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Kidney supportive care (KSC) is a patient-centered model of multidisciplinary care designed for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Our goal was to characterize the types, frequencies, and costs of services accessed by patients enrolled in a KSC program. We analyzed health care utilization data prospectively collected from 102 patients who enrolled in the KSC program during the first 52 weeks of its existence. The data comprised program appointments, emergency department presentations, ambulance service use, outpatient visits, inpatient episodes, and dialysis treatments made within the Brisbane area of Metro North. Costs of resource use were estimated using Queensland Health funding principles and guidelines. Analyses included descriptive statistics, correlations, and multivariate regressions. During the median program participation of 22 weeks, patients had 3975 contacts with health care, with the total value of services amounting to nearly A$3 million. Dialysis treatments accounted for 70% of visits and 49% of costs. Patients receiving dialysis had higher utilization of outpatient services and associated cost, compared to patients who were not dialyzed. The presence of diabetes and the choice of conservative pathway were both predictors of higher frequency and cost of services. Longer program participation was associated with lower weekly utilization and cost. The program attracted patients representing various characteristics, pathways, needs, and outcomes. Exploring these patterns will enable better understanding of the patient population and improved service planning, in KSC and similar programs that aim to comprehensively address the needs of patients with advanced CKD and ESKD.

International audience; The paper questions whether data-driven and problem-driven models are sufficient for a software to automatically represent a meaningful graphi-cal representation of scientific findings. The paper presents descriptive and prescriptive case studies to understand the benefits and the shortcomings of existing models that aim to provide graphical representations of data-sets. First, the paper considers data-sets coming from the field of software metrics and shows that existing models can provide the expected outcomes for descriptive scientific studies. Second, the paper presents data-sets coming from the field of human mobility and sustainable development, and shows that a more comprehensive model is needed in the case of prescriptive scientific fields requiring interdisciplinary research. Finally, an interdisciplinary problem-driven model is proposed to guide the software users, and specifically scientists, to produce meaningful graphical representation of research findings. The proposal is indeed based not only on a data-driven and/or problem-driven model but also on the different knowledge domains and scientific aims of the experts, who can provide the information needed for a higher-order structure of the data, supporting the graphical representation output.

The authors examine the role of interdisciplinary competences in the development of higher education on the basis of the analysis of their integrative nature, nature and characteristics. The role of monitoring and indicators in the assessment of students’ knowledge obtained through the use of interdisciplinary competences is revealed. The importance of interdisciplinary models by identifying the stages of implementation of practice-oriented communicative approach in teaching is exposed. The problems of interdisciplinary competences are discussed in the context of forming tolerance and minimizing risk-taking in society. Against the backdrop of youth's problems the issue of educational reform is put forward and solved from the perspective of interdisciplinary, systematic, integrity. In the authors’ opinion, the formation of multi-disciplinary competencies, which would have formed the basis of social tolerance, is relevant to present day.

Water scarcity, land use conversion and cultural and ecosystem changes threaten the way of life for traditional irrigation communities of the semi-arid southwestern United States. Traditions are strong, yet potential upheaval is great in these communities that rely on acequia irrigation systems. Acequias are ancient ditch systems brought from the Iberian Peninsula to the New World over 400 years ago; they are simultaneously gravity flow water delivery systems and shared water governance institutions. Acequias have survived periods of drought and external shocks from changing economics, demographics, and resource uses. Now, climate change and urbanization threaten water availability, ecosystem functions, and the acequia communities themselves. Do past adaptive practices hold the key to future sustainability, or are new strategies required? To explore this issue we translated disciplinary understanding into a uniform format of causal loop diagrams to conceptualize the subsystems of the entire acequia-based human-natural system. Four subsystems are identified in this study: hydrology, ecosystem, land use/economics, and sociocultural. Important linkages between subsystems were revealed as well as variables indicating community cohesion (e.g., total irrigated land, intensity of upland grazing, mutualism). Ongoing work will test the conceptualizations with field data and modeling exercises to capture tipping points for non-sustainability and thresholds for sustainable water use and community longevity.