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

Psychosocial factors related to children’s active school travel : A comparison of two European regions

Peer reviewedPublisher PD

Do pedometers motivate people to walk more?

Physical activity confers many important health benefits. The 'active living message' recommends that adults should accumulate 30 ruin of moderate-intensity physical activity (e.g. brisk walking) on most--preferably all--days of the week, but the populations of most developed countries are not meeting this target. Walking is one mode of activity that most people can do without skills, equipment, facilities or extra expense and walking has less bias in terms of age, sex and social class than facility-based exercise. Thus we need to investigate interventions that promote walking

Qualitative approaches to research using identity process theory

Qualitative research in psychology has had an interesting history over the last couple of decades in terms of its development, standing and popularity (see Howitt, 2010) but its story varies across domains of the discipline and across geographical locations. Social, health and counselling psychology in Europe (particularly in the UK) have been notably open to qualitative work, whereas, with some exceptions, qualitative approaches to psychological research have struggled to make a major impression in North American psychology generally. In places where it has become relatively established, the story of qualitative approaches to psychological research has not been marked by a cumulative upward trajectory of popularity. Even in the UK, for example, where qualitative methods became an increasingly standard presence in psychology degree programs in the 1990s, there may have been a flattening in popularity in recent years associated with a changing research culture and the ascendancy of cognitive neuroscience as a powerful domain within psychology. In the time since its original, most complete presentation within British social psychology (Breakwell, 1986), Identity Process Theory (IPT) has been employed in both quantitative and qualitative research. In this chapter, we examine the contributions that qualitative research located within an IPT framework can make to the understanding of identity and of the theory itself, while also noting some of the challenges associated with using qualitative approaches within IPT research. In parallel with Vivian L. Vignoles in his chapter on quantitative approaches to IPT research in this volume, we want to make it clear that our chapter should not be seen as suggesting that qualitative research methods are inherently superior to quantitative approaches for studying identity from an IPT perspective. Mindful of critical questions that have been raised about the role and value of qualitative research in the social sciences (e.g. Hammersley, 2008), we advocate a pragmatic approach to methodology. The question is always which research approach – singly or in combination with others – is most useful for achieving the aims and answering the research question of any given study and for maximizing the value of the research, however “research value” might be defined. We agree that some research aims are best suited to quantitative approaches, such as testing theoretical predictions, and other research aims are best achieved through qualitative approaches, such as developing rich, contextualized understandings of phenomena

Evaluation of cosmic ray rejection algorithms on single-shot exposures

To maximise data output from single-shot astronomical images, the rejection of cosmic rays is important. We present the results of a benchmark trial comparing various cosmic ray rejection algorithms. The procedures assess relative performances and characteristics of the processes in cosmic ray detection, rates of false detections of true objects and the quality of image cleaning and reconstruction. The cosmic ray rejection algorithms developed by Rhoads (2000), van Dokkum (2001), Pych (2004) and the IRAF task xzap by Dickinson are tested using both simulated and real data. It is found that detection efficiency is independent of the density of cosmic rays in an image, being more strongly affected by the density of real objects in the field. As expected, spurious detections and alterations to real data in the cleaning process are also significantly increased by high object densities. We find the Rhoads' linear filtering method to produce the best performance in detection of cosmic ray events, however, the popular van Dokkum algorithm exhibits the highest overall performance in terms of detection and cleaning.Comment: 12 pages, 4 figures, accepted for publication in PAS

Concentrated Differential Privacy: Simplifications, Extensions, and Lower Bounds

"Concentrated differential privacy" was recently introduced by Dwork and Rothblum as a relaxation of differential privacy, which permits sharper analyses of many privacy-preserving computations. We present an alternative formulation of the concept of concentrated differential privacy in terms of the Renyi divergence between the distributions obtained by running an algorithm on neighboring inputs. With this reformulation in hand, we prove sharper quantitative results, establish lower bounds, and raise a few new questions. We also unify this approach with approximate differential privacy by giving an appropriate definition of "approximate concentrated differential privacy.

