bluuebunny/crossref_metadata_2025 huggingface dataset:
Moving teachers to the center of school improvement
Authors: Khachatryan Edit , Parkerson Emma
Published: February 2020

Teachers have historically been at the margins of educational improvement, and they are just beginning to drive improvements in the profession. Networked improvement communities (NICs) are one approach for collective reprofessionalization of teaching, where practice is defined and managed by practitioners. Edit Khachatryan and Emma Parkerson offer insight into the social organization of a NIC and use two real and mature networks — the Network to Transform Teaching and the National Writing Project — to describe how NICs structure roles and relationships and foster vital norms and identities among professionals.
Organizing schools so teachers can succeed: A conversation with Susan Moore Johnson
Authors: Heller Rafael
Published: February 2020

Kappan’s editor-in-chief talks with renowned scholar Susan Moore Johnson about her extensive research into the professional lives of public school teachers. For decades, studies have shown that teaching tends to be isolating work, with few opportunities for teachers to collaborate with and learn from each other or to play meaningful roles in school decision making. In her most recent book, however, Johnson describes the much more supportive professional culture she observed in a group of successful schools in a high-poverty urban district.
The under-funding of Latinx-serving school districts
Authors: Baker Bruce , Cotto Robert
Published: February 2020

An analysis of school district spending across the U.S. reveals 66 districts where the students face much greater needs than in surrounding districts (i.e., child poverty is more than 20% higher) but where per-pupil spending is less than 90% of the region’s average. This not only means that they have less money to spend on children who require more expensive services and supports, but it also puts them at a competitive disadvantage when it comes to hiring and retaining high-quality teachers and staff from the local area. These districts tend to be located in small to mid-size cities, and they serve disproportionately large numbers of Latinx students.
Under the Law: Discriminatory practices in voucher programs
Authors: Eckes Suzanne E. , Mead Julie F.
Published: February 2020

A recent case in Maryland raises the question of how state policies related to school funding apply to religious schools with discriminatory practices. A private Maryland school was denied voucher funds when the state learned that the school’s handbook required that dress codes, pronoun use, and restroom choice align with a student’s sex assigned at birth. The school sued, claiming that the policy was not discriminatory because it does not apply to student admission. Suzanne Eckes and Julie Mead consider this case in light of past cases involving school discrimination.
Career Confidential: Is it OK for a teacher to be sarcastic with students?
Authors: Fagell Phyllis L.
Published: February 2020

Phyllis Fagell offers advice to educators dealing with professional problems. In this monthly column, a teacher wonders if they should worry about a principal’s directive to stop being sarcastic with students. A male principal wants to know how to appropriately manage an otherwise promising young female teacher’s unprofessional language and dress.
Backtalk: Engineering fairer science fairs
Authors: Pittinsky Todd L.
Published: February 2020

Students who come from wealthy families and schools often have an advantage when it comes to science fairs. Parents with the time and resources to do so often get involved in every stage of the science fair project, enabling their students to create projects that are far beyond what they could achieve on their own. Todd L. Pittinsky suggests adding constraints by requiring students to develop projects based on a small list of items. Such constraints would not only spark student creativity, they would help level the playing field.
Knowledge Creation in Information Technology and Tourism Research
Authors: Cai Wenjie , McKenna Brad
Published: February 2020

We critique Information Technology and Tourism (ITT) research and make recommendations to enhance its theoretical and methodological development. Our recommendations are based on four critiques: (1) ITT is primarily a self-referential research area; (2) ITT is popular with tourism academics, but not in other technology-related disciplines; (3) ITT does not synchronize with its mother discipline of information systems; and (4) ITT is primarily focused on business applications of technology, with limited engagement of theoretical developments in social science. We first suggest ITT researchers should engage with wider disciplinary knowledge through their parent fields of Information Systems and Tourism. Second, we suggest a shift from the user-centric and overcrowded applied business studies’ focus of ITT and encourage theorizing IT and tourism in a larger social context critically and reflexively. Third, we encourage academics to develop ITT-specific guidance to offer rigorous directions and instructions of theoretical and methodological development.
Convertible local currency and trust: ‘It’s Not You, It’s Me’ – A field experiment in the French Basque Country
Authors: Alia Hayyan , Spiegelman Eli
Published: February 2020

We present a field experiment investigating the mechanism by which community currencies enhance trust. Our question is the following: do I trust more when using a community currency because I am a trusting-type person or because I think that you are trustworthy? We call the former preference-based trust; while the latter is belief-based trust. We apply a modification of the standard trust game from the experimental economics literature to disentangle these mechanisms. Player A has to choose whether or not to trust player B, and player B can either reciprocate that trust or not. Our innovation is in experimentally separating the currency in which the game is played ( effective currency), from the currency preferred by the participant ( preferred currency). If the mechanism is preference-based, then preferred currency will determine trust more than effective; if it is belief-based, then the effective currency will be determinant. We find strong evidence of the preference-based mechanism of community currencies on trust, and only weak evidence of the belief-based mechanism.
Combination of plasma exchange and haemofiltration for treating thrombotic microangiopathy in children
Authors: Huang Jun , Chen Guangming , Ma Liqiang , Tan Ting
Published: February 2020

Objective

To investigate the therapeutic effects of a combination of plasma exchange (PE) and haemofiltration (HF) for the treatment for paediatric patients with severe thrombotic microangiopathy (TMA).

