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Dual-process models of cognition distinguish relatively automatic from relatively controlled processes in terms of their interactive impact on perception, judgment, and behavior. Such models have advanced explanation and prediction in a variety of domains across psychology but have yet to be comprehensively applied to the pressing societal and public health problem of suicide. We propose a model of suicide that integrates dual-process models of social cognition with ideation-to-action conceptualizations of suicide. The model specifies: (a) suicide-relevant automatic associations involving the self, others, the future, death, and bodily harm, (b) suicide-relevant motives involving the self, interpersonal relations, the future, and the desire to die, and (c) hypotheses regarding the conditions under which automatic associations and motives individually and interactively impact suicidal ideation and lethal action at various stages of an ideation-to-action framework. The model recasts a number of suicide-relevant variables in terms of the opportunity factor of dual-process theories of attitudes, which encompasses capacity-relevant variables (e.g., time, cognitive resources) that determine whether suicide-relevant judgments and behavior are the result of relatively automatic associations or more controlled, deliberative cognition. Accordingly, the model articulates a number of novel predictions regarding the sources of suicide-relevant automatic associations, motives, and opportunity factors, as well as their interactive influences on suicidal ideation and action. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A neural architecture that preferentially processes immediate survival threats relative to other negatively and positively valenced stimuli presumably evolved to facilitate survival. The empirical literature on threat superiority, however, has suffered two problems: methodologically distinguishing threatening stimuli from negative stimuli and differentiating whether responses are sped and strengthened by threat superiority or delayed and diminished by conscious processing of nonthreatening stimuli. We addressed both problems in three within-subject studies that compared responses to empirically validated sets of threating, negative, positive, and neutral stimuli, and isolated threat superiority from the opposing effect of conscious attention by presenting stimuli outside conscious perception. Consistent with threat superiority, threatening stimuli elicited stronger skin-conductance (Study 1), startle-eyeblink (Study 2), and more negative downstream evaluative responses (Study 3) relative to the undifferentiated responses to negative, positive, and neutral stimuli. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42761-021-00090-6.

Introduction Low health literacy is widely reported in people with chronic kidney disease (CKD) and has been associated with reduced disease self-management, poor health outcomes, increased mortality and poorer quality of life. However, these associations are still not well understood. Methods Electronic-based systematic searches were performed to identify studies examining associations between health literacy and self-management behaviours and/or health outcomes in patients with CKD. A tabular and narrative synthesis of the data was performed. Meta-analysis was not appropriate due to the heterogeneity of study designs and methods. Results Searches identified 48 studies that met the inclusion criteria. A total of 41 published articles, six conference abstracts, and one thesis were included. Of the 48 studies, 11 were cohort and 37 were cross-sectional. In total there were 25,671 patients; 16,952 from cohort studies. Median study sample size was 159 (IQR 92–275). Study quality was high (5), moderate (24) and poor (19). Thirteen measures of health literacy were used. Despite the limitations of the available evidence, there appear to be consistent relationships between higher health literacy and favourable self-management behaviours for patients with CKD. Definitive relationships between health literacy and patient outcomes are far less clear and remain incompletely understood. Discussion Conclusive evidence describing a causal link between health literacy and patient outcomes remains limited, but for many outcomes, a consistent association is described. In addition to associations with mortality, hospitalisation and clinical events, there were consistent associations between health literacy and favourable self-management behaviours which could support the development of patient education aimed at improving health literacy. Graphical abstract

Background Around 186 million individuals are facing infertility worldwide, with a huge impact on their wellbeing. Fertility care is considered a key element to promote reproductive health. This study aims to explore young adults’ knowledge, perceptions and concerns about infertility and Assisted Reproductive Technology (ART), and to contrast it with the information provided by ART clinics. Methods A multi-country qualitative study was conducted in Albania, Belgium, Slovenia, Spain, Italy, Kosovo, North Macedonia and Switzerland within the H2020 B2-INF project (Grant Agreement 872706). In 2021, 10-15 semi-structured interviews were conducted in each country with participants aged 18-30, childless and non-ART users. Additionally, 3-5 clinics’ websites in each country were explored. Data was collected in native languages and translated into English. A thematic analysis was carried out. Results In total, 98 interviews were conducted and 38 clinics’ websites were explored. Three themes emerged from the analysis of the interviews: 1. Parenthood and (in)fertility; 2. Young people's perception on ART; 3. Information and publicity of ART. Parenthood was described as a relationship beyond biological ties and infertility as a social taboo. Most participants perceived ART positively and would use it if needed, although knowledge on ART was low. Participants considered information on ART as scarce and suggested that government-led information campaigns should be launched to raise awareness on it. Concerning clinics, the websites provided information on infertility and exhaustive technical descriptions of ART techniques, although it may be difficult for the general population to understand. Data offered on success rates were unclear and heterogeneous. Conclusions Gaps in citizens’ expectations and needs and the information provided by ART clinics were identified. Awareness campaigns are needed to diminish social taboo on infertility and ART and to promote reproductive health. Key messages • Assisted Reproductive Technology is positively perceived by young adults, though their knowledge of it and infertility is low. Information campaigns are thus needed to raise awareness among the young. • ART clinics have room for improvement in aligning the information provided on their websites with young people's perceptions and needs, and to show it in a more accessible and understandable way.

