Patients who choose not to dialyze: a prospective national observational study in Australia.

BACKGROUND: It is unclear how many incident patients with stage 5 chronic kidney disease (CKD) referred to nephrologists are presented with information about conservative care as a treatment option and how many plan not to dialyze. STUDY DESIGN: National observational survey study with random-effects logistic regression. SETTING & PARTICIPANTS: Incident adult and pediatric pre-emptive transplant, dialysis, and conservative-care patients from public and private renal units in Australia, July to September 2009. PREDICTORS: Age, sex, health insurance status, language, time known to nephrologist, timing of information, presence of caregiver, unit conservative care pathway, and size of unit. OUTCOMES & MEASUREMENTS: The 2 main outcome measures were information provision to incident patients about conservative care and initial treatment regardless of planned conservative care. RESULTS: 66 of 73 renal units (90%) participated. 10 (15%) had a formal conservative-care pathway. Of 721 incident patients with stage 5 CKD, 470 (65%) were presented with conservative care as a treatment option and 102 (14%) planned not to dialyze; median age was 80 years. Multivariate analysis for information provision showed that patients older than 65 years (OR, 3.40; 95% CI, 1.97-5.87) and those known to a nephrologist for more than 3 months (OR, 6.50; 95% CI, 3.18-13.30) were more likely to receive information about conservative care. Patients with conservative care as planned initial treatment were more likely to be older than 65 years (OR, 4.71; 95% CI, 1.77-12.49) and women (OR, 2.23; 95% CI, 1.23-4.02) than those who started dialysis therapy. Those with private health insurance were less likely to forgo dialysis therapy (OR, 0.40; 95% CI, 0.17-0.98). LIMITATIONS: Cross-sectional design prohibited longer term outcome measurement. Excluded patients with stage 5 CKD managed in the community. CONCLUSIONS: 1 in 7 patients with stage 5 CKD referred to nephrologists plans not to dialyze. Comprehensive service provision with integrated palliative care needs to be improved to meet the demands of the aging population

Patients who choose not to dialyze: a prospective national observational study in Australia.

BACKGROUND: It is unclear how many incident patients with stage 5 chronic kidney disease (CKD) referred to nephrologists are presented with information about conservative care as a treatment option and how many plan not to dialyze. STUDY DESIGN: National observational survey study with random-effects logistic regression. SETTING & PARTICIPANTS: Incident adult and pediatric pre-emptive transplant, dialysis, and conservative-care patients from public and private renal units in Australia, July to September 2009. PREDICTORS: Age, sex, health insurance status, language, time known to nephrologist, timing of information, presence of caregiver, unit conservative care pathway, and size of unit. OUTCOMES & MEASUREMENTS: The 2 main outcome measures were information provision to incident patients about conservative care and initial treatment regardless of planned conservative care. RESULTS: 66 of 73 renal units (90%) participated. 10 (15%) had a formal conservative-care pathway. Of 721 incident patients with stage 5 CKD, 470 (65%) were presented with conservative care as a treatment option and 102 (14%) planned not to dialyze; median age was 80 years. Multivariate analysis for information provision showed that patients older than 65 years (OR, 3.40; 95% CI, 1.97-5.87) and those known to a nephrologist for more than 3 months (OR, 6.50; 95% CI, 3.18-13.30) were more likely to receive information about conservative care. Patients with conservative care as planned initial treatment were more likely to be older than 65 years (OR, 4.71; 95% CI, 1.77-12.49) and women (OR, 2.23; 95% CI, 1.23-4.02) than those who started dialysis therapy. Those with private health insurance were less likely to forgo dialysis therapy (OR, 0.40; 95% CI, 0.17-0.98). LIMITATIONS: Cross-sectional design prohibited longer term outcome measurement. Excluded patients with stage 5 CKD managed in the community. CONCLUSIONS: 1 in 7 patients with stage 5 CKD referred to nephrologists plans not to dialyze. Comprehensive service provision with integrated palliative care needs to be improved to meet the demands of the aging population

Audit of a clinical guideline for neonatal hypoglycaemia screening

NHRMC Early Career Fellowship #511481RMT was supported by NHRMC Grant #63300

Social fit of coral reef governance varies among individuals

Improved natural resource governance is critical for the effective conservation of ecosystems, and the well-being of societies that depend on them. Understanding the social fit of institutional arrangements in different contexts can help guide the design of effective environmental governance. This empirical study assessed individual-level variation in institutional acceptance of coral reef governance among 652 respondents in 12 fishing and tourism-oriented communities in the Wider Caribbean. High institutional acceptance was strongly associated with perceptions of community cohesiveness, underlining the potential contribution of civil society to effective governance processes. Institutional acceptance was also influenced by reef use, awareness of rules, perceived trends in reef fish populations, education, and contextual community-level factors. Understanding what influences diverse perceptions of coral reef governance among individuals can help to assess the likelihood of support for conservation measures. This study highlights how knowledge of institutional acceptance can inform the design of more targeted interventions that enhance the social fit of conservation governance to local contexts and diverse resource users

The curious nonexistence of Gaussian 2-designs

2-designs -- ensembles of quantum pure states whose 2nd moments equal those of the uniform Haar ensemble -- are optimal solutions for several tasks in quantum information science, especially state and process tomography. We show that Gaussian states cannot form a 2-design for the continuous-variable (quantum optical) Hilbert space L2(R). This is surprising because the affine symplectic group HWSp (the natural symmetry group of Gaussian states) is irreducible on the symmetric subspace of two copies. In finite dimensional Hilbert spaces, irreducibility guarantees that HWSp-covariant ensembles (such as mutually unbiased bases in prime dimensions) are always 2-designs. This property is violated by continuous variables, for a subtle reason: the (well-defined) HWSp-invariant ensemble of Gaussian states does not have an average state because the averaging integral does not converge. In fact, no Gaussian ensemble is even close (in a precise sense) to being a 2-design. This surprising difference between discrete and continuous quantum mechanics has important implications for optical state and process tomography.Comment: 9 pages, no pretty figures (sorry!