Methods

This retrospective study analysed data from paediatric patients who were diagnosed with severe TMA and managed with either supportive therapy and additional PE and HF (PE + HF group) or supportive therapy alone (control group). Demographic and clinical characteristics, haemopurification and blood parameters and survival of the patients were compared between the two groups.

Results

This study enrolled 32 patients: PE + HF group ( n = 15) and control group ( n = 17). There were no significant differences between the two groups at baseline, including specific features for differentiating the two categories of TMA. The median time between onset and recovery, defined by the markers of platelet count, lactate dehydrogenase, blood urine nitrogen and hospital stay, were all significantly longer in the control group compared with the PE + HF group. Kaplan–Meier curve analysis demonstrated that the cumulative survival rate was significantly higher in the PE + HF group compared with the control group.

Conclusion

The combination of PE and HF could be considered as one of the treatment choices for TMA.
Autologous platelet-rich plasma therapy for refractory pain after low-grade medial collateral ligament injury
Authors: Zou Guoyou , Zheng Minqian , Chen Wang , He Xiao , Cang Dingwei
Published: February 2020

Objective

This study was performed to explore the effect of intra-articular injection of autologous platelet-rich plasma (PRP) on refractory pain after low-grade medial collateral ligament (MCL) injury.

Methods

In total, 52 patients with refractory pain after low-grade knee MCL injury were treated by intra-articular injection of autologous PRP. Every patient received a 5-mL intra-articular injection of autologous PRP once weekly for 3 weeks. All patients were evaluated by the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form score before treatment and 1, 3, and 6 months after treatment. Magnetic resonance imaging of the knee was performed to observe the healing of the MCL injury 6 months after treatment.

Results

After one injection, the patients’ pain was greatly decreased and they stopped taking nonsteroidal anti-inflammatory drugs. The IKDC Subjective Knee Evaluation Form scores were significantly better after than before treatment; however, there were no significant differences among the various post-treatment time points. Magnetic resonance imaging showed that the low-grade MCL injury had completely healed, and no edema was present around the MCL.

Conclusions

Intra-articular injection of autologous PRP is an effective treatment for refractory pain after low-grade MCL injury.
Relationship between hypertension and geographic altitude: a cross-sectional survey among residents in Tibet
Authors: Song Ci , Chongsuvivatwong Virasakdi , Zhu Luo Bu Ou , Ji De , Sang Zhuo Ma Ba , Sriplung Hutcha
Published: February 2020

Objective

This study aimed to assess the prevalence of hypertension (HT) among individuals living at different altitudes in Tibet.

Methods

We conducted a stratified cluster survey among 1,631 participants in Tibet living in areas at three different altitudes.

Results

Mean systolic and diastolic blood pressure and body mass index (BMI) values were highest at the lowest altitudes. After adjusting for age and sex, the prevalence of HT at low, medium, and high altitudes was 40.6%, 32.5%, and 20.4%, respectively. The prevalence of HT decreased with increasing altitude and increased with increasing age and BMI value.

Conclusion

Increasing altitude tended to decrease BMI levels, and as a consequence, the prevalence of HT was reduced. National policies and guidelines for HT in Tibet should focus on this relationship.
Beyond a sedentary Other and a mobile tourist: Transgressing mobility categories in the informal tourism sector in India
Authors: Bloch Natalia
Published: February 2020

Taking the informal tourism sector in India as a case study, this article demonstrates ethnographically that dichotomous classifications often taken for granted when conceptualizing human mobilities are undermined in people’s everyday practices. One of them is the binary between mobile cosmopolitan tourists (“guests” from the Global North) and local “hosts” (i.e. service providers from the Global South), who are denied the right to be mobile. The aim of the article is to overcome these outdated anthropological conceptualizations of the sedentary Other, based on ethnological naturalism and currently reproduced in the tourism marketing, in the context of global mobility regimes. The article shows that a high level of mobility is not only an attribute of tourists, but it also characterizes the “locals,” who work in the informal tourism sector in India. It also reveals the multiple ways that various forms of people’s spatial mobility – such as tourism and migration – intersect.
Moving urban political ecology beyond the ‘urbanization of nature’
Authors: Tzaninis Yannis , Mandler Tait , Kaika Maria , Keil Roger
Published: February 2020

Urban political ecology (UPE) focuses on unsettling traditional understandings of ‘cities’ as ontological entities separate from ‘nature’ and on how the production of settlements is metabolically linked with flows of capital and more-than-human ecological processes. The contribution of this paper is to recalibrate UPE to new urban forms and processes of extended urbanization. This exploration goes against the reduction of what goes on outside of cities to processes that emanate unidirectionally from cities. Acknowledging UPE’s rich intellectual history and aiming to enrich rather than split the field, this paper identifies four emerging discourses that go beyond UPE’s original formulation.
Real-Time Predictive Control Strategy Optimization
Authors: Gupta Samarth , Seshadri Ravi , Atasoy Bilge , Prakash A. Arun , Pereira Francisco , Tan Gary , Ben-Akiva Moshe
Published: February 2020

