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European journal of neurology 30(2), 719-728 (2022). doi:10.1111/ene.15649, Published by Wiley-Blackwell, Oxford [u.a.]

We present here results of the Quantum Technology Flagship project UNIQORN in the area of integrated photonics for quantum communication applications. Three distinct integration platforms, namely indium phosphide based monolithic integration, polymer-based hybrid integration and the CMOS-compatible silicon platform, have been employed to manufacture components and sub-systems on chip for quantum communication devices. The choice of different platforms was made to exploit the best characteristics of each platform for the intended quantum communication device. The indium phosphide platform was employed to manufacture a transmitter chip for quantum key distribution featuring laser, modulators, and attenuators. The transmitter chip was evaluated in a QKD experiment achieving a secure rate of 1 kbit/s. The polymer platform was investigated for engineering non-classical light sources. Entangled and heralded single-photon sources, based on non-linear optics, were assembled on the polymer in a hybrid fashion together with waveguides and other passive micro-optical elements. A quantum random number generator, featuring a 70% randomness extraction efficiency, was also fabricated using the polymer integration technique. An array of 32 individual single-photon avalanche diodes, operating at room temperature and featuring an onboard coincidence logic, was coupled to the chip to demonstrate direct detection of photons on the polymer. Finally, a transimpedance amplifier based on gallium arsenide high electron mobility transistors was produced with an exceptional large electrical noise clearance of 28 dB at 100 MHz.

Materials and structures = Matériaux et constructions 54(2), 87 (2021). doi:10.1617/s11527-021-01658-1, Published by Springer Netherlands, Dordrecht

Computational protein design, ab initio protein/RNA folding, and protein-ligand screening can be too computationally demanding for explicit treatment of solvent. For these applications, implicit solvent offers a compelling alternative, which we describe here for the polarizable atomic multipole AMOEBA force field based on three treatments of continuum electrostatics: numerical solutions to the nonlinear and linearized versions of the Poisson-Boltzmann equation (PBE), the domain-decomposition conductor-like screening model (ddCOSMO) approximation to the PBE, and the analytic generalized Kirkwood (GK) approximation. The continuum electrostatics models are combined with a nonpolar estimator based on novel cavitation and dispersion terms. Electrostatic model parameters are numerically optimized using a least-squares style target function based on a library of 103 small-molecule solvation free energy differences. Mean signed errors for the adaptive Poisson-Boltzmann solver (APBS), ddCOSMO, and GK models are 0.05, 0.00, and 0.00 kcal/mol, respectively, while the mean unsigned errors are 0.70, 0.63, and 0.58 kcal/mol, respectively. Validation of the electrostatic response of the resulting implicit solvents, which are available in the Tinker (or Tinker-HP), OpenMM, and Force Field X software packages, is based on comparisons to explicit solvent simulations for a series of proteins and nucleic acids. Overall, the emergence of performative implicit solvent models for polarizable force fields opens the door to their use for folding and design applications.

Seismic performance and loss assessments are required in areas of Insurance, Finance and Public Policy. Providers are Structural Engineers and Risk Management Firms. There are no current procedures to evaluate the epistemic and aleatory uncertainties for such assessments. The essential issue is whether or not there is sufficient reliability in the result to use the result as the basis for risk management decisions and actions. For a single building this may be whether or not a prescribed earthquake performance level is met, life safety or if a portfolio’s vulnerability level is acceptable, whether the. loss for a given time period is less than a stated value. A method based in part on Federal Emergency Management Agency P-695, is developed for evaluating the reliability of performance and/or loss assessments for both individual and portfolios of buildings. Consideration is given to how well the building investigation and corresponding evaluation process have been performed, the qualifications of the person(s) doing the assessment, the thoroughness of the building evaluation, the technical validity of the assessment procedure or model and what computational reliabilities are presented. The method characterizes the uncertainty of each component of the assessment procedure for each building by qualitative determined assignments. The resulting reliability measure is likely to be most useful for determining whether/or not a building has acceptable life safety performance, or if a portfolio has an acceptably low loss risk over a given period of time. In both cases, the reliability must either be sufficient to warrant action, or serve to indicate need for improved assessment.

