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

A novel route to phase formation of cobalt oxyhydrates using KMnO4 as an oxidizing agent

We have first succeefully synthesized the sodium cobalt oxyhydrate superconductors using KMnO4 as a de-intercalating and oxidizing agent. It is a novel route to form the superconductive phase of NaxCoO2.yH2O without resorting to the commonly used Br2/CH3CN solution. The role of the KMnO4 is to de-intercalate the Na+ from the parent compound Na0.7CoO2 and oxidize the Co ion as a result. The higher molar ratio of KMnO4 relative to the sodium content tends to remove more Na+ from the parent compound and results in a slight expansion of the c-axis in the unit cell. The superconducting transition temperature is 4.6-3.8 K for samples treated by the aqueous KMnO4 solution with the molar ratio of KMnO4 relative to the sodium content in the range of 0.3 and 2.29.Comment: 10 pages, 3 figure

Magnetic and Metal-Insulator Transitions in beta-Na0.5CoO2 and gamma-K0.5CoO2 -NMR and Neutron Diffraction Studies-

Co-oxides beta-Na0.5CoO2 and gamma-K0.5CoO2 have been prepared by the Na de-intercalation from alpha-NaCoO2 and by the floating-zone method, respectively. It has been found that successive phase transitions take place at temperatures Tc1 and Tc2 in both systems. The appearance of the internal magnetic field at Tc1 with decreasing temperature T indicates that the antiferromagnetic order exists at T < Tc1, as in gamma-Na0.5CoO2. For beta-Na0.5CoO2, the transition temperatures and the NMR parameters determined from the data taken for magnetically ordered state are similar to those of gamma-Na0.5CoO2, indicating that the difference of the stacking ways of the CoO2 layers between these systems do not significantly affect their physical properties. For gamma-K0.5CoO2, the quantitative difference of the physical quantities are found from those of beta- and gamma-Na0.5CoO2. The difference between the values of Tci (i = 1 and 2) of these systems might be explained by considering the distance between CoO2 layers.Comment: 8 pages, 14 figures, 1 Tabl

Thermal and Electrical Properties of gamma-NaxCoO2 (0.70 < x < 0.78)

We have performed specific heat and electric resistivity measurements of Na$_{x}$CoO$_{2}$ ($x=0.70$-0.78). Two anomalies have been observed in the specific heat data for $x=0.78$, corresponding to magnetic transitions at $T_{c}=22$ K and $T_{k}\simeq 9$ K reported previously. In the electrical resistivity, a steep decrease at $T_{c}$ and a bending-like variation at $T_{b}$(=120K for $x=0.78$) have been observed. Moreover, we have investigated the $x$-dependence of these parameters in detail. The physical properties of this system are very sensitive to $x$, and the inconsistent results of previous reports can be explained by a small difference in $x$. Furthermore, for a higher $x$ value, a phase separation into Na-rich and Na-poor domains occurs as we previously proposed, while for a lower $x$ value, from characteristic behaviors of the specific heat and the electrical resistivity at the low-temperature region, the system is expected to be in the vicinity of the magnetic instability which virtually exists below $x=0.70$.Comment: 4 pages (3 figures included) and an extra figure (gif), to be published in J. Phys. Soc. Jpn. 73 (9) with possible minor revision

Large enhancement of the thermopower in Nax_xCoO2_2 at high Na doping

Research on the oxide perovskites has uncovered electronic properties that are strikingly enhanced compared with those in conventional metals. Examples are the high critical temperatures of the cuprate superconductors and the colossal magnetoresistance in the manganites. The conducting layered cobaltate $\rm Na_xCoO_2$ displays several interesting electronic phases as $x$ is varied including water-induced superconductivity and an insulating state that is destroyed by field. Initial measurements showed that, in the as-grown composition, $\rm Na_xCoO_2$ displays moderately large thermopower $S$ and conductivity $\sigma$. However, the prospects for thermoelectric cooling applications faded when the figure of merit $Z$ was found to be small at this composition (0.6$<x<$0.7). Here we report that, in the poorly-explored high-doping region $x>$0.75, $S$ undergoes an even steeper enhancement. At the critical doping $x_p\sim$ 0.85, $Z$ (at 80 K) reaches values $\sim$40 times larger than in the as-grown crystals. We discuss prospects for low-temperature thermoelectric applications.Comment: 6 pages, 7 figure

Effect of Condensed Tannin in Lotus Corniculatus and Lotus Pedunculatus on Digestion of Rubisco in the Rumen

