Prevalence and determinants of anxiety and depression in end stage renal disease (ESRD). A comparison between ESRD patients with and without coexisting diabetes mellitus

Objective: To compare anxiety and/or depressive symptoms between patients with end-stage renal disease with and without comorbid diabetes and identify factors associated with symptoms of distress in this population. Methods: Data from two studies (conducted between 2010 and 2014) were pooled. A total of 526 patients on hemodialysis (68.8% with diabetes) completed the Hospital Anxiety and Depression Scale (HADS). Elevated symptoms were defined as HADS-Anxiety or HADS-Depression ≥ 8. Univariate and multivariate logistic regressions were used to estimate associations between diabetic status, and other socio-demographic and clinical factors with baseline clinical anxiety and depression. Results: A total of 233 (45.4%) reported elevated anxiety symptoms and 256 (49.9%) reported elevated depressive symptoms sufficient for caseness. Rates were not different between patients with and without diabetes. Risk for clinical depression was higher in patients who were single/unpartnered (OR = 1.828), Chinese vs. Malay (OR = 2.05), or had lower albumin levels (OR = 0.932). None of the parameters were associated with anxiety caseness. Conclusion: Sociocultural factors rather than comorbid burden may help identify patients at risk for depression. The high rates of anxiety and depression underlie the importance for monitoring and intervention in dialysis care

Spreading Width for Decay out of a Superdeformed Band

The attenuation factor F responsible for the decay out of a superdeformed (SD) band is calculated with the help of a statistical model. This factor is given by 1/F = (1 + Gamma(down) / Gamma(S)). Here, Gamma(S) is the width for the collective E2 transition within the superdeformed band, and Gamma(down) is the spreading width which describes the mixing between a state in the SD band and the normally deformed (ND) states of equal spin. The attenuation factor F is independent of the statistical E1 decay widths Gamma(N) of the ND states provided that the Gamma(N) are much larger than both Gamma(down) and Gamma(S). This condition is generically met. Previously measured values of F are used to determine Gamma(down).Comment: Submitted to Physical Review Letter

Route to nonlocality and observation of accessible solitons

We develop a general theory of spatial solitons in a liquid crystalline medium exhibiting a nonlinearity with an arbitrary degree of effective nonlocality. The model accounts the observability of "accessible solitons" and establishes an important link with parametric solitons.Comment: 4 pages, 2 figure

The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach

Background: This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the “Combined Diabetes and Renal Control Trial” (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. Methods: An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. Results: Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. Conclusions: The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients

Markers of Oxidative Damage Are Not Elevated in Otherwise Healthy Individuals With the Metabolic Syndrome

OBJECTIVE- The role of oxidative damage in the pathogenesis of metabolic syndrome is poorly understood. RESEARCH DESIGN AND METHODS- A detailed cross-sectional study was performed to assess the relationship between lipid oxidation products, γ-glutamyltransferase, highsensitivity C-reactive protein (hs-CRP), and phospholipase activities with respect to the metabolic status in a cohort of otherwise healthy individuals. RESULTS- A total of 179 individuals (87 men and 92 women) aged 43 ± 14 years (mean ± SD) participated in this study. There were no differences in the levels of plasma F 2-isoprostanes, hydroxyeicosatetraenoic acids, cholesterol oxidation products, and phospholipase activities in individuals with features of metabolic syndrome. In multivariate analyses, serum hs-CRP was a consistent independent predictor of metabolic syndrome. CONCLUSIONS- Minimal changes were observed in multiple markers of oxidative damage in a well-characterized cohort of individuals with features of metabolic syndrome. © 2010 by the American Diabetes Association.link_to_subscribed_fulltex

Robust filtering for a class of nonlinear stochastic systems with probability constraints

This paper is concerned with the probability-constrained filtering problem for a class of time-varying nonlinear stochastic systems with estimation error variance constraint. The stochastic nonlinearity considered is quite general that is capable of describing several well-studied stochastic nonlinear systems. The second-order statistics of the noise sequence are unknown but belong to certain known convex set. The purpose of this paper is to design a filter guaranteeing a minimized upper-bound on the estimation error variance. The existence condition for the desired filter is established, in terms of the feasibility of a set of difference Riccati-like equations, which can be solved forward in time. Then, under the probability constraints, a minimax estimation problem is proposed for determining the suboptimal filter structure that minimizes the worst-case performance on the estimation error variance with respect to the uncertain second-order statistics. Finally, a numerical example is presented to show the effectiveness and applicability of the proposed method

Low-energy electronic states of carbon nanocones in an electric field

«Non v’è salvezza al di fuori del mostruoso»; «la diserzione, intrinseca alla letteratura, diventa nel fantastico sfida blasfema, obiezione, tradimento»: in questi passi, lo scrittore italiano Giorgio Manganelli (1922-1990) riafferma la portata trasgressiva della sua opera, indicando nel superamento dei limiti razionali, del verosimile, dell’accettabile o, in altre parole, del narrabile la via per sottrarre la letteratura ad una funzione strumentale. Così, nel privilegiarla come atto di linguaggio e nel disimpegnarla da mansioni mimetico-realistiche, Manganelli la popola di esseri informi e metamorfici. Ad esempio, in opere quali Hilarotragoedia (1964) e Dall’inferno (1985) il mostruoso non si presenta come qualcosa di aberrante, ma piuttosto come il risultato di una sorta di teologia paradossale, in grado di sovvertire o burlare le grandi convenzioni umane. Partendo da tali questioni, l’articolo affronterà il tema del mostro quale infrazione e sovversione essenziali allo scardinamento di un orizzonte ermeneutico antropocentrico, come voleva, tra gli altri, Foucault. «There is no salvation beyond the monstrous»; «desertion, intrinsic to literature, becomes in the Fantastic a blasphemous challenge, objection and betrayal»: with these words, the Italian writer Giorgio Manganelli (1922-1990) reaffirms the transgression of his work. With the overcoming of rational limits, of the plausible, of the acceptable or, in other words, of the tellable, the writer illustrates the way to prevent the use of literature as an instrumental function. Therefore, by using literature as an act of speech and by disengaging it from its mimetic-realistic responsibilities, Manganelli populates it with shapeless and metamorphic beings. In works such as Hilarotragoedia (1964) and From Hell (1985), for example, the monstrous does not resemble something aberrant, but rather it represents a kind of paradoxical theology, capable of subverting or mocking the great human convictions. Starting from these questions, this paper will approach the subject of the monster as infringement and subversion essential for the disruption of a hermeneutic and anthropocentric horizon, as Foucault, among others, wished