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.

Lifestyle management of unipolar depression

Objective To be used in conjunction with ‘Pharmacological management of unipolar depression’ [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6–23] and ‘Psychological management of unipolar depression’ [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24–37]. To provide clinically relevant recommendations for lifestyle modifications in depression, derived from a literature review.

Method A search of pertinent literature was conducted up to August 2012 in the area of lifestyle factors and depression. A narrative review was then conducted.

Results There is evidence that level of physical activity plays a role in the risk of depression, and there is a large and validated evidence base for exercise as a therapeutic modality. Smoking and alcohol and substance misuse appear to be independent risk factors for depression, while the new epidemiological evidence supports the contention that diet is a risk factor for depression; good quality diets appear protective and poor diets increase risk.

Conclusion Lifestyle modification, with a focus on exercise, diet, smoking and alcohol, may be of substantial value in reducing the burden of depression in individuals and the community.

Reasons for using web-based counselling among family and friends impacted by problem gambling

Despite the range of free services available in Australia, few family and friends of people with problem gambling access them. Over recent years, the Australian gambling help service system has expanded to include web-based counselling. Family and friends make up approximately 15% of people accessing this new modality, however little is known of the reasons for choosing this form of assistance over other interventions. This research aimed to understand the reasons family and friends choose to use single-session web-based counselling over other modes (i.e., face-to-face and telephone), as well as why they would recommend it to other affected people.

The study involved 63 participants (70% intimate partners, 13% children, 6% friends, 5% parents, 6% other family members) who completed openended questions on reasons for using and recommending web-based counselling, with over three-quarters of the sample seeking help for the first time.

A descriptive content analysis revealed multiple overlapping themes, including ease of access (41.3% of reasons for choosing), privacy and anonymity (17.5%), and a preference for the characteristics inherent in the therapeutic medium (23.8%). We also found webbased counselling provided a pathway into services (11.1%) and that the intervention provided was viewed as helpful and a reason for recommendation (34.9% of reasons for recommending).

This research provides important new information on the help seeking preferences of family and friends. Future research is required to understand the relationship between reasons for use, help-seeking preferences and the effectiveness of single-session web-based counselling for people affected by problem gambling.

Development and assessment of an incremental fatigue protocol for contemporary dance

Nine trained contemporary dancers performed a modality-specific, heart-rate-monitored, choreographed fatiguing dance protocol with an assumption of fatigue at volitional exhaustion (RPE 16). Postural stability was assessed as the variability of ground reaction forces and the centre of pressure during the performance of a flat-foot arabesque. Psychological response was assessed using self-reported fatigue, psychological distress (PD), and psychological well-being (PWB) (Subjective Exercise Experience Scale). After reaching RPE 16 in 15.7 ± 2.6 mins, heart rate decreased to the post-warm-up level within 64 ± 9 sec. Variability of ground reaction forces or the centre of pressure was not changed. There were no significant changes in fatigue, psychological distress, or psychological well-being. Within fatigue, there was a significant increase in the item tired (p = 0.04). As supported by the heart rate data and RPE, the protocol achieved an appropriate level of physical demand. No changes in the stability indices were observed, possibly attributed to the rapid recovery in heart rate. The expression of only tiredness suggests the use of a disassociative attentional style by the dancers. The project represents pilot work toward the validation of a monitoring process that supports dancer health and awareness training.

‘Knowledge aid’ as instrument of regulation: World Bank’s non-lending higher education support for Ethiopia

In the context of low-income countries, the role of donors in public policymaking is of great importance. Donors use a combination of lending and non-lending instruments as pathways of influence to shape policy directions in aid-recipient countries. This paper reports some findings from a doctoral study on the role of the World Bank in the recent higher education (HE) policy reform process in Ethiopia. It focuses on the nature and impact of non-lending assistance by the Bank to the Ethiopian HE subsystem. Based on an interpretive policy analysis of sector reviews and advisory activities of the Bank, and selected national HE policy documents, the following findings are highlighted. First, as a ‘knowledge institution’, the World Bank produces, systematises and disseminates knowledge through policy advice, policy reports, analytical sector reviews, and thematic conferences and workshops. Second, knowledge aid from the Bank not only has a profound discursive effect on shaping Ethiopian HE policy reform priorities in accordance with its neoliberal educational agenda but also undermines the knowledge production capacity of the nation. The paper also argues that, for an effective education policy support, the Bank needs to shift its modality of engagement from knowledge aid to research capacity building. 

