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People living with a long-term condition, such as chronic kidney disease (CKD), often suffer from multiple symptoms simultaneously, making symptom management challenging. This study aimed to identify symptom clusters in adults with CKD across treatment groups and investigate their association with people's ability to perform their usual activities. We conducted a secondary analysis of both cross-sectional and longitudinal data collected as part of a national service improvement programme in 14 kidney centres in England, UK. This data included symptom severity (17 items, POS-S Renal) and the extent to which people had problems performing their usual activities (single item, EQ-5D-5L). We categorised data by treatment group: haemodialysis (n = 1,462), transplantation (n = 866), peritoneal dialysis (n = 127), or CKD without kidney replacement therapy (CKD non-KRT; n = 684). We used principal component analysis to identify symptom clusters per treatment group, and proportional odds models to assess the association between clusters and usual activities. Overall, clusters related to: lack of energy and mobility; gastrointestinal; skin; and mental health. Across groups, the 'lack of energy and mobility' clusters were associated with having problems with usual activities, with odds ratios (OR) ranging between 1.24 (95% confidence interval [CI], 1.21-1.57) for haemodialysis and 1.56 for peritoneal dialysis (95% CI, 1.28-1.90). This association was confirmed longitudinally in haemodialysis (n = 399) and transplant (n = 249) subgroups. Our findings suggest that healthcare professionals should consider routinely assessing symptoms in the 'lack of energy & mobility' cluster in all people with CKD, regardless of whether they volunteer this information; not addressing these symptoms is likely to be related to them having problems with performing usual activities. Future studies should explore why symptoms within clusters commonly co-occur and how they interrelate. This will inform the development of cluster-level symptom management interventions with enhanced potential to improve outcomes for people with CKD.

Background Quality of life (QOL) is important to patients with end stage renal disease and their partners. Despite the first 12 weeks being a critical time in the treatment pathway, limited research exists which examines how the transition onto dialysis impacts QOL. In this study we measured QOL in patients and their partners at pre-dialysis and over the first 12 weeks on dialysis to investigate QOL during this crucial period. Methods Patients and their partners, recruited from 10 renal units in England, completed questionnaires at pre-dialysis ( n  = 166 participants, 83 couples), 6 weeks ( n  = 90 participants, 45 couples) and 12 weeks ( n  = 78, 39 couples) after starting dialysis. On each occasion participants completed a QOL questionnaire (WHOQOL-BREF). Multilevel modelling accommodated the nested structure of couples with repeated measures within participants. Three-level random intercept models estimated changes in WHOQOL general QOL and its four domains (Physical, Psychological, Social and Environment). Two-level random intercept models assessed the relationship between baseline clinical and socio-demographic variables with changes in general QOL. Results Patients reported positive changes in general QOL from pre-dialysis to 6 weeks (β = 0.42, p  < 0.001, 95% CI 0.19, 0.65) and from pre-dialysis to 12 weeks (β = 0.47, p  < 0.001, 95% CI 0.24, 0.71). Partners’ general QOL decreased significantly from pre-dialysis to 6 weeks (β = − 0.24, p  = 0.04, 95% CI -0.47, − 0.01) but returned to its original level at 12 weeks. Patients reported improvements in the physical domain between pre-dialysis and 12 weeks (β = 6.56, p  < 0.004, 95% CI 2.10, 11.03). No other domains changed significantly in patients or partners. Only in patients were there significant associations between moderator variables and general QOL. High comorbidity risk level and diabetes were associated with poorer QOL at pre-dialysis whereas being female and having an arteriovenous fistula were linked with improvements in general QOL. Conclusions Patients reported significant improvements in their general and physical QOL after starting dialysis. Partners’ general QOL worsened after patients started dialysis but improved by 12 weeks. Both patients and partners may benefit from additional educational and counselling services in the lead up to, and immediately after starting dialysis, which could facilitate the transition onto dialysis and improve QOL in both. Study registration This study was adopted on the NIHR Clinical Research Network (UK). The details of this study are registered on the Research Registry website ( www.researchregistry.com ). The identifier for this study is researchregistry2574.

