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

Coherent and Squeezed Vacuum Light Interferometry: Parity detection hits the Heisenberg limit

The interference between coherent and squeezed vacuum light can produce path entangled states with very high fidelities. We show that the phase sensitivity of the above interferometric scheme with parity detection saturates the quantum Cramer-Rao bound, which reaches the Heisenberg-limit when the coherent and squeezed vacuum light are mixed in roughly equal proportions. For the same interferometric scheme, we draw a detailed comparison between parity detection and a symmetric-logarithmic-derivative-based detection scheme suggested by Ono and Hofmann.Comment: Change in the format from aps to iop since we decided to submit it to NJP; Minor changes in tex

Endoscopy is of low yield in the identification of gastrointestinal neoplasia in patients with dermatomyositis: A cross-sectional study.

AimTo determine the prevalence of gastrointestinal neoplasia among dermatomyositis patients who underwent an esophagogastroduodenoscopy and/or colonoscopy.MethodsA cross-sectional study examining the results of upper endoscopy and colonoscopy in adults with dermatomyositis at an urban, university hospital over a ten year period was performed. Chart review was performed to confirm the diagnosis of dermatomyositis. Findings on endoscopy were collected and statistical analyses stratified by age and presence of symptoms were performed.ResultsAmong 373 adult patients identified through a code based search strategy, only 163 patients had dermatomyositis confirmed by chart review. Of the 47 patients who underwent upper endoscopy, two cases of Barrett's esophagus without dysplasia were identified and there were no cases of malignancy. Of the 67 patients who underwent colonoscopy, no cases of malignancy were identified and an adenoma was identified in 15% of cases. No significant differences were identified in the yield of endoscopy when stratified by age or presence of symptoms.ConclusionThe yield of endoscopy is low in patients with dermatomyositis and is likely similar to the general population; we identified no cases of malignancy. A code based search strategy is inaccurate for the diagnosis of dermatomyositis, calling into question the results of prior population-based studies. Larger studies with rigorously validated search strategies are necessary to understand the risk of gastrointestinal malignancy in patients with dermatomyositis

A Balanced Budget View on Forming Giant Planets by Pebble Accretion

Pebble accretion refers to the assembly of rocky planet cores from particles whose velocity dispersions are damped by drag from circumstellar disc gas. Accretion cross-sections can approach maximal Hill-sphere scales for particles whose Stokes numbers approach unity. While fast, pebble accretion is also lossy. Gas drag brings pebbles to protocores but also sweeps them past; those particles with the largest accretion cross-sections also have the fastest radial drift speeds and are the most easily drained out of discs. We present a global model of planet formation by pebble accretion that keeps track of the disc's mass budget. Cores, each initialized with a lunar mass, grow from discs whose finite stores of mm-cm sized pebbles drift inward across all radii in viscously accreting gas. For every 1 $M_\oplus$ netted by a core, at least 10 $M_\oplus$ and possibly much more are lost to radial drift. Core growth rates are typically exponentially sensitive to particle Stokes number, turbulent Mach number, and solid surface density. This exponential sensitivity, when combined with disc migration, tends to generate binary outcomes from 0.1-30 AU: either sub-Earth cores remain sub-Earth, or explode into Jupiters, with the latter migrating inward to varying degrees. When Jupiter-breeding cores assemble from mm-cm sized pebbles, they do so in discs where such particles drain out in $\sim$10$^5$ yr or less; such fast-draining discs do not fit mm-wave observations.Comment: Accepted to MNRA

Valuation bases for generalized algebraic series fields

We investigate valued fields which admit a valuation basis. Given a countable ordered abelian group G and a real closed, or algebraically closed field F, we give a sufficient condition for a valued subfield of the field of generalized power series F((G)) to admit a K-valuation basis. We show that the field of rational functions F(G) and the field F(G) of power series in F((G)) algebraic over F(G) satisfy this condition. It follows that for archimedean F and divisible G the real closed field F(G) admits a restricted exponential function

A scattered data approximation tool to map carbon nanotube dispersion to the processing parameters in polymer nanocomposites

The relationship of nanocomposite dispersion was studied with the variation of dispersion techniques and other processing parameters. Examining all permutations of the various factors in the laboratory is a challenging task. In this thesis, we propose to map a correlation between inputs and output via a self-adaptive scattered data approximation method. The proposed greedy algorithm, Sequential Function Approximation (SFA), reveals the multidimensional behavior of the system, provides the sensitivity of each input, and presents the combination of inputs that is most suitable for a specific output. In this research, we have collected data from various research institutions and applied it to SFA. The results show that CNT weight percent, sonication time, CNT modification, and high shear mixing time are key factors that affect the dispersion. This thesis discusses SFA, the data, and the results in detail. This work serves as a proof of concept and recommended future work is discussed

OPTIC: Orbiting Plutonian Topographic Image Craft Proposal for an Unmanned Mission to Pluto

The proposal for an unmanned probe to Pluto is presented and described. The Orbiting Plutonian Topographic Image Craft's (OPTIC's) trip will take twenty years and after its arrival, will begin its data collection which includes image and radar mapping, surface spectral analysis, and magnetospheric studies. This probe's design was developed based on the request for proposal of an unmanned probe to Pluto requirements. The distinct problems which an orbiter causes for each subsystem of the craft are discussed. The final design revolved around two important factors: (1) the ability to collect and return the maximum quantity of information on the Plutonian system; and (2) the weight limitations which the choice of an orbiting craft implied. The velocity requirements of this type of mission severely limited the weight available for mission execution-owing to the large portion of overall weight required as fuel to fly the craft with present technology. The topics covered include: (1) scientific instrumentation; (2) mission management; (3) power and propulsion; (4) attitude and articulation control; (5) structural subsystems; and (6) command, control, and communication

The epithelial–mesenchymal transition: new insights in signaling, development, and disease

The conversion of an epithelial cell to a mesenchymal cell is critical to metazoan embryogenesis and a defining structural feature of organ development. Current interest in this process, which is described as an epithelial–mesenchymal transition (EMT), stems from its developmental importance and its involvement in several adult pathologies. Interest and research in EMT are currently at a high level, as seen by the attendance at the recent EMT meeting in Vancouver, Canada (October 1–3, 2005). The meeting, which was hosted by The EMT International Association, was the second international EMT meeting, the first being held in Port Douglas, Queensland, Australia in October 2003. The EMT International Association was formed in 2002 to provide an international body for those interested in EMT and the reverse process, mesenchymal–epithelial transition, and, most importantly, to bring together those working on EMT in development, cancer, fibrosis, and pathology. These themes continued during the recent meeting in Vancouver