Assessment of a five-year survival on hemodialysis in Brazil: a cohort of 3,082 incident patients

Brazil has the third largest contingent of patients on maintenance hemodialysis (HD) worldwide. However, little is known regarding survival rate and predictors of mortality risk in that population, which are the purposes of this study. A total of 3,082 patients incident on HD, from 2000 to 2004, at 25 dialysis facilities distributed among 7 out of 26 states of Brazil were followed-up until 2009. Patients were 52 ± 16 years-old, 57.8% men, and 20.4%, diabetics. The primary outcome was all causes of mortality. Data were censored at five years of follow-up. The global five-year survival rate was 58.2%. In the Cox proportional model, variables associated with risk of death were: age (hazard ratio - HR = 1.44 per decade, p < 0.0001), diabetes (HR = 1.51, p < 0.0001), serum albumin (HR = 0.76 per g/dL, p = 0.001), creatinine (HR = 0.92 per mg/dL, p < 0.0001), and phosphorus (HR = 1.06 per mg/dL, p = 0.04). The present results show that the mortality rate on HD in this Brazilian cohort was relatively low, but the population is younger and with a lower prevalence of diabetes than the ones reported for developed countries.

Early changes in serum albumin: impact on 2-year mortality in incident hemodialysis patients

AbstractIntroduction/objective:We evaluated the predictability of early changes in serum albumin (sAlb) on the two-year mortality of incident hemodialysis patients.Methods:Observational, longitudinal retrospective study using the database of Fresenius Medical Care of Latin America. Adult patients starting dialysis from January/2000 to June/2004, from 25 centers were included. Changes in sAlb during the first 3 months on hemodialysis were used as the main predictor. The outcome was death from any cause.Results:1,679 incident patients were included. They were 52 ± 15 years old, 58.7% male and 21.5% diabetic, with a median sAlb of 38 g/L (bromocresol green). 923 patients had sAlb < 38 g/L (Low sAlb Group) and 756 ones had sAlb > 38.0 g/L (Adequate sAlb Group). The mortality was significantly higher in Low sAlb Group (17% vs. 11%, p < 0.001). Early changes in sAlb significantly affected two-year mortality. Factoring the Kaplan Meier curve of Low sAlb Group by the presence of an increase in sAlb uncovered of a statistically significant difference in mortality favoring the ones whose sAlb went up (19% vs. 15%, p = 0.043). Differently, patients from Adequate sAlb Group with a decrease in their sAlb had a statistically higher mortality rate (13% vs. 8%, p = 0.029).Conclusions:Early sAlb changes showed a significant predictive power on mortality at 2 years in incident hemodialysis patients. Those with low initial sAlb may have a better prognosis if their sAlb rises. In contrast, patients with satisfactory initial levels can have a worsening of their prognosis in the case of an early reduction in sAlb.

Troponin I serum levels predict the need of dialysis in incident sepsis patients with acute kidney injury in the intensive care unit

Abstract Introduction: Sepsis, an extremely prevalent condition in the intensive care unit, is usually associated with organ dysfunction, which can affect heart and kidney. Objective: To determine whether the cardiac dysfunction and the Troponin I forecast the occurrence of acute renal failure in sepsis. Methods: Cardiac dysfunction was assessed by echocardiography and by the serum troponin I levels, and renal impairment by AKIN criteria and the need of dialysis. Twenty-nine patients with incident sepsis without previous cardiac or renal dysfunction were enrolled. Results and Discussion: Patients averaged 75.3 ± 17.3 years old and 55% were male. Median APACHE II severity score at ICU admission was 16 (9.7 - 24.2) and mortality rate in 30 days was 45%. On the fifth day, 59% had ventricular dysfunction. Troponin serum levels on day 1 in the affected patients were 1.02 ± 0.6 ng/mL compared with 0.23 ± 0.18 ng/mL in patients without heart dysfunction (p = 0.01). Eighteen out of 29 patients (62%) underwent renal replacement therapy (RRT) and the percent of patients with ventricular dysfunction who required dialysis was higher (94% vs. 16%, p = 0.0001). Values of troponin at day 1 were used to develop a ROC curve to determine their ability to predict the need of dialysis. The area under the curve was 0.89 and the cutoff value was 0.4 ng/mL. Conclusion: We found that an elevation in serum troponin levels, while guarding a relationship with ventricular dysfunction, can be a precious tool to predict the need for dialysis in sepsis patients.

