The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients

Purpose: The present study was conducted to investigate the effect of individual, multistep intervention on adherence to treatment in hemodialysis patients referred to a hemodialysis center in Shahrekord, Iran. Method: In this interventional study, hemodialysis patients referring the center of the study were randomly assigned into two control and intervention groups (each 33). The control group received routine treatment, recommended dietary and fluid restrictions. The intervention group participated in eight individual interventional sessions accompanied routine treatment. At the beginning and the end of the study, routine laboratory tests and end-stage renal disease-adherence questionnaire were filled out for patients in both groups. The data were analyzed using Mann-Whitney and Wilcoxon tests. Results: At the end of the study, the two groups showed a significant difference in all domains of adherence except adherence to diet and adherence was better in the intervention group (p < 0.05). In demographic characteristic, only age indicated a positive correlation with adherence to dialysis program (p = 0.04, r = 0.254). After intervention, serum phosphorus decreased significantly in the intervention group (p < 0.05). Conclusions: Adherence to treatment is one of the major problems in hemodialysis patients; however, comprehensive interventions are required in view of individual condition. ▸ Implications for Rehabilitation • Adherence to treatment means that all patients behaviors (diet, fluids and drugs intake) should be in line with the recommendations given by healthcare professionals. • There is evidence on the association between adherence to treatment and decreased risk of hospitalization in dialysis patients. • Individual structured programs are most likely to be successful in encouraging adherence to treatment. © 2015 Informa UK Ltd. All rights reserved

Synthesis of New Mono- and Bis- Photochromic Compounds Based on Isatins

Among various photochromic compounds, 1,3-diazabicyclo[3.1.0]hex-3-ene derivatives are the subject of intense research due to their photochromic behavior even in the crystalline state, although molecules which show photochromic reactivity in the crystalline state are rare. In this research synthesis of several mono- and bis-1,3-diazabicyclo[3.1.0]hex-3-enes with isatin linkage are enclosed. All synthesized compounds undergo reversible photochromic reactions not only in the solution but also in crystalline state by irradiation with UV light (254 nm). Keywords: Photochromic, Isatin, Bis-1,3-diazabicyclo[3.1.0]hex-3-en

Using a taxonomy of behaviour change techniques to define key components of Stop Delirium! a complex intervention to prevent delirium in care homes

Objective: This paper aims to describe Behaviour Change Techniques (BCTs) used within a multi-component intervention to prevent delirium in older people living in care homes, called Stop Delirium! Methods: The Behaviour Change Technique Taxonomy version 1 (BCTTv1) was used to code and characterise the ‘key ingredients’ within Stop Delirium!. Four sources of information were examined to identify BCTs used: intervention manual and toolkit; the delirium resource box; and contemporaneous written logs recorded by staff delivering the intervention in two feasibility studies. Details of BCTs used in each part of the intervention and whom they were targeting were recorded, as well as the frequency of each identified BCT. Results: 31.2% of all BCTs described in the BCTTv1 were used in the Stop Delirium! intervention. The majority of BCTs focused on changing care home staff behaviour through enhanced education, training and empowerment. ‘Social support (practical)’ was the most frequently occurring BCT. Conclusion: The large number of different BCTs identified within the Stop Delirium! intervention reflects the complexities of multicomponent interventions. The prominence of social support and empowerment further emphasises the group and organisational effort required to improve delirium care. By explicitly identifying and describing the BCTs used in Stop Delirium!, can enhance standardisation and replicability, and promote intervention fidelity for future trial evaluation and implementation of a multicomponent intervention to prevent delirium in long-term care

Mechanical Characterization of Torsional Micropaddles Using Atomic Force Microscopy

The reference cantilever method is shown to act as a direct and simple method for determination of torsional spring constant. It has been applied to the characterization of micropaddle structures similar to those proposed for resonant functionalized chemical sensors and resonant thermal detectors. It is shown that this method can be used as an effective procedure to characterize a key parameter of these devices and would be applicable to characterization of other similar MEMS/NEMS devices such as micromirrors. In this study, two sets of micropaddles are manufactured (beams at centre and offset by 2.5 μm) by using LPCVD silicon nitride as a substrate. The patterning is made by direct milling using focused ion beam. The torsional spring constant is achieved through micromechanical analysis via atomic force microscopy. To obtain the gradient of force curve, the area of the micropaddle is scanned and the behaviour of each pixel is investigated through an automated developed code. The experimental results are in a good agreement with theoretical results

