76 research outputs found

    Family consultation to reduce early hospital readmissions among patients with end stage kidney disease: A randomized controlled trial

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    Background and objectives The US Centers for Medicare and Medicaid Services have mandated reducing early (30-day) hospital readmissions to improve patient care and reduce costs. Patients with ESKD have elevated early readmission rates, due in part to complex medical regimens but also cognitive impairment, literacy difficulties, low social support, and mood problems. We developed a brief family consultation intervention to address these risk factors and tested whether it would reduce early readmissions. Design, setting, participants, & measurements One hundred twenty hospitalized adults with ESKD (mean age=58 years; 50% men; 86% black, 14% white) were recruited from an urban, inpatient nephrology unit. Patients were randomized to the family consultation (n=60) or treatment-as-usual control (n=60) condition. Family consultations, conducted before discharge at bedside or via telephone, educated the family about the patient’s cognitive and behavioral risk factors for readmission, particularly cognitive impairment, and how to compensate for them. Blinded medical record reviews were conducted 30 days later to determine readmission status (primary outcome) and any hospital return visit (readmission, emergency department, or observation; secondary outcome). Logistic regressions tested the effects of the consultation versus control on these outcomes. Results Primary analyses were intent-to-treat. The risk of a 30-day readmission after family consultation (n=12, 20%) was 0.54 compared with treatment-as-usual controls (n=19, 32%), although this effect was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.23 to 1.24; P=0.15). A similar magnitude, nonsignificant result was observed for any 30-day hospital return visit: family consultation (n=19, 32%) versus controls (n=28, 47%; odds ratio, 0.53; 95% confidence interval, 0.25 to 1.1; P=0.09). Per protocol analyses (excluding three patients who did not receive the assigned consultation) revealed similar results. Conclusions A brief consultation with family members about the patient’s cognitive and psychosocial risk factors had no significant effect on 30-day hospital readmission in patients with ESKD

    Design and characterisation of the new CIS115 sensor for JANUS, the high resolution camera on JUICE

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    JUICE, the Jupiter Icy Moon Explorer, is a European Space Agency L-class mission destined for the Jovian system. Due for launch in 2022, it will begin a science phase after its transit to Jupiter that will include detailed investigations of three of the Galilean moons: Ganymede, Callisto and Europa. JUICE will carry payloads to characterise the Jovian environments, divided into in situ, geophysical and remote sensing packages. A key instrument in the remote sensing package is JANUS, an optical camera operating over a wavelength range of 350 nm to 1064 nm. JANUS will be used to study the external layers of Jupiter’s atmosphere, the ring system and the planetary bodies. To achieve the science goals, resolutions of better than 5 m per pixel are required for the highest resolution observations during the 200 km altitude orbit of Ganymede, whilst the system is operated with a signal to noise ratio of better than 100. Jupiter’s magnetic field is a dominant object in the solar system, trapping electrons and other charged particles leading to the radiation environment around Jupiter being very hostile, especially in the regions closest to Jupiter in the Ganymede orbit. The radiation tolerance of the focal plane detector in JANUS is therefore a major concern and radiation testing is vital to confirm its expected performance after irradiation will meet requirements set by the science goals. JANUS will be using a detector from e2v technologies plc, the CMOS Imaging Sensor 115 (CIS115), which is a device manufactured using 0.18 μm Imaging CMOS Process with a 2000 by 1504 pixel array each 7 μm square. The pixels have a 4T pinned photodiode pixel architecture, and the array is read out through four differential analogue outputs. This paper describes the preliminary characterisation of the CIS115, and results obtained with the CIS107 precursor sensor

    The use of EM-CCDs on high resolution soft x-ray spectrometers

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    Charge-Coupled Devices (CCDs) have been traditionally used on high resolution soft X-ray spectrometers, but with their ability to increase the signal level in the detector before the readout noise of the system is added, Electron-Multiplying CCDs (EM-CCDs) have the potential to offer many advantages in soft X-ray detection. Through this signal multiplication an EM-CCD has advantages over conventioanl CCDs of increased signal, suppressed noise, faster readout speeds for the same equivalent readout noise and an increased inmmunity to Electro-Magnetic Intereference. This paper will look at present and future spacel applications for high resolution soft X-ray spectrometers and assess the advantages and disadvantage of using EM-CCDs in these applications

