A politics of what: the enactment of peritoneal dialysis in indigenous Australians

This paper explores, on the one hand, the requirements of the technologies and practices that have been developed for a particular type of renal patient and health network in Australia. On the other, we examine the cultural and practical specificities entailed in the performance of these technologies and practices in the Indigenous Australian context. The praxiographic orientation of the actor-network approach – which has been called 'the politics of what' (Mol 2002) – enabled us to understand the difficulties involved in translating renal healthcare networks across cultural contexts in Australia; to understand the dynamic and contested nature of these networks; and to suggest possible strategies that make use of the tensions between these two disparate networks in ways that might ensure better healthcare for Indigenous renal patients.

Effect of timing of dialysis commencement on clincial outcomes of patients with planned initiation of peritoneal dialysis in the ideal trial

Background: Since the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early-compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.

Methods: Adults with an estimated glomerular filtration rate (eGFR) of 10 - 15 mL/min/1.73 m2 who planned to be treated with PD were randomly allocated to commence dialysis at an eGFR of 10 - 14 mL/min/1.73 m2 (early start) or 5 - 7 mL/min/1.73 m2 (late start). The primary outcome was all-cause mortality.

Results: Of the 828 IDEAL trial participants, 466 (56%) planned to commence PD and were randomized to early start (n = 233) or late start (n = 233). The median times from randomization to dialysis initiation were, respectively, 2.03 months [interquartile range (IQR):1.67 - 2.30 months] and 7.83 months (IQR: 5.83 - 8.83 months). Death occurred in 102 early-start patients and 96 late-start patients [hazard ratio: 1.04; 95% confidence interval (CI): 0.79 - 1.37]. No differences in composite cardiovascular events, composite infectious deaths, or dialysis-associated complications were observed between the groups. Peritonitis rates were 0.73 episodes (95% CI: 0.65 - 0.82 episodes) per patient-year in the early-start group and 0.69 episodes (95% CI: 0.61 - 0.78 episodes) per patient-year in the late-start group (incidence rate ratio: 1.19; 95% CI: 0.86 - 1.65; p = 0.29). The proportion of patients planning to commence PD who actually initiated dialysis with PD was higher in the early-start group (80% vs 70%, p = 0.01).

Conclusion: Early initiation of dialysis in patients with stage 5 chronic kidney disease who planned to be treated with PD was associated with clinical outcomes comparable to those seen with late dialysis initiation. Compared with early-start patients, late-start patients who had chosen PD as their planned dialysis modality were less likely to commence on PD.

High volume versus low volume balance training on postural sway in adults with previous ankle inversion injury

Balance training is commonly used in the rehabilitation process of ankle injuries; however, the exercise prescription guidelines for prescribing balance training are poorly understood. The aim of the present study was to determine if high or low volume balance training is more effective in improving postural sway after an 8 week balance training program utilising the same exercises. Seventeen subjects (14 male, 3 female) with a mean age of 24.06 ± 5.6 years were randomly allocated into a control group (CG), low volume training (LVT) or high volume training (HVT). All subjects had sustained at least two inversion ankle injuries within the last 18 months. Subjects completed 8 weeks of balance training of up to 30 mins duration, 3 times per week. LVT consisted of 40 repetitions for week 1, progressing to 90 repetitions by week 8. HVT consisted of 60 repetitions for week 1, progressing to 130 repetitions by week 8. The maximum centre of pressure (COP) excursion was obtained from the porce plate in the medial-lateral (ML) direction and subsequently used for pre-test and post-test analysis. After the 8 week training intervention, there was a significant (P<0.001) difference in postural sway between pre and post testing for both the LVT (pre = 88.69mm ± 25.08mm, post = 72.17mm ± 27.53mm) and HVT (pre = 77.47mm ±10.57mm, post = 58.54mm ± 7.01mm) groups. There was no significant (P>0.01) difference detected for improvements between the LVT and HVT, however reported effect sizes (ES) showed large effect size chances in the high volume training (ES = 1.7) whereas low volume training showed medium effect sizes changes (ES = 0.6). This preliminary study demonstrates the importance of training volume in the rehabilitation of ankle injuries, with the HVT being superior to LVT.

Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease

BACKGROUND: Taiwan has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world with 55,499 ESRD patients on long-term dialysis. Nevertheless, 90.96% of these patients are managed on maintenance haemodialysis (HD), with only 9.03% enrolled in a peritoneal dialysis (PD) programme. AIM: The study aim was to identify the factors affecting Taiwanese patient's selection of PD in preference to HD for chronic kidney disease. METHODS: A cross-sectional research design was utilized with 130 chronic renal failure (CRF) patients purposively selected from outpatient nephrology clinics at four separate Taiwan hospitals. Logistic regression was used to identify the main factors affecting the patient's choice of dialysis type. RESULTS: Single-factor logistic regression found significant differences in opinion related to age, education level, occupation type, disease characteristics, lifestyle modifications, self-care ability, know-how of dialysis modality, security considerations and findings related to the decisions made by medical personnel (P < 0.05). Moreover, multinomial logistic regression after adjustment for interfering variables found that self-care ability and dialysis modality know-how were the two main factors affecting the person's selection of dialysis type. CONCLUSIONS: Self-care ability and the person's knowledge of the different types of dialysis modality and how they function were the major determinants for selection of dialysis type in Taiwan based on the results from this study. The results indicate that the education of CRF patients about the types of dialysis available is essential to enable them to understand the benefits or limitations of both types of dialysis.

