bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Prognostic Value of Coronary Atherosclerotic Plaque Characteristics Assessed by Computerized Tomographic Angiography
Authors: Ateş Ahmet Hakan , Yorgun Hikmet , Canpolat Uğur , Kaya Ergun Baris , Şahiner Levent , Hazirolan Tuncay , Dural Muhammet , Okşul Metin , Şener Yusuf Ziya , Karahan Sevilay , Aytemir Kudret
Published: October 2020

We aimed to present the long-term prognostic role of coronary computed tomography angiography (CTA) in a cohort of patients with coronary artery disease (CAD) and noncritical stenosis. A total of 1138 patients who underwent coronary CTA for suspected CAD were included in the study. For the categorization of the coronary atherosclerotic plaque (CAP), the coronary system was divided into 16 segments. For each segment, CAPs were categorized as calcified, noncalcified, and mixed. All-cause and cardiovascular (CV) mortality data were collected for prognostic evaluation. Coronary CTA analyses showed that 34.5% of patients had noncalcified CAP, 14.5% of patients had calcified CAP, and 11% of patients had mixed CAP. During a median of 141.5 months follow-up, CV and all-cause mortality was observed in 57 (5%) and 149 (13.1%) patients, respectively. In multivariable Cox regression analysis, calcified CAP morphology and the extent of involved segments were significant predictors of both CV and all-cause mortality. The presence of calcified CAP morphology and the higher number of diseased coronary segments via coronary CTA might help stratify patients at risk for adverse CV outcomes during long-term follow-up. Patients with these features at index coronary CTA may be evaluated more closely with aggressive preventive measures.
Thermal Camera-Based Fourier Transform Infrared Thermospectroscopic Imager
Authors: Chevalier Stéphane , Tourvieille Jean-Noël , Sommier Alain , Batsale Jean-Christophe , Beccard Bruno , Pradère Christophe
Published: October 2020

In this technical note, we present an advanced thermospectroscopic imager based on a Fourier transform infrared (FT-IR) spectrometer and a thermal camera. This new instrument can image both thermal emission and multispectral absorbance fields in a few seconds at a resolution of 4 cm−1 or less. The setup is made of a commercial FT-IR spectrometer (ThermoFisher Nicolet iS50R) synchronized to an IR camera (indium antimonide and strained layer superlattice) as a detector to record the interferograms in each pixel of the images. A fast Fourier transform algorithm with apodization and Mertz phase correction is applied to the images, and the background is rationed to process the interferograms into the absorbance spectra in each pixel. The setup and image processing are validated using thin polystyrene films; during this processing, more than 1750 spectra per second are recorded. A spectral resolution equivalent to that of commercial FT-IR spectrometers is obtained for absorbance peaks valued less than two. The transient capability of the FT-IR thermospectroscopic imager is illustrated by measuring the heterogeneous thermal and absorbance fields during the phase change of paraffin over a few minutes. The complete mechanism of the thermochemical processes during a polymer solidification is revealed through the thermospectroscopic images, demonstrating the usefulness of such an instrument in studying fast transient thermal and chemical phenomena with an improved spectral resolution.
An Examination of Email Fraudsters’ Modus Operandi
Authors: Maimon David , Howell C. Jordan , Moloney Maria , Park Young Sam
Published: October 2020

Focusing on two of the most common deceptive strategies employed by fraudsters, we assess which type of cue—politeness or urgency—is more likely to result in an email fraud attempt. We also examine whether these cues are mutually exclusive and consistent throughout the progression of a fraud attempt. To answer our research questions, we posted “for-sale” advertisements on classified-advertisement websites and interacted with fraudsters who responded to our advertisements. Findings reveal that fraud attempts are more likely to follow probe emails that include cues of urgency than cues of politeness. Moreover, although the majority of fraudsters’ probe emails include deceptive cues of either politeness or urgency, the majority of subsequent emails include deceptive cues of both politeness and urgency.
Building Systemic Capacity to Improve Identification and Services in Gifted Education: A Case Study of One District
Authors: Mun Rachel U. , Ezzani Miriam D. , Lee Lindsay Ellis , Ottwein Jessica K.
Published: October 2020

The problem of culturally, linguistically, and economically diverse (CLED) student underrepresentation in gifted programs demonstrates a need to examine systemic processes, including the building of systemic capacity at the district and school levels where policies for gifted programs are formed and implemented. To examine the effects of this process on one diverse district’s gifted identification and services, we conducted 10 focus group interviews with 61 participants including gifted coordinators, teacher leaders, and gifted facilitators in the middle of a district initiative aimed at improving equitable identification and services in its gifted program. Data were analyzed using the six-phase approach of Thematic Analysis, which included (1) familiarization, (2) coding, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and then (6) writing our report. Three overarching themes emerged from the in-depth analysis: (1) building systemic capacity, (2) shifting conceptions of giftedness, and (3) equitable identification practices and inclusive programming. Findings indicated the importance of systemic capacity building in teachers for improved CLED student identification into gifted programs and services. Essentially, building systemic capacity and shifting conceptions of giftedness share a reciprocal relationship in leading to more equitable gifted identification practices and inclusive programming. Moreover, implementing flexible and nuanced policy that takes into consideration school climate and culture is critical to building systemic capacity while working toward goals of equity. Recommendations are provided for researchers and practitioners based on these major findings.
Design analysis of end notch flexure sandwich specimen with honeycomb core
Authors: Tauhiduzzaman Mohammad , Carlsson Leif A , Ayanoglu Mustafa O
Published: October 2020

