Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?

Dietary therapy represents an important tool in the management of chronic kidney disease (CKD), mainly through a balanced reduction of protein intake aimed at giving the remnant nephrons in damaged kidneys a "functional rest". While dialysis, transplantation, and pharmacological therapies are usually seen as "high tech" medicine, non pharmacological interventions, including diets, are frequently considered lifestyle-complementary treatments. Diet is one of the oldest CKD treatments, and it is usually considered a part of "mainstream" management. In this narrative review we discuss how the lessons of complementary alternative medicines (CAMs) can be useful for the implementation and study of low-protein diets in CKD. While high tech medicine is mainly prescriptive, prescribing a "good" life-style change is usually not enough and comprehensive counselling is required; the empathic educational approach, on which CAMs are mainly, though not exclusively based, may support a successful personalized nutritional intervention.There is no gold-standard, low-protein diet for all CKD patients: from among a relatively vast choice, the best compliance is probably obtained by personalization. This approach interferes with the traditional RCT-based analyses which are grounded upon an assumption of equal preference of treatments (ideally blinded). Whole system approaches and narrative medicine, that are widely used in the study of CAMs, may offer ways to integrate EBM and personalised medicine in the search for innovative solutions respecting individualization, but gaining sound data, such as with partially-randomised patient preference trials

Type 1 diabetes, diabetic nephropathy, and pregnancy: a systematic review and meta-study

BACKGROUND: In the last decade, significant improvements have been achieved in maternal-fetal and diabetic care which make pregnancy possible in an increasing number of type 1 diabetic women with end-organ damage. Optimal counseling is important to make the advancements available to the relevant patients and to ensure the safety of mother and child. A systematic review will help to provide a survey of the available methods and to promote optimal counseling. OBJECTIVES: To review the literature on diabetic nephropathy and pregnancy in type 1 diabetes. METHODS: Medline, Embase, and the Cochrane Library were scanned in November 2012 (MESH, Emtree, and free terms on pregnancy and diabetic nephropathy). Studies were selected that report on pregnancy outcomes in type 1 diabetic patients with diabetic nephropathy in 1980-2012 (i.e. since the detection of microalbuminuria). Case reports with less than 5 cases and reports on kidney grafts were excluded. Paper selection and data extraction were performed in duplicate and matched for consistency. As the relevant reports were highly heterogeneous, we decided to perform a narrative review, with discussions oriented towards the period of publication. RESULTS: Of the 1058 references considered, 34 fulfilled the selection criteria, and one was added from reference lists. The number of cases considered in the reports, which generally involved single-center studies, ranged from 5 to 311. The following issues were significant: (i) the evidence is scattered over many reports of differing format and involving small series (only 2 included over 100 patients), (ii) definitions are non-homogeneous, (iii) risks for pregnancy-related adverse events are increased (preterm delivery, caesarean section, perinatal death, and stillbirth) and do not substantially change over time, except for stillbirth (from over 10% to about 5%), (iv) the increase in risks with nephropathy progression needs confirmation in large homogeneous series, (v) the newly reported increase in malformations in diabetic nephropathy underlines the need for further studies. CONCLUSIONS: The heterogeneous evidence from studies on diabetic nephropathy in pregnancy emphasizes the need for further perspective studies on this issue

Quantifying Web Adblocker Privacy

Web advertisements, an integral part of today\u27s web browsing experience, financially support countless websites. Meaningful advertisements, however, require behavioral targeting, user tracking and profile fingerprinting that raise serious privacy concerns. To counter privacy issues and enhance usability, adblockers emerged as a popular way to filter web requests that do not serve the website\u27s main content. Despite their popularity, little work has focused on quantifying the privacy provisions of adblockers. In this paper, we develop a quantitative approach to objectively compare the privacy of adblockers. We propose a model based on a set of privacy metrics that captures not only the technical web architecture, but also the underlying corporate institutions of the problem across time and geography. We investigate experimentally the effect of various combinations of ad-blocking software and browser settings on 1000 Web sites. Our results highlight a significant difference among adblockers in terms of filtering performance, in particular affected by the applied configurations. Besides the ability to judge the filtering capabilities of existing adblockers and their particular configurations, our work provides a general framework to evaluate new adblocker proposals

Service-oriented product lines: a systematic mapping study

Software product line engineering and service-oriented architectures both enable organizations to capitalize on reuse of existing software assets and capabilities and improve competitive advantage in terms of development savings, product flexibility, time-to-market. Both approaches accommodate variation of assets, including services, by changing the software being reused or composing services according a new orchestration. Therefore, variability management in Service-oriented Product Lines (SoPL) is one of the main challenges today. In order to highlight the emerging evidence-based results from the research community, we apply the well-defined method of systematic mapping in order to populate a classification scheme for the SoPL field of interest. The analysis of results throws light on the current open issues. Moreover, different facets of the scheme can be combined to answer more specific research questions. The report reveals the need for more empirical research able to provide new metrics measuring efficiency and efficacy of the proposed models, new methods and tools supporting variability management in SoPL, especially during maintenance and verification and validation. The mapping study about SoPL opens further investigations by means of a complete systematic review to select and validate the most efficient solutions to variability management in SoPL.</jats:p

Tabularizing the Business Knowledge: modeling, maintenance and validation

Achieving business flexibility implies to explicitly represent business knowledge and make it easy to understand for decision-makers. There is a renewed interest for decision tables as knowledge modeling formalism able to provide representation of the relationships among business conditions, actions and decisions with completeness and consistency. We explore the benefits of decision tables applied to modeling and management of business rules and constraints, finding the major advantages in their compact formalization, safe maintenance and automated validation

Tabularizing the Business Knowledge: modeling, maintenance and validation

Achieving business flexibility implies to explicitly represent business knowledge and make it easy to understand for decision-makers. There is a renewed interest for decision tables as knowledge modeling formalism able to provide representation of the relationships among business conditions, actions and decisions with completeness and consistency. We explore the benefits of decision tables applied to modeling and management of business rules and constraints, finding the major advantages in their compact formalization, safe maintenance and automated validation