Urban traffic congestion has led to an increasing emphasis on management measures for more efficient utilization of existing infrastructure. In this context, this paper proposes a novel framework that integrates real-time optimization of control strategies (tolls, ramp metering rates, etc.) with the generation of traffic guidance information using predicted network states for dynamic traffic assignment systems. The efficacy of the framework is demonstrated through a fixed demand dynamic toll optimization problem, which is formulated as a non-linear program to minimize predicted network travel times. A scalable efficient genetic algorithm that exploits parallel computing is applied to solve this problem. Experiments using a closed-loop approach are conducted on a large-scale road network in Singapore to investigate the performance of the proposed methodology. The results indicate significant improvements in network-wide travel time of up to 9% with real-time computational performance.
Rural healthcare delivery: Navigating a complex ecosystem
Authors: Fyfe Trina M. , Payne Geoffrey W.
Published: February 2020

Clinical Practice Guidelines (CPGs) provide evidence-based recommendations for Healthcare Providers (HCPs) to utilize when making patient care decisions. Rural providers face challenges in the provision of evidence-based care, including the use of guidelines. The aim of this article is to explore the complexities of providing healthcare in rural areas. This article will focus on a specific aspect of rural maternity care with well-established CPGs, the prevention of Rhesus D factor alloimmunization. An applied health research approach, interpretive description, utilized semistructured interviews with HCPs across the vast geographic region of northern British Columbia. The study found that HCPs are aware of guidelines but face various barriers during implementation. In order to implement guidelines within practice, rural HCPs adapt processes to overcome local barriers. These process adaptations need to be identified and shared across a large health authority with a complex geography and healthcare system to ensure quality of care.
Evaluation of Thyroid Ultrasound Report Quality and Assessing Effect of Adherence to Risk Stratification Criteria on Referral for Thyroid Nodule Biopsy
Authors: Thejeel Bashiar , Rahimi Behruz , Seidler Michael , Al-Agha Rany , Fung Christopher
Published: February 2020

Purpose:

This study aims to evaluate the quality of diagnostic thyroid ultrasound reports and determine the impact of consistent adherence to 2015 American Thyroid Association (ATA) and 2017 American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) on reducing unnecessary referrals for thyroid nodule biopsy.

Materials and Methods:

Reports from 291 referrals for thyroid nodule biopsy were included for retrospective report evaluation (males: 42; mean age: 56) according to 2015 ATA and ACR TI-RADS lexicon. Cytology results were collected for each patient. Two radiologists blinded to cytology results independently, retrospectively reviewed imaging of the referrals, and rescored them according to 2015 ATA and 2017 ACR TI-RADS risk stratification systems. Statistical analysis was completed using chi-square analysis and calculation of κ statistic for interobserver variability.

Results:

No report completely addressed all features associated with malignancy. Over half of the reports did not include descriptors on echogenicity, shape, margin, or echogenic foci. In all, 9.3% of biopsies showed malignant histology. Rescoring of referrals demonstrated decrease in biopsy referrals by 55% as per 2017 ACR TI-RADS and 14% as per 2015 ATA ( P < .0001). There was no impact on detection of malignancy with adherence to ATA or ACR criteria and less interobserver variability with application of 2017 ACR TI-RADS compared to 2015 ATA.

Conclusion:

Thyroid ultrasound report quality was found variable with respect to nodule description. Reports recommended biopsy based on nodule size with no detailed description of other imaging features. Adherence to risk stratification system would have resulted in significant reduction in the number of unnecessary biopsy referrals.
Experience in an Urban Level 1 Trauma Center With Tranexamic Acid in Pediatric Trauma: A Retrospective Chart Review
Authors: Thomson Julie M. , Huynh Hanh H. , Drone Holly M. , Jantzer Jessica L. , Tsai Albert K. , Jancik Jon T.
Published: February 2020

Background:

Evidence for tranexamic acid (TXA) in the pharmacologic management of trauma is largely derived from data in adults. Guidance on the use of TXA in pediatric patients comes from studies evaluating its use in cardiac and orthopedic surgery. There is minimal data describing TXA safety and efficacy in pediatric trauma. The purpose of this study is to describe the use of TXA in the management of pediatric trauma and to evaluate its efficacy and safety end points.

Methods:

This retrospective, observational analysis of pediatric trauma admissions at Hennepin County Medical Center from August 2011 to March 2019 compares patients who did and did not receive TXA. The primary end point is survival to hospital discharge. Secondary end points include surgical intervention, transfusion requirements, length of stay, thrombosis, and TXA dose administered.

Results:

There were 48 patients aged ≤16 years identified for inclusion using a massive transfusion protocol order. Twenty-nine (60%) patients received TXA. Baseline characteristics and results are presented as median (interquartile range) unless otherwise specified, with statistical significance defined as P < .05. Patients receiving TXA were more likely to be older, but there was no difference in injury type or Injury Severity Score at baseline. There was no difference in survival to discharge or thrombosis. Patients who did not receive TXA had numerically more frequent surgical intervention and longer length of stay, but these did not reach significance.