Laminate beam theory based design analysis of the sandwich End Notch Flexure (ENF) test specimen is presented. The analysis is specifically considering specimens with honeycomb core, prone to in-plane compression failure of the core, other undesirable failure modes such as face indentation and core shear failure are analyzed. In addition, crack stability and energy dissipation due to frictional sliding between the crack surfaces are analyzed. Parametric analysis of ENF specimens with a range of face and core thickness, is presented to guide the design. In-plane compression failure of the core, but shorten the range of crack lengths were stable growth occurs. A thicker face will also increase the critical load for crack propagation and by so elevate the risk for indentation and core shear failures. Increased core density is beneficial for preventing indentation and core shear failures, but may increase the risk for in-plane compression failure of the core. The thickness of the core does not strongly influence the critical load for crack propagation. A thicker core increases frictional energy loss, but reduces the risk for core shear failure. A thicker core, however, makes the ENF specimen more prone to in-plane compression failure. ENF sandwich specimens with foam and honeycomb core were tested. The test results support the design analysis.
Terrorism and internet censorship
Authors: Meserve Stephen A , Pemstein Daniel
Published: October 2020

The internet provides a powerful tool to terror organizations, enhancing their public messaging, recruitment ability, and internal communication. In turn, governments have increasingly moved to disrupt terror organizations’ internet communications, and even democracies now routinely work to censor terrorist propaganda, and related political messaging, in the name of national security. We argue that democratic states respond to terror attacks by increasing internet censorship and broadening their capacity to limit the digital dissemination of information. This article builds on previous work suggesting this relationship, substantially improving measurement and estimation strategy. We use latent variable modeling techniques to create a new measure of internet censorship, cross nationally and over time, from internet firm transparency reports, and compare this measure to an expert-survey based indicator. Leveraging both measures, we use a variety of panel specifications to establish that, in democracies, increases in terror predict surges in digital censorship. Finally, we examine the posited relationship using synthetic control methods in a liberal democracy that experienced a large shock in terror deaths, France, showing that digital censorship ramped up after several large terrorist attacks.
Using practitioner surveys to measure human rights: The Human Rights Measurement Initiative’s civil and political rights metrics
Authors: Clay K Chad , Bakker Ryan , Brook Anne-Marie , Hill Daniel W , Murdie Amanda
Published: October 2020

Most cross-national datasets of civil and political rights practices have relied on internationally distributed English language secondary sources as the core source of information for their metrics. This approach has yielded data that are highly reliable, but also suffer from the fact that their information sources under-represent the overall level of abuse internationally and do so in a way that is biased across countries. The combined knowledge of the individual human rights practitioners working to directly monitor the abuses occurring within a country would likely serve to overcome much of this biased under-reporting, but it is difficult to compare that knowledge across country and cultural contexts. In this article, we discuss how we overcome these problems in the Human Rights Measurement Initiative (HRMI) civil and political rights data. Using an expert survey that contains anchoring vignettes in concert with Bayesian scaling techniques, we present a new methodology for collecting and aggregating data on the intensity and distribution of respect for eight separate civil and political rights.
Introduction to the RBPE Special Issue on Criminal Justice Reform titled “Criminal Justice Reform: 2020 and Beyond”
Authors: Chiteji Ngina , Goldsmith Art , Pate David
Published: October 2020

This essay introduces the reader to the papers in this special volume about criminal justice reform.
Organizational Memory Studies
Authors: Foroughi Hamid , Coraiola Diego M. , Rintamäki Jukka , Mena Sébastien , Foster William M.
Published: October 2020

This paper provides an overview and discussion of the rapidly growing literature on organizational memory studies (OMS). We define OMS as an inquiry into the ways that remembering and forgetting shape, and are shaped by, organizations and organizing processes. The contribution of this article is threefold. We briefly review what we understand by organizational memory and explore some key debates and points of contestation in the field. Second, we identify four different perspectives that have been developed in OMS (functional, interpretive, critical and performative) and expand upon each perspective by showcasing articles published over the past decade. In particular, we examine four papers previously published in Organization Studies to show the distinctiveness of each perspective. Finally, we identify a number of areas for future research to facilitate the future development of OMS.
Are Australian speech-language therapists working in the literacy domain with children and adolescents? If not, why not?
Authors: Serry Tanya , Levickis Penny
Published: October 2020

