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

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

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

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

Reconstitution of the complete pathway of ITS2 processing at the pre-ribosome

Removal of internal transcribed spacer 2 (ITS2) from pre-ribosomal RNA is essential to make functional ribosomes. This complicated processing reaction begins with a single endonucleolytic cleavage followed by exonucleolytic trimming at both new cleavage sites to generate mature 5.8S and 25S rRNA. We reconstituted the 7S -> 5.8S processing branch within ITS2 using purified exosome and its nuclear cofactors. We find that both Rrp44's ribonuclease activities are required for initial RNA shortening followed by hand over to the exonuclease Rrp6. During the in vitro reaction, ITS2-associated factors dissociate and the underlying 'foot' structure of the pre-60S particle is dismantled. 7S pre-rRNA processing is independent of 5S RNP rotation, but 26S -> 25S trimming is a precondition for subsequent 7S -> 5.8S processing. To complete the in vitro assay, we reconstituted the entire cycle of ITS2 removal with a total of 18 purified factors, catalysed by the integrated activities of the two participating RNA-processing machines, the Las1 complex and nuclear exosome

Necessary conditions for variational regularization schemes

We study variational regularization methods in a general framework, more precisely those methods that use a discrepancy and a regularization functional. While several sets of sufficient conditions are known to obtain a regularization method, we start with an investigation of the converse question: How could necessary conditions for a variational method to provide a regularization method look like? To this end, we formalize the notion of a variational scheme and start with comparison of three different instances of variational methods. Then we focus on the data space model and investigate the role and interplay of the topological structure, the convergence notion and the discrepancy functional. Especially, we deduce necessary conditions for the discrepancy functional to fulfill usual continuity assumptions. The results are applied to discrepancy functionals given by Bregman distances and especially to the Kullback-Leibler divergence.Comment: To appear in Inverse Problem

Magneto-optical Trapping of Cadmium

We report the laser-cooling and confinement of Cd atoms in a magneto-optical trap, and characterize the loading process from the background Cd vapor. The trapping laser drives the 1S0-1P1 transition at 229 nm in this two-electron atom and also photoionizes atoms directly from the 1P1 state. This photoionization overwhelms the other loss mechanisms and allows a direct measurement of the photoionization cross section, which we measure to be 2(1)x10^(-16)cm^(2) from the 1P1 state. When combined with nearby laser-cooled and trapped Cd^(+) ions, this apparatus could facilitate studies in ultracold interactions between atoms and ions.Comment: 8 pages, 11 figure

Offenders' Crime Narratives across Different Types of Crimes

The current study explores the roles offenders see themselves playing during an offence and their relationship to different crime types. One hundred and twenty incarcerated offenders indicated the narrative roles they acted out whilst committing a specific crime they remembered well. The data were subjected to Smallest Space Analysis (SSA) and four themes were identified: Hero, Professional, Revenger and Victim in line with the recent theoretical framework posited for Narrative Offence Roles (Youngs & Canter, 2012). Further analysis showed that different subsets of crimes were more like to be associated with different narrative offence roles. Hero and Professional were found to be associated with property offences (theft, burglary and shoplifting), drug offences and robbery and Revenger and Victim were found to be associated with violence, sexual offences and murder. The theoretical implications for understanding crime on the basis of offenders' narrative roles as well as practical implications are discussed

Detailing the relation between renal T(2)* and renal tissue pO2 using an integrated approach of parametric magnetic resonance imaging and invasive physiological measurements

OBJECTIVES: This study was designed to detail the relation between renal T2* and renal tissue pO2 using an integrated approach that combines parametric magnetic resonance imaging (MRI) and quantitative physiological measurements (MR-PHYSIOL. MATERIALS AND METHODS: Experiments were performed in 21 male Wistar rats. In vivo modulation of renal hemodynamics and oxygenation was achieved by brief periods of aortic occlusion, hypoxia, and hyperoxia. Renal perfusion pressure (RPP), renal blood flow (RBF), local cortical and medullary tissue pO2, and blood flux were simultaneously recorded together with T2*, T2 mapping, and magnetic resonance-based kidney size measurements (MR-PHYSIOL). Magnetic resonance imaging was carried out on a 9.4-T small-animal magnetic resonance system. Relative changes in the invasive quantitative parameters were correlated with relative changes in the parameters derived from MRI using Spearman analysis and Pearson analysis. RESULTS: Changes in T2* qualitatively reflected tissue pO2 changes induced by the interventions. T2* versus pO2 Spearman rank correlations were significant for all interventions, yet quantitative translation of T2*/pO2 correlations obtained for one intervention to another intervention proved not appropriate. The closest T2*/pO2 correlation was found for hypoxia and recovery. The interlayer comparison revealed closest T2*/pO2 correlations for the outer medulla and showed that extrapolation of results obtained for one renal layer to other renal layers must be made with due caution. For T2* to RBF relation, significant Spearman correlations were deduced for all renal layers and for all interventions. T2*/RBF correlations for the cortex and outer medulla were even superior to those between T2* and tissue pO2. The closest T2*/RBF correlation occurred during hypoxia and recovery. Close correlations were observed between T2* and kidney size during hypoxia and recovery and for occlusion and recovery. In both cases, kidney size correlated well with renal vascular conductance, as did renal vascular conductance with T2*. Our findings indicate that changes in T2* qualitatively mirror changes in renal tissue pO2 but are also associated with confounding factors including vascular volume fraction and tubular volume fraction. CONCLUSIONS: Our results demonstrate that MR-PHYSIOL is instrumental to detail the link between renal tissue pO2 and T2* in vivo. Unravelling the link between regional renal T2* and tissue pO2, including the role of the T2* confounding parameters vascular and tubular volume fraction and oxy-hemoglobin dissociation curve, requires further research. These explorations are essential before the quantitative capabilities of parametric MRI can be translated from experimental research to improved clinical understanding of hemodynamics/oxygenation in kidney disorders

Design and Implementation of an Instrumented Cane for Gait Recognition

Independent mobility is an important aspect of an individual's life and must sometimes be augmented by use of an assistive device such as a wheeled walker or cane following a fall, injury, or functional decline. Physical therapists perform functional gait assessments to gauge the probability of an individual experiencing a fall and often recommend use of a walker, cane, or walking stick to decrease fall risk. Our team has developed a clinical assessment tool centered on a standard walking cane embedded system that can enhance a therapist's observation-based gait assessment with use of additional objective and quantitative data. This system can be utilized to detect timing and speed of cane placement, angular acceleration of the cane, and amounts of weight borne on the cane. This system is designed to assist physical therapists at the basic level in collection of objective data during gait analysis, to facilitate appropriate assistive gait device prescription, to provide patients and therapists feedback during gait training, and to reduce wrist and shoulder injuries with cane usage. However, more importantly, using the plethora of objective data that can be obtained from this cane, automated gait analysis and gait pattern classification can be performed to understand a patient's walking performance