Trolling in asynchronous computer-mediated communication: From user discussions to academic definitions

Whilst computer-mediated communication (CMC) can benefit users by providing quick and easy communication between those separated by time and space, it can also provide varying degrees of anonymity that may encourage a sense of impunity and freedom from being held accountable for inappropriate online behaviour. As such, CMC is a fertile ground for studying impoliteness, whether it occurs in response to perceived threat (flaming), or as an end in its own right (trolling). Currently, first and secondorder definitions of terms such as im/politeness (Brown and Levinson 1987; Bousfield 2008; Culpeper 2008; Terkourafi 2008), in-civility (Lakoff 2005), rudeness (Beebe 1995, Kienpointner 1997, 2008), and etiquette (Coulmas 1992), are subject to much discussion and debate, yet the CMC phenomenon of trolling is not adequately captured by any of these terms. Following Bousfield (in press), Culpeper (2010) and others, this paper suggests that a definition of trolling should be informed first and foremost by user discussions. Taking examples from a 172-million-word, asynchronous CMC corpus, four interrelated conditions of aggression, deception, disruption, and success are discussed. Finally, a working definition of trolling is presented

Investigating the physical properties of transiting hot Jupiters with the 1.5-m Kuiper Telescope

We present new photometric data of 11 hot Jupiter transiting exoplanets (CoRoT-12b, HAT-P-5b, HAT-P-12b, HAT-P-33b, HAT-P-37b, WASP-2b, WASP-24b, WASP-60b, WASP-80b, WASP-103b, XO-3b) in order to update their planetary parameters and to constrain information about their atmospheres. These observations of CoRoT-12b, HAT-P-37b and WASP-60b are the first follow-up data since their discovery. Additionally, the first near-UV transits of WASP-80b and WASP-103b are presented. We compare the results of our analysis with previous work to search for transit timing variations (TTVs) and a wavelength dependence in the transit depth. TTVs may be evidence of a third body in the system and variations in planetary radius with wavelength can help constrain the properties of the exoplanet's atmosphere. For WASP-103b and XO-3b, we find a possible variation in the transit depths that may be evidence of scattering in their atmospheres. The B-band transit depth of HAT-P-37b is found to be smaller than its near-IR transit depth and such a variation may indicate TiO/VO absorption. These variations are detected from 2-4.6$\sigma$, so follow-up observations are needed to confirm these results. Additionally, a flat spectrum across optical wavelengths is found for 5 of the planets (HAT-P-5b, HAT-P-12b, WASP-2b, WASP-24b, WASP-80b), suggestive that clouds may be present in their atmospheres. We calculate a refined orbital period and ephemeris for all the targets, which will help with future observations. No TTVs are seen in our analysis with the exception of WASP-80b and follow-up observations are needed to confirm this possible detection.Comment: 18 pages, 7 figures, 9 Tables. Light Curves available online. Accepted to MNRAS (2017 August 25

Prognostic value of cardiac tests in potential kidney transplant recipients: a systematic review

Background: Whether abnormal myocardial perfusion scintigraphy (MPS), dobutamine stress echocardiography (DSE) or coronary angiography, performed during preoperative evaluation for potential kidney transplant recipients, predicts future cardiovascular morbidity is unclear. We assessed test performance for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACE). Methods: We searched MEDLINE and EMBASE (to February 2014), appraised studies, and calculated risk differences and relative risk ratios (RRR) with 95% confidence intervals (95% CI) using random effects meta-analysis. Results: Fifty-two studies (7401 participants) contributed data to the meta-analysis. Among the different tests, similar numbers of patients experienced MACE after an abnormal test result compared with a normal result (risk difference: MPS 20 per 100 patients tested [95% CI, 0.11-0.29], DSE 24 [95% CI, 0.10-0.38], and coronary angiography 20 [95% CI, 0.08-0.32; P = 0.91]). Although there was some evidence that coronary angiography was better at predicting all-cause mortality than MPS (RRR, 0.69; 95% CI, 0.49-0.96; P = 0.03) and DSE (RRR, 0.72; 95% CI, 0.50-1.02; P = 0.06), noninvasive tests were as good as coronary angiography at predicting cardiovascular mortality (RRR, MPS, 0.89; 95% CI, 0.38-2.10; P = 0.78; DSE, 1.09; 95% CI, 0.12-10.05; P = 0.93), and MACE (RRR: MPS, 1.09; 95% CI, 0.64-1.86; P = 0.74; DSE, 1.56; 95% CI, 0.71-3.45; P = 0.25). Conclusions: Noninvasive tests are as good as coronary angiography at predicting future adverse cardiovascular events in advanced chronic kidney disease. However, a substantial number of people with negative test results go on to experience adverse cardiac events