Symptom burden in patients with chronic kidney disease not requiring renal replacement therapy

Background: Although evidence shows that patients with end stage renal disease (ESRD) experience a high symptom burden which impacts on quality of life (QoL), less is known about patients with earlier stages of chronic kidney disease (CKD). This study aimed to explore symptom burden and potential contributing factors in patients with CKD Stage 1-5 not requiring renal replacement therapy (RRT). Methods: Patients with CKD Stage 1-5 and not on RRT were asked to report their symptoms using the Leicester Uraemic Symptom Score (LUSS), a questionnaire which assesses the frequency and intrusiveness of 11 symptoms commonly reported by kidney patients. Results: Symptoms were assessed in 283 CKD Stage 1-5 patients: 54% male, mean age 60.5 standard error± 1.0, mean eGFR 38ml/min/1.73m2. Some 96% (95% confidence interval 93.2-98.0) of participants reported experiencing at least one symptom, the median reported being six. Excessive tiredness (81%;76.0-85.6), sleep disturbance (70%;64.3-75.3) and pain in bones/joints (69%;63.4-74.6) were reported most commonly. Overall, few significant associations were found between biochemical markers of disease severity and symptom burden. Men tended to report fewer symptoms than women and South Asian patients often described experiencing symptoms with a greater severity. Older patients found musculoskeletal symptoms more intrusive whereas younger patients found reduced concentration more intrusive. Conclusions: Our findings suggest that patients with CKD stages 1-5 experience a multitude of symptoms that could potentially impact QoL. Using multidimensional tools like the LUSS, more exploration and focus could provide a greater opportunity for patient focussed symptom control from the earliest stages of CKD.Peer-reviewedPublisher Versio

EMPOWERing older people and their communities to manage their own CARE (EMPOWERCARE): Evaluation study of a social innovation initiative across four European countries

This paper outlines the evaluation strategy of the EMPOWERCARE, an EU Interreg 2 Seas funded social innovation project, which involves a partnership of local authorities, universities and non-governmental organisations from four European countries: Belgium, France, the Netherlands and the United Kingdom. Partners are working in collaboration with local people aged 65+, and those aged 50+ with at least one chronic condition, to respond to current gaps in the care of older people. The project aims specifically to contribute to person-centred care and technology knowledge transfer whilst reducing isolation, loneliness and increasing solidarity amongst older people and their communities. During the project, partners are jointly developing a strategy for implementing good-practice models, a workforce transformation approach via shared training and a technology blueprint with emphasis on caring digital technologies to address the rising demand for health and social care services for older people. The project addresses this challenge by drawing on community assets, involving older people in decisions about their own health and wellbeing, enabling them to keep healthier and in their own homes and communities safely for longer. The project’s evaluation aims to measure the impact of the EMPOWERCARE initiative across 7 pilot sites in the 4 participating countries. Given the Covid-19 pandemic, the evaluation design has been developed with a view to being agile and able to respond to complex and shifting situations, and especially so in terms of what and how data are collected. A realist synthesis approach (Pawson & Tilley, 2004) guides the evaluation within a descriptive case study design (Yin 2003) to identify and contextualise the project strategies that are influential within and across the 7 different case study sites. The evaluation uses multiple interdisciplinary methods, such as surveys, Photovoice and Social Return on Investment, to capture a range of perspectives across three timepoints, baseline (T0), mid-point (T1) and end-point (T2). Online surveys are conducted with both end-users and the workforce in all pilot sites at T0 and T2. At T1, end-users are actively involved in creating visual data through Photovoice to capture their lived experiences with local initiatives in pilot sites. Visual data are going to be displayed at pilot site exhibitions targeted to key local stakeholders and members of the workforce. Focus groups will be conducted with all participants reflecting on the visual data exhibition to explore insights about the initiative from current and future perspectives. This aspect is informed by a Social Return on Investment approach. The sequential data collection of multiple sources and longitudinal study design identify patterns of change and impact. The evaluation design will deliver a theory-driven rich explanation of what works about EMPOWERCARE and for whom, why, how and in what circumstances it works. The analysis of the evaluation findings will contribute to a more empowered person-centred approach, with more inclusive and caring digital health solutions that will allow policy makers to develop localised, efficient and social-value driven services to meet the rising needs of older people in the European regions

Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: a systematic review and meta-analysis

Background Parents of babies admitted to neonatal units (NNU) are exposed to a range of potentially distressing experiences, which can lead to mental health symptoms such as increased anxiety and post-traumatic stress (PTS). This review aimed to describe how anxiety and PTS are defined and assessed, and to estimate anxiety and PTS prevalence among parents of babies admitted to NNU. Method Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health literature were searched to identify studies published prior to April 14, 2021. Included studies were assessed using Hoy risk of bias tool. A random-effects model was used to estimate pooled prevalence with 95% CIs. Potential sources of variation were investigated using subgroup analyses and meta-regression. The review is registered with PROSPERO (CRD42020162935). Findings Fifty six studies involving 6,036 parents met the review criteria; 21 studies assessed anxiety, 35 assessed PTS, and 8 assessed both. The pooled prevalence of anxiety was 41.9% (95%CI:30.9, 53.0) and the pooled prevalence of PTS was 39.9% (95%CI:30.8, 48.9) among parents up to one month after the birth. Anxiety prevalence decreased to 26.3% (95%CI:10.1, 42.5) and PTS prevalence to 24.5% (95%CI:17.4, 31.6) between one month and one year after birth. More than one year after birth PTS prevalence remained high 27.1% (95%CI:20.7, 33.6). Data on anxiety at this time point were limited. There was high heterogeneity between studies and some evidence from subgroup and meta-regression analyses that study characteristics contributed to the variation in prevalence estimates. Interpretation The prevalence of anxiety and PTS was high among parents of babies admitted to NNU. The rates declined over time, although they remained higher than population prevalence estimates for women in the perinatal period. Implementing routine screening would enable early diagnosis and effective intervention. Funding This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care

Valuing improvements in the water rights system in South Africa : a contingent ranking approach

In the context of increasing water scarcity, understanding is growing that irrigation water rights are important and that a lack of effective water rights systems constitute a major reason for inefficient water management. This study carried out a contingent ranking experiment to study how smallholder irrigators in South Africa would value potential changes in water rights. Three specific dimensions of water rights, relevant for the South African case, are considered: duration, quality of title and transferability. Results indicate that smallholder irrigators are prepared to pay considerably higher water prices if improvements are made in the water rights system. This implies that the proposed interventions in the water rights system would improve the efficiency and productivity of the small-scale irrigation sector. The increased willingness to pay could furthermore also assist South African government to reach the objective of increased cost recovery

The Percolation Signature of the Spin Glass Transition

Magnetic ordering at low temperature for Ising ferromagnets manifests itself within the associated Fortuin-Kasteleyn (FK) random cluster representation as the occurrence of a single positive density percolating network. In this paper we investigate the percolation signature for Ising spin glass ordering -- both in short-range (EA) and infinite-range (SK) models -- within a two-replica FK representation and also within the different Chayes-Machta-Redner two-replica graphical representation. Based on numerical studies of the $\pm J$ EA model in three dimensions and on rigorous results for the SK model, we conclude that the spin glass transition corresponds to the appearance of {\it two} percolating clusters of {\it unequal} densities.Comment: 13 pages, 6 figure

Civil society participation in global governance: Insights from climate politics

A rather unique feature of global climate negotiations is that most governments allow representatives of civil society organisations to be part of their national delegation. It remains unclear, however, why states grant such access in the first place. While there are likely to be benefits from formally including civil society, there are also substantial costs stemming from constraints on sovereignty. In light of this tradeoff, this article argues for a ‘contagion’ effect that explains this phenomenon besides domestic determinants. In particular, states, which are more central to the broader network of global governance, are more likely to be informed of and influenced by other states' actions and policies toward civil society. In turn, more central governments are likely to include civil society actors if other governments do so as well. This argument is tested with data on the participation of civil society organisations in national delegations to global climate negotiations between 1995 and 2005. To further uncover the underlying mechanisms, the article also provides an analysis of survey data collected at the United Nations Framework Convention on Climate Change (UNFCCC) negotiations in Durban in 2011