Objective Accurate threat appraisal is central to survival. In the case of the coronavirus pandemic, accurate threat appraisal is difficult due to incomplete medical knowledge as well as complex social factors (e.g., mixed public health messages). The purpose of this study was to evaluate the degree to which individuals accurately perceive COVID-19 infection rates and to explore the role of COVID-19 threat perception on emotional and behavioral responses both cross sectionally and prospectively. Methods: A community sample (N = 249) was assessed using online crowdsourcing and followed for one month. COVID-19 threat appraisal was compared with actual COVID-19 infection rates and deaths at the time of data collection in each participant's county and state. It was predicted that actual versus perceived COVID-19 infection rates would only be modestly associated. Relative to actual infection rates, perceived infection rates were hypothesized to be a better predictor of COVID-related behaviors, distress, and impairment. Results: Findings indicated that relative to actual infection, perceived infection was a better predictor of COVID-related outcomes cross sectionally and longitudinally. Interestingly, actual infection rates were negatively related to behaviors cross sectionally (e.g., less stockpiling). Prospectively, these variables interacted to predict avoidance behaviors over time such that the relationship between perceived infection and avoidance was stronger as actual infection increased. Conclusions: These data suggest that perceived COVID-19 infection is significantly associated with COVID-related behaviors, distress and impairment whereas actual infection rates have a less important and perhaps even paradoxical influence on behavioral responses to the pandemic.

Mouse-tracking facilitates exploration of the mental processes underlying decision-making. As the cognitive system works to settle on a decision, response competition manifests in the motor movements of the hand, bringing the mouse relatively closer to one alternative versus the other. Many metrics provide insight into decision-making processes by indexing the shape or complexity of the mouse trajectory. Lacking, however, is a metric that estimates the point in time when a participant begins to correctly categorize a stimulus. We rectify this absence by introducing a metric we refer to as time of initiating correct categorization (TICC), which is the point in time when people began moving relatively closer to the selected target relative to the distractor. We briefly review existing approaches to measuring time in mouse-tracking before describing the TICC and demonstrating its utility in three data sets.

Introduction No formal cost-effectiveness analysis has been performed for programs of cycling exercise during dialysis (intradialytic cycling [IDC]). The objective of this analysis is to determine the effect of a 6-month program of IDC on health care costs. Methods This is a retrospective formal cost-effectiveness analysis of adult participants with end-stage kidney disease undertaking in-center maintenance hemodialysis enrolled in the CYCLE-HD trial. Data on hospital utilization, primary care consultations, and prescribed medications were extracted from medical records for the 6 months before, during, and after a 6-month program of thrice-weekly IDC. The cost-effectiveness analysis was conducted from a health care service perspective and included the cost of implementing the IDC intervention. The base-case analyses included a 6-month “within trial” analysis and a 12-month “within and posttrial” analysis considering health care utilization and quality of life (QoL) outcomes. Results Data from the base-case within trial analysis, based on 109 participants (n = 56 control subjects and n = 53 IDC subjects) showed a reduction in health care utilization costs between groups, favoring the IDC group, and a 73% chance of IDC being cost-effective compared with control subjects at a willingness to pay of £20,000 and £30,000 per quality-adjusted life year (QALY) gained. When QoL data points were extrapolated forward to 12 months, the probability of IDC being cost-effective was 93% and 94% at £20,000 and £30,000 per QALY gained. Sensitivity analysis broadly confirms these findings. Conclusion A 6-month program of IDC is cost-effective and the implementation of these programs nationally should be a priority., Graphical abstract

Study question Are the young citizens’ perceptions and expectations on Assisted Reproduction Technologies (ART) aligned with the information that ART clinics offer to citizens? Summary answer There is a gap between young citizen’s perceptions and expectations and the information offered by ART providers taking into account gender, sociocultural, and legal perspectives. What is known already Studies investigating young people’s opinions, concerns, and expectations in relation to ART are scarce. Some studies have highlighted that young adults reported low general knowledge about ART and overestimated its success rates. In addition, gaps in knowledge about fertility and the potential of ART have been described among this population. To our knowledge, there are no studies that compare young people’s perceptions with the information offered by ART providers. Study design, size, duration B2-Inf is funded by the European Union’s Horizon 2020 research and innovation programme (Grant Agreement No 872706), to be executed in 36 months. B2-InF contrasts ART perceptions of young population from 8 countries (Spain, Belgium, Italy, Switzerland, Kosovo, Albania, Macedonia, Slovenia) with the information provided by ART clinics to society in the same countries. To reach this objective, a descriptive multicentre qualitative study was designed through semi-structured interviews and documentary data collection from ART clinics Participants/materials, setting, methods From March to December 2021, 10-15 semi-structured interviews were conducted in each country. Participants were men and women aged 18 to 30 years old, childless and non-ART users. Additionally, 3-5 clinics’ websites from each country were planned to be explored and clinics’ ‘physical information’, such as consent forms, were requested. All the information was collected and transcribed verbatim in the native language and afterwards translated into English. A thematic analysis was conducted using Atlas.ti V9. Main results and the role of chance In total, 98 interviews were conducted: 15 in Spain, 14 in Belgium, 13 in Italy, 10 in Switzerland, 15 in Kosovo, 11 in Albania, 10 in North Macedonia and 10 in Slovenia; and 33 clinics were explored: 5 in Spain, 5 in Belgium, 5 in Italy, 5 in Switzerland, 5 in Kosovo, 5 in Albania, 5 in North Macedonia and 3 in Slovenia. The themes that emerged in the analysis of interviews were: 1. Social perceptions of parenthood and fertility; 2. Young people’s perceptions on ART; 3. Information and publicity of ART. Participants described parenthood as a relationship beyond biological ties and identified infertility as a social taboo. Young’s perceptions on ART techniques were positive and most would use it in case of need, but the knowledge related to ART was limited. Most participants suggested that trustworthy national information campaigns led by Governments should be implemented to raise awareness of ART. Regarding clinics, information on websites addressed risk factors and prevalence of infertility. It included description of ART techniques with unclear data about success rates, economic information and clinics human resources and facilities. Gaps were identified between citizens’ expectations and needs and the online information provided by ART clinics. Limitations, reasons for caution This is a first thematic analysis that provides an overview of the possible gaps between young citizen’s expectations and the information provided by ART clinics. In next steps of B2-InF project, an in-depth qualitative analysis will be conducted considering gender, sociocultural, and legal perspectives. Wider implications of the findings This is the first systematic multinational study that compare young people’s perceptions about ART and information provided by ART clinics. Although this is a preliminary analysis, the results will be used to develop national guidelines to inform policies on ART services with potential impact on European citizens and ART providers. Trial registration number European Union’s Horizon 2020 Research and Innovation Programme (Grant Agreement No 872706)

