Chronic Care Model Staff Education and Adherence with End-Stage Renal Disease Patients

The management and treatment of chronic diseases, such as end-stage renal disease, is often unproductive because of patients\u27 poor adherence to treatment. The chronic care model toolkit is an Agency for Healthcare Research and Quality supported framework, associated with improved outcomes in patients living with chronic disease. The purpose of this project was to develop and plan an educational program using the chronic care model toolkit for the interdisciplinary clinical staff of a renal hemodialysis center. The goal of this project was to adapt team building between patients and their clinicians through the use of the chronic care model in order to improve patients\u27 adherence to treatment. The educational program materials were developed, including a plan for future implementation over 6 weeks in 2-hour twice-weekly sessions. Program planning accounted for the mixed roles and responsibilities of the interdisciplinary clinical team members, who will share their knowledge among the team and act as patient advisors. The pretest and posttest materials were developed from the toolkit Team Health Audit Questionnaire, which can be used to evaluate staff learning after the program is delivered. Existing clinical metrics are tracked through a Quality Assessment Performance Improvement measure, which will be used to evaluate potential long term influences of the program on patient adherence and outcomes. The project may contribute to social change in practice by enhancing teamwork that has the potential to improve clinical outcomes. Future research should include longitudinal studies on team building using the chronic care model toolkit to determine if its adaption enhances team effort and contributes to a collaborative workforce that improves clinical outcomes

Investigation of the relation between local diffusivity and local inherent structures in the Kob-Andersen Lennard-Jones model

We analyze one thousand independent equilibrium trajectories of a system of 155 Lennard Jones particles to separate in a model-free approach the role of temperature and the role of the explored potential energy landscape basin depth in the particle dynamics. We show that the diffusion coefficient $D$ can be estimated as a sum over over contributions of the sampled basins, establishing a connection between thermodynamics and dynamics in the potential energy landscape framework. We provide evidence that the observed non-linearity in the relation between local diffusion and basin depth is responsible for the peculiar dynamic behavior observed in supercooled states and provide an interpretation for the presence of dynamic heterogeneities.Comment: minor text changes, references adde

Survival Probability in Patients with Sickle Cell Anemia Using the Competitive Risk Statistical Model.

The clinical picture of patients with sickle cell anemia (SCA) is associated with several complications some of which could be fatal. The objective of this study is to analyze the causes of death and the effect of sex and age on survival of Brazilian patients with SCA. Data of patients with SCA who were seen and followed at HEMORIO for 15 years were retrospectively collected and analyzed. Statistical modeling was performed using survival analysis in the presence of competing risks estimating the covariate effects on a sub-distribution hazard function. Eight models were implemented, one for each cause of death. The cause-specific cumulative incidence function was also estimated. Males were most vulnerable for death from chronic organ damage (p = 0.0005) while females were most vulnerable for infection (p=0.03). Age was significantly associated (p ≤ 0.05) with death due to acute chest syndrome (ACS), infection, and death during crisis. The lower survival was related to death from infection, followed by death due to ACS. The independent variables age and sex were significantly associated with ACS, infection, chronic organ damage and death during crisis. These data could help Brazilian authorities strengthen public policies to protect this vulnerable population

Does More Money Make You Fat? The Effects of Quasi-Experimental Income Transfers on Adolescent and Young Adult Obesity

This paper examines how exogenous income transfers during adolescence affect contemporaneous body mass index (BMI) measures and young adult obesity rates using evidence from the Great Smoky Mountains Study of Youth. The effects of extra income differ depending on the households’ initial socio-economic status, tracing out an inverted U-shaped relationship between initial income and BMI. Youths who resided in families that had high pre-treatment annual incomes experience no change in young adult obesity rates as a result of the income transfers, while the BMI of poorer children increases. Part of this effect is due to differential increases in height, as well as weight. An exogenous annual transfer of $4,000 per adult family member results in an almost 4 cm gain in height-for-age. Adolescents coming from worse-off households experience an increase in weight only, without the corresponding change in height. The cumulative effects of the increase in household income persist for several years into young adulthood.obesity, health, cash transfer, adolescents, indigenous peoples

Konvergensi Harga Pangan Pokok Antar Wilayah di Indonesia

In Indonesia, the increase in food prices usually results in the rise in the inflation rate. To cope with this problem, a better food distribution among regionsis absolutely required. This study aimed to describe the dynamics of food prices, to test the convergence level of food prices and to analyze the factors that influence the changes in food prices between regions in Indonesia. The data used were obtained from the Central Agency of Statistics and the Ministry of Agriculture from 2002 to 2010. The method used was analysis of dynamic panel data (First Difference-Generalized Methode Moment/FD-GMM). The results of the study showed that all commodities of food prices were convergent, sugar at the highest level and rice at the lowest, while the factors that influence changes in food prices were production rate, Gross Domestic Product (GDP) and population

