Management of Hyperphosphataemia in Chronic Kidney Disease:Summary of National Institute for Health and Clinical Excellence (NICE) Guideline

Bone disease and ectopic calcification are the two main consequences of hyperphosphataemia of chronic kidney disease (CKD). Observational studies have demonstrated that hyperphosphataemia in CKD is associated with increased mortality. Furthermore, the use of phosphate binders in dialysis patients is associated with significantly lower mortality. The UK Renal Registry data show significant underachievement of phosphate targets in dialysis patients. It is believed to be due to wide variation in how management interventions are used. The National Institute for Health and Clinical Excellence (NICE) has developed a guideline on the management of hyperphosphataemia in CKD. This is based on the evidence currently available using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This review outlines the recommendations including research recommendations and discusses methodology, rationale and challenges faced in developing this guideline and the health economic model used to assess the cost-effectiveness of different phosphate binders. © 2013 S. Karger AG, Basel.

Identifying childhood deprivation:How well do national indicators of poverty and social exclusion in Ireland Perform?

In the context of the significance that the life-cycle has been afforded in social policy discussion in Ireland, current national measures of poverty and social exclusion have been criticised for failing to capture such phenomena accurately in relation to particular stages of the life-course. In this paper we have taken advantage of the inclusion of a special module on childhood deprivation in EU-SILC 2009 to create reliable measures of both household basic deprivation and childhood deprivation. Overall, our analysis leads us to the conclusion that those exposed to childhood deprivation are generally a sub-set of the children captured by population indicators. Adopting a multidimensional and dynamic perspective on household resources and deprivation enables us to capture the large majority of children exposed to childhood deprivation. Restricting our attention to childhood deprivation would lead us to miss out on a significant number of children living in households experiencing basic deprivation but not exposed to childhood deprivation. It would be unwise to assume that such deprivation has no consequences for children. While there is clearly a value in supplementing existing national measures with child specific indicators, it would not appear sensible to rely solely on the latter.

1987-1991. Joint Archaeological Project of the National Museum of Malta and the Universities of Bristol, Cambridge and Malta.

Malone, C.A.T. and S.K.F. Stoddart, Five Year Statement.1991: Cambridge University.

Pathophysiology of anemia and erythrocytosis.

An increasing understanding of the process of erythropoiesis raises some interesting questions about the pathophysiology, diagnosis and treatment of anemia and erythrocytosis. The mechanisms underlying the development of many of the erythrocytoses, previously characterised as idiopathic, have been elucidated leading to an increased understanding of oxygen homeostasis. Characterisation of anemia and erythrocytosis in relation to serum erythropoietin levels can be a useful addition to clinical diagnostic criteria and provide a rationale for treatment with erythropoiesis stimulating agents (ESAs). Recombinant human erythropoietin as well as other ESAs are now widely used to treat anemias associated with a range of conditions, including chronic kidney disease, chronic inflammatory disorders and cancer. There is also heightened awareness of the potential abuse of ESAs to boost athletic performance in competitive sport. The discovery of erythropoietin receptors outside of the erythropoietic compartment may herald future applications for ESAs in the management of neurological and cardiac diseases. The current controversy concerning optimal hemoglobin levels in chronic kidney disease patients treated with ESAs and the potential negative clinical outcomes of ESA treatment in cancer reinforces the need for cautious evaluation of the pleiotropic effects of ESAs in non-erythroid tissues.

A heuristic model for the simulation of the deformation of elastic and spongy material for virtual reality applications

This paper presents a practical algorithm for the simulation of interactive deformation in a 3D polygonal mesh model. The algorithm combines the conventional simulation of deformation using a spring-mass-damping model, solved by explicit numerical integration, with a set of heuristics to describe certain features of the transient behaviour, to increase the speed and stability of solution. In particular, this algorithm was designed to be used in the simulation of synthetic environments where it is necessary to model realistically, in real time, the effect on non-rigid surfaces being touched, pushed, pulled or squashed. Such objects can be solid or hollow, and have plastic, elastic or fabric-like properties. The algorithm is presented in an integrated form including collision detection and adaptive refinement so that it may be used in a self-contained way as part of a simulation loop to include human interface devices that capture data and render a realistic stereoscopic image in real time. The algorithm is designed to be used with polygonal mesh models representing complex topology, such as the human anatomy in a virtual-surgery training simulator. The paper evaluates the model behaviour qualitatively and then concludes with some examples of the use of the algorithm.

Gender and Public Space in Divided Cities

The paper addresses two connected questions: firstly, in what ways might ‘public’ and ‘private’ spaces in cities be gendered; and secondly, what might this mean for the possibilities for complex forms of civility in a divided city such as Belfast? The specific focus on gendered dynamics of entitlement to inhabit urban space in this paper begins with some consideration of debates about the quality and experience of everyday life in cities, and the emergence of commonsense notions of ‘public’ and ‘private’ behaviour. Following this, key research concerned with the gendered dynamics of claimed collective, and particularly national, identities are outlined, in order to consider the significance of this literature for any study of the gender dynamics of life in a contested political context such as Belfast.