Physically threatening objects are negative, but negative objects are not necessarily threatening. Moreover, responses elicited by threats to physical harm are distinct from those elicited by other negatively (and positively) valenced stimuli. We discuss the importance of the threat versus valence distinction for implicit measurement both in terms of the activated evaluation and the design of the measure employed to assess that evaluation. We suggest that accounting for the distinct evaluations of threat and valence better enables implicit measures to provide understanding and prediction of subsequent judgment, emotion, and behavior.

Objective This systematic review provides an up-to-date synthesis on the effects of extended hemodialysis on nutritional outcomes. Design and Methods Ten databases were searched. Inclusion criteria were: randomised and non-randomised studies of extended hemodialysis (defined by > 15 h/week) with a comparator group which received conventional in-centre hemodialysis (usually ≤ 12 h per week). Outcomes of interest included lean body mass, protein and carbohydrate intake, body mass index, dry lean mass, water-soluble vitamin levels, serum levels of appetite hormones, and nutritional status as assessed by the PEW and SGA scoring tools. Results Five studies were eligible. All investigated extended nocturnal hemodialysis (one with the addition of short daily), three were in-centre and two were at home. Range of duration for the included studies was 2–18 months. These studies reported data on lean body mass, protein and carbohydrate intake, body mass index, dry lean mass and water-soluble vitamin levels. There was insufficient homogeneity between the studies to meta-analyse the data. Extended hemodialysis had no significant effects on any of the reported outcomes except for lean body mass, where a significant increase was found, and water-soluble vitamin levels, where deficiency was identified in one of the included studies. Conclusion There is currently no evidence to suggest that extended hemodialysis modalities impact nutritional parameters, although the quality of the available evidence is low. Graphical abstract

BackgroundFewer trials are conducted in nephrology than any other specialty, often failing to recruit to target, resulting in unclear evidence affecting translation to clinical practice. This mixed-methods study aims to provide guidance for designing and reporting future randomised controlled trials (RCTs) in the haemodialysis population.MethodA scoping review was conducted. Five databases (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov) were searched for RCTs published between 2013 and 2019 involving prevalent adult haemodialysis patients. Reporting of sample size, recruitment, retention and statistical significance of primary outcome were assessed. Face-to-face semistructured interviews were conducted with individuals from a single centre during dialysis sessions. Interviews were analysed thematically.ResultsOf 786 RCTs identified, 636 (80.9%) were parallel-group, 139 (17.7%) were crossover and 11 (1.4%) were cluster (including one stepped-wedge) design. Sample size justification was reported in 73.1%, 53.8% and 45.5% of parallel-group, crossover and cluster trials, respectively.Target recruitment was achieved by 45.5% of cluster, 53.8% of crossover and 57.7% of parallel-group trials with patient retention at 75.6%, 83.1% and 87.8%, respectively. Primary outcome reached statistical significance in 81.8% of cluster trials, 69.2% of parallel-group and 38.5% of crossover trials.Themes identified from individual interviews: perceptions of the convenience of trial participation; group allocation; perceptions of the benefits and adverse effects of taking part in clinical trials.ConclusionThe recruitment and reporting of RCTs involving people on haemodialysis could be improved. Involvement of all stakeholders and especially participants in the trial design process may address issues around participant burden and ultimately improve the evidence base for clinical practice.

Following theories of emotional embodiment, the facial feedback hypothesis suggests that individuals' subjective experiences of emotion are influenced by their facial expressions. However, evidence for this hypothesis has been mixed. We thus formed a global adversarial collaboration and carried out a preregistered, multicentre study designed to specify and test the conditions that should most reliably produce facial feedback effects. Data from n = 3,878 participants spanning 19 countries indicated that a facial mimicry and voluntary facial action task could both amplify and initiate feelings of happiness. However, evidence of facial feedback effects was less conclusive when facial feedback was manipulated unobtrusively via a pen-in-mouth task., National Science Centre, Poland [2019/35/B/HS6/00528]; JSPS KAKENHI [16H03079, 17H00875, 18K12015, 20H04581, 21H03784]; National Council for Scientific and Technological Development (CNPq); Polish National Science Center; DFG Beethoven grant [2016/23/G/HS6/01775]; National Science Foundation Graduate Research Fellowship [R010138018]; Ministerio de Ciencia, Innovacion y Universidades [PGC2018-098558-B-I00]; Comunidad de Madrid [H2019/HUM-5705]; Teesside University; Occidental College Academic Student Project Award, This work was financially supported by B. Stastny, who generously donated funds for this research in memory of his father, Bill Stastny (J.T.L.). The work was also supported by the National Science Centre, Poland (grant no. 2019/35/B/HS6/00528; K.B.), JSPS KAKENHI (grant nos 16H03079, 17H00875, 18K12015, 20H04581 and 21H03784; Y.Y.), the National Council for Scientific and Technological Development (CNPq; R.M.K.F.), the Polish National Science Center (M.P.), the DFG Beethoven grant no. 2016/23/G/HS6/01775 (M.P.), the National Science Foundation Graduate Research Fellowship (grant no. R010138018; N.A.C.), the Ministerio de Ciencia, Innovacion y Universidades (grant no. PGC2018-098558-B-I00; J.A.H.), the Comunidad de Madrid (grant no. H2019/HUM-5705; J.A.H.), Teesside University (N.B.) and the Occidental College Academic Student Project Award (S.L.). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We also thank C. Scavo and A. Bidani for help with translating the study materials, L. Pullano and R. Giorgini for help with coding, and E. Tolomeo and L. Pane for help with data collection.

