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

Climate change, water and agriculture in the Greater Mekong subregion

Climate change / Adaptation / Indicators / Water resource management / River basins / Water availability / Water quality / Groundwater / Fisheries / Ecosystems / Water power / Population growth / Land use / Biofuels / Sea level / South East Asia / Cambodia / Laos / Myanmar / Thailand / Vietnam / China / Greater Mekong Subregion / Yunnan Province

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

Exact Inference on Gaussian Graphical Models of Arbitrary Topology using Path-Sums

We present the path-sum formulation for exact statistical inference of marginals on Gaussian graphical models of arbitrary topology. The path-sum formulation gives the covariance between each pair of variables as a branched continued fraction of finite depth and breadth. Our method originates from the closed-form resummation of infinite families of terms of the walk-sum representation of the covariance matrix. We prove that the path-sum formulation always exists for models whose covariance matrix is positive definite: i.e.~it is valid for both walk-summable and non-walk-summable graphical models of arbitrary topology. We show that for graphical models on trees the path-sum formulation is equivalent to Gaussian belief propagation. We also recover, as a corollary, an existing result that uses determinants to calculate the covariance matrix. We show that the path-sum formulation formulation is valid for arbitrary partitions of the inverse covariance matrix. We give detailed examples demonstrating our results

RANS and DES Computations for a Wing with Ice Accretion

A computational investigation was performed to assess the effectiveness of Detached Eddy Simulation (DES) as a tool for predicting icing effects. The AVUS code, a public domain flow solver, was employed to compute solutions for an iced wing configuration using DES and steady Reynolds Averaged Navier-Stokes (RANS) equation methodologies. The wing section considered here was a business jet airfoil (GLC305) with a 22.5-minute glaze ice accretion (944-ice shape). The section was extruded to form a rectangular planform. The model was mounted between two walls so no tip effects were considered. The numerical results were validated by comparison with experimental data for the same configuration. The time-averaged DES computations showed some improvement in lift and drag results near stall when compared to steady RANS results. However, comparisons of the flow field details did not show the level of agreement suggested by the integrated quantities. More validation is needed to determine what role DES can play as part of an overall icing effects prediction strategy

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

Scoping study on natural resources and climate change in Southeast Asia with a focus on agriculture. Final report

Climate change / Natural resources / Environmental effects / Agroecology / Agricultural production / Crops / Cropping systems / Farming systems / Livestock / Fisheries / Food security / Water management / Economic aspects / Rural poverty / Policy / Nutrient management / South East Asia / Cambodia / Laos / Thailand / Vietnam / Myanmar / China / Greater Mekong Subregion / Tonle Sap / Yunnan

Psychological Safety and Norm Clarity in Software Engineering Teams

In the software engineering industry today, companies primarily conduct their work in teams. To increase organizational productivity, it is thus crucial to know the factors that affect team effectiveness. Two team-related concepts that have gained prominence lately are psychological safety and team norms. Still, few studies exist that explore these in a software engineering context. Therefore, with the aim of extending the knowledge of these concepts, we examined if psychological safety and team norm clarity associate positively with software developers' self-assessed team performance and job satisfaction, two important elements of effectiveness. We collected industry survey data from practitioners (N = 217) in 38 development teams working for five different organizations. The result of multiple linear regression analyses indicates that both psychological safety and team norm clarity predict team members' self-assessed performance and job satisfaction. The findings also suggest that clarity of norms is a stronger (30\% and 71\% stronger, respectively) predictor than psychological safety. This research highlights the need to examine, in more detail, the relationship between social norms and software development. The findings of this study could serve as an empirical baseline for such, future work.Comment: Submitted to CHASE'201

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

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