Conclusions:

TXA was utilized in 60% of pediatric trauma admissions at a single level 1 trauma center, more commonly in older patients. Although limited by observational design, we found patients receiving TXA had no difference in mortality or thrombosis.
Autobiographical Memory Impairment in Adolescents in Out-of-Home Care
Authors: Jimeno María Verónica , Latorre Jose Miguel , Cantero María José
Published: February 2020

Childhood maltreatment is a major risk factor for emotional problems in adolescence and adulthood and has deleterious effects on cognitive functions such as working memory. A key aspect in the study of the cognitive and affective consequences of maltreatment is autobiographical memory, especially regarding the difficulty retrieving specific memories, known as overgeneral memory. In this study, autobiographical memory tests, working memory, and a depressive symptom assessment were administered to 48 adolescents in care with a history of maltreatment (22 abused and 26 neglected) without mental disorder, who had been removed from their family and were living in residential child care, and to 61 adolescents nonmaltreated who had never been placed in care. The results show that adolescents with a history of maltreatment remember fewer specific events (Cohen d = 1.1–1.3) and that both working memory and depressive symptoms are involved in overgeneral memory ( R2 = .13–.26). Directions for future research include neuropsychological assessment and implementation of a training program to increase specific memory recall in this population.
Breastfeeding Duration in a Low-Income Sample Is Associated With Child Diet Quality at Age Three
Authors: Weinfield Nancy S. , Borger Christine , Gola Alice Ann
Published: February 2020

Background

Little research has focused on breastfeeding and diet quality, particularly in low-income populations at risk for shorter breastfeeding duration and poorer diet quality.

Research Aim

The aim of this study was to examine the association between breastfeeding duration and later diet quality in a low-income population.

Methods

For this longitudinal prospective cohort study we conducted a secondary analysis of data from the Infant and Toddler Feeding Practices Study-2, a national study of infant feeding practices and child outcomes. Study infants were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children by 2.5 months of age and followed until 36 months ( N = 1,223). We examined the association between breastfeeding duration until 13 months of age, and child diet quality derived from a 24-hour dietary recall with a usual intake adjustment at child age 36 months. Multiple regression analyses were used to examine the association of breastfeeding duration with overall diet quality, as measured by the Heathy Eating Index 2015, and with consumption of specific food groups.

Results

Longer breastfeeding duration during infancy was associated with better diet quality at child age 36 months after controlling for key socio-demographic variables. In follow-up analyses, the origin of the association was narrowed to greater consumption of mature/dried beans and peas.

Conclusions

Longer breastfeeding duration in infancy was associated with better diet quality at 36 months, in a population at risk for shorter breastfeeding duration and poorer diet quality. Breastfeeding was particularly associated with children’s consumption of mature/dried beans and peas.

Clinical Trial Registration

This study is registered at clinicaltrials.gov as Feeding My Baby—A National WIC Study, NCT02031978
Intraperitoneal Insulin Reduces Plasma Leptin Concentration in Diabetic Patients on CAPD
Authors: Nevalainen Pasi I. , Lahtela Jorma T. , Mustonen Jukka , Pasternack Amos
Published: February 2020

Objective

To determine the effects of subcutaneous (SC) and intraperitoneal (IP) insulin on serum leptin concentration in type I diabetic patients with end-stage renal failure treated with continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective, open, before–after study.

Setting

Tertiary-care university hospital.

Participants

Twelve type I diabetic patients with stabilized CAPD, age 43.9 ± 2.8 years, and duration of diabetes 30.4 ± 3.5 years.

Intervention

After stabilized CAPD therapy, all patients were treated first with SC insulin for a median of 3 months, and thereafter with IP insulin for another 3 months.

Main Outcome Measures

Plasma leptin, insulin sensitivity with euglycemic clamp, and glycemic and uremic status after both treatment periods.

Results

During SC insulin therapy, plasma leptin concentration was significantly higher than during IP insulin (19.8 ± 5.9 ng/mL and 12.8 ± 6.2 ng/mL, respectively; p < 0.001). Leptin concentration was higher in CAPD patients and was related to body mass index in both genders. No correlation was detected between plasma leptin and fasting insulin, glycemic control, glucose disposal rate, or serum lipids.

Conclusion

Plasma leptin concentration is lower during IP insulin therapy compared to SC insulin. Insulin has probably a direct effect on both peritoneal leptin clearance and adipose tissue leptin production. The significance of leptin in regulating appetite and anorexia in uremia remains unclear.
Correlation between Peritoneal Equilibration Test and Dialysis Adequacy and Transport Test, for Peritoneal Transport Type Characterization
Authors:   for the Mexican Nephrology Collaborative Study Group, Paniagua Ramón , Amato Dante , Correa–Rotter Ricardo , Ramos Alfonso , Vonesh Edward F. , Mujais Salim K.
Published: February 2020

Objective

The aim of this study was to analyze the correlation between the peritoneal equilibration test (PET) and the dialysis adequacy and transport test (DATT) for peritoneal transport type characterization, and the degree of patients’ acceptance for each test.

Design

Cross-sectional, observational multicenter study.

Setting

Five referral (tertiary) dialysis centers of institutional practice.

Patients

The study included 107 adult continuous ambulatory peritoneal dialysis (CAPD) patients with a prescription of four exchanges of 2 L per day, irrespective of age, gender, cause of end-stage renal disease, time on dialysis, nutritional status, or residual renal function. Patients on immunosuppressive therapy and those with cancer, hepatitis B, or HIV, and those having a peritonitis episode within the previous 30 days, or three or more episodes during the previous 12 months, were excluded.

