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.

Development and independent validation of a prognostic assay for stage ii colon cancer using formalin-fixed paraffin-embedded tissue

Purpose: Current prognostic factors are poor at identifying patients at risk of disease recurrence after surgery for stage II colon cancer. Here we describe a DNA microarray-based prognostic assay using clinically relevant formalin-fixed paraffin-embedded (FFPE) samples. Patients and Methods: A gene signature was developed from a balanced set of 73 patients with recurrent disease (high risk) and 142 patients with no recurrence (low risk) within 5 years of surgery. Results: The 634-probe set signature identified high-risk patients with a hazard ratio (HR) of 2.62 (P <.001) during cross validation of the training set. In an independent validation set of 144 samples, the signature identified high-risk patients with an HR of 2.53 (P <.001) for recurrence and an HR of 2.21 (P = .0084) for cancer-related death. Additionally, the signature was shown to perform independently from known prognostic factors (P <.001). Conclusion: This gene signature represents a novel prognostic biomarker for patients with stage II colon cancer that can be applied to FFPE tumor samples. © 2011 by American Society of Clinical Oncology.

Estimation of survival rate and extinction probability for stage-structured populations with overlapping life stages

The development of methods providing reliable estimates of demographic parameters (e. g., survival rates, fecundity) for wild populations is essential to better understand the ecology and conservation requirements of individual species. A number of methods exist for estimating the demographics of stage-structured populations, but inherent mathematical complexity often limits their uptake by conservation practitioners. Estimating survival rates for pond-breeding amphibians is further complicated by their complex migratory and reproductive behaviours, often resulting in nonobservable states and successive cohorts of eggs and tadpoles. Here we used comprehensive data on 11 distinct breeding toad populations (Bufo calamita) to clarify and assess the suitability of a relatively simple method [the Kiritani-Nakasuji-Manly (KNM) method] to estimate the survival rates of stage-structured populations with overlapping life stages. The study shows that the KNM method is robust and provides realistic estimates of amphibian egg and larval survival rates for species in which breeding can occur as a single pulse or over a period of several weeks. The study also provides estimates of fecundity for seven distinct toad populations and indicates that it is essential to use reliable estimates of fecundity to limit the risk of under- or overestimating the survival rates when using the KNM method. Survival and fecundity rates for B. calamita populations were then used to define population matrices and make a limited exploration of their growth and viability. The findings of the study recently led to the implementation of practical conservation measures at the sites where populations were most vulnerable to extinction. © 2010 The Society of Population Ecology and Springer.

Rate-determining stage in NOSCR with propane on low-exchanged Cu-ZSM-5 catalyst

The kinetics of the NO SCR with propane has been studied on a low-exchanged Cu-ZSM-5 catalyst. The study of the kinetics of individual reaction stages (2-nitrosopropane isomerization to acetone oxime and reaction of adsorbed acetone oxime with gaseous NO) has shown that the NO reaction with acetone oxime is the rate-determining stage in the whole chain of transformations leading to the formation of molecular nitrogen in the low-temperature region below 300 C-degrees. The kinetic analysis of the reaction has revealed that at the temperatures above 300(degrees)C propane plays a more important role.

Anodic stripping voltammetry with photochemical preconcentration at nanocrystalline TiO2 films: Detection of Ag+ and Hg2+

Nanocrystalline TiO2 deposited on conducting glass plates is shown to be an excellent material for preconcentration of silver and mercury, via photochemical reaction, prior to their detection by anodic stripping voltammetry (ASV). During the first stage of growth in the photoreduction of silver or mercury, 3D nuclei are formed on the TiO2 film. As the deposition proceeds micrometer size agglomerates grow on the surface. The conical morphology of the silver nuclei grown on a (110) rutile single crystal in the initial stages of growth suggests that there is a preferential deposition of silver at the centre of the growing nuclei. When the nuclei size reach a critical value (ca. 400 nm diameter, 40 nm height) the morphology changes to a globular shape without any preferential site for deposition on the surface of the silver nucleus. It was observed that micromolar concentrations of silver or mercury can be detected by anodic stripping voltammetry and relatively large amounts of these metals (micrometer scale nuclei) can be loaded on the nanocrystalline TiO2 film surface. The latter opens the possibility of analytical applications of nanocrystalline TiO2 electrodes for the selective detection of silver or mercury via photochemical anodic stripping voltammetry.

Coherent Control of High Harmonic Generation via Dual-Gas Multijet Arrays

High harmonic generation (HHG) is a central driver of the rapidly growing field of ultrafast science. We present a novel quasiphase-matching (QPM) concept with a dual-gas multijet target leading, for the first time, to remarkable phase control between multiple HHG sources (> 2) within the Rayleigh range. The alternating jet structure with driving and matching zones shows perfect coherent buildup for up to six QPM periods. Although not in the focus of the proof-of-principle studies presented here, we achieved competitive conversion efficiencies already in this early stage of development.