PAlliative Care in chronic Kidney diSease: the PACKS study—quality of life, decision making, costs and impact on carers in people managed without dialysis

BACKGROUND: The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK.

METHODS: In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to 'opt-in' with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists.

DISCUSSION: The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

The potential of electron beam irradiation for simultaneous surface modification and bioresorption control of PLLA for medical device applications

Bioresorbable polymers have been widely investigated as materials exhibiting significant potential for successful application in the medical fields of bone fixation devices and drug delivery. Further to the ability to control degradation, surface engineering of polymers has been highlighted as a key method central to their development. Previous work has demonstrated the ability of electron beam (e-beam) technology to control the degradation profiles and bioresorption of a number of commercially relevant bioresorbable polymers (poly-l-lactic acid (PLLA), L-lactide/ DL-lactide co-polymer (PLDL) and poly(lactic-co-glycolic acid) (PLGA). This work investigates the further potential of e-beam technology to impart added biofunctionality through the manipulation of polymer (PLLA) surface properties. A Dynamatron Continuous DC e-beam unit (Synergy Health, UK), with beam energies of 0.5, 0.75, and 1.5 MeV, was used for the irradiation of PLLA samples with delivered surface doses of 150 or 500 kGy at each energy level. The chosen conditions reflect the need to achieve a specific surface modification for the control of surface degradation as demonstrated in previous work. Surface characterization was then performed using contact angle analysis, X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, and atomic force microscopy.
Results demonstrated a significant increase in surface wettability post e-beam treatment. In correlation with this, XPS data showed the introduction of oxygen-containing functional groups to the surface of PLLA. Raman spectroscopy indicated chain scission in the near surface region of PLLA. E-beam irradiation did not seem to affect the surface roughness of PLLA as a direct consequence of the treatment. In conclusion electron beam surface modification has been found to modify both the surface-to-bulk bioresorption profile and the surface hydrophilicity. Both could provide benefits in relation to the performance of implantable medical devices.

Identification and output tracking control of Hammerstein systems through wireless networks

his paper investigates the identification and output tracking control of a class of Hammerstein systems through a wireless network within an integrated framework and the statistic characteristics of the wireless network are modelled using the inverse Gaussian cumulative distribution function. In the proposed framework, a new networked identification algorithm is proposed to compensate for the influence of the wireless network delays so as to acquire the more precise Hammerstein system model. Then, the identified model together with the model-based approach is used to design an output tracking controller. Mean square stability conditions are given using linear matrix inequalities (LMIs) and the optimal controller gains can be obtained by solving the corresponding optimization problem expressed using LMIs. Illustrative numerical simulation examples are given to demonstrate the effectiveness of our proposed method.

Accurate image capturing control of bottle caps based on iterative learning control and Kalman filtering

This paper investigates camera control for capturing bottle cap target images in the fault-detection system of an industrial production line. The main purpose is to identify the targeted bottle caps accurately in real time from the images. This is achieved by combining iterative learning control and Kalman filtering to reduce the effect of various disturbances introduced into the detection system. A mathematical model, together with a physical simulation platform is established based on the actual production requirements, and the convergence properties of the model are analyzed. It is shown that the proposed method enables accurate real-time control of the camera, and further, the gain range of the learning rule is also obtained. The numerical simulation and experimental results confirm that the proposed method can not only reduce the effect of repeatable disturbances but also non-repeatable ones.

Feasibility Assessment of Plug and Play Model Predictive Control for use in DC Grids

Distributed control techniques can allow Transmission System Operators (TSOs) to coordinate their responses via TSO-TSO communication, providing a level of control that lies between that of centralised control and communication free decentralised control of interconnected power systems. Recently the Plug and Play Model Predictive Control (PnPMPC) toolbox has been developed in order to allow practitioners to design distributed controllers based on tube-MPC techniques. In this paper, some initial results using the PnPMPC toolbox for the design of distributed controllers to enhance AGC in AC areas connected to Multi-Terminal HVDC (MTDC) grids, are illustrated, in order to evaluate the feasibility of applying PnPMPC for this purpose.

Beyond Criminal Justice: An anthology of abolitionist papers presented to conferences of the European Group for the Study of Deviance and Social Control over the past decade

Beyond Criminal Justice presents a vision of a future without brutal, authoritarian and repressive penal regimes. Many of the papers brought together here have been unavailable for more than two decades. Their republication indicates not only their continuing theoretical importance to abolitionist studies but also how they provide important insights into the nature and legitimacy of criminal processes in the here and now. Contributors highlight the human consequences of the harms of imprisonment, evidencing the hurt, injury and damage of penal incarceration across a number of different countries in Europe. Focusing on penal power and prisoner contestation to such power, the moral and political crises of imprisonment are laid bare. The contributors to Beyond Criminal Justice explore the urgent need for a coherent, rational and morally and politically sophisticated theoretical basis for penal abolitionism. Advocating a utopian imagination and at the same time practical solutions already implemented in countries around Europe - alongside grappling with controversial debates such as abolitionist responses to rape and sexual violence - the book steps outside of common sense assumptions regarding 'crime', punishment and 'criminal justice'. Beyond Criminal Justice will be of interest to students of criminology, zemiology, sociology, penology and critical legal studies as well as anyone interested in rethinking the problem of 'crime' and challenging the logic of the penal rationale.