Incremental Hemodialysis: What We Know so Far

Traditionally, patients that develop progressive chronic kidney disease in need of kidney replacement therapy are prescribed thrice weekly in-center hemodialysis sessions at the beginning of therapy. This empiric prescription is based on historic trials that were comprised of mostly prevalent patients. Incremental hemodialysis is the process of performing transition, mimicking the progressive nature of kidney disease. Adding clearance contributions from residual kidney function is the standard of care with peritoneal dialysis but has not routinely been employed with hemodialysis. Accounting for residual kidney function accompanied by improvement in adjuvant pharmacotherapy, such as newer potassium binding agents and dietary modification, can augment dialytic clearances and allow for an incremental approach. Utilizing incremental dialysis has been associated with both preserving residual kidney function as well as improving patient quality of life. Barriers to this approach include concerns regarding patient acceptance of dialysis prescription changes, adherence to therapy, and provider factors that would require a restructuring of the current thrice weekly hemodialysis rubric. Candidacy for incremental therapy has shown the best outcomes when urea clearances exceed 3 mL/min and urine volumes are \u3e500 mL/day, although these measures have been deemed conservative. A significant amount of retrospective and registry data has been supportive of initiating incremental hemodialysis and several pilot studies have shown the feasibility of implementing such an approach. Larger, randomized control trials are needed to fully evaluate safety and efficacy to allow for more widespread acceptance of this patient-centered approach to chronic kidney disease

Resilience of systems by value of information and SHM

Critical infrastructure systems such as energy provision and distribution systems, transport systems and the built environment in general are subject to and sensitive to deterioration processes. Structural Health Monitoring (SHM) strategies have been increasingly employed as a means to detect deterioration, facilitate timely and efficient interventions – and thereby to enhance resilience of critical infrastructure. However, in specific situations, it is generally not obvious if and to what degree different SHM strategies are efficient and sufficient for enhancing the resilience of critical infrastructure systems. In response to this challenge, the present contribution puts forwards a novel approach, taking basis in the concept of value of information analysis from Bayesian pre-posterior decision. Utilizing a principal model framework we show how the proposed approach is implemented with due consideration of the resilience governing characteristics and interdependencies between infrastructure systems, social/organisational systems, regulatory systems, ecological systems as well as anthropological and geological hazard systems

Social consequences of CEE migration

__Abstract__ Migration from Central and Eastern Europe (CEE) to the Netherlands did not just start with the EU-enlargements of 2004 and 20071. However, after the EU-enlargements in 2004 and 2007, the number of (officially registered) residents from CEE countries in the Netherlands increased rapidly. In the late 1990s, there were about 50,000 CEE residents while in 2003, shortly before the EU-enlargement of 2004, this number grew to 62,000 CEE residents. In 2013, this number increased to almost 180,000 – nearly three times more than in 2003. By far the largest subcategory in the Netherlands is the group of Poles. Their numbers more than tripled between 2004 and 2013 (from almost 36,000 to 111,000). Particularly after 2007, when the Netherlands lifted the transitional restrictions for Poles and residents from the other new member states of 2004, the number of Polish residents in the Netherlands increased rapidly. The other three main CEE migrant categories in the Netherlands are Bulgarians (almost 21,000 persons in 2013), Hungarians (almost 19,500 persons) and Romanians (almost 18,000 persons). The number of Bulgarians in the Netherlands in 2013 was almost five times higher than in 2007, when Bulgaria acceded the EU. Hungary joined the EU in 2004 and one third of the current Hungarian resi

De novo once-monthly darbepoetin α treatment for the anemia of chronic kidney disease using a computerized algorithmic approach

Background: Anemia of chronic kidney disease (CKD) has been traditionally treated by erythropoiesis-stimulating agents (ESAs) and/or iron following manual determination of dose. We hypothesized that once-monthly (QM) algorithmically dosed darbepoetin α (DA) and iron administration would successfully treat anemia of CKD in ESA-naive CKD subjects. Methods: QM DA and iron doses were determined via a computerized program targeting a hemoglobin (Hb) of 10.5 - 12.5 g/dl in anemic, ESA-naive, CKD Stages 3 - 5 subjects. Six consecutive QM doses were administered. Hb, ferritin, and transferrin saturation were recorded. Data are presented as means ± standard deviation. Results: Anemia was identified in 133 subjects, with a mean follow-up of 188 days. DA doses and Hb were significantly greater at Months 3 and 6 compared to baseline (p \u3c 0.05); DA doses were 109 ± 68 μg and 118 ± 91, respectively, at Months 3 and 6. Hemoglobin levels were correspondingly 11.3 ± 1.1 g/dl and 11.3 ± 1.0. 78% of patients achieved the target Hb by 6 months of therapy. The elevation of Hb was greater in non-proteinuric than proteinuric subjects at 6 months of treatment (11.6 ± 0.8 g/dl vs. 11.0 ± 1.1; p \u3c 0.05), despite lower DA dose (96 ± 76 μg vs. 139 ± 98; p \u3c 0.05). Conclusion: Successful treatment of the anemia of CKD by QM DA based upon a computerized dosing program was achieved by 6 months in 78% of ESA-naïve, CKD subjects. © 2011 Dustri-Verlag Dr. K. Feistle

