Purpose of review:
Provision of education to inform decision making for renal replacement therapy (RRT) is a key component in the management of chronic kidney disease (CKD), yet patients report ...suboptimal satisfaction with the process of selecting a dialysis modality. Our purpose is to review the influencers of RRT decision making in the CKD population, which will better inform the process of shared decision making between clinicians and patients.
Sources of information:
PubMed and Google Scholar.
Methods:
A narrative review was performed using the main terms “chronic kidney disease,” “CKD,” “dialysis,” “review,” “decision-making,” “decision aids,” “education,” and “barriers.” Only articles in English were accessed. The existing literature was critically analyzed from a theoretical and contextual perspective and thematic analysis was performed.
Key findings:
Eight common themes were identified as influencers for decision making. “Patient-focused” themes including social influence, values and beliefs, comprehension, autonomy and sociodemographics, and “clinician-focused” themes including screening, communication, and engagement. Early predialysis education and decision aids can effectively improve decision making. Patient-valued outcomes need to be more fully integrated into clinical guidelines.
Limitations:
This is not a systematic review; therefore, no formal tool was utilized to evaluate the rigor and quality of studies included and findings may not be generalizable.
Implications:
Standardized comprehensive RRT education programs through multidisciplinary health teams can help optimize CKD patient education and shared decision making. Involving patients in the research process itself and implementing patient values and preferences into clinical guidelines can help to achieve a patient-centered model of care.
Abstract
The paintings acquired by the 7th and 8th Barons Kinnaird in the period c.1795–1828 included some of the finest Old Masters on the market, including works by Titian, Rembrandt and Rubens, ...and works from the Orléans collection. Mounting debts, however, meant that several were soon sold. Those that remained would eventually be displayed (from c.1825) in the newly built family home, Rossie Priory in Perthshire. There they attracted the attention of Gustav Friedrich Waagen, Wilhelm von Bode, Cornelis Hofstede de Groot and Bernard Berenson. The collection, however, was larger than the reports of these scholars suggested and contained important works they failed to mention. Two sources of information presented here provide fuller knowledge of the pictures in the Priory: a group of early photographs made in the 1850s and 1860s (accessible at https://collections.st-andrews.ac.uk/collection/the-rossie-priory-glass-plate-negative-collection/503453) and an inventory of the contents of the house made in 1878 and reproduced in annotated form in an online Appendix to this article. Between them they document the collection before its dispersal, principally at a London sale in 1946.
Background:
Patients with chronic kidney disease (CKD) are asked to choose a renal replacement therapy or conservative management. Education and knowledge transfer play key roles in this ...decision-making process, yet they remain a partially met need.
Objective:
We sought to understand the dialysis modality decision-making process through exploration of the predialysis patient experience to better inform the educational process.
Design:
Qualitative descriptive study.
Setting:
Kidney Care Centre of London Health Sciences Centre in London, Ontario, Canada.
Patients:
Twelve patients with CKD, with 4 patients on in-center hemodialysis, home hemodialysis, and peritoneal dialysis, respectively.
Measurements:
Not applicable.
Methods:
We conducted semistructured interviews with each participant, along with any family members who were present. Interviews were transcribed verbatim. Conventional content analysis was used to analyze the transcripts for common themes. Representative quotes were decided via team consensus. A patient collaborator was part of the research team.
Results:
Three themes influenced dialysis modality decision making: (i) Patient Factors: individualization, autonomy, and emotions; (ii) Educational Factors: tailored education, time and preparation, and available resources; and (iii) Support Systems: partnership with health care team, and family and friends.
Limitations:
Sample not representative of wider CKD population. Limited number of eligible patients. Poor recall may affect findings.
Conclusions:
Modality decision making is a complex process, influenced by the patient’s health literacy, willingness to accept information, predialysis lifestyle, support systems, and values. Patient education requires the flexibility to individualize the delivery of a standardized CKD curriculum in partnership with a patient-health care team, to fulfill the goal of informed, shared decision making.
