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

Sandpiles on multiplex networks

We introduce the sandpile model on multiplex networks with more than one type of edge and investigate its scaling and dynamical behaviors. We find that the introduction of multiplexity does not alter the scaling behavior of avalanche dynamics; the system is critical with an asymptotic power-law avalanche size distribution with an exponent $\tau = 3/2$ on duplex random networks. The detailed cascade dynamics, however, is affected by the multiplex coupling. For example, higher-degree nodes such as hubs in scale-free networks fail more often in the multiplex dynamics than in the simplex network counterpart in which different types of edges are simply aggregated. Our results suggest that multiplex modeling would be necessary in order to gain a better understanding of cascading failure phenomena of real-world multiplex complex systems, such as the global economic crisis.Comment: 7 pages, 7 figure

A system to enrich for primitive streak-derivatives, definitive endoderm and mesoderm, from pluripotent cells in culture

Two lineages of endoderm develop during mammalian embryogenesis, the primitive endoderm in the pre-implantation blastocyst and the definitive endoderm at gastrulation. This complexity of endoderm cell populations is mirrored during pluripotent cell differentiation in vitro and has hindered the identification and purification of the definitive endoderm for use as a substrate for further differentiation. The aggregation and differentiation of early primitive ectoderm-like (EPL) cells, resulting in the formation of EPL-cell derived embryoid bodies (EPLEBs), is a model of gastrulation that progresses through the sequential formation of primitive streak-like intermediates to nascent mesoderm and more differentiated mesoderm populations. EPL cell-derived EBs have been further analysed for the formation of definitive endoderm by detailed morphological studies, gene expression and a protein uptake assay. In comparison to embryoid bodies derived from ES cells, which form primitive and definitive endoderm, the endoderm compartment of embryoid bodies formed from EPL cells was comprised almost exclusively of definitive endoderm. Definitive endoderm was defined as a population of squamous cells that expressed Sox17, CXCR4 and Trh, which formed without the prior formation of primitive endoderm and was unable to endocytose horseradish peroxidase from the medium. Definitive endoderm formed in EPLEBs provides a substrate for further differentiation into specific endoderm lineages; these lineages can be used as research tools for understanding the mechanisms controlling lineage establishment and the nature of the transient intermediates formed. The similarity between mouse EPL cells and human ES cells suggests EPLEBs can be used as a model system for the development of technologies to enrich for the formation of human ES cell-derived definitive endoderm in the future.Sveltana Vassilieva, Hweee Ngee Goh, Kevin X. Lau, James N. Hughes, Mary Familari, Peter D. Rathjen and Joy Rathje

A box-covering algorithm for fractal scaling in scale-free networks

A random sequential box-covering algorithm recently introduced to measure the fractal dimension in scale-free networks is investigated. The algorithm contains Monte Carlo sequential steps of choosing the position of the center of each box, and thereby, vertices in preassigned boxes can divide subsequent boxes into more than one pieces, but divided boxes are counted once. We find that such box-split allowance in the algorithm is a crucial ingredient necessary to obtain the fractal scaling for fractal networks; however, it is inessential for regular lattice and conventional fractal objects embedded in the Euclidean space. Next the algorithm is viewed from the cluster-growing perspective that boxes are allowed to overlap and thereby, vertices can belong to more than one box. Then, the number of distinct boxes a vertex belongs to is distributed in a heterogeneous manner for SF fractal networks, while it is of Poisson-type for the conventional fractal objects.Comment: 12 pages, 11 figures, a proceedings of the conference, "Optimization in complex networks." held in Los Alamo

Safely dissolvable and healable active packaging films based on alginate and pectin

Extensive usage of long-lasting petroleum based plastics for short-lived application such as packaging has raised concerns regarding their role in environmental pollution. In this research, we have developed active, healable, and safely dissolvable alginate-pectin based biocomposites that have potential applications in food packaging. The morphological study revealed the rough surface of these biocomposite films. Tensile properties indicated that the fabricated samples have mechanical properties in the range of commercially available packaging films while possessing excellent healing effciency. Biocomposite films exhibited higher hydrophobicity properties compared to neat alginate films. Thermal analysis indicated that crosslinked biocomposite samples possess higher thermal stability in temperatures below 120 °C, while antibacterial analysis against E. coli and S. aureus revealed the antibacterial properties of the prepared samples against different bacteria. The fabricated biodegradable multi-functional biocomposite films possess various imperative properties, making them ideal for utilization as packaging material

Nonlocal evolution of weighted scale-free networks

We introduce the notion of globally updating evolution for a class of weighted networks, in which the weight of a link is characterized by the amount of data packet transport flowing through it. By noting that the packet transport over the network is determined nonlocally, this approach can explain the generic nonlinear scaling between the strength and the degree of a node. We demonstrate by a simple model that the strength-driven evolution scheme recently introduced can be generalized to a nonlinear preferential attachment rule, generating the power-law behaviors in degree and in strength simultaneously.Comment: 4 pages, 4 figures, final version published in PR

Utility of models to predict 28-day or 30-day unplanned hospital readmissions: an updated systematic review.