Materials and structures 53(6), 136 (2020). doi:10.1617/s11527-020-01558-w, Published by Springer, Dordrecht

In order to reduce carbon dioxide emissions, the construction sector is increasingly using clinker-reduced concretes. Concrete with high amounts of ground granulated blast furnace slag (GGBFS) show increased durability performance in certain environmental conditions compared to concrete with Ordinary Portland cement (OPC). However, in laboratory studies, concrete with GGBFS show an increased initial scaling rate in comparison with OPC concrete. Changing weather conditions and high relative humidities > 70 % in field lead to less carbonation and thus, to a better freeze-thaw deicing salt resistance (FTDSR). Therefore, the current lab performance test penalizes GGBFS concrete. This contribution studied the impact of carbonation and intermittent dry periods on FTDSR of GGBFS concrete compared to that of OPC concrete. It could be shown that for concrete with OPC, intermittent dry periods lead to an accumulation of salt in the near surface, which causes a reduction of the scaling. GGBFS concrete, on the other hand, shows an opposite behavior: carbonation causes an increase in scaling after the dry period. GGBFS concrete samples with CO2-free pre-storage show the lowest scaling of all samples investigated. A better simulation of the behavior of GGBFS concrete could lead to economical as well as optimized solutions for the local environment conditions and enable the large-scale use of more environmentally-friendly concretes. Therefore, by taking the effect of carbonation and intermittent dry periods into account in a simple engineering model, the prediction of concrete scaling under consideration of real climatic conditions is possible in an eco-efficient manner.

Moisture and ionic transport under non-saturated condition is an important, but poorly understood transport phenomena particularly for mature systems containing supplementary cementitious materials. This paper investigates the moisture and chloride profiles of 3-year old mortars containing Portland cement (OPC), slag and silica fume (SF) after long-term (30–48 months) wick action exposure in 1.09 M NaCl solution. Moisture profiles were measured with 1H NMR relaxometry and chloride profiles with microXRF. The measured profiles were discussed in relation to moisture dependent material properties such as chloride diffusion coefficients, moisture diffusion coefficients, and desorption isotherms. Results show that the combination of different cementitious materials, e.g. the cementitious binder, is the key factor affecting chloride penetration depth. The cementitious binder also strongly affects chloride diffusion coefficient, moisture diffusion coefficient and chloride binding properties, which are all important parameters for the prediction of chloride ingress.

Postmenopausal hormone therapy (HT) is known to affect the development of hormone-dependent endometrial carcinoma (type I EC). Several studies on breast and ovarian carcinoma have shown that HT influences the molecular profile and prognostic behavior of these tumors. This study aimed to investigate the influence of prior HT and other risk factors on the prognosis in a cohort of patients with invasive endometrial carcinoma (EC).Among 525 patients diagnosed with EC between 1987 and 2010, 426 postmenopausal patients were identified. Information regarding HT was available in 287 of these patients, 78 of whom had a history of HT and 209 of whom did not. Both overall survival (OS) and progression-free survival (PFS) were analyzed. In addition to OS and PFS, risk factors such as age at diagnosis, postmenopausal HT, body mass index (BMI), diabetes mellitus, tumor stage, EC type (I or II), and recurrences were analyzed.Relative to HT alone, women with EC and a history of HT had a longer survival than those with no HT. However, the Cox proportional hazards model showed that it was not HT itself, but rather other characteristics in the HT group that were causally associated with longer survival.Age (the older, the worse) and tumor stage (the higher, the worse) were significant influences on overall survival. Patients with HT also had lower BMIs, less diabetes, more type I EC, and fewer recurrences in comparison with the non-HT group. With regard to the PFS, it made no difference whether the patient was receiving HT.

We present forgi, a Python library to analyze the tertiary structure of RNA secondary structure elements. Our representation of an RNA molecule is centered on secondary structure elements (stems, bulges and loops). By fitting a cylinder to the helix axis, these elements are carried over into a coarse-grained 3D structure representation. Integration with Biopython allows for handling of all-atom 3D information. forgi can deal with a variety of file formats including dotbracket strings, PDB and MMCIF files. We can handle modified residues, missing residues, cofold and multifold structures as well as nucleotide numbers starting at arbitrary positions. We apply this library to the study of stacking helices in junctions and pseudo knots and investigate how far stacking helices in solved experimental structures can divert from coaxial geometries.

We summarize different levels of RNA structure prediction, from classical 2D structure to extended secondary structure and motif-based research toward 3D structure prediction of RNA. We outline the importance of classical secondary structure during all those levels of structure prediction.