Main Measures

Peritoneal transport type as classified by creatinine and urea dialysis-to-plasma (D/P) ratios by PET and DATT.

Results

Correlation coefficients between D/P ratios for creatinine and urea, obtained for the PET and the DATT, were 0.73 for D/P creatinine and 0.96 for D/P urea. Patients were classified into high, high-average, low-average, and low transport categories according to the mean and standard deviation of D/P creatinine values obtained from the PET at 4 hours. These values showed excellent concordance with those generated from the DATT data (κ = 0.82, 95% confidence interval 0.67 – 0.93). Nineteen percent of patients showed discordance in their category when classified according to the PET versus the DATT. Patients’ acceptance was better for the DATT than for the PET, as evaluated with a questionnaire.

Conclusion

The DATT is an easy, inexpensive, and reliable test to assess peritoneal transport type, and it also provides information about peritoneal clearance of solutes and ultrafiltration. The DATT has better patient acceptance than the PET. Since the DATT has only been validated for patients on a fixed CAPD daily schedule of 4 x 2 L, the results should be confined only to patients receiving such a prescription.
Quality of Life in Predialysis End-Stage Renal Disease Patients at the Initiation of Dialysis Therapy
Authors:   for The NECOSAD Study Group, Korevaar Johanna C. , Jansen Maarten A.M. , Merkus Maruschka P. , Dekker Friedo W. , Boeschoten Elisabeth W. , Krediet Raymond T.
Published: February 2020

Objective

To assess health-related quality of life (QL) in a group of Dutch predialysis end-stage renal disease (ESRD) patients prior to the initiation of dialysis, and to compare QL between patients with different intended initial dialysis treatments.

Design

In a prospective cohort study, demographic, clinical, and QL data were obtained from Dutch adult patients who were consecutively enrolled from 27 different centers 0 – 4 weeks prior to the beginning of their chronic dialysis treatment.

Patients

Of the 301 patients who completed the QL questionnaires (of a possible 337 enrolled patients), 152 intended to start with hemodialysis (pre-HD) and 149 patients with peritoneal dialysis (pre-PD).

Main Outcome Measure

Perceived QL of pre-HD and pre-PD patients. Quality of life was assessed with two generic health assessment instruments: the SF-36 and the EuroQol.

Results

After correction for group differences, pre-HD patients scored consistently, but not significantly, lower for all separate dimensions of the SF-36 and the overall health score of the EuroQol compared to pre-PD patients. However, analyzing the dimensions of the SF-36 together, adjusted for case-mix, pre-HD patients scored significantly lower than pre-PD patients. Mean difference was 6.5 points ( p = 0.04).

Conclusion

Multivariate adjustment for known case-mix differences at the start of dialysis therapy was not sufficient to adjust for all patient selection effects on QL. Consequently, published QL comparisons between HD and PD in nonrandomized cohort studies should be interpreted with caution. Assessment of QL just before start of dialysis therapy and subsequent adjustment for baseline values may be the only valid alternative for randomized studies.
A Retrospective Study of Seven Cases of Candida Parapsilosis Peritonitis in CAPD Patients: The Therapeutic Implications
Authors: Wong Ping-Nam , Mak Siu-Ka , Lo Kin-Yee , Tong Gensy M.W. , Wong Andrew K.M.
Published: February 2020

Background

Candida peritonitis accounts for the majority of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD), but the Candida species were not routinely subtyped in previous studies. The clinical course and the outcome of Candida parapsilosis peritonitis remain unclear.

Objective

To study the clinical course and outcome of C. parapsilosis peritonitis in CAPD patients.

Setting

Peritoneal dialysis unit in a regional hospital.

Patients and Design

A retrospective study on seven cases of C. parapsilosis peritonitis occurring in a single center over 3 years.

Results

The 7 patients included 4 males and 3 females. Their mean age was 62 ± 11.5 years. Two (29%) were diabetic. Three (43%) had a history of preceding peritonitis and 5 (71%) had received broad spectrum antibiotic within the previous 1 month. All presented with cloudy dialysate, abdominal pain, and fever. The mean dialysate white cell count was 300 ± 168/mm3 with a predominance of neutrophils (81.4% ± 13.1%). The mean time from onset of symptoms to diagnosis was 5.7 ± 3.1 days. All had been treated with immediate catheter removal within 24 hours of diagnosis and antifungal therapy, including oral fluconazole, intravenous (IV) amphotericin, or their sequential combination. Environmental samplings were negative for C. parapsilosis. The overall complication rate was exceptionally high (71%), with three (43%) complicated by abscess formation requiring surgical drainage, one peritoneal adhesion (14%), and one mortality (14%). In the end, only two (29%) could resume CAPD.

Conclusions

The outcome of this study group appeared worse than those previously described in the literature, and the optimal treatment for this group of patients remains unclear.
The Effect of Small Solute Clearances on Survival of Anuric Peritoneal Dialysis Patients
Authors: Bhaskaran Shanmukham , Schaubel Douglas E. , Jassal Sarbjit V. , Thodis Elias , Singhal Manoj K. , Bargman Joanne M. , Vas Stephen I. , Oreopoulos Dimitrios G.
Published: February 2020

Objective

Primarily, to determine whether peritoneal small solute clearance is related to patient and technique survival among anuric peritoneal dialysis [continuous ambulatory (CAPD) and automated peritoneal dialysis (APD)] patients. A secondary goal was to describe the ability to attain Dialysis Outcomes Quality Initiative (DOQI) targets among anuric patients on peritoneal dialysis.