The in vitro precipitation of ribulose-1,5-bisphosphate carboxylase (Rubisco) by condensed tannin (CT) extracted from Lotus corniculatus and Lotus pedunculatus and the effect of these CT on the in vitro rumen degradation of Rubisco was used to compare the reactivity of these CT. The chemical structure of CT from Lotus corniculatus was homogenous with epicatechin stereochemistry and mostly procyanidin units. The CT from Lotus pedunculatus was heterogenous with mostly prodelphinidin units. The amount of CT required to precipitate all the Rubisco when total soluble leaf protein was incubated with CT from Lotus corniculatus and Lotus pedunculatus was similar. Although CT from both species were able to reduce the in vitro degradation of Rubisco, CT from Lotus corniculatus was less effective than CT from Lotus pedunculatus at reducing this degradation

Extended magic phase in twisted graphene multilayers

Theoretical and experimental studies have verified the existence of ``magic angles'' in twisted bilayer graphene, where the twist between layers gives rise to flat bands and consequently highly correlated phases. Narrow bands can also exist in multilayers with alternating twist angles, and recent theoretical work suggests that they can also be found in trilayers with twist angles between neighboring layers in the same direction. We show here that flat bands exist in a variety of multilayers where the ratio between twist angles is close to coprime integers. We generalize previous analyses, and, using the chiral limit for interlayer coupling, give examples of many combinations of twist angles in stacks made up of three and four layers which lead to flat bands. The technique we use can be extended to systems with many layers. Our results suggest that flat bands can exist in graphene multilayers with angle disorder, that is, narrow samples of turbostatic graphite.Comment: Main text: 4 pages, 4 figures -- Supplementary Material: 15 pages, 13 figure

IL-33 ameliorates Alzheimer’s disease-like pathology and cognitive decline

Alzheimer’s disease (AD) is a devastating condition with no known effective treatment. AD is characterized by memory loss as well as impaired locomotor ability, reasoning, and judgment. Emerging evidence suggests that the innate immune response plays a major role in the pathogenesis of AD. In AD, the accumulation of β-amyloid (Aβ) in the brain perturbs physiological functions of the brain, including synaptic and neuronal dysfunction, microglial activation, and neuronal loss. Serum levels of soluble ST2 (sST2), a decoy receptor for interleukin (IL)-33, increase in patients with mild cognitive impairment, suggesting that impaired IL-33/ST2 signaling may contribute to the pathogenesis of AD. Therefore, we investigated the potential therapeutic role of IL-33 in AD, using transgenic mouse models. Here we report that IL-33 administration reverses synaptic plasticity impairment and memory deficits in APP/PS1 mice. IL-33 administration reduces soluble Aβ levels and amyloid plaque deposition by promoting the recruitment and Aβ phagocytic activity of microglia; this is mediated by ST2/p38 signaling activation. Furthermore, IL-33 injection modulates the innate immune response by polarizing microglia/macrophages toward an antiinflammatory phenotype and reducing the expression of proinflammatory genes, including IL-1β, IL-6, and NLRP3, in the cortices of APP/PS1 mice. Collectively, our results demonstrate a potential therapeutic role for IL-33 in AD

NMR studies of Successive Phase Transitions in Na0.5CoO2 and K0.5CoO2

59Co- and 23Na-NMR measurements have been carried out on polycrystalline and c-axis aligned samples of Na0.5CoO2, which exhibits successive transitions at temperatures T = 87 K (= Tc1) and T = 53 K (= Tc2). 59Co-NMR has also been carried out on c-axis aligned crystallites of K0.5CoO2 with similar successive transitions at Tc1 ~ 60 K and Tc2 ~ 20 K. For Na0.5CoO2, two sets of three NMR lines of 23Na nuclei explained by considering the quadrupolar frequencies nuQ ~1.32 and 1.40 MHz have been observed above Tc1, as is expected from the crystalline structure. Rather complicated but characteristic variation of the 23Na-NMR spectra has been observed with varying T through the transition temperatures, and the internal fields at two crystallographically distinct Na sites are discussed on the basis of the magnetic structures reported previously. The internal fields at two distinct Co sites observed below Tc1 and the 591/T1-T curves of Na0.5CoO2 and K0.5CoO2 are also discussed in a comparative way.Comment: 7 pages, 10 figures, submitted to J. Phys. Soc. Jpn, correction is made in right colum of p6 (35th line) as K0.5CoO2-->Na0.5CoO