The telomerase RNA in yeasts is large, usually &gt, 1000 nt, and contains functional elements that have been extensively studied experimentally in several disparate species. Nevertheless, they are very difficult to detect by homology-based methods and so far have escaped annotation in the majority of the genomes of Saccharomycotina. This is a consequence of sequences that evolve rapidly at nucleotide level, are subject to large variations in size, and are highly plastic with respect to their secondary structures. Here, we report on a survey that was aimed at closing this gap in RNA annotation. Despite considerable efforts and the combination of a variety of different methods, it was only partially successful. While 27 new telomerase RNAs were identified, we had to restrict our efforts to the subgroup Saccharomycetacea because even this narrow subgroup was diverse enough to require different search models for different phylogenetic subgroups. More distant branches of the Saccharomycotina remain without annotated telomerase RNA.

Background Daysy is a fertility monitor that uses the fertility awareness method by tracking and analyzing the individual menstrual cycle. In addition, Daysy can be connected to the application DaysyView to transfer stored personal data from Daysy to a smartphone or tablet (IOS, Android). This combination is interesting because as it is shown in various studies, the use of apps is increasing patients´ focus on their disease or their health behavior. The aim of this study was to investigate if by the additional use of an App and thereby improved usability of the medical device, it is possible to enhance the typical-use related as well as the method-related pregnancy rates. Result In the resultant group of 125 women (2076 cycles in total), 2 women indicated that they had been unintentionally pregnant during the use of the device, giving a typical-use related Pearl-Index of 1.3. Counting only the pregnancies which occurred as a result of unprotected intercourse during the infertile (green) phase, we found 1 pregnancy, giving a method-related Pearl-Index of 0.6. Calculating the pregnancy rate resulting from continuous use and unprotected intercourse exclusively on green days, gives a perfect-use Pearl-Index of 0.8. Conclusion It seems that combining a specific biosensor-embedded device (Daysy), which gives the method a very high repeatable accuracy, and a mobile application (DaysyView) which leads to higher user engagement, results in higher overall usability of the method. Electronic supplementary material The online version of this article (10.1186/s12978-018-0479-6) contains supplementary material, which is available to authorized users.

In this contribution we evaluated both the structurally-controlled failure susceptibility of the fractured Cretaceous chalk rocks and the topographically-controlled shallow landslide susceptibility of the overlying glacial sediments for the Jasmund cliff area on Rügen Island, Germany. We employed a combined methodology involving spatially distributed kinematical rock slope failure testing with tectonic fabric data, and both physically- and inventory-based shallow landslide susceptibility analysis. The rock slope failure susceptibility model identifies areas of recent cliff collapses, confirming its value in predicting the locations of future failures. The model reveals that toppling is the most important failure type in the Cretaceous chalk rocks of the area. The shallow landslide susceptibility analysis involves a physically-based slope stability evaluation which utilizes material strength and hydraulic conductivity data, and a bivariate landslide susceptibility analysis exploiting landslide inventory data and thematic information on ground conditioning factors. Both models show reasonable success rates when evaluated with the available inventory data, and an attempt was made to combine the individual models to prepare a map displaying both terrain instability and landslide susceptibility. This combination highlights unstable cliff portions lacking discrete landslide areas as well as cliff sections highly affected by past landslide events. Through a spatial integration of the rock slope failure susceptibility model with the combined shallow landslide assessment we produced a comprehensive landslide susceptibility map for the Jasmund cliff area.

Interactions between grassland ecosystems and vertebrate herbivores are critical for a better understanding of ecosystem processes, but diverge widely in different ecosystems. In this study, we examined plant responses to simulated red deer (Cervus elaphus L.) grazing using clip-plot experiments in a subalpine grassland ecosystem of the Central European Alps. We measured aboveground net primary production (ANPP) and phosphorus (P) concentration of leaf tissue from plants of two vegetation types with different grazing history. The experimental plots were placed on a soil-P gradient and subject to two different clipping treatments, which simulated moderate and heavy grazing, respectively. We found distinct differences in the response of both ANPP and P concentration in leaf tissues in the two vegetation types. Compared to moderate, heavy grazing simulation did not affect ANPP in the vegetation type adapted to grazing, but decreased ANPP in the non-grazing adapted vegetation type. High soil-P levels also had different effects on the response of the vegetation to clipping in the two vegetation types with different grazing history. ANPP correlated positively with soil-P in non-grazing adapted tall-grass vegetation, while in grazing adapted short-grass vegetation a positive relationship between soil-P and the P concentration in leaf tissues was found. Our experiments provide data for a better understanding of ecosystem processes in high-elevation grasslands of the Alps with possible implications for both nature conservation purposes in protected areas and the management of agriculturally used grasslands.

