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

Mapping the spin-dependent electron reflectivity of Fe and Co ferromagnetic thin films

Spin Polarized Low Energy Electron Microscopy is used as a spin dependent spectroscopic probe to study the spin dependent specular reflection of a polarized electron beam from two different magnetic thin film systems: Fe/W(110) and Co/W(110). The reflectivity and spin-dependent exchange-scattering asymmetry are studied as a function of electron kinetic energy and film thickness, as well as the time dependence. The largest value of the figure of merit for spin polarimetry is observed for a 5 monolayer thick film of Co/W(110) at an electron kinetic energy of 2eV. This value is 2 orders of magnitude higher than previously obtained with state of the art Mini-Mott polarimeter. We discuss implications of our results for the development of an electron-spin-polarimeter using the exchange-interaction at low energy.Comment: 5 pages, 4 figure

Fireside corrosion degradation of ferritic alloys at 600°C in oxy-fired conditions

This paper reports the results of a study carried out to investigate the effects of simulated coal/biomass combustion conditions on the fireside corrosion. The 1000 h deposit recoat exposure (5 × 200 h cycles) was carried out at 600 °C. In these tests ferritic alloys were used 15Mo3, T22, T23 and T91. Kinetics data were generated for the alloys exposed using both traditional weight change methods and metal loss measurements. The highest rate of corrosion based on EDX results occurred under D1 deposit where provoke mainly by the formation of alkali iron tri-sulphate phase

Magnetic fields of intermediate mass T Tauri stars

Aims. In this paper, we aim to measure the strength of the surface magnetic fields for a sample of five intermediate mass T Tauri stars and one low mass T Tauri star from late-F to mid-K spectral types. While magnetic fields of T Tauri stars at the low mass range have been extensively characterized, our work complements previous studies towards the intermediate mass range; this complementary study is key to evaluate how magnetic fields evolve during the transition from a convective to a radiative core. Methods. We studied the Zeeman broadening of magnetically sensitive spectral lines in the H-band spectra obtained with the CRIRES high-resolution near-infrared spectrometer. These data are modelled using magnetic spectral synthesis and model atmospheres. Additional constraints on non-magnetic line broadening mechanisms are obtained from modelling molecular lines in the K band or atomic lines in the optical wavelength region. Results. We detect and measure mean surface magnetic fields for five of the six stars in our sample: CHXR 28, COUP 107, V2062 Oph, V1149 Sco, and Par 2441. Magnetic field strengths inferred from the most magnetically sensitive diagnostic line range from 0.8 to 1.8 kG. We also estimate a magnetic field strength of 1.9 kG for COUP 107 from an alternative diagnostic. The magnetic field on YLW 19 is the weakest in our sample and is marginally detected, with a strength of 0.8 kG. Conclusions. We populate an uncharted area of the pre-main-sequence HR diagram with mean magnetic field measurements from high-resolution near-infrared spectra. Our sample of intermediate mass T Tauri stars in general exhibits weaker magnetic fields than their lower mass counterparts. Our measurements will be used in combination with other spectropolarimetric studies of intermediate mass and lower mass T Tauri stars to provide input into pre-main-sequence stellar evolutionary models.Comment: 8 pages, 8 figures, accepted for publication in Astronomy and Astrophysic

Factors affecting the role of human resource department in private healthcare sector in Pakistan: a case study of Rehman Medical Institute (RMI)

The role of Human Resource Management in healthcare sector and challenges it faces has always been an important area of research both in developed and developing countries. The objective of this study is to evaluate the role of HR department in private healthcare sector in the province of Khyber Pakhtunkhwa (KPK), Pakistan and to analyze the challenges/factors affecting the role of HR department. Being the largest private sector hospital in KPK the researchers have selected RMI as a case for this study. Data was collected through interviews from different levels of employees in RMI. Constant comparative method was used for analyzing the data. Results present that HR department plays the role of an administrative expert in RMI. The major internal factors include workload, top management interference, management style and organizational culture which negatively effect motivation, performance and morale of the employees. While small labour market, undue interference of government and other higher authorities and trade unions are the external factors that affect the role of HR department in RMI. All these external factors create difficulties for HR department to attract and retain the desired workforce

Behaviour, welfare, and tibia traits of fast- and slow-growing chickens reared in intensive and free range systems

The behaviour, welfare, and tibia characteristics of fast- and slow-growing chickens were evaluated in free-range and intensive production systems. A total of 720 birds of three strains were subjected to these systems after 21 days of rearing under the same intensive environment. Each treatment was replicated six times with 20 birds in each replicate. Data were collected for welfare aspects, including feather condition, footpad, hock joint and tonic immobility, behavioural features, especially feeding or foraging, sitting, walking, scratching, pecking and dust-bathing, and tibia characteristics, including weight, length, width, medullary canal diameter and robusticity index (4 - 8 weeks). Production system had significant effects on all welfare and behaviour aspects of the birds. However, tibia characteristics were not influenced by production system, except for medullary canal diameter. The strains differed significantly in welfare, tibia characteristics and behaviour. For example, the slow-growing strains had better feather condition,  footpad and hock joint scores. Significant interactions of strain and production system were noted for all characteristics. It was recommended that Rhode Island Red chickens could be raised under either production system without compromising their welfare or causing adverse effects on leg health

The Coronal Structure of AB Doradus

We perform a numerical simulation of the corona of the young, rapidly rotating K0 dwarf AB Doradus using a global MHD model. The model is driven by a surface map of the radial magnetic field constructed using Zeeman-Doppler Imaging. We find that the global structure of the stellar corona is dominated by strong azimuthal tangling of the magnetic field due to the rapid rotation. The MHD solution enables us to calculate realistic Alfv\'en surfaces and we can therefore estimate the stellar mass loss rate and angular momentum loss rate without making undue theoretical simplifications. We consider three cases, parametrized by the base density of the corona, that span the range of possible solutions for the system. We find that overall, the mass and angular-momentum loss rates are higher than in the solar case; the mass loss rates are 10 to 500 times higher, and the angular momentum loss rate can be up to $3\times{10}^4$ higher than present day solar values. Our simulations show that this model can be use to constrain the wide parameter space of stellar systems. It also shows that an MHD approach can provide more information about the physical system over the commonly used potential field extrapolation.Comment: 13 pages, 7 figure

Asymptotic Behaviour of the Proper Length and Volume of the Schwarzschild Singularity

Though popular presentations give the Schwarzschild singularity as a point it is known that it is spacelike and not timelike. Thus it has a "length" and is not a "point". In fact, its length must necessarily be infinite. It has been proved that the proper length of the Qadir-Wheeler suture model goes to infinity [1], while its proper volume shrinks to zero, and the asymptotic behaviour of the length and volume have been calculated. That model consists of two Friedmann sections connected by a Schwarzschild "suture". The question arises whether a similar analysis could provide the asymptotic behaviour of the Schwarzschild black hole near the singularity. It is proved here that, unlike the behaviour for the suture model, for the Schwarzschild essential singularity $\Delta s$ $\thicksim$ $K^{1/3}\ln K$ and $V\thicksim$ $K^{-1}\ln K$, where $K$ is the mean extrinsic curvature, or the York time.Comment: 13 pages, 1 figur