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

Development of a Friction Rig and Experimental Results

The development of a friction rig, which is integrated into a milling machine for testing the frictional characteristics of various types of materials and specimen shapes are described. This is followed by the experimental technique used to measure the friction coefficient for different experimental conditions. The results obtained indicate the frictional coefficient obtained changes with the specimen type, contact area and lubrication condition. The results obtained are also compared to available published results. The discussions and conclusions related to the development and experimental results are finally presented

Synthesis and characterization of Na03RhO206H2O - a semiconductor with a weak ferromagnetic component

We have prepared the oxyhydrate Na03RhO206H2O by extracting Na+ cations from NaRhO2 and intercalating water molecules using an aqueous solution of Na2S2O8. Synchrotron X-ray powder diffraction, thermogravimetric analysis (TGA), and energy-dispersive x-ray analysis (EDX) reveal that a non-stoichiometric Na03(H2O)06 network separates layers of edge-sharing RhO6 octahedra containing Rh3+(4d6, S=0) and Rh4+ (4d5, S=1/2). The resistivities of NaRhO2 and Na03RhO206H2O (T < 300) reveal insulating and semi-conducting behavior with activation gaps of 134 meV and 7.8 meV, respectively. Both Na03RhO206H2O and NaRhO2 show paramagnetism at room temperature, however, the sodium-deficient sample exhibits simultaneously a weak but experimentally reproducible ferromagnetic component. Both samples exhibit a temperature-independent Pauli paramagnetism, for NaRhO2 at T > 50 K and for Na03RhO206H2O at T > 25 K. The relative magnitudes of the temperature-independent magnetic susceptibilities, that of the oxide sample being half that of the oxyhydrate, is consistent with a higher density of thermally accessible electron states at the Fermi level in the hydrated sample. At low temperatures the magnetic moments rise sharply, providing evidence of localized and weakl -ordered electronic spins.Comment: 15 fages 5 figures Solid State Communications in prin

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

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

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

Transport and Magnetic Studies on the Spin State Transition of Pr1-xCaxCoO3 up to High Pressure

Transport and magnetic measurements and structural and NMR studies have been carried out on (Pr1-yR'y)1-xAxCoO3 {R'=(rare earth elements and Y); A=(Ca, Ba and Sr)} at ambient pressure or under high pressure. The system exhibits a phase transition from a nearly metallic to an insulating state with decreasing temperature T, where the low spin (LS) state of Co3+ is suddenly stabilized. For y=0, we have constructed a T-x phase diagram at various values of the external pressure p. It shows that the (T, x) region of the low temperature phase, which is confined to a very narrow region around x=0.5 at ambient pressure, expands as p increases, suggesting that the transition is not due to an order-disorder type one. For the occurrence of the transition, both the Pr and Ca atoms seem to be necessary. The intimate relationship between the local structure around the Co ions and the electronic (or spin) state of Co3+ ions is discussed: For the smaller unit cell volume or the smaller volume of the CoO6 octahedra and for the larger tilting angle of the octahedra, the temperature of the transition becomes higher. The role of the carriers introduced by the doping of the A atoms, is also discussed. By analyzing the data of 59Co-NMR spectra and magnetic susceptibilities of Pr1-xCaxCoO3 the energy separations among the different spin states of Co3+ and Co4+ are roughly estimated.Comment: 15 pages, 15 figures, 2 tables, submitted to J. Phys. Soc. Jp

Applicability of Solar Airflow Windows

Accurate prediction of the performance of Solar Air Windows (SAWs) operating in various climates under real conditions has not been investigated. This paper reports the results of numerical simulations of SAWs carried out using ANSYS-CFX considering real boundary conditions. In order to determine the feasibility of SAWs, their performance has been examined in two similar office buildings located at two different climates. Each building has 30% of its south facing wall covered with SAWs in the spandrel areas. The results of the numerical simulations of the SAW operating in supply mode in January indicated that that for an office building located in Ottawa, Canada, 6% of its ventilation load and 12% of its heating load could be supplied by SAWs during a sunny day. Operating in exhaust mode in June, SAWs could be used to provide about 14% of the ventilation load of the office building located in Dubai, UAE

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

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