Threat avoidance involves both detection of a threatening stimulus and reaction to it. We demonstrate with empirically validated stimuli (that are threatening, nonthreatening-negative, neutral, or positive) that threat detection is more pronounced among males, whereas threat reactivity is more pronounced among females. Why women are less efficient detectors of threat challenges Benenson et al.'s conceptual analysis.

The Dual Implicit Process Model (March et al., 2018b) distinguishes the implicit processing of physical threat (i.e., "Can it hurt or kill me?") from valence (i.e., "Do I dislike/like it?"). Five studies tested whether automatic anti-Black bias is due to White Americans associating Black men with threat, negative valence, or both. Studies 1 and 2 assessed how quickly White participants decided whether positive, negative, and threatening images were good versus bad when primed by Black versus White male-faces. Studies 3 and 4 assessed how early in the decision process White participants began deciding whether Black and White (and, in Study 3, Asian) male-faces displaying anger, sadness, happiness, or no emotion were, in Study 3, dangerous, depressed, cheerful, or calm or, in Study 4, dangerous, negative, or positive. Study 5 assessed how quickly White participants decided whether negative and threatening words were negative versus dangerous when primed by Black versus White male-names. All studies indicated that White Americans automatically associate Black men with physical threat. Study 3 indicated the association is unique to Black men and did not extend to Asian men as a general intergroup effect. Studies 3, 4, and 5, which simultaneously paired threat against negativity, indicated that the Black-threat association is stronger than a Black-negative association. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Recent work suggests that good/bad out-group favoritism of Blacks for Whites may reflect positive associations with White rather than negative associations with Black. The Dual Implicit Process Model suggests that Blacks may come to associate their own group with threat, even absent a concurrent Black-negative association. This work tests this idea among Black Americans. Three studies tested this possibility using mouse-tracking (Study 1) and evaluative priming tasks (Studies 2 and 3) to assess how quickly participants make judgments involving Black versus White male faces and names. All studies found that that Black Americans hold automatic Black-threat associations absent automatic Black-negative associations. This supports the Dual Implicit Process Model’s threat versus negativity distinction within the realm of anti-Black bias and supplements recent work by showing that the presence of out-group favoritism on one dimension (i.e., threat) can occur even in the absence of out-group favoritism on a seemingly related dimension (i.e., negativity).

Background Acute kidney injury (AKI) can lead to chronic kidney disease, which results in poor long-term outcomes. There is plausibility that increased levels of physical activity may promote renal recovery post-AKI. This study aimed to investigate associations between physical activity levels and renal recovery following stage 3 AKI, and to assess the feasibility of measuring physical activity levels in this population. Methods Forty One hospitalised patients with AKI stage 3 were enrolled. Serum creatinine and estimated glomerular filtration rate (eGFR) were collected at 12 months prior to the development of AKI, during the hospital admission when the episode of AKI stage 3 occurred, and at 1-, 3- and 6-months post discharge. All participants completed the General Practice Activity Questionnaire (GPPAQ) to assess physical activity levels. A pedometer was also worn for 7 days immediately following discharge and at 6-months post discharge to ascertain an average daily step count. Feasibility outcomes including eligibility, recruitment and retention rates, and losses to follow up were also assessed. Results The average (± SD) baseline eGFR and median (IQR) serum creatinine was 71 ± 20 mL/min/1.73m2 and 85 (49) μmol/L respectively. A threefold increase in creatinine occurred during hospitalisation 436 (265) μmol/L. Greatest renal recovery occurred prior to discharge, with recovery continuing for a further three months. Inactive individuals (low GPPAQ scores) had consistently higher serum creatinine values compared to those who were active: 1 months 122 (111) μmol/L vs 70 (0) μmol/L, 6 months 112 (57) μmol/L vs 68 (0) μmol/L. Individuals with higher step counts also displayed better renal recovery 6-months post discharge (r = -0.600, p = 0.208). Conclusions Higher levels of physical activity are associated with improved renal recovery after 6- months following an episode of stage 3 AKI. A future randomised controlled trial is feasible and would be required to confirm these initial findings.

Poster presented during the31st National IVF Conference, Brno, Czech Republic. &nbsp

Purpose Patients receiving haemodialysis (HD) display elevated circulating microparticle (MP) concentration, tissue factor (TF) expression and markers of systemic inflammation, though regular intradialytic cycling (IDC) may have a therapeutic effect. This study investigated the impact of regular, moderate-intensity IDC on circulating MPs and inflammatory markers in unit-based HD patients. Methods Patients were cluster-randomised to intervention (n = 20, age: 51.4 ± 18.1 years, body mass: 77.6 ± 18.3 kg, mean ± SD) or no-exercise control (n = 20, 56.8 ± 14.0 years, 80.5 ± 26.5 kg). Intervention participants completed 30 min of moderate intensity (rating of perceived exertion [RPE] of 12–14) IDC, thrice weekly for 6 months. Pre-dialysis venous blood samples were obtained at 0, 3 and 6 months. Circulating MP phenotypes, cytokines, chemokine and MP TF expression were quantified using flow cytometry and cytometric bead array assays. Results Despite high exercise compliance (82%), no IDC-dependent effects were observed for any MP, cytokine or chemokine measure (p ≥ 0.051, ηρ2 ≤ 0.399) other than TNF-α (p = 0.001, ηρ2 = 0.186), though no significance was revealed upon post hoc analysis. Conclusion Six months of regular, moderate-intensity IDC had no effect on MPs, cytokines or chemokines. This suggests that the exercise did not exacerbate thrombotic or inflammatory status, though further functional assays are required to confirm this. Trial registration ISRCTN1129707, prospectively registered on 05/03/2015.