A cross-sectional online survey was completed by 219 speech-language therapists (SLTs) to explore their views and practices when working with children and adolescents who have literacy difficulties. They were recruited via 11 workshops hosted by Speech Pathology Australia, held across Australia and completed the survey prior to attending their respective workshop. Participants reported overwhelming support for SLTs to work with students struggling to learn literacy and supported not only a role for SLTs to work with children in the preschool years to promote readiness to learn to read at school, but also a role for services to students beyond the early years of school. While SLTs valued specific clinical and collaborative activities, a significant gap was found between their perceived feasibility of those activities and their perceived value. Results show SLTs are less confident providing written support to students than they are in providing phonological awareness and vocabulary interventions. While SLTs clearly value their role in the literacy domain, this study highlights evident gaps in preservice training in this area, as well as a need for improved SLT and teacher knowledge exchange, and collaboration in supporting children and adolescents with literacy difficulties.
A successful case of heart transplantation concurrent with pulmonary thromboendarterectomy
Authors: Cao Liang , Yao Yuntai , Yang Jing
Published: October 2020

Introduction:

Pre-transplant irreversible pulmonary hypertension and high pulmonary vascular resistance are generally considered as contraindications for orthotopic heart transplantation due to the high risk of right ventricular dysfunction after transplantation. However, there is no consensus on whether reversible pulmonary hypertension increases the incidence of post-transplant complications and mortality.

Case report:

A patient with acute heart failure and pulmonary artery occlusion successfully underwent heart transplantation concurrent with pulmonary thromboendarterectomy.

Discussion and Conclusion:

This case illustrates that heart transplantation concurrent with pulmonary thromboendarterectomy can be performed successfully with meticulous operability assessment, superb surgical technique and careful perioperative management.
Challenging the presumptive link between musical preference and aggression
Authors: Merz Zachary C , Lace John W , Coleman Thatcher R , Roth Robert M
Published: October 2020

The present study sought to examine the relationship between musical preference and aspects of aggression in a United States of America community sample. A total of 400 adults ( M age = 34.14; 50.3% female) completed the Short Test of Musical Preference, Revised (STOMP-R), the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5) Level 1 Cross-Cutting Symptom Measure, and several aggression questionnaires aimed at assessing normative beliefs about aggression and prior history of aggressive behaviors. Results of correlational analyses revealed significant relationships between all examined musical genres and psychopathology. Results of regression analyses revealed the presence of psychopathology as the main contributor to scores across aggression measures, with age and gender variables also varying in their significance. Importantly, preference for intense and rebellious musical genres (i.e., alternative, rock, punk, and heavy metal) was a nonsignificant predictor across all aggression questionnaires. As such, the current results do not support a correlational nor causal link between intense and/or rebellious musical preference and aggressive behaviors.
Decision-based territorial life cycle assessment for the management of cement concrete demolition waste
Authors: Mousavi Marjan , Ventura Anne , Antheaume Nicolas
Published: October 2020

Existing territorial life cycle assessments (LCAs) consider all activities in a given geographical area, defined as the foreground system, but cannot lead to operational decisions. In product scale LCA, the foreground system is defined as the part of the system directly controlled by an actor and is thus more adapted to compare possible scenarios within a decision perimeter. The present paper uses that concept applied to a geographical area. The developed method consists of five steps: (a) definition of the foreground material flow analysis (MFA) or LCA system corresponding to the decision perimeter; (b) territorial MFA; (c) geo-location of activities and downscaling of territorial flows to individual activities; (d) calculation of local transport distances; and (e) calculation of LCA impact indicators. The case study concerns the management of primary and secondary resources of basic quality aggregates (BQAs) in the Loire-Atlantique department (France) in 2012. Our results show that the amount of recycled cement concrete is only 7% of total consumed BQAs, although 90% of cement concrete demolition waste (CCDW) is recycled. The environmental impacts are importantly related to off-site activities. Local impacts are mainly driven by the transport of aggregates. For land planning, a concentration of fewer recycling facilities with high authorised production capacities in main cities, close to where CCDW is mainly produced, would divide transport needs in half and thus considerably reduce environmental impacts.
A Meta-Analysis of Single-Case Research on Word-Problem Instruction for Students With Learning Disabilities
Authors: Shin Mikyung , Bryant Diane P. , Powell Sarah R. , Jung Pyung-Gang , Ok Min Wook , Hou Fangjuan
Published: October 2020

In this meta-analysis of single-case designs, the researchers investigated the effects of word-problem instruction for students with learning disabilities in Grades 1 through 12, as reported in 20 peer-reviewed articles published between 1975 and 2020. A two-level multilevel model with a robust variance estimation method was implemented to calculate the effect sizes. A significant overall effect of word-problem instruction for students with learning disabilities was found, and the results indicate that studies meeting all three quality indicators of implementation fidelity (i.e., adherence, dosage, and regularity) showed greater effects. The average weighted effect sizes of word-problem instruction varied depending on the content and practice standards of the Common Core State Standards for Mathematics. Limitations and future research directions are also discussed.
Key Success Factors for a Quality Peritoneal Dialysis Program
Authors: Nayak K.S.
Published: October 2020

