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

Slicing Sets and Measures, and the Dimension of Exceptional Parameters

We consider the problem of slicing a compact metric space \Omega with sets of the form \pi_{\lambda}^{-1}\{t\}, where the mappings \pi_{\lambda} \colon \Omega \to \R, \lambda \in \R, are \emph{generalized projections}, introduced by Yuval Peres and Wilhelm Schlag in 2000. The basic question is: assuming that \Omega has Hausdorff dimension strictly greater than one, what is the dimension of the 'typical' slice \pi_{\lambda}^{-1}{t}, as the parameters \lambda and t vary. In the special case of the mappings \pi_{\lambda} being orthogonal projections restricted to a compact set \Omega \subset \R^{2}, the problem dates back to a 1954 paper by Marstrand: he proved that for almost every \lambda there exist positively many $t \in \R$ such that \dim \pi_{\lambda}^{-1}{t} = \dim \Omega - 1. For generalized projections, the same result was obtained 50 years later by J\"arvenp\"a\"a, J\"arvenp\"a\"a and Niemel\"a. In this paper, we improve the previously existing estimates by replacing the phrase 'almost all \lambda' with a sharp bound for the dimension of the exceptional parameters.Comment: 31 pages, three figures; several typos corrected and large parts of the third section rewritten in v3; to appear in J. Geom. Ana

The prevalence and factors affecting psychoactive substance use among undergraduate students in University of Uyo, Nigeria

Background: Psychoactive substance use is a proliferating public health and social problem leading to negative multi-dimensional impact especially among young people. This study was done to determine the prevalence and factors predisposing to psychoactive substance use among undergraduates in University of Uyo, Nigeria.Methodology: This was a cross-sectional descriptive study carried out among 350 undergraduates in the University of Uyo, Nigeria between March and July 2016. Data collection was done using a self-administered structured questionnaire and was analyzed using the Statistical Package for the Social Sciences, version 23.Results: The mean age of the respondents was 21.57±1.96 years. The prevalence of psychoactive substance use was 27.5% and was more in females (37.7%) than males (18.2%). Peer group influence (94.3%), Stress (70.5%), Curiosity (58.7%), were the most common factors perceived to predispose to psychoactive substance use among undergraduate students. Among the 89 substance users in the study, alcohol 89 (100.0%), codeine 71 (79.8%), tramadol 66(74.2%) and cigarette 37(41.6%) were the most commonly used substances. The commonest source of substances was from friends 76 (85.4%), while the commonest reasons for substance use were to boost confidence, 82 (92.1%) and to read for exams, 76 (85.4%). A statistically significant association existed between substance use and age, sex, intra family relationship, family member substance use, peer group use of psychoactive substance and academic performance (p<0.05).Conclusion: Psychoactive substance use was high among the study group. A multi-dimensional approach is needed in curbing substance use among undergraduate students both at the educational institution and family levels.Keywords: Psychoactive substance, Undergraduate students, Peer group, Uyo, Nigeria

On thin plate spline interpolation

We present a simple, PDE-based proof of the result [M. Johnson, 2001] that the error estimates of [J. Duchon, 1978] for thin plate spline interpolation can be improved by $h^{1/2}$. We illustrate that ${\mathcal H}$-matrix techniques can successfully be employed to solve very large thin plate spline interpolation problem

South Korean energy outlook: Coal and electricity focus

An energy profile for South Korea is presented. The emphasis is on coal and electricity

Implementing person-centred outcome measures (PCOMs) into routine palliative care: A protocol for a mixed-methods process evaluation of the RESOLVE PCOM Implementation Strategy