Objective: To update previous systematic review of predictive models for 28-day or 30-day unplanned hospital readmissions. Design: Systematic review. Setting/data source: CINAHL, Embase, MEDLINE from 2011 to 2015. Participants: All studies of 28-day and 30-day readmission predictive model. Outcome measures Characteristics of the included studies, performance of the identified predictive models and key predictive variables included in the models. Results: Of 7310 records, a total of 60 studies with 73 unique predictive models met the inclusion criteria. The utilisation outcome of the models included all-cause readmissions, cardiovascular disease including pneumonia, medical conditions, surgical conditions and mental health condition-related readmissions. Overall, a wide-range C-statistic was reported in 56/60 studies (0.21–0.88). 11 of 13 predictive models for medical condition-related readmissions were found to have consistent moderate discrimination ability (C-statistic ≥0.7). Only two models were designed for the potentially preventable/avoidable readmissions and had C-statistic >0.8. The variables ‘comorbidities’, ‘length of stay’ and ‘previous admissions’ were frequently cited across 73 models. The variables ‘laboratory tests’ and ‘medication’ had more weight in the models for cardiovascular disease and medical condition-related readmissions.Conclusions: The predictive models which focused on general medical condition-related unplanned hospital readmissions reported moderate discriminative ability. Two models for potentially preventable/avoidable readmissions showed high discriminative ability. This updated systematic review, however, found inconsistent performance across the included unique 73 risk predictive models. It is critical to define clearly the utilisation outcomes and the type of accessible data source before the selection of the predictive model. Rigorous validation of the predictive models with moderate-to-high discriminative ability is essential, especially for the two models for the potentially preventable/avoidable readmissions. Given the limited available evidence, the development of a predictive model specifically for paediatric 28-day all-cause, unplanned hospital readmissions is a high priority

Bioaccessibility of Carotenoids and Tocopherols in Marine Microalgae, Nannochloropsis sp. and Chaetoceros sp.

Microalgae can produce various natural products such as pigments, enzymes, unique fatty acids and vitamin that benefit humans. The objective of the study is to study the bioaccessibility of carotenoids (β-carotene and lycopene) and vitamin E (α- and β- tocopherol) of Nannochloropsis oculata and Chaetoceros calcitrans. Analyses were carried out for both the powdered forms of N. oculata and C. calcitrans, and the dried extract forms of N. oculata and C. calcitrans. In vitro digestion method together with RP-HPLC was used to determine the bioaccessibility of carotenoids and vitamin E for both forms of microalgae. Powdered form of N. oculata had the highest bioaccessibility of β-carotene (28.0 ± 0.6 g kg-1), followed by dried extract N. oculata (21.5 ± 1.1 g kg-1), dried extract C. calcitrans (16.9 ± 0.1 g kg-1), and powdered C. calcitrans (15.6 ± 0.1 g kg-1). For lycopene, dried extract of N. oculata had the highest bioaccessibility of lycopene (42.6 ± 1.1 g kg- 1), followed by dried extract C. calcitrans (41.9 ± 0.6 g kg-1), powdered C. calcitrans (39.7 ± 0.1 g kg-1) and powdered N. oculata (32.6 ± 0.7 g kg-1). Dried extract C. calcitrans had the highest bioaccessibility of α-tocopherol (72.1 ± 1.2 g kg-1). However, β-tocopherol was not detected in both dried extract and powdered form of C. calcitrans. In conclusion, all samples in their dried extract forms were found to have significantly higher bioaccessibilities than their powdered forms. This may be due to the disruption of the food matrix contributing to a higher bioaccessibility of nutrients shown by the dried extract form

Learning activation functions from data using cubic spline interpolation

Neural networks require a careful design in order to perform properly on a given task. In particular, selecting a good activation function (possibly in a data-dependent fashion) is a crucial step, which remains an open problem in the research community. Despite a large amount of investigations, most current implementations simply select one fixed function from a small set of candidates, which is not adapted during training, and is shared among all neurons throughout the different layers. However, neither two of these assumptions can be supposed optimal in practice. In this paper, we present a principled way to have data-dependent adaptation of the activation functions, which is performed independently for each neuron. This is achieved by leveraging over past and present advances on cubic spline interpolation, allowing for local adaptation of the functions around their regions of use. The resulting algorithm is relatively cheap to implement, and overfitting is counterbalanced by the inclusion of a novel damping criterion, which penalizes unwanted oscillations from a predefined shape. Experimental results validate the proposal over two well-known benchmarks.Comment: Submitted to the 27th Italian Workshop on Neural Networks (WIRN 2017

High-pressure spin shifts in the pseudogap regime of superconducting YBa2Cu4O8 as revealed by 17O NMR

A new NMR anvil cell design is used for measuring the influence of high pressure on the electronic properties of the high-temperature superconductor YBa$_2$Cu$_4$O$_8$ above the superconducting transition temperature $T_{\rm c}$. It is found that pressure increases the spin shift at all temperatures in such a way that the pseudo-gap feature has almost disappeared at 63 kbar. This change of the temperature dependent spin susceptibility can be explained by a pressure induced proportional decrease (factor of two) of a temperature dependent component, and an increase (factor of 9) of a temperature independent component, contrary to the effects of increasing doping. The results demonstrate that one can use anvil cell NMR to investigate the tuning of the electronic properties of correlated electronic materials with pressure.Comment: 4 pages, 4 figures, accepted for publication in Phys. Rev.