Self-reported antidepressant use in haemodialysis patients is associated with increased mortality independent of concurrent depression severity

© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).Peer reviewe

Children's Antisocial Behavior, Mental Health, Drug Use, and Educational Performance After Parental Incarceration: A Systematic Review and Meta-Analysis

Unprecedented numbers of children experience parental incarceration worldwide. Families and children of prisoners can experience multiple difficulties after parental incarceration, including traumatic separation, loneliness, stigma, confused explanations to children, unstable childcare arrangements, strained parenting, reduced income, and home, school, and neighborhood moves. Children of incarcerated parents often have multiple, stressful life events before parental incarceration. Theoretically, children with incarcerated parents may be at risk for a range of adverse behavioral outcomes. A systematic review was conducted to synthesize empirical evidence on associations between parental incarceration and children's later antisocial behavior, mental health problems, drug use, and educational performance. Results from 40 studies (including 7,374 children with incarcerated parents and 37,325 comparison children in 50 samples) were pooled in a meta-analysis. The most rigorous studies showed that parental incarceration is associated with higher risk for children's antisocial behavior, but not for mental health problems, drug use, or poor educational performance. Studies that controlled for parental criminality or children's antisocial behavior before parental incarceration had a pooled effect size of OR = 1.4 (p < .01), corresponding to about 10% increased risk for antisocial behavior among children with incarcerated parents, compared with peers. Effect sizes did not decrease with number of covariates controlled. However, the methodological quality of many studies was poor. More rigorous tests of the causal effects of parental incarceration are needed, using randomized designs and prospective longitudinal studies. Criminal justice reforms and national support systems might be needed to prevent harmful consequences of parental incarceration for children

Identifying Depression in South Asian Patients with End-Stage Renal Disease: Considerations for Practice

Depression is a prevalent burden for patients with end-stage renal disease (ESRD) and one that is under-recognized and consequently under-treated. Although several studies have explored the association between depression symptoms, treatment adherence and outcomes in Euro-American patient groups, quantitative and qualitative exploration of these issues in patients from different cultural and ethnic backgrounds has been lacking. This review discusses the methodological issues associated with measuring depression in patients of South Asian origin who have a 3- to 5-fold greater risk of developing ESRD. There is a need to advance research into the development of accurate screening practices for this patient group, with an emphasis on studies utilizing rigorous approaches to evaluating the use of both emic (culture-specific) and etic (universal or culture-general) screening instruments

‘Breaking and Entering’: Sherman Alexie’s urban Indian literature

This thesis reads the fiction and poetry of Spokane/Coeur d’Alene writer Sherman Alexie as predominantly urban Indian literature. The primary experience of the growing majority of American Indians in the twenty-first century consists in the various threats and opportunities presented by urban living, yet contemporary criticism of literature by (and about) American Indians continues to focus on the representations of life for those tribally enrolled American Indians living on reservations, under the jurisdiction of tribal governments. This thesis provides critical responses to Alexie’s contemporary literary representations of those Indians living apart from tribal lands and the communities and traditions contained therein. I argue that Alexie’s multifaceted representations of Indians in the city establish intelligible urban voices that speak across tribal boundaries to those urban Indians variously engaged in creating diverse Indian communities, initiating new urban traditions, and adapting to the anonymities and visibilities that characterise city living. The thesis takes a broadly linear chronological structure, beginning with Alexie’s first published collection of short stories and concluding with his most recent works. Each chapter isolates for examination a distinct aspect of Alexie’s urban Indian literature, so demonstrating a potential new critical methodology for reading urban Indian literatures. I open with a short piece explaining my position as a white, British scholar of the heavily politicised field of American Indian literary studies, before the introductory chapter positions Alexie in the wider body of Indian literatures and establishes the historical grounds for the aims and claims of my research. Chapter one is primarily concerned with the short story ‘Distances’, from The Lone Ranger and Tonto Fistfight in Heaven (1993), and the Ghost Dance religion of the late nineteenth century, reading Alexie’s representations of this phenomenon as explorations of the historical and political tensions that divide those Indians living on tribal lands and those living in cities. Chapter two discusses the difficulties of maintaining a tribal identity when negotiating this divide towards the city, analysing the politics of indigenous artistic expression and reception in Alexie’s first novel, Reservation Blues (1995). Alexie’s second novel, Indian Killer (1996), signals the relocation of his literary aesthetics to the city streets, and chapter three detects and unravels the anti-essentialist impulse in Alexie’s (mis)use of the distinctly urban mystery thriller genre. Grief, death and ritual are explored in chapter four, which focusses on selected stories from Ten Little Indians (2003), and explains Alexie’s characters’ need for new, urban traditions with reference to an ethics of grieving. Chapter five connects the politics of time travel to the representation of trauma in Flight (2007), and addresses Alexie’s representations of violence in Ten Little Indians and The Toughest Indian in the World (2000), proposing that it is the structural violences of daily life, rather than the murder and beatings found throughout his work, that leave lasting impressions on urban Indian subjectivities. My conclusion brings together my approaches to Alexie’s urban Indian literature, and suggests further areas for research