Physics of Earth’s Radiation Belts

This open access book serves as textbook on the physics of the radiation belts surrounding the Earth. Discovered in 1958 the famous Van Allen Radiation belts were among the first scientific discoveries of the Space Age. Throughout the following decades the belts have been under intensive investigation motivated by the risks of radiation hazards they expose to electronics and humans on spacecraft in the Earth’s inner magnetosphere. This textbook teaches the field from basic theory of particles and plasmas to observations which culminated in the highly successful Van Allen Probes Mission of NASA in 2012-2019. Using numerous data examples the authors explain the relevant concepts and theoretical background of the extremely complex radiation belt region, with the emphasis on giving a comprehensive and coherent understanding of physical processes affecting the dynamics of the belts. The target audience are doctoral students and young researchers who wish to learn about the physical processes underlying the acceleration, transport and loss of the radiation belt particles in the perspective of the state-of-the-art observations

Magnetic cloud prediction model for forecasting space weather relevant properties of Earth-directed coronal mass ejections

Context. Coronal mass ejections (CMEs) are major eruptive events on the Sun that result in the ejection of large-scale magnetic clouds (MCs) in interplanetary space, consisting of plasma with enhanced magnetic fields whose direction changes coherently when measured in situ. The severity of CME-induced geomagnetic perturbations and space weather impacts depends on the direction and strength of the interplanetary magnetic field (IMF), as well as on the speed and duration of the passage of the magnetic cloud associated with the storm. The coupling between the heliospheric environment and Earth's magnetosphere is strongest when the IMF direction is persistently southward (i.e. negative B-z) for a prolonged period. Predicting the magnetic profile of such Earth-directed CMEs is therefore critical for estimating their space weather consequences; this remains an outstanding challenge, however. Aims. Our aim is to build upon and integrate diverse techniques towards the development of a comprehensive magnetic cloud prediction (MCP) model that can forecast the magnetic field vectors, Earth-impact time, speed, and duration of passage of solar storms. Methods. The configuration of a CME is approximated as a radially expanding force-free cylindrical structure. Combining near-Sun geometrical, magnetic, and kinematic properties of CMEs with the probabilistic drag-based model and cylindrical force-free model, we propose a method for predicting the Earth-arrival time, propagation speed, and magnetic vectors of MCs during their passage through 1 AU. Our model is able to predict the passage duration of the storm without recourse to computationally intensive time-dependent dynamical equations. Results. Our method is validated by comparing the MCP model output with observations of ten MCs at 1 AU. In our sample, we find that eight MCs show a root mean square (rms) deviation smaller than 0.1 between the predicted and observed magnetic profiles, and the passage durations of seven MCs fall within the predicted range. Conclusions. Based on the success of this approach, we conclude that predicting the near-Earth properties of MCs based on an analysis and modelling of near-Sun CME observations is a viable endeavour with potential applications for the development of early-warning systems for space weather and enabling mitigation strategies.Peer reviewe

Control of VEGF-A transcriptional programs by pausing and genomic compartmentalization.

Vascular endothelial growth factor A (VEGF-A) is a master regulator of angiogenesis, vascular development and function. In this study we investigated the transcriptional regulation of VEGF-A-responsive genes in primary human aortic endothelial cells (HAECs) and human umbilical vein endothelial cells (HUVECs) using genome-wide global run-on sequencing (GRO-Seq). We demonstrate that half of VEGF-A-regulated gene promoters are characterized by a transcriptionally competent paused RNA polymerase II (Pol II). We show that transition into productive elongation is a major mechanism of gene activation of virtually all VEGF-regulated genes, whereas only ∼40% of the genes are induced at the level of initiation. In addition, we report a comprehensive chromatin interaction map generated in HUVECs using tethered conformation capture (TCC) and characterize chromatin interactions in relation to transcriptional activity. We demonstrate that sites of active transcription are more likely to engage in chromatin looping and cell type-specific transcriptional activity reflects the boundaries of chromatin interactions. Furthermore, we identify large chromatin compartments with a tendency to be coordinately transcribed upon VEGF-A stimulation. We provide evidence that these compartments are enriched for clusters of regulatory regions such as super-enhancers and for disease-associated single nucleotide polymorphisms (SNPs). Collectively, these findings provide new insights into mechanisms behind VEGF-A-regulated transcriptional programs in endothelial cells