Background The transition onto dialysis is a stressful time that affects both patients and their partners. Research suggests that psychological and interpersonal characteristics within the couple are related to how well they adapt to dialysis. The aim of this multi-phase, mixed methods study was to develop a measure, the Starting Dialysis Questionnaire (SDQ), that is applicable to both patients and their partners and assesses their own thoughts and feelings about these constructs. Methods Data from semi-structured interviews with patients and their partners (n = 22 couples) were analysed using theoretical thematic analysis to identify and define constructs related to quality of life (QOL). Next, items addressing these constructs were derived from the interviews. Then, cognitive interviews were conducted with patients with chronic kidney disease and their partners (n = 5 couples) to assess the face validity and comprehensibility of the items. Lastly, preliminary psychometric properties were evaluated in a sample of patients preparing to start dialysis and their partners (n = 83 couples). Results Three themes related to QOL were identified, namely dialysis expectations, accepting dialysis and dyadic relationship characteristics. The cognitive interviews refined the SDQ and established its face validity. Psychometric assessments indicated that overall the items performed well and did not show significant floor or ceiling effects. Good internal consistency was found within the three domains, and items correlated within the domains. Conclusions The SDQ is a measure (34 items) that assesses key psychological and interpersonal factors in patients and their partners as they start dialysis. It shows good preliminary psychometric properties; however, a large-scale field trial is needed to establish its validity. Once validated, it could offer a clinically useful tool to assist clinicians in preparing patients and partners for dialysis.

An amendment to this paper has been published and can be accessed via the original article.

Patients with established renal failure (ERF) and their partners prioritise quality of life (QOL), especially as the patient prepares to start dialysis. However, limited research exists which examines QOL in patient-partner couples around the start of dialysis. Patients and their partners form a unique social unit, or dyad, who influence each other and may be mutually or individually affected by illness or its treatment. Examining QOL in patient-partner dyads may provide new insight into the psychological or relationship factors related to QOL.The thesis comprises a literature review and three empirical studies which are described across four chapters: 1) a narrative literature review exploring QOL in ERF patients and their partners (Chapter 3), 2) a qualitative study using dyadic thematic analysis to examine the impact of dialysis on the dyadic relationship between male patients and their female partners (Chapter 4), 3) a multi-phase study to develop a measure to assess psychological and interpersonal factors related to QOL (Chapter 5), and 4) a longitudinal, quantitative questionnaire-based study to describe changes in QOL in patient-partner dyads over the transition onto dialysis (Chapter 6).The literature review is the first to focus on QOL in ERF patients and their partners. It identified 14 studies (8 qualitative, 4 quantitative and 2 mixed methods). A narrative review of quantitative results and a narrative synthesis of qualitative findings suggested that ERF and dialysis significantly affect QOL. Both patients and their partners described impairments in their QOL, most notably in their psychological QOL.Semi-structured interviews were conducted with 20 dyads (male patients and their female partners) who were in the early phases of dialysis (pre-dialysis to first 16 months on dialysis). Dyadic thematic analysis highlighted the substantial ways dialysis impacted their lives and were captured by the themes 'Prioritising the patient', 'Carrying the burden' and 'Changing identities'. Despite these changes, dyads who worked together and found ways to be positive, accepting of or normalised dialysis minimised negative effects on their relationship. Further analysis of the findings suggested that dialysis expectations, accepting dialysis and features of the dyadic relationship relate to QOL. A measure, the Starting Dialysis Questionnaire (SDQ), was developed to assess these constructs. Cognitive interviews and preliminary psychometric evaluations indicate that the SDQ has good face validity and overall performance.A longitudinal, quantitative study measured changes in QOL from pre-dialysis (83 dyads), at 6 weeks (42 dyads) and 12 weeks (39 dyads) after starting dialysis. Patients' general and physical QOL improved from poor to good QOL. For partners, QOL was good overall despite it worsening at 6 weeks after the patient started dialysis.he thesis makes a novel contribution to the ERF literature by focusing on patient-partner dyads over a critical time period in the illness trajectory and using methods which better our understanding of the wider interpersonal context in which dialysis occurs.

