How do patients from South Asian backgrounds experience life on haemodialysis in the UK? : A multicentre qualitative study

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: End-stage kidney disease disproportionately affects people of South Asian origin. This study aimed to uncover the lived experiences of this group of patients on centre-based haemodialysis (HD), the most prevalent dialysis modality. DESIGN: The study utilised a qualitative focus group methodology. Seven focus groups were conducted across four NHS Trusts in the UK including three in Gujarati and two each in Punjabi and Urdu. This provided an inclusive opportunity for South Asian patients to contribute in their language of origin. A total of 24 patients participated. Focus groups were facilitated by bilingual project workers and data were forward translated and analysed using thematic analysis. RESULTS: Four themes were identified. This included (1) 'treatment imposition', which comprised of the restrictive nature of HD, the effects of treatment and the feeling of being trapped in an endless process. (2) The 'patient-clinician relationship' centred around the impact of a perceived lack of staff time, and inadequacies in the quality of interactions. (3) 'Coping strategies' highlighted the role of cognitive reappraisal, living in the moment and family support networks in facilitating adjustment. (4) 'Pursuit of transplantation' included equating this form of treatment with restoring normality, alongside cultural factors limiting hopefulness for receiving an organ. CONCLUSIONS: In general, the experiences of South Asian patients receiving HD were not unique to this ethnic group. We did find distinct issues in relation to interactions with healthcare professionals, views on access to transplantation and the importance of family support networks. The study provides useful insights which may help enhance culturally tailored renal care.Peer reviewe

A New Brown Dwarf Desert? A Scarcity of Wide Ultracool Binaries

We present the results of a deep-imaging search for wide companions to low-mass stars and brown dwarfs using NSFCam on IRTF. We searched a sample of 132 M7-L8 dwarfs to magnitude limits of $J \sim 20.5$ and $K \sim 18.5$, corresponding to secondary-primary mass ratios of $\sim 0.5$. No companions were found with separations between 2{\arcsec} to 31{\arcsec} ($\sim$40 AU to $\sim$1000 AU). This null result implies a wide companion frequency below 2.3% at the 95% confidence level within the sensitivity limits of the survey. Preliminary modeling efforts indicate that we could have detected 85% of companions more massive than $0.05 M_{\odot}$ and 50% above $0.03 M_{\odot}$.Comment: 27 pages, 8 figures, 3 tables: accepted to the Astronomical Journa

Psychiatric morbidity in older people with moderate and severe learning disability (mental retardation). Part I: development and reliability of the patient interview (the PAS-ADD)

This paper describes the development of the PAS-ADD, a semistructured clinical interview for use specifically with patients with learning disabilities, based on items drawn from the PSE. The PAS-ADD includes a number of novel features including: parallel interviewing of patient and informant; a three-tier structure to provide a flexible interview appropriate to the patient's intellectual level; use of a memorable 'anchor event' in the patient's life to improve time focus; and simplified wording, improved organisation and lay out. Inter-rater reliability was investigated using an experimental design in which two raters viewed and re-rated videotaped PAS-ADD interviews which had been conducted by an experienced clinician. Reliability results compared favourably with those obtained in a major study of PSE reliability with a sample drawn from non-learning disabled individuals. Mean kappa for all items was 0.72. Other indexes of reliability were also good. In the current phase of development, the PAS-ADD is to be expanded to include further diagnostic categories, including schizophrenia and autism. The new version will be updated for use with ICD-10 criteria

Exploring the Designer-Constructor Teamwork Interface to improve Collaboration: A review of current literature

The construction industry has been criticised over several decades for functioning and producing output with low levels of productivity when compared to other manufacturing-based industries. One possible solution to improve productivity is the adoption of collaborative working practices by project teams, particularly designers and constructors during the design phase. Arguments in support of the need to manage the design process effectively during a construction project are well documented. Issues such as providing the client with a sustainable, affordable, quality design that adds value to their business needs, requires attention. Managing the interpersonal interface between designers and constructors during the design phase is a vital requirement of design management practice. Design management is a discipline that requires a thorough understanding of the nature and culture of the different professionals to improve the social behaviours and performance of teams, which in turn may improve project outcomes and thus industrial productivity. The current study, which is part of an ongoing project, presents the position of the design management literature focused on the interpersonal behaviour between designers and constructors. Following a strategically focused review of the extant literature, current themes relevant to Teamwork Quality (TWQ), specific to the designer-constructor interface, are presented. The findings confirm the presence of 14 articles that explore collaborative teamwork behaviour between designers and constructors and that survey methods dominate publications in this area. Few studies capture the power of space and place by observing ‘live' industry practice, particularly from a longitudinal perspective. Recommendations include the identification of research themes worthy of future exploration that may assist in teamwork performance concerning productivity. An increase in the use of alternative methodological approaches such as ethnographic and action research is also justified and discussed

Two nearby M dwarf binaries from the Two Micron All Sky Survey

We report the discovery of two binary M dwarf systems in the immediate solar neighbourhood using the Two Micron All Sky Survey (2MASS). The first is an M6.5 companion to the nearby G star HD 86728 (Gl 376). The known properties of HD 86728 indicate that the M dwarf (Gl 376B) is old, metal-rich and only 14.9 parsec away. The M dwarf is highly active, with both Hα and X-ray emission. Thus, Gl 376B offers the opportunity to study an old, bright, active M dwarf with known metallicity, age and luminosity. We show that it is probable that Gl 376B is itself an unresolved pair. The other system consists of an M6.5 and an M8 dwarf with 14.5 arcsec separation. We estimate a distance of ∼16 parsec for this very low-mass pair. Stronger activity is observed in the M6.5 dwarf, supporting evidence that chromospheric activity is weakening near the hydrogen-burning limit