Children receiving Immediate Hypersensitivity Skin Tests (IHST) often experience intense itchiness at the test site prior to completion of the procedure, which can lead to incompliance and increased stress. This study assessed low-cost virtual reality (VR) with the standard of care (e.g., Look and Find or I Spy books) as forms of interactive distraction on pediatric patient’s cooperation and perception of negative procedural outcomes (i.e., itchiness and distress) for patients receiving IHST. Two hundred and twenty patients five to 12 years of age who received an IHST were randomized to either the VR (experimental) or standard of care (control) group. Compliance, coping, and perceived itch outcomes were compared between groups in addition to being compared by age category and sex. None of the primary outcomes differed significantly for patients in the control versus experimental group, although patients in the experimental group were significantly more likely to fail to complete the assessment (p = 0.034). Despite VR being a novel technology, the results showed that the VR group had similar outcomes compared to the standard of care group regarding patients’ compliance, coping, and perceived itch.

No abstract available.

Availability of data and materials: All data and material used in the production of this guideline can be found within the references. Supplementary Information: available at https://static-content.springer.com/esm/art%3A10.1186%2Fs12882-021-02618-1/MediaObjects/12882_2021_2618_MOESM1_ESM.docx - Additional file 1: Appendix HD1. Full search strategies for a review of recent systematic reviews and randomised controlled trial data. Physical activity and exercise guidelines for individuals with end-stage kidney disease (ESKD) receiving haemodialysis. Appendix HD2. Flow diagram of search results. Appendix TX1. Full search strategies for a review of reviews reporting on the importance of physical activity and exercise in renal transplant recipients. Appendix TX2. Full search strategies for meta-analysis investigating the evidence for the effect of exercise training interventions in adult kidney transplant recipients. Appendix TX3. Flow diagram of systematic search of literature and included studies (until January 2020). Appendix TX4. Table of characteristics of included studies. Appendix TX5. Forest plots. Appendix TX6. Risk of bias summary. Appendix TX7. ‘Leave-one-out’ sensitivity analysis. Appendix TX8. Funnel plots. Copyright © The Author(s) 2022. Background: The statement that ‘if exercise were a pill it would be one of the most widely prescribed and cost-effective drugs ever invented’ has been used many times, with many slightly different iterations and with good reason; because the evidence is compelling, and the message is clear that being active provides a foundation for a longer, healthier and happier life. Although other national and international kidney disease guideline documents include some basic recommendations for physical activity and lifestyle, at the time of publication this is the first document of its kind to set out the evidence for those people living with kidney disease, including those on haemodialysis and with a kidney transplant. The scope of these guidelines was agreed by a multi-professional group of healthcare experts, experienced in this field, over three separate meetings of the UK Kidney Research Consortium Clinical Study Group for Exercise and Lifestyle. The authors and guideline development group entirely accept that physical activity recommendations comprise the majority of this document; this is intentional to avoid duplicating expert evidence that can be found elsewhere. Throughout, these national and international resources have been signposted, where appropriate. Systematic literature searches were undertaken to identify all published clinical evidence relevant to the review questions and the exact parameters are outlined below. As well as pragmatic audit measures, we have included ‘Points for implementation’ which we hope will help to translate some of the recommendations into clinical practice in your units. The group would like to particularly highlight the contributions of Drs Baker, March and Wilkinson who led the evidence reviews for the CKD, haemodialysis and transplantation sections, respectively. Not applicable.

Background and Aims Individuals who receive haemodialysis have a high mortality rate, up to 20% within one year of starting dialysis and just under 50% at 5 years. One of the risk factors that contributes to this high mortality rate is the nutritional status of haemodialysis patients; improving this will be a key element of risk mitigation. Extended haemodialysis may improve nutritional outcomes through better clearance and reduced dietary restrictions and medications. The aim of this systematic review is to provide an up to date assessment of trials of extended haemodialysis reporting the following nutritional outcomes: Lean body mass, body mass index, protein intake and energy intake, nutritional status assessed by the subjective global assessment and PEW scores, and circulating markers of appetite. Method No limits on language were set, and databases were searched from inception to December 2020 using a predefined search strategy. Inclusion criteria were; randomised and non-randomised trials of extended haemodialysis (defined by >15 hours per week of total haemodialysis time), with a comparator group which received conventional in-centre haemodialysis (usually Results Searches identified 9251 records. After removing duplicates 6190 records were screened for title and abstract against inclusion criteria, leaving 22 papers for full text screening. A further 17 records were removed following full text screening. Of the remaining 5 papers, one was a randomised controlled trial and four were prospective, non-randomised trials. All studies investigated nocturnal haemodialysis (one with the additional of short daily), three were in-centre and two were at home. Range of duration for the included studies was 2-18 months. Outcomes of interest measured included lean body mass, protein and carbohydrate intake, body mass index, dry lean mass and water soluble vitamin levels. Of these trials, only one reported a statistically significant increase in an outcome of interest (lean body mass). One study also reported cross-sectional data highlighting Vitamin-C deficiency in half of their nocturnal haemodialysis population. Conclusion There is insufficient high-quality evidence assessing the effect of extended haemodialysis on nutritional parameters. Further research is required to understand the impact of novel dialysis prescriptions on these clinical parameters.

