Transition Period Research Articles

A large-scale transcontinental river system crossed West Antarctica during the Eocene.

Extensive ice coverage largely prevents investigations of Antarctica's unglaciated past. Knowledge about environmental and tectonic development before large-scale glaciation, however, is important for understanding the transition into the modern icehouse world. We report geochronological and sedimentological data from a drill core from the Amundsen Sea shelf, providing insights into tectonic and topographic conditions during the Eocene (~44 to 34 million years ago), shortly before major ice sheet buildup. Our findings reveal the Eocene as a transition period from >40 million years of relative tectonic quiescence toward reactivation of the West Antarctic Rift System, coinciding with incipient volcanism, rise of the Transantarctic Mountains, and renewed sedimentation under temperate climate conditions. The recovered sediments were deposited in a coastal-estuarine swamp environment at the outlet of a >1500-km-long transcontinental river system, draining from the rising Transantarctic Mountains into the Amundsen Sea. Much of West Antarctica hence lied above sea level, but low topographic relief combined with low elevation inhibited widespread ice sheet formation.

A Scoping Review of Military Culture, Military Identity, and Mental Health Outcomes in Military Personnel.

The military is a unique cultural institution that significantly influences its members, contributing to the development and transformation of their identities. Despite growing interest in identity research in the military, challenges persist in the conceptualization of military identity, including understanding how it forms, assessing the influence of military culture on identity development, and evaluating the implications for mental health. The primary objective of this scoping review was to map the complexities of military culture's impact on military identity and its effects on mental health. A scoping review of the literature was conducted using the Joanna Briggs Institute Scoping Review Methodology. Studies were included if they described military culture, military identity, and mental health, resulting in 65 eligible studies. The extracted data were thematically analyzed to identify how military culture impacts military identity and mental health and well-being. Multiple identities were evident within the military population, with 2 overarching identities, loyalty and military, overall conferring positive mental health outcomes. Where these identities were hidden or disrupted, poorer mental health outcomes were observed. The scoping review conducted in this study challenges the notion of military identity as a singular concept promoting positive mental health outcomes. It highlights its multifaceted nature, revealing that individuals may face identity concealment and disruptions during periods of transition or adjustment, resulting in adverse mental health outcomes. To capture the complexity of military identity, the authors developed the Military Identity Model (MIM). Military leaders, policymakers, and health care professionals are encouraged to recognize the complex nature of military identity and its impact on mental health and well-being. We recommend using the Military Identity Model to explore military identity and adjustment-related difficulties.

Transition from a mixotrophic/heterotrophic protist community during the dark winter to a photoautotrophic spring community in surface waters of Disko Bay, Greenland.

Unicellular eukaryotic plankton communities (protists) are the major basis of the marine food web. The spring bloom is especially important, because of its high biomass. However, it is poorly described how the protist community composition in Arctic surface waters develops from winter to spring. We show that mixotrophic and parasitic organisms are prominent in the dark winter period. The transition period toward the spring bloom event was characterized by a high relative abundance of mixotrophic dinoflagellates, while centric diatoms and the haptophyte Phaeocystis pouchetii dominated the successive phototrophic spring bloom event during the study. The data shows a continuous community shift from winter to spring, and not just a dormant spring community waiting for the right environmental conditions. The spring bloom initiation commenced while sea ice was still scattering and absorbing the sunlight, inhibiting its penetration into the water column. The initial increase in fluorescence was detected relatively deep in the water column at ~55 m depth at the halocline, at which the photosynthetic cells accumulated, while a thick layer of snow and sea ice was still obstructing sunlight penetration of the surface water. This suggests that water column stratification and a complex interplay of abiotic factors eventually promote the spring bloom initiation.

Designing 'Aku yang Bersinar' Illustration Book as an Educational Media for Teenage Self-Confidence

Adolescence is a transitional period from childhood to adulthood. Due to this condition, adolescent development is also followed by other developmental tasks. If adolescents fail to carry out their developmental tasks, it will have negative consequences in social life in the following phases. The role of parental care is very influential on the nature and behavior of adolescents, good parenting forms traits that are confident, take initiative, have ambition, have normal emotions, are responsible, and are able to carry out positive interpersonal ties. The lack of full parenting in the Child Social Welfare Institution (LKSA) or orphanage makes adolescents have a negative self-concept, one of which is the low character of self-confidence. This design aims to create learning media in the form of illustration books that provide education on self-confidence in adolescents, learning to know the strengths and weaknesses of individuals so as to prepare orphanage adolescents to become part of society. The methods used in this design are quantitative and qualitative. The result of the design is a printed book entitled 'Aku yang Bersinar'.

