Associations of Polyethylenimine-Coated AN69ST Membrane in Continuous Renal Replacement Therapy with the Intensive Care Outcomes: Observations from a Claims Database from Japan.

BACKGROUND/AIMS: Polyethylenimine-coated polyacrylonitrile (AN69ST) membrane is expected to improve the outcomes of critically ill patients treated by continuous renal replacement therapy (CRRT). METHODS: Using a Japanese health insurance claim database, we identified adult patients receiving CRRT in intensive care units (ICUs) from April 2014 to October 2015. We used a multivariable logistic regression model to assess in-hospital mortality and Fine and Gray's proportional subhazards model to assess the ICU length of stay (ICU-LOS) accounting for the competing risks. RESULTS: Of 2,469 ICU patients, 156 were treated by AN69ST membrane. Crude in-hospital mortality was 50.0% in the AN69ST group and 54.0% in the non-AN69ST group. Adjusted odds ratio (OR) of AN69ST membrane use for in-hospital mortality was 0.65 (95% CI 0.45-0.93). The use of AN69ST membrane was also independently associated with shorter ICU-LOS. CONCLUSION: This retrospective observational study suggested that CRRT with AN69ST membrane might be associated with better in-hospital outcomes

Gravitational Radiation and Very Long Baseline Interferometry

Gravitational waves affect the observed direction of light from distant sources. At telescopes, this change in direction appears as periodic variations in the apparent positions of these sources on the sky; that is, as proper motion. A wave of a given phase, traveling in a given direction, produces a characteristic pattern of proper motions over the sky. Comparison of observed proper motions with this pattern serves to test for the presence of gravitational waves. A stochastic background of waves induces apparent proper motions with specific statistical properties, and so, may also be sought. In this paper we consider the effects of a cosmological background of gravitational radiation on astrometric observations. We derive an equation for the time delay measured by two antennae observing the same source in an Einstein-de Sitter spacetime containing gravitational radiation. We also show how to obtain similar expressions for curved Friedmann-Robertson-Walker spacetimes.Comment: 31 pages plus 3 separate figures, plain TeX, submitted to Ap

Quasar Proper Motions and Low-Frequency Gravitational Waves

We report observational upper limits on the mass-energy of the cosmological gravitational-wave background, from limits on proper motions of quasars. Gravitational waves with periods longer than the time span of observations produce a simple pattern of apparent proper motions over the sky, composed primarily of second-order transverse vector spherical harmonics. A fit of such harmonics to measured motions yields a 95%-confidence limit on the mass-energy of gravitational waves with frequencies <2e-9 Hz, of <0.11/h*h times the closure density of the universe.Comment: 15 pages, 1 figure. Also available at http://charm.physics.ucsb.edu:80/people/cgwinn/cgwinn_group/index.htm

Optical detection of the Pictor A jet and tidal tail : evidence against an IC/CMB jet

Date of Acceptance: 12/06/2015New images of the FR II radio galaxy Pictor A from the Hubble Space Telescope reveal a previously undiscovered tidal tail, as well as a number of jet knots coinciding with a known X-ray and radio jet. The tidal tail is approximately 5″ wide (3 kpc projected), starting 18″ (12 kpc) from the center of Pictor A, and extends more than 90″ (60 kpc). The knots are part of a jet observed to be about 4′ (160 kpc) long, extending to a bright hotspot. These images are the first optical detections of this jet, and by extracting knot flux densities through three filters, we set constraints on emission models. While the radio and optical flux densities are usually explained by synchrotron emission, there are several emission mechanisms that might be used to explain the X-ray flux densities. Our data rule out Doppler-boosted inverse Compton scattering as a source of the high-energy emission. Instead, we find that the observed emission can be well described by synchrotron emission from electrons with a low-energy index (p ∼ 2) that dominates the radio band, while a high-energy index (p ∼ 3) is needed for the X-ray band and the transition occurs in the optical/infrared band. This model is consistent with a continuous electron injection scenario.Peer reviewedFinal Accepted Versio

Partnership for the Revitalization of National Wind Tunnel Force Measurement Capability

Lack of funding and lack of focus on research over the past several years, coupled with force measurement capabilities being decentralized and distributed across the National Aeronautics and Space Administration (NASA) research centers, has resulted in a significant erosion of (1) capability and infrastructure to produce and calibrate force measurement systems; (2) NASA s working knowledge of those systems; and (3) the quantity of high-quality, full-capability force measurement systems available for use in aeronautics testing. Simultaneously, and at proportional rates, the capability of industry to design, manufacture, and calibrate these test instruments has been eroding primarily because of a lack of investment by the aeronautics community. Technical expertise in this technology area is a core competency in aeronautics testing; it is highly specialized and experience-based, and it represents a niche market for only a few small precision instrument shops in the United States. With this backdrop, NASA s Aeronautics Test Program (ATP) chartered a team to examine the issues and risks associated with the problem, focusing specifically on strain- gage balances. The team partnered with the U.S. Air Force s Arnold Engineering Development Center (AEDC) to exploit their combined capabilities and take a national level government view of the problem. This paper describes the team s approach, its findings, and its recommendations, and the current status for revitalizing the government s balance capability with respect to designing, fabricating, calibrating, and using the instruments

Dystonia Associated with Idiopathic Slow Orthostatic Tremor

Background: We aimed to characterize the clinical and electrophysiological features of patients with slow orthostatic tremor. Case Report: The clinical and neurophysiological data of patients referred for lower limb tremor on standing were reviewed. Patients with symptomatic or primary orthostatic tremor were excluded. Eight patients were identified with idiopathic slow 4–8 Hz orthostatic tremor, which was associated with tremor and dystonia in cervical and upper limb musculature. Coherence analysis in two patients showed findings different to those seen in primary orthostatic tremor. Discussion: Slow orthostatic tremor may be associated with dystonia and dystonic tremor

Patient and caregiver values, beliefs and experiences when considering home dialysis as a treatment option: a semi-structured interview study

Background Home dialysis can offer improved quality of life and economic benefits compared with facility dialysis. Yet the uptake of home dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering home dialysis, to inform strategies to align policy and practice with patients' needs. Methods Semi-structured interviews with adult patients with chronic kidney disease Stage 4–5D (on dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically. Results In total, 43 patients [pre-dialysis (n = 18), peritoneal dialysis (n = 13), home haemodialysis (n = 4) and facility haemodialysis (n = 9)] and 9 caregivers participated. We identified five themes related to home dialysis: lacking decisional power (complexity of information, limited exposure to home dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival. Conclusions To engage and empower patients and caregivers to consider home dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-dialysis and home dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake home dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas

Economic considerations of patients and caregivers in choosing a dialysis modality

Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy-relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio-economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out-of-pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out-of-pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out-of-pocket costs, need to be addressed directly by healthcare providers and payers

Economic considerations of patients and caregivers in choosing a dialysis modality

Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy-relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio-economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out-of-pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out-of-pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out-of-pocket costs, need to be addressed directly by healthcare providers and payers