OBJECTIVE: Protein-energy wasting is highly prevalent in people with end-stage kidney disease receiving regular hemodialysis. Currently, it is unclear what the optimal nutritional recommendations are, which is further complicated by differences in dietary patterns between countries. The aim of the study was to understand and compare dietary intake between individuals receiving hemodialysis in Leicester, UK and Nantong, China. METHODS: The study assessed 40 UK and 44 Chinese participants’ dietary intake over a period of 14 days using 24-hour diet recall interviews. Nutritional blood parameters were obtained from medical records. Food consumed by participants in the UK and China was analyzed using the Nutritics and Nutrition calculator to quantify nutritional intake. RESULTS: Energy and protein intake were comparable between UK and Chinese participants, but with both below the recommended daily intake. Potassium intake was higher in UK participants compared to Chinese participants (2,115 [888] versus 1,159 [861] mg/d; P < .001), as was calcium (618 [257] versus 360 [312] mg/d; P < .001) and phosphate intake (927 [485] versus 697 [434] mg/d; P = .007). Vitamin C intake was lower in UK participants compared to their Chinese counterparts (39 [51] versus 64 [42] mg/d; P = .024). Data are reported here as median (interquartile range). CONCLUSION: Both UK and Chinese hemodialysis participants have insufficient protein and energy in their diet. New strategies are required to increase protein and energy intakes. All participants had inadequate daily intake of vitamins C and D; there may well be a role in the oral supplementation of these vitamins, and further studies are urgently needed.

Mouse-tracking facilitates exploration of the mental processes underlying decision-making. As the cognitive system works to settle on a decision, response competition manifests in the motor movements of the hand, bringing the mouse relatively closer to one alternative versus the other. Many metrics provide insight into decision-making processes by indexing the shape or complexity of the mouse trajectory. Lacking, however, is a metric that estimates the point in time when a participant begins to correctly categorize a stimulus. We rectify this absence by introducing a metric we refer to as time of initiating correct categorization (TICC), which is the point in time when people began moving relatively closer to the selected target relative to the distractor. We briefly review existing approaches to measuring time in mouse-tracking before describing the TICC and demonstrating its utility in three data sets.

The role of implicit processes during police-civilian encounters is well studied from the perspective of the police. Decades of research on the “shooter bias” suggests that implicit Black-danger associations potentiate the perception of threat of Black individuals, leading to a racial bias in the decision to use lethal force. Left understudied are civilians’ possible associations of police with danger and how such associations pervade behavior and explicit views of the police. The current work begins to address this gap. In two within-subjects studies, we separately assess police-threat (i.e., safety/danger) and police-valence (i.e., good/bad) associations as well as their relative influences on explicit perceptions of police. Study 1 revealed that implicit threat evaluations (police-danger associations) more strongly predicted negative explicit views of the police compared to implicit valence evaluations (police-negative associations). Study 2 replicated these findings and suggests that individuals evaluate the police as more dangerous versus negative when each response is pitted against each other within single misattribution procedure trials. The possible implications for explicit attitudes toward police reform and behavior during police-civilian encounters are discussed. Supplementary Information The online version contains supplementary material available at 10.1186/s41235-021-00343-9.

ObjectivesFrailty is highly prevalent in haemodialysis (HD) patients, leading to poor outcomes. This study aimed to determine whether a randomised controlled trial (RCT) of intradialytic exercise is feasible for frail HD patients, and explore how the intervention may be tailored to their needs.DesignMixed-methods feasibility.Setting and participantsPrevalent adult HD patients of the CYCLE-HD trial with a Clinical Frailty Scale Score of 4–7 (vulnerable to severely frail) were eligible for the feasibility study.InterventionsParticipants in the exercise group undertook 6 months of three times per week, progressive, moderate intensity intradialytic cycling (IDC).OutcomesPrimary outcomes were related to feasibility. Secondary outcomes were falls incidence measured from baseline to 1 year following intervention completion, and exercise capacity, physical function, physical activity and patient-reported outcomes measured at baseline and 6 months. Acceptability of trial procedures and the intervention were explored via diaries and interviews with n=25 frail HD patients who both participated in (n=13, 52%), and declined (n=12, 48%), the trial.Results124 (30%) patients were eligible, and of these 64 (52%) consented with 51 (80%) subsequently completing a baseline assessment. n=24 (71% male; 59±13 years) dialysed during shifts randomly assigned to exercise and n=27 (81% male; 65±11 years) shifts assigned to usual care. n=6 (12%) were lost to follow-up. The exercise group completed 74% of sessions. 27%–89% of secondary outcome data were missing. Frail HD patients outlined several ways to enhance trial procedures. Maintaining ability to undertake activities of daily living and social participation were outcomes of primary importance. Participants desired a varied exercise programme.ConclusionsA definitive RCT is feasible, however a comprehensive exercise programme may be more efficacious than IDC in this population.Trial registration numbersISRCTN11299707; ISRCTN12840463.

Acute kidney injury (AKI) is a known risk factor for chronic kidney disease (CKD) and end stage kidney disease (ESKD). The progression from AKI to CKD, despite being well recognised, is not completely understood, although sustained inflammation and fibrosis are implicated. A therapeutic intervention targeting the post AKI stage could reduce the progression to CKD, which has high levels of associated morbidity and mortality. Exercise has known anti-inflammatory effects with animal AKI models demonstrating its use as a therapeutic agent in abrogating renal injury. This suggests the use of an exercise rehabilitation programme in AKI patients following discharge could attenuate renal damage and improve long term patient outcomes. In this review article we outline considerations for future clinical studies of exercise in the AKI population.

