Description: Objectives Socioeconomically deprived individuals with renal disease are less likely to receive a live-donor kidney transplant (LDKT) than less deprived individuals. This study aimed to develop and pilot a questionnaire designed to determine what factors explain this association. Design Questionnaire development and a pilot case–control study. Primary aims were to develop and evaluate a questionnaire, assess response rates, and to generate data to inform full-scale study design. Setting A UK tertiary renal referral hospital and transplant centre. Participants Invited participants comprised 30 LDKT recipients (cases) and 30 deceased-donor kidney transplant (DDKT) recipients (controls). Stratified random sampling was used to select cases and controls from all adults who had been transplanted at Southmead Hospital North Bristol National Health Service Trust, between 1 August 2007 and 31 July 2013. Methods Participants were posted questionnaires that were accompanied by an invitation letter from the renal consultant responsible for their care, and a patient information leaflet. Non-responders were sent a second questionnaire after 4–6 weeks. Data were extracted from returned questionnaires, and entered onto a Research Electronic Data Capture (REDCap) database. Results 63% (n=38) of those invited returned questionnaires. 16 (42%) declined to answer the question on income. 58% of participants had not asked any of their potential donors to consider living kidney donation (52% LDKT vs 65% DDKT, p=0.44). There was some evidence of a difference between the R3K-T knowledge score for recipients of LDKTs (mean 6.7, SD 1.8) and for recipients of DDKTs (mean 4.9, SD 2.1), p=0.008. Variables’ distribution for the exposure variables of interest was determined. Conclusions Findings from this study will inform a sample size calculation for a full-scale study. The findings of the full-scale case–control study will help us better understand how socioeconomic deprivation is related to the type of transplant an individual receives. This understanding will help us to design and appropriately tailor an intervention to reduce inequitable access to live-donor kidney transplantation.

Description: Introduction Young adults fare worse than younger adolescents or older adults on a broad range of health indicators. Those with a chronic illness such as renal failure are a particularly vulnerable group, who experience poor outcomes compared with both children and older adults. Understanding how being in receipt of renal replacement therapy (RRT) affects the lives of young adults might help us to better prepare and support these individuals for and on RRT, and improve outcomes. This study aimed to synthesise research describing young adults’ experiences of the psychosocial impact of kidney failure and RRT. Design A systematic literature review identified qualitative research reporting the perspectives of people aged 16–30 years receiving RRT on the psychosocial impact of renal failure. Electronic databases (including Medline/EMBASE/PsycINFO/ASSIA) were searched to November 2017 for full-text papers. The transparency of reporting of each study was assessed using the Consolidated Criteria for Reporting Qualitative Health Research (COREQ) framework. Quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. An inductive thematic synthesis was undertaken. Participants Seven studies from five different countries were included, comprising 123 young adults receiving RRT. Results Comprehensiveness of reporting was variable: studies reported 9–22 of the 32 COREQ-checklist items. Three global themes about the impact of kidney failure on young adults were identified: (1) difference desiring normality, (2) thwarted or moderated dreams and ambitions, and (3) uncertainty and liminality. These reflected five organising themes: (1) physical appearance and body image, (2) activity and participation, (3) educational disruption and underachievement, (4) career ambitions and employment difficulties, and (5) social isolation and intimate relationships. Conclusions Across different countries and different healthcare settings, young adults on RRT experience difference and liminality, even after transplantation. Tailored social and psychological support is required to allow young adults to experience wellness while in receipt of RRT, and not have life on hold.

