Patient and health care professional decision-making to commence and withdraw from renal dialysis: A systematic review of qualitative research

Background and objectives. To ensure decisions to start and stop dialysis in end stage kidney disease are shared, the factors that affect patients and healthcare professionals in making such decisions need to be understood. This systematic review aims to explore how and why different factors mediate the choices about dialysis treatment. Design, setting, participants, and measurements. Medline, Embase, CINAHL and PsychINFO were searched for qualitative studies of factors that affect patients’ and/or healthcare professionals’ decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. Results. Of 494 articles screened, 12 studies (conducted: 1985-2014) were included. These involved 206 predominantly haemodialysis patients and 64 healthcare professionals (age range: patients 26-93; professionals 26-61 years). (i) Commencing dialysis: patients based their choice on ‘gut-instinct’ as well as deliberating the impact of treatment on quality-of-life and survival. How individuals coped with decision-making was influential, some tried to take control of the problem of progressive renal failure, whilst others focussed on controlling their emotions. Healthcare professionals weighed-up biomedical factors and were led by an instinct to prolong life. Both patients and healthcare professionals described feeling powerless. (ii) Dialysis withdrawal: Only after prolonged periods of time on dialysis, were the realities of life on dialysis fully appreciated and past choice questioned. By this stage however patients were physically treatment dependent. Similar to commencing dialysis, individuals coped with treatment withdrawal in a problem or emotion-controlling way. Families struggled to differentiate choosing versus allowing death. Healthcare teams avoided and queried discussions regarding dialysis withdrawal. Patients however missed the dialogue they experienced during pre-dialysis education. Conclusions. Decision-making in end stage kidney disease is complex, dynamic, and evolves over time and towards death. The factors at work are multi-faceted and operate differently for patients and health professionals. More training and research on open-communication and shared decision-making is needed

New Caribbean Locality for the Extinct Great White Shark Carcharodon

Carcharodon is represented by a single upper tooth (Fig. 1) which we extracted from the eroding Pliocene limestone wall, some six meters above the floor at the northern end of Darby Sink. Much of the tooth is missing, but the remaining portion includes features diagnostic of this genus. The tooth conforms in size and morphology to Carcharodon megalodon (Agassiz, 1843), an extinct great white shark

RSRA sixth scale wind tunnel test. Tabulated balance data, volume 2

Summaries are presented of all the force and moment data acquired during the RSRA Sixth Scale Wind Tunnel Test. These data include and supplement the data presented in curve form in previous reports. Each summary includes the model configuration, wing and empennage incidences and deflections, and recorded balance data. The first group of data in each summary presents the force and moment data in full scale parametric form, the dynamic pressure and velocity in the test section, and the powered nacelle fan speed. The second and third groups of data are the balance data in nondimensional coefficient form. The wind axis coefficient data corresponds to the parametric data divided by the wing area for forces and divided by the product of the wing area and wing span or mean aerodynamic chord for moments. The stability axis data resolves the wind axis data with respect to the angle of yaw

Evolution of precipitates, in particular cruciform and cuboid particles, during simulated direct charging of thin slab cast vanadium microalloyed steels

A study has been undertaken of four vanadium based steels which have been processed by a simulated direct charging route using processing parameters typical of thin slab casting, where the cast product has a thickness of 50 to 80mm ( in this study 50 mm) and is fed directly to a furnace to equalise the microstructure prior to rolling. In the direct charging process, cooling rates are faster, equalisation times shorter and the amount of deformation introduced during rolling less than in conventional practice. Samples in this study were quenched after casting, after equalisation, after 4th rolling pass and after coiling, to follow the evolution of microstructure. The mechanical and toughness properties and the microstructural features might be expected to differ from equivalent steels, which have undergone conventional processing. The four low carbon steels (~0.06wt%) which were studied contained 0.1wt%V (V-N), 0.1wt%V and 0.010wt%Ti (V-Ti), 0.1wt%V and 0.03wt%Nb (V-Nb), and 0.1wt%V, 0.03wt%Nb and 0.007wt%Ti (V-Nb-Ti). Steels V-N and V-Ti contained around 0.02wt% N, while the other two contained about 0.01wt%N. The as-cast steels were heated at three equalising temperatures of 1050C, 1100C or 1200C and held for 30-60 minutes prior to rolling. Optical microscopy and analytical electron microscopy, including parallel electron energy loss spectroscopy (PEELS), were used to characterise the precipitates. In the as-cast condition, dendrites and plates were found. Cuboid particles were seen at this stage in Steel V-Ti, but they appeared only in the other steels after equalization. In addition, in the final product of all the steels, fine particles were seen, but it was only in the two titanium steels that cruciform precipitates were present. PEELS analysis showed that the dendrites, plates, cuboids, cruciforms and fine precipitates were essentially nitrides. The two Ti steels had better toughness than the other steels but inferior lower yield stress values. This was thought to be, in part, due to the formation of cruciform precipitates in austenite, thereby removing nitrogen and the microalloying elements which would have been expected to precipitate in ferrite as dispersion hardening particles

RSRA sixth scale wind tunnel test

The sixth scale model of the Sikorsky/NASA/Army rotor systems research aircraft was tested in an 18-foot section of a large subsonic wind tunnel for the purpose of obtaining basic data in the areas of performance, stability, and body surface loads. The model was mounted in the tunnel on the struts arranged in tandem. Basic testing was limited to forward flight with angles of yaw from -20 to +20 degrees and angles of attack from -20 to +25 degrees. Tunnel test speeds were varied up to 172 knots (q = 96 psf). Test data were monitored through a high speed static data acquisition system, linked to a PDP-6 computer. This system provided immediate records of angle of attack, angle of yaw, six component force and moment data, and static and total pressure information. The wind tunnel model was constructed of aluminum structural members with aluminum, fiberglass, and wood skins. Tabulated force and moment data, flow visualization photographs, tabulated surface pressure data are presented for the basic helicopter and compound configurations. Limited discussions of the results of the test are included

Letter from A. Flemming, to Anne Whitney, 1882 December 24

https://repository.wellesley.edu/whitney_correspondence/3017/thumbnail.jp

Interference-filter-stabilized external-cavity diode lasers

We have developed external-cavity diode lasers, where the wavelength selection is assured by a low loss interference filter instead of the common diffraction grating. The filter allows a linear cavity design reducing the sensitivity of the wavelength and the external cavity feedback against misalignment. By separating the feedback and wavelength selection functions, both can be optimized independently leading to an increased tunability of the laser. The design is employed for the generation of laser light at 698, 780 and 852 nm. Its characteristics make it a well suited candidate for space-born lasers.Comment: 12 pages, 5 figure

State-space models' dirty little secrets: even simple linear Gaussian models can have estimation problems

State-space models (SSMs) are increasingly used in ecology to model time-series such as animal movement paths and population dynamics. This type of hierarchical model is often structured to account for two levels of variability: biological stochasticity and measurement error. SSMs are flexible. They can model linear and nonlinear processes using a variety of statistical distributions. Recent ecological SSMs are often complex, with a large number of parameters to estimate. Through a simulation study, we show that even simple linear Gaussian SSMs can suffer from parameter- and state-estimation problems. We demonstrate that these problems occur primarily when measurement error is larger than biological stochasticity, the condition that often drives ecologists to use SSMs. Using an animal movement example, we show how these estimation problems can affect ecological inference. Biased parameter estimates of a SSM describing the movement of polar bears (\textit{Ursus maritimus}) result in overestimating their energy expenditure. We suggest potential solutions, but show that it often remains difficult to estimate parameters. While SSMs are powerful tools, they can give misleading results and we urge ecologists to assess whether the parameters can be estimated accurately before drawing ecological conclusions from their results

Wear Mechanisms of Hydrogenated DLC in Oils Containing MoDTC

Diamond-Like Carbon (DLC) coatings are well known for offering excellent tribological properties. They have been shown to offer low friction and outstanding wear performance in both dry and lubricated conditions. Application of these coatings for automotive components is considered as a promising strategy to cope with the emerging requirements regarding fuel economy and durability. Commercially available oils are generally optimised to work on conventional ferrous surfaces and are not necessarily effective in lubricating non-ferrous surfaces. Recently, the adverse effect of the Molybdenum DialkyldithioCarbamate (MoDTC) friction modifier additive on the wear performance of the hydrogenated DLC has been reported. However, the mechanisms by which MoDTC imposes this high wear to DLC are not yet well understood. A better understanding of DLC wear may potentially lead to better compatibility between DLC surfaces and current additive technology being achieved. In this work, the wear properties of DLC coatings in the DLC/cast iron (CI) system under boundary lubrication conditions have been investigated to try to understand what appears to be a tribocorrosion-type process. A pin-on-plate tribotester was used to run the experiments using High Speed Steel (HSS) plates coated with 15 at.% hydrogenated DLC (a-C:15H) sliding against CI pins or ceramic balls. The lubricants used in this study are typical examples of the same fully formulated oil with and without ZDDP. The friction and wear responses of the fully formulated oils are discussed in detail. Furthermore, Optical Microscopy (OM) and Scanning Electron Microscopy (SEM), Energy-Dispersive X-ray spectroscopy (EDX), Focused Ion Beam (FIB) and Transmission Electron Microscopy (TEM) were used to observe the wear scar and propose wear mechanisms. The X-ray Photoelectron Spectroscopy (XPS) analysis was performed on the tribofilms to understand the tribochemical interactions between oil additives and the DLC coating. Nano-indentation analysis was conducted to assess potential structural modifications of the DLC coating. Coating hardness data could provide a better insight into the wear mode and failure mechanism of such hard coatings. Given the obtained results, the wear behaviour of the hydrogenated DLC coating was found to depend not only on the presence of ZDDP in the oil formulation but also on the counterpart type. This study revealed that the steel counterpart is a critical component of the tribocouple leading to MoDTC-induced wear of the hydrogenated DLC

A random-effects hurdle model for predicting bycatch of endangered marine species

Understanding and reducing the incidence of accidental bycatch, particularly for vulnerable species such as sharks, is a major challenge for contemporary fisheries management worldwide. Bycatch data, most often collected by at-sea observers during fishing trips, are clustered by trip and/or vessel and typically involve a large number of zero counts and very few positive counts. Though hurdle models are very popular for count data with excess zeros, models for clustered forms have received far less attention. Here we present a novel random-effects hurdle model for bycatch data that makes available accurate estimates of bycatch probabilities as well as other clusterspecific targets. These are essential for informing conservation and management decisions as well as for identifying bycatch hotspots, often considered the first step in attempting to protect endangered marine species. We validate our methodology through simulation and use it to analyze bycatch data on critically endangered hammerhead sharks from the U.S. National Marine Fisheries Service Pelagic Observer Program