Oral health and kidney disease with emphasis on diabetic nephropathy

Chronic kidney disease (CKD) is a worldwide health problem, with adverse outcomes of cardiovascular disease and premature death. The ageing of populations along with the growing prevalence of chronic diseases such as diabetes and hypertension is leading to worldwide increase in the number of CKD patients. It has become evident that inflammation plays an important role in the pathogenesis of atherosclerosis complications. CKD patients also have an increased risk of atherosclerosis complications (including myocardial infarction, sudden death to cardiac arrhythmia, cerebrovascular accidents, and peripheral vascular disease). In line with this, oral and dental problems can be an important source of systemic inflammation. A decline in oral health may potentially act as an early marker of systemic disease progression. This series of studies examined oral health of CKD patients from predialysis, to dialysis and kidney transplantation in a 10-year follow-up study and in a cross-sectional study of predialysis CKD patients. Patients had clinical and radiographic oral and dental examination, resting and stimulated saliva flow rates were measured, whilst the biochemical and microbiological composition of saliva was analyzed. Lifestyle and oral symptoms were recorded using a questionnaire, and blood parameters were collected from the hospital records. The hypothesis was that the oral health status, symptoms, sensations, salivary flow rates and salivary composition vary in different renal failure stages and depend on the etiology of the kidney disease. No statistically significant difference were seen in the longitudinal study in the clinical parameters. However, some saliva parameters after renal transplantation were significantly improved compared to levels at the predialysis stage. The urea concentration of saliva was high in all stages. The salivary and plasma urea concentrations followed a similar trend, showing the lowest values in kidney transplant patients. Levels of immunoglobulin (Ig) A, G and M all decreased significantly after kidney transplantation. Increased concentrations of IgA, IgG and IgM may reflect disintegration of the oral epithelium and are usually markers of poor general oral condition. In the cross-sectional investigation of predialysis CKD patients we compared oral health findings of diabetic nephropathy patients to those with other kidney disease than diabetes. The results showed eg. more dental caries and lower stimulated salivary flow rates in the diabetic patients. HbA1C values of the diabetic patients were significantly higher than those in the other kidney disease group. A statistically significant difference was observed in the number of drugs used daily in the diabetic nephropathy group than in the other kidney disease group. In the logistic regression analyses, age was the principal explanatory factor for high salivary total protein concentration, and for low unstimulated salivary flow. Poor dental health, severity of periodontal disease seemed to be an explanatory factor for high salivary albumin concentrations. Salivary urea levels were significantly linked with diabetic nephropathy and with serum urea concentrations. Contrary to our expectation, however, diabetic nephropathy did not seem to affect periodontal health more severely than the other kidney diseases. Although diabetes is known to associate with xerostomia and other oral symptoms, it did not seem to increase the prevalence of oral discomfort. In summary, this series of studies has provided new information regarding the oral health of CKD patients. As expected, the commencement of renal disease reflects in oral symptoms and signs. Diabetic nephropathy, in particular, appears to impart a requirement for special attention in the oral health care of patients suffering from this disease.

Functional outcome and health-related quality of life after traumatic brain injury in the framework of the International Classification of Functioning, Disability and Health (ICF)

Traumatic brain injury (TBI) affects people of all ages and is a cause of long-term disability. In recent years, the epidemiological patterns of TBI have been changing. TBI is a heterogeneous disorder with different forms of presentation and highly individual outcome regarding functioning and health-related quality of life (HRQoL). The meaning of disability differs from person to person based on the individual s personality, value system, past experience, and the purpose he or she sees in life. Understanding of all these viewpoints is needed in comprehensive rehabilitation. This study examines the epidemiology of TBI in Finland as well as functioning and HRQoL after TBI, and compares the subjective and objective assessments of outcome. The frame of reference is the International Classification of Functioning, Disability and Health (ICF). The subjects of Study I represent the population of Finnish TBI patients who experienced their first TBI between 1991 and 2005. The 55 Finnish subjects of Studies II and IV participated in the first wave of the international Quality of life after brain injury (QOLIBRI) validation study. The 795 subjects from six language areas of Study III formed the second wave of the QOLIBRI validation study. The average annual incidence of Finnish hospitalised TBI patients during the years 1991-2005 was 101:100 000 in patients who had TBI as the primary diagnosis and did not have a previous TBI in their medical history. Males (59.2%) were at considerably higher risk of getting a TBI than females. The most common external cause of the injury was falls in all age groups. The number of TBI patients ≥ 70 years of age increased by 59.4% while the number of inhabitants older than 70 years increased by 30.3% in the population of Finland during the same time period. The functioning of a sample of 55 persons with TBI was assessed by extracting information from the patients medical documents using the ICF checklist. The most common problems were found in the ICF components of Body Functions (b) and Activities and Participation (d). HRQoL was assessed with the QOLIBRI which showed the highest level of satisfaction on the Emotions, Physical Problems and Daily Life and Autonomy scales. The highest scores were obtained by the youngest participants and participants living independently without the help of other people, and by people who were working. The relationship between the functional outcome and HRQoL was not straightforward. The procedure of linking the QOLIBRI and the GOSE to the ICF showed that these two outcome measures cover the relevant domains of TBI patients functioning. The QOLIBRI provides the patients subjective view, while the GOSE summarises the objective elements of functioning. Our study indicates that there are certain domains of functioning that are not traditionally sufficiently documented but are important for the HRQoL of persons with TBI. This was the finding especially in the domains of interpersonal relationships, social and leisure activities, self, and the environment. Rehabilitation aims to optimize functioning and to minimize the experience of disability among people with health conditions, and it needs to be based on a comprehensive understanding of human functioning. As an integrative model, the ICF may serve as a frame of reference in achieving such an understanding.