Comprehensive Evaluation of the ‘Shixia’ Longan Quality under Postharvest Ambient Storage: The Volatile Compounds Played a Critical Part

Longan fruit generally undergoes rapid quality deterioration during the postharvest stage, with the manifestation of flavor loss as well as pronounced off-odor production. Nevertheless, the unapparent aroma makes people ignore the odor change in postharvest longan. Sensory analysis serves as an indispensable method combining instrumental detection and the perceptibility of human sensation in a comprehensive evaluation of quality during production and consumption. In this study, we established the evaluating data of the appearance, flavor, taste substances, volatile profiles, and deterioration of ‘Shixia’ longan throughout room-temperature storage using instrument assessment and descriptive measurements. Our results indicated that both the appearance state and the taste condition notably engendered confusion or trouble for consumers to judge under the quality transition period. Conversely, the development of odor was highly consistent with that of quality deterioration. Some unpleasant volatile substances including alcohol (ethanol), acid (acetic acid), and esters (acetic acid methyl ester and ethyl acetate) were probably the cause of off-odor during the storage. The result of the sensory evaluation also presents a more significant relevance between the overall quality and the odor. Generally, the work paved the way to reveal the importance of odor profiles for assessing the comprehensive quality condition of postharvest room-temperature stored longan.

Domestication theory in action: Indonesian Twitter corpus analysis during distance learning

This research aims at analyzing how COVID-19 discourse in the world of education unfolds in the Indonesian Twittersphere by separating public discourse in transition periods, large-scale social restrictions (PSBB), and imposition of emergency restrictions toward community activities (PPKM) and PPKM level 1 to 4. This research used qualitative approach and employed the Domestication Theory to provide a deeper understanding of how individuals integrate technology into their everyday lives. The dataset consisting of 3,196,627 tweets from two keywords and two hashtags was collected and analyzed using corpus linguistics techniques. This study found the emergence of the five main theme groups suggests that users have tried to make sense of and adapt to this new digital learning environment, while also expressing their frustrations and concerns. This highlights the importance of understanding how users domesticate technology and incorporate it into their social and cultural practices. The practical implications of this research include the need to address not only the technical aspects of online learning but also the psychological and social well-being of students, as they navigate this new learning environment.

"And Now that I Feel Safe…I'm Coming Out of Fight or Flight": A Qualitative Exploration of Challenges and Opportunities for Residents' Mental Health in Substance Use Recovery Housing.

Co-occurring mental health concerns are prevalent among substance use recovery housing residents. We sought to explore how residents with co-occurring mental health and substance use needs experience recovery housing. We conducted semi-structured interviews with residents (N = 92) in recovery homes across Texas and developed themes through thematic analysis. Residents note that living in a group home can exacerbate anxiety and paranoia, especially during periods of high turnover. Overwhelmingly, however, residents believe recovery housing improves their mental health. Residents use their shared lived experiences to support one another. Residents also express appreciation for the transition period offered by recovery housing, allowing them to solidify their recoveries before fully re-entering society. Participants describe recovery homes as a critical support for their co-occurring mental health and substance use concerns. These results provide key insights on how to better support mental health in recovery housing.

Jurisdictional convergence, remedial divergence: parallel post-Brexit merger reviews

The UK’s departure from the EU’s competition regime in 2020 introduced the prospect of parallel CMA-Commission reviews. However, the risk of divergence between the two authorities has achieved new prominence as a result of the controversy surrounding the reviews of Microsoft’s acquisition of video gaming company Activision Blizzard, which the CMA initially prohibited, in sharp contrast to the Commission’s decision to accept behavioural remedies. Against this background, this article considers what lessons can be drawn from the parallel reviews in the first three years following the end of the transition period. It concludes that while divergence of some form can be seen in a significant number of cases, consistent outcomes remain the most common result, with apparent variances sometimes explained by differences in market conditions as between the UK and the EU.