Introduction Person-centred outcome measures improve quality of care and patient outcomes but are used inconsistently in palliative care practice. To address this implementation gap, we developed the 'RESOLVE Implementation Strategy'. This protocol describes a process evaluation to explore mechanisms through which this strategy does, or does not, support the implementation of outcome measures in routine palliative care practice. Methods and analysis Multistrand, mixed-methods process evaluation. Strand one will collect routine outcomes data (palliative Phase of Illness, Integrated Palliative care Outcomes Scale, Australia-modified Karnofsky Performance Status) to map the changes in use of outcome measures over 12 months (July 2021-July 2022). Strand two will collect survey data over the same 12-month period to explore how professionals' understandings of, skills in using and ability to build organisational practices around, outcome measures change over time. Strand three will collect interview data to understand the mechanisms underpinning/affecting our implementation strategy. Thematic framework analysis and descriptive statistics will be used to analyse qualitative and quantitative data, respectively. Ethics and dissemination For strand one, ethical approval has been obtained (Cambridge REC, REF: 20/EE/0188). For strands two and three, ethical approval has been obtained from Hull York Medical School ethics committee (2105). Tailored feedback of study findings will be provided to participating sites. Abstracts and papers will be submitted to national/international conferences and peer-reviewed journals. Lay and policy briefings and newsletters will be shared through patient and public involvement and project networks, plus via the project website

Tackling LGBTQ+ youth mental health inequality:Mapping mental health support across the UK

Young people who identify as lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) experience higher rates of mental health distress than reported in the general population, yet are far less likely to seek support services. Factors such as homophobia, biphiobia and transphobia, cis-heteronormativity, fear of judgement and lack of staff awareness of LGBTQ+ identities are barriers to help seeking. This paper reports on the first stage of a study that investigated and mapped current LGBTQ+ youth specific mental health service provision across the UK. An online and offline service mapping exercise was undertaken to identify services. 111 services were identified across the search strategies, the majority in urban settings in England. There were three significant characteristics of LGBTQ+ child and adolescent mental health UK provision. Firstly, there was an absence of mainstream NHS support that specifically addressed the needs of LGBTQ+ young people. Secondly, the majority of LGBTQ+ youth mental health support was provided by voluntary/community organisations. Thirdly, there was a new emerging model of service that is based on collaborative working between NHS trusts and community/voluntary organisations. The results of this mapping exercise suggest that there is a reliance on the voluntary/community sector to provide mental health provision for LGBTQ+ young people. Furthermore, there was a distinct divergence in the approaches of the support provided by the voluntary/community sector and those from within the NHS. The affirmation of LGBTQ+ identities that is pivotal to the support provided by voluntary/community services contrasted with the ‘treating everyone the same’ approach prevalent in mainstream service provision. NHS mental health services must recognise that to tackle LGBTQ+ youth mental health inequality, statutory mental health support must address specifically the mental health needs of LGBTQ+ young people

Theory of Melting and the Optical Properties of Gold/DNA Nanocomposites

We describe a simple model for the melting and optical properties of a DNA/gold nanoparticle aggregate. The optical properties at fixed wavelength change dramatically at the melting transition, which is found to be higher and narrower in temperature for larger particles, and much sharper than that of an isolated DNA link. All these features are in agreement with available experiments. The aggregate is modeled as a cluster of gold nanoparticles on a periodic lattice connected by DNA bonds, and the extinction coefficient is computed using the discrete dipole approximation. Melting takes place as an increasing number of these bonds break with increasing temperature. The melting temperature corresponds approximately to the bond percolation threshold.Comment: 5 pages, 4 figure. To be published in Phys. Rev.

The first ever anti-football painting: A consideration of the soccer match in John Singer Sargent’s "Gassed"

The paper presents a discussion of Gassed, a large oil painting by John Singer Sargent displayed at the Imperial War Museum in London. Completed in 1919, Gassed is the major achievement from Sargent’s commission as an official war artist at the appointment of the British War Memorials Committee during the latter period of World War I. Prominent in the painting is a group of soldiers, blinded by a mustard gas attack, being lead to a casualty clearing station tent. In the distant background of the painting, another group of soldiers can be seen kitted out in football attire playing a match. The significance of this football imagery is our point of enquiry. As our title suggests, some recent interpretations regard the painting as offering critical reflection, from the time, about the symbolic links between sport and war. However, while the painting may certainly be left open to this type of viewer interpretation, archival and secondary resource material research does not support such a critical intention by the artist. Yet, nor is there evidence that Sargent’s intention was the projection of war-heroism. Rather, Sargent’s endeavour to faithfully represent what he observed allows Gassed to be regarded as a visual record of routine activity behind the lines and of football as an aspect of the daily life of British soldiers during the Great War