The relationship between motivations of architectural designers and environmentally sustainable construction design

Research on sustainability in construction design has tended to focus on technological, institutional and economic drivers but there has been little change in the industry. Social scientific approaches offer insights on the lack of progress. However, few previous studies have investigated psychological factors despite the pivotal role of the individual professional decision-maker. The aim was to understand what personal motivations drive architectural designers to pursue sustainable design in their work and whether non-environmental motivations can drive sustainable outcomes. Twenty-eight architectural designers in fourteen small firms in the London area were interviewed. Thematic analysis was conducted, informed by the self-determination theory of motivation. Although extrinsic motivators were noted, autonomous motivations including a moral imperative and personal commitment predominated. Further, the participants demonstrated other self-determined motivations including realisation of self-identity, pursuit of quality in design and awareness of their work’s impact on people. These autonomous motivations align closely with sustainability principles including design for durability, high standards and technical expertise. The findings point to the risks of reliance on extrinisic motivators such as regulation, and the opportunities to engage architectural designers more extensively in sustainable design by linking sustainability to autonomous motivations

Mumford dendrograms and discrete p-adic symmetries

In this article, we present an effective encoding of dendrograms by embedding them into the Bruhat-Tits trees associated to $p$-adic number fields. As an application, we show how strings over a finite alphabet can be encoded in cyclotomic extensions of $\mathbb{Q}_p$ and discuss $p$-adic DNA encoding. The application leads to fast $p$-adic agglomerative hierarchic algorithms similar to the ones recently used e.g. by A. Khrennikov and others. From the viewpoint of $p$-adic geometry, to encode a dendrogram $X$ in a $p$-adic field $K$ means to fix a set $S$ of $K$-rational punctures on the $p$-adic projective line $\mathbb{P}^1$. To $\mathbb{P}^1\setminus S$ is associated in a natural way a subtree inside the Bruhat-Tits tree which recovers $X$, a method first used by F. Kato in 1999 in the classification of discrete subgroups of $\textrm{PGL}_2(K)$. Next, we show how the $p$-adic moduli space $\mathfrak{M}_{0,n}$ of $\mathbb{P}^1$ with $n$ punctures can be applied to the study of time series of dendrograms and those symmetries arising from hyperbolic actions on $\mathbb{P}^1$. In this way, we can associate to certain classes of dynamical systems a Mumford curve, i.e. a $p$-adic algebraic curve with totally degenerate reduction modulo $p$. Finally, we indicate some of our results in the study of general discrete actions on $\mathbb{P}^1$, and their relation to $p$-adic Hurwitz spaces.Comment: 14 pages, 6 figure

The role of environmental sustainability in marketing of small architectural design practices

Environmental sustainability in construction is a pressing concern. Despite their importance to the industry, and evident differences from large organizations in business strategy, markets and challenges, the literature has little to say about how small architectural design firms view the marketing potential of improved environmental sustainability. The aim is to address this gap by examining practitioner experience of sustainability and marketing in small architectural design practices. Semi-structured interviews were conducted with 16 such practices. A critical interpretive stance was adopted in analysis, drawing on the theoretical framings of service-dominant logic (SDL) and relationship marketing. Sustainable design is part of the co-creation of value in architecture, enhancing the value proposition beyond a cost basis. Its inclusion contributed to business development through referrals. Taken together, co-creation of value and asymmetry of knowledge between professional and client drive the conclusion that the architectural designer has primary responsibility in guiding clients towards greater environmental sustainability. This responsibility and the role of sustainability in business development were not necessarily recognized by the designers. Insights from SDL challenge assumptions that cost and lack of client demand prevent greater sustainability in design

Maximising the acquisition of core communication skills at the start of medical training

Background Clinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the simulated patient encounter. Aim To explore the impact of real patient contact on the experience of communication skills training and simulated patient contact for first year medical undergraduate students. Methods As part of the six-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a simulated patient encounter. The performance of both groups was analysed alongside follow up focus group data from a sample of the study group. Results Quantitative analysis revealed there was no significant difference in communication skills during a scored simulated patient interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalise their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the simulated patient setting. Conclusion Real patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation there needs to be a clear curricular purpose at pedagogical, practical and organisational levels. Students’ experience of real patient contact can provide an informed foundation upon which to implement other modes of teaching. Keywords: Real patient contact, Communication skills training, Early years curriculu