An international survey of daily disposable contact lens prescribing

The aim was to determine the extent of daily disposable contact lens prescribing worldwide and to characterise the associated demographics and fitting patterns. Up to 1,000 survey forms were sent to contact lens fitters in up to 40 countries between January and March every year for five consecutive years (2007 to 2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Survey data collected since 1996 were also analysed for seven nations to assess daily disposable lens fitting trends since that time. Data were collected in relation to 97,289 soft lens fits, of which 23,445 (24.1 per cent) were with daily disposable lenses and 73,170 (75.9 per cent) were with reusable lenses. Daily disposable lens prescribing ranged from 0.6 per cent of all soft lenses in Nepal to 66.2 per cent in Qatar. Compared with reusable lens fittings, daily disposable lens fittings can be characterised as follows: older age (30.0 ± 12.5 versus 29.3 ± 12.3 years for reusable lenses); males are over-represented; a greater proportion of new fits versus refits; 85.9 per cent hydrogel; lower proportion of toric and presbyopia designs and a higher proportion of part-time wear. There has been a continuous increase in daily disposable lens prescribing between 1996 and 2011. The proportion of daily disposable lens fits (as a function of all soft lens fits) is positively related to the gross domestic product at purchasing power parity per capita (r(2) = 0.55, F = 46.8, p < 0.0001). The greater convenience and other benefits of daily disposable lenses have resulted in this modality capturing significant market share. The contact lens field appears to be heading toward a true single-use-only, disposable lens market.

Multifunctional nanoparticle-EpCAM aptamer bioconjugates: a paradigm for targeted drug delivery and imaging in cancer therapy

The promising proposition of multifunctional nanoparticles for cancer diagnostics and therapeutics has inspired the development of theranostic approach for improved cancer therapy. Moreover, active targeting of drug carrier to specific target site is crucial for providing efficient delivery of therapeutics and imaging agents. In this regard, the present study investigates the theranostic capabilities of nutlin-3a loaded poly (lactide-co-glycolide) nanoparticles, functionalized with a targeting ligand (EpCAM aptamer) and an imaging agent (quantum dots) for cancer therapy and bioimaging. A wide spectrum of in vitro analysis (cellular uptake study, cytotoxicity assay, cell cycle and apoptosis analysis, apoptosis associated proteins study) revealed superior therapeutic potentiality of targeted drug loaded NPs over other formulations in EpCAM expressing cells. Moreover, our nanotheranostic system served as a superlative bio-imaging modality both in 2D monolayer culture and tumor spheroid model. Our result suggests that, these aptamer-guided multifunctional NPs may act as indispensable nanotheranostic approach toward cancer therapy.

Health cosmopolitanism: melding universality and difference – the case of childbirth in post-conflict Timor Leste

ABSTRACTThis study will consider the case of TBAs (traditional birth attendants) under the health cosmopolitan banner. Fifteen interviews with health administrators, obstetricians, midwives, traditional birth attendants and women in Timor Leste, provide evidence : (1) that the WHO (1992) directive to dismiss the inclusion of TBAs within the formal maternity care system has been precipitous (2) that TBAs could, with adequate training in emergency obstetric techniques and hygienic practices, assist in meeting MDG No 5, and (3) that TBAs may assist in sustaining hybrid cosmologies and serving other cultural aims. Although Millennium Development Goals embrace the idea of the universal right to health, a human rights framework remains abstract and legalistic. I argue that health cosmopolitanism offers a more inclusive lens. Applied to maternity care it shifts childbirth to a central focus of government policy, obliges all nations to contribute international aid yet recognises the interpretation of complex needs at the local level. It defines a philosophy of care that is person-centred (not professional or institution-centred), ensures equal access to quality care (based not on ability to pay or other obstacles such as geographical distance) and choice of carer and modality (Western, traditional or hybrid). It underlines the argument here that TBAs trained in emergency obstetric care and hygiene and funded by international agencies would ensure every woman has a known carer, plus choice of location, modality and provider. Health cosmopolitanism thus embraces universality, individual autonomy, reciprocal respect and global responsibility.

Infrared face recognition: a comprehensive review of methodologies and databases

Automatic face recognition is an area with immense practical potential which includes a wide range of commercial and law enforcement applications. Hence it is unsurprising that it continues to be one of the most active research areas of computer vision. Even after over three decades of intense research, the state-of-the-art in face recognition continues to improve, benefitting from advances in a range of different research fields such as image processing, pattern recognition, computer graphics, and physiology. Systems based on visible spectrum images, the most researched face recognition modality, have reached a significant level of maturity with some practical success. However, they continue to face challenges in the presence of illumination, pose and expression changes, as well as facial disguises, all of which can significantly decrease recognition accuracy. Amongst various approaches which have been proposed in an attempt to overcome these limitations, the use of infrared (IR) imaging has emerged as a particularly promising research direction. This paper presents a comprehensive and timely review of the literature on this subject. Our key contributions are (i) a summary of the inherent properties of infrared imaging which makes this modality promising in the context of face recognition; (ii) a systematic review of the most influential approaches, with a focus on emerging common trends as well as key differences between alternative methodologies; (iii) a description of the main databases of infrared facial images available to the researcher; and lastly (iv) a discussion of the most promising avenues for future research. © 2014 Elsevier Ltd.