Characterization and Investigation on Material Compatibilities of Building Integrated Photovoltaic Module Components

Building Integrated Photovoltaics (BIPV) are considered as the future of photovoltaic (PV) technology. The advantage of BIPV system is its multi-functionality; they fulfil the functions of a building envelope with the added benefit of generating power by replacing the traditional roofing and façade materials with PV that generate power. In this thesis, different types of PV cells and modules have been described in detail with their efficiencies and usage trends in the last decade. The different BIPV products for roof and façade are discussed in detail giving several examples. The electricity generation potential of BIPV in selected countries is compared with their actual electricity consumption. Further, the avoided greenhouse gas (GHG) emissions associated with electricity generation from traditional sources and transportation and distribution (T&D) losses are calculated. The results illustrate huge savings in GHGs. In BIPV different types of façade and backsheets are used. In this thesis, selected backsheets and façade were characterized in terms of their surface structure identification using infrared spectroscopy (FTIR-ATR), scanning electron microscopy with energy dispersive X-ray (SEM-EDX) and physical characterization using surface energy measurements. By using FTIR-ATR, surface polymeric materials were identified and with SEM-EDX, identification of the surface elements was possible. Surface energy measurements were useful in finding the adhesives and knowing the surface energies of the various backsheets and façade. The strength of adhesion between the facade and backsheets was studied using peel test. Four different types of adhesives were used to study the fracture pattern and peel tests values to identify the most suitable adhesive. It was found out that pretreatment increased the adhesive strength significantly.

Preparation and Investigation of Bio-coal Mixture Fuels Used in Large Diesel Engines

Coal slurry was of vital interest during the last century due to its potential as an alternative fuel where liquid fuels were necessary. Recently, environmental impacts of the traditional fuels, similarities of bio-coal to that of coal, and huge bio-coal supply has attracted the attention to prepare bio-coal slurries as a new fuel. Rudolf Diesel who invented the diesel engine on 1895 was of the opinion that diesel engines are capable to use different kinds of fuels due to the special design. He tried some kind of vegetable oil to operate on his IC engine. Recently, due to high energy density and more environmentally friendly fuel, researchers believe that bio-coal slurries could act as a new alternative fuel in large diesel engines. Loads of research on different kinds of bio-coal slurry were done by the other researchers worldwide and a lot of progress to boost slurry’s quality were achieved recently. The present study aims to achieve the ideal condition of different factors affecting on the quality of bio-coal slurry. One charcoal sample and two kinds of torrefied wood were used to investigate and compare the reaction of various factors. The results show a great gap between the quality of slurries made of different samples and more researches are necessary to fully understand the impact of the different parameter and improving the quality.

Investigation of the fatigue performance of welded duplex stainless steel

Diplomityössä tutkitaan hitsatun duplex-teräksen, laatu: EN 1.4462 (Outokumpu laatu 2205) väsymislujuutta. Tutkimusmetodologia noudattaa sekä kokeellisia että laskennallisia menetelmiä. Kokeelliset menetelmät sisältävät hitsatun teräksen väsytystestaukset laboratoriossa, hitsausten jälkikäsittelyt (HiFIT) sekä perusaineelle ja hitseille tehtävät metallurgiset tutkimukset. Väsytyskokeista saatavia tuloksia verrataan kansainvälisen hitsausinstituutin (IIW) vahvistamiin rakennekohtaisiin standardeihin sekä kirjallisuudessa esiintyviin tutkimustuloksiin. Laskennalliset menetelmät sisältävät vertailulaskelmia tehollisen lovijännityksen (ENS) menetelmää hyödyntäen. Tehollisen lovijännityksen menetelmässä liitoksissa vaikuttavat teholliset lovijännitykset selvitetään elementtimenetelmän (FEM) avulla. Tulokset vahvistavat, että hitsauksella ja hitsausten jälkikäsittelyllä on suuri merkitys rakenteen kestoikään. Suurin osa väsytyskokeiden tuloksista osoitti parempia väsymiskestävyyden arvoja kuin rakennekohtaiset standardit, mutta liitosten liitosvirheiden todettiin heikentävän väsytyskestävyyttä. Jälkikäsittelyiden todettiin parantavan liitosten väsymiskestävyyden tuloksia ja todettiin tulosten olevan hyödynnettävissä mitoituksessa.