Background Suicide is the leading cause of avoidable death in prisons worldwide and suicide prevention is an international priority. Consequently, there is an urgent need to develop evidence‐based treatments. We conducted a randomized controlled trial of a novel suicide prevention psychological therapy for male prisoners. To promote ecological validity by addressing the “real‐world” situation of suicidal prisoners, we involved a consultant group of ex‐offenders with past experience of being suicidal during imprisonment. Service user involvement in prison research is challenging and underdeveloped. Objective We aimed to investigate the ex‐offender service user consultants’ experiences of being involved in the research. Design Individual qualitative interviews were conducted and analysed using an Interpretative Phenomenology Analysis (IPA) framework. Setting/participants The study was conducted at a university in North England, UK, comprising four ex‐offenders with experience of being suicidal during past imprisonments. Results Two superordinate themes were identified: “Working Together” depicted participants’ perceptions of the pivotal role of good relationships with researchers, and “Journey of Change” outlined how participants’ involvement in the research impacted on their personal lives. Discussion Little is known about how to successfully involve ex‐offender service users in research. Our results indicate the conditions necessary for successfully engaging ex‐offender service users in research and have important implications for improving the quality of prison research. Conclusions Involving forensic service users in research is feasible and should be encouraged, as despite certain challenges, it is highly rewarding both for the research and the ex‐offender service users.

Editor Post: The people of the lower Cape Fear section are very much interested in a bill now before Congress to repair Moore's Creek monument, buy some land adjoining and to beautify the grounds. The monument was built in 1837, and has been safely neglected. The battle fought there February 27, 1776, was a brilliant victory for the American forces.

Editor Post: An article in the New York Independent by Hon. H.W. Blair, LL. D., on \"Educational Conditions in Southern States,\" certainly sounds the keynote and gives a correct and true statement as to the Southern States. Considering the impoverished condition of the South, made so by the war between the States, it has done nobly and raised and expended many millions of dollars to educate her illiterate masses.

In this study, we use an exceptional skeleton of the pachycephalosaur Stegoceras validum (UALVP 2) to inform a comprehensive appendicular muscle reconstruction of the animal, with the goal of better understanding the functional morphology of the pachycephalosaur postcranial skeleton. We find that S . validum possessed a conservative forelimb musculature, particularly in comparison to early saurischian bipeds. By contrast, the pelvic and hind limb musculature are more derived, reflecting peculiarities of the underlying skeletal anatomy. The iliotibialis, ischiocaudalis, and caudofemoralis muscles have enlarged attachment sites and the caudofemoralis has greater leverage owing to the distal displacement of the fourth trochanter along the femur. These larger muscles, in combination with the wide pelvis and stout hind limbs, produced a stronger, more stable pelvic structure that would have proved advantageous during hypothesized intraspecific head-butting contests. The pelvis may have been further stabilized by enlarged sacroiliac ligaments, which stemmed from the unique medial iliac flange of the pachycephalosaurs. Although the pubis of UALVP 2 is not preserved, the pubes of other pachycephalosaurs are highly reduced. The puboischiofemoralis musculature was likely also reduced accordingly, and compensated for by the aforementioned improved pelvic musculature.

\"We are perhaps delayed,\" Street chief of staff Joyce Wilkerson said of the reorganization plan. \"We're not backing off.\" \"To us, it's something that was important to the councilwoman,\" Joe Grace said. \"What we're most focused on is moving ahead with housing reorganization.\" \"The mayor and I have fallen in and fallen out before,\" she said Wednesday. \"I think it's interesting that relationships and alliances are fluid.\"