Symptom Burden in Geriatric Hospitalized ESRD Patients: Quantifying symptoms to increase Nephrologist Awareness and use of Palliative Care Consultation

poster abstractBackground: End Stage Renal Disease (ESRD) patients have significant symptom burden. Reduced provider awareness of symptoms contributes to underutilization of symptom management resources. Hypothesis: We hypothesize that improved nephrologist awareness of symptoms will lead to symptom improvement. Methods: In this prospective, multicenter intervention study, 27 geriatric ESRD inpatients underwent symptom assessment using the modified Edmonton Symptom Assessment System (ESAS) at admission and 1 week post-discharge. Enrollees were sequentially randomized into 2 groups. In group 1, the nephrologist of each individual was provided baseline symptom assessment and not in group 2. Severity ratings were compared between in-hospital and post discharge scores as well as between the 2 groups. Results: 26 patients completed the study; 1 died. There were no significant differences in baseline characteristics and scores, except increased diabetes in Group 2(P = 0.03). For 70% of the total cohort physicians reported not being surprised if the patient died within a year. Among the total cohort, total ESAS scores improved between initial and follow-up assessments except for depression, anxiety, lack of appetite and nausea. The absolute change in total ESAS scores was 10.9 in group1 and 6.8 in group2 (NS). Among individual symptoms significant improvement was found in pain and itching in group 1 only. Drowsiness and dyspnea improved in both groups. There was one palliative care consult. Conclusions: Our findings reinforce the high symptom burden in geriatric ESRD patients. Residual symptoms post hospitalization and low utilization of palliative care resources is suggestive of a missed opportunity by nephrologists to address the high symptom burden at the inpatient encounter which is selective for sicker patients and/or inadequacy of dialysis to control these symptoms. The trend in improvement in pain and itching in group 1 may indicate better achievable symptom control if physician awareness is increased and simple pharmacological interventions are available

Survey of sediment quality in Sabine Lake, Texas and vicinity

The toxicity of sediments in Sabine Lake, Texas, and adjoining Intracoastal Waterway canals was determined as part of bioeffects assessment studies managed by NOAA’s National Status and Trends Program. The objectives of the survey were to determine: (1) the incidence and degree of toxicity of sediments throughout the study area; (2) the spatial patterns (or gradients) in chemical contamination and toxicity, if any, throughout the study area; (3) the spatial extent of chemical contamination and toxicity; and (4) the statistical relationships between measures of toxicity and concentrations of chemicals in the sediments. Surficial sediment samples were collected during August, 1995 from 66 randomly-chosen locations. Laboratory toxicity tests were performed as indicators of potential ecotoxicological effects in sediments. A battery of tests was performed to generate information from different phases (components) of the sediments. Tests were selected to represent a range in toxicological endpoints from acute to chronic sublethal responses. Toxicological tests were conducted to measure: reduced survival of adult amphipods exposed to solid-phase sediments; impaired fertilization success and abnormal morphological development in gametes and embryos, respectively, of sea urchins exposed to pore waters; reduced metabolic activity of a marine bioluminescent bacteria exposed to organic solvent extracts; and induction of a cytochrome P-450 reporter gene system in exposures to solvent extracts of the sediments. Chemical analyses were performed on portions of each sample to quantify the concentrations of trace metals, polynuclear aromatic hydrocarbons, and chlorinated organic compounds. Correlation analyses were conducted to determine the relationships between measures of toxicity and concentrations of potentially toxic substances in the samples. Based upon the compilation of results from chemical analyses and toxicity tests, the quality of sediments in Sabine Lake and vicinity did not appear to be severely degraded. Chemical concentrations rarely exceeded effects-based numerical guidelines, suggesting that toxicant-induced effects would not be expected in most areas. None of the samples was highly toxic in acute amphipod survival tests and a minority (23%) of samples were highly toxic in sublethal urchin fertilization tests. Although toxic responses occurred frequently (94% of samples) in urchin embryo development tests performed with 100% pore waters, toxicity diminished markedly in tests done with diluted pore waters. Microbial bioluminescent activity was not reduced to a great degree (no EC50 <0.06 mg/ml) and cytochrome P-450 activity was not highly induced (6 samples exceeded 37.1 ug/g benzo[a]pyrene equivalents) in tests done with organic solvent extracts. Urchin embryological development was highly correlated with concentrations of ammonia and many trace metals. Cytochrome P450 induction was highly correlated with concentrations of a number of classes of organic compounds (including the polynuclear aromatic hydrocarbons and chlorinated compounds). (PDF contains 51 pages

The Development of India’s Financial Inclusion Agenda—Some Lessons for Pakistan

Financial Inclusion has assumed a vital position in the Public Policy discourse of developing economies. Provision of financial services to the otherwise excluded strata of the society enhances their potential to climb the economic ladder of opportunity and prosperity. Access to financial services to the otherwise excluded impacts their quality of life and enables the less privileged to increase and diversify their incomes, improve their social and economic conditions. Due to lack of access to financial services, most poor households have to rely on their meagre savings or money lenders which limit their ability to actively participate and benefit from the development process. The main theoretical arguments that economic theory postulates regarding the failure of financial markets in percolating poor and rural areas are of informational asymmetries, difficulties in contract designing and enforcement, greater transaction costs. The demand side aspects may be low demand for such services, arising from illiteracy, less investment opportunities in rural areas and difficult loan contracts [Basu (2006)]. When households are access constrained with respect to financial services, it becomes one of the important reasons for persisting inequalities. Economic theory suggests that unrelenting inequalities has a negative impact on the long term growth prospects of an economy [World Bank (2007)]. While establishing causality between financial development and economic growth has been quite tedious, with no simple answers, the evidence of a strong link between financial development and economic growth has continued to rise [Gattoo and Akhtar (2014)]. The interest in the financial inclusion discourse across developing and developing world stems from the recognition that a strong and vibrant financial system does not necessarily imply increasing financial to all across the societal divide [Honohan (2003)]