Background Medical research studies are becoming increasingly important for optimizing the prevention, diagnosis and treatment of illnesses. Participation in research studies can have many benefits for patients. In randomized and controlled clinical studies, they can receive the best possible medical care currently available. However, only a small proportion of patients nowadays are treated within the framework of medical research. The primary endpoint of this study was to discover what level of knowledge patients have about clinical studies and how they currently perceive them, in order to identify ways of optimizing the information provided about studies from the patients’ point of view. Methods The study included 2546 patients (breast cancer 21.6 %, gynecological cancer 8.3 %, obstetrics 32.7 %, endometriosis 7.8 %, fertility treatment 3.2 %, other benign gynecological illnesses 19.2 %, no information for 7.2 %) in the outpatient clinic (45.2 %) and in the in-patient sector (54.8 %) at the Department of Gynecology at Erlangen University Hospital and associated centers. In the single-center study, conducted between January 2011 and January 2012, the patients were asked about their level of knowledge regarding the background to medical research studies and the ways in which they are carried out and used. The patients were also asked how they perceived medical studies and how they thought study conditions might be optimized. The three-page questionnaire was included in the feedback sheet received by patients as part of the hospital’s quality management system. Results As a whole, the group only had moderate knowledge about clinical studies. A majority of the respondents considered that studies were valuable (91.6 %), but only a few were also willing to take part in them (58.4 %). Knowledge and willingness to participate strongly depended on age (P

Background: Previous epidemiological studies have inconsistently shown an increased or decreased risk of cancer of the breast, ovary, and uterine corpus in users of HRT. Limited information is available about different formulations - particularly concerning different progestins. Methods: A nested case-control study within the German Cohort Study on Women's Health was analyzed concerning the risk of gynecological malignancies in HRT users as opposed to never users. Logistic regression analysis was applied to estimate crude and adjusted odds ratios (OR) and 95% confidence intervals (95% Cl). Stratified analyses were performed to compare the risk of different estrogens and progestins in different formulations. Results: 427 cases of breast cancer, 69 of uterine corpus cancer, and 35 of ovarian cancer were identified in the cohort and compared with 1614, 263, and 135 controls for breast, uterine corpus, and ovarian cancer, respectively. The adjusted overall risk estimates for breast, uterine corpus, and ovarian cancer were 1.0 (0.8-1.3), 0.6 (0.2-1.5), and 0.2 (0.04-0.8) for breast, uterine corpus, and ovarian cancer, respectively. No clear trend of increasing risk with increasing lag-time between exposure and tumor diagnosis was observed. No clear time trends for the risk of gynecological cancer were observed with respect to duration of use, time since first HRT use, or time since last use. No obvious differences in the risk of gynecological cancer were found for the different HRT formulations; the numbers in the subgroups for uterine corpus and ovarian cancer, however, were too small to draw final conclusions. Conclusion: Ever-use of hormone replacement therapy is associated with risk estimates very close to unity (1.0-1.1). HRT use appears not to be associated with an increased risk of uterine corpus or ovarian cancer. In addition, no significant cancer risk trend was observed for duration of use or for time since first or last use. Different HRT formulations (composition and regimen) appear not to be associated with different cancer risks. These results need confirmation in a larger, sufficiently powered, case-control study.

We investigated the distribution of phytoplankton species and the associated dimethyl sulfur species, dimethylsulfoniopropionate (DMSP) and dimethylsulfide (DMS) on a cruise into the spring bloom region of the northern North Atlantic (near 47 degrees N, 19 degrees W). The cruise was timed to characterize the relationship between plankton dynamics and sulfur species production during the spring plankton bloom period. At the same time, we measured the DMS concentrations in the atmospheric boundary layer and determined the abundance and composition of the atmospheric aerosol. The water column studies showed that the interplay of wind-driven mixing and stratification due to solar heating controlled the evolution of the plankton population, and consequently the abundance of particulate and dissolved DMSP and DMS. The sea-to-air transfer of DMS was modulated by strong variations in wind speed, and was found to be consistent with currently available transfer parameterizations. The atmospheric concentration of DMS was strongly dependent on the sea surface emission, the depth of the atmospheric boundary layer and the rate of photooxidation as inferred from UV irradiance. Sea-salt and anthropogenic sulfate were the most abundant components of the atmospheric aerosol. On two days, a strong dust episode was observed bringing mineral dust aerosol from the Sahara desert to our northerly study region. The background concentrations of marine biogenic sulfate aerosol were low, near 30-60 ppt. These values were consistent with the rate of sulfate production estimated from the abundance of DMS in the marine boundary layer.