On Application of the Empirical Bayes Shrinkage in Epidemiological Settings

This paper aims to provide direct and indirect evidence on setting up rules for applications of the empirical Bayes shrinkage (EBS), and offers cautionary remarks concerning its applicability. In epidemiology, there is still a lack of relevant criteria in the application of EBS. The bias of the shrinkage estimator is investigated in terms of the sums of errors, squared errors and absolute errors, for both total and individual groups. The study reveals that assessing the underlying exchangeability assumption is important for appropriate use of EBS. The performance of EBS is indicated by a ratio statistic f of the between-group and within-group mean variances. If there are significant differences between the sample means, EBS is likely to produce erratic and even misleading information

Evidence for weathering and volcanism during the PETM from Arctic Ocean and Peri-Tethys osmium isotope records

Sudden global warming during the Paleocene–Eocene Thermal Maximum (PETM, 55.9 Ma) occurred because of the rapid release of several thousand gigatonnes of isotopically light carbon into the oceans and atmosphere; however, the cause of this release is not well understood. Some studies have linked carbon injection to volcanic activity associated with the North Atlantic Igneous Province (NAIP), while others have emphasised carbon cycle feedbacks associated with orbital forcing. This study presents the osmium isotope compositions of mudrocks that were deposited during the PETM at four locations (one from the Arctic Ocean, and three from the Peri-Tethys). The Os-isotope records all exhibit a shift of similar magnitude towards relatively radiogenic values across the PETM. This observation confirms that there was a transient, global increase in the flux of radiogenic Os from the weathering of continental rocks in response to elevated temperatures at that time. The tectonic effects of NAIP volcanic emplacement near the onset of the PETM is recorded by anomalously radiogenic Os-isotope compositions of PETM-age Arctic Ocean samples, which indicate an interval of hydrographic restriction that can be linked tectonic uplift due to hotspot volcanism in the North Atlantic seaway. The Peri-Tethys data also document a transient, higher flux of unradiogenic osmium into the ocean near the beginning of the PETM, most likely from the weathering of young mafic rocks associated with the NAIP. These observations support the hypothesis that volcanism played a major role in triggering the cascade of environmental changes during the PETM, and highlight the influence of paleogeography on the Os isotope characteristics of marine water masses

Glucanocellulosic ethanol: The undiscovered biofuel potential in energy crops and marine biomass

Converting biomass to biofuels is a key strategy in substituting fossil fuels to mitigate climate change. Conventional strategies to convert lignocellulosic biomass to ethanol address the fermentation of cellulose-derived glucose. Here we used super-resolution fluorescence microscopy to uncover the nanoscale structure of cell walls in the energy crops maize and Miscanthus where the typical polymer cellulose forms an unconventional layered architecture with the atypical (1, 3)-β-glucan polymer callose. This raised the question about an unused potential of (1, 3)-β-glucan in the fermentation of lignocellulosic biomass. Engineering biomass conversion for optimized (1, 3)-β-glucan utilization, we increased the ethanol yield from both energy crops. The generation of transgenic Miscanthus lines with an elevated (1, 3)-β-glucan content further increased ethanol yield providing a new strategy in energy crop breeding. Applying the (1, 3)-β-glucan-optimized conversion method on marine biomass from brown macroalgae with a naturally high (1, 3)-β-glucan content, we not only substantially increased ethanol yield but also demonstrated an effective co-fermentation of plant and marine biomass. This opens new perspectives in combining different kinds of feedstock for sustainable and efficient biofuel production, especially in coastal regions