A transputer-based extended hypercube

The Extended Hypercube is a new approach in multiprocessor architectures, which reduces the communication burden on the processor elements. We propose a scheme for implementing such an architecture using INMOS transputers as the processor and controller elements to achieve a very high computation to communication ratio.

Exotic Physics in the Negative-U, Extended-Hubbard Model for Barium Bismuthates?

We point out possibilities for exotic physics in barium bismuthates, from a detailed study of the negative-U, extended-Hubbard model proposed for these systems. We emphasize the different consequences of electronic and phononic mechanisms for negative U. We show that, for an electronic mechanism, the semiconducting phases must be unique, with their transport properties dominated by charge ± 2e Cooperon bound states. This can explain the observed difference between the optical and transport gaps. We propose other experimental tests for this novel mechanism of charge transport.

Mean-field results of the multiple-band extended Hubbard model for the square-planar CuO2 lattice

We obtain metal-insulator phase diagrams at half-filling for the five-band extended Hubbard model of the square-planar CuO2 lattice treated within a Hartree-Fock mean-field approximation, allowing for spiral spin-density waves. We indicate the existence of an insulating phase (covalent insulator) characterized by strong covalency effects, not identified in the earlier Zaanen-Sawatzky-Allen phase diagram. While the insulating phase is always antiferromagnetic, we also obtain an antiferromagnetic metallic phase for a certain range of interaction parameters. Performing a nonperturbative calculation of J(eff), the in-plane antiferromagnetic interaction is presented as a function of the parameters in the model. We also calculate the band gap and magnetic moments at various sites and discuss critically the contrasting interpretation of the electronic structure of high-T(c) materials arising from photoemission and neutron-scattering experiments.

Lattice embedding and equilibrium geometry of metal-halogen chains in the two-band extended Hubbard model

Two-band extended Hubbard model studies show that the shift in optical gap of the metal-halogen (MX) chain upon embedding in a crystalline environment depends upon alternation in the site-diagonal electron-lattice interaction parameter (epsilon(M)) and the strength of electron-electron interactions at the metal site (U(M)). The equilibrium geometry studies on isolated chains show that the MX chains tend to distort for alternating epsilon(M) and small U(M) values.

Load balancing algorithms for an extended hypercube

Reduction of the execution time of a job through equitable distribution of work load among the processors in a distributed system is the goal of load balancing. Performance of static and dynamic load balancing algorithms for the extended hypercube, is discussed. Threshold algorithms are very well-known algorithms for dynamic load balancing in distributed systems. An extension of the threshold algorithm, called the multilevel threshold algorithm, has been proposed. The hierarchical interconnection network of the extended hypercube is suitable for implementing the proposed algorithm. The new algorithm has been implemented on a transputer-based system and the performance of the algorithm for an extended hypercube is compared with those for mesh and binary hypercube networks

Extended gravitational action and novel consequences

It is found that the inclusion of higher derivative terms in the gravitational action along with concepts of phase transition and spontaneous symmetry breaking leads to some novel consequence. The Ricci scalar plays the dual role, like a physical field as well as a geometrical field. One gets Klein-Gordon equation for the emerging field and the corresponding quanta of geometry are called Riccions. For the early universe the model removes singularity along with inflation. In higher dimensional gravity the Riccions can break into spin half particle and antiparticle along with breaking of left-right symmetry. Most tantalizing consequences is the emergence of the physical universe from the geometry in the extreme past. Riccions can Bose condense and may account for the dark matter.

Extended kac-akhiezer formulae and the fredholm determinant of finite section hilbert-schmidt kernels

This paper deals with some results (known as Kac-Akhiezer formulae) on generalized Fredholm determinants for Hilbert-Schmidt operators on L2-spaces, available in the literature for convolution kernels on intervals. The Kac-Akhiezer formulae have been obtained for kernels which are not necessarily of convolution nature and for domains in R(n).