We begin by classifying all solutions of two natural recurrences that Bernstein polynomials satisfy. The first scheme gives a natural characterization of Stancu polynomials. In Section 2, we identify the Bernstein polynomials as coefficients in the generating function for the elementary symmetric functions, which gives a new proof of total positivity for Bernstein polynomials, by identifying the required determinants as Schur functions. In the final section, we introduce a new class of approximation polynomials based on the symplectic Schur functions. These polynomials are shown to agree with the polynomials introduced by Vaughan Jones in his work on subfactors and knots. We show that they have the same fundamental properties as the usual Bernstein polynomials: variation diminishing (whose proof uses symplectic characters), uniform convergence, and conditions for monotone convergence.

Cost increases in the healthcare system are leading to a need to distribute financial resources in accordance with the value of each service performed. Health-economic decision-making models can support these decisions. Due to the previous unavailability of health utilities in Germany (scored states of health as a basis for calculating quality-adjusted life-years, QALYs) for women undergoing treatment, international data are often used for such models. However, these may widely deviate from the values for a woman actually living in Germany. It is, therefore, necessary to collect and analyze health utilities in Germany.In a questionnaire survey, health utilities were collected, along with data for a healthy control group, for 580 female patients receiving treatment in the fields of mastology and gynecological oncology using a German version of the EuroQol questionnaire (EQ-5D) and a visual analogue scale (VAS). Data were also collected for the patients' medical history, tumor disease, and treatment.Significant differences with regard to quality of life were measured in relation to the individual tumor entities and in comparison to the controls. Apart from the healthy control group, patients with breast or cervical carcinoma had the best quality of life. In patients with recurrent and metastatic disease, those with breast carcinoma experienced the greatest impairment of their quality of life. According to current treatment, the most important impairment of life quality occurred in patients under radiotherapy and after surgical treatment. There are significant differences from the health utilities recorded for other countries - for example, the state of health declines much more markedly in patients with metastatic disease among American women with breast carcinoma than among German women, in whom recurrent disease and a first diagnosis of metastasis were comparable. Overall, the VAS was able to distinguish more adequately than the EQ-5D questionnaire between the different situations and impairments resulting from diagnosis and therapy.Health utilities are now, for the first time, available for further health-economics analyses in the field of gynecological oncology and mastology for women living in Germany. Important differences in these utilities from those of other countries are evident.

Are the established clinical symptoms of the female climacteric really specific for women? We were interested to compare the prevalence of these symptoms across age and sex. In the absence of longitudinal (cohort) studies, we tried to find cross-sectional, population-based studies with a broad age span to find a preliminary answer. We obtained six surveys that contained information for at least some of the symptoms. We re-analyzed these databases, which included over 8000 males and 8000 females, in a pooled fashion. Sixteen symptoms of predominantly somatic, psychological and urogenital origin were identified and the age-dependent increase of the relative frequencies was compared between genders. A general tendency for women to report more symptoms was confirmed; however, no significant differences were found between genders regarding the time trend of these symptoms. The analyses suggest that males experience a similar symptomatology in the same age span as women. One may thus be tempted to conclude that aging males experience similar phenomena to women during their menopausal transition. This should be confirmed in a specifically designed study.

