Cooking rice in a high water to rice ratio reduces inorganic arsenic content

Total arsenic and arsenic speciation was performed on different rice types (basmati, long-grain, polished ([white] and wholegrain [brown]) that had undergone various forms of cooking. The effect of rinse washing, low volume (2.5 : 1 water : rice) and high volume (6 : 1 water : rice) cooking, as well as steaming, were investigated. Rinse washing was effective at removing circa. 10% of the total and inorganic arsenic from basmati rice, but was less effective for other rice types. While steaming reduced total and inorganic arsenic rice content, it did not do so consistently across all rice types investigated. Low volume water cooking did not remove arsenic. High volume water : rice cooking did effectively remove both total and inorganic arsenic for the long-grain and basmati rice (parboiled was not investigated in high volume cooking water experiment), by 35% and 45% for total and inorganic arsenic content, respectively, compared to uncooked (raw) rice. To reduce arsenic content of cooked rice, specifically the inorganic component, rinse washing and high volume of cooking water are effective.

Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Factores asociados a calidad de vida en pacientes de hemodiálisis incidentes y prevalentes

Introducción: la insuficiencia renal crónica IRC ha aumentado su prevalencia en los últimos años pasando de 44.7 pacientes por millón en 1993 a 538.46 pacientes por millón en 2010, los pacientes quienes reciben terapia de remplazo renal hemodiálisis en Colombia cada vez tienen una mayor sobrevida. El incremento de los pacientes y el incremento de la sobrevida nos enfocan a mejorar la calidad de vida de los años de diálisis. Metodología: se comparó la calidad de vida por medio del SF-36 en 154 pacientes con IRC estadio terminal en manejo con hemodiálisis, 77 pacientes incidentes y 77 pacientes prevalentes, pertenecientes a una unidad renal en Bogotá, Colombia. Resultados: se encontró una disminución de la calidad de vida en los componentes físicos (PCS) y metales (MCS) de los pacientes de hemodiálisis en ambos grupos. En el modelo de regresión logística la incapacidad laboral (p=0.05), el uso de catéter (p= 0,000), el bajo índice de masa corporal (p=0.021), la hipoalbuminemia (p=0,033) y la anemia (p=0,001) fueron factores determinantes en un 78,9% de baja calidad de vida de PCS en los pacientes incidentes con respecto a los prevalentes. En el MCS de los pacientes incidentes vs. Prevalentes se encontró la hipoalbuminemia (p=0.007), la anemia (p=0.001) y el acceso por catéter (p=0.001) como factores determinantes en un 70.6% de bajo MCS Conclusiones: la calidad de vida de los pacientes de diálisis se encuentra afectada con mayor repercusión en el grupo de los pacientes incidentes, se debe mejorar los aspectos nutricionales, hematológicos y de acceso vascular en este grupo.

Being dialysis-dependant: a qualitative perspective

The technology of renal dialysis offers a way in which life can be sustained, so it is not surprising that the complex, diverse and evolving iatrogenic aspects of dialysis-dependency continue to be researched. However, there has been a tendency to take for granted the human process of making sense of the intrusiveness of dialysis. This study was designed to explore the meanings of dialysis-dependency. The study sample was 10 participants: five female, five male; five on peritoneal dialysis, five on haemodialysis; whose ages ranged from 22 to 68 years. Using a narrative methodology the following methods were used: in-depth interviews, narrative and thematic analysis, fieldwork/notes from five renal units, participant validation, and journal reflections. A thematic analysis revealed the continuum themes of Freedom-Restrictions, Being Normal-Being Visible, Control-Acquiesce, Hope-Despair and Support-Abandon. The themes portrayed as continuums serve to remind health care professionals that those with chronic illnesses strive to make sense of what is happening to them. Variations within each of these themes can occur daily, weekly or monthly. Acceptance may never be reached or may be tentative. Some clients will strive for control and freedom to choose for themselves, others will acquiesce to the overwhelming changes wrought in their lives. Thus, health care professionals might consider placing the personal meanings of those who are dialysis-dependent to the fore, being sensitive to the sufferings wrought by the regime, which treats but does not cure, which sustains life but does not heal.

