A Composite Index of Compliance for Chronic In‐Center Hemodialysis Patients

We developed a composite compliance index as the sum of the compliance scores for interdialytic weight gain (IDWG), pre‐dialysis serum potassium and phosphorus concentrations (each scored from zero to 3, with 3 indicating the poorest compliance), and skipping hemodialysis sessions (scored from zero to 9, with 9 indicating the poorest compliance). We used this composite score to prospectively evaluate compliance in 25 prevalent hemodialysis patients over a period of 1 year. We then followed these patients for another 3.5 years. The patients studied were divided into two groups: group A (poor compliance) consisted of 9 subjects with composite score ≥ 9 (13.2 ± 3.2); group B (better compliance) consisted of 16 subjects with composite score < 9 (4.7 ± 1.8). Age, duration of hemodialysis, and frequency of diabetes mellitus did not differ between the groups. Group A contained higher fractions of subjects with history of alcoholism (66.7% vs 12.5%, p = 0.010), other substance addiction (44.4% vs 0%, p = 0.010), and severe psychosocial problems (88.9% vs 18.8%, p = 0.002). Mean survival from the beginning of observation, estimated by actuarial life‐table survival analysis, was 1.19 years in group A and 2.60 years in group B (p = 0.0265). A composite compliance index incorporating domains indicating adherence to diet, medications, and dialysis schedule identified other behavioral problems in poorly compliant patients. Hemodialysis patients characterized by this composite index as poorly compliant had shortened survival.     

The Association of Human Herpesviruses with Malignant Brain Tumor Pathology and Therapy: Two Sides of a Coin

The role of certain viruses in malignant brain tumor development remains controversial. Experimental data demonstrate that human herpesviruses (HHVs), particularly cytomegalovirus (CMV), Epstein–Barr virus (EBV) and human herpes virus 6 (HHV-6), are implicated in brain tumor pathology, although their direct role has not yet been proven. CMV is present in most gliomas and medulloblastomas and is known to facilitate oncomodulation and/or immunomodulation, thus promoting cancer cell proliferation, invasion, apoptosis, angiogenesis, and immunosuppression. EBV and HHV-6 have also been detected in brain tumors and high-grade gliomas, showing high rates of expression and an inflammatory potential. On the other hand, due to the neurotropic nature of HHVs, novel studies have highlighted the engagement of such viruses in the development of new immunotherapeutic approaches in the context of oncolytic viral treatment and vaccine-based strategies against brain tumors. This review provides a comprehensive evaluation of recent scientific data concerning the emerging dual role of HHVs in malignant brain pathology, either as potential causative agents or as immunotherapeutic tools in the fight against these devastating diseases.     

Public-Private Partnerships in the Water Sector

Abstract

Types of partnerships between public and private companies in water and sewage services are evaluated on the basis of the economic efficiency of the scheme for each partner. Modeling of public-private partnerships involves the formulation of a contract prototype, which determines the roles, functions, and responsibilities as well as the allocation of costs and revenues for each partner. Alternative water management scenarios are used to identify the investments required for meeting the projected demand for water and sewage services. Investment and operational costs as well as revenues from water and sewage services are estimated according to the allocation defined in the contract prototype. The economic efficiency of the scheme is assessed through a cost benefit analysis for each partner. The evaluation of different water management scenarios indicates that, for the Cyclades Islands, Greece, there is a substantial water market where several forms of partnerships could be attractive for both the public and the private sectors. Such partnerships include, among others, lease purchase, temporary privatization, built operate transfer (BOT), and built own operate transfer (BOOT). These forms of public-private partnerships could also be successful in similar regions where significant improvements and expansion of the infrastructure is required while access to the required funds and expertise is restricted for small public water companies.     

On the gradient elastic wave propagation in cylindrical waveguides with microstructure

The present work describes the development of a complete theoretical framework of wave propagation in cylindrical waveguides possessing microstructure. In parallel, a thorough investigation of the full 3-D model of wave propagation in cylinders is presented. The first step is the spectral decomposition of the boundary value problem emerging via wave propagation analysis. The spectral representation of the specific gradient elasticity problem reflects the ability to construct all the possible propagating modes in cylindrical geometry. Several byproducts arise along the present work, which constitute generalizations of well known important features of classical elasticity and are indispensable for modeling the gradient elasticity problem. We note the construction of the set of dyadic Navier eigenfunctions which constitute the generalization of the Navier eigenvectors. The restriction of the Navier eigendyadics on cylindrical surfaces gives birth to the dyadic cylindrical harmonics, which constitute the generalization of the well known vector harmonics. This set is also a basis in the sense that the trace of every dyadic field on a cylindrical surface can be represented as a countable superposition of dyadic cylindrical harmonics. The method aims at providing the necessary theoretical establishment for the determination of the dispersion curves emerging in cortical bones.