Prevalence and determinants of anxiety and depression in end stage renal disease (ESRD). A comparison between ESRD patients with and without coexisting diabetes mellitus

Objective: To compare anxiety and/or depressive symptoms between patients with end-stage renal disease with and without comorbid diabetes and identify factors associated with symptoms of distress in this population. Methods: Data from two studies (conducted between 2010 and 2014) were pooled. A total of 526 patients on hemodialysis (68.8% with diabetes) completed the Hospital Anxiety and Depression Scale (HADS). Elevated symptoms were defined as HADS-Anxiety or HADS-Depression ≥ 8. Univariate and multivariate logistic regressions were used to estimate associations between diabetic status, and other socio-demographic and clinical factors with baseline clinical anxiety and depression. Results: A total of 233 (45.4%) reported elevated anxiety symptoms and 256 (49.9%) reported elevated depressive symptoms sufficient for caseness. Rates were not different between patients with and without diabetes. Risk for clinical depression was higher in patients who were single/unpartnered (OR = 1.828), Chinese vs. Malay (OR = 2.05), or had lower albumin levels (OR = 0.932). None of the parameters were associated with anxiety caseness. Conclusion: Sociocultural factors rather than comorbid burden may help identify patients at risk for depression. The high rates of anxiety and depression underlie the importance for monitoring and intervention in dialysis care

Simple model for decay of superdeformed nuclei

Recent theoretical investigations of the decay mechanism out of a superdeformed nuclear band have yielded qualitatively different results, depending on the relative values of the relevant decay widths. We present a simple two-level model for the dynamics of the tunneling between the superdeformed and normal-deformed bands, which treats decay and tunneling processes on an equal footing. The previous theoretical results are shown to correspond to coherent and incoherent limits of the full tunneling dynamics. Our model accounts for experimental data in both the A~150 mass region, where the tunneling dynamics is coherent, and in the A~190 mass region, where the tunneling dynamics is incoherent.Comment: 4 page

Spreading Width for Decay out of a Superdeformed Band

The attenuation factor F responsible for the decay out of a superdeformed (SD) band is calculated with the help of a statistical model. This factor is given by 1/F = (1 + Gamma(down) / Gamma(S)). Here, Gamma(S) is the width for the collective E2 transition within the superdeformed band, and Gamma(down) is the spreading width which describes the mixing between a state in the SD band and the normally deformed (ND) states of equal spin. The attenuation factor F is independent of the statistical E1 decay widths Gamma(N) of the ND states provided that the Gamma(N) are much larger than both Gamma(down) and Gamma(S). This condition is generically met. Previously measured values of F are used to determine Gamma(down).Comment: Submitted to Physical Review Letter

Route to nonlocality and observation of accessible solitons

We develop a general theory of spatial solitons in a liquid crystalline medium exhibiting a nonlinearity with an arbitrary degree of effective nonlocality. The model accounts the observability of "accessible solitons" and establishes an important link with parametric solitons.Comment: 4 pages, 2 figure

The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach

Background: This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the “Combined Diabetes and Renal Control Trial” (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. Methods: An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. Results: Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. Conclusions: The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients

Markers of Oxidative Damage Are Not Elevated in Otherwise Healthy Individuals With the Metabolic Syndrome

OBJECTIVE- The role of oxidative damage in the pathogenesis of metabolic syndrome is poorly understood. RESEARCH DESIGN AND METHODS- A detailed cross-sectional study was performed to assess the relationship between lipid oxidation products, γ-glutamyltransferase, highsensitivity C-reactive protein (hs-CRP), and phospholipase activities with respect to the metabolic status in a cohort of otherwise healthy individuals. RESULTS- A total of 179 individuals (87 men and 92 women) aged 43 ± 14 years (mean ± SD) participated in this study. There were no differences in the levels of plasma F 2-isoprostanes, hydroxyeicosatetraenoic acids, cholesterol oxidation products, and phospholipase activities in individuals with features of metabolic syndrome. In multivariate analyses, serum hs-CRP was a consistent independent predictor of metabolic syndrome. CONCLUSIONS- Minimal changes were observed in multiple markers of oxidative damage in a well-characterized cohort of individuals with features of metabolic syndrome. © 2010 by the American Diabetes Association.link_to_subscribed_fulltex