The success of a peritoneal dialysis (PD) program depends on a multitude of factors that are interlinked and inseparable from one another. Each program needs to identify its special circumstances, deficiencies, and strong points, and then to strategize accordingly. Ultimately, “teamwork” is the mantra for a successful outcome, the patient being central to all endeavors. A belief and a passion for PD are the fountainhead and cornerstone on which to build a quality PD program.
Our Experience of Home Visits in City and Rural Areas
Authors: Nayak K.S. , Sinoj K.A. , Subhramanyam S.V. , Mary B. , Rao N.V.V.
Published: October 2020

In a peritoneal dialysis (PD) program, an efficient and well-structured home visit schedule is imperative for ensuring patient compliance, adherence to proper exchange technique, nutrition status monitoring and intervention, and early detection of evolving medical co-morbid problems so as to prevent further complications. Regular home-visit follow-up of the PD patient directly affects technique survival and quality of life. The clinical coordinator is ideally placed to be the direct link between the PD center and patients in their domiciliary surroundings. This professional plays a crucial role in the success of a PD program.
Peritoneal Dialysis Utilization and Outcome: What are we Facing?
Authors: Lo Wai-Kei
Published: October 2020

Penetration of peritoneal dialysis (PD) varies tremendously across the world. It ranges from about 80% in Hong Kong and Mexico to just a few percentage points in the United States, Japan, and Germany. While PD is growing in China, India, and some Eastern European and South American countries, it is declining in many European and North American countries. In terms of outcomes, the survival of PD patients is generally comparable to that of hemodialysis (HD) patients and better than that of HD patients during the first few years on dialysis. According to the U.S. Renal Data System, survival of patients on PD has been improving faster than that of patients on HD. In terms of cost, PD is usually cheaper than HD. Hence, declining PD utilization is unjustified. Work is required to identify and overcome negative factors such as physician bias, unfair medical reimbursement systems, and poor patient education.
Development of the “Peritoneal Dialysis First” Model in Hong Kong
Authors: Yu Alex Wai-Yin , Chau Ka-Foon , Ho Yiu-Wing , Li Philip Kam-Tao
Published: October 2020

Maintenance dialysis is an expensive treatment modality for patients with end-stage renal-disease (ESRD). The number of patients on maintenance dialysis is rising rapidly and will reach 2.5 million globally by 2010. The predicted expenditure will be US$1 trillion. Since the 1960s, Hong Kong has faced financial restraints on the provision of dialysis. Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis at home were found to be less expensive than in-centre chronic hemodialysis. The development of a “peritoneal dialysis first” (PD-First) policy has contributed significantly to a successful dialysis program in Hong Kong since 1960. Currently in Hong Kong, 80% of ESRD patients on maintenance dialysis are on PD, mainly CAPD; 20% are on hemodialysis. The success of the PD-First policy is a combination of accumulated experience of PD in each dialysis unit that has at least 200 CAPD patients under care and of impressive technique and patient survival rates for this modality. Concerted effort by government and charity organizations and commitment on the part of nephrologists and nursing staff to patient education are also important in making the PD program in Hong Kong a successful one.
Increased Utilization of Peritoneal Dialysis to Cope with Mounting Demand for Renal Replacement Therapy—Perspectives from Asian Countries
Authors: Li Philip Kam-Tao , Sing Leung Lui , Chi Bon Leung , Alex Wai-Yin Yu , Lee Evan , Just Paul M. , Abraham Georgi , Almazan–Gomez Lynn , Huang Chiu Ching , Hooi Lai Seong , Kawaguchi Yoshindo , Kuok Un I. , Tungsanga Kriang , Wang Tao , Wong Andrew Kui-Man , Yu Xue-Qing , Lo Wai Kei
Published: October 2020

With the number of end-stage renal disease (ESRD) patients growing, one of the crucial questions facing health care professionals and funding agencies in Asia is whether funding for dialysis will be sufficient to keep up with demand.

During the ISPD's 2006 Congress, academic nephrologists and government officials from China, Hong Kong, India, Indonesia, Japan, Macau, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam participated in a roundtable discussion on dialysis economics in Asia. The focus was policy and health care financing. The roundtable addressed ESRD growth in Asia and how to obtain enough funding to keep up with the growth in patient numbers. Various models were presented: the “peritoneal dialysis (PD) first” policy model, incentive programs, nongovernmental organizations providing PD, and PD reimbursement in a developing economy. This article summarizes the views of the participant nephrologists on how to increase the utilization of PD to improve on clinical and financial management of patients with ESRD.
Mediators of Inflammation and Fibrosis
Authors: Lai Kar Neng , Tang Sydney C.W. , Leung Joseph C.K.
Published: October 2020

