Advocating for in-center hemodialysis patients via anonymous survey.

We conducted an anonymous survey in 9 of our university affiliated outpatient dialysis units to address the concern that many in-center hemodialysis patients may not feel comfortable sharing their experiences. Major goals of this study: Investigating level of patient satisfaction with their care; Evaluating the subjective perception of the level of understanding of patients regarding pertinent issues of their disease and its management; Identifying potential avenues for care improvement. Survey was conducted in English, paper-based, with answer choices to individual questions for patient satisfaction and education graded using a 5-point Likert scale. Regarding potential areas of improvement, patients were asked to choose as many areas as deemed appropriate. To ensure anonymity, the completed surveys were folded and dropped into a box. Overall, 253 out of 516 (49%) screened patients were eligible and completed the survey. Patients expressed favorable responses regarding satisfaction (mean rating > 4 in each of 14 questions) and education (mean rating > 4 in 8 questions, > 3.5 in 2 questions) regarding hemodialysis. About 62% of overall study participants identified at least one area where they felt additional information would result in improvement of care. Our results indicate that patients undergoing outpatient hemodialysis were overall satisfied and had a good perceptive understanding about their health. Based on the patients' input, strategies focused on addressing pain and discomfort, privacy, providing information about palliative care/hospice, mental health resources, and the process of kidney transplantation may promote improvement in overall quality of care.

Time-scale dependence of solar wind-based regression models of ionospheric electrodynamics.

The solar wind influence on geospace can be described as the sum of a directly driven component, or dayside reconnection, and an unloading component, associated with the release of magnetic energy via nightside reconnection. The two processes are poorly correlated on short time scales, but exactly equal when averaged over long time windows. Because of this peculiar property, regression models of ionospheric electrodynamics that are based on solar wind data are time scale specific: Models derived from 1 min resolution data will be different from models derived from hourly, daily, or monthly data. We explain and quantify this effect on simple linear regression models of various geomagnetic indices. We also derive a time scale-dependent correction factor that can be used with the Average Magnetic field and Polar current System model. Finally, we show how absolute estimates of the nightside reconnection rate can be calculated from solar wind measurements and geomagnetic indices.

Inferring Source Properties of Monoenergetic Electron Precipitation From Kappa and Maxwellian Moment-Voltage Relationships.

We present two case studies of FAST electrostatic analyzer measurements of both highly nonthermal ( κ ≲  2.5) and weakly nonthermal/thermal monoenergetic electron precipitation at ∼4,000 km, from which we infer the properties of the magnetospheric source distributions via comparison of experimentally determined number density-, current density-, and energy flux-voltage relationships with corresponding theoretical relationships. We also discuss the properties of the two new theoretical number density-voltage relationships that we employ. Moment uncertainties, which are calculated analytically via application of the Gershman et al. (2015, https://doi.org/10.1002/2014JA020775) moment uncertainty framework, are used in Monte Carlo simulations to infer ranges of magnetospheric source population densities, temperatures, κ values, and altitudes. We identify the most likely ranges of source parameters by requiring that the range of κ values inferred from fitting experimental moment-voltage relationships correspond to the range of κ values inferred from directly fitting observed electron distributions with two-dimensional kappa distribution functions. Observations in the first case study, which are made over ∼78-79° invariant latitude in the Northern Hemisphere and 4.5-5.5 magnetic local time, are consistent with a magnetospheric source population density n m= 0.7-0.8 cm-3, source temperature T m≈ 70 eV, source altitude h= 6.4-7.7 R E, and κ= 2.2-2.8. Observations in the second case study, which are made over 76-79° invariant latitude in the Southern Hemisphere and ∼21 magnetic local time, are consistent with a magnetospheric source population density n m= 0.07-0.09 cm-3, source temperature T m≈ 95 eV, source altitude h ≳  6 R E, and κ= 2-6.

Effects of Probiotics on Inflammation and Uremic Toxins Among Patients on Dialysis: A Systematic Review and Meta-Analysis.

BACKGROUND/OBJECTIVES: We performed this systematic review and meta-analysis to evaluate effects of probiotics on inflammation, uremic toxins, and gastrointestinal (GI) symptoms in end-stage renal disease (ESRD) patients. METHODS: A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane Database from inception through October 2017. We included studies that assessed assessing effects of probiotics on inflammatory markers, protein-bound uremic toxins (PBUTs), and GI symptoms in ESRD patients on dialysis. Effect estimates from the individual study were extracted and combined utilizing random effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO; No. CRD42017082137. RESULTS: Seven clinical trials with 178 ESRD patients were enrolled. There was a significant reduction in serum C-reactive protein (CRP) from baseline to post-probiotic course (≥ 2 months after treatment) with standardized mean difference (SMD) of - 0.42 (95% CI - 0.68 to - 0.16, p = 0.002). When compared to control, patients who received probiotics also had a significant higher degree of reduction in CRP level with SMDs of - 0.37 (95% CI - 0.72 to 0.03, p = 0.04). However, there were no significant changes in serum TNF-alpha or albumin with SMDs of - 0.32 (95% CI - 0.92 to 0.28, p = 0.29) and 0.16 (95% CI - 0.20 to 0.53, p = 0.39), respectively. After probiotic course, there were also significant decrease in PBUTs and improvement in overall GI symptoms (reduction in GI symptom scores) with SMDs of - 0.61 (95% CI - 1.16 to - 0.07, p = 0.03) and - 1.04 (95% CI - 1.70 to - 0.38, p = 0.002), respectively. CONCLUSION: Our study demonstrates potential beneficial effects of probiotics on inflammation, uremic toxins, and GI Symptoms in ESRD patients. Future large-scale clinical studies are required to assess its benefits on other important clinical outcomes including patient mortality.