Temporal dynamics of the circadian heart rate following low and high volume exercise training in sedentary male subjects

Purpose: Increased risk of arrhythmic events occurs at certain times during the circadian cycle with the highest risk being in the second and fourth quarter of the day. Exercise improves treatment outcome in individuals with cardiovascular disease. How different exercise protocols affect the circadian rhythm and the associated decrease in adverse cardiovascular risk over the circadian cycle has not been shown. Methods: Fifty sedentary male participants were randomized into an 8-week high volume and moderate volume training and a control group. Heart rate was recorded using Polar Electronics and investigated with Cosinor analysis and by Poincaré plot derived features of SD1, SD2 and the complex correlation measure (CCM) at 1-h intervals over the 24-h period. Results: Moderate exercise significantly increased vagal modulation and the temporal dynamics of the heart rate in the second quarter of the circadian cycle (p = 0.004 and p = 0.007 respectively). High volume exercise had a similar effect on vagal output (p = 0.003) and temporal dynamics (p = 0.003). Cosinor analysis confirms that the circadian heart rate displays a shift in the acrophage following moderate and high volume exercise from before waking (1st quarter) to after waking (2nd quarter of day). Conclusions: Our results suggest that exercise shifts vagal influence and increases temporal dynamics of the heart rate to the 2nd quarter of the day and suggest that this may be the underlying physiological change leading to a decrease in adverse arrhythmic events during this otherwise high-risk period.

Being dialysis-dependant: a qualitative perspective

The technology of renal dialysis offers a way in which life can be sustained, so it is not surprising that the complex, diverse and evolving iatrogenic aspects of dialysis-dependency continue to be researched. However, there has been a tendency to take for granted the human process of making sense of the intrusiveness of dialysis. This study was designed to explore the meanings of dialysis-dependency. The study sample was 10 participants: five female, five male; five on peritoneal dialysis, five on haemodialysis; whose ages ranged from 22 to 68 years. Using a narrative methodology the following methods were used: in-depth interviews, narrative and thematic analysis, fieldwork/notes from five renal units, participant validation, and journal reflections. A thematic analysis revealed the continuum themes of Freedom-Restrictions, Being Normal-Being Visible, Control-Acquiesce, Hope-Despair and Support-Abandon. The themes portrayed as continuums serve to remind health care professionals that those with chronic illnesses strive to make sense of what is happening to them. Variations within each of these themes can occur daily, weekly or monthly. Acceptance may never be reached or may be tentative. Some clients will strive for control and freedom to choose for themselves, others will acquiesce to the overwhelming changes wrought in their lives. Thus, health care professionals might consider placing the personal meanings of those who are dialysis-dependent to the fore, being sensitive to the sufferings wrought by the regime, which treats but does not cure, which sustains life but does not heal.

Dialysis-dependency: the reformulated or remnant person

Being dependent on dialysis is a potentially overwhelming experience where life as previously known is permanently altered. A dialysis-dependent individual may reformulate their identify or perceive that they are a remnant if their former self. This paper will explore and expand Morse and Penrod's (1999) model as a useful way to understand how a person might reconstruct their identify. Grounded in a narrative methodology, interviews if those on haemodialysis and peritoneal dialysis were thematically analysed. It was found that dialysis dependency brings an acknowledgment if a lost past, an inescapable present and an unknowable future, filtered through hope and despair. Nurses need to understand the suffering, wrought by such a struggle,to facilitate the positive re-envisioning if those who are dialysis dependent.

Fabrication of high specificity hollow mesoporous silica nanoparticles assisted by Eudragit for targeted drug delivery.

Hollow mesoporous silica nanoparticles (HMSNs) are one of the most promising carriers for effective drug delivery due to their large surface area, high volume for drug loading and excellent biocompatibility. However, the non-ionic surfactant templated HMSNs often have a broad size distribution and a defective mesoporous structure because of the difficulties involved in controlling the formation and organization of micelles for the growth of silica framework. In this paper, a novel "Eudragit assisted" strategy has been developed to fabricate HMSNs by utilising the Eudragit nanoparticles as cores and to assist in the self-assembly of micelle organisation. Highly dispersed mesoporous silica spheres with intact hollow interiors and through pores on the shell were fabricated. The HMSNs have a high surface area (670m(2)/g), small diameter (120nm) and uniform pore size (2.5nm) that facilitated the effective encapsulation of 5-fluorouracil within HMSNs, achieving a high loading capacity of 194.5mg(5-FU)/g(HMSNs). The HMSNs were non-cytotoxic to colorectal cancer cells SW480 and can be bioconjugated with Epidermal Growth Factor (EGF) for efficient and specific cell internalization. The high specificity and excellent targeting performance of EGF grafted HMSNs have demonstrated that they can become potential intracellular drug delivery vehicles for colorectal cancers via EGF-EGFR interaction.

