Factors Associated With the Development of Chronic Kidney Disease in Children With Congenital Anomalies of the Kidney and Urinary Tract

Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of end-stage renal disease in children and adolescents. The diversity of the malformations summarized by CAKUT is high and there are numerous associated syndromes. The genetic background of these malformations remains unknown in the majority of cases. The aim of this study was to evaluate factors associated with the development of chronic kidney disease (CKD) and underlying genetic aberrations in children and adolescents with CAKUT. For this purpose, data from patients with CAKUT presented at the pediatric nephrology outpatient clinic were analyzed in a cross-sectional single-center study. Among the 405 patients, the commonest findings related to CAKUT were renal hypoplasia/dysplasia (65%), followed by hydronephrosis (43%). Forty-four percent of the patients were suffering from CKD, 6% were ranked as end-stage renal disease. In the univariate analysis, male gender and premature birth were associated with higher CKD stages (p = 0.004 resp. p < 0.001). Children with an abnormal prenatal ultrasound had more often a glomerular filtration rate of <30 ml/min/1.73 m2 (p = 0.004). Patients with urinary tract infections as first symptom whereas had significant lower CKD stages (p = 0,006). In the multivariate analysis, premature birth (p = 0.033) and urinary tract infection as the first symptom (p = 0.043) were significantly associated with CKD stage ≥ II. Among the 16% of the children who have undergone genetic analyses the most frequent genetic aberration was a mutation in HNF1β-gene. These results can be used for the care of patients with CAKUT subject to factors associated with developing CKD

Intensivierte Hämodialyseverfahren bei Kindern und Jugendlichen

Bei erwachsenen Patient*innen stellen intensivierte HD-Verfahren eine Option dar, die Morbidität und Lebensqualität der Betroffenen zu verbessern. Um zu untersuchen, ob diese positiven Effekte auch bei Kindern und Jugendlichen zu beobachten sind, wurde ein nächtliches intermittierendes HD-Programm als prospektive Beobachtungsstudie initiiert. Es wurde untersucht, welchen Einfluss die nächtlich intermittierende HD auf Urämie-assoziierte Parameter, auf die Medikamentenmenge und auf die Lebensqualität der Betroffenen im Vergleich zur konventionellen HD und zur PD hat. Des Weiteren wurde versucht, ob die nächtliche intermittierende HDF gegenüber der nächtlich intermittierenden HD die Dialysequalität weiter verbessert. Um zu analysieren, in wieweit intensivierte HD-Verfahren bereits im klinischen Alltag sowohl bei Kindern und Jugendlichen als auch bei Erwachsenen eingesetzt werden, und welche Einstellung die Behandler gegenüber diesen Verfahren haben, wurden Umfragen unter Erwachsenennephrolog*innen und Kindernephrolog*innen durchgeführt

Making Tactile Textures with Predefined Affective Properties

A process for the design and manufacture of 3D tactile textures with predefined affective properties was developed. Twenty four tactile textures were manufactured. Texture measures from the domain of machine vision were used to characterize the digital representations of the tactile textures. To obtain affective ratings, the textures were touched, unseen, by 107 participants who scored them against natural, warm, elegant, rough, simple, and like, on a semantic differential scale. The texture measures were correlated with the participants' affective ratings using a novel feature subset evaluation method and a partial least squares genetic algorithm. Six measures were identified that are significantly correlated with human responses and are unlikely to have occurred by chance. Regression equations were used to select 48 new tactile textures that had been synthesized using mixing algorithms and which were likely to score highly against the six adjectives when touched by participants. The new textures were manufactured and rated by participants. It was found that the regression equations gave excellent predictive ability. The principal contribution of the work is the demonstration of a process, using machine vision methods and rapid prototyping, which can be used to make new tactile textures with predefined affective properties

Different judgments about visual textures invoke different eye movement patterns

Top-down influences on the guidance of the eyes are generally modeled as modulating influences on bottom-up salience maps. Interested in task-driven influences on how, rather than where, the eyes are guided, we expected differences in eye movement parameters accompanying beauty and roughness judgments about visual textures. Participants judged textures for beauty and roughness, while their gaze-behavior was recorded. Eye movement parameters differed between the judgments, showing task effects on how people look at images. Similarity in the spatial distribution of attention suggests that differences in the guidance of attention are non-spatial, possibly feature-based. During the beauty judgment, participants fixated on patches that were richer in color information, further supporting the idea that differences in the guidance of attention are feature-based. A finding of shorter fixation durations during beauty judgments may indicate that extraction of the relevant features is easier during this judgment. This finding is consistent with a more ambient scanning mode during this judgment. The differences in eye movement parameters during different judgments about highly repetitive stimuli highlight the need for models of eye guidance to go beyond salience maps, to include the temporal dynamics of eye guidance

Conservative Care, Dialysis Withdrawal, and Palliative Care: Results from a Survey of a Non-Profit Dialysis Provider in Germany