Patients with end-stage kidney disease (ESKD) are often sedentary and decreased functional capacity associates with mortality. The relationship between cardiovascular disease (CVD) and physical function has not been fully explored. Understanding the relationships between prognostically relevant measures of CVD and physical function may offer insight into how exercise interventions might target specific elements of CVD. 130 patients on haemodialysis (mean age 57 ± 15 years, 73% male, dialysis vintage 1.3 years (0.5, 3.4), recruited to the CYCLE-HD trial (ISRCTN11299707), underwent cardiovascular phenotyping with cardiac MRI (left ventricular (LV) structure and function, pulse wave velocity (PWV) and native T1 mapping) and cardiac biomarker assessment. Participants completed the incremental shuttle walk test (ISWT) and sit-to-stand 60 (STS60) as field-tests of physical function. Linear regression models identified CV determinants of physical function measures, adjusted for age, gender, BMI, diabetes, ethnicity and systolic blood pressure. Troponin I, PWV and global native T1 were univariate determinants of ISWT and STS60 performance. NT pro-BNP was a univariate determinant of ISWT performance. In multivariate models, NT pro-BNP and global native T1 were independent determinants of ISWT and STS60 performance. LV ejection fraction was an independent determinant of ISWT distance. However, age and diabetes had the strongest relationships with physical function. In conclusion, NT pro-BNP, global native T1 and LV ejection fraction were independent CV determinants of physical function. However, age and diabetes had the greatest independent influence. Targeting diabetic care may ameliorate deconditioning in these patients and a multimorbidity approach should be considered when developing exercise interventions. Electronic Supplementary Material The online version of this article ( 10.1007/s10554-020-02112-z ) contains supplementary material, which is available to authorized users.

Background Identifying coronary artery disease (CAD) in patients with end-stage renal disease (ESRD) is challenging. Adenosine stress native T1 mapping with cardiovascular magnetic resonance (CMR) may accurately detect obstructive CAD and microvascular dysfunction in the general population. This study assessed the feasibility and reliability of adenosine stress native T1 mapping in patients on haemodialysis. Methods The feasibility of undertaking rest and adenosine stress native T1 mapping using the single-shot Modified Look-Locker inversion recovery (MOLLI) sequence was assessed in 58 patients on maintenance haemodialysis using 3 T CMR. Ten patients underwent repeat stress CMR within 2 weeks for assessment of test-retest reliability of native T1, stress T1 and delta T1 (ΔT1). Interrater and intrarater agreement were assessed in 10 patients. Exploratory analyses were undertaken to assess associations between clinical variables and native T1 values in 51 patients on haemodialysis. Results Mean age of participants was 55 ± 15 years, 46 (79%) were male, and median dialysis vintage was 21 (8; 48) months. All patients completed the scan without complications. Mean native T1 rest, stress and ΔT1 were 1261 ± 57 ms, 1297 ± 50 ms and 2.9 ± 2.5%, respectively. Interrater and intrarater agreement of rest T1, stress T1 and ΔT1 were excellent, with intraclass correlation coefficients (ICC) > 0.9 for all. Test-retest reliability of rest and stress native T1 were excellent or good (CoV 1.2 and 1.5%; ICC, 0.79 and 0.69, respectively). Test-retest reliability of ΔT1 was moderate to poor (CoV 27.4%, ICC 0.55). On multivariate analysis, CAD, diabetes mellitus and resting native T1 time were independent determinants of ΔT1 (β = − 0.275, p = 0.019; β = − 0.297, p = 0.013; β = − 0.455; p Conclusions Rest and adenosine stress native T1 mapping is feasible and well-tolerated amongst patients with ESRD on haemodialysis. Although rater agreement of the technique is excellent, test-retest reliability of ΔT1 is moderate to poor. Prospective studies should evaluate the relationship between this technique and established methods of CAD assessment and association with outcomes.

Background and Aims Individuals with end-stage kidney disease receiving haemodialysis have elevated levels of circulating endotoxin as a result of changes to the intestinal barrier. These elevated levels are believed to play a role in the high levels of inflammation in this population. Programmes of cycling during dialysis (Intradialytic cycling (IDC)) can provide benefits to individuals receiving haemodialysis, but it is unclear how they may effect circulating levels of endotoxin. Therefore, the primary aim of this study is to investigate the effect of a 6-month programme of IDC on circulating endotoxin. Further aims are to investigate the associations between levels of physical activity and levels of circulating endotoxin and markers of inflammation in haemodialysis patients. Method This is a secondary analysis of the CYCLE-HD randomised controlled trial (ISRCTN11299707). Participants were randomised to either a 6-month programme of IDC (thrice weekly, moderate intensity cycling at RPE 12-14) in addition to usual care (n=46), or usual care (n=46) only. At baseline and 6 months blood samples were collected from the arterial needle immediately prior to haemodialysis therapy and following centrifugation stored at -80°C. Endotoxin, interleukin (IL)-6, IL-10, tumour necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (Hs-CRP) were quantified using immunoassays. Levels of physical activity were measured using an accelerometer. Participants were instructed to wear the accelerometer for 7 days at baseline, and steps per day were calculated by dividing total steps by number of days worn . Results Steps per day data and endotoxin and inflammatory data was available for n=81 participants at baseline. There was a significant negative association between number of steps per day and IL-6 (P=0.001, R=-0.361), Hs-CRP (P Conclusion Higher levels of physical activity were associated with lower levels of circulating endotoxin, IL-6 and Hs-CRP in individuals receiving haemodialysis. A 6-month programme of IDC did not result in increases in circulating endotoxin, indicating that this physiological stress does not result in changes to the intestinal barrier in haemodialysis patients. Lastly, IDC did not appear to increase circulating markers of inflammation.

