Patterns of Hemodialysis Catheter Dysfunction Defined According to National Kidney Foundation Guidelines As Blood Flow <300 mL/min

Blood flow rate (BFR) <300 mL/min commonly is used to define hemodialysis catheter dysfunction and the need for interventions to prevent complications. The objective of this study was to describe patterns of unplanned BFR <300 mL/min during catheter hemodialysis using data from DaVita dialysis facilities and the United States Renal Data System. Patients were included if they received at least eight weeks of hemodialysis exclusively through a catheter between 08/04 and 12/06, and catheter hemodialysis was the first treatment modality following diagnosis of end-stage renal disease (first access), or it immediately followed at least one 30-day period of dialysis exclusively through a fistula or graft (replacement access). Actual BFR <300 mL/min despite a planned BFR ≥300 mL/min defined catheter dysfunction during each dialysis session. There were 3,364 patients, 268,363 catheter dialysis sessions, and 19,118 (7.1%) sessions with catheter dysfunction. Almost two-thirds of patients had ≥1 catheter dysfunction session, and 30% had ≥1 catheter dysfunction session per month. Patients with catheter as a replacement access had a higher rate of catheter dysfunction than those with a catheter as first access (hazard ratio: 1.13; P = 0.04). Catheter dysfunction affects almost one-third of catheter dialysis patients each month and two-thirds overall

A Deep VLA survey at 20cm of the ISO ELAIS survey regions

We have used the Very Large Array(VLA) in C configuration to carry out a sensitive 20cm radio survey of regions of sky that have been surveyed in the Far Infra-Red over the wavelength range 5-200 microns with ISO as part of the European Large Area ISO Survey(ELAIS). As usual in surveys based on a relatively small number of overlapping VLA pointings the flux limit varies over the area surveyed. The survey has a flux limit that varies from a 5$\sigma$ limit of 0.135mJy over an area of 0.12deg$^2$ to a 5$\sigma$ limit of 1.15mJy or better over the whole region covered of 4.22 deg$^2$. In this paper we present the radio catalogue of 867 sources. These regions of sky have previously been surveyed to shallow flux limits at 20cm with the VLA as part of the VLA D configuration NVSS(FWHM=45 arcsec) and VLA B configuration FIRST(FWHM=5 arcsec) surveys. We have carried out a a detailed comparison of the reliability of our own survey and these two independent surveys in order to assess the reliability and completeness of each survey.Comment: 19 pages, 24 figures, submitted to MNRAS, also available in http://www.ast.cam.ac.uk/~ciliegi/elais/paper

DOP17 Identification of biomarkers and mechanistic insight for upadacitinib in ulcerative colitis: Analysis of serum inflammatory mediators in the phase 2b U-ACHIEVE study

Abstract Background The U-ACHIEVE trial evaluated upadacitinib (UPA), an oral JAK1 selective inhibitor, in patients with moderately to severely active ulcerative colitis (UC). Patient-reported and endoscopic outcomes improved after UPA treatment. This analysis used pharmacodynamic profiling to link changes in serum biomarkers to changes in UC disease activity, and to assess the UPA mechanism of action in UC. Methods U-ACHIEVE (NCT02819635) was a randomised, double-blind, placebo (PBO)-controlled phase 2b clinical trial. Adults with an inadequate response, loss of response, or intolerance to corticosteroids, immunosuppressants, or biologic therapies were randomised to receive 7.5, 15, 30, or 45 mg UPA once daily or PBO for 8 weeks (weeks). Serum samples (baseline [BL], weeks 2, 4, and 8) were analysed by OLINK® inflammation panel (92 proteins) and by Singulex immunoassay for interleukin-1b (IL-1b), IL-17A, IL-17F, and IL-22. Protein-level changes were analysed by a mixed-effect model; BL protein level was adjusted as a covariate; treatment group, time point, and their interaction were included as fixed effects. Spearman rank-correlation coefficients were used to determine the relationship between changes of serum biomarker levels and improvements in adapted Mayo scores and endoscopic subscores. Multiplicity adjusted P values were calculated using 1000 runs of random permutations. Results Paired BL and week 8 serum samples were available from 114 patients (PBO, n = 17; UPA 7.5 mg, n = 21; UPA 15 mg, n = 21; UPA 30 mg, n = 29; UPA 45 mg, n = 26). UPA treatment reduced expression of pro-inflammatory mediators associated with immune cell migration, type I/II IFN responses, T-cell responses, macrophage and dendritic cell activity and increased expression of biomarkers associated with haematopoiesis, neuroprotection and mucosal repair in a dose-dependent manner. Improvements in adapted Mayo score, endoscopic subscore, and stool frequency correlated with increases in CX3CL1, DNER and FLt3L (p &lt; 0.05 for all). Endoscopic improvements correlated with reductions in OSM, and improvements in fatigue correlated with increases in CCL25 and NT-3. There was a substantial overlap in biomarkers modulated by UPA in patients with UC and Crohn's disease (Figure). Conclusion UPA modulated expression of serum pro-inflammatory mediators found in pathways associated with the pathogenesis of UC, including immune cell migration, type I/II IFN responses, T-cell responses, macrophage and dendritic cell activity, haematopoiesis, neuroprotection, and mucosal repair. Consistent correlations were observed between changes in biomarker expression and improvements in disease activity and symptoms of UC