Peak Force Kelvin Probe Force Microscopy Investigation of ZrO2 Nanocomposites for Hygroelectricity Power Element

ZrO2 nanocomposites were investigated considering their perspective application in hygroelectric power elements. Scanning probe microscopy (SPM) techniques allowed to visualize the surface topography and electrical properties. In this work was compared spacial charge behaviour of sample in humid and dry air conditions. Also different SPM modes were compared. Kelvin probe force microscopy (KPFM) was applied to characterize the spacial charge distribution on surface of the sample. Measurements showed, that trapped charge is not dissipated and can be manipulated with low voltages. Humidity influence on the electric potential of the sample was shown.

Investigation of the applicability of LVDC microgrids in utility distribution in Russia

The research towards efficient, reliable and environmental-friendly power supply solutions is producing growing interest to the “Smart Grid” approach for the development of the electricity networks and managing the increasing energy consumption. One of the novel approaches is an LVDC microgrid. The purpose of the research is to analyze the possibilities for the implementation of LVDC microgrids in public distribution networks in Russia. The research contains the analysis of the modern Russian electric power industry, electricity market, electricity distribution business, regulatory framework and standardization, related to the implementation of LVDC microgrid concept. For the purpose of the economic feasibility estimation, a theoretical case study for comparing low voltage AC and medium voltage AC with LVDC microgrid solutions for a small settlement in Russia is presented. The results of the market and regulatory framework analysis along with the economic comparison of AC and DC solutions show that implementation of the LVDC microgrid concept in Russia is possible and can be economically feasible. From the electric power industry and regulatory framework point of view, there are no serious obstacles for the LVDC microgrids in Russian distribution networks. However, the most suitable use cases at the moment are expected to be found in the electrification of remote settlements, which are isolated from the Unified Energy System of Russia.

Ontario high school sport : an investigation of organizational design and its context

In 2002, The Ontario Federation of School Athletic Associations (OFSAA) identified that in providing extracurricular sport programs schools are faced with the 'new realities' of the education system. Although research has been conducted exploring the pressures impacting the provision of extracurricular school sport (Donnelly, Mcloy, Petherick, & Safai, 2000), few studies within the field have focused on understanding extracurricular school sport from an organizational level. The focus of this study was to examine the organizational design (structure, systems, and values) of the extracurricular sport department within three Ontario high schools, as well as to understand the context within which the departments exist. A qualitative multiple case study design was adopted and three public high schools were selected from one district school board in Ontario to represent the cases under investigation. Interviews, observations and documents were used to analyze the extracurricular sport department design of each case and to better understand the context within which the departments exist. As the result of the analysis of the structure, systems and values of each case, two designs emerged- Design KT1 and Design KT2. Differences in the characteristics of design archetype KT1 and KT2 centered on the design dimension of values, and therefore this study identified that contrasting organizational values reflect differences in design types. The characteristics of the Kitchen Table archetype were found to be transferable to the sub-sector of extracurricular school sport, and therefore this research provides a springboard for further research in organizational design within the education sector of extracurricular high school sport. Interconnections were found between the data associated with the external and internal contexts within which the extracurricular sport departments exist. The analysis of the internal context indicated the important role played by organizational members in shaping the context within which the departments exist. The analysis of the external context highlighted the institutional pressures that were present within the education environment. Both political and cultural expectations related to the role of extracurricular sport within schools were visible and were subsequently used by the high schools to create legitimacy and prestige, and to access resources.

