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In this thesis, we discover knowledge from workflow logs with temporal-state transitions in the form of Bayesian networks. Bayesian network is a graphical model that encodes probabilistic relationships among variables of interest, and easily incorporates with new instances to maintain rules up to date. The Bayesian networks can predict, communicate, train, and offer more alternatives to make better decisions. We demonstrate the proposed method in representing the causal relationships between medical treatments and transitions of patient¡¦s physiological states in the Hemodialysis process. The discovery of clinical pathway patterns of Hemodialysis can be used for predicting possible paths for an admitted patient, and facilitating medical professionals to control the Hemodialysis machines during the Hemodialysis process. The reciprocal knowledge management can be extended from the results in future research.

The research has applied both Resource Dependence Theory and Institutional Theory to analyze the organization and the market factors that will influence the hemodialysis centers in adopting a strategic alliance, contracting with and choosing the number of strategic partners. The followings have been examined and analyzed: 1) the current trend of hemodialysis centers¡¦ strategic alliance, including variety of alliance partners, number of strategic alliance, and the degree of an alliance. 2) the factors that will cause hemodialysis centers to adopt a strategic alliance. 3) the factors that will affect the hemodialysis centers to contract with their strategic alliance partners. 4) the factors that influence centers¡¦ choosing alliance partner(s). Questionnaires and collection of secondary dada were conducted. The empirical analysis of the 219 valid questionnaires shows that hemodialysis centers¡¦ strategic alliance decision is influenced by coerce, normativeness and mimicry caused more by institutional environment than by resource environment. However, after an alliance has been adopted, the resource environment has more influence than institutional environment in deciding whether to contract with strategic partners. The research found the number of strategic alliance partners is not influenced by the resource or institutional environment factors. This research found both theories play different roles at the different stages of adopting strategic alliance and contracting with partners. The finding not only can help examine the theory framework but also be quite useful to insurance policy decision making and to centers¡¦ daily operation.

Hemodialysis is widely used for kidney failure patients, it is well known that oxidative stress is induced during hemodialysis process. To figure out what kind of proteins may adhere to the hemodialysis tube, and were those proteins oxidized during dialysis process. In this study, proteins adhere to hemodialysis membrane are eluted and examined by protein two-dimensional gel electrophoresis and MALDI-TOF technique. The two-dimensional gel electrophoresis results demonstrate 153 proteins binding to hemodialysis tube including Vsm-Rho GEF, Fibroblast growth factor 23, Prothrombin, Glomulin and Nucleobindin-1. The oxidation detection shows that some tube binding proteins are oxidized including MAP4K3 protein and Sulfiredoxin-1, and the oxidation level of hemodialysis tube binding proteins are higher then serum proteins. In conclusion, we find out 20 novel proteins which bind to hemodialysis tube and 5 novel proteins which oxidized during hemodialysis. And protein oxidation level was related to inflammation where high CRP levels were detected.

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 242-253). Available also in a digital version from Dissertation Abstracts.

Hemodialysis is a renal replacement therapy that removes waste solutes from the blood stream using concentration gradients across a membrane. In order to overcome several shortcomings and increase the waste removal rate, a new dialyzer (filter) design is proposed in this study. In the new dialyzer design, the blood concurrently flows with a sheath fluid in a micro-fluidic channel. Because the blood stream directly contacts the sheath stream, it is important to prevent blood cell migration from the blood stream to the sheath stream while providing enough time for the waste solutes to diffuse into the sheath stream. This research was intended to understand the migration behavior of red blood cells (RBC) and platelets in non-uniform suspension flow, where the blood and sheath flows in direct contact, and apply the results to identify the feasible design space of the proposed dialyzer. The effect of different flow conditions and channel geometry on the blood cell extraction ratios (ER), the ratio of cells lost into the sheath stream, in non-uniform suspension flows was parametrically studied using Lattice Boltzmann and Spectrin Link (LB-SL) method based direct numerical simulation (DNS). Analyzing ER over the flow distance showed that the channel size and the area ratio of sheath to channel are the main variables that affect the ER. Based on the relationship found, a meta-model of RBC ER was created, although platelet ERs showed only a general trend. Based on the study, feasible conditions that will retain blood cells in the blood stream were identified. Then, the DNS results of blood cell ER were used with a molecule diffusion model and a hemodialysis system model to study the feasibility of the proposed dialyzer design that maximizes middle molecule filtration with limited blood cell and protein loss. No feasible design was found in the studied range suggesting that relying purely on the diffusion based on the direct contact for the removal of middle molecules is not a feasible solution with the small channel size (~700 µm) due to the loss of protein. It suggested that in order to increase the middle molecule removal while maintain the protein level, clearance ratio of middle molecule to protein should be increased using large channel size, small sheath stream thickness, long tubule length, and slow blood flow velocity. The intellectual merit of this research lies in understanding the migration behavior of blood cells in a non-uniform suspension. This knowledge helped to establish the feasibility of the proposed dialyzer design and can be applied in a variety of applications for the manipulation of cells in a micro-fluidic channel.

No description available.

Background: Levels of physical activity are significantly lower among individuals with end-stage renal disease (ESRD) compared to their healthy sedentary counterparts. Low levels of self-efficacy (SE) with respect to exercise may contribute to a sedentary lifestyle in the ESRD population. Therefore, in a pilot investigation we examined the effects of an 8-week intra-dialytic (ID) exercise program on SE and physical activity (PA) in hemodialysis (HD) patients and determined the appropriateness and sensitivity of the selected outcome measures and proposed intervention. Methods: HD patients were randomized into an Exercise group (EX, n=4) or a Control group (CON, n=4). The EX group cycled for approximately 60 min during HD, thrice weekly for 8 weeks. The CON group continued with their usual activity. At 8 weeks, participants in both groups had the option to participate in the exercise program. Physical Activity was determined using the Human Activity Profile (Maximal Activity Score, MAS; Adjusted Activity Score, AAS) and SE was evaluated using the Chronic Disease Self-Efficacy Scale (CDSES) and Exercise Self-Efficacy Scale (ESES). Measures were obtained at pre, post and 8 weeks following the intervention. Results: No significant changes in PA or SE occurred between or within groups at any time point. Limited statistical power due to the small sample size and a ceiling effect due to initial high-function levels of the participants may have contributed to the lack of significant changes. MAS and AAS were generally lower in the CON group. Age was significantly associated with the AAS, MAS, and the Perform Social/Recreational Activities sub-scale of the CDSES. Serum albumin was significantly related to the AAS and the Exercise Regularly and Do Chores sub-scales of the CDSES. Conclusions: Age and albumin should be taken into account when assessing physical activity in HD patients. Recruitment of additional participants is required to more clearly define the role of intra-dialytic exercise in enhancing exercise self-efficacy and physical activity in HD patients. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2010-07-27 09:51:11.297

Thesis (M.Tech.: Clinical Technology)- Dept. of Clinical Technology, Durban University of Technology, 2008. xviii, 160 leaves.

Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility.