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

Design Enhancement of Biomedical Scaffolds Made By Selective Laser Melting

Selective laser melting (SLM) is increasingly used to fabricate biomedical scaffolds. However, the intrinsic specifications of the process such as laser spot size, layer thickness, and particle size limit the production accuracy, altering the geometrical characteristics and mechanical properties of the scaffolds. This work attempts to assess and improve the mechanical properties of TiAl6V4 biomedical scaffolds by eliminating/modifying the sharp and thin nodes (as the main source of stress concentrations and lowering the mechanical properties). This is carried out through a gradual increase of the beam (strut) thickness around the nodes where corresponding struts meet. The compression performance of these scaffolds was assessed and compared to common examples (unaltered struts) and to scaffolds designed with thicker struts in the centre of the beams (demonstrating the largest contrast). The findings prove that the thickening of the nodal points improves the strain distribution while maintains the mechanical properties at an identical solid volume fraction. This can be used to improve the scaffold design by a gradual strut thickness (in a comparable volume fraction) for an improved bio-mechanical performance.Mechanical Engineerin

Rheological behavior of β-Ti and NiTi powders produced by atomization for SLM production of open porous orthopedic implants

The growing interest for Selective Laser Melting (SLM) in orthopedic implant manufacturing is accompanied by the introduction of novel Ti alloys, in particular β-Ti for their excellent corrosion resistance as well as favorable combination of high mechanical strength, fatigue resistance and relatively low elastic modulus. As part of the SLM process for producing quality β-Ti parts powder flowability is essential to achieve uniform thickness of powder layers. In this work the flowability of different gas atomized β-Ti, including NiTi, powders has been studied. Their rheological properties were compared to those of commercially available plasma-atomized Ti–6Al–4V powder using a newly developed semi-automatic experimental set-up. Not only the particle size, shape and size distribution of the powders display a large influence on the powder flowability but also particle surface properties such as roughness, chemical composition and the presence of liquid on the surface of the particles. It was found that plasma or gas atomization production techniques for SLM powder have a considerable effect on the particle topography. Among the powders studied regarding SLM applicability only rheological properties of the fine size fraction (25–45 μm) of Ti–45Nb didn't conform to SLM processing requirements. To improve flowability of the Ti–45Nb powder itwas annealed both in air and argon atmosphere at 600 °C during 1 h, resulting in an improved rheological behavior suitable for SLM processing

No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia : a pre-planned subgroup analysis of the seven-country PACE trial

Background: 'PACE Steps to Success' is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents' comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying-End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (- 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (- 0.6; p = 0.741), non-advanced and without dementia (- 1.5; p = 0.428), and advanced and non-advanced dementia (0.9; p = 0.632). Conclusions: The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents' comfort, this program needs further development

AMBRA1 is able to induce mitophagy via LC3 binding, regardless of PARKIN and p62/SQSTM1

Damaged mitochondria are eliminated by mitophagy, a selective form of autophagy whose dysfunction associates with neurodegenerative diseases. PINK1, PARKIN and p62/SQTMS1 have been shown to regulate mitophagy, leaving hitherto ill-defined the contribution by key players in 'general' autophagy. In basal conditions, a pool of AMBRA1 - an upstream autophagy regulator and a PARKIN interactor - is present at the mitochondria, where its pro-autophagic activity is inhibited by Bcl-2. Here we show that, upon mitophagy induction, AMBRA1 binds the autophagosome adapter LC3 through a LIR (LC3 interacting region) motif, this interaction being crucial for regulating both canonical PARKIN-dependent and -independent mitochondrial clearance. Moreover, forcing AMBRA1 localization to the outer mitochondrial membrane unleashes a massive PARKIN- and p62-independent but LC3-dependent mitophagy. These results highlight a novel role for AMBRA1 as a powerful mitophagy regulator, through both canonical or noncanonical pathways

Expressed emotion in professional relationships

Purpose of review: Expressed emotion refers to the amount of critical comments, hostility or emotional overinvolvement of a caregiver towards clients with severe and enduring psychiatric disorders. In family members, it is a well-established measure to assess the affective climate, and is a good and reliable predictor of patients' functioning. Expressed emotion research has recently been expanded towards formal relationships. This paper reviews the existing expressed emotion literature in relationships between professional caregivers and their clients. Recent findings: The findings confirm that in professional caregivers, high expressed emotion attitudes can be present and that these attitudes can also have a significant influence on outcomes. Although professional caregivers; are not usually emotionally overinvolved, 'role confusion' does exist. The limited information concerning correlates with expressed emotion suggests that expressed emotion is related to the clients' level of functioning and with the amount of openness and internal attribution from the professionals' perspective. As for families, training intervention programmes for professionals were developed that aimed to lower the amount of expressed emotion. Summary: Compared with the expressed emotion research in family relationships, this research line is still in its infancy. However, the expressed emotion construct seems to be very useful to chart the emotional climate between clients and professional caregivers. The future of the construct of expressed emotion in this field will probably depend upon the possibility of predicting the wellbeing, the functioning and the relapse of clients.status: publishe