Experiences of a cognitive behavioural therapy (CBT) intervention for fatigue in patients receiving haemodialysis

© 2022 The Authors. Journal of Renal Care published by John Wiley & Sons Ltd on behalf of European Dialysis & Transplant Nurses Association/European Renal Care Association. This is an open access article under the terms of the Creative Commons Attribution License https://creativecommons.org/licenses/by/4.0/Abstract: Background: A feasibility randomised‐controlled trial found that a cognitive‐behavioural therapy intervention for renal fatigue has the potential to reduce fatigue in patients receiving haemodialysis, but uptake was low. Objectives: Nested in the randomised‐controlled trial (RC) qualitative interviews were undertaken to understand the acceptability of renal fatigue, the facilitators of, and barriers to, engagement, and the psychosocial processes of change. Design: The trial included 24 participants at baseline. Semi‐structured interviews were conducted with nine participants from the intervention arm (n = 12). Approach Interviews were carried out immediately following treatment (3 months post‐randomisation). Data were analysed using inductive thematic analysis. Findings: Five main themes were formulated. The overarching theme was a sense of coherence (whether the illness, symptoms and treatment made sense to individuals), which appeared to be central to acceptability and engagement. Two themes captured the key barriers and facilitators to engagement, cognitive and illness/treatment burdens and collaboration with the therapist. Participants described changes related to their activity, thoughts and social identity/interactions, which shaped perceptions of change in fatigue. Lastly, participants discussed the optimal delivery of the intervention. Conclusions: This study revealed the importance of patients' understanding of fatigue and acceptance of the treatment model for the acceptability of and engagement with a cognitive‐behavioural therapy‐based intervention for fatigue. Overall, there was an indication that such an intervention is acceptable to patients and the mechanisms of change align with the proposed biopsychosocial model of fatigue. However, it needs to be delivered in a way that is appealing and practical to patients, acknowledging the illness and treatment burdens.Peer reviewedFinal Published versio

Family factors in the intergenerational transmission of offending

ABSTRAC

Cognitive-behavioural therapy (CBT) for renal fatigue (BReF) : a feasibility randomised-controlled trial of CBT for the management of fatigue in haemodialysis (HD) patients

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/INTRODUCTION: Fatigue is one of the most common and disabling symptoms in end-stage kidney disease, particularly among in-centre haemodialysis patients. This two-arm parallel group feasibility randomised controlled trial will determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of a cognitive-behavioural therapy (CBT)-based intervention for fatigue among in-centre haemodialysis patients. METHODS: We aim to recruit 40 adult patients undergoing in-centre haemodialysis at secondary care outpatient dialysis units, who meet clinical levels of fatigue. Patients will be randomised individually (using a 1:1 ratio) to either a 4-6 weeks' CBT-based intervention (intervention arm) or to a waiting-list control (control arm). The primary feasibility outcomes include descriptive data on numbers within each recruiting centre meeting eligibility criteria, rates of recruitment, numbers retained postrandomisation and treatment adherence. To assess the potential benefits of the cognitive-behavioural therapy for renal fatigue intervention, secondary self-report outcomes include measures of fatigue severity (Chalder Fatigue Questionnaire), fatigue-related functional impairment (Work and Social Adjustment Scale), sleep quality (Pittsburgh Sleep Quality Index), depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). Changes in fatigue perceptions (Brief Illness Perception Questionnaire), cognitive and behavioural responses to fatigue (Cognitive and Behavioural Responses to Symptoms Questionnaire), sleep hygiene behaviours (Sleep Hygiene Index) and physical activity (International Physical Activity Questionnaire-short form) will also be explored. These self-report measures will be collected at baseline and 3 months postrandomisation. Nested qualitative interviews will be conducted postintervention to explore the acceptability of the intervention and identify any areas in need of improvement. The statistician and assessor will be blinded to treatment allocation. ETHICS AND DISSEMINATION: A National Health Service (NHS) Research Ethics Committee approved the study. Any amendments to the protocol will be submitted to the NHS Committee and study sponsor. TRIAL REGISTRATION NUMBER: ISRCTN91238019;Pre-results.Peer reviewe

Machine learning for real-time aggregated prediction of hospital admission for emergency patients

Machine learning for hospital operations is under-studied. We present a prediction pipeline that uses live electronic health-records for patients in a UK teaching hospital's emergency department (ED) to generate short-term, probabilistic forecasts of emergency admissions. A set of XGBoost classifiers applied to 109,465 ED visits yielded AUROCs from 0.82 to 0.90 depending on elapsed visit-time at the point of prediction. Patient-level probabilities of admission were aggregated to forecast the number of admissions among current ED patients and, incorporating patients yet to arrive, total emergency admissions within specified time-windows. The pipeline gave a mean absolute error (MAE) of 4.0 admissions (mean percentage error of 17%) versus 6.5 (32%) for a benchmark metric. Models developed with 104,504 later visits during the Covid-19 pandemic gave AUROCs of 0.68-0.90 and MAE of 4.2 (30%) versus a 4.9 (33%) benchmark. We discuss how we surmounted challenges of designing and implementing models for real-time use, including temporal framing, data preparation, and changing operational conditions