During peritoneal dialysis, peritoneal cells are repeatedly exposed to a non-physiologic hypertonic environment with high glucose content and low pH. Current sterile dialysis solutions cause inflammation in the submesothelial compact zone, leading to fibrosis, angiogenesis, and, eventually, ultrafiltration failure. Although the normal interstitium separates the peritoneal microvasculature from the dialysis fluid and makes transperitoneal transport less efficient, changes in the submesothelial compact zone can result in progressive increases in solute transfer and ultrafiltration diminution. This peritoneal dysfunction will further be amplified with the development of an epithelial-to-mesenchymal transition of mesothelial cells and dissipation of the osmotic driving force through the increased area and solute transport that accompany neoangiogenesis of the submesothelial microvasculature. The alteration of the peritoneal membrane can be further aggravated by peritonitis, advanced glycation end-products, and glucose degradation products. Furthermore, new data are emerging to support a proinflammatory role for peritoneal adipocytes.
Studying the Effects of New Peritoneal Dialysis Solutions on the Peritoneum
Authors: Tak Mao Chan , Yung Susan
Published: October 2020

♦ Background

Compelling data underscore the bioincompatible nature of glucose-based peritoneal dialysis (PD) solutions and their detrimental effects on peritoneal physiology and morphology. New PD solutions have been formulated to tackle common clinical problems such as inadequate ultrafiltration or malnutrition, and to improve biocompatibility—the latter aimed at preserving the structural and functional integrity of the peritoneum and reducing adverse systemic effects on the patient.

♦ Methods

This article reviews the factors in PD fluids that alter normal peritoneal anatomy and physiology, and the data that illustrate approaches to investigating the local and systemic biocompatibility of new PD solutions.

♦ Results

Chronic exposure of the peritoneal membrane to glucose-based PD solutions results in denudation of the mesothelium, thickened submesothelium, and hyalinization of the vasculature, often resulting in reduced or lost solute and water clearance. Data from in vitro or animal experiments and clinical studies have shown improved bio-compatibility profiles with new PD solutions that are glucose-free (that is, dialysates with amino acids or icodextrin), bicarbonate-buffered, or compartmentalized during heat sterilization to reduce levels of glucose degradation products. Improved biocompatibility is denoted by reduced induction of proinflammatory, profibrotic, or angiogenic growth factors in mesothelial cells and macrophages, or by less perturbation of leukocyte phagocytic function.

♦ Conclusions

Data from in vitro and animal experiments show more favorable biocompatibility profiles with new PD fluids than with glucose-based dialysates. Clinical studies are ongoing to assess the impact of the new PD fluids on peritoneal function, morbidity, and mortality.
Mesothelial Cells
Authors: Yung Susan , Tak Mao Chan
Published: October 2020

♦ Background

The introduction of peritoneal dialysis (PD) as a modality of renal replacement therapy has provoked much interest in the biology of the peritoneal mesothelial cell. Mesothelial cells isolated from omental tissue have immunohistochemical markers that are identical to those of mesothelial stem cells, and omental mesothelial cells can be cultivated in vitro to study changes to their biologic functions in the setting of PD.

♦ Method

The present article describes the structure and function of mesothelial cells in the normal peritoneum and details the morphologic changes that occur after the introduction of PD. Furthermore, this article reviews the literature of mesothelial cell culture and the limitations of in vitro studies.

♦ Results

The mesothelium is now considered to be a dynamic membrane that plays a pivotal role in the homeostasis of the peritoneal cavity, contributing to the control of fluid and solute transport, inflammation, and wound healing. These functional properties of the mesothelium are compromised in the setting of PD. Cultures of peritoneal mesothelial cells from omental tissue provide a relevant in vitro model that allows researchers to assess specific molecular pathways of disease in a distinct population of cells. Structural and functional attributes of mesothelial cells are discussed in relation to long-term culture, proliferation potential, age of tissue donor, use of human or animal in vitro models, and how the foregoing factors may influence in vitro data.

♦ Conclusions

The ability to propagate mesothelial cells in culture has resulted, over the past two decades, in an explosion of mesothelial cell research pertaining to PD and peritoneal disorders. Independent researchers have highlighted the potential use of mesothelial cells as targets for gene therapy or transplantation in the search to provide therapeutic strategies for the preservation of the mesothelium during chemical or bacterial injury.
Clinical Effects of Combined Therapy with Peritoneal Dialysis and Hemodialysis
Authors: Kawanishi Hideki , Moriishi Misaki
Published: October 2020

The fundamental objective of dialysis is to maintain the dose of solute clearance and ultrafiltration (UF). When peritoneal dialysis (PD) patients cannot maintain target clearances, the dialysis dose needs to be increased. The means of increasing dose by PD alone are limited, especially in patients with UF failure. Combination therapy with PD and hemodialysis (PD+HD) is the simplest way to solve this problem. The general prescription for PD+HD should be 5 – 6 days of PD and 1 session of HD weekly. To determine the adequacy of PD+HD, we adopted the equivalent renal clearance (EKR), transforming the weekly Kt/V from PD and then evaluating the total clearance from both modalities.