Dialysis-dependency: the reformulated or remnant person

Being dependent on dialysis is a potentially overwhelming experience where life as previously known is permanently altered. A dialysis-dependent individual may reformulate their identify or perceive that they are a remnant if their former self. This paper will explore and expand Morse and Penrod's (1999) model as a useful way to understand how a person might reconstruct their identify. Grounded in a narrative methodology, interviews if those on haemodialysis and peritoneal dialysis were thematically analysed. It was found that dialysis dependency brings an acknowledgment if a lost past, an inescapable present and an unknowable future, filtered through hope and despair. Nurses need to understand the suffering, wrought by such a struggle,to facilitate the positive re-envisioning if those who are dialysis dependent.

Fabrication of high specificity hollow mesoporous silica nanoparticles assisted by Eudragit for targeted drug delivery.

Hollow mesoporous silica nanoparticles (HMSNs) are one of the most promising carriers for effective drug delivery due to their large surface area, high volume for drug loading and excellent biocompatibility. However, the non-ionic surfactant templated HMSNs often have a broad size distribution and a defective mesoporous structure because of the difficulties involved in controlling the formation and organization of micelles for the growth of silica framework. In this paper, a novel "Eudragit assisted" strategy has been developed to fabricate HMSNs by utilising the Eudragit nanoparticles as cores and to assist in the self-assembly of micelle organisation. Highly dispersed mesoporous silica spheres with intact hollow interiors and through pores on the shell were fabricated. The HMSNs have a high surface area (670m(2)/g), small diameter (120nm) and uniform pore size (2.5nm) that facilitated the effective encapsulation of 5-fluorouracil within HMSNs, achieving a high loading capacity of 194.5mg(5-FU)/g(HMSNs). The HMSNs were non-cytotoxic to colorectal cancer cells SW480 and can be bioconjugated with Epidermal Growth Factor (EGF) for efficient and specific cell internalization. The high specificity and excellent targeting performance of EGF grafted HMSNs have demonstrated that they can become potential intracellular drug delivery vehicles for colorectal cancers via EGF-EGFR interaction.

Multi-phase microstructure design of a novel high strength TRIP steel through experimental methodology

The multi-phase structure of a novel low-alloy transformation induced plasticity (TRIP) steel was designed through experimental analysis. The evolutions of both microstructure and mechanical properties during the two-stage heat treatment were analyzed. The phase transformations during the intercritical annealing and the isothermal bainitic transformation were investigated by means of dilatometry. It was shown that two types of C diffusion were detected during intercritical annealing and a complex microstructure was formed after heat treatment. The processing parameters were selected in such a way to obtain microstructures with systematically different volume fractions of ferrite, bainite and retained austenite. The volume fractions of ferrite and retained austenite were found to be two main factors controlling the ductility. Furthermore, a high volume fraction of C-rich retained austenite, which was stabilized at room temperature, was the origin of a TRIP effect. The resulting material demonstrates a significant improvement in the ultimate tensile strength (1077. MPa) with good uniform elongation (22.5%), as compared to conventional TRIP steels. © 2014 Elsevier B.V.

Peritonitis in Latin America

Peritoneal dialysis has a high acceptance rate in Latin America, thus the knowledge concerning complication patterns is of great relevance. This work reviews Latin American data on peritonitis, the most serious complication of peritoneal dialysis.The incidence of peritonitis has been reduced over time, concomitantly with the incorporation of safer exchange systems and the use of prophylactic measurements. Today, rates tower than 1 episode per 24 patient-months are commonly reported. Furthermore, changes in causative organisms have been observed, with predominance of Staphylococcus aureus up through the mid-1990s, as welt as increases in coagulase-negative staphylococcus and participation of gram negatives. However, the prevalence of S. aureus is still high, due possibly to climatic conditions and the elevated prevalence of carriers. Resolution rate varies from 55% to 78%, transfer to hemodialysis from 10.9% to 15.4%, and death in 3% to 9.9% of cases. Outcome is worse in S. aureus episodes compared to those with coagulase-negative staphylococcus, despite the higher percentage of oxacillin-resistant strains among the former. In general, despite socioeconomic or climatic conditions, our results are similar to those in developed countries, perhaps as a consequence of technological improvements and/or center expertise.