Description: Author(s): E. Collin, W. Bailey, P. Fozooni, P. G. Frayne, P. Glasson, K. Harrabi, and M. J. Lea We present measurements of the resonant microwave absorption between the Rydberg energy levels of surface-state electrons on the surface of superfluid liquid helium, in the frequency range 165–220 GHz. The resonant frequency was temperature dependent. The experiments are in agreement with recent the... [Phys. Rev. B 96, 235427] Published Wed Dec 20, 2017

Description: Introduction Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch. Methods and analysis A dataset of OHCA calls and their corresponding metadata will be analysed from an interdisciplinary perspective, combining linguistic analysis and health services research. The calls will be transcribed and coded for linguistic and interactional variables and then used to answer a series of research questions about the recognition of OHCA and the delivery of basic life-support instructions to bystanders. Linguistic analysis of calls will provide a deeper understanding of the interactional dynamics between caller and call-taker which may affect recognition and dispatch for OHCA. Findings from this research will translate into recommendations for modifications of the protocols for ambulance dispatch and provide directions for further research. Ethics and dissemination The study has been approved by the Curtin University Human Research Ethics Committee (HR128/2013) and the St John Ambulance Western Australia Research Advisory Group. Findings will be published in peer-reviewed journals and communicated to key audiences, including ambulance dispatch professionals.

Description: We report a methodology for measuring 85 Kr/Kr isotopic abundances using Atom Trap Trace Analysis (ATTA) that increases sample measurement throughput by over an order of magnitude to 6 samples per 24 hours. The noble gas isotope 85 Kr (half-life = 10.7 yr) is a useful tracer for young groundwater in the age range of 5-50 years. ATTA, an efficient and selective laser-based atom counting method, has recently been applied to 85 Kr/Kr isotopic abundance measurements, requiring 5-10 μ L of krypton gas at STP extracted from 50-100 L of water. Previously a single such measurement required 48 hours. Our new method demonstrates that we can measure 85 Kr/Kr ratios with 3-5% relative uncertainty every 4 hours, on average, with the same sample requirements. This article is protected by copyright. All rights reserved.

Description: As global temperatures rise, regional differences in evaporation ( E ) and precipitation ( P ) are likely to become more disparate, causing the drier E -dominated regions of the tropics to become drier and the wetter P -dominated regions to become wetter. Models suggest such intensification of the water cycle should already be taking place; however, quantitatively verifying these changes is complicated by inherent difficulties in measuring E and P with sufficient spatial coverage and resolution. This paper presents a new metric for tracking changes in regional moisture imbalances (e.g. E-P ) by defining δD q —the isotope ratio normalized to a reference water vapor concentration of 4 mmol mol -1 —and evaluates its efficacy using both remote-sensing retrievals and climate model simulations in the tropics. By normalizing the isotope ratio with respect to water vapor concentration, δD q isolates the portion of isotopic variability most closely associated with shifts between E - and P -dominated regimes. Composite differences in δD q between cold and warm phases of El Niño-Southern Oscillation (ENSO) verify that δD q effectively tracks changes in the hydrological cycle when large-scale convective reorganization takes place. Simulated δD q also demonstrates sensitivity to shorter-term variability in E-P at most tropical locations. Since the isotopic signal of E-P in free tropospheric water vapor transfers to the isotope ratios of precipitation, multi-decadal observations of both water vapor and precipitation isotope ratios should provide key evidence of changes in regional moisture imbalances now and in the future.

Description: Aberrant activation of embryonic signaling pathways is frequent in pancreatic ductal adenocarcinoma (PDA), making developmental regulators therapeutically attractive. Here we demonstrate diverse functions for pancreatic and duodenal homeobox 1 (PDX1), a transcription factor indispensable for pancreas development, in the progression from normal exocrine cells to metastatic PDA. We identify a critical role for PDX1 in maintaining acinar cell identity, thus resisting the formation of pancreatic intraepithelial neoplasia (PanIN)-derived PDA. Upon neoplastic transformation, the role of PDX1 changes from tumor-suppressive to oncogenic. Interestingly, subsets of malignant cells lose PDX1 expression while undergoing epithelial-to-mesenchymal transition (EMT), and PDX1 loss is associated with poor outcome. This stage-specific functionality arises from profound shifts in PDX1 chromatin occupancy from acinar cells to PDA. In summary, we report distinct roles of PDX1 at different stages of PDA, suggesting that therapeutic approaches against this potential target need to account for its changing functions at different stages of carcinogenesis. These findings provide insight into the complexity of PDA pathogenesis and advocate a rigorous investigation of therapeutically tractable targets at distinct phases of PDA development and progression.

