Successful use of steroids and ureteric stents in 24 patients with idiopathic retroperitoneal fibrosis : a retrospective study

Original article can be found at : http://content.karger.com/ Copyright Karger [Full text of this article is not available in the UHRA]Background/Aims: Retroperitoneal fibrosis (RPF) is a chronic inflammatory disorder causing obstructive nephropathy and renal failure. We reviewed our management of this condition. Method: All patients with RPF treated at a single center over a 15-year period were identified. A full review of notes and computer records was undertaken. Results: Data was available on 27 patients, 3 of which were excluded from later analysis. Diagnosis was based on clinical history and cross-sectional imaging. Retroperitoneal biopsy was undertaken in 3 patients. 96% had significant renal impairment at presentation with a mean serum creatinine of 688 μmol/l. 46% required emergency hemodialysis. All patients were treated with a combination of ureteric stents and/or steroids with an excellent clinical response. The mean best creatinine reached by the cohort was 136 μmol/l, and renal function remained stable in the long term. No patients required chronic dialysis. Ureteric stents were removed within 12 months and low-dose steroids were continued for a mean of 34 months. Recurrent disease was observed in 25% of patients, who all responded well to further steroid therapy. Mean duration of follow-up was 76 months. Conclusions: RPF is very effectively treated by a combination of ureteric stents and steroids, with excellent long-term results using this approach. Continued follow-up is advised because of the possibility of recurrent disease.Peer reviewe

The impact of selected stakeholders on family business continuity and family harmony

The growth, survival and success of a family business are often influenced by issues relating to family relationships and family harmony. Not only do the actions of family members influence the success or failure of the family business, but so does the behaviour of non-family stakeholders. The success or failure of the family business may also have important emotional and financial ramifications for the different stakeholders involved in the business, whether that involvement is physical or emotional. Yet, very little is known about the impact that the various stakeholder groups have on the success of the family business, its continuity or the family harmony that prevails. Consequently, the primary objective of this study is to evaluate the impact of selected stakeholders, namely non-family members, inactive family members, the senior generation and the incumbent generation on the success of family businesses. Success, for the purposes of this study, was measured using two variables, family harmony and perceived future continuity. Respondents were identified by means of convenience sampling,and a total of 468 usable questionnaires were returned. The data collected were subjected to various statistical analyses. The validity of the measuring instrument was assessed by means of an exploratory factor analysis and reliability by calculating Cronbach’s alpha coefficients. The relationships proposed in the hypothesised model were assessed by means of structural equation modelling (SEM).The empirical results of this study reveal that family harmony influences the perceived future continuity of family businesses. In turn, inactive family members and the incumbent generation have a significant impact on the family harmony that exists in the family business.Key words: family business, inactive stakeholders, active stakeholders, continuity, family harmon

Comparison of resting and total energy expenditure in peritoneal dialysis patients and body composition measured by dual-energy X-ray absorptiometry

Under basal resting conditions muscle metabolism is reduced, whereas metabolism increases with physical activity. We wished to determine whether there was an association between resting energy expenditure (REE) and total energy expenditure (TEE) in peritoneal dialysis (PD) patients and lean body mass (LBM). We determined REE and TEE by recently validated equations, using doubly labelled isotopic water, and LBM by dual-energy X-ray absorptiometry (DXA) scanning. We studied 87 patients, 50 male (57.4%), 25 diabetic (28.7%), mean age 60.3±17.6 years, with a median PD treatment of 11.4 (4.7-29.5) months. The mean weight was 70.1±17.7 kg with a REE of 1509±245 kcal/day and TEE 1947±378 kcal/day. REE was associated with body size (weight r=0.78 and body mass index (BMI) r=0.72) and body composition (LBM r=0.77, lean body mass index (LBMI) r=0.76, r=0.62), all P<0.001). For TEE, there was an association with weight r=0.58, BMI r=0.49 and body composition (LBM r=0.64, LBMI (r=0.54), all P<0.001). We compared LBMI measured by DXA and that estimated by the Boer equation using anthropomorphic measurements, which overestimated and underestimated LBM for smaller patients and heavier patients, respectively. Muscle metabolism is reduced at rest and increases with physical activity. Whereas previous reports based on REE did not show any association with LBM, we found an association between both REE and TEE, using a recently validated equation derived from dialysis patients, and LBM measured by DXA scanning. Estimation of muscle mass from anthropomorphic measurements systematically overestimated LBM for small patients and conversely underestimated for heavier patients

TeleCPT: Delivery of a Better Conversations Approach to Communication Partner Training During a Global Pandemic and Beyond

