Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: An interview study

Objective To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Design Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. Setting 21 haemodialysis centres across Australia. Participants 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. Results Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). Conclusions Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient-clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis

Estradiol valerate and dienogest: a new approach to oral contraception

Most combination oral contraceptives contain ethinyl estradiol and a progestin. A new and novel oral contraceptive formulation combines estradiol valerate (E2V) with dienogest (DNG) in a four-phase dosing regimen. 17β-estradiol is a naturally-occurring estrogen, and a contraceptive pill containing such an estrogen offers potential benefits with regard to metabolic side effects and adverse events. Dienogest is derived from 19-nortestosterone and exerts profound progestational effects on the endometrium, but it differs from other progestins in its class by its antiandrogenic activity. Estradiol valerate plus dienogest (E2V/DNG) is now available in a four-phasic regimen that integrates an estrogen stepdown and progestin stepup dosing approach along with a short two-day hormone-free interval. This regimen offers safe, reliable contraception and has been shown to be an effective treatment for heavy menstrual bleeding. Metabolic effects and adverse events appear similar to those reported with oral contraceptives containing ethinyl estradiol

Acoustic and Thermal Testing of an Integrated Multilayer Insulation and Broad Area Cooling Shield System

A Multilayer Insulation (MLI) and Broad Area Cooling (BAC) shield thermal control system shows promise for long-duration storage of cryogenic propellant. The NASA Cryogenic Propellant Storage and Transfer (CPST) project is investigating the thermal and structural performance of this tank-applied integrated system. The MLI/BAC Shield Acoustic and Thermal Test was performed to evaluate the MLI/BAC shield's structural performance by subjecting it to worst-case launch acoustic loads. Identical thermal tests using Liquid Nitrogen (LN2) were performed before and after the acoustic test. The data from these tests was compared to determine if any degradation occurred in the thermal performance of the system as a result of exposure to the acoustic loads. The thermal test series consisted of two primary components: a passive boil-off test to evaluate the MLI performance and an active cooling test to evaluate the integrated MLI/BAC shield system with chilled vapor circulating through the BAC shield tubes. The acoustic test used loads closely matching the worst-case envelope of all launch vehicles currently under consideration for CPST. Acoustic test results yielded reasonable responses for the given load. The thermal test matrix was completed prior to the acoustic test and successfully repeated after the acoustic test. Data was compared and yielded near identical results, indicating that the MLI/BAC shield configuration tested in this series is an option for structurally implementing this thermal control system concept

eHealth interventions for people with chronic kidney disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of using eHealth interventions in the CKD population

Interventions for improving health literacy in people with chronic kidney disease

This is the protocol for a review and there is no abstract. The objectives are as follows: This review aims to look at the benefits and harms of interventions for improving health literacy in patients with CKD

Rural Schools' Mental Health Needs

This is the publisher's official version. It is also available electronically from: http://dx.doi.org/10.1037/h0095970.Rural schools often can not provide the same access to mental health service as schools in larger population areas can.. Understanding the implications of these sometimes limited services is important in overcoming barriers to adequate services for those in rural areas. This study surveyed a national sample of (n = 80) teachers, administrators, and other school professionals serving rural schools about their perceptions of mental health needs, available services, and barriers to services. The results indicate that respondents perceive needs as generally met, although available services across a variety of areas are not readily accessible. Barriers to meeting those needs include staff turnover rate and lack of funding. Suggestions for addressing these issues are considered

Thermophysical properties of Co-free WC-FeCr hardmetals

Fe-Cr alloys can potentially replace carcinogenic Co as the binder system in WC-hardmetals. Furthermore, they may be used in emerging applications such as nuclear fusion reactor shielding, where use of Co is forbidden due to the formation of hazardous activated species. In such applications, a good understanding of thermophysical properties is critical to predicting high temperature performance. By combining several thermal analysis techniques (dilatometry, laser flash and calorimetry) we have determined the thermal conductivity and thermal expansivity of several grades of WC-FeCr hardmetals between room temperature and 1200 °C. In these materials the WC grain size was varied between 0.2 and 5 microns. The binder content was kept constant at 10 wt.%, and the nominal binder composition was Fe-8 wt.% Cr. The room temperature thermal conductivities of these materials varied between about 50 and 110 W/m-K, which are similar values to analogous WC-Co materials. Thermal expansion curves exhibited discontinuous shrinkage events at about 850 °C, due to an allotropic phase transition within the FeCr binder between its BCC and FCC structures. The magnitude of the shrinkage was about a third that predicted by the rule-of-mixtures, suggesting significant internal stresses could be generated during the transformation. Such internal stresses could affect the properties of WC-FeCr hardmetals when operating at high temperature

Targeted, structured text messaging to improve dietary and lifestyle behaviours for people on maintenance haemodialysis (KIDNEYTEXT): Study protocol for a randomised controlled trial

Introduction Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis. Methods and analysis Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken. Ethics and dissemination The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee-Westmead. Results will be presented at scientific meetings and published in peer-reviewed publications. Trial registration number ACTRN12617001084370; Pre-results

Targeting Hypoxia Signaling for Perioperative Organ Injury

Perioperative organ injury has a significant impact on surgical outcomes and presents a leading cause of death in the United States. Recent research has pointed out an important role of hypoxia signaling in the protection from organ injury, including for example myocardial infarction, acute respiratory distress syndrome, acute kidney, or gut injury. Hypoxia induces the stabilization of hypoxia-inducible factors (HIFs), thereby leading to the induction of HIF target genes, which facilitates adaptive responses to low oxygen. In this review, we focus on current therapeutic strategies targeting hypoxia signaling in various organ injury models and emphasize potential clinical approaches to integrate these findings into the care of surgical patients. Conceptually, there are 2 options to target the HIF pathway for organ protection. First, drugs became recently available that promote the stabilization of HIFs, most prominently via inhibition of prolyl hydroxylase. These compounds are currently trialed in patients, for example, for anemia treatment or prevention of ischemia and reperfusion injury. Second, HIF target genes (such as adenosine receptors) could be activated directly. We hope that some of these approaches may lead to novel pharmacologic strategies to prevent or treat organ injury in surgical patients

Iterative in Situ Click Chemistry Assembles a Branched Capture Agent and Allosteric Inhibitor for Akt1

We describe the use of iterative in situ click chemistry to design an Akt-specific branched peptide triligand that is a drop-in replacement for monoclonal antibodies in multiple biochemical assays. Each peptide module in the branched structure makes unique contributions to affinity and/or specificity resulting in a 200 nM affinity ligand that efficiently immunoprecipitates Akt from cancer cell lysates and labels Akt in fixed cells. Our use of a small molecule to preinhibit Akt prior to screening resulted in low micromolar inhibitory potency and an allosteric mode of inhibition, which is evidenced through a series of competitive enzyme kinetic assays. To demonstrate the efficiency and selectivity of the protein-templated in situ click reaction, we developed a novel QPCR-based methodology that enabled a quantitative assessment of its yield. These results point to the potential for iterative in situ click chemistry to generate potent, synthetically accessible antibody replacements with novel inhibitory properties