Home haemodialysis for older patients: barriers and enablers

The uptake of home-based treatments among kidney patients remains low, especially so in patients over the age of 65. In this article, Marissa Dainton reviews a number of studies that have been carried out to explain the lack of enthusiasm for this kind of treatment, indicates potential barriers to home-based treatments and establishes ways of addressing these

A review of the evidence for the use of haemodiafiltration

Most patients with end stage renal disease (ESRD) are supported with maintenance haemodialysis (HD) and this has been the case for many years. Recent improvements in water quality have led to the increased use of high-flux HD and more recently of online-haemodiafiltration (HDF). HDF has been promoted by some clinicians and by renal industry as potentially offering improved clinical and quality of life outcomes for patients over conventional HD. However, despite such benefits making theoretical sense very few studies of the use of HDF as compared to HD (especially high-flux HD) have been able to demonstrate any significant benefit for the therapy. This article reviews the most recent research that has compared HDF and HD and has identified that the evidence for the benefit of HDF remains elusive. This article, therefore, concludes that there is currently still not sufficient evidence from the research to support the contention that HDF confers benefits to patients over conventional HD and thereby no compelling evidence to justify its widespread use as a preferred form of treatment

Authentic allyship for gender minorities

The visibility and discussion on the rights and needs of Trans and Non-Binary communities in relation to healthcare have seen growing prominence in recent years. Despite an overall improvement in access to legal protections, civil rights, and in many jurisdictions specialist provision of healthcare for gender minorities, there remain poorer health outcomes in many areas and ongoing experiences of discrimination and transphobia. In this article, we set out the prerogative for nurses to step up as authentic allies for Trans and Non Binary people and put forward strategies to enhance the experience of gender minorities in healthcare through practice, education, and systems change

Plan S briefing for Academic Staff - December 2020

Briefing for academic staff who are likely to be impacted by the introduction of Plan S associated Open Access policies from January 2021. Provides guidance for complying with policies when submitting to journals and specific local advice to apply for funding of Ariticle Processing Charge

Z' Coupling Information from the LHeC

If the LHC discovers a $Z'$-like state the extraction of its couplings to the particles of the Standard Model becomes mandatory in order to determine the nature of the underlying new physics theory. It has been well-known for some time that the direct measurements performed at the LHC in the Drell-Yan channel cannot determine these parameters uniquely in a model-independent manner even if large integrated luminosities, $\sim 100 fb^{-1}$, become available and the $Z'$ is relatively light \lsim 1.5 TeV. Here we examine the possibility that a proposed $e_{L,R}^\pm p$ collider upgrade at the LHC, the LHeC, with $\sqrt s=1.5-2$ TeV could be helpful with such coupling determinations in the years before a Linear Collider is constructed. We show that the polarization and charge asymmetries constructed from the cross sections for these processes can be useful in this regard depending upon the specific values of the particular $Z'$ model parameters.Comment: 16 pages, 9 figs, minor modification

Photon Structure and Quantum Fluctuation

Photon structure derives from quantum fluctuation in quantum field theory to fermion and anti-fermion, and has been an experimentally established feature of electrodynamics since the discovery of the positron. In hadronic physics, the observation of factorisable photon structure is similarly a fundamental test of the quantum field theory Quantum Chromodynamics (QCD). An overview of measurements of hadronic photon structure in e+e- and ep interactions is presented, and comparison made with theoretical expectation, drawing on the essential features of photon fluctuation into quark and anti-quark in QCD.Comment: 29 pages, 15 figures, to appear in Philosophical Transactions of the Royal Society of London (Series A: Mathematical, Physical and Engineering Sciences

Seeing motion and apparent motion

In apparent motion experiments, participants are presented with what is in fact a succession of two brief stationary stimuli at two different locations, but they report an impression of movement. Philosophers have recently debated whether apparent motion provides evidence in favour of a particular account of the nature of temporal experience. I argue that the existing discussion in this area is premised on a mistaken view of the phenomenology of apparent motion and, as a result, the space of possible philosophical positions has not yet been fully explored. In particular, I argue that the existence of apparent motion is compatible with an account of the nature of temporal experience that involves a version of direct realism. In doing so, I also argue against two other claims often made about apparent motion, viz. that apparent motion is the psychological phenomenon that underlies motion experience in the cinema, and that apparent motion is subjectively indistinguishable from real motion

Personhood, consciousness, and god : how to be a proper pantheist

© Springer Nature B.V. 2018In this paper I develop a theory of personhood which leaves open the possibility of construing the universe as a person. If successful, it removes one bar to endorsing pantheism. I do this by examining a rising school of thought on personhood, on which persons, or selves, are understood as identical to episodes of consciousness. Through a critique of this experiential approach to personhood, I develop a theory of self as constituted of qualitative mental contents, but where these contents are also capable of unconscious existence. On this theory, though we can be conscious of our selves, consciousness turns out to be inessential to personhood. This move, I then argue, provides resources for responding to the pantheist’s problem of God’s person.Peer reviewedFinal Accepted Versio