Collaboration: Spirit of Supply Chain Management

The paper establishes the necessity for collaboration for effective supply chain management. We briefly explore some enablers and obstacles and propose the basic components of a strategy for enabling and overcoming these obstacles. Supporting technology for collaboration involves Supply Chain Management Software, Enterprise Resource Planning systems as well as the Internet for the communication platform. A brief discussion of the benefits that go beyond the bottom line, including customer demands and personalisation are noted

Agronav: Autonomous Navigation Framework for Agricultural Robots and Vehicles using Semantic Segmentation and Semantic Line Detection

The successful implementation of vision-based navigation in agricultural fields hinges upon two critical components: 1) the accurate identification of key components within the scene, and 2) the identification of lanes through the detection of boundary lines that separate the crops from the traversable ground. We propose Agronav, an end-to-end vision-based autonomous navigation framework, which outputs the centerline from the input image by sequentially processing it through semantic segmentation and semantic line detection models. We also present Agroscapes, a pixel-level annotated dataset collected across six different crops, captured from varying heights and angles. This ensures that the framework trained on Agroscapes is generalizable across both ground and aerial robotic platforms. Codes, models and dataset will be released at \href{https://github.com/shivamkumarpanda/agronav}{github.com/shivamkumarpanda/agronav}

A Fully Implicit Method for Robust Frictional Contact Handling in Elastic Rods

Accurate frictional contact is critical in simulating the assembly of rod-like structures in the practical world, such as knots, hairs, flagella, and more. Due to their high geometric nonlinearity and elasticity, rod-on-rod contact remains a challenging problem tackled by researchers in both computational mechanics and computer graphics. Typically, frictional contact is regarded as constraints for the equations of motions of a system. Such constraints are often computed independently at every time step in a dynamic simulation, thus slowing down the simulation and possibly introducing numerical convergence issues. This paper proposes a fully implicit penalty-based frictional contact method, Implicit Contact Model (IMC), that efficiently and robustly captures accurate frictional contact responses. We showcase our algorithm's performance in achieving visually realistic results for the challenging and novel contact scenario of flagella bundling in fluid medium, a significant phenomenon in biology that motivates novel engineering applications in soft robotics. In addition to this, we offer a side-by-side comparison with Incremental Potential Contact (IPC), a state-of-the-art contact handling algorithm. We show that IMC possesses comparable performance to IPC while converging at a faster rate.Comment: * Equal contribution. A video summarizing this work is available on YouTube: https://youtu.be/g0rlCFfWJ8

TERMINALIA CHEBULA: AN EPHEMERAL GLANCE

Herbal drugs represent a major allocation of all the recognized systems of health in the world. Also, the medicinal plants have been regarded as valuable and cheap sources of various phytoconstituents which are used extensively in the development of drugs against various diseases. Terminalia chebula, commonly called as black myrobalan, ink tree, or chebulic myrobalan, is a deciduous tree belonging to the family Combretaceae, has been regarded as one of the most important medicinal plants used in medicines of ayurveda, siddha, unani and homeopathy. Numbers of phytochemical constituents have been found to be associated with the drug such as tannins, chebulinic acid, ellagic acid, gallic acid, punicalagin and flavonoids. Moreover, Terminalia chebula has been well reported to possess antioxidant, antidiabetic, antibacterial, antiviral, antifungal, anticancerous, antiulcer, antimutagenic and wound healing activities. In addition, Terminalia chebula has been used extensively in the preparation of many Ayurvedic formulations for infectious diseases like chronic ulcer, leucorrhoea, pyorrhoea and fungal infections of the skin. The present review article has been designed to elucidate data on phytochemistry, pharmacognostic characters and pharmacological activities associated with Terminali

Protective Effects of Salivary Factors in Dental Caries in Diabetic Patients of Pakistan

Salivary factors have been studied for their effects on the process of dental caries in patients of diabetes mellitus type 2. In this study, protective role of salivary pH, salivary flow rate, and salivary calcium is assessed in the patients of diabetes mellitus type 2 with dental caries. The samples of saliva were collected from 400 patients of diabetes mellitus type 2 and 300 age- and sex- matched controls after getting informed consent. All the subjects were classified into four groups according to age. The severity of dental caries was counted by decayed, missed, and filled teeth (DMFT) score. The salivary pH, flow rate, and calcium levels were found to be low in patients as compared to controls. The levels of fasting blood sugar, HbA1c, and DMFT score were found to be significantly high in patients than controls. The glycemic factors were significantly correlated with salivary factors indicating their influence on progression of caries in diabetes. On the basis of findings, it is concluded that the suitable salivary pH and flow rate may be regarded as main protective factors against dental caries in diabetes. Optimum level of salivary calcium may be responsible for continuous supply of calcium to arrest the demineralization and help reduce the occurrence of dental caries