H2 Formation on the Dust Grain Surface in Divertor Plasma

Edge plasma of divertor in tokamak is characterized by different values of plasma parameters (plasmadensity and temperature), plasma composition and overcoming plasma dynamics processes. We survey amodel for theoretical study of the interaction of hydrogen with dust surface and apply our results the H2formation on dust grain surfaces in the divertor. In this model, considering both physisorbed andchemisorbed sites on the grain surface and then adatoms mobility to go from one site to other site bythermal diffusion, describes the formation of H2 on grain surfaces. We find H2 formation rate on the hightemperature dust surfaces in divertor for a range of dust and gas temperatures and densities

Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration

PURPOSE: To investigate detailed patient experiences specific to receiving vascular endothelial growth factor inhibitors (anti-VEGF) for wet age-related macular degeneration (wAMD), and to acquire a snapshot of the frequency of clinically significant levels of depression, anxiety, and posttraumatic stress among patients and levels of burden in patients’ carers. DESIGN: Observational cross-sectional mixed-methods study. METHODS: Three hundred patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited. Qualitative data on patients’ experience of treatment were collected using a structured survey. Standardized validated questionnaires were used to quantify clinically significant levels of anxiety, depression, and posttraumatic stress, as well as cognitive function and carers’ burden. RESULTS: Qualitative data showed that 56% of patients (n =132) reported anxiety related to antiVEGF treatment. The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain. From validated questionnaires, 17% of patients (n= 52) showed clinical levels of anxiety and 12% (n =36) showed clinical levels of depression. Depression levels, but not anxiety, were significantly higher in patients who received up to 3 injections compared with patients who received from 4 to 12 injections (analysis of variance [ANOVA] P = .027) and compared with patients who received more than 12 injections (ANOVA P = .001). CONCLUSIONS: Anti-VEGF treatment is often experienced with some anxiety related to treatment, regardless of the number of injections received. Clinical levels of depression seem to be more frequent in patients at early stages of anti-VEGF treatment. Strategies to improve patient experience of treatment and minimize morbidity are suggested

What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment?

Background: Although fertility preservation (FP) treatment options have increased, the existing evidence suggests that many women with cancer do not feel well supported in making these decisions, but find them stressful and complex and fail to take up fertility care at this crucial time. Whilst existing reviews have all made important contributions to our understanding of the FP decision-making process, none of them examine solely and specifically these processes for women of reproductive age with a diagnosis of any cancer, leaving a gap in the knowledge base. Given the expectation that care is patient-centred, our review aims to address this gap which may be of help to those managing patients struggling to make difficult decisions in the often brief period before potentially sterilising cancer treatment is started. Objective and rationale: Underpinning this narrative review was the question “What factors hinder the decision-making process for women with any cancer and contemplating FP treatment?” Our objectives were to i) assess and summarise this existing literature, ii) identify the factors that hinder this decision-making process, iii) explore to what extent these factors may differ for women choosing different methods of FP, and iv) make recommendations for service delivery and future research. Search methods: A systematic search of the medical and social science literature from the 1st January 2005 up to the end of January 2016 was carried out using three electronic databases (Web of Science (PubMed), Ovid SP Medline and CINAHL via Ebsco). Included in the review were quantitative, qualitative and mixed-method studies. Reference lists of relevant papers were also hand searched. From the 983 papers identified, 46 papers were included. Quality assessment was undertaken using the Mixed Methods Appraisal Tool and thematic analysis was used to analyse the data. Outcomes: From the analysis, six key themes with 15 sub-themes emerged: 1) fertility information provision (lack of information, timing of the information, patient-provider communication); 2) fear concerning the perceived risks associated with pursuing FP (delaying cancer treatment, aggravating a hormone positive cancer, consequences of a future pregnancy); 3) non-referral from oncology (personal situation, having a hormone positive cancer, not a priority, transition between service issues); 4) the dilemma (in survival mode, whether to prioritise one treatment over another); 5) personal situation (parity, relationship status); and 6) costs (financial concerns). Wider implications: This review has found that a wide range of internal and external factors impact the FP decision-making process. Key external issues related to current service delivery such as the provision and timing of FP information, and lack of referral from oncology to the fertility clinic. However, internal issues such as women’s fears concerning the perceived risks associated with pursuing FP also hindered decision-making but these ‘risks’ were typically overestimated and non-evidence based. These findings suggest that the implementation of a range of decision support interventions may be of benefit within the clinical care pathway of FP and cancer. Women would benefit from the provision of more evidence-based FP information, ideally received at cancer diagnosis, in advance of seeing a fertility specialist, for example through the implementation of patient decision aids. Health care professionals in both oncology and fertility services may also benefit from the implementation of training programs and educational tools targeted at improving the communication skills needed to improve collaborative decision-making and deliver care that is patient-centred. Exploration of the current barriers, both intellectual and practical, that prevent some patients from accepting FP will help care providers to do better for their patients in the future. Finally, the extent to which a poor prognosis and moral, ethical and religious beliefs influence the FP decision-making process also warrant further research