Consistent diurnal pattern of leaf respiration in the light among contrasting species and climates

Leaf daytime respiration (leaf respiration in the light, R (L)) is often assumed to constitute a fixed fraction of leaf dark respiration (R (D)) (i.e. a fixed light inhibition of respiration (R (D))) and vary diurnally due to temperature fluctuations. These assumptions were tested by measuring R (L), R (D) and the light inhibition of R (D) in the field at a constant temperature using the Kok method. Measurements were conducted diurnally on 21 different species: 13 deciduous, four evergreen and four herbaceous from humid continental and humid subtropical climates. R (L) and R (D) showed significant diurnal variations and the diurnal pattern differed in trajectory and magnitude between climates, but not between plant functional types (PFTs). The light inhibition of R (D) varied diurnally and differed between climates and in trajectory between PFTs. The results highlight the entrainment of leaf daytime respiration to the diurnal cycle and that time of day should be accounted for in studies seeking to examine the environmental and biological drivers of leaf daytime respiration

Molecular hydrogen deficiency in HI-poor galaxies and its implications for star formation

We use a sample of 47 homogeneous and high sensitivity CO images taken from the Nobeyama and BIMA surveys to demonstrate that, contrary to common belief, a significant number (~40%) of HI-deficient nearby spiral galaxies are also depleted in molecular hydrogen. While HI-deficiency by itself is not a sufficient condition for molecular gas depletion, we find that H2 reduction is associated with the removal of HI inside the galaxy optical disk. Those HI-deficient galaxies with normal H2 content have lost HI mainly from outside their optical disks, where the H2 content is low in all galaxies. This finding is consistent with theoretical models in which the molecular fraction in a galaxy is determined primarily by its gas column density. Our result is supported by indirect evidence that molecular deficient galaxies form stars at a lower rate or have dimmer far infrared fluxes than gas rich galaxies, as expected if the star formation rate is determined by the molecular hydrogen content. Our result is consistent with a scenario in which, when the atomic gas column density is lowered inside the optical disk below the critical value required to form molecular hydrogen and stars, spirals become quiescent and passive evolving systems. We speculate that this process would act on the time-scale set by the gas depletion rate and might be a first step for the transition between the blue and red sequence observed in the color-magnitude diagram.Comment: 12 pages, 9 figures, accepted for publication in Ap

Breaking the Curve with CANDELS: A Bayesian Approach to Reveal the Non-Universality of the Dust-Attenuation Law at High Redshift

Dust attenuation affects nearly all observational aspects of galaxy evolution, yet very little is known about the form of the dust-attenuation law in the distant Universe. Here, we model the spectral energy distributions (SEDs) of galaxies at z = 1.5--3 from CANDELS with rest-frame UV to near-IR imaging under different assumptions about the dust law, and compare the amount of inferred attenuated light with the observed infrared (IR) luminosities. Some individual galaxies show strong Bayesian evidence in preference of one dust law over another, and this preference agrees with their observed location on the plane of infrared excess (IRX, $L_{\text{TIR}}/L_{\text{UV}}$) and UV slope ($\beta$). We generalize the shape of the dust law with an empirical model, $A_{\lambda,\delta}=E(B-V)\ k_\lambda\ (\lambda/\lambda_V)^\delta$ where $k_\lambda$ is the dust law of Calzetti et al. (2000), and show that there exists a correlation between the color excess ${E(B-V)}$ and tilt $\delta$ with ${\delta=(0.62\pm0.05)\log(E(B-V))}$+ ${(0.26~\pm~0.02)}$. Galaxies with high color excess have a shallower, starburst-like law, and those with low color excess have a steeper, SMC-like law. Surprisingly, the galaxies in our sample show no correlation between the shape of the dust law and stellar mass, star-formation rate, or $\beta$. The change in the dust law with color excess is consistent with a model where attenuation is caused by by scattering, a mixed star-dust geometry, and/or trends with stellar population age, metallicity, and dust grain size. This rest-frame UV-to-near-IR method shows potential to constrain the dust law at even higher ($z>3$) redshifts.Comment: 20 pages, 18 figures, resubmitted to Ap