Impact of Hemodialysis Catheter Dysfunction on Dialysis and Other Medical Services: An Observational Cohort Study

Practice guidelines define hemodialysis catheter dysfunction as blood flow rate (BFR) <300 mL/min. We conducted a study using data from DaVita and the United States Renal Data System to evaluate the impact of catheter dysfunction on dialysis and other medical services. Patients were included if they had ≥8 consecutive weeks of catheter dialysis between 8/2004 and 12/2006. Actual BFR <300 mL/min despite planned BFR ≥300 mL/min was used to define catheter dysfunction during each dialysis session. Among 9,707 patients, the average age was 62,53% were female, and 40% were black. The median duration of catheter dialysis was 190 days, and the cohort accounted for 1,075,701 catheter dialysis sessions. There were 70,361 sessions with catheter dysfunction, and 6,33 1 (65.2%) patients had at least one session with catheter dysfunction. In multivariate repeated measures analysis, catheter dysfunction was associated with increased odds of missing a dialysis session due to access problems (Odds ratio [OR] 2.50; P < 0.001), having an access-related procedure (OR 2.10; P < 0.001), and being hospitalized (OR 1.10; P = 0.001). Catheter dysfunction defined according to NKF vascular access guidelines results in disruptions of dialysis treatment and increased use of other medical services

The European Large Area ISO Survey: ELAIS

The European Large Area ISO Survey (ELAIS) has surveyed 12 square degrees of the sky at 15 and 90 microns, and subsets of this area at 6.75 and 175 microns, using the Infrared Space Observatory (ISO). This project was the largest single open time programme executed by ISO, taking 375 hours of data. A preliminary catalogue of more than 1000 galaxies has been produced. In this talk we describe the goals of the project, describe the follow-up programmes that are in progress, and present some first scientific results including a provisional number count analysis at 15 and 90 microns.Comment: 5 pages, 3 figures, 4 tables, to appear in 'The universe as seen by ISO', eds P.Cox and M.F.Kessler, 1998, UNESCO, Paris, ESA Special Publications Series (SP-427

A Spectroscopic Survey of the Galaxy Cluster CL 1358+62 at z=0.328

We present a spectroscopic survey of the rich, X-ray selected, galaxy cluster CL 1358+6245 at z=0.328. When our 173 new multi-slit spectra of cluster galaxies are combined with data from the literature, we produce a catalog of 232 cluster members in a region 10'x11' (3.5 Mpc x 3.8 Mpc) surrounding the brightest cluster galaxy. These data are used to study the structure and dynamics of the cluster and to examine the radial and velocity distributions as a function of spectral type. We classify the spectral types of the cluster members according to the strengths of the Balmer absorption lines (Hdelta, Hgamma, and Hbeta) and the [OII] 3727 Ang emission line.Comment: 29 pages, 14 figures, uses aas2pp4, Accepted for publication in Ap

The redshift-space two-point correlation functions of galaxies and groups in the Nearby Optical Galaxy sample