The weekly PD+HD regimen improves clinical status in patients in whom PD alone does not result in dialysis adequacy, and it permits a substantial prolongation of PD. The complementary effects of PD and HD improve clinical status and prognosis in patients undergoing dialysis; we therefore propose to use the term “complementary dialysis” for this technique.
Advances in the Technology of Automated, Tidal, and Continuous Flow Peritoneal Dialysis
Authors: Dell'Aquila Roberto , Rodighiero Maria Pia , Spano’ Emilia , Pierluigi Di Loreto , Kohn Catalina Ocampo , Cruz Dinna , Polanco Natalia , Kuang Dingwei , Corradi Valentina , Massimo De Cal , Ronco Claudio
Published: October 2020

Automated peritoneal dialysis (APD) has undergone substantial growth in recent years because of an increased demand for higher doses of peritoneal dialysis (PD) treatment and a need to improve quality of life for patients. The evolution of this treatment is closely linked with the development of new automatic machines and with recent advances in prescription and monitoring of PD treatment. In the present article, we describe the characteristics of the new generation of APD cyclers with particular regard to adequacy targets and safety. There is renewed interest in continuous-flow peritoneal dialysis (CFPD), because of a belief that new peritoneal access technologies will make the success of this modality a possibility. In the CFPD technique, a certain amount of fluid is constantly present in the abdomen, and constant inflow and outflow are maintained without interruption thanks to paired indwelling catheters. The PD solution is used either in a single pass or in a recirculation loop with a regeneration systems (sorbent cartridge or dialyzer).
Long-Term Peritoneal Dialysis in Infants
Authors: Rees Lesley
Published: October 2020

Although the numbers of infants requiring dialysis are small, management of these patients presents many challenges. Mortality is high in infants with comorbidities, complications of dialysis are common, and most of these infants need enteral feeding. However, the long-term outcome for otherwise healthy infants is comparable to that for older children.
The “Heart” of Peritoneal Dialysis
Authors: Wang Angela Yee-Moon
Published: October 2020

Cardiovascular disease accounts for more than half of all deaths in end-stage renal disease patients receiving chronic peritoneal dialysis (PD) treatment. The recent demonstration of the important association between residual renal clearance (but not PD clearance) and overall and cardiovascular survival in chronic PD patients has led us to further explore the mechanisms that can potentially explain the close link between residual renal function and cardiovascular disease in this population. This John Maher Award Lecture provides a review of my own work and that of other groups that provides support for the importance of residual renal function not only in providing small-solute clearance but also in maintaining the cardiovascular health, nutrition status, and wellbeing of PD patients. Data are provided to demonstrate why preservation of residual renal function may be the key to improving survival and cardiovascular outcomes in PD patients.
Association of Carnitine Deficiency in Indian Continuous Ambulatory Peritoneal Dialysis Patients with Anemia, Erythropoietin Use, Residual Renal Function, and Diabetes Mellitus
Authors: Ramalakshmi S. , Baben Bjoe , Ashok Ben S. , Jayanthi V. , Leslie Nancy , Abraham Georgi
Published: October 2020

♦

In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters.

♦

Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 μmol/L.

♦

The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 μmol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 μmol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension.

♦ Conclusion

This study is the first demonstration that Indian dialysis patients have carnitine deficiency.
Gram-Negative Peritonitis—The Achilles Heel of Peritoneal Dialysis?
Authors: Szeto Cheuk-Chun , Chow Kai-Ming
Published: October 2020

Peritonitis caused by gram-negative bacteria is a serious complication of peritoneal dialysis. Antibiotic resistance is common, and response to medical treatment is often poor. In the present article, we review recent advances in the understanding of the pathogenesis and treatment of this serious condition.
Pure Red-Cell Aplasia “Epidemic”—Mystery Completely Revealed?
Authors: Locatelli Francesco , Lucia Del Vecchio , Pozzoni Pietro
Published: October 2020

Starting in 1998, the number of pure red-cell aplasia (PRCA) cases in patients treated with recombinant human erythropoietin (rHuEPO) increased dramatically. Most cases were observed in patients treated with epoetin alfa produced outside the United States. The peak was observed in 2002; since then, the PRCA incidence has declined.

Many factors are likely to have contributed to this upsurge. The molecular structure of the various epoetins and patient characteristics do not seem to play a major role. The route of administration holds some importance, because most PRCA patients received rHuEPO subcutaneously. The peak of PRCA cases overlapped with the removal of human serum albumin from the Eprex formulation (Janssen-Pharmaceutica NV, Beerse, Belgium), for which polysorbate 80 and glycine were substituted. Polysorbate 80 may have increased the immunogenicity of Eprex by eliciting the formation of epoetin-containing micelles or by interacting with leachates released by the uncoated rubber stoppers of prefilled syringes. Compared with the previous formulation, the polysorbate 80 formulation has lower stability, making it more susceptible to stress conditions such as insufficient attention to the cold chain. This situation could facilitate protein denaturation or aggregate formation.

Uncoated rubber stoppers were replaced with coated stoppers, and the cold chain was reinforced; the Eprex formulation has remained unchanged.