Early initiation of dialysis: mortality and renal function recovery in acute kidney injury patients

INTRODUÇÃO: A decisão de quando iniciar a diálise em pacientes com lesão renal aguda (LRA) que apresentam síndrome urêmica está bem estabelecida, entretanto, com ureia < 200 mg/dl o melhor momento para iniciar a diálise torna-se incerto. OBJETIVO: Este estudo teve como objetivo avaliar a mortalidade e a recuperação da função renal em pacientes com LRA, cujo início da diálise ocorreu em diferentes níveis de ureia. MÉTODOS: Estudo retrospectivo desenvolvido em hospital escola, no estado de São Paulo, Brasil, envolvendo 86 pacientes submetidos à diálise. RESULTADOS: A diálise foi iniciada com uréia > 150 mg/dl em 23 pacientes (grupo I) e uréia > 150 mg/dl em 63 pacientes (grupo II). Hipervolemia e mortalidade foram mais frequentes no grupo I que no grupo II (65,2 x 14,2% - p < 0,05; 39,1 x 68,9% - p < 0,05, respectivamente). Entre os sobreviventes, a recuperação renal foi maior no grupo I (71,4 e 36,8%, respectivamente, p < 0,05). A análise multivariada mostrou risco independente de mortalidade relacionado à sepse, idade > 60 anos, diálise peritoneal e uréia > 150 mg/dl no início da diálise. CONCLUSÃO: Menor mortalidade e maior recuperação renal estão associadas com o diálise iniciada precocemente, conforme baixos níveis de ureia, em pacientes com LRA.

Prolactin and zinc in dialysis patients

The objectives of the present study were to investigate the frequencies of hyperprolactinemia and hypozincemia in patients undergoing hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), the associations between blood levels of zinc (Zn2+) and hormones, and dietary zinc intake amount and its relation to zincemia. We studied 28 patients (14 HD and 14 CAPD) who had their blood levels of Zn2+, prolactin (PRL), parathyroid hormone (PTH), and gonadotropins (LH, FSH) evaluated. Thirteen patients had dietary nutrient amounts evaluated from a 3-d nutritional record. Hyperprolactinemia occurred in 29% patients (HD = CAPD), hypozincemia in 62% (20% HD and 42% CAPD), and low dietary Zn2+ intake in 90% of patients. No correlation among blood concentration of Zn2+ and PRL, PTH, LH, and FSH were observed in the two modalities of dialysis or between zincemia and Zn2+ ingestion. We concluded that the occurrence of hyperprolactinemia and hypozincemia were not related to dialysis modality and that zincemia did not reflect the observed low dietary intake of Zn2+.

Nurse-patient communication while performing home dialysis: The patients' perceptions

This study aimed at describing patients' perception of their communication with nurses when performing home dialysis. Data were collected from interviews guided by the question: What is communication like, between you and nurses, during home dialysis treatment? Results show participants' perception of treatment during home peritoneal dialysis [Continuous ambulatory peritoneal dialysis (CAPD)]; relationship with nurses and family and the effects of treatment on one's existence. Patients can be self-caring and they learn to value the autonomy in their own care. However, some are unable to assume the responsibility for self-care. It was discovered that the connotation of inspection that some participants attributed to the nurse's visits, led to an alienation from the education process in the CAPD education. Findings suggest that effective communication and the development of the relationship of a working partnership with patients is crucial. Improvement in the nurses' communication, aiming at adapting it to the characteristics, limitations and specific needs of each patient, is significant for achieving better outcomes. © 2010 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Avaliação respiratória de pacientes com lesão renal aguda submetidas à diálise peritoneal contínua ou a hemodiálise diária

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Associações entre estado de hidratação, inflamtório e marcadores nutricionais em pacientes em diálise peritoneal crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)