OBJECTIVE: To develop and pilot study an information aid for women with a family history of breast cancer. DESIGN, SETTING AND PARTICIPANTS: The information aid, consisting of a booklet and audiotape, was developed by a multi-disciplinary team of health care professionals, breast cancer survivors and their relatives. Women with no personal history of breast cancer, on the waiting list for a familial breast cancer clinic at either of two centres, who could read English, were eligible for the pilot study which consisted of three sets of mailed questionnaires. MAIN OUTCOME MEASURES: The baseline questionnaires included: demographic information: the Breast Cancer and Heredity Knowledge Scale (BCHK); psychological measures (the State-Trait Anxiety Inventory [STAI], Centre for Epidemiologic Studies Depression Scale [CES-D] and an item about breast cancer worry), and an item about breast cancer risk perception. Immediately after reviewing the information aid, participants completed a satisfaction survey, the risk perception and cancer worry items and a checklist about their personal family history. The third set of questionnaires, completed 2-4 weeks after reviewing the aid, was identical to the first. Patients then attended their scheduled clinic visit and an objective hereditary breast cancer risk assessment was made by the genetic counselling team. RESULTS AND CONCLUSIONS: Of 97 eligible women who were contacted, 67 completed all three sets of questionnaires. Overall, women were very satisfied with the aid and 96% would recommend it to other women. There was a highly significant improvement in their knowledge scores after they reviewed the aid. Anxiety and depression did not change and there was a decline in breast cancer worry. Risk perception did not change significantly. Ninety per cent of women completed their personal family history checklist accurately. Several important improvements have been made in the information aid and it will now be evaluated in the community.

PURPOSE: A patient decision aid for the surgical treatment of early stage breast cancer was developed and evaluated. The rationale for its development was the knowledge that breast conserving therapy (lumpectomy followed by breast radiation) and mastectomy produce equivalent outcomes, and the current general agreement that the decision for the type of surgery should rest with the patient. METHODS: A decision aid was developed and evaluated in sequential pilot studies of 18 and 10 women with newly diagnosed breast cancer who were facing a decision for breast conserving therapy or mastectomy. Both qualitative (general reaction, self-reported anxiety, clarity, satisfaction) and quantitative (knowledge and decisional conflict) measures were assessed. RESULTS: The decision aid consists of an audiotape and workbook and takes 36 min to complete. Based on qualitative comments and satisfaction ratings, 17 of 18 women reported a positive reaction to the decision aid, and all 18 reported that it helped clarify information given by the surgeon. Women did not report an increase in anxiety and 17 of 18 women were either satisfied or very satisfied with the decision aid. CONCLUSION: This pilot study supports the hypothesis that this decision aid may be a helpful adjunct in the decision for surgical management of early stage breast cancer. We are currently conducting a randomized trial of the decision aid versus a simple educational pamphlet to evaluate its efficacy as measured by knowledge, decisional conflict, anxiety and post-decisional regret.

The purpose of this study was to describe the life-sustaining treatment preferences of dialysis patients and to compare the acceptability of two generic and a disease-specific advance directive (AD). Of 532 potentially eligible hemodialysis patients, 95 (17.9%) participated in the study. These patients completed two generic (the Centre for Bioethics Living Will and the Medical Directive) and one disease-specific (the Dialysis Living Will) AD in a randomized cross-over trial. Treatment preferences were measured by using the Centre for Bioethics Living Will. Acceptability of the AD was measured by using a 13-item advance directive acceptability questionnaire (ADAQ) for each AD, and the advance directive choice questionnaire (ADCQ) to elicit participants' preferred AD. Twenty-five percent of the participants wanted to continue dialysis in case of severe stroke, 19% in severe dementia, and 14% in permanent coma. Averaged across treatments, proportions of participants wanting treatment in various health states were: current health (86%), mild stroke (84%), moderate stroke (60%), severe stroke (21%), mild dementia (78%), moderate dementia (51%), severe dementia (14%), terminal illness (41%), and permanent coma (10%). Averaged across health states, proportions of participants wanting various types of treatment were: dialysis (58%), antibiotics (53%), transfusion (53%), surgery (48%), cardiopulmonary resuscitation (48%), respirator (47%), and tube feeding (41%). Mean ADAQ scores were: Dialysis Living Will, 71%; Centre for Bioethics Living Will, 70%; and Medical Directive, 60% (F = 8.27, P < 0.001 (repeat measures analysis of variance); the Dialysis Living Will and Centre for Bioethics Living Will scored significantly higher than the Medical Directive). The proportion of participants who said they would choose to complete each AD was: Dialysis Living Will, 28%; Centre for Bioethics Living Will, 38%; Medical Directive, 31%; and unsure, 3% (chi 2 = 1.465, df = 2, P = 0.48). In conclusion, twenty-five percent or less of hemodialysis patients want to continue dialysis in three specific health states: severe stroke, severe dementia, and permanent coma. Health states and illness severity, far more than treatment descriptions, influence preferences. Dialysis patients should be offered a generic AD, and some generic AD are more acceptable than others. Only a minority of dialysis patients will complete any AD, but the completion of written AD forms is only one element in the process of advance care planning.