지석묘사회에서 목관묘사회로의 전환

The biggest difference between the dolmen society and the wooden coffin tomb society is the existence of the dolmen. Since dolmen is a strategy to lead an agricultural society, the absence of dolmen means entry into a new society. In this review, the tombs in the Yeongnam region were comprehensively reviewed to identify the transition pattern. The transition is carried out in three stages. The first stage is the stage where the relics of the wooden coffin tomb society ‘appear’ from the tombs of the dolmen society. The second stage is the stage where the relics of the wooden coffin tomb society are “deprived” in the tombs of the dolmen society. The third stage is the stage where the shape of the tomb “change” to the wooden coffin tomb. However, even in the third stage, the attributes of dolmen remain. A representative example of the third stage is dolmen A2-1 in Gusan-dong, Gimhae. The transformation pattern is understood as a form in which the existing dolmen society has accepted the culture of the new wooden coffin tomb society step by step. Therefore, the subject of the transition can be seen as the dolmen society of the land. Even during the transition period, the dolmen society maintained the idea of building tombs with stones, the idea of expressing hierarchy through enlargement, and the idea of building dolmen. The maintenance of this notion shows that the subject of transformation is the dolmen society. Transition means the beginning of a new society. The social strategy of dolmen disappears from the new society. However, the change to a new era is not disconnected, but has a continuous aspect. Immediately after the transition is completed, the Yeongnam region emerges as a leader in a new era in a short time. An example of this is the concentration of Han Chinese-style bronze mirror in the Yeongnam region. Therefore, it can be said that the wooden coffin tomb society in the Yeongnam region was formed based on the potential of the dolmen society.

Couple relationship functioning and social adjustment during the transition to parenthood among fathers with a history of maltreatment.

Study of fathers has gained significant traction over recent decades. However, the experience for men over the transition to parenthood remains focused on high-socioeconomic and socially advantaged fathers. Researchers have yet to thoroughly investigate how fathers may uniquely experience this transition period with a history of childhood maltreatment, given that childhood abuse is known to impact several components of development and relationship functioning into adulthood. The current study endeavored to fill this gap by evaluating the associations between fathers' childhood experiences of physical and emotional abuse and their relationship functioning over the transition to parenthood in terms of both the couple relationship and social adjustment in relationships with others. Using data from 399 fathers who participated in a randomized control trial during pregnancy, the results from stepwise regressions indicate fathers with a history of emotional abuse experience particular declines in their external relationships (reductions in social support and increases in social stress) from prenatal (Wave 1) to postpartum (Wave 2) reports. However, no significant association emerged between fathers' history of maltreatment and their relationship functioning with their partners. These results underscore the importance of investigating the impact of different types of abuse on men in fatherhood. Moreover, we emphasize the need to study further fathers' social adjustment over the transition to parenthood beyond the couple relationship and broad social support to address the needs of men with a history of maltreatment in their new role as fathers.

Royal Supremacy and Its Influence on the Formation of Early British Nation-State

Tudor Dynasty is in the transitional period of modern Europe. On the one hand, it is characterized by the struggle of religious power and kingship. On the other hand, it is featured by the formation and development of the early nation-state. This paper briefly discusses the "royal supremacy" of Tudor Dynasty in England and the development of the early nation-state in British and the concrete manifestation of "royal supremacy" and expounds the influence of it on the formation of British nation-state from the following five aspects: economy, political institutions, law, local administration and national consciousness. By analyzing the definition of "royal supremacy" and its influence on the formation of the British nation-state, it is helpful to grasp the development process of modern countries and the particularity of the formation of different nation-states, so as to better grasp the law of British historical development. In a word, "royal supremacy", as the result of the religious reform, greatly promotes the formation and development of the British nation-state in the early modern times in the specific historical period.

The Architectural Christian Spolia in Early Medieval Iberia: Reflections between Material Reuse and Cultural Appropriation

The reuse of construction materials has been a consistent practice throughout the history of architecture, especially prevalent during periods of transition when it was preferred for its ability to simplify installation and reduce construction costs. This practice was particularly common in late Roman urban contexts, where construction materials, especially ashlar and sculptural elements, were abundant following the abandonment of temples and public buildings. However, there are occasions when the use of spolia, or reused materials, goes beyond simple material recycling. The reuse and display of certain pieces carry complex implications involving symbology, cultural appropriation, or collective memory exercises that convey messages through new buildings. In this paper, we focus on the unique case of Hispanic Christian architectural sculptures that were “recycled” in new buildings during the first centuries of Islamic domination of the Iberian Peninsula, specifically within places of worship. Through a general analysis and review of some examples, we aim to reflect on the motivations and intentionality behind the use of certain sculptural pieces and their placement in new buildings, which is not arbitrary.

