Patients' experiences of transitioning between different renal replacement therapy modalities : a qualitative study

BACKGROUND: Different kidney replacement therapy modalities are available to manage end-stage kidney disease, such as home-based dialysis, in-center hemodialysis, and kidney transplantation. Although transitioning between modalities is common, data on how patients experience these transitions are scarce. This study explores patients' perspectives of transitioning from a home-based to an in-center modality. METHODS: Patients transitioning from peritoneal dialysis to in-center hemodialysis were purposively selected. Semi-structured interviews were performed, digitally recorded, and transcribed verbatim. Data analysis, consistent with Charmaz' constructivist approach of grounded theory was performed. RESULTS: Fifteen patients (10 males; mean age 62 years) participated. The conditions of the transitioning process impacted the participants' experiences, resulting in divergent experiences and associated emotions. Some participants experienced a loss of control due to the therapy-related changes. Some felt tied down and having lost independence, whereas others stated they regained control as they felt relieved from responsibility. This paradox of control was related to the patient having or not having (1) experienced a fit of hemodialysis with their personal lifestyle, (2) a frame of reference, (3) higher care requirements, (4) insight into the underlying reasons for transitioning, and (5) trust in the healthcare providers. CONCLUSIONS: Care teams need to offer opportunities to elicit patients' knowledge and fears, dispel myths, forge connections with other patients, and visit the dialysis unit before transition to alleviate anxiety. Interventions that facilitate a sense of control should be grounded in the meaning that the disorder has for the person and how it impacts their sense of self

Crystallization and visible-near-infrared luminescence of Bi-doped gehlenite glass

Gehlenite glass microspheres, doped with a different concentration of Bi3+ ions (0.5, 1, 3 mol%), were prepared by a combination of solid-state reaction followed by flame synthesis. The prepared glass microspheres were characterized from the point of view of surface morphology, phase composition, thermal and photoluminescence (PL) properties by optical and scanning electron microscopy (SEM), X-ray diffraction (XRD), differential scanning calorimetry (DSC) and PL spectroscopy. The closer inspection of glass microsphere surface by SEM confirmed a smooth surface. This was further verified by XRD. The basic thermal characteristics of prepared glasses, i.e. Tg (glass transition temperature), Tx (onset of crystallization peak temperature), Tf (temperature of the inflection point of the crystallization peak) and Tp (maximum of crystallization peak temperature), were estimated from the DSC records. High-temperature XRD experiments in the temperature interval range 600–1100°C were also performed. The PL emission properties of prepared glasses and their polycrystalline analogues (glass crystallized at 1000°C for 10 h) were studied in the visible and near-infrared (NIR) spectral range. When excited at 300 nm, the glasses, as well as their polycrystalline analogues, exhibit broad emission in the visible spectral range from 350 to 650 nm centred at about 410–450 nm, corresponding to Bi3+ luminescence centres. The emission intensity of polycrystalline samples was found to be at least 30 times higher than the emission of their glass analogues. In addition, a weak emission band was observed around 775 nm under 300 nm excitation. This band was attributed to the presence of a minor amount of Bi2+ species in prepared samples. In the NIR spectral range, the broad band emission was observed in the spectral range of 1200–1600 nm with the maxima at 1350 nm. The chemistry of Bi and its oxidation state equilibrium in glasses and polycrystalline matrices is discussed in detail

Accurate measurements of Optical Turbulence with Sonic-anemometers

The minimization of optical turbulence in and around the dome is key to reach optimum performance on large telescopes equipped with adaptive optics. We present the method and preliminary results of in-situ measurements of optical measurements made using sonic-anemometers. We show the impact of correcting the raw data for aliasing, path averaging, pulse sequence delays and Taylors' hypothesis. Finally, we highlight the occurrence of non-Kolmogorov turbulence which complicates the quantitative impact of the measurements on the telescope's resolution

New insight into the causes, consequences, and correction of hematopoietic stem cell aging

Aging of hematopoietic stem cells (HSCs) is characterized by lineage bias, increased clonal expansion, and functional decrease. At the molecular level, aged HSCs typically display metabolic dysregulation, upregulation of inflammatory pathways, and downregulation of DNA repair pathways. Cellular aging of HSCs, driven by cell-intrinsic and cell-extrinsic factors, causes a predisposition to anemia, adaptive immune compromise, myelodys, plasia, and malignancy. Most hematologic diseases are strongly associated with age. But what is the biological foundation for decreased fitness with age? And are there therapeutic windows to resolve age-related hematopoietic decline? These questions were the focus of the International Society for Experimental Hematology (ISEH) New Investigator Committee Fall 2022 Webinar. This review touches on the latest insights from two leading laboratories into inflammatory- and niche-driven stem cell aging and includes speculation on strategies to prevent or correct age-related decline in HSC function