Design

Retrospective cohort study via chart reviews.

Setting

Peritoneal Dialysis Unit of Toronto Hospital (Western Division).

Patients

The study included 122 CAPD and APD patients between January 1992 and September 1997, with 24-hour urine volume less than 100 mL, or renal creatinine clearance (CCr) less than 1 mL/minute. Adequacy data were available for 115 patients.

Outcome Measures

Mortality and technique failure (TF). Regression analysis was used to estimate the mortality and TF rate ratios (RR) for peritoneal Kt/V urea (pKt/V) and pCCr, adjusting for age, gender, diabetes, months of follow-up prior to anuria, albumin, transport status, coronary artery disease, cardiovascular disease, and peripheral vascular disease.

Results

Fifty seven per cent (51/89) of patients on CAPD and 81% (21/26) on APD had a weekly pKt/V ≥ 2 and ≥ 2.2, respectively (DOQI targets); whereas only 35% on CAPD (31/89) and 35% (9/26) on APD had a weekly pCCr ≥ 60 L/1.73 m2 and 66 L/1.73 m2, respectively. Median follow-up times among patients were 16.5 and 19.5 months pre- and postanuria, respectively. Patients with pKt/V ≥ 1.85 experienced a strong decrease in patient mortality (RR = 0.54, p = 0.10); the effect was less pronounced for pCCr ≥ 50 L/1.73 m2 (RR = 0.63, p = 0.25). No relationship was observed between pKt/V or pCCr and TF.

Conclusion

Mortality was noticeably less frequent among patients with a pKt/V ≥ 1.85 compared with those with a Kt/V < 1.85 ( p = 0.10). Given the magnitude of the association, the failure to observe statistical significance relates to the size of the patient cohort. Our results imply that it is, in fact, possible to achieve DOQI targets among anuric patients on peritoneal dialysis.
Peritoneal Dialysis Case Forum
Authors: Burkart John M. , Piraino Beth , Warady Bradley A.
Published: February 2020

The Trials and Tribulations of an Adolescent Patient with End-Stage Renal Disease
Chronic Peritoneal Dialysis in the Elderly: A Review
Authors: Dimkovic Nada , Oreopoulos Dimitrios G.
Published: February 2020

During the past few decades, the pattern of end-stage renal disease has changed significantly with the emerging predominance of elderly patients. Because this heterogeneous population is characterized by a physiological decline in function of all organs, the nephrologist must contemplate the special needs of individual patients when they develop end-stage renal disease. Before the initiation of dialysis, these patients must be given detailed information to help them select the particular mode that will maximize their quality of life. According to available data, peritoneal dialysis offers some advantages for elderly patients, such as hemodynamic stability, steady-state metabolic control, good control of hypertension, independence from hospital, and avoidance of repeated vascular access. Early referral promotes the establishment of peritoneal access and minimizes the consequences of uremia, subsequent morbidity, and frequent hospitalization. Elderly patients are compliant and highly motivated to cooperate with their treatment. They have no higher modality-related complications than younger patients and their quality of life is satisfactory. Although most have comorbid conditions that interfere with self-performance of dialysis, such as impaired vision and reduced physical and mental activity, they can perform peritoneal dialysis successfully if they have a high level of family support. Patients who do not have family support may have successful peritoneal dialysis if they have access to a network of medical and social support, that is, private home nurses, rehabilitation and chronic care dialysis units, or nursing homes.
Dyslipidemia in Peritoneal Dialysis — Relation to Dialytic Variables
Authors: Johansson Ann-Cathrine , Samuelsson Ola , Attman Per-Ola , Haraldsson Börje , Moberly James , Knight–Gibson Carolyn , Alaupovic Petar
Published: February 2020

Objective

To investigate whether the specific lipoprotein (LP) abnormalities of peritoneal dialysis (PD) are associated with functional variables of this mode of dialysis.

Design

A survey of the LP profile in relation to peritoneal dialysis capacity (PDC) variables. The LP profile was compared to that of a group of age- and sex-matched controls.

Setting

The Peritoneal Dialysis Unit at Sahlgrenska University Hospital in Gothenburg, Sweden.

Patients

Twenty-two nondiabetic PD patients (5 women, 17 men) who had been on PD for at least 6 months.

Main Outcome Measures

The LP profile included plasma lipids, apolipoproteins (Apo), and individual ApoA- and ApoB-containing LP. The PDC measurement determined peritoneal glucose uptake, protein losses, effective peritoneal surface area, and total weekly creatinine clearance.

