Evaluation of a Phosphate Management Protocol to Achieve Optimum Serum Phosphate Levels in Hemodialysis Patients

Original article can be found at: http://www.sciencedirect.com/science/journal/10512276 Copyright National Kidney Foundation, Inc. DOI: 10.1053/j.jrn.2008.05.003To evaluate the effectiveness of a protocol designed to optimize serum phosphate levels in patients undergoing regular hemodialysis (HD).Peer reviewe

Assessing housing quality and its impact on health, safety and sustainability

Background The adverse health and environmental effects of poor housing quality are well established. A central requirement for evidence-based policies and programmes to improve housing standards is a valid, reliable and practical way of measuring housing quality that is supported by policy agencies, the housing sector, researchers and the public. Methods This paper provides guidance on the development of housing quality-assessment tools that link practical measures of housing conditions to their effects on health, safety and sustainability, with particular reference to tools developed in New Zealand and England. Results The authors describe how information on housing quality can support individuals, agencies and the private sector to make worthwhile improvements to the health, safety and sustainability of housing. The information gathered and the resultant tools developed should be guided by the multiple purposes and end users of this information. Other important issues outlined include deciding on the scope, detailed content, practical administration issues and how the information will be analysed and summarised for its intended end users. There are likely to be considerable benefits from increased international collaboration and standardisation of approaches to measuring housing hazards. At the same time, these assessment approaches need to consider local factors such as climate, geography, culture, predominating building practices, important housing-related health issues and existing building codes. Conclusions An effective housing quality-assessment tool has a central role in supporting improvements to housing. The issues discussed in this paper are designed to motivate and assist the development of such tools

Chromosome 9p deletion in clear cell renal cell carcinoma predicts recurrence and survival following surgery

BACKGROUND: Wider clinical applications of 9p status in clear cell renal cell carcinoma (ccRCC) are limited owing to the lack of validation and consensus for interphase fluorescent in situ hybridisation (I-FISH) scoring technique. The aim of this study was to analytically validate the applicability of I-FISH in assessing 9p deletion in ccRCC and to clinically assess its long-term prognostic impact following surgical excision of ccRCC. METHODS: Tissue microarrays were constructed from 108 renal cell carcinoma (RCC) tumour paraffin blocks. Interphase fluorescent in situ hybridisation analysis was undertaken based on preset criteria by two independent observers to assess interobserver variability. 9p status in ccRCC tumours was determined and correlated to clinicopathological variables, recurrence-free survival and disease-specific survival. RESULTS: There were 80 ccRCCs with valid 9p scoring and a median follow-up of 95 months. Kappa statistic for interobserver variability was 0.71 (good agreement). 9p deletion was detected in 44% of ccRCCs. 9p loss was associated with higher stage, larger tumours, necrosis, microvascular and renal vein invasion, and higher SSIGN (stage, size, grade and necrosis) score. Patients with 9p-deleted ccRCC were at a higher risk of recurrence (P=0.008) and RCC-specific mortality (P=0.001). On multivariate analysis, 9p deletion was an independent predictor of recurrence (hazard ratio 4.323; P=0.021) and RCC-specific mortality (hazard ratio 4.603; P=0.007). The predictive accuracy of SSIGN score improved from 87.7% to 93.1% by integrating 9p status to the model (P=0.001). CONCLUSIONS: Loss of 9p is associated with aggressive ccRCC and worse prognosis in patients following surgery. Our findings independently confirm the findings of previous reports relying on I-FISH to detect 9p (CDKN2A) deletion

Preregistration house officers in general practice: review of evidence

OBJECTIVES: To examine the strengths and weaknesses of the national and local schemes for preregistration house officers to spend four months in general practice, to identify any added value from such placements, and to examine the impact on career choices. DESIGN: Review of all studies that reported on placements of preregistration house officers in general practice. SETTING: 19 accounts of preregistration house officers’ experience in general practice, ranging from single case reports to a national evaluation study, in a variety of locations in Scotland and England. PARTICIPANTS: Views of 180 preregistration house officers, 45 general practitioner trainers, and 105 consultant trainers. MAIN OUTCOME MEASURES: Main findings or themes weighted according to number of studies reporting them and weighted for sample size. RESULTS: The studies were unanimous about the educational benefits of the placements. The additional learning included communication skills, social and psychological factors in illness, patient centred consultations, broadening of knowledge base, and dealing with uncertainty about diagnosis and referral. CONCLUSIONS: Despite the reported benefits and recommendations of the scheme, it is not expanding. General practitioner trainers reported additional supervision that was unremunerated. The reforms of the senior house officer grade may resolve this problem by offering the placements to senior house officers, who require less supervision

Landslides in sensitive soils, Tauranga, New Zealand.

In the Tauranga region sensitive soil failures commonly occur after heavy rainfall events, causing considerable infrastructure damage. Several notable landslides include a large failure at Bramley Drive, Omokoroa in 1979, the Ruahihi Canal collapse in 1981, and numerous landslides in May 2005; recently the Bramley Drive scarp was reactivated in 2011. These failures are associated with materials loosely classified as the Pahoia Tephras - a mixture of rhyolitic pyroclastic deposits of approximately 1 Ma. The common link with extreme rainfall events suggests a pore water pressure control on the initiation of these failures. Recent research on the structure of the soils shows a dominance of halloysite clay minerals packed loosely in arrangements with high porosity (51 – 77 %), but with almost entirely micropores. This leads us to conclude that the permeability is very low, and the materials remain continuously wet. The formation of halloysite is encouraged by a wet environment with no episodes of drying, supporting this assumption. A high-resolution CPT trace at Bramley Drive indicates induced pore water pressures rising steadily to a peak at approximately 25 m depth; this depth coincides with the base of the landslide scarp. We infer that elevated pore water pressures develop within this single, thick aquifer, triggering failure through reduced effective stresses. The inactive halloysite clay mineral results in low plasticity indices (13 – 44 %) and hence high liquidity indices (1.2 – 2.4) due to the saturated pore space; remoulding following failure is sudden and dramatic and results in large debris runout distances

Design of the Annular Suspension and Pointing System (ASPS) (including design addendum)

The Annular Suspension and Pointing System is an experiment pointing mount designed for extremely precise 3 axis orientation of shuttle experiments. It utilizes actively controlled magnetic bearing to provide noncontacting vernier pointing and translational isolation of the experiment. The design of the system is presented and analyzed