We use the two-point correlation function in redshift space, $\xi(s)$, to study the clustering of the galaxies and groups of the Nearby Optical Galaxy (NOG) sample, which is a nearly all-sky, complete, magnitude-limited sample of $\sim$7000 bright and nearby optical galaxies. The correlation function of galaxies is well described by a power law, $\xi(s)=(s/s_0)^{-\gamma}$, with slope $\gamma\sim1.5$ and $s_0\sim6.4 h^{-1}$Mpc (on scales $2.7 - 12 h^{-1}$Mpc), in agreement with previous results of several redshift surveys of optical galaxies. We confirm the existence of morphological segregation between early- and late-type galaxies and, in particular, we find a gradual decreasing of the strength of clustering from the S0 galaxies to the late-type spirals, on intermediate scales. Furthermore, luminous galaxies turn out to be more clustered than dim galaxies. The luminosity segregation, which is significant for both early- and late-type objects, starts to become appreciable only for galaxies brighter than $M_B\sim -19.5 + 5 \log h$ ($\sim 0.6 L^*$) and is independent on scale. The NOG group correlation functions are characterized by $s_0$-values ranging from $\sim 8 h^{-1}$ Mpc (for groups with at least three members) to $\sim10 h^{-1}$ Mpc (for groups with at least five members). The degree of group clustering depends on the physical properties of groups. Specifically, groups with greater velocity dispersions, sizes and masses tend to be more clustered than those with lower values of these quantities.Comment: Astrophysical Journal, in press, 72 pages, 16 eps figure

Thick tori around AGN: the case for extended tori and consequences for their X-ray and IR emission

Two families of models of dusty tori in AGNs (moderately thick and extended versus very thick and compact) are tested against available observations. The confrontation suggests that the former class better explains the IR broad-band spectra of both broad and narrow line AGNs, the anisotropy of the emission deduced by comparing IR properties of Seyfert 1 and 2 nuclei, the results of IR spectroscopy and those of high spatial resolution observations. There is however clear evidence for a broad distribution of optical depths. We also examine the relationship between IR and X-ray emission. The data support a view in which the matter responsible for the X-ray absorption is mostly dust free, lying inside the dust sublimation radius. The consequences of these results for the hard X-ray background as well as IR counts and background are discussed.Comment: 33 pages, 9 Postscript figures, to appear in ApJ, September 199

Preventing PTSD, depression and associated health problems in student paramedics: Protocol for PREVENT-PTSD, a randomised controlled trial of supported online cognitive training for resilience versus alternative online training and standard practice

This the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Introduction: Emergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an associated increased risk for physical health problems, which may be linked to specific immunological and endocrine markers or changes in relevant markers. Poor physical and mental health is costly to organisations, the National Health Service and society. Existing interventions aimed at reducing risk of mental ill health in this population are not very successful. More effective preventative interventions are urgently needed. We first conducted a large-scale prospective study of newly recruited student paramedics, identifying two cognitive factors (rumination and resilience appraisals) that predicted episodes of PTSD and MD over a 2-year period. We then developed internet-delivered cognitive training for resilience (iCT-R), a supported online intervention, to modify cognitive predictors. This protocol is for a randomised controlled trial to evaluate the efficacy of the resilience intervention. Methods and analysis: 570 student paramedics will be recruited from participating universities. They will be randomly allocated to iCT-R or to supported online training of an alternative, widely available intervention or to training-as-usual. Follow-up will occur after the intervention/standard practice period and at 6, 12 and 24 months. Primary outcomes include rates of PTSD and MD and subsydnromal PTSD and MD, measured by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Patient-Health Questionnaire-9 and the Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Secondary outcomes include measures of resilience, rumination, anxiety, psychological distress, well-being, salivary cortisol, plasma levels of C-reactive protein, smoking and alcohol use, weight gain, sleep problems, health-related quality of life, health resource utilisation and productivity. Ethics and dissemination: The Medical Sciences Inter-Divisional Research Ethics Committee at the University of Oxford granted approval, reference: R44116/RE001. The results will be published in a peer-reviewed journal. Access to raw data and participant information will be available only to members of the research team. Trial registration number ISRCTN16493616; Pre-results.Wellcome TrustMQ: Transforming Mental HealthNIHR: National Institute for Health Researc