A Combined Metaheuristic Algorithm for the Vehicle Routing Problem and its Open Version

Abstract: The Open Vehicle Routing Problem (OVRP) is one of the most important extensions of the vehicle routing problem (VRP) that has many applications in industrial and service. In the VRP, a set of customers with a specified demand of goods are given and a depot where a fleet of identical capacitated vehicles is located. We are also given the ‘‘traveling costs’’ between the depot and all the customers, and between each pair of customers. In the OVRP against to VRP, vehicles are not required to return to the depot after completing service. Because VRP and OVRP belong to NP-hard Problems, an efficient hybrid elite ant system called EACO is proposed for solving them in the paper. In this algorithm, a modified tabu search (TS), a new state transition rule and a modified pheromone updating rule are used for more improving solutions. These modifications lead that the proposed algorithm does not trapped at the local optimum and discovers different parts of the solution space. Computational results on fourteen standard benchmark instances for VRP and OVRP show that EACO finds the best known solutions for most of the instances and is comparable in terms of solutions quality to the best performing published metaheuristics in the literature

INVESTIGATING THE MORTALITY CAUSES OF 1-59 MONTHS BABIES OF VILLAGE FROM 2012 TO 2015, ZAHEDAN, IRAN

Since the mortality of 1-59 babies is the most serious challenges facing human society and an important indicator of the health and development of countries, providing solutions to reduce this rate as much as possible is of paramount importance. The main objective of the present study is to examine mortality causes of 1-59 months babies in villages under the protection of Zahedan University of Medical Sciences from 2012 to 2015. The present cross-sectional study was conducted through census. The study included the death of all babies registered in Zahedan villages from 2012 to 2015. Required data was collected using raw information form and Child Health Bureau of the Ministry of Health standard questionnaire; SPSS, version 18, was used to process and analyze collected data. The present study examined the death of an overall number of 1252 Zahedan village babies aged between 1 to 59 months; 752 infants aged less than month and this age group turned out to have highest mortality rate; i.e. 60; the lowest mortality rate, 16.7, happened in the age group of 1 to 4 years. The most common causes of death included perinatal disease (29.8), unintentional injuries (17.5), respiratory system diseases (13.2), infectious and parasitic diseases (6.5), congenital and chromosome diseases (6), and cardiovascular disease (2.5). Since the highest mortality rate, 29.8, is related to perinatal diseases of infants, couples pre-pregnancy care and counselling can play crucial role in decreasing the rate of baby, and specially infants, mortality

Causal role of a neural system for separating and selecting multidimensional social cognitive information

People are multi-faceted, typically good at some things but bad at others, and a critical aspect of social judgement is the ability to focus on those traits relevant for the task at hand. However, it remains unknown how the brain supports such context-dependent social judgement. Here, we examine how people represent multidimensional individuals, and how the brain extracts relevant information and filters out irrelevant information when comparing individuals within a specific dimension. Using human fMRI, we identify distinct neural representations in dorsomedial prefrontal cortex (dmPFC) and anterior insula (AI) supporting separation and selection of information for context-dependent social judgement. Causal evaluation using non-invasive brain stimulation shows that AI disruption alters the impact of relevant information on social comparison, whereas dmPFC disruption only affects the impact of irrelevant information. This neural circuit is distinct from the one supporting integration across, as opposed to separation of, different features of a multidimensional cognitive space