Background: In Germany, practice patterns of conservative renal care (CRC), dialysis withdrawal (DW), and concomitant palliative care in patients who choose these options are unknown. Method: A survey was designed including 13 structured and one open questions on the management and frequency of CRC and DW, local palliative care structure, and fundamentals of the decision-making process, and addressed to the head physicians of all renal centers (n = 193) of a non-profit renal care provider (KfH – Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany). Results: Response rate was 62.2% (n = 122 centers) comprising 14,197 prevalent dialysis patients and 159,652 renal outpatients. Two-thirds of the respondents were men (85% in the age group between 45 and 64 years). Mean time of experience in renal medicine was 22.2 years in men, 20.8 years in women. 94% of all centers provided CRC with a different frequency and proportion of patients (mean 8.4% of the center population, median 5%, range 0–50%). Mean proportion of DW was 2.85% per year (median 2%, range 1–15%). Physicians and center features were not significantly associated with utilization of CRC or DW. Palliative care management varied including local palliative teams, support by general physicians, or by the renal team itself. Hospice care was only established in patients undergoing CRC. Fundamentals of the decision-making process were the desire of the patient (90% in CRC, 67% in DW). Patients undergoing CRC changed their opinion towards treatment modality “frequently” in 18% of the cases, “occasionally” in 73%. Physicians’ decisions were mostly driven by presumed fatal prognosis and poor physical or mental conditions of the individual patient. Different barriers to provide palliative care for the renal population like lack of education in palliative medicine, shortness of staff, lack of financial resources, and local palliative care structures were reported. Conclusion: Compared to international numbers, in Germany, proportion of CRC and DW reported by non-profit renal centers is in the lower range. Center practice of palliative care management varies and is driven by availability of local palliative care resources and presumably by attitudes of the renal teams. Quality of palliative care and the decision-making process need further evaluation

a qualitative study

Objectives: It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents’ lives with an increased risk for non- adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. Setting: In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. Results: This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of successful transition. Key elements of transitional care are well understood and mutually agreed on. Nonetheless, implementation within daily routine seems challenging, and the absence of written, structured procedures may hamper successful transition. Conclusions: While professionals aim for an individual timing of transfer based on medical, social, emotional and structural aspects, rigid regulations on transfer age as given by the relevant health authorities add on to the challenge. Trial registration number: ISRCTN Registry no 22988897; results (phase I) and pre-results (phase II)

Hierarchical aesthetic quality assessment using deep convolutional neural networks

Aesthetic image analysis has attracted much attention in recent years. However, assessing the aesthetic quality and assigning an aesthetic score are challenging problems. In this paper, we propose a novel framework for assessing the aesthetic quality of images. Firstly, we divide the images into three categories: “scene”, “object” and “texture”. Each category has an associated convolutional neural network (CNN) which learns the aesthetic features for the category in question. The object CNN is trained using the whole images and a salient region in each image. The texture CNN is trained using small regions in the original images. Furthermore, an A & C CNN is developed to simultaneously assess the aesthetic quality and identify the category for overall images. For each CNN, classification and regression models are developed separately to predict aesthetic class (high or low) and to assign an aesthetic score. Experimental results on a recently published large-scale dataset show that the proposed method can outperform the state-of-the-art methods for each category

Aesthetics by Numbers: Links between Perceived Texture Qualities and Computed Visual Texture Properties.

Our world is filled with texture. For the human visual system, this is an important source of information for assessing environmental and material properties. Indeed-and presumably for this reason-the human visual system has regions dedicated to processing textures. Despite their abundance and apparent relevance, only recently the relationships between texture features and high-level judgments have captured the interest of mainstream science, despite long-standing indications for such relationships. In this study, we explore such relationships, as these might be used to predict perceived texture qualities. This is relevant, not only from a psychological/neuroscience perspective, but also for more applied fields such as design, architecture, and the visual arts. In two separate experiments, observers judged various qualities of visual textures such as beauty, roughness, naturalness, elegance, and complexity. Based on factor analysis, we find that in both experiments, ~75% of the variability in the judgments could be explained by a two-dimensional space, with axes that are closely aligned to the beauty and roughness judgments. That a two-dimensional judgment space suffices to capture most of the variability in the perceived texture qualities suggests that observers use a relatively limited set of internal scales on which to base various judgments, including aesthetic ones. Finally, for both of these judgments, we determined the relationship with a large number of texture features computed for each of the texture stimuli. We find that the presence of lower spatial frequencies, oblique orientations, higher intensity variation, higher saturation, and redness correlates with higher beauty ratings. Features that captured image intensity and uniformity correlated with roughness ratings. Therefore, a number of computational texture features are predictive of these judgments. This suggests that perceived texture qualities-including the aesthetic appreciation-are sufficiently universal to be predicted-with reasonable accuracy-based on the computed feature content of the textures