    High-resolution soft x-ray spectrometry using the electron-multiplying charge-coupled device (EM-CCD)

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    The Electron-Multiplying Charge-Coupled Device (EM-CCD) shares a similar structure to the CCD except for the inclusion of a gain register that multiplies signal before the addition of read-noise, offering sub-electron effective readnoise at high frame-rates. EM-CCDs were proposed for the dispersive spectrometer on the International X-ray Observatory (IXO) to bring sub-300 eV X-rays above the noise, increasing the science yield. The high-speed, low-noise performance of the EMCCD brought added advantages of reduced dark current and stray-light per frame, reducing cooling and filtering requirements. To increase grating efficiency, several diffracted spectral orders were co-located so the inherent energy resolution of the detector was required for order separation. Although the spectral resolution of the EM-CCD is degraded by the gain process, it was shown that the EM-CCD could achieve the required separation. The RIXS spectrometer at the Advanced Resonant Spectroscopy beamline (ADRESS) of the Swiss Light Source (SLS) at the Paul Scherrer Institute currently uses a CCD, with charge spreading between pixels limiting the spatial resolution to 24 μm (FWHM). Through improving the spatial resolution below 5 μm alongside upgrading the grating, a factor of two energy resolution improvement could theoretically be made. With the high-speed, low-noise performance of the EM-CCD, photon-counting modes could allow the use of centroiding techniques to improve the resolution. Using various centroiding techniques, a spatial resolution of 2 μm (FWHM) has been achieved experimentally, demonstrating the benefits of this detector technology for soft X-ray spectrometry. This paper summarises the use of EM-CCDs from our first investigations for IXO through to our latest developments in ground-based testing for synchrotron-research and looks beyond to future possibilities

    Comparison of Back-Thinned Detector Ultraviolet Quantum Efficiency for Two Commercially Available Passivation Treatments

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    Back-thinned silicon detectors offer a high response over a very broad spectrum for direct detection by providing an efficient optical path into the sensing silicon avoiding front face structures manufactured from metal, polysilicon, nitrides, and oxides that may absorb the incident light before reaching the sensing silicon. We have tested two CCDs with different back-surface shallow p+ implant thicknesses (basic and enhanced) at the M4 line (wavelength between 40 and 400 nm) at Physikalisch-Technische Bundesanstalt (PTB)’s Metrology Light Source in Berlin. This characterization in the ultraviolet spectral range extends the soft X-ray quantum efficiency (QE) data set previously acquired with the exact same devices. Due to the short absorption depth and the scope for many types of interactions of the device materials with ultraviolet photons, QE measurement and stability of the device against extended exposure in the UV are of ongoing interest. Therefore, QE measurements have been carried out before and after exposures to quantify any change in behavior. To allow characterization of the passivation processes only, the devices have no antireflection coating. The measured QE of the standard back-thinned CCD is below 10% between 70 and 370 nm. An average additional 5% efficiency is achieved in the enhanced device within the same range. At the limits of the measured spectrum, toward soft X-rays or toward the visible range, the QE increases and the difference between the standard and the enhanced process is reduced as the photon absorption length increases beyond the immediate back-surface. The measured QE after long high-flux exposures at 200 nm shows remarkable improvement

    A Novel TLR4-Mediated Signaling Pathway Leading to IL-6 Responses in Human Bladder Epithelial Cells

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    The vigorous cytokine response of immune cells to Gram-negative bacteria is primarily mediated by a recognition molecule, Toll-like receptor 4 (TLR4), which recognizes lipopolysaccharide (LPS) and initiates a series of intracellular NF-κB–associated signaling events. Recently, bladder epithelial cells (BECs) were reported to express TLR4 and to evoke a vigorous cytokine response upon exposure to LPS. We examined intracellular signaling events in human BECs leading to the production of IL-6, a major urinary cytokine, following activation by Escherichia coli and isolated LPS. We observed that in addition to the classical NF-κB–associated pathway, TLR4 triggers a distinct and more rapid signaling response involving, sequentially, Ca(2+), adenylyl cyclase 3–generated cAMP, and a transcriptional factor, cAMP response element–binding protein. This capacity of BECs to mobilize secondary messengers and evoke a more rapid IL-6 response might be critical in their role as first responders to microbial challenge in the urinary tract
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