The Case of Probationary Teachers in Teaching Senior High School Students

One of the challenges that new teachers face in the Philippines is the probationary period. Probationary teachers are those who are newly hired and are subject to a probationary period of usually one to two years. During this time, they are expected to demonstrate their competence and effectiveness as teachers, and their performance is closely monitored by school administrators. This study strived to determine the experiences of Probationary Teacher in teaching senior high school students, how they overcome their obstacles and their coping mechanisms. This qualitative study employed case study research to determine experiences of Probationary Teacher in teaching senior high school students, how they overcome their challenges and their coping mechanisms, involving ten Probationary senior high school teachers of the Schools Division of Ilocos Sur who participated voluntarily. The data was gathered through each informant’s voice-recorded narrative and analyzed thematically. Findings showed that Probationary teachers experienced most with Academic and Behavioral Dynamics, Age-related challenges in handling behavior, Student attitudes and lack of respect, Challenges in adjusting to higher-order thinking skills, Sensitivity to student feelings and compliance issues, Transition and Adjustment Period of adjustment from elementary to SHS teaching, Challenges in adapting teaching methods from elementary to SHS, Emotional challenges and feelings of uncertainty, Pedagogical Challenges - Teaching loads and complexities of SHS curriculum, Perception of spoon feeding and need for adaptation in lesson delivery, Challenges in delivering unfamiliar subjects or lessons, Student attitudes towards learning and compliance, Disruption caused by students' lack of focus and disrespect, Student reliance on gadgets and games for engagement. Despite the experiences encountered by these Probationary teachers, they describe how the overcome the obstacles in teaching senior high school learners by Creating an Inclusive and Supportive Environment, Engaging Teaching Methods, Engaging Teaching Methods, Effective Classroom Management, Adapting Instruction to Individual Needs, Utilizing Technology and Trends, Continuous Assessment and Feedback, they also describe their coping mechanisms as Challenges in Teaching Senior High School Learners, Maintaining Professionalism and Positivity., Stress Management and Self-care, Passion for Teaching and Professional Development, Emotional Regulation and Self-Reflection Probationary teachers’ resiliency and determination is evident during these difficulties. Hence, administrators are encouraged to provide adequate support for Probationary teachers to keep their effectiveness in teaching senior high school learners.

Some Good News, More Bad News: Two Decades of the Gender Pay Gap for Nonprofit Directors and Chief Financial Officers

This research examines differences in the compensation of male and female executive directors and chief financial officers in nonprofit organizations. We utilize executive transition periods within organizations as an empirical strategy for isolating how gender impacts the salaries of two people who occupy the same role in the same organization. Two waves of IRS 990 compensation data are used to assess compensation practices over the past two decades. The good news includes an overall increase in the number of women holding executive positions and indications that the discriminatory component of pay (discrepancies for two people holding the same position within the same organization) is relatively small and may be decreasing. This good news, however, is accompanied by bad news: large cross-sectional gaps in pay that result from an over-representation of male executives in the largest nonprofits and those in industries with the highest executive pay.

COMBINATION OF ETHNOMATHEMATICS AND THE MOZART EFFECT TO IMPROVE PROBLEM-SOLVING SKILLS AND MATHEMATICAL DISPOSITION

The background of this research is that student learning outcomes in analytical geometry lecture during the transition from pandemic to Covid-19 endemic are still low, which is due to a lack of student interest in learning, and they are still accustomed to online learning, thus having an impact on their low problem-solving skills and mathematical disposition. This research aims to determine to what extent the implementation of ethnomathematics and the Mozart effect can improve students' problem-solving skills and mathematical disposition in analytical geometry lecture during the transition from pandemic to endemic COVID-19, so the research is important to do. The implementation of ethnomathematics and the Mozart effect in mathematics learning is unique because it is a combination of learning approaches that have never been used before in Indonesia and other countries. The research method used was a quasi-experimental non-equivalent control group design because this research was experimental and sample determination was not carried out randomly, but using purposive sampling technique on the second-semester students of the mathematics undergraduate program, Faculty of Mathematics and Natural Sciences, Universitas Padjadjaran. The instruments used in this study were problem-solving skills test, mathematical disposition scale, and students’ attitude questionnaire toward learning with the implementation of ethnomathematics and the Mozart effect. The results showed that: (1) problem-solving skills of students who received learning by implementing ethnomathematics and the Mozart effect are better than students who achieved direct instruction; (2) mathematical disposition of students who received learning by implementing ethnomathematics and the Mozart effect is better than students who achieved direct instruction; and (3) students are interested and motivated to learn mathematics by implementing ethnomathematics and the Mozart effect. This research concludes that the implementation of ethnomathematics and the Mozart effect can improve students' problem-solving skills and mathematical disposition in analytical geometry lecture during the transition period from the pandemic to endemic COVID-19. It can be seen from good average post test scores achieved by students.