Description: Author(s): D. J. Strozzi, D. S. Bailey, P. Michel, L. Divol, S. M. Sepke, G. D. Kerbel, C. A. Thomas, J. E. Ralph, J. D. Moody, and M. B. Schneider The effects of laser-plasma interactions (LPI) on the dynamics of inertial confinement fusion hohlraums are investigated via a new approach that self-consistently couples reduced LPI models into radiation-hydrodynamics numerical codes. The interplay between hydrodynamics and LPI—specifically stimula… [Phys. Rev. Lett. 118, 025002] Published Thu Jan 12, 2017

Description: Pancreatic cancer has become the third leading cause of cancer-related death, with little improvement in outcomes despite decades of research. Surgery remains the only chance of cure, yet only 20% of patients will be alive at 5 years after pancreatic resection. Few chemotherapeutics provide any improvement in outcome, and even then, for approved therapies, the survival benefits are marginal. Genomic sequencing studies of pancreatic cancer have revealed a small set of consistent mutations found in most pancreatic cancers and beyond that, a low prevalence for targetable mutations. This may explain the failure of conventional clinical trial designs to show any meaningful survival benefit, except in small and undefined patient subgroups. With the development of next-generation sequencing technology, genomic sequencing and analysis can be performed in a clinically meaningful turnaround time. This can identify therapeutic targets in individual patients and personalize treatment selection. Incorporating preclinical discovery and molecularly guided therapy into clinical trial design has the potential to significantly improve outcomes in this lethal malignancy. In this review, we discuss the findings of recent large-scale genomic sequencing projects in pancreatic cancer and the potential relevance of these data to therapeutic development. Clin Cancer Res; 23(7); 1638–46. ©2017 AACR . See all articles in this CCR Focus section, "Pancreatic Cancer: Challenge and Inspiration."

Description: Objectives Socioeconomically deprived individuals with renal disease are less likely to receive a live-donor kidney transplant than less-deprived individuals. This qualitative study aimed to identify reasons for the observed socioeconomic disparity in live-donor kidney transplantation. Design A qualitative study using face-to-face in-depth semistructured interviews. Setting A UK tertiary renal referral hospital and transplant centre. Participants Purposive sampling was used to select deceased-donor transplant recipients from areas of high socioeconomic deprivation (SED) (19 participants), followed by a low SED comparison group (13 participants), aiming for maximum diversity in terms of age, gender, ethnicity, primary renal disease and previous renal replacement therapy. Methods Participants were interviewed following their routine transplant clinic review. Interviews were digitally audio-recorded and transcribed verbatim. Transcripts were coded using NVivo software and analysed using the constant comparison method described in Grounded Theory. Results Themes common and distinct to each socioeconomic group emerged. 6 themes appeared to distinguish between individuals from areas of high and low SED. 4 themes were distinct to participants from areas of high SED: (1) Passivity, (2) Disempowerment, (3) Lack of social support and (4) Short-term focus. 2 themes were distinct to the low SED group: (1) Financial concerns and (2) Location of donor. Conclusions Several of the emerging themes from the high SED individuals relate to an individual's lack of confidence and skill in managing their health and healthcare; themes that are in keeping with low levels of patient activation. Inadequate empowerment of socioeconomically deprived individuals by healthcare practitioners was also described. Financial concerns did not emerge as a barrier from interviews with the high SED group. Interventions aiming to redress the observed socioeconomic inequity should be targeted at both patients and clinical teams to increase empowerment and ensure shared decision-making.