BACKGROUND Hemodialysis machine-generated circuit pressures and clearance profiles are potential predictors of quality assurances. In our practice, we previously we observed that elevated static access pressures were ...BACKGROUND Hemodialysis machine-generated circuit pressures and clearance profiles are potential predictors of quality assurances. In our practice, we previously we observed that elevated static access pressures were associated with abnormal Kt/V values, high access recirculation and deviation of the Kt/V profile (Abnormal Kt/V profile) from normally expected values (Normal Kt/V profile). AIM To hypothesize that static or derived access pressures would correlate with direct intra-access blood flow rates and that clearance (Kt/V) profiles would correlate with measured Kt/V values. METHODS Static access pressures, real-time adequacy of dialysis and intra-access blood flow were investigated in end stage renal disease patients undergoing hemodialysis. Wilcoxon-Mann-Whitney test, chi-square test or Fisher’s exact test was used to investigate differences between the groups;Spearman’s rank correlation test to investigate relationships between static pressures, direct intra-access pressures and Kt/V profiles;and multinomial logistic regression models to identify the independent effect of selected variables on Kt/V profiles. Odds ratio were calculated to measure the association between the variables and Kt/V profiles. RESULTS One hundred and seven patients were included for analysis. There were no significant differences between genders, and types of vascular access between the normal vs. abnormal clearance (Kt/V) profile groups. No significant correlation could be demonstrated between static access pressures and Kt/V profiles, static access pressures and intra-access blood flow, intra-access blood flow and Kt/V profiles, measured Kt/V and Kt/V profiles or recirculation and Kt/V profiles. CONCLUSION In this study utilizing measured versus estimated data, we could not validate that dialysis machine generated elevated static pressures predict intra-access blood flow disturbances or that abnormal Kt/V profiles predict access recirculation or inadequate dialysis. These parameters, though useful estimates, cannot be accepted as quality assurance for dialysis adequacy or access function without further evidences.展开更多
This paper investigates the relationship between intra-regional accessibility and economic development within the Cardiff City Region. Embracing the Capital City of Cardiff and its hinterland, this region is regarded ...This paper investigates the relationship between intra-regional accessibility and economic development within the Cardiff City Region. Embracing the Capital City of Cardiff and its hinterland, this region is regarded as the economically most important one in Wales, and the key driver of Wale's current and future economic prosperity. Therefore, it is a significant problem how to fully realize its economic potential and its national role, and it is also controversial whether poor intra-regional accessibility is the biggest barrier to its further growth. This has been debated for years and provoked great research interest. By using a qualitative methodology, the paper identifi es that intra-regional accessibility is necessary, though not suff icient, for economic growth. It is necessary since it can increase the productivity of economic activities and infl uence the fi rms' location behavior, based on which this paper proposes some recommendations for economic development.展开更多
基金the Gatorade Trust through funds distributed by the University of Florida,Division of Nephrology,Hypertension,and Renal Transplantation,Gainesville,FL [Awarded to Abhilash Koratala(Principal investigator)Abutaleb A Ejaz(Mentor)]
文摘BACKGROUND Hemodialysis machine-generated circuit pressures and clearance profiles are potential predictors of quality assurances. In our practice, we previously we observed that elevated static access pressures were associated with abnormal Kt/V values, high access recirculation and deviation of the Kt/V profile (Abnormal Kt/V profile) from normally expected values (Normal Kt/V profile). AIM To hypothesize that static or derived access pressures would correlate with direct intra-access blood flow rates and that clearance (Kt/V) profiles would correlate with measured Kt/V values. METHODS Static access pressures, real-time adequacy of dialysis and intra-access blood flow were investigated in end stage renal disease patients undergoing hemodialysis. Wilcoxon-Mann-Whitney test, chi-square test or Fisher’s exact test was used to investigate differences between the groups;Spearman’s rank correlation test to investigate relationships between static pressures, direct intra-access pressures and Kt/V profiles;and multinomial logistic regression models to identify the independent effect of selected variables on Kt/V profiles. Odds ratio were calculated to measure the association between the variables and Kt/V profiles. RESULTS One hundred and seven patients were included for analysis. There were no significant differences between genders, and types of vascular access between the normal vs. abnormal clearance (Kt/V) profile groups. No significant correlation could be demonstrated between static access pressures and Kt/V profiles, static access pressures and intra-access blood flow, intra-access blood flow and Kt/V profiles, measured Kt/V and Kt/V profiles or recirculation and Kt/V profiles. CONCLUSION In this study utilizing measured versus estimated data, we could not validate that dialysis machine generated elevated static pressures predict intra-access blood flow disturbances or that abnormal Kt/V profiles predict access recirculation or inadequate dialysis. These parameters, though useful estimates, cannot be accepted as quality assurance for dialysis adequacy or access function without further evidences.
文摘This paper investigates the relationship between intra-regional accessibility and economic development within the Cardiff City Region. Embracing the Capital City of Cardiff and its hinterland, this region is regarded as the economically most important one in Wales, and the key driver of Wale's current and future economic prosperity. Therefore, it is a significant problem how to fully realize its economic potential and its national role, and it is also controversial whether poor intra-regional accessibility is the biggest barrier to its further growth. This has been debated for years and provoked great research interest. By using a qualitative methodology, the paper identifi es that intra-regional accessibility is necessary, though not suff icient, for economic growth. It is necessary since it can increase the productivity of economic activities and infl uence the fi rms' location behavior, based on which this paper proposes some recommendations for economic development.
