Key stakeholders’ perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A mixed-methods study

Background: Chronic kidney disease (CKD), classified as stages 1-5, costs the NHS an estimated £1.44-1.45 billion annually, with the cost of provision predominantly in dialysis services when milder CKD progresses to stage 5. Delaying disease progression and the commencement of dialysis, is desirable. CKD alters phosphate metabolism, which is strongly associated with a rise in fibroblast growth factor 23 (FGF-23) and disease progression. The provision of an early dietary phosphate self-management (EPSM) strategy may reduce FGF-23 levels and delay disease progression. Purpose: To explore the perspectives of children and young people (CYP), parents and key healthcare professionals (HCPs) towards the development of an EPSM strategy for CYP with CKD 1-3, within a managed paediatric renal network. Methodology: This three-phase study used an exploratory QUALITATIVE-quantitative mixed-methods research (MMR) design. A systematic review informed the development of a topic guide for qualitative semi-structured interviews (n=17) with CYP, parents and HCP (n=21). Interpretive description (ID) provided the qualitative methodology. The co-constructed themes developed from the qualitative interviews informed the first round of the modified online Delphi survey. Findings: Integration of the findings produced 3 novel MMR themes, emphasising the need for (1) a new paradigm of early dietary intervention to promote kidney health; to be (2) offered by the paediatric renal dietitian as part of an early engagement diagnosis package; and (3) accessible culinary medicine workshops, providing education, social networking, and upskilling to address the practical prerequisites of the strategy. Recommendations: The testing and implementation of an EPSM, and an action plan to address the challenges and enablers to implementing the strategy. Conclusion: This MMR produced a collective agreement and some early modelling on the operationalisation of an EPSM strategy. The findings will facilitate developments in the regional paediatric nephrology network, as well as informing national and international policy to improve health outcomes, delay disease progression, and reduce healthcare utilisation and costs

A Common Place, Volume 3, Spring 2024

Fiction Widowmaker by Char Lavigne Waning Eve by Lee Kassay Smoker’s Diner by John Travis Bridgham The Rusty Scabbard by Hannah Rice Nonfiction Portraito of My Father by Jordan Mcpherson Poetry Angel Girl by Grace (Asher) Beverly Sons Of Actaeon by Grace (Asher) Beverly Good Soil by Pearl Siff Celestial by Nat Velez-Camp The Hill by Mallory Isabella Davis Hierba Mala Nunca Muere by Mallory Isabella Davis Visual Art Lips by Judson Atkins Discarded Cigarettes by Nyla Mceachin Open Space and Safety by Bradley Pugh Conte Crayon Self-Portrait by Shaylise Jones Untitled 2363 by Judson Atkinshttps://digitalcommons.longwood.edu/special_studentpubs/1218/thumbnail.jp

The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis-clinical practice recommendation from the Pediatric Renal Nutrition Taskforce

In children with chronic kidney disease (CKD), optimal control of bone and mineral homeostasis is essential, not only for the prevention of debilitating skeletal complications and achieving adequate growth but also for preventing vascular calcification and cardiovascular disease. Complications of mineral bone disease (MBD) are common and contribute to the high morbidity and mortality seen in children with CKD. Although several studies describe the prevalence of abnormal calcium, phosphate, parathyroid hormone, and vitamin D levels as well as associated clinical and radiological complications and their medical management, little is known about the dietary requirements and management of calcium (Ca) and phosphate (P) in children with CKD. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists, who develop clinical practice recommendations (CPRs) for the nutritional management of various aspects of renal disease management in children. We present CPRs for the dietary intake of Ca and P in children with CKD stages 2-5 and on dialysis (CKD2-5D), describing the common Ca- and P-containing foods, the assessment of dietary Ca and P intake, requirements for Ca and P in healthy children and necessary modifications for children with CKD2-5D, and dietary management of hypo- and hypercalcemia and hyperphosphatemia. The statements have been graded, and statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.Peer reviewe

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

Key stakeholders’ perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A mixed-methods study

Background: Chronic kidney disease (CKD), classified as stages 1-5, costs the NHS an estimated £1.44-1.45 billion annually, with the cost of provision predominantly in dialysis services when milder CKD progresses to stage 5. Delaying disease progression and the commencement of dialysis, is desirable. CKD alters phosphate metabolism, which is strongly associated with a rise in fibroblast growth factor 23 (FGF-23) and disease progression. The provision of an early dietary phosphate self-management (EPSM) strategy may reduce FGF-23 levels and delay disease progression. Purpose: To explore the perspectives of children and young people (CYP), parents and key healthcare professionals (HCPs) towards the development of an EPSM strategy for CYP with CKD 1-3, within a managed paediatric renal network. Methodology: This three-phase study used an exploratory QUALITATIVE-quantitative mixed-methods research (MMR) design. A systematic review informed the development of a topic guide for qualitative semi-structured interviews (n=17) with CYP, parents and HCP (n=21). Interpretive description (ID) provided the qualitative methodology. The co-constructed themes developed from the qualitative interviews informed the first round of the modified online Delphi survey. Findings: Integration of the findings produced 3 novel MMR themes, emphasising the need for (1) a new paradigm of early dietary intervention to promote kidney health; to be (2) offered by the paediatric renal dietitian as part of an early engagement diagnosis package; and (3) accessible culinary medicine workshops, providing education, social networking, and upskilling to address the practical prerequisites of the strategy. Recommendations: The testing and implementation of an EPSM, and an action plan to address the challenges and enablers to implementing the strategy. Conclusion: This MMR produced a collective agreement and some early modelling on the operationalisation of an EPSM strategy. The findings will facilitate developments in the regional paediatric nephrology network, as well as informing national and international policy to improve health outcomes, delay disease progression, and reduce healthcare utilisation and costs

Histoire critique du magnétisme animal. Partie 2 / , par J. P. F. Deleuze

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On corporate structure, strategy, and performance: a study with directed acyclic graphs and PC algorithm

This paper reconsiders empirical evidence on relationships among variables related to corporate strategy, structure, and performance. Causal relationships among variables are modeled as directed acyclic graphs using PC-algorithm. Return on Assets appears to be determined by Advertising Intensity, Unrelated Diversification, R&D Intensity, and Organizational Ownership Hierarchy. Debt Structure and Investor Characteristics do not cause (either directly or indirectly) return on assets. These latter two variables appear to be effects of return on assets, not causes. Results offer mixed support of the theory that structure causes strategy, which in turn causes performance. Copyright © 2009 John Wiley & Sons, Ltd.