Spin-orbit driven band inversion in bilayer graphene by van der Waals proximity effect

Spin orbit coupling (SOC) is the key to realizing time-reversal invariant topological phases of matter. Famously, SOC was predicted by Kane and Mele to stabilize a quantum spin Hall insulator; however, the weak intrinsic SOC in monolayer graphene has precluded experimental observation. Here, we exploit a layer-selective proximity effect---achieved via van der Waals contact to a semiconducting transition metal dichalcogenide--to engineer Kane-Mele SOC in ultra-clean \textit{bilayer} graphene. Using high-resolution capacitance measurements to probe the bulk electronic compressibility, we find that SOC leads to the formation of a distinct incompressible, gapped phase at charge neutrality. The experimental data agrees quantitatively with a simple theoretical model in which the new phase results from SOC-driven band inversion. In contrast to Kane-Mele SOC in monolayer graphene, the inverted phase is not expected to be a time reversal invariant topological insulator, despite being separated from conventional band insulators by electric field tuned phase transitions where crystal symmetry mandates that the bulk gap must close. Electrical transport measurements, conspicuously, reveal that the inverted phase has a conductivity $\sim e^2/h$, which is suppressed by exceptionally small in-plane magnetic fields. The high conductivity and anomalous magnetoresistance are consistent with theoretical models that predict helical edge states within the inversted phase, that are protected from backscattering by an emergent spin symmetry that remains robust even for large Rashba SOC. Our results pave the way for proximity engineering of strong topological insulators as well as correlated quantum phases in the strong spin-orbit regime in graphene heterostructures.Comment: 7 pages of main text + 13 pages supplementary material and figures. More information available at http://www.afylab.com/publications

Robust filtering for a class of nonlinear stochastic systems with probability constraints

This paper is concerned with the probability-constrained filtering problem for a class of time-varying nonlinear stochastic systems with estimation error variance constraint. The stochastic nonlinearity considered is quite general that is capable of describing several well-studied stochastic nonlinear systems. The second-order statistics of the noise sequence are unknown but belong to certain known convex set. The purpose of this paper is to design a filter guaranteeing a minimized upper-bound on the estimation error variance. The existence condition for the desired filter is established, in terms of the feasibility of a set of difference Riccati-like equations, which can be solved forward in time. Then, under the probability constraints, a minimax estimation problem is proposed for determining the suboptimal filter structure that minimizes the worst-case performance on the estimation error variance with respect to the uncertain second-order statistics. Finally, a numerical example is presented to show the effectiveness and applicability of the proposed method

O-Glycosylation of snails

The glycosylation abilities of snails deserve attention, because snail species serve as intermediate hosts in the developmental cycles of some human and cattle parasites. In analogy to many other host-pathogen relations, the glycosylation of snail proteins may likewise contribute to these host-parasite interactions. Here we present an overview on the O-glycan structures of 8 different snails (land and water snails, with or without shell): Arion lusitanicus, Achatina fulica, Biomphalaria glabrata, Cepaea hortensis, Clea helena, Helix pomatia, Limax maximus and Planorbarius corneus. The O-glycans were released from the purified snail proteins by β-elimination. Further analysis was carried out by liquid chromatography coupled to electrospray ionization mass spectrometry and – for the main structures – by gas chromatography/mass spectrometry. Snail O-glycans are built from the four monosaccharide constituents: N-acetylgalactosamine, galactose, mannose and fucose. An additional modification is a methylation of the hexoses. The common trisaccharide core structure was determined in Arion lusitanicus to be N-acetylgalactosamine linked to the protein elongated by two 4-O-methylated galactose residues. Further elongations by methylated and unmethylated galactose and mannose residues and/or fucose are present. The typical snail O-glycan structures are different to those so far described. Similar to snail N-glycan structures they display methylated hexose residues