Advance care planning for patients with end-stage kidney disease on dialysis: narrative review of the current evidence, and future considerations

Patients with end-stage kidney disease (ESKD) have a high symptom-burden and high rates of morbidity and mortality. Despite this, evidence has shown that this patient group does not have timely discussions to plan for deterioration and death, and at the end of life there are unmet palliative care needs. Advance care planning is a process that can help patients share their personal values and preferences for their future care and prepare for declining health. Earlier, more integrated and holistic advance care planning has the potential to improve access to care services, communication, and preparedness for future decision-making and changing circumstances. However, there are many barriers to successful implementation of advance care planning in this population. In this narrative review we discuss the current evidence for advance care planning in patients on dialysis, the data around the barriers to advance care planning implementation, and interventions that have been trialled. The review explores whether the concepts and approaches to advance care planning in this population need to be updated to encompass current and future care. It suggests that a shift from a problem-orientated approach to a goal-orientated approach may lead to better engagement, with more patient-centred and satisfying outcomes

Identifying Candida albicans Gene Networks Involved in Pathogenicity

Acknowledgments This is a short text to acknowledge the contributions of specific colleagues, institutions, or agencies that aided the efforts of the authors. Funding RA was generously supported by a Wellcome Trust Institutional Strategic Support Award [WT105618MA], a Microbiology Research Visit Grant [RVG16/18], and a EPSRC/BBSRC Innovation Fellowship [EP/S001352/1]. AB was supported by a programme grant from the UK Medical Research Council [MR/M026663/1] and by the Medical Research Council Centre for Medical Mycology at the University of Aberdeen [MR/N006364/1]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Reliability of Standardized Assessment for Adults who are Deafblind

This study assessed the reliability of the interRAI Community Health Assessment (interRAI CHA) and Deafblind Supplement (DbS). The interRAI CHA and DbS represents a multidimensional, standardized assessment instrument for use with adults (18 and older) who are deafblind. The interrater reliability of the instrument was tested through the completion of dual assessments with 44 individuals who were deafblind in the province of Ontario, Canada. Overall, nearly 50% of items had a kappa value of at least 0.60, indicating fair to substantial agreement for these items. Several items related to psychosocial well-being, mood, and sense of involvement had kappa scores of less than 0.40. However, among these items with low kappa values, most (78%) showed at least 70% agreement between the two assessors. The internal consistency of several health subscales, embedded within the assessment, was also very good and ranged from 0.63 to 0.93. The interRAI was also very good and ranged from 0.63 to 0.93. The interRAI CHA and DbS represents a reliable instrument for assessing adults with deafblindness to better understand their needs, abilities, and preferences

Supersymmetric Homogeneous Quantum Cosmologies Coupled to a Scalar Field

Recent work on $N=2$ supersymmetric Bianchi type IX cosmologies coupled to a scalar field is extended to a general treatment of homogeneous quantum cosmologies with explicitely solvable momentum constraints, i.e. Bianchi types I, II, VII, VIII besides the Bianchi type IX, and special cases, namely the Friedmann universes, the Kantowski-Sachs space, and Taub-NUT space. Besides the earlier explicit solution of the Wheeler DeWitt equation for Bianchi type IX, describing a virtual wormhole fluctuation, an additional explicit solution is given and identified with the `no-boundary state'.Comment: 23 PAGE

J D Bernal: philosophy, politics and the science of science

This paper is an examination of the philosophical and political legacy of John Desmond Bernal. It addresses the evidence of an emerging consensus on Bernal based on the recent biography of Bernal by Andrew Brown and the reviews it has received. It takes issue with this view of Bernal, which tends to be admiring of his scientific contribution, bemused by his sexuality, condescending to his philosophy and hostile to his politics. This article is a critical defence of his philosophical and political position

J D Bernal: philosophy, politics and the science of science

This paper is an examination of the philosophical and political legacy of John Desmond Bernal. It addresses the evidence of an emerging consensus on Bernal based on the recent biography of Bernal by Andrew Brown and the reviews it has received. It takes issue with this view of Bernal, which tends to be admiring of his scientific contribution, bemused by his sexuality, condescending to his philosophy and hostile to his politics. This article is a critical defence of his philosophical and political position

Denosumab rapidly increases cortical bone in key locations of the femur: a 3D bone mapping study in women with osteoporosis.

