Exploring access to end of life care for ethnic minorities with end stage kidney disease through recruitment in action research

BACKGROUND: Variation in provision of palliative care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes (T2DM) and end stage kidney failure (ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting. METHODS: The study employed an action research methodology with interviews and focus groups to capture and reflect on the process of engaging with South Asian patients about end of life care. Researchers and kidney care clinicians on four NHS sites in the UK recruited South Asian patients with ESKF who were requiring end of life care to take part in individual interviews; and other clinicians who provided care to South Asian kidney patients at end of life to take part in focus groups exploring end of life care issues. In action research planning, action and evaluation are interlinked and data were analysed with emergent themes fed back to care providers through the research cycle. Reflections on the process of patient recruitment generated focus group discussions about access which were analysed thematically and reported here. RESULTS: Sixteen patients were recruited to interview and 45 different care providers took part in 14 focus groups across the sites. The process of recruiting patients to interview and subsequent focus group data highlighted some of the key issues concerning access to end of life care. These were: the identification of patients approaching end of life; and their awareness of end of life care; language barriers and informal carers' roles in mediating communication; and contrasting cultures in end of life kidney care. CONCLUSIONS: Reflection on the process of recruitment in this action research study provided insight into the complex scenario of end of life in kidney care. Some of the emerging issues such as the difficulty identifying patients are likely to be common across all patient groups, whilst others concerning language barriers and third party communication are more specific to ethnic minorities. A focus on South Asian ethnicity contributes to better understanding of patient perspectives and generic concepts as well as access to end of life kidney care for this group of patients in the UK. Action research was a useful methodology for achieving this and for informing future research to include informal carers and other ethnic groups.Peer reviewedFinal Published versio

Phylogeny and evolutionary history of glycogen synthase kinase 3/SHAGGY-like kinase genes in land plants

Background: GSK3 (glycogen synthase kinase 3) genes encode signal transduction proteins with roles in a variety of biological processes in eukaryotes. In contrast to the low copy numbers observed in animals, GSK3 genes have expanded into a multi-gene family in land plants (embryophytes), and have also evolved functions in diverse plant specific processes, including floral development in angiosperms. However, despite previous efforts, the phylogeny of land plant GSK3 genes is currently unclear. Here, we analyze genes from a representative sample of phylogenetically pivotal taxa, including basal angiosperms, gymnosperms, and monilophytes, to reconstruct the evolutionary history and functional diversification of the GSK3 gene family in land plants. Results: Maximum Likelihood phylogenetic analyses resolve a gene tree with four major gene duplication events that coincide with the emergence of novel land plant clades. The single GSK3 gene inherited from the ancestor of land plants was first duplicated along the ancestral branch to extant vascular plants, and three subsequent duplications produced three GSK3 loci in the ancestor of euphyllophytes, four in the ancestor of seed plants, and at least five in the ancestor of angiosperms. A single gene in the Amborella trichopoda genome may be the sole survivor of a sixth GSK3 locus that originated in the ancestor of extant angiosperms. Homologs of two Arabidopsis GSK3 genes with genetically confirmed roles in floral development, AtSK11 and AtSK12, exhibit floral preferential expression in several basal angiosperms, suggesting evolutionary conservation of their floral functions. Members of other gene lineages appear to have independently evolved roles in plant reproductive tissues in individual taxa. Conclusions: Our phylogenetic analyses provide the most detailed reconstruction of GSK3 gene evolution in land plants to date and offer new insights into the origins, relationships, and functions of family members. Notably, the diversity of this “green” branch of the gene family has increased in concert with the increasing morphological and physiological complexity of land plant life forms. Expression data for seed plants indicate that the functions of GSK3 genes have also diversified during evolutionary time

Evolving information systems: meeting the ever-changing environment

To meet the demands of organizations and their ever-changing environment, information systems are required which are able to evolve to the same extent as organizations do. Such a system has to support changes in all time-and application-dependent aspects. In this paper, requirements and a conceptual framework for evolving information systems are presented. This framework includes an architecture for such systems and a revision of the traditional notion of update. Based on this evolutionary notion of update (recording, correction and forgetting) a state transition-oriented model on three levels of abstraction (event level, recording level, correction level) is introduced. Examples are provided to illustrate the conceptual framework for evolving information systems

Pembentukan 8-OHdG Dari Zat Toksik Pemicu Radikal Bebas

This study was conducted to observethe profile of DNA Adduct (8-OHdG) formation as DNA damage indicators, by using calf thymus DNA incubated with toxic and carcinogenic compounds. The compounds which could trigger free radicals in this research were PAH(Benzo[a]Pyrene), TiO2, and CuCl2. Calf thymus DNA was incubated with Benzo[a]Pyrene and CuCl2 compounds under pH and temperature variations. The incubation of calf thymus DNA with TiO2-UV radiation (254 nm) wasused to induce the formation of reactive oxygen species (ROS) in the process of oxidative DNA damage. From this research, all of compounds have potency to trigger the formation of DNA Adduct (8-OHdG). The ratio of absorbance to assess the purity of DNA at 260 nm and 280 nm (λ260/ λ280 ) was measured at ~1.9. The shifted peaks at λmax were indicating changes on structures of DNA as a result of calf thymus DNA incubation with B[a]P and CuCl2. The highest level of 8-OHdG results in calf thymus DNA incubation with B[a]P and CuCl2 under pH 8.5 and incubation temperature at 60°C, was about 120.856 μg/L. Calf thymus DNA incubation with TiO2-UV radiation (254 nm) under pH 8.5 resulting 8-OHdG level at 57.025 μg/L

Old Testament Principles Relevant to Mutually Consensual Homoerotic Activity - Part 1

This first section of a three-part study seeks to identify principles in the Old Testament relevant to the relationship between God’s community of faith and individuals who engage in some forms of sexual activity outside heterosexual marriage. My primary focus will be on mutually consensual homoerotic activityas practiced by people within the lesbian, gay, bisexual, transgender, queer (LGBTQ) spectrum

Streaming to the Lord

The author describes how, if the Israelites had continued to accept the loving guidance of the Lord, they would have received the wonderful blessings He was eager to lavish upon them