End-stage renal disease afflicts *750,000 Americans and claims >100,000 lives annually in the United States. Kidney transplantation is associated with longest survival and least cost but is limited by scarcity of donor organs. The balance of patients are treated with dialysis, a cumbersome, morbid, and expensive procedure. Each hemodialysis treatment consumes in excess of 160 liters of water and anchors the patient to a machine for 12-15 h per week. Cultured tubule cells can reduce the obligate fluid requirements of a bioengineered artificial kidney by concentrating wastes and reabsorbing filtered salt and water. Primary tubule epithelial cells rapidly dedifferentiate in culture and form a flattened epithelium lacking the brush border essential to apicobasal transport. We hypothesized that substrate mechanical properties have a strong influence on differentiation in primary cell culture. We cultured primary renal tubule cells on polyacrylamide hydrogels of varying elasticity and measured expression of key transporter proteins essential to renal tubule cell function. Primary tubule cells cultured on soft substrates for extended periods showed increased expression of key transporters characteristic of differentiated proximal tubule cells. These data support the hypothesis that scaffold elasticity is a critical factor in cell culture, and, unexpectedly, that prolonged culture of primary cells was essential to observing this difference.
Auditory medical alarms in healthcare are uninformative, poorly localizable, have a low positive predictive value, and are set at thresholds forcing practitioners to be reactive instead of proactive. Sonifying patient physiology as it transitions from normal to abnormal will allow practitioners to respond before the patient status devolves into an emergency. Multimodal interactions have the potential to enhance future sonification tools by reducing alarm fatigue—the addition of haptic cuing to novel physiologic sonification may improve patient safety. To increase the overall efficiency of alarm design in healthcare, we propose reducing alarm fatigue by integrating multisensory streams. We present an experiment that characterizes how the integration of tactile and auditory signals affects the speed and accuracy of alarm responses. Participants received multisensory auditory and haptic input while performing a task designed to tax attentional resources mimicking working in the ICU. Our results indicate there is a trend towards increased perception of change of physiologic variables with concordant haptic stimuli and participants are significantly better at determining the direction of change versus the physiologic variable of change. Future directions include simplification of the sonification schemata and increasing information complexity in the haptic modality to utilize multisensory integration.
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