Women with osteoporosis treated for 36 months with twice-yearly injections of denosumab sustained fewer hip fractures compared with placebo. Treatment might improve femoral bone at locations where fractures typically occur. To test this hypothesis, we used 3D cortical bone mapping of postmenopausal women with osteoporosis to investigate the timing and precise location of denosumab versus placebo effects in the hips. We analyzed clinical computed tomography scans from 80 female participants in FREEDOM, a randomized trial, wherein half of the study participants received subcutaneous denosumab 60 mg twice yearly and the others received placebo. Cortical 3D bone thickness maps of both hips were created from scans at baseline, 12, 24, and 36 months. Cortical mass surface density maps were also created for each visit. After registration of each bone to an average femur shape model followed by statistical parametric mapping, we visualized and quantified statistically significant treatment effects. The technique allowed us to pinpoint systematic differences between denosumab and control and to display the results on a 3D average femur model. Denosumab treatment led to an increase in femoral cortical mass surface density and thickness, already evident by the third injection (12 months). Overall, treatment with denosumab increased femoral cortical mass surface density by 5.4% over 3 years. One-third of the increase came from increasing cortical density, and two-thirds from increasing cortical thickness, relative to placebo. After 36 months, cortical mass surface density and thickness had increased by up to 12% at key locations such as the lateral femoral trochanter versus placebo. Most of the femoral cortex displayed a statistically significant relative difference by 36 months. Osteoporotic cortical bone responds rapidly to denosumab therapy, particularly in the hip trochanteric region. This mechanism may be involved in the robust decrease in hip fractures observed in denosumab-treated women at increased risk of fracture.This study was funded by Amgen Inc., Thousand Oaks, CA, USA. Cambridge Bone Group is supported by Arthritis Research UK, The Evelyn Trust, and Cambridge NIHR Biomedical Research Centre.This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/jbmr.232

Cellular structure of qq-Brauer algebras

In this paper we consider the $q$-Brauer algebra over $R$ a commutative noetherian domain. We first construct a new basis for $q$-Brauer algebras, and we then prove that it is a cell basis, and thus these algebras are cellular in the sense of Graham and Lehrer. In particular, they are shown to be an iterated inflation of Hecke algebras of type $A_{n-1}.$ Moreover, when $R$ is a field of arbitrary characteristic, we determine for which parameters the $q$-Brauer algebras are quasi-heredity. So the general theory of cellular algebras and quasi-hereditary algebras applies to $q$-Brauer algebras. As a consequence, we can determine all irreducible representations of $q$-Brauer algebras by linear algebra methods

Calculating Casimir Energies in Renormalizable Quantum Field Theory

Quantum vacuum energy has been known to have observable consequences since 1948 when Casimir calculated the force of attraction between parallel uncharged plates, a phenomenon confirmed experimentally with ever increasing precision. Casimir himself suggested that a similar attractive self-stress existed for a conducting spherical shell, but Boyer obtained a repulsive stress. Other geometries and higher dimensions have been considered over the years. Local effects, and divergences associated with surfaces and edges have been studied by several authors. Quite recently, Graham et al. have re-examined such calculations, using conventional techniques of perturbative quantum field theory to remove divergences, and have suggested that previous self-stress results may be suspect. Here we show that the examples considered in their work are misleading; in particular, it is well-known that in two dimensions a circular boundary has a divergence in the Casimir energy for massless fields, while for general dimension $D$ not equal to an even integer the corresponding Casimir energy arising from massless fields interior and exterior to a hyperspherical shell is finite. It has also long been recognized that the Casimir energy for massive fields is divergent for $D\ne1$. These conclusions are reinforced by a calculation of the relevant leading Feynman diagram in $D$ and three dimensions. There is therefore no doubt of the validity of the conventional finite Casimir calculations.Comment: 25 pages, REVTeX4, 1 ps figure. Revision includes new subsection 4B and Appendix, and other minor correction