Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-Hemodiafiltration

This work aimed to evaluate how aging could influence patients' perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient's records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management

3D microsimulation of milkruns and pickers in warehouses using SIMIO

To help the Bosch Car Multimedia Portugal in Ferreiros, Braga to reduce its costs (both in time and space) with its warehouse, a micro simulation model is being developed in Simio. Particularly, the tool needs to be able to model pickers riding milkruns to collect containers of products, from a warehouse, to satisfy the needs of the production lines. In this sense, the storage strategy used on the warehouse, the quantity of requests a picker gets per shift, the time between shifts, the number of types of products, the arrival rate of requests, and the number of milkruns and pickers needs to be adjustable. Additionally, to design the corridors of the warehouse in a configurable way, an Add-in in C#, using the API of Simio, is being developed. Thus, this paper intends to document the first part of the simulation model developed, which consists on the pickers receiving requests and riding their milkruns to collect the respective containers from the warehouse. Five different Simio models compose the main simulation model. Conclusions and future work are discussed.This work has been co-supported by SI I&DT project in joint-promotion nº 36265/2013 (HMIEXCEL - 2013-2015 Project) and by FCT – Fundação para a Ciência e Tecnologia in the scope of the project: PEst-OE/EEI/UI0319/2014

Potential cardiovascular risk protection of bilirubin in end-stage renal disease patients under hemodialysis

We evaluated the potential cardiovascular risk protection of bilirubin in hemodialysis (HD) patients. An enlarged set of studies were evaluated in 191 HD patients, including hematological study, lipid profile, iron metabolism, nutritional, inflammatory markers, and dialysis adequacy. The TA duplication screening in the UDP-glucuronosyltransferase 1 A1 (UGT1A1) promoter region was also performed. The UGT1A1 genotype frequencies in HD patients were 49.2%, 42.4%, and 8.4% for 6/6, 6/7, and 7/7 genotypes, respectively. Although no difference was found in UGT1A1 genotype distribution between the three tertiles of bilirubin, significant differences were found with increasing bilirubin levels, namely, a decrease in platelet, leukocyte, and lymphocyte counts, transferrin, oxidized low-density lipoprotein (ox-LDL), ox-LDL/low-density lipoprotein cholesterol ratio, apolipoprotein (Apo) A, Apo B, and interleukin-6 serum levels and a significant increased concentration of hemoglobin, hematocrit, erythrocyte count, iron, transferrin saturation, Apo A/Apo B ratio, adiponectin, and paraoxonase 1 serum levels. After adjustment for age these results remained significant. Our data suggest that higher bilirubin levels are associated with beneficial effects in HD patients, by improving lipid profile and reducing the inflammatory grade, which might contribute to increase in iron availability. These results suggest a potential cardiovascular risk protection of bilirubin in HD patient

iFloW: an integrated logistics software system for inbound supply chain traceability

Visibility plays an important role in supply chain management. Such visibility is not only important for better planning, but especially for real-time execution related with the traceability of goods. In inbound supply chain management, logistics planners need to trace raw materials from their requests in order to properly plan a plant’s production. The iFloW (Inbound Logistics Tracking System) integrates logistics providers IT applications and Global Positioning System (GPS) technology to track and trace incoming freights. The Estimated Time of Arrival (ETA) is updated in real-time allowing an improved materials planning process. This paper presents the iFloW project and describes how these issues are addressed and validated in a real pilot project.This research is sponsored by the Portugal Incentive System for Research and technological Development PEst-UID/CEC/00319/2013 and by project in co-promotion no 36265/2013 (Project HMIExcel—2013–2015)

Using scrum together with UML models: a collaborative university-industry R&D software project

Conducting research and development (R&D) software projects, in an environment where both industry and university collaborate, is challenging due to many factors. In fact, industrial companies and universities have generally different interests and objectives whenever they collaborate. For this reason, it is not easy to manage and negotiate the industrial companies’ interests, namely schedules and their expectations. Conducting such projects in an agile framework is expected to decrease these risks, since partners have the opportunity to frequently interact with the development team in short iterations and are constantly aware of the characteristics of the system under development. However, in this type of collaborative R&D projects, it is often advantageous to include some waterfall practices, like upfront requirements modeling using UML models, which are not commonly used in agile processes like Scrum, in order to better prepare the implementation phase of the project. This paper presents some lessons learned that result from experience of the authors in adopting some Scrum practices in a R&D project, like short iterations, backlogs, and product increments, and simultaneously using UML models, namely use cases and components.This research is sponsored by the Portugal Incentive System for Research and Technological Development PEst-UID/CEC/00319/2013 and by project in co–promotion nº 36265/2013 (Project HMIExcel - 2013-2015)