Precision medicine for suicidality: from universality to subtypes and personalization

Suicide remains a clear, present and increasing public health problem, despite being a potentially preventable tragedy. Its incidence is particularly high in people with overt or un(der)diagnosed psychiatric disorders. Objective and precise identification of individuals at risk, ways of monitoring response to treatments and novel preventive therapeutics need to be discovered, employed and widely deployed. We sought to investigate whether blood gene expression biomarkers for suicide (that is, a ‘liquid biopsy’ approach) can be identified that are more universal in nature, working across psychiatric diagnoses and genders, using larger cohorts than in previous studies. Such markers may reflect and/or be a proxy for the core biology of suicide. We were successful in this endeavor, using a comprehensive stepwise approach, leading to a wealth of findings. Steps 1, 2 and 3 were discovery, prioritization and validation for tracking suicidality, resulting in a Top Dozen list of candidate biomarkers comprising the top biomarkers from each step, as well as a larger list of 148 candidate biomarkers that survived Bonferroni correction in the validation step. Step 4 was testing the Top Dozen list and Bonferroni biomarker list for predictive ability for suicidal ideation (SI) and for future hospitalizations for suicidality in independent cohorts, leading to the identification of completely novel predictive biomarkers (such as CLN5 and AK2), as well as reinforcement of ours and others previous findings in the field (such as SLC4A4 and SKA2). Additionally, we examined whether subtypes of suicidality can be identified based on mental state at the time of high SI and identified four potential subtypes: high anxiety, low mood, combined and non-affective (psychotic). Such subtypes may delineate groups of individuals that are more homogenous in terms of suicidality biology and behavior. We also studied a more personalized approach, by psychiatric diagnosis and gender, with a focus on bipolar males, the highest risk group. Such a personalized approach may be more sensitive to gender differences and to the impact of psychiatric co-morbidities and medications. We compared testing the universal biomarkers in everybody versus testing by subtypes versus personalized by gender and diagnosis, and show that the subtype and personalized approaches permit enhanced precision of predictions for different universal biomarkers. In particular, LHFP appears to be a strong predictor for suicidality in males with depression. We also directly examined whether biomarkers discovered using male bipolars only are better predictors in a male bipolar independent cohort than universal biomarkers and show evidence for a possible advantage of personalization. We identified completely novel biomarkers (such as SPTBN1 and C7orf73), and reinforced previously known biomarkers (such as PTEN and SAT1). For diagnostic ability testing purposes, we also examined as predictors phenotypic measures as apps (for suicide risk (CFI-S, Convergent Functional Information for Suicidality) and for anxiety and mood (SASS, Simplified Affective State Scale)) by themselves, as well as in combination with the top biomarkers (the combination being our a priori primary endpoint), to provide context and enhance precision of predictions. We obtained area under the curves of 90% for SI and 77% for future hospitalizations in independent cohorts. Step 5 was to look for mechanistic understanding, starting with examining evidence for the Top Dozen and Bonferroni biomarkers for involvement in other psychiatric and non-psychiatric disorders, as a mechanism for biological predisposition and vulnerability. The biomarkers we identified also provide a window towards understanding the biology of suicide, implicating biological pathways related to neurogenesis, programmed cell death and insulin signaling from the universal biomarkers, as well as mTOR signaling from the male bipolar biomarkers. In particular, HTR2A increase coupled with ARRB1 and GSK3B decreases in expression in suicidality may provide a synergistic mechanistical corrective target, as do SLC4A4 increase coupled with AHCYL1 and AHCYL2 decrease. Step 6 was to move beyond diagnostics and mechanistical risk assessment, towards providing a foundation for personalized therapeutics. Items scored positive in the CFI-S and subtypes identified by SASS in different individuals provide targets for personalized (psycho)therapy. Some individual biomarkers are targets of existing drugs used to treat mood disorders and suicidality (lithium, clozapine and omega-3 fatty acids), providing a means toward pharmacogenomics stratification of patients and monitoring of response to treatment. Such biomarkers merit evaluation in clinical trials. Bioinformatics drug repurposing analyses with the gene expression biosignatures of the Top Dozen and Bonferroni-validated universal biomarkers identified novel potential therapeutics for suicidality, such as ebselen (a lithium mimetic), piracetam (a nootropic), chlorogenic acid (a polyphenol) and metformin (an antidiabetic and possible longevity promoting drug). Finally, based on the totality of our data and of the evidence in the field to date, a convergent functional evidence score prioritizing biomarkers that have all around evidence (track suicidality, predict it, are reflective of biological predisposition and are potential drug targets) brought to the fore APOE and IL6 from among the universal biomarkers, suggesting an inflammatory/accelerated aging component that may be a targetable common denominator