Patient-caregiver dyad concordance of transition readiness assessment for adolescent with cancer: A network analysis.

The concordance of adolescents with cancer and caregivers was examined, and the core elements of transition readiness were identified. In this cross-sectional study, 196 adolescent-caregiver dyads completed the Chinese version of Self-Management and Transition to Adulthood with Rx = Treatment Questionnaire and its parent version between March 2023 and August 2023. Intraclass correlation coefficients, paired t-tests and network analysis were used for data analysis. Caregivers reported slightly lower scores for transition readiness than adolescents (3.28 vs. 3.32). Healthcare engagement and provider communication were core elements in transition readiness networks. At the dyad level, agreement between adolescents' and caregivers' transition readiness ranged from poor to fair (intraclass correlation coefficients 0.103-0.486), and a significant difference in structure was found between the two networks. Caregivers tended to underestimate adolescents' transition readiness. Attaining better concordance between adolescents and family caregivers is critical to aligning roles and responsibilities in the transition process. This study extends the evidence on the variation in adolescents' transition readiness, clarifying the complex associative relationships among the elements of transition readiness, which can be potential pathways for improving transition readiness. Second, this study is the first to assess transition readiness from a dyad's perspective. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness, suggesting that targeted dyadic interventions should be developed and implemented to improve patient-caregiver transition readiness concordance, facilitate effective communication and mutuality between patients and caregivers, and contribute to their collaboration during the transition of adolescents and optimization of outcomes. WHAT PROBLEM DID THE STUDY ADDRESS?: Increased long-term survival rates of survivors of paediatric cancer highlighted the significant need for care continuity. Transitional readiness is an important predictor of adolescent survivor's ability to adapt to a long-term survival period. Assessments of adolescents' transition readiness are limited and overlook the synergies between family caregivers and adolescents in the transition period. WHAT WERE THE MAIN FINDINGS?: The levels of agreement on rating transition readiness varied from poor to fair among adolescent-caregiver dyads, and caregivers tended to underestimate adolescents' transition readiness. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness. Targeted dyadic interventions should be developed and implemented to improve patient-caregiver's transition readiness concordance, and facilitate effective communication and mutuality between patients and caregivers. Study methods and results reported in adherence to the STROBE checklist. No patients or members of the public were involved in the study. The main findings introduce pathways for improving transition readiness, which can enhance healthcare transition among other medical populations.

Anatomy of Financial Crises: Periodization and Causes

Financial crises have a significant impact on the global economy, leading to recessions, increased unemployment rates, and other negative consequences. Deep understanding of the mechanisms of origin and development of financial crises is necessary to enhance the resilience of economic systems. The aim of this article is to study financial crises in terms of their periodization and the systematization of their causes. The study employed methods such as analysis, systematization, and historical methodology to analyze and periodize financial crises during the transitional period from the late 20th century to the early 21st century; comparison, analogies, and systematization to generalize the causes of financial crises; and a logical-consequential method to draw conclusions based on the conducted research. The article explores the specific manifestations of financial crises in the global economy and summarizes their periodization. Systemic determinants of global financial crises are examined. The distinguishing features of banking and currency crises are characterized. The sequence of the development of financial crises in a state based on the "contagion effect" is considered. It is proven that financial crises are not random events; they are caused by various factors, including speculative operations, a lack of regulation and oversight, and excessive lending. Special attention is given to geopolitical factors as one of the most common causes of financial crises in recent decades and to their specific manifestations. It is established that, despite the cyclical nature of financial crises, their scales and consequences always vary, necessitating the development of dynamic tools for crisis management. The research aims to identify patterns and factors that cause financial crises. The results can serve as a basis for developing a system of indicators to predict the likelihood of financial crises, enabling timely preventive measures to prevent or mitigate possible negative consequences. Developing such a system is a complex and comprehensive task that presents prospects for further research. The type of article is theoretical.