Purpose: This case report provides an overview of telehealth delivery of our Better Conversations approach to communication partner training (CPT) for people with primary progressive aphasia (PPA) and their communication partner (CP). The purpose is to advance the knowledge of speech and language therapists/pathologists (SLTs) on this type of CPT and empower them to deliver teleCPT as part of their clinical practice. // Method: We provide a case report describing therapy delivery, outcomes, and self-reflections from our clinical practice, which represents a collaboration between a UK National Health Service CPT clinic and the Better Conversations Research Lab at University College London, UK. A man with PPA and his CP (a dyad) video-recorded everyday conversations at home using a video conferencing platform. These formed the basis of an evaluation of conversation barriers and facilitators, which led to four weekly 1-hr therapy sessions covering the mechanics of conversation, identification of barriers and facilitators, goal setting, and practice of positive conversation strategies. // Results: Dyad self-rating of goal attainment revealed that three of four conversation strategies were achieved much more than expected, a positive outcome given the progressive nature of F.F.'s condition. SLT access to the dyad at home via teleCPT facilitated the carryover of strategies from the session to everyday conversations in the home environment. TeleCPT was acceptable to this couple during a global pandemic, with benefits including no travel, ease of therapy scheduling around the CP's work and family commitments, and access to a specialist CPT clinic outside their geographical area. // Conclusions: TeleCPT is feasible and acceptable to clients, improving access to therapy in a way that should not just be the preserve of service delivery during a global pandemic. SLTs can enable clients and their families to have better conversations despite communication difficulties by offering teleCPT. We have shared practical suggestions for delivering teleCPT

Livestock, vulnerability, and poverty dynamics in India

The focus of this study is to identify the livelihood activities that produce the major share of household income as well as to identify the livelihood pathways and strategies, and the role of livestock in these activities and strategies over a six year period. The paper is organized as follows. Section one is Introduction; Section 2 describes the methodology and data. Section 3 examines the extent of movements into and out of poverty amongst the sample households. Sections 4 and 5 describe the extent of destitution, vulnerability, viability and sustainability in connection with livelihood pathways. Section 6 examines the factors associated with economic/poverty status. Section 7 summarises the role of livestock in these livelihood connections. Finally, the paper draws some policy conclusions and recommendations and discusses the future direction of research

Comparison of energy estimates in chronic kidney disease using doubly-labelled water

This is the peer reviewed version of the following article: S. Sridharan, J. Wong, E. Vilar, and K. Farrington, ‘Comparison of energy estimates in chronic kidney disease using doubly-labelled water’, Journal of Human Nutrition and Dietetics, Vol. 29 (1): 59-66, February 2016, which has been published in final form at https://doi.org/10.1111/jhn.12326. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. © 2015 The British Dietetic Association Ltd.BACKGROUND: Total energy expenditure (TEE) is estimated in clinical practice as a combined measure of resting energy expenditure and physical activity level. Commonly available questionnaires to estimate physical activity level have not been validated in patients with kidney disease using the doubly-labelled water method. METHODS: This prospective, cross-sectional study was conducted on 40 patients with chronic kidney disease stages 1-5 with the objective of validating two physical activity questionnaires: the Recent Physical Activity Questionnaire (RPAQ) and the Stanford 7-day recall questionnaire. TEE was measured using doubly-labelled water technique. TEE was also estimated using predicted resting energy expenditure and estimated physical activity measures from the questionnaires. RESULTS: Measured TEE correlated better with TEE estimated from RPAQ compared to that from the Stanford questionnaire. In Bland-Altman analysis, TEE estimated from RPAQ had the least bias and narrower limits of agreement compared to the measured TEE. A metabolic equivalent of task value of 1.3 for the unaccounted time in RPAQ provided the best approximation of estimated TEE to the measured TEE. CONCLUSIONS: RPAQ is an acceptable questionnaire tool for assessing physical activity level in patients with chronic kidney disease.Peer reviewedFinal Accepted Versio

Synthesis and crosscutting topics of the GoMRI special issue

Author Posting. © The Oceanography Society, 2016. This article is posted here by permission of The Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 29, no. 3 (2016): 204-213, doi:10.5670/oceanog.2016.84.In recent years, there have been significant advances in fluid dynamics/physical oceanography, microbiology, weathering, remote sensing, and analytical chemistry as they pertain to the fate and effects of oil spills. Effects of the Deepwater Horizon oil spill on water column organisms and ecosystems have been difficult to ascertain. Laboratory experiments have expanded understanding of oil effects on phytoplankton and zooplankton. “Marine oil snow” has been identified as a significant factor in the fate of oil chemicals and their deposition with sediments. Oil chemicals and their effects on 24 km2 of mud-benthic communities surrounding the well site, and in a few other areas, have lasted several years. Some deep-sea corals have also been affected for several years, and oil chemicals and their effects in heavily oiled marsh areas are projected to last a decade or longer. Lightly oiled marsh areas have recovered or are recovering. Research about use of dispersants highlights the need to update the 2005 National Research Council study of dispersant use on oil spills. Ongoing research should provide some closure for the issues of long-term effects on fisheries and marine mammals, and impacts on human health. Practical uses of this new knowledge are discussed briefly