Even though the incidence of PRCA returned to very low levels, discriminating the cause–effect relationship of a single action is difficult, given that all occurred with a similar chronology, and that PRCA develops after a relatively long exposure period. Careful observation of future trends of new PRCA cases is thus mandatory.
Risk Stratification of the Peritoneal Dialysis Patient—a Single-Center Experience
Authors: Lee Evan J.C.
Published: October 2020

⋄ Background

Peritoneal dialysis (PD) patients have many risk factors that may affect their clinical outcomes. Age and diabetes status are unequally distributed in the dialysis population of Singapore. Risk stratification is a means of reducing the effects of case mix such that high-risk groups in the dialysis population can be identified.

⋄ Patients and Methods

Records for 543 patients who started on chronic dialysis during 2002 – 2005 were retrospectively studied for survival in the first year on dialysis. The age, sex, ethnicity, and diabetes status of the patients were noted.

⋄ Results

For patients 60 years of age and older, we observed no differences in the prevalences of diabetes, male sex, or Chinese ethnicity between patients on PD and those on hemodialysis (HD). Patients of Chinese ethnicity on PD were found to have a higher likelihood of survival in the first year as compared with patients on HD. Age, sex, and diabetes status were not associated with survival in the first year.

⋄ Conclusions

In a single PD treatment center, Chinese ethnicity conferred a survival advantage in the first year on dialysis. The reasons for that finding are not clear, but they were not related to age, diabetes status, or sex.
The Development of a Continuous Ambulatory Peritoneal Dialysis Program in Indonesia
Authors: Suhardjono
Published: October 2020

Chronic kidney disease is prevalent in Indonesia, running at 29.1% in the population at risk (hypertension, diabetes, and proteinuria). In a recent survey, the incidence rate for end-stage renal disease (ESRD) was 30.7 per million population (pmp), and the prevalence rate was 23.4 pmp. In 2006, about 10 000 patients were being treated with hemodialysis. Nevertheless, many ESRD patients remained untreated. Financial problems, scarcity of dialysis facilities, and insufficient numbers of skilled health care providers were among reasons why renal replacement treatment is not so well developed in Indonesia.

The continuous ambulatory peritoneal dialysis (CAPD) program begun in 1985 was slowly growing until an economic crisis in 1998. Afterward, with new development of CAPD and government support, the number of patients on CAPD increased. In the middle of 2007, CAPD patients numbered 774 in total. Drop-out rates remained high, because of death, infection, and catheter failure. Almost all new CAPD patients are older than 35 years of age, and the technique is still costly: 51% of patients receive 4 daily exchanges, costing $6000 annually; the rest receive 3 daily exchanges, costing $4800 annually. Government insurance reimburses only 3 exchanges. Expensive drugs such as erythropoietin, intravenous iron, and vitamin D3 are not covered by insurance. The infection rate for the most recent year was 1 episode in 47.17 patient–months. The cost of antibiotic treatment to cure peritonitis is still expensive. Many patients experience some complication related to catheter obstruction or hemorrhage.

In Indonesia, CAPD is relatively new and just beginning to progress. In our archipelago, with its many islands and limited resources and investment, CAPD may be the better choice of therapy. More training is needed to increase the number of skilled and experienced doctors, nurses, and other CAPD team members. We hope that CAPD can be made more affordable for ESRD patients.
Standardized Peritoneal Equilibration Test in Japanese Children and the Influence of Long-Term Peritoneal Dialysis
Authors: Kaku Yoshitsugu , Honda Masataka
Published: October 2020

⋄ Objective

To establish a standardized method and standard values of peritoneal equilibration test (PET) in children and to elucidate the factors influencing peritoneal permeability, we standardized the method of PET in the leading hospitals of the Japanese Study Group of Pediatric Peritoneal Dialysis.

⋄ Methods

Using 2.5% glucose dialysate and an infusion volume of 1100 mL/m2 body surface area (BSA), we performed 202 standardized PETs. The patients within 1 month of a peritonitis episode were excluded.

⋄ Results

The–1 standard deviation (SD), mean, and +1 SD values of end dialysate–to–initial dialysate ratio of (D/D0) glucose were 0.31, 0.41, and 0.51 respectively. The dialysate-to-plasma ratios (D/P) of creatinine were 0.52, 0.65, and 0.78. These values were similar to those of Twardowski's adult PET, although previous reports about standardized pediatric PET described more permeable values. Because the duration of PD was longer in the study patients, peritoneal permeability was increased significantly in patients with and without experience of peritonitis alike. The slope indices of the regression equations between the duration of PD and peritoneal permeability in the two groups were same.