In December 1778 the English merchant ship "Westmorland" set sail from Livorno bound for London. In the hold were crates of souvenirs, books, and works of art being shipped home by Grand Tourists. ...The "Westmorland," however, was never to reach Britain. In January 1779, it was captured by French frigates off the coast of Spain and taken to the port of Málaga, where the impounded cargo was dispersed. The perishables (including anchovies, olive oil and Parmesan cheese) were sold immediately. The works of art and books, after protracted negotiations over two years (1783-85), were purchased by King Charles III of Spain. Some of the more choice objects entered the royal collection, many of the others were donated by the King to the Real Academia de Bellas Artes in Madrid for teaching purposes, and some were appropriated by various Spanish ministers. Among the cargo was a crate marked "I. H." belonging to Sir Joseph Henderson of Fordell in Fife. Besides 93 prints by Piranesi, Henderson's crate contained a collection of books by French and Italian authors (including Petrarch, Molière, Tasso, and Goldoni), three copies of paintings by Titian and Correggio, and the portrait of a young man which is the subject of his article. Publication Abstract
Deceptive design practices have been identified and studied in games but, to date, there have been no substantial explorations of deceptive design practices within 3D environments typically found in ...PC games. These offer a new set of affordances for interacting with the player, and game developers may be able to utilize these in order to shape gameplay experiences. The goal of this work was to explore users’ perceptions of deceptive design present in a popular free-to-play 3D game. A survey was carried out with 259 adult respondents identifying and explaining instances of deceptive design within video clips of gameplay from a popular Roblox game. Thematic analysis of the responses revealed six new categories of deceptive design pattern within a 3D gameplay context: Predatory Monetization, Default to Purchase, UI Misdirection, Emotional Interpersonal Persuasion, Physical Placement, and Narrative Obligation. Through our work we hope to highlight the use of deceptive design both within current 3D games and future 3D gaming environments. This work is particularly important as 3D and VR gaming grow in popularity alongside game publishers increasingly moving towards “freemium” monetization models for income.
Until the mid-nineteenth century Giorgione was largely an ahistorical figure, a construct of the imaginations and speculations of early writers such as Vasari and Ridolfi. Of the hundreds of ...paintings attributed to him between the seventeenth and early nineteenth centuries, very few were actually painted by him. This article considers three such paintings. All had been acquired by British collectors in Venice in the second half of the eighteenth century and brought to London for sale. Their owners, the Scots artist Gavin Hamilton, and the diplomats Sir James Wright and John Strange, thought highly of their acquisitions and priced them accordingly. But although the three paintings were executed by masters in the Véneto in the first half of the Cinquecento they are not by Giorgione. This article identifies the three paintings with works now in Jerusalem, Dublin and Philadelphia, charts their histories and considers them in the context of the eighteenth-century's concept of Giorgione and in relation to other paintings attributed to Giorgione at the time.
Abstract
This paper describes a Virtual Reality (VR) prototype developed to help archaeologists and other stakeholders explore and analyse archaeological data in a more immersive context. We describe ...a VR reconstruction of Pleito Cave, a fragile world class rock-art site with accessibility limitation. Key stakeholders are identified and a prototype is described that provides a VR platform for visualizing and interacting with complex archaeological data (gathered from techniques such as decorrelation stretch and X-ray fluorescence) virtually ‘in situ’, in a way that would not be possible at the real site. The prototype allows multiple remote users to interact with the cave together remotely providing opportunities for collaborative interpretation and analysis of archaeological data. We also present a survey-based evaluation in which both archaeologists and Native American stakeholders indicate positive responses for measures of both engagement and value.
Research Highlights
An interactive, multi-user, immersive archaeological data visualization tool is described. Survey evaluation elicits insights into where the system provides value and engagement for key stakeholders. Thematic Analysis provides further design insights for future development of immersive archaeological data visualization tools.
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