Multi-phase microstructure design of a novel high strength TRIP steel through experimental methodology

The multi-phase structure of a novel low-alloy transformation induced plasticity (TRIP) steel was designed through experimental analysis. The evolutions of both microstructure and mechanical properties during the two-stage heat treatment were analyzed. The phase transformations during the intercritical annealing and the isothermal bainitic transformation were investigated by means of dilatometry. It was shown that two types of C diffusion were detected during intercritical annealing and a complex microstructure was formed after heat treatment. The processing parameters were selected in such a way to obtain microstructures with systematically different volume fractions of ferrite, bainite and retained austenite. The volume fractions of ferrite and retained austenite were found to be two main factors controlling the ductility. Furthermore, a high volume fraction of C-rich retained austenite, which was stabilized at room temperature, was the origin of a TRIP effect. The resulting material demonstrates a significant improvement in the ultimate tensile strength (1077. MPa) with good uniform elongation (22.5%), as compared to conventional TRIP steels. © 2014 Elsevier B.V.

Nephrology nursing publications : topics and research methods

Four peer-reviewed nephrology nursing society journal publications from 2010 to 2015 were analysed. Journal articles (n=638) were categorised into type, treatment cohort, specific topic and research methods. Primary research (40%) were the most frequent types of publications, followed by systematic reviews (25%) and case studies (16%). Publication patient cohorts were dominated by haemodialysis (41%), followed by chronic kidney disease (15%), kidney transplantation (14%), peritoneal dialysis (12%) and end-of-life care (9%). The most frequent specific topics were vascular access (56 publications), nutrition (35), patient self-management (31), medications (26) and patient quality of life (24). The case study was the most popular method of publishing clinical experience, while cross-sectional survey was the most published research method, followed by qualitative research approaches. There were a low number of publications addressing cost and new therapies.

Balancing the risk of injury to gymnasts : how effective are the counter measures?

Background—To minimise injury risk and maximise gymnastics performance, coaches, parents, and health professionals working with young gymnasts need to understand and practise safe gymnastics.

Aims—To (a) identify the various injury counter measures specific to gymnastics, (b) critically review the literature describing each injury prevention measure, and (c) assess, using available risk factor and injury data, the weight of evidence to support each of these counter measures. Specific recommendations for further research and implementation strategies to prevent injury and improve safety are also given.

Methods—The relevant literature was identified through the use of Medline (1966 to May 1998) and SPORT Discus (1975 to May 1998) searches, hand searching of journals and reference lists, and discussions with key Australian gymnastics organisations.

Results—The key gymnastics injury counter measures identified in this review include coaching (physical preparation, education, spotting, and performance technique), equipment, and the health support system (medical screening, treatment, and rehabilitation). Categorisation of the type of evidence for the effectiveness of each of these counter measures in preventing injury showed that most of it is based on informal opinion/anecdotal evidence, uncontrolled data based studies, and several prospective epidemiological studies. There is no evidence from formally controlled trials or specific evaluation studies of counter measures for gymnastics.

Conclusions—Although gymnastics is a sport associated with young participants and frequent high volume, high impact training, there is a paucity of information on injury risk factors and the effectiveness of injury practices. Further controlled trials are needed to examine the extent to which injury prevention counter measures can prevent or reduce the occurrence of injury and re-injury. Particular attention should be devoted to improving training facilities, the design and testing of apparatus and personal equipment used by gymnasts, and coaching and the role of spotting in preventing injury.

An analysis of factors influencing waste minimisation and use of recycled materials for the construction of residential buildings

Residential building construction activities, whether it is new build, repair or maintenance, consumes a large amount of natural resources. This has a negative impact on the environment in the form depleting natural resources, increasing waste production and pollution. Previous research has identified the benefits of preventing or reducing material waste, mainly in terms of the limited available space for waste disposal, and escalating costs associated with landfills, waste management and disposal and their impact on a  building company's profitability. There has however been little development internationally of innovative waste management strategies aimed at reducing the resource requirement of the construction process. The authors contend that embodied energy is a useful indicator of resource value. Using data provided by a regional high-volume residential builder in the State of Victoria, Australia, this paper identifies the various types of waste that are generated from the construction of a typical standard house. It was found that in this particular case, wasted amounts of materials were less than those found previously by others for cases in capital cities (5-10 per cent), suggesting that waste minimisation strategies are successfully being implemented. Cost and embodied energy savings from using materials with recycled content are potentially more beneficial in terms of embodied energy and resource depletion than waste minimisation strategies.