Results

The patients had been on PD for 6 to 48 months (mean 15.3 months) and had a total weekly creatinine clearance of 69.7 ± 13.3 L/1.73m2 body surface area, an average peritoneal glucose uptake corresponding to 446 ± 162 kcal/24 hour, and a protein loss of 8.1 ± 2.5 g/24 hr. The patients had significantly higher total cholesterol (7.1 mmol/L), VLDL-cholesterol (1.0 mmol/L), LDL-cholesterol (4.7 mmol/L), and triglyceride levels (2.5 mmol/L); whereas the HDL-cholesterol level (1.2 mmol/L) was significantly lower than in controls. The PD patients had increased levels of ApoB-containing LPs, both of the cholesterol-rich LP-B and of the triglyceride-rich LP-B complex, reflected in higher plasma concentrations of ApoB, ApoC-III, and ApoE. Furthermore, they had significantly lower levels of LP-A-I:A-II, as well as of ApoA-I and ApoA-II. The LP-A-I:A-II and ApoA-II levels correlated inversely with the duration of PD treatment ( r = 0.54, p < 0.01 and r = 0.52, p < 0.05, respectively). The ApoA-II level was inversely correlated with the peritoneal surface area ( r = 0.53, p < 0.05). There were no other correlations between LP variables and PDC variables, nor did any of the LP variables correlate with peritoneal glucose uptake or protein losses.

Conclusion

The proatherogenic lipoprotein profile of patients on PD is characterized by increased concentrations of cholesterol-rich and triglyceride-rich ApoB-containing LPs. While the duration of treatment appears to have some influence on the development of this type of dyslipidemia, the pathophysiological links to the dialysis mode must be further explored.
Continuous Ambulatory Peritoneal Dialysis is Responsible for an Increase in Plasma Norepinephrine
Authors: Vlachojannis John G. , Tsakas Sotiris , Alexandri Sotiria , Petropoulou Chrysanthi , Goumenos Dimitris S.
Published: February 2020

Objective

To investigate the reason for increasing norepinephrine (NE) levels reported in continuous ambulatory peritoneal dialysis (CAPD) patients.

Methods

Norepinephrine was measured in the plasma and peritoneal dialysate of CAPD patients ( n = 22) and in the plasma and the urine of healthy subjects ( n = 20). It was also measured in the plasma of patients with chronic renal failure (CRF) ( n = 15) and patients on hemodialysis (HD) ( n = 15).

Results

It was found that NE was increased in CAPD patients compared with healthy individuals (687 ± 221 pg/mL vs 199 ± 25 pg/mL, p < 0.01). The daily removal of NE from the peritoneum of CAPD patients was lower compared with the amount of NE excreted in the urine of healthy subjects. Plasma NE increased after infusion of peritoneal dialysate. In 15 new patients on CAPD, it was found that NE plasma levels increased from 329 ± 67 pg/mL before initiation of dialysis, to 584 ± 173 pg/mL after 12 months of treatment ( p < 0.01). Finally, plasma NE in CAPD patients (687 ± 221 pg/mL) was significantly higher compared with the already increased levels in patients on HD or with CRF (406 ± 143 pg/mL and 378 ± 142 pg/mL, respectively).

Conclusions

It is concluded that CAPD in patients with end-stage renal disease is responsible for a progressive increase of plasma norepinephrine.
Preliminary Evaluation of Incremental Peritoneal Dialysis in 25 Patients
Authors: De Vecchi Amedeo F. , Scalamogna Antonio , Finazzi Silvia , Colucci Patrizia , Ponticelli Claudio
Published: February 2020

Background

Incremental dialysis has been suggested for patients with some residual renal function. However, very little published clinical data exist on the feasibility of this schedule.

Objectives

To assess feasibility of incremental dialysis, with regard to its effect, complications, and impact on quality of life.

Design

Pilot prospective study, not controlled.

Setting

Nephrology division, public clinical research hospital.

Patients

Twenty-five patients (19 men, mean age 61 ± 13 years, body weight 63 ± 11 kg) began peritoneal dialysis (the first treatment of uremia) with a single nightly exchange lasting 10 hours or 2 daily exchanges over 12 hours according to creatinine clearance and Kt/V. Patients gave informed consent and reported their work activity, degree of rehabilitation, and their quality of life by answering a questionnaire prepared for this purpose.

Outcome Measures

Survival rate, complications related to peritoneal dialysis, and residual renal and peritoneal clearances.

Results

During the study period no patient died. Complications related to dialysis were peritonitis (0.41 episodes/year) and exit-site infection (0.32 episodes/year). All patients continued to work with full rehabilitation and considered 1 or 2 exchanges per day less troublesome than 3 or 4.

Conclusions

Incremental dialysis is well accepted by patients and staff. This technique does not involve a high risk of complications and is economical. Therefore incremental dialysis is feasible.
Incremental Initiation of Dialysis: One Center's Experience over a Two-Year Period
Authors: Burkart John M. , Satko Scott G.
Published: February 2020

Objective

This pilot study describes our center's experience with peritoneal dialysis (PD) over the past 2 years using a “healthy start” dialysis protocol with an incremental approach to prescription management.

Design

Nonrandomized, prospective pilot study.

Setting

Single PD unit of a university teaching hospital.

Patients

Thirteen PD patients who initiated dialysis at our center from April 1997 to June 1999.

Methods

Patients initiating PD with residual renal Kt/V of 1.0 – 2.0/week were invited to participate. They were given an initial dialysis prescription so that total (residual renal + dialysis) weekly Kt/V exceeded 2.0. The dialysis prescription was “incrementally” increased as residual renal function (RRF) declined. Data collected for all patients included monthly serum chemistries, residual renal weekly Kt/V and creatinine clearance (CCr) at 1- to 2-month intervals, and peritoneal weekly Kt/V and CCr at 3-month intervals and 1 month after each prescription change.