Management of children with congenital nephrotic syndrome: challenging treatment paradigms

Background: Management of children with congenital nephrotic syndrome (CNS) is challenging. Bilateral nephrectomies followed by dialysis and transplantation are practiced in most centres, but conservative treatment may also be effective. / Methods: We conducted a 6-year review across members of the European Society for Paediatric Nephrology Dialysis Working Group to compare management strategies and their outcomes in children with CNS. / Results: Eighty children (50% male) across 17 tertiary nephrology units in Europe were included (mutations in NPHS1, n = 55; NPHS2, n = 1; WT1, n = 9; others, n = 15). Excluding patients with mutations in WT1, antiproteinuric treatment was given in 42 (59%) with an increase in S-albumin in 70% by median 6 (interquartile range: 3–8) g/L (P < 0.001). Following unilateral nephrectomy, S-albumin increased by 4 (1–8) g/L (P = 0.03) with a reduction in albumin infusion dose by 5 (2–9) g/kg/week (P = 0.02). Median age at bilateral nephrectomies (n = 29) was 9 (7–16) months. Outcomes were compared between two groups of NPHS1 patients: those who underwent bilateral nephrectomies (n = 25) versus those on conservative management (n = 17). The number of septic or thrombotic episodes and growth were comparable between the groups. The response to antiproteinuric treatment, as well as renal and patient survival, was independent of NPHS1 mutation type. At final follow-up (median age 34 months) 20 (80%) children in the nephrectomy group were transplanted and 1 died. In the conservative group, 9 (53%) remained without dialysis, 4 (24%; P < 0.001) were transplanted and 2 died. / Conclusion: An individualized, stepwise approach with prolonged conservative management may be a reasonable alternative to early bilateral nephrectomies and dialysis in children with CNS and NPHS1 mutations. Further prospective studies are needed to define indications for unilateral nephrectomy

Clinical practice recommendations for native vitamin D therapy in children with chronic kidney disease Stages 2-5 and on dialysis

Vitamin D deficiency is widely prevalent and often severe in children and adults with chronic kidney disease (CKD). Although native vitamin D {25-hydroxyvitamin D [25(OH)D]} is thought to have pleiotropic effects on many organ systems, its skeletal effects have been most widely studied. The 25(OH)D deficiency is causally linked with rickets and fractures in healthy children and those with CKD, contributing to the CKD–mineral and bone disorder (MBD) complex. There are few studies to provide evidence for vitamin D therapy or guidelines for its use in CKD. A core working group (WG) of the European Society for Paediatric Nephrology (ESPN) CKD–MBD and Dialysis WGs have developed recommendations for the evaluation, treatment and prevention of vitamin D deficiency in children with CKD. We present clinical practice recommendations for the use of ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3) in children with CKD Stages 2–5 and on dialysis. A parallel document addresses treatment recommendations for active vitamin D analogue therapy. The WG has performed an extensive literature review to include meta-analyses and randomized controlled trials in healthy children as well as children and adults with CKD, and prospective observational studies in children with CKD. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system has been used to develop and grade the recommendations. In the absence of applicable study data, the opinion of experts from the ESPN CKD–MBD and Dialysis WGs is provided, but clearly GRADE-ed as such and must be carefully considered by the treating physician, and adapted to individual patient needs as appropriate

Haemodialysis for children under the age of two years

Less than 10% of children under 2 years old with end-stage renal failure in Europe and in the United States of America are treated with haemodialysis. For small children, peritoneal dialysis is often the preferred treatment. Haemodialysis is chosen for a very small number of children, and is only used in some selected centres because of its highly complex technique, the difficulties related to vascular access, and the need to have a skilled and experienced nursing and medical team. With the technological development of recent years, the quality of dialysis treatment offered to paediatric patients has improved considerably and haemodialysis is presently considered to be a safe and efficient treatment for acute or chronic paediatric renal impairment. However, because a successful renal transplant continues to be linked to a better quality of life for children with terminal chronic renal impairment, dialysis ought to be regarded as a temporary treatment method, while waiting for a renal transplant.info:eu-repo/semantics/publishedVersio

Hepcidin serum levels and resistance to recombinant human erythropoietin therapy in haemodialysis patients.

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