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

Forensic investigation of cooperative storage cloud service: Symform as a case study

Researchers envisioned Storage as a Service (StaaS) as an effective solution to the distributed management of digital data. Cooperative storage cloud forensic is relatively new and is an under-explored area of research. Using Symform as a case study, we seek to determine the data remnants from the use of cooperative cloud storage services. In particular, we consider both mobile devices and personal computers running various popular operating systems, namely Windows 8.1, Mac OS X Mavericks 10.9.5, Ubuntu 14.04.1 LTS, iOS 7.1.2, and Android KitKat 4.4.4. Potential artefacts recovered during the research include data relating to the installation and uninstallation of the cloud applications, log-in to and log-out from Symform account using the client application, file synchronization as well as their time stamp information. This research contributes to an in-depth understanding of the types of terrestrial artifacts that are likely to remain after the use of cooperative storage cloud on client devices

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

Navier-Stokes Analysis of the Flowfield Characteristics of an Ice Contaminated Aircraft Wing

An analytical study was performed as part of the NASA Lewis support of a National Transportation Safety Board (NTSB) aircraft accident investigation. The study was focused on the performance degradation associated with ice contamination on the wing of a commercial turbo-prop-powered aircraft. Based upon the results of an earlier numerical study conducted by the authors, a prominent ridged-ice formation on the subject aircraft wing was selected for detailed flow analysis using 2-dimensional (2-D), as well as, 3-dimensional (3-D) Navier-Stokes computations. This configuration was selected because it caused the largest lift decrease and drag increase among all the ice shapes investigated in the earlier study. A grid sensitivity test was performed to find out the influence of grid spacing on the lift, drag, and associated angle-of-attack for the maximum lift (C(sub lmax)). This study showed that grid resolution is important and a sensitivity analysis is an essential element of the process in order to assure that the final solution is independent of the grid. The 2-D results suggested that a severe stability and control difficulty could have occurred at a slightly higher angle-of-attack (AOA) than the one recorded by the Flight Data Recorder (FDR). This stability and control problem was thought to have resulted from a decreased differential lift on the wings with respect to the normal loading for the configuration. The analysis also indicated that this stability and control problem could have occurred whether or not natural ice shedding took place. Numerical results using an assumed 3-D ice shape showed an increase of the angle at which this phenomena occurred of about 4 degrees. As it occurred with the 2-D case, the trailing edge separation was observed but started only when the AOA was very close to the angle at which the maximum lift occurred

Health Behaviours and Its Associated Factors among Undergraduate Students in Kuala Lumpur, Malaysia

University students are asset of any nations for future development. Their current lifestyle practices, diet and physical activity can determine their future health. This study aims to assess health behaviours and its associated factors among undergraduate students from a public university in Malaysia. This cross-sectionalstudy was conducted between July to September 2015 among 1023 students using a structured questionnaire. The mean positive health practice score was 8.72/13 (±1.77). The most common positive health care practised was non-tobacco use while the least common was avoiding eating foods that contain fats and cholesterol. Year of study, self-perceived health status, internet addiction and self-perceived importance of taking health measures were significant predictors of health practice among the students. The odds ratios of 0.68, 0.49, and 0.57 indicate that the odds of students in year 2, 3 and 4, respectively practising positive health behaviours were 32% (1-0.68), 51% and 43% lower than those in Year 1. The odds of students who have self-perceived poor health status and those without Internet addiction were 95% and 25% lower in practising positive health behaviours compared to students who perceived themselves to have excellent health status and students with internet addiction, respectively. Students who perceived high importance of taking health measures were 1.77 times more likely to have positive health practices compared to those who have lower perceived importance of taking health measures. The findings of this study will enable development of targeted interventions to improve health behaviors among university students. Keywords: health behaviours, undergraduate students, lifestyle, Malaysi

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

A performance comparison of the contiguous allocation strategies in 3D mesh connected multicomputers

The performance of contiguous allocation strategies can be significantly affected by the distribution of job execution times. In this paper, the performance of the existing contiguous allocation strategies for 3D mesh multicomputers is re-visited in the context of heavy-tailed distributions (e.g., a Bounded Pareto distribution). The strategies are evaluated and compared using simulation experiments for both First-Come-First-Served (FCFS) and Shortest-Service-Demand (SSD) scheduling strategies under a variety of system loads and system sizes. The results show that the performance of the allocation strategies degrades considerably when job execution times follow a heavy-tailed distribution. Moreover, SSD copes much better than FCFS scheduling strategy in the presence of heavy-tailed job execution times. The results also show that the strategies that depend on a list of allocated sub-meshes for both allocation and deallocation have lower allocation overhead and deliver good system performance in terms of average turnaround time and mean system utilization

Na+/K+-ATPase α-subunit ( nkaα) isoforms and their mRNA expression levels, overall nkaαα protein abundance, and kinetic properties of Nka in the skeletal muscle and three electric organs of the electric eel, electrophorus electricus

10.1371/journal.pone.0118352PLoS ONE103e011835

Anti-tumor activity mediated by protein and peptide transduction of HIV viral protein R (Vpr)

Peptides that are capable of traversing the cell membrane, via protein transduction domains (PTDs), are attractive either directly as drugs or indirectly as carriers for the delivery of therapeutic molecules. One such PTD, a HIV-1 Tat derived peptide has successfully delivered a variety of "cargoes" including proteins, peptides and nucleic acids into cells. There also exists other naturally occurring membrane permeable peptides which have potential as PTDs. Specifically, one of the accessory proteins of HIV (viral protein R; i.e., Vpr), which is important in controlling viral pathogenesis, possesses cell transduction domain characteristics. Related to these characteristics, Vpr has also been demonstrated to induce cell cycle arrest and host/target cell apoptosis, suggesting a potential anticancer activity for this protein. In this report we assessed the ability of Vpr protein or peptides, with or without conjugation to a PTD, to mediate anti-cancer activity against several tumor cell lines. Specifically, several Vpr peptides spanning carboxy amino acids 65-83 induced significant (i.e., greater than 50%) in vitro growth inhibition/toxicity of murine B16.F10 melanoma cells. Likewise, in in vitro experiments with other tumor cell lines, conjugation of Vpr to the Tat derived PTD and transfection of this construct into cells enhanced the induction of in vitro apoptosis by this protein when compared to the effects of transfection of cells with unconjugated Vpr. These results underscore the potential for Vpr based reagents as well as PTDs to enhance anti-tumor activity, and warrants further examination of Vpr protein and derived peptides as potential therapeutic agents against progressive cell proliferative diseases such as cancer. ©2009 Landes Bioscience