A unified framework for thermal face recognition

The reduction of the cost of infrared (IR) cameras in recent years has made IR imaging a highly viable modality for face recognition in practice. A particularly attractive advantage of IR-based over conventional, visible spectrumbased face recognition stems from its invariance to visible illumination. In this paper we argue that the main limitation of previous work on face recognition using IR lies in its ad hoc approach to treating different nuisance factors which affect appearance, prohibiting a unified approach that is capable of handling concurrent changes in multiple (or indeed all) major extrinsic sources of variability, which is needed in practice. We describe the first approach that attempts to achieve this – the framework we propose achieves outstanding recognition performance in the presence of variable (i) pose, (ii) facial expression, (iii) physiological state, (iv) partial occlusion due to eye-wear, and (v) quasi-occlusion due to facial hair growth.

Recent advances on singlemodal and multimodal face recognition : A survey

High performance for face recognition systems occurs in controlled environments and degrades with variations in illumination, facial expression, and pose. Efforts have been made to explore alternate face modalities such as infrared (IR) and 3-D for face recognition. Studies also demonstrate that fusion of multiple face modalities improve performance as compared with singlemodal face recognition. This paper categorizes these algorithms into singlemodal and multimodal face recognition and evaluates methods within each category via detailed descriptions of representative work and summarizations in tables. Advantages and disadvantages of each modality for face recognition are analyzed. In addition, face databases and system evaluations are also covered.

Alternative service delivery models for families with a new speech generating device: perspectives of parents and therapists

Purpose: Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

Method: Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants’ suggestions for the optimal implementation of these approaches.

Result: Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

Conclusion: Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.

Multipoint haptic guidance for micrograsping systems

The ability to perform accurate micromanipulation offers wide-reaching benefits and is of increasing interest to researchers. Recent research into microgripper, microtweezer, and microforcep systems contributes toward accurate micrograsping and manipulation. Despite these efforts, achieving adequate operator control remains a distinct research challenge. Haptic interfaces interact with the human's haptic modality and offer the ability to enhance the operator's controllability of micromanipulation systems. Our previous work introduced single-point haptic guidance to assist the operator during intracellular microinjection. This paper extends the approach to propose multipoint haptic guidance for micrograsping tasks. Accurate micrograsping is valuable in many applications, including microassembly and biomanipulation. A multipoint haptic gripper facilitates haptic interaction, and haptic guidance assists the operator in controlling systems suitable for micrograsping. Force fields are used to guide the operator to suitable grasp points on micrometer-sized objects and consist of attractive and repulsive forces. The ability of the force field to effectively assist the operator in grasping the cell is evaluated using a virtual environment. Evaluation results demonstrate the ability of the approach to significantly reduce participants' average grasping error.

A shadow-like task migration model based on context semantics for mobile and pervasive environments

Pervasive computing is a user-centric mobile computing paradigm, in which tasks should be migrated over different platforms in a shadow-like way when users move around. In this paper, we propose a context-sensitive task migration model that recovers program states and rebinds resources for task migrations based on context semantics through inserting resource description and state description sections in source programs. Based on our model, we design and develop a task migration framework xMozart which extends the Mozart platform in terms of context awareness. Our approach can recover task states and rebind resources in the context-aware way, as well as support multi- modality I/O interactions. The extensive experiments demonstrate that our approach can migrate tasks by resuming them from the last broken points like shadows moving along with the users.

Trends in US contact lens prescribing 2002 to 2014

Purpose To document contact lens prescribing patterns in the United States between 2002 and 2014. Methods A survey of contact lens prescribing trends was conducted each year between 2002 and 2014, inclusive. Randomly selected contact lens practitioners were asked to provide information relating to 10 consecutive contact lens fits between January and March each year. Results Over the 13-year survey period, 1650 survey forms were received from US practitioners representing details of 7702 contact lens fits. The mean (±SD) age of lens wearers was 33.6 (±15.2) years, of whom 65.2% were female. Rigid lens new fits decreased from 13.0% in 2002 to 9.4% in 2014. Across this period, silicone hydrogels have replaced mid water contact lens hydrogels as the soft lens material of choice. Toric lenses represented about 25 to 30% of all soft lens fits. Multifocal soft lenses are generally preferred to monovision. Daily disposable lens fits have recently increased, and in 2014, they represented 27.1% of all soft lens fits. Most lenses are prescribed on 1 to 2 weekly or monthly lens replacement regimen. Extended wear remains a minority lens wearing modality. The vast majority of those wearing reusable lenses use multipurpose lens care solutions. Lenses are mostly worn 7 d/wk. Conclusions This survey has revealed prescribing trends and preferences in the United States over the past 13 years.