Results

To date, we have followed 13 patients on our incremental PD protocol for a total of 159.3 patient-months. Mean serum albumin concentration and mean normalized protein equivalent of nitrogen appearance (nPNA) were stable throughout the study. Mean total Kt/V and CCr remained above the recommended targets of 2.0/wk and 60 L/wk, respectively. Residual renal function declined rather slowly in our PD patients. One patient died from complications of aortic valve surgery and a second died from pneumonia. A third patient died from peritonitis. One patient required a new Tenckhoff catheter after catheter migration. Three patients were temporarily switched to hemodialysis after a hernia repair, a pleural leak, and elective native/transplant nephrectomies, respectively. Two patients were permanently switched to hemodialysis: one after an episode of peritonitis, the second after accidentally damaging his PD catheter.

Conclusions

Providing incremental dialysis to maintain adequate total small solute clearance has been technically feasible in our patient population. However, a larger than expected number of complications was seen in our study. Fortunately, complications were easier to manage due to the presence of RRF. Because this study was not designed to compare outcome with that observed after traditional initiation of dialysis, further large-scale studies are needed.
Continuous Adaptation of the Dialysis Prescription Maintains Adequate Kprt/V in CAPD Patients
Authors: Andersson Helene , Buxbaum Martina , Meisl Franz Thomas
Published: February 2020

Objective

To analyze the effect of individual adaptation of the dialysis prescription in continuous ambulatory peritoneal dialysis (CAPD), as compensation for the decline of residual renal function (RRF), on peritoneal (Kpt/V) and total (Kprt/V) urea clearance as well as on peritoneal (Kpcr) and total weekly creatinine clearances (CCr).

Design

Retrospective analysis of a 2-year period.

Patients

We analyzed 18 patients [15 male, 3 female; mean age 58.2 (24 – 80) years].

Main Outcome Measures

Correlations between increased dialysis prescription and Kpt/V, Kprt/V, and Kpcr. Kprt/V and CCr measurements were based on a 24-hour dialysate and urine collection. Measurements were performed over a time period of 3 to 6 months.

Results

The results show a linear correlation between Kpt/V and Kpcr and the prescribed volume by kilogram body weight. Kprt/V was increased slightly by increasing the dialysis prescription. Dialysate-to-plasma (D/P) ratios of urea and creatinine remained unchanged. The mean prescribed dialysate volume increased from 7.4 ± 1.1 L to 10.6 ± 2.5 L. Mean Kprt/V could be maintained on a stable level for a 36-month period.

Conclusion

By adapting the dialysis prescription on an individual basis to the continuous decline of RRF, and taking the patient's body weight into account in the prescription decision, the increases in Kpt/V offset the decline in RRF. We recommend early individualization of prescription for patients on CAPD.
Peritoneal Transport Characteristics, Comorbid Diseases and Survival in CAPD Patients
Authors: Chung Sung Hee , Chu Won Suk , Lee Hyun Ah , Kim Yong Hwa , Lee In Sang , Lindholm Bengt , Lee Hi Bahl
Published: February 2020

Objective

To evaluate the influence of initial peritoneal transport rate, serum albumin concentration, and comorbid diseases on continuous ambulatory peritoneal dialysis (CAPD) patient survival.

Design

A prospective single-center study with a long-term follow-up.

Patients

A total of 213 consecutive CAPD patients, who underwent a peritoneal equilibration test (PET) at a mean of 7 days (range 3 – 30 days) after beginning CAPD, were included in this study. One hundred twenty patients were male, 116 patients had comorbid diseases, and mean age was 49.5 years (range 18 – 76 years).

Methods

A modified PET was performed using 4.25% glucose dialysis solution. Based on the dialysate-to-plasma creatinine concentration ratio at 4 hours’ dwell (D4/P4 Cr, 0.62 ± 0.14), patients were divided into high (H), high-average (HA), low-average (LA), or low (L) transporters.

Results

Of 213 patients, 16.9% were classified as H transporters, 30.5% as HA, 36.6% as LA, and 16.0% as L transporters. The H transporter group had a higher proportion of men, higher proportion of patients with comorbid diseases, lower initial serum albumin concentration, lower D4/D0 glucose, and lower drained volume. The initial D4/P4 Cr correlated with initial serum albumin ( r = –0.35, p < 0.001). The patients with comorbid diseases had lower initial serum albumin and higher initial D4/P4 Cr. On Kaplan–Meier analysis, 2-year patient survival of group H was significantly lower compared to the other groups combined (57.1% vs 79.5%, p = 0.009). On Cox proportional hazards analysis, age, comorbid diseases, initial serum albumin concentration, and initial D4/P4 Cr were found to be independent risk factors for mortality. However, in the patients without comorbid diseases, patient survival was not different between group H and the other transport groups combined ( p > 0.05), and only age was found to be an independent risk factor for mortality.

Conclusion

These data suggest that a high peritoneal transport rate at initial PET is associated with high mortality, and that this is in part due to an increased prevalence of comorbid disease in H transporters. These H transporters with comorbid diseases represent a subset of patients with an especially poor prognosis. In patients without comorbid diseases, high transport status or low serum albumin concentration was not an independent risk factor for mortality.