Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study

Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure.

Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process.

Design. Qualitative practitioner research study.

Method. Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied.

Results. Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic.

Conclusions. Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service.

Relevance to clinical practice. Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group.

In-situ gel formulations of econazole nitrate: preparation and in-vitro and in-vivo evaluation

Objectives This study describes the in-situ gelling of econazole nitrate containing thermosensitive polymers composed of poloxamer 407 and 188 as a novel treatment platform for vaginal candidiasis.

The band structures of gallium and indium selenide

The band structures of the group III-VI monochalcogenides GaSe and InSe have been calculated using a semi-empirical tight-binding method in a two-dimensional approximation. Many of the discrepancies between experimental work and previous calculations for GaSe have been resolved. The results for InSe appear for the first time.

The colonization of macroalgal rafts by the genus Idotea (sub-phylum Crustacea; Order Isopoda):An active or passive process?

The association of invertebrate communities with macroalgae rafts has received much attention over recent decades, yet significant gaps in our knowledge remain with respect to the colonization process. Using laboratory-based experiments and in situ field trials in Strangford Lough, Northern Ireland, this study investigated whether members of the known rafting genus Idotea (sub-phylum Crustacea; order Isopoda) could effectively colonize rafts after shore seaweed detachment, or if their presence merely reflected a passive marooning process. Test tank arenas were used to identify traits that may influence the rafting potential of the dominant shore species Idotea granulosa and the well known rafter Idotea baltica. When released mid-water, I. granulosa initially ascended and associated with floating seaweed whereas I. baltica tended to descend with no clear habitat association. These findings conflict with the differential distribution of these Idotea species among rafts and shore algae, thus highlighting the complex nature of the potential of organisms to raft. In the field we considered the relative ability of different Idotea species to colonize tethered rafts composed of Ascophyllum nodosum and Fucus vesiculosus, cleaned of all vagile organisms and deployed at locations adjacent to established intertidal Idotea species populations. At the end of the experiment (after 44 days) rafts were inhabited by known rafting and shoreline species, confirming that colonization can occur after algal detachment. Previously considered shoreline species on occasion outnumbered well known rafters suggesting that a wide range of Idotea species can readily avail of macroalgal rafts as a potential dispersal mechanism or alternative habitat. © 2012 Marine Biological Association of the United Kingdom.

Process of debonding in RC beams shear-strengthened with FRP U-strips or side strips

Reinforced concrete (RC) beams may be strengthened for shear using externally bonded fiber reinforced polymer (FRP) composites in the form of side bonding, U-jacketing or complete wrapping. The shear failure of almost all RC beams shear-strengthened with side bonded FRP and the majority of those strengthened with FRP U-jackets, is due to debonding of the FRP. The bond behavior between the externally-bonded FRP reinforcement (referred to as FRP strips for simplicity) and the concrete substrate therefore plays a crucial role in the failure process of these beams. Despite extensive research in the past decade, there is still a lack of understanding of how debonding of FRP strips in such a beam propagates and how the debonding process affects its shear behavior. This paper presents an analytical study on the progressive debonding of FRP strips in such strengthened beams. The complete debonding process is modeled and the contribution of the FRP strips to the shear capacity of the beam is quantified. The validity of the analytical solution is verified by comparing its predictions with numerical results from a finite element analysis. This analytical treatment represents a significant step forward in understanding how interaction between FRP strips, steel stirrups and concrete affects the shear resistance of RC beams shear-strengthened with FRP strips.

A downlink power control scheme for interference avoidance in femtocells

Femtocells being small low powered base stations provide sufficient increase in system capacity along with better indoor coverage. However, the dense deployment of femtocells face the main challenge of co channel interference with macrocell users. In this paper, this interference problem is addressed by proposing a novel downlink power control algorithm for femtocells. The proposed algorithm gradually reduces the downlink transmit power of femtocells when they are informed about a nearby macrocell user under interference. This information is given to the femtocells by the macrocell base station through a unidirectional downlink broadcast channel. Simulation results show that the algorithm causes the macrocell to accommodate large number of femtocells within its area, whereas at the same time protecting the macrocell users from any harmful interference.

One-Year Safety of Olodaterol Once Daily via Respimat® in Patients with GOLD 2-4 Chronic Obstructive Pulmonary Disease: Results of a Pre-Specified Pooled Analysis

The novel long-acting β2-agonist olodaterol demonstrated an acceptable safety profile in short-term phase II clinical studies. This analysis of four randomized, double-blind, placebo-controlled, parallel-group, phase III studies (1222.11, NCT00782210; 1222.12, NCT00782509; 1222.13, NCT00793624; 1222.14, NCT00796653) evaluated the long-term safety of olodaterol once daily (QD) in a large cohort of patients with moderate to very severe (Global initiative for chronic Obstructive Lung Disease 2-4) chronic obstructive pulmonary disease (COPD). The studies compared olodaterol (5 or 10 μg) QD via Respimat®, formoterol 12 μg twice daily (BID) via Aerolizer® (1222.13 and 1222.14), and placebo for 48 weeks. Patients continued receiving background maintenance therapy, with ∼60% receiving concomitant cardiovascular therapy and 25% having a history of concomitant cardiac disease. Pre-specified analyses of pooled data assessed the adverse events (AEs) and serious AEs in the whole population, and in subgroups with cardiac disease, along with in-depth electrocardiogram and Holter monitoring. In total, 3104 patients were included in the safety analysis: 876 received olodaterol 5 μg, 883 received olodaterol 10 μg, 885 received placebos, and 460 received formoterol 12 μg BID. Overall incidence of on-treatment AEs (71.2%), serious AEs (16.1%), and deaths (1.7%) were balanced across treatment groups. Respiratory and cardiovascular AEs, including major adverse cardiac events, were reported at similar frequencies in placebo and active treatment groups. The safety profiles of both olodaterol 5 μg (marketed and registered dose) and 10 μg QD delivered via Respimat® are comparable to placebo and formoterol BID in this population, with no safety signals identified.

On the Merit of Selecting Different Belief Merging Operators

Belief merging operators combine multiple belief bases (a profile) into a collective one. When the conjunction of belief bases is consistent, all the operators agree on the result. However, if the conjunction of belief bases is inconsistent, the results vary between operators. There is no formal manner to measure the results and decide on which operator to select. So, in this paper we propose to evaluate the result of merging operators by using three ordering relations (fairness, satisfaction and strength) over operators for a given profile. Moreover, a relation of conformity over operators is introduced in order to classify how well the operator conforms to the definition of a merging operator. By using the four proposed relations we provide a comparison of some classical merging operators and evaluate the results for some specific profiles.