#1899 Transitional care clinic for incident hemodialysis patients : the Singapore experience

Abstract Background and Aims The period of transition from chronic kidney disease (CKD) to End stage kidney disease (ESKD) presents significant morbidity and mortality risk to the patients. This higher mortality risk is largely contributed by cardiovascular factors and infection. The last 2 decades have seen a remarkable succession of programs to improve outcome in incident dialysis patients. One such initiative is the use of ‘fistula first’ policy. In Singapore, pre-emptive access creation among ESKD patients continues to be low, with up to 80% of incident dialysis patients being commenced on hemodialysis (HD) via a dialysis catheter. Ensuring that incident dialysis patients have definitive vascular access, early referral to transplantation and adequate psychosocial support, amongst other factors, is an important consideration in their journey towards improved health outcomes. In order to achieve this, meticulous care coordination and a multifaceted approach is required. This realization is what led to the inception of our transition care clinic (TCC) in 2019. Conducted bi-monthly by a multidisciplinary team of nephrologists and renal coordinators, with inputs from pharmacists and medical social workers as needed, the TCC engages patients within 4-6 weeks post-hospital discharge. Its focus includes vascular access, dietary and fluid compliance, blood pressure control, HD adherence, transplantation referral, and medication reconciliation. Method A retrospective analysis of 314 ESKD patients who initiated HD between September 2019 and September 2022 compared outcomes between TCC attendees (n=164) and non-attendees Results TCC attendees exhibited a lower 1- year mortality rate (p=0.002) and higher rates for vascular access creation within first 6 months (p=0.001) as compared to non-attendees. However, no statistical differences were observed in hospitalization rates in the first year (p=0.760) and kidney transplantation referrals (p=0.20) between the two groups. Conclusion While notable improvements were observed in mortality rates and vascular access creation, there was no significant difference in hospitalization rates or kidney transplantation referrals between the two groups. In spite of the limitations due to its retrospective nature, this study clearly demonstrates the effectiveness of TCC in enhancing patient outcomes during the critical initial phase of hemodialysis. The study highlights the importance of setting up, refinement and expansion of such services in improving the outcome of this vulnerable patient group.

#1928 Stepwise incremental hemodialysis and low-protein diet supplemented with keto-analogues to preserve residual kidney function: a pilot study

