Standardized Coding of the Medical Problem List (Letter)

journal articleBiomedical Informatic

The Welsh revival.

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Progression of renal insufficiency: Role of blood pressure

Progression of renal insufficiency: Role of blood pressure. The effect of blood pressure on progression of renal insufficiency was examined in a large group of patients who eventually required dialysis. Out of 198 consecutive new chronic dialysis patients, 86 had sufficient data predi alysis to determine rates of progression of renal insufficiency by reciprocal creatinine versus time plots. Average plasma creatinine at first contact was 3.8 ± 0.2 mg/dl and at the time of dialysis was 11.4 ± 0.4 mg/dl. Mean duration of follow-up was 33.4 ± 2.5 months and the average rate of decline in reciprocal creatinine was -0.009 ± 0.001 di! mg month. Patients were stratified by average value of diastolic blood pressure measured in clinic. Patients in the lowest quartile had a rate of decline in reciprocal creatinine of -0.007 ± 0.001 dl/mg month, which was slower than that of patients in the third and fourth quartiles, -0.010 ± 0.001 and -0.011 ± -0.002 dl/mg month, respectively (P < 0.05). In individual patients, a mean diastolic BP of <90mm Hg was associated with a rate of decline in reciprocal creatinine of -0.006 ± 0.001 dl/mg month which was significantly less than the rate of -0.009 ± 0.001 when the diastolic BP was >90mm Hg. Thus, in a large group of patients who have progressed to ESRD, there is an associatiOn between control of diastolic blood pressure and a slower rate of decline in renal function

Students’ Experiences of In-person and Online Clinical Residencies: A Qualitative Study

Online counselor education programs have continued to grow in popularity. There is limited current research about residency experiences of counseling students. The coronavirus pandemic has forced counselor educators to move traditionally face to face residencies to the online platform. Our study explores the experiences of counseling students who attended both online and face to face residency using an in-depth phenomenological interviewing. Four major themes emerged including (a) self-care, (b) faculty interactions, (c) student connections, and (d) counselor identity and future practice. One narrative highlights the participant’s experiences

Role of sand as substrate and dietary component for juvenile sea cucumber Holothuria scabra

The sea cucumber Holothuria scabra, or sandfish, is a commercially valuable aquaculture species; however viable intensive tank-based aquaculture techniques have not yet been developed. This study aimed to assess the role of sand as a substrate and/or dietary component in the intensive tank culture of sandfish in recirculating aquaculture systems (RAS) in South Africa. A control experiment was conducted to confirm the reported positive effect of sand as a substrate on sandfish growth and a sand-in-diet experiment was conducted to determine if the incorporation of sand into formulated diets could improve sandfish growth in bare tanks. In the control experiment, the mean growth rate of juvenile sandfish in the bare tanks was significantly lower than that of the juveniles reared in tanks with a sand substrate (-0.12 +/- 0.16 g day(-1) SE and 0.03 +/- 0.01 g day(-1) respectively; F-(1,F-2)=1.91, p0.05). Results confirmed the reported positive effect on sandfish growth when sand is provided as a substrate, however sand in diets did not promote growth in the same way, indicating that the inclusion of sand in formulated diets is unlikely to compensate for the lack of sand as a substrate. Future research should therefore aim to identify the optimum parameters of sand substrate and develop tank holding systems capable of maintaining favourable substrate conditions for intensive sandfish culture

The effect of resource quality on the growth of Holothuria scabra during aquaculture waste bioremediation

Reducing dependency on environmentally unsustainable formulated feeds, most of which include limited reserves of fishmeal as a protein source, is a priority for the aquaculture industry, particularly for intensive culture systems. One approach is to increase nitrogen reuse within the system by feeding nitrogen-rich aquaculture effluent to deposit feeders, thereby closing the aquaculture nitrogen-loop. This study, for the first time and on a laboratory-scale, has reared juveniles of the sea cucumber Holothuria scabra at high densities solely on particulate organic waste from a commercial-scale land-based abalone recirculating aquaculture system. Furthermore, growth rates and biomass yields were increased significantly by adjusting the effluent C:N from 5:1 to 20:1 by adding exogenous organic carbon sources (glucose, starch and cellulose), so fuelling accelerated heterotrophic bacterial production within the redox-stratified tank sediment. Sea cucumber juveniles reared solely on effluent had a biomass density of 711 g m−2 after four months whereas animals reared on starch-amended effluent (the best performing treatment) had a final density of 1011 g m−2. Further optimisation of this approach could increase biomass yields and pave the way for the commercial cultivation of deposit feeding animals on waste streams, thus contributing to more environmentally sustainable aquaculture. Here, the nitrogen that originated from fishmeal is not lost through the discharge of aquaculture effluent; rather, it is immobilised into single cell biomass that is up-cycled into high-value secondary biomass. We demonstrate that sea cucumbers can be produced at high density through the manipulation of the C:N ratio of aquaculture effluent