quantities in the localised regime: the magnetisation of any sublattice of the system as well as the linear magnetic response function of the system. We confirm our results through numerical simulations.Comment: 35 pages; 5 figure

Nosocomial hepatitis C virus infection in a renal transplantation center

AbstractNosocomial hepatitis C virus (HCV) infections were recorded in the renal transplantation unit of the university hospital. There were cases of acute HCV infection with aggressive clinical courses diagnosed from a positive HCV RNA test in the early post-transplantation period and which remained anti-HCV negative. Their anti-HCV seronegativity was attributed to them having acquired HCV under intense immunosuppressive therapy and suggested that the aggressive clinical course could be due to the deficient immune response resulting in an inability to limit viral replication. There were also donors diagnosed as having acute HCV infection in the early post-operative period. Genotyping and sequence analysis for HCV were performed on the isolates of eight of these patients who were consecutively transplanted and of three donors whose recipients were infected with HCV prior to transplantation, and who acquired acute HCV infection after transplantation. Of the eight recipients in the first group three were genotype 1a, three were genotype 1b, one wasgenotype 3a, and the last one was genotype 4 according to Simmond's classification. Of the three donor-recipient couples both the HCV isolates from one couple were genotyped as 1b and the phylogenetic analysis indicated that the patients were infected with a common variant of HCV, but the genotypesof HCV isolates from the other couples were different. Recipients were genotype 1b and the donors were genotype 1a in these couples. Genotype results of the first group and donor-recipient couples, and sequence analysis of genotype 1b and 1a isolates, showed that the source of infection was not a unique strain and there were multiple breaks in universal precautions while managing these patients

Selective Chemical Raman Enhancement for Organic Adsorbates at Metal Surfaces

It has long been observed that in surface enhanced Raman spectroscopy (SERS) relative mode intensities differ from gas- and solution-phase data, which obscures understanding of SERS in general. Using first-principles methods, we examine how chemisorption affects Raman scattering of molecules on metal surfaces relative to gas-phase, and provide a quantitative description of this effect. Calculated Raman spectra for benzene thiol bound at different sites on Au(111) show that chemical enhancement arises from the mode dependent electron-phonon coupling of the metal-molecule interface. Site-dependent enhancements are explained correlated to interfacial electronic structure. Comparison to experiments suggests affinity of benzene thiol for bridge sites on Au(111) surfaces

Traveling Granular Segregation Patterns in a Long Drum Mixer

Mixtures of granular media often exhibit size segregation along the axis of a partially-filled, horizontal, rotating cylinder. Previous experiments have observed axial bands of segregation that grow from concentration fluctuations and merge in a manner analogous to spinodal decomposition. We have observed that a new dynamical state precedes this effect in certain mixtures: bi-directional traveling waves. By preparing initial conditions, we found that the wave speed decreased with wavelength. Such waves appear to be inconsistent with simple PDE models which are first order in time.Comment: 11 page