Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis

Background: Poor adherence to treatment is common in hemodialysis patients. However, effective interventions for adherence in this population are lacking. Small studies of behavioral interventions have yielded improvements, but clinical effectiveness and long-term effects are unclear. Study Design: Multicenter parallel (1:1) design, blinded cluster-randomized controlled trial. Setting & Participants: Patients undergoing maintenance hemodialysis enrolled in 14 dialysis centers. Intervention: Dialysis shifts of eligible patients were randomly assigned to either an interactive and targeted self-management training program (HED-SMART; intervention; n = 134) or usual care (control; n = 101). HED-SMART, developed using the principles of problem solving and social learning theory, was delivered in a group format by health care professionals over 4 sessions. Outcomes & Measurements: Serum potassium and phosphate concentrations, interdialytic weight gains (IDWGs), self-reported adherence, and self-management skills at 1 week, 3 months, and 9 months postintervention. Results: 235 participants were enrolled in the study (response rate, 44.2%), and 82.1% completed the protocol. IDWG was significantly lowered across all 3 assessments relative to baseline (P < . 0.001) among patients randomly assigned to HED-SMART. In contrast, IDWG in controls showed no change except at 3 months, when it worsened significantly. Improvements in mineral markers were noted in the HED-SMART arm at 3 months (P < . 0.001) and in potassium concentrations (P < . 0.001) at 9 months. Phosphate concentrations improved in HED-SMART at 3 months (P = 0.03), but these effects were not maintained at 9 months postintervention. Significant differences between the arms were found for the secondary outcomes of self-reported adherence, self-management skills, and self-efficacy at all time points. Limitations: Low proportion of patients with diabetes. Conclusions: HED-SMART provides an effective and practical model for improving health in hemodialysis patients. The observed improvements in clinical markers and self-report adherence, if maintained at the longer follow-up, could significantly reduce end-stage renal disease-related complications. Given the feasibility of this kind of program, it has strong potential for supplementing usual care. Trial Registration: Registered at ISRCTN with study number ISRCTN31434033

The effect of brief self-management intervention for hemodialysis patients (HED-SMART) on trajectories of depressive and anxious symptoms

Objective: Depression is often comorbid with End-Stage Renal Disease, and associated with poor adherence and clinical outcomes but course of symptoms is variable. This study sought to describe the long-term trajectories of anxiety and depression in hemodialysis patients, to identify predictors of these trajectories over 12 months and to evaluate the effectiveness of the HEmoDialysis Self-Management Randomized Trial (HED SMART) against usual care on symptoms of anxiety and depression. Methods: A secondary analysis of data from a randomized controlled trial that contrasted HED SMART (n = 101) against usual care (n = 134). Depressive and anxious symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) at baseline, 1 week and at 3 and 9 months post-intervention. Latent class growth analysis identified trajectories of depression and anxiety, and their sociodemographic and clinical predictors. Results: Symptoms of depression and anxiety over 12 months were characterized by two trajectories: low stable (depression: 55%; anxiety: 59%) with non-clinical levels of distress, and high stable (depression: 45%; anxiety: 41%) with clinical levels of distress. HED SMART predicted significant reductions in depression relative to usual care. A similar trend was noted for anxiety. Younger age, Chinese ethnicity, and more comorbidities were associated with persistent high depression. Younger age and shorter dialysis vintage was associated with persistent high anxiety. Conclusion: A brief self-management intervention designed to support behavioral change can also lead to significant reductions in symptoms of depression and may be of great value for younger HD patients shown to be at greater risk for persistent distress. Trial registration: ISRTN31434033

IdeS: A Bacterial Proteolytic Enzyme with Therapeutic Potential

Background: IdeS, a proteinase from Streptococcus pyogenes, cleaves immunoglobulin (Ig)G antibodies with a unique degree of specificity. Pathogenic IgG antibodies constitute an important clinical problem contributing to the pathogenesis of a number of autoimmune conditions and acute transplant rejection. To be able to effectively remove such antibodies is therefore an important clinical challenge. Methodology/Principal Findings: IdeS was found to specifically and efficiently cleave IgG in human blood in vitro (20 mg of IdeS caused a complete degradation of IgG in one ml of human whole blood in 15 minutes) and to clear IgG from the blood stream of rabbits in vivo (no IgG was detected six hours following an intravenous injection of 5 mg of IdeS) without any side effects. In a mouse model of immune thrombocytopenic purpura (ITP), polyclonal IgG antibodies against platelet surface antigens were used to induce a lethal disease. These profoundly thrombocytopenic animals were treated and cured by a single injection of IdeS. Conclusions/Significance: Novel information is provided concerning the IgG-cleaving activity of IdeS in vitro and in vivo. The highly specific and rapid elimination of IgG in vivo, the dramatic effect in a mouse model of ITP, and the lack of sid

Critical marine habitat restoration programme - initiative on mangrove restoration in Kerala, India

Mangroves are unique habitats which function as nursery ground for several valuable species of finfishes and shellfishes and they play a vital role in supporting marine food chains, protecting coastal areas and in improving water quality. Mangroves in general have relatively high productivity and tend to create highly organic soil and also export organic matter to nearby marine environments. They are effective in stabilizing soils in intertidal areas. Some species of mangroves have been planted in the coastal areas as bio-protection shields to guard coastal households from wind and wave action. They provide shelter to several avian fauna which feed on its fruits and nest in the branches. Rare or endangered species of birds have also been documented in the mangroves

Capacity-Speed Relationships in Prefrontal Cortex

Working memory (WM) capacity and WM processing speed are simple cognitive measures that underlie human performance in complex processes such as reasoning and language comprehension. These cognitive measures have shown to be interrelated in behavioral studies, yet the neural mechanism behind this interdependence has not been elucidated. We have carried out two functional MRI studies to separately identify brain regions involved in capacity and speed. Experiment 1, using a block-design WM verbal task, identified increased WM capacity with increased activity in right prefrontal regions, and Experiment 2, using a single-trial WM verbal task, identified increased WM processing speed with increased activity in similar regions. Our results suggest that right prefrontal areas may be a common region interlinking these two cognitive measures. Moreover, an overlap analysis with regions associated with binding or chunking suggest that this strategic memory consolidation process may be the mechanism interlinking WM capacity and WM speed.National Center for Research Resources (U.S.) (grant UL1RR025011)National Institutes of Health (U.S.) (grant NIH RO1 DC05375)Wallace H. Coulter FoundationNational Institute of Mental Health (U.S.) (Challenge Grant RC1MH090912-01

A model for fresh produce shelf-space allocation and inventory management with freshness-condition-dependent demand

Asignificant amount of work has investigated inventory control problems associated with fresh produce. Much of this work has considered deteriorating inventory control with many models having been proposed for various situations. However, no researchers have specifically studied fresh produce, which has its own special characteristics. Most research categorizes fresh produce into more general deteriorating categories with random lifetimes and nondecaying utilities. However, this classification is not reasonable or practical because the freshness of an item usually plays an important role in influencing the demand for the produce. In this paper, a single-period inventory and shelf-space allocation model is proposed for fresh produce. These items usually have a very short lifetime. The demand rate is assumed to be deterministic and dependent on both the displayed inventory (the number of facings of items on the shelves) and the items' freshness condition (which decreases over time). Several problem instances of different sizes are provided and solved by a modified generalized reduced gradient algorithm

New Measurements of Upsilon(1S) Decays to Charmonium Final States

Using substantially larger data samples collected by the CLEO III detector, we report on new measurements of the decays of Upsilon(1S) to charmonium final states, including J/Psi, psi(2S), and chi_cJ. The latter two are first observations of these decays. We measure the branching fractions as follows: B(Y(1S)--> J/Psi+X)=(6.4+-0.4+-0.6)x10^-4, B(Y(1S)--> psi(2S)+X)/B(Y(1S)--> J/Psi+X)=0.41+-0.11+-0.08, B(Y(1S)--> chi_c1+X)/B(Y(1S)--> J/Psi+X)=0.35+-0.08+-0.06, B(Y(1S)--> chi_c2+X)/B(Y(1S)--> J/Psi+X)=0.52+-0.12+-0.09, and B(Y(1S)--> chi_c0+X)/B(Y(1S)--> J/Psi+X)<7.4% at 90% confidence level. We also report on the momentum and angular spectra of J/Psi's in Upsilon(1S) decay. The results are compared to predictions of the color octet and color singlet models.Comment: 27 pages postscript,also available through http://w4.lns.cornell.edu/public/CLNS/, submitted to PR

Branching Fractions of tau Leptons to Three Charged Hadrons

From electron-positron collision data collected with the CLEO detector operating at CESR near \sqrt{s}=10.6 GeV, improved measurements of the branching fractions for tau decays into three explicitly identified hadrons and a neutrino are presented as {\cal B}(\tau^-\to\pi^-\pi^+\pi^-\nu_\tau)=(9.13\pm0.05\pm0.46)%, {\cal B}(\tau^-\to K^-\pi^+\pi^-\nu_\tau)=(3.84\pm0.14\pm0.38)\times10^{-3}, {\cal B}(\tau^-\to K^-K^+\pi^-\nu_\tau)=(1.55\pm0.06\pm0.09)\times10^{-3}, and {\cal B}(\tau^-\to K^-K^+K^-\nu_\tau)<3.7\times10^{-5} at 90% C.L., where the uncertainties are statistical and systematic, respectively.Comment: 10 pages postscript, also available through http://w4.lns.cornell.edu/public/CLNS, to appear in Phys. Rev. Let

Evidence for B^(*)_s bar{B}^(*)_s Production at the Upsilon(5S)

Using data collected by the CLEO III detector at CESR, we started a series of investigations on the Upsilon(5S) resonance decay properties. The data sample used for this analysis consists of 0.42 fb-1 of data taken on the Upsilon(5S) resonance, 6.34 fb-1 of data collected on the Upsilon(4S) and 2.32 fb-1 of data taken in the continuum below the Upsilon(4S). B_s mesons are expected to decay predominantly into D_s meson, while the lighter B mesons decay into D_s only about 10% of the time. We exploit this difference to make a preliminary model dependent estimate of the ratio of B_s(*) anti-B_s(*) to the total b anti-b quark pair production at the Upsilon(5S) energy to be (21 +- 3 +- 9)%.Comment: 17 pages postscript,also available through http://www.lns.cornell.edu/public/CONF/2004/, Presented at ICHEP Aug 16-22,2004, Beijing, Chin