Background and Aims There are fewer trials conducted in nephrology than any other speciality. Many trials fail to recruit to target and are therefore underpowered, resulting in unclear evidence and unlikely to be implemented into clinical practice. Carefully designed trials could improve the treatment options for haemodialysis patients. These could include designs other than individually randomised parallel group designs. We have reviewed cluster, stepped wedge and crossover randomised trials carried out in prevalent haemodialysis patients. Method A search for randomised controlled trials (RCTs) in haemodialysis patients was conducted across five databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov) in October 2019. The first publication of a stepped wedge trial in haemodialysis was in 2013, so we searched from 2013-2019. Inclusion criteria were RCTs including adults receiving at least 3 months of haemodialysis. Once eligible studies were identified, we compared the sample size sections to the CONSORT requirements and extracted data on these parameters and assessed recruitment targets, attrition rates and primary outcome result. Results We identified 911 RCTs of which 13 (1.4%) cluster randomised trials, including one stepped wedge, and 145 (15.9%) crossover trials were identified. Data were extracted for 10 randomly selected crossover trials. The total sample size required was not reported in 46% (n=6) cluster trials and 60% (n=6) crossover trials, with only 37.5% (n=3) of cluster trials and 50% (n=4) of crossover trials providing a justification for their sample size. In cluster trials, 13% (n=1) stated number of clusters required and 25% (n=2) gave the average cluster size, none of these stated the anticipated variance in cluster size and only 12.5% (n=1) stated the intracluster correlation (ICC) used to calculate the sample size, with none taking into account uncertainty in ICC. In 31% (n=4) of the cluster trials, the dialysis centre was the cluster and in the other 69% (n=9), the dialysis shift was the cluster. For crossover trials, within participant variability was only accounted for in 12.5% (n=1) of trials. A CONSORT flow diagram was reported in 70% of the trials assessed, with 39% recruiting to target. There were also some differences seen between crossover and cluster designs. The average number of participants at the start of a cluster trial was 470, compared to 26 in crossover trials. Where able to assess, cluster trials had an average attrition rate of 25% this was lower in crossover trials, where the average attrition rate was 14%. Eighty five percent (n=11) of cluster trials had a primary outcome reaching statistical significance, however only 20% (n=2) of crossover trials reached statistical significance. Conclusion Cluster and crossover randomised trials are poorly reported. There was insufficient information provided for sample size calculations to be replicated in majority of trials. The average attrition rate was low in crossover trials, however a large proportion of these trials did not have a primary outcome reaching statistical significance, suggesting these trials could have been underpowered. Improvements in the design, conduct and reporting of cluster and crossover trials in the haemodialysis population is urgently required.

Background and Aims Acute kidney injury (AKI) is a known risk factor for the development of chronic kidney disease (CKD). Animal studies have demonstrated the potentially reno-protective effects of physical activity, both against the development of AKI and in promoting renal recovery. However, this has not been investigated in humans. The aim of the study was to investigate the association between physical activity levels and recovery in kidney function, measured by eGFR and creatinine, following an episode of stage 3 AKI. Method Twelve hospitalised participants with non-obstructive stage 3 AKI (as per KDIGO criteria) were asked to complete two questionnaires; the General Practitioner Physical Activity Questionnaire (GPPAQ), a measure of physical activity and; the Duke Activity Status Index, a measure of functional capacity. Baseline questionnaires were completed whilst in hospital (where participants were asked to recall their physical activity and functional capacity levels before hospitalisation) and again at 6-months post discharge. In addition, participants wore a pedometer for 7 consecutive days following discharge to ascertain their daily step count. Baseline renal function was collected using eGFR and creatinine measurements within the 12-months prior to admission; further readings were collected 25 ± 46 days after discharge as a measure of renal recovery (referred to as recovered creatinine). Results Data from the 12 participants who provided step count information were analysed. At diagnosis of stage 3 AKI, participants had a mean creatinine of 547 ± 280 with their mean baseline and recovered creatinine as follows; 95 ± 35 and 172 ± 83. A higher daily step count after discharge was associated with both a higher baseline eGFR (r=0.73, p Conclusion These results show a positive association between physical activity levels and renal recovery following an episode of AKI. This suggests that higher levels of physical activity may be protective and promote recovery of renal function following an episode of AKI. Physical activity and exercise interventions should be tested in the setting of AKI to see whether they are efficacious in promoting renal recovery.

Recently, major societal events have shaped perceptions of race relations in the US. The current work argues that people’s motivations to be nonprejudiced toward Black people have changed in concert with these broader societal forces. Analyses of two independent archival datasets reveal that nonprejudiced motivations changed predictably in accordance with shifts in the social milieu over the last 15 years. In one dataset ( N = 13,395), we track movement in internal and external motivations to respond without prejudice from 2004 to 2017. Internal motivation initially decreased before ticking upward following multiple events suggesting worsening race relations (e.g., noteworthy killings of unarmed Black men, resurgent racialized politics). Conversely, external motivation initially increased but reversed course across the same time span. A second dataset ( N = 2,503) corroborates these trends in two conceptually related nonprejudiced motivations. Results suggest that changes in nonprejudiced motivations may reflect broader shifts in the sociopolitical climate.

This systematic review and meta-analysis provides a synthesis of the available evidence for the effects of interventions on outcome measures associated with sarcopenia in end-stage kidney disease (ESKD). Thirteen databases were searched, supplemented with internet and hand searching. Randomised controlled trials of non-pharmacological or pharmacological interventions in adults with ESKD were eligible. Trials were restricted to those which had reported measures of sarcopenia. Primary outcome measures were hand grip strength and sit-to-stand tests. Sixty-four trials were eligible (with nineteen being included in meta-analyses). Synthesised data indicated that intradialytic exercise increased hand grip strength (standardised mean difference, 0.58; 0.24 to 0.91; p = 0.0007; I2 = 40%), and sit-to-stand (STS) 60 score (mean difference, 3.74 repetitions; 2.35 to 5.14; p < 0.001; I2 = 0%). Intradialytic exercise alone, and protein supplementation alone, resulted in no statistically significant change in STS5 (−0.78 s; −1.86 to 0.30; p = 0.16; I2 = 0%), and STS30 (MD, 0.97 repetitions; −0.16 to 2.10; p = 0.09; I2 = 0%) performance, respectively. For secondary outcomes, L-carnitine and nandrolone-decanoate resulted in significant increases in muscle quantity in the dialysis population. Intradialytic exercise modifies measures of sarcopenia in the haemodialysis population; however, the majority of trials were low in quality. There is limited evidence for efficacious interventions in the peritoneal dialysis and transplant recipient populations.