Abstract Background and Aims Studies have demonstrated that chronic dialysis with residual kidney function (RKF) had better survival rates in comparison to those with diminished or absent RKF and are also further associated with improved cardiovascular outcomes. Thus, the strategic preservation of RKF following the initiation of hemodialysis or during transitional periods emerges as a crucial consideration. Compelling evidence suggests that more frequent hemodialysis may contribute to an accelerated decline in RKF, contrasting with the beneficial effects of a low-protein diet (LPD) supplemented with keto-analogues, which has been shown to delay the progression of kidney function decline in the chronic kidney disease (CKD) non-dialysis population. Our pilot study aims to investigate the impact of a stepwise incremental hemodialysis with LPD supplemented with keto-analogues approach on the preservation of RKF after the need to initiate dialysis. Method This open-label, randomized controlled trial (RCT) pilot study employed a 1:1 allocation ratio (Groups 1 and 2) and included 30 patients in CKD stage V non-dialysis, aged ≥18 years, with an eGFR of 5-10 ml/min/1.73 m² as per the CKD-EPI equation, and a urine output of ≥800 ml/day. Exclusion criteria comprised patients with active infection or inflammation, indicated by C-reactive protein (CRP) levels exceeding 10 mg/L, individuals with cancer, or those with a body mass index (BMI) ≥35 kg/m². Group 1 underwent once-weekly hemodialysis (HD) initiation lasting 4 hours, coupled with a low-protein diet (LPD) of 0.6 g/kg/day supplemented with keto-analogues (0.12 g/kg/day) on non-dialysis days and a regular protein diet (1.0 g/kg/day) on dialysis days. In contrast, Group 2 underwent twice-weekly HD initiation (4 hours each) and maintained a regular protein diet (1.0 g/kg/day) every day. A stepwise incremental approach to HD frequency (once to twice per week in Group 1 and twice to thrice per week in Group 2) was implemented if renal kidney function (RKF) fell below 3 ml/min/1.73 m², eqKt/V was ≤1.2/session, Kru was <3 mL/min, ultrafiltration rate exceeded 15 ml/kg/hour, serum potassium was >5.5 mEq/L, and serum phosphate or serum albumin were outside the ranges of >5.5 mg/dL and <3.5 g/dL, respectively. The study spanned a duration of 12 months. Results A total of 30 patients were enrolled in the study and randomized into Group 1 (N = 15) and Group 2 (N = 15). There were no significant differences in baseline characteristics, including age (58.0 ± 19.3 vs 61.9 ± 16.8 years; p = 0.638), BMI (24.0 ± 3.8 vs 23.5 ± 3.6 kg/m²; p = 0.751), eGFR (6.9 ± 1.4 vs 6.2 ± 1.9 mL/min/1.73 m²; p = 0.241), urine volume (2226 ± 729 vs 1690 ± 986 mL/day; p = 0.128), and serum albumin (3.8 ± 0.3 vs 3.6 ± 0.3 g/dL; p = 0.123). In both groups, urine volume decreased over 12 months but Group 1 exhibited significantly higher urine volumes compared to Group 2 at M6 (1697 ± 442 vs 1063 ± 480; p = 0.01), M9 (1453 ± 522 vs 918 ± 404; p = 0.02), and M12 (1119 ± 429 vs 768 ± 367; p = 0.03). Consistent with urine volume, there were significant differences in creatinine clearance (CCr) at M6 (3.9 ± 0.5 in Group 1 vs 2.7 ± 1.8 in Group 2; p = 0.05) and M9 (3.5 ± 0.3 in Group 1 vs 1.9 ± 0.9 in Group 2; p = 0.01). In Group 1, there was a need to increase the rate of dialysis to twice/week in 5 patients at average of 3.6 months after start of study. No significant differences in hospitalization, adverse effects, and patient survival were observed between the two groups. The body weight of all participant were well maintained and no sign of malnutrition. Conclusion Stepwise incremental HD initiated as once-weekly hemodialysis coupled with LPD with keto-analogue supplementation better preserved urine output and CCr compared with twice weekly HD on a regular protein diet. In a period of 12 months after initiation of dialysis, we demonstrated that this stepwise strategy was feasible.

Cardiovascular and cerebrovascular effects of caffeine maintenance in preterm infants during the transitional period.

Caffeine is routinely used for the prophylaxis of prematurity-related apnoeas. We aimed to evaluate the effect of caffeine maintenance on cardiovascular and cerebrovascular haemodynamics using a non-invasive multimodal monitoring in preterm infants during the transitional period. Infants <32 weeks' gestational age (GA) were enrolled in this observational prospective study. The following parameters were recorded before and after the administration of caffeine citrate 5 mg/kg using near-infrared spectroscopy, pulse oximetry and electrical velocimetry: heart rate, cardiac output, stroke volume, cardiac contractility, systemic vascular resistance (SVR), perfusion index, peripheral and cerebral oxygenation, cerebral fractional oxygen extraction, correlation index between cerebral oxygenation and heart rate (TOHRx, marker of cerebrovascular reactivity). Multilevel mixed-effects linear models were used to assess the impact of caffeine and of relevant clinical covariates on each parameter. Seventy-seven infants (mean GA 29.3 ± 2.5 weeks, mean birthweight 1148 ± 353 g) were included. Caffeine administration was associated with increased SVR (B = 0.623, p = 0.004) and more negative TOHRx values (B = -0.036, p = 0.022), which suggest improved cerebrovascular reactivity. Caffeine administration at maintenance dosage during postnatal transition is associated with increased systemic vascular tone and improved cerebrovascular reactivity. A possible role for caffeine-mediated inhibition of adenosine receptors may be hypothesized. This study provides a thorough and comprehensive overview of multiple cerebrovascular and cardiovascular parameters, monitored non-invasively by combining near-infrared spectroscopy, electrical velocimetry and pulse oximetry, before and after the administration of caffeine at maintenance dosage in preterm infants during postnatal transition. Caffeine was associated with an improvement in cerebrovascular reactivity and with a slight but significant increase in systemic vascular resistance, with no additional effects on other cardiovascular and cerebrovascular parameters. Our results support the safety of caffeine treatment even during a phase at risk for haemodynamic instability such as postnatal transition and suggest potential beneficial effects on cerebral haemodynamics.