Supersolid Phase in One-Dimensional Bose-Hubbard Model With Extended Range Interactions: DMRG And Field Theoretic Study at Different Densities

We use the Density Matrix Renormalization Group and the Abelian bosonization method to study the effect of density on quantum phases of one-dimensional extended Bose-Hubbard model. We predict the existence of supersolid phase and also other quantum phases for this system. We have analyzed the role of extended range interaction parameters on solitonic phase near half-filling. We discuss the effects of dimerization in nearest neighbor hopping and interaction as well as next nearest neighbor interaction on the plateau phase at half-filling.

Extended Huckel molecular orbital calculations on hydroxobridged heterotrinuclear cobalt(III) complexes

EHT calculations on heterotrinuclear cobalt(III) complexes of the type [Cu{(OH)(2)Co(L(4))}(2)](4+) where L(4) denotes (en)(2) or (NH3)(4), en = ethylenediamine and their component species have been carried out. The results regarding bonding and structure for the trinuclear complexes are compared with those for the monomer components such as [Co(en)(2)(OH)(2)](+), [Co(NH3)(4)(OH)(2)](+) and [Cu(OH)(4)](2-) are discussed.

Spin and charge density waves in the extended Hubbard model: A slave-boson approach

We use the extended Hubbard model to investigate the properties of the charge- and spin-density-wave phases in the presence of a nearest-neighbors repulsion term in the framework of the slave-boson technique. We show that, contrary to Hartree-Fock results, an instablity may occur for sufficiently high values of the Hubbard repulsion, both in the spin- and charge-density-wave phase, which makes the system discontinuously jump to a phase with a smaller or zero wave amplitude. The limits of applicability of our approach are discussed and our results are compared with previous numerical analysis. The phase diagram of the model at half-filling is determined.

Predictive uncertainty of chaotic daily streamflow using ensemble wavelet networks approach

Perfect or even mediocre weather predictions over a long period are almost impossible because of the ultimate growth of a small initial error into a significant one. Even though the sensitivity of initial conditions limits the predictability in chaotic systems, an ensemble of prediction from different possible initial conditions and also a prediction algorithm capable of resolving the fine structure of the chaotic attractor can reduce the prediction uncertainty to some extent. All of the traditional chaotic prediction methods in hydrology are based on single optimum initial condition local models which can model the sudden divergence of the trajectories with different local functions. Conceptually, global models are ineffective in modeling the highly unstable structure of the chaotic attractor. This paper focuses on an ensemble prediction approach by reconstructing the phase space using different combinations of chaotic parameters, i.e., embedding dimension and delay time to quantify the uncertainty in initial conditions. The ensemble approach is implemented through a local learning wavelet network model with a global feed-forward neural network structure for the phase space prediction of chaotic streamflow series. Quantification of uncertainties in future predictions are done by creating an ensemble of predictions with wavelet network using a range of plausible embedding dimensions and delay times. The ensemble approach is proved to be 50% more efficient than the single prediction for both local approximation and wavelet network approaches. The wavelet network approach has proved to be 30%-50% more superior to the local approximation approach. Compared to the traditional local approximation approach with single initial condition, the total predictive uncertainty in the streamflow is reduced when modeled with ensemble wavelet networks for different lead times. Localization property of wavelets, utilizing different dilation and translation parameters, helps in capturing most of the statistical properties of the observed data. The need for taking into account all plausible initial conditions and also bringing together the characteristics of both local and global approaches to model the unstable yet ordered chaotic attractor of a hydrologic series is clearly demonstrated.

Extended Muskingum method for flood routing

Routing of floods is essential to control the flood flow at the flood control station such that it is within the specified safe limit. In this paper, the applicability of the extended Muskingum method is examined for routing of floods for a case study of Hirakud reservoir, Mahanadi river basin, India. The inflows to the flood control station are of two types-one controllable which comprises of reservoir releases for power and spill and the other is uncontrollable which comprises of inflow from lower tributaries and intermediate catchment between the reservoir and the flood control station. Muskingum model is improved to incorporate multiple sources of inflows and single outflow to route the flood in the reach. Instead of time lag and prismoidal flow parameters, suitable coefficients for various types of inflows were derived using Linear Programming. Presently, the decisions about operation of gates of Hirakud dam are being taken once in 12 h during floods. However, four time intervals of 24, 18, 12 and 6 h are examined to test the sensitivity of the routing time interval on the computed flood flow at the flood control station. It is observed that mean relative error decreases with decrease in routing interval both for calibration and testing phase. It is concluded that the extended Muskingum method can be explored for similar reservoir configurations such as Hirakud reservoir with suitable modifications. (C) 2010 International Association of Hydro-environment Engineering and Research. Asia Pacific Division. Published by Elsevier By. All rights reserved.