The Extrasolar Planet epsilon Eridani b - Orbit and Mass

Hubble Space Telescope observations of the nearby (3.22 pc), K2 V star epsilon Eridani have been combined with ground-based astrometric and radial velocity data to determine the mass of its known companion. We model the astrometric and radial velocity measurements simultaneously to obtain the parallax, proper motion, perturbation period, perturbation inclination, and perturbation size. Because of the long period of the companion, \eps b, we extend our astrometric coverage to a total of 14.94 years (including the three year span of the \HST data) by including lower-precision ground-based astrometry from the Allegheny Multichannel Astrometric Photometer. Radial velocities now span 1980.8 -- 2006.3. We obtain a perturbation period, P = 6.85 +/- 0.03 yr, semi-major axis, alpha =1.88 +/- 0.20 mas, and inclination i = 30.1 +/- 3.8 degrees. This inclination is consistent with a previously measured dust disk inclination, suggesting coplanarity. Assuming a primary mass M_* = 0.83 M_{\sun}, we obtain a companion mass M = 1.55 +/- 0.24 M_{Jup}. Given the relatively young age of epsilon Eri (~800 Myr), this accurate exoplanet mass and orbit can usefully inform future direct imaging attempts. We predict the next periastron at 2007.3 with a total separation, rho = 0.3 arcsec at position angle, p.a. = -27 degrees. Orbit orientation and geometry dictate that epsilon Eri b will appear brightest in reflected light very nearly at periastron. Radial velocities spanning over 25 years indicate an acceleration consistent with a Jupiter-mass object with a period in excess of 50 years, possibly responsible for one feature of the dust morphology, the inner cavity

Thirty Meter Telescope Site Testing I: Overview

As part of the conceptual and preliminary design processes of the Thirty Meter Telescope (TMT), the TMT site testing team has spent the last five years measuring the atmospheric properties of five candidate mountains in North and South America with an unprecedented array of instrumentation. The site testing period was preceded by several years of analyses selecting the five candidates, Cerros Tolar, Armazones and Tolonchar in northern Chile; San Pedro Martir in Baja California, Mexico and the 13 North (13N) site on Mauna Kea, Hawaii. Site testing was concluded by the selection of two remaining sites for further consideration, Armazones and Mauna Kea 13N. It showed that all five candidates are excellent sites for an extremely large astronomical observatory and that none of the sites stands out as the obvious and only logical choice based on its combined properties. This is the first article in a series discussing the TMT site testing project.Comment: Accepted for publication in PASP, April 2009 issu

Developing a Patient-Specific Maxillary Implant Using Additive Manufacturing and Design

Published Conference ProceedingsMaxillectomy is the surgical removal or resection of the maxilla or upper jaw bone. A total or partial maxillectomy can be performed depending on how far the tumour has spread. This paper will discuss a patient diagnosed with an aggressive tumour in half of the top jaw who had to undergo an operation to remove the hemi-maxilla and orbital floor. Due to the extent and complexity of the defect, it was decided to manufacture an anatomical model of the hard tissues for planning a possible laser-sintered titanium implant using Additive Manufacturing (AM). The CRPM had only two weeks to design and manufacture the titanium implant, due to the severity of the tumour. The anatomical model was sent to the surgeon to cut the nylon model where the bone resection was planned. Furthermore, the prosthodontist made a wax model of the planned titanium frame that was reverse- engineered and used as reference geometry in the design software.Materialise® design suite was used to design the patient-specific maxilla and cutting jig. The EOS M280 Direct Metal Laser Sintering (DMLS) system was instrumental in achieving the direct manufacturing of the bio-compatible titanium implant. The EOS P385 system was used to manufacture the pre-operation planning model as well as the cutting jig.The process chain followed to complete this case study will be discussed showing how this intervention improved the quality of life of a SA patient. Furthermore, the proposed paper and presentation will discuss the post-operation review of the patient showing the impact AM had in accelerating patient-specific implant manufacturing. The authors seek to claim a progressed level of maturity in the proposed manufacturing value chain. The claim is based on the successful completion of the analysis and synthesis of the problem , the validated proof-of-concept of the manufacturing process and the in-vivo implementation of the final product

Domain excitations in spin-Peierls systems

We study a model of a Spin-Peierls material consisting of a set of antiferromagnetic Heisenberg chains coupled with phonons and interacting among them via an inter-chain elastic coupling. The excitation spectrum is analyzed by bosonization techniques and the self-harmonic approximation. The elementary excitation is the creation of a localized domain structure where the dimerized order is the opposite to the one of the surroundings. It is a triplet excitation whose formation energy is smaller than the magnon gap. Magnetic internal excitations of the domain are possible and give the further excitations of the system. We discuss these results in the context of recent experimental measurements on the inorganic Spin-Peierls compound CuGeO$_3$Comment: 5 pages, 2 figures, corrected version to appear in Phys. Rev.