⋄ Conclusions

Standardized PET in Japanese children with 2.5% glucose dialysate and an infusion volume of 1100 mL/m2 BSA produces standard values similar to those of Twardowski's adult PET. This standardized method of PET is suitable for pediatric PD patients, and peritoneal permeability in children is not higher than that in adults. In addition, the study data show that long-term peritoneal dialysis worsens peritoneal function more than experience of peritonitis does.
The Relationship of P1 and Lewis Antigens with Peritoneal Dialysis–Related Escherichia Coli Peritonitis
Authors: Ting I-Wen , Kao Tze-Wah , Chiu Yen-Ling , Lo Shyh-Chyi , Hu Fu-Chang , Wu Kwan-Dun
Published: October 2020

It has been known that the P1 and Lewis antigens on red blood cells (RBCs) affect the risk of Escherichia coli–related urinary tract infection. In the present study, we investigated the associations between those antigens and peritoneal dialysis (PD)–related peritonitis and E. coli peritonitis.

We recruited 155 patients (66 men, 89 women) who were under PD treatment in July 2005, checked the P1 and Lewis antigen status of their RBCs, reviewed their medical charts, and recorded the dates and the causative pathogens of peritonitis episodes. The relationships between peritonitis and the antigens were analyzed.

The mean age of these PD patients was 52.5 ± 14.9 years, and the mean PD duration was 39.8 ± 38.2 months. A total of 66 peritonitis episodes occurred (over 93.4 patient– months) in 41 patients, with 8 patients having more than 1 episode. In particular, E. coli peritonitis accounted for 16 of the 66 peritonitis episodes. We fitted two multiple Cox proportional hazards models (with the robust variance method) for predicting the hazard rates of peritonitis-free and E. coli peritonitis-free survival times to our right-censored data with recurrent events. We found that patients on PD treatment for less than 4 years with (A) lower serum albumin, (B) one or more previous peritonitis episodes, or (C) negative Lewis a and positive Lewis b antigens (secretor) would be at higher risk of peritonitis. And, conditioning on blood type, the PD patients with one or more previous peritonitis episodes and (A) positive P1 antigen, (B) negative Lewis a and positive Lewis b antigens (secretor), or (C) positive Lewis a and negative Lewis b antigens (non-secretor) would be at higher risk of E. coli peritonitis.
Characteris Tics and Causes of Immune Dysfunction Related to Uremia and Dialysis
Authors: Hauser Aline Borsato , Stinghen Andréa E. M. , Kato Sawako , Bucharles Sérgio , Aita Carlos , Yuzawa Yukio , Pecoits–Filho Roberto
Published: October 2020

From the immunologic viewpoint, chronic kidney disease (CKD) is characterized by disorders of both the innate and adaptive systems, generating a complex and still not fully understood immune dysfunction. Markers of a chronically activated immune system are closely linked to several complications of CKD and represent powerful predictors for mortality in the CKD population. On the other hand, CKD patients respond poorly to vaccination and to challenges such as bacterial infection. Interestingly, the main causes of death in patients with CKD are cardiovascular and infectious diseases, both being pathologic processes closely linked to immune function. Therefore, accelerated tissue degeneration (as a consequence of chronic inflammation) and increased rate of sepsis (because of a poorly orchestrated immune response) represent the most important targets for interventions aiming to reduce mortality in CKD patients. Understanding the mechanisms behind the immune dysfunction that is peculiar to CKD generates a perspective to improve outcomes in this group of patients.
Automatic Guidance (and Misguidance) of Visuospatial Attention by Acquired Scene Memory: Evidence From an N1pc Polarity Reversal
Authors: Zinchenko Artyom , Conci Markus , Töllner Thomas , Müller Hermann J. , Geyer Thomas
Published: October 2020

Visual search is facilitated when the target is repeatedly encountered at a fixed position within an invariant (vs. randomly variable) distractor layout—that is, when the layout is learned and guides attention to the target, a phenomenon known as contextual cuing. Subsequently changing the target location within a learned layout abolishes contextual cuing, which is difficult to relearn. Here, we used lateralized event-related electroencephalogram (EEG) potentials to explore memory-based attentional guidance ( N = 16). The results revealed reliable contextual cuing during initial learning and an associated EEG-amplitude increase for repeated layouts in attention-related components, starting with an early posterior negativity (N1pc, 80–180 ms). When the target was relocated to the opposite hemifield following learning, contextual cuing was effectively abolished, and the N1pc was reversed in polarity (indicative of persistent misguidance of attention to the original target location). Thus, once learned, repeated layouts trigger attentional-priority signals from memory that proactively interfere with contextual relearning after target relocation.
Sexual abuse by superintending staff in the nineteenth-century lunatic asylum: medical practice, complaint and risk
Authors: Dobbing Cara , Tomkins Alannah
Published: October 2020

The nineteenth century witnessed a great shift in how insanity was regarded and treated. Well documented is the emergence of psychiatry as a medical specialization and the role of lunatic asylums in the West. Unclear are the relationships between the heads of institutions and the individuals treated within them. This article uses two cases at either end of the nineteenth century to demonstrate sexual misdemeanours in sites of mental health care, and particularly how they were dealt with, both legally and in the press. They illustrate issues around cultures of complaint and the consequences of these for medical careers. Far from being representative, they highlight the need for further research into the doctor–patient relationship within asylums, and what happened when the boundaries were blurred.