An investigation of the emotion assumptions of just-world theory /

The purpose ofthis study was to investigate the emotion assumptions underlying just-world theory. This theory proposes that people have a need to believe in a just world - a world where people get what they deserve. The first emotion assumption is that people, therefore, find injustices (Le., undeserved outcomes) threatening and thus emotionally arousing. Second, it is this arousal that is assumed to drive subsequent strategies for maintaining the belief in a just world. One strategy an individual may use to maintain this belief is derogating victims of injustice, or seeing their character in a more negative light. To test these two assumptions, 102 participants viewed a video depicting either a victim who presumably presented a high threat to people's belief in ajust world (she was innocent and, therefore, undeserving of her fate) or low threat (she was not innocent and, therefore, more deserving of her fate) while their heart rate and EDA was measured. Half of the participants were then given the opportunity to help the victim whereas the other half were not given this opportunity. The manipulations were followed by both explicit and indirect measures of evaluations ofthe victim as well as self-report measures of affect experienced while watching the victim video, and an individual difference scale assessing the strength of participants' just-world beliefs (as well as other measures that were part ofa larger study). Results indicated that participants did report feeling more threatened by the innocent victim. Although there was some evidence of victim derogation on the implicit measure of victim evaluation, there was no evidence that emotional arousal drove the negative evaluations of the victim who could not be helped. Some interaction effects with individual differences in just-world beliefs did occur, but these were not entirely consistent with the rationale behind the individual difference scales. These results provide only weak support for the first emotion assumption ofjust-world theory. Implications of these findings as well as limitations of the study and future directions concerning just-world theory are discussed.

Adolescent sexuality : an investigation into the relation between sexuality and self-concept /

The present study explored the connections among adolescents' sense of self, sexuality, and perceptions of risk. Such an exploration may help educators to further understand why adolescents engage in risk-taking behaviours such as unprotected sex. The study involved secondary analysis on the data collected from the Youth Lifestyle Choices - Community University Research Alliance 2000 (YLC - CURA) Youth Resilience Questionnaire (YRQ). Participants were 300 male and female students in Grades 9, 1 1 and OAC. Data analyses involved both descriptive and inferential statistics (correlational and multivariate analysis). Chi-square analyses were performed on the open-ended self-description question. Separate analyses were conducted on gender and age (grade levels). Correlational analyses revealed that adolescents with a more positive sense of self were more likely to perceive sexual involvement as a relatively high-risk behaviour. Specifically, results found that male adolescents were less likely than females to perceive sex to be risky. Results are discussed in relation to previous research in the area of selfcognitions and risk-taking sexual behaviour. Results are also discussed in terms of educational implications in that the current results may provide the beginnings of a framework for more holistic sexual education programs.

An exploration of the experience of implementing the second step violence prevention curriculum in one primary general learning disabilities class /

Violence has always been a part of the human experience, and therefore, a popular topic for research. It is a controversial issue, mostly because the possible sources of violent behaviour are so varied, encompassing both biological and environmental factors. However, very little disagreement is found regarding the severity of this societal problem. Most researchers agree that the number and intensity of aggressive acts among adults and children is growing. Not surprisingly, many educational policies, programs, and curricula have been developed to address this concern. The research favours programs which address the root causes of violence and seek to prevent rather than provide consequences for the undesirable behaviour. But what makes a violence prevention program effective? How should educators choose among the many curricula on the market? After reviewing the literature surrounding violence prevention programs and their effectiveness, The Second Step Violence Prevention Curriculum surfaced as unique in many ways. It was designed to address the root causes of violence in an active, student-centred way. Empathy training, anger management, interpersonal cognitive problem solving, and behavioural social skills form the basis of this program. Published in 1992, the program has been the topic of limited research, almost entirely carried out using quantitative methodologies.The purpose of this study was to understand what happens when the Second Step Violence Prevention Curriculum is implemented with a group of students and teachers. I was not seeking a statistical correlation between the frequency of violence and program delivery, as in most prior research. Rather, I wished to gain a deeper understanding of the impact ofthe program through the eyes of the participants. The Second Step Program was taught to a small, primary level, general learning disabilities class by a teacher and student teacher. Data were gathered using interviews with the teachers, personal observations, staff reports, and my own journal. Common themes across the four types of data collection emerged during the study, and these themes were isolated and explored for meaning. Findings indicate that the program does not offer a "quick fix" to this serious problem. However, several important discoveries were made. The teachers feU that the program was effective despite a lack of concrete evidence to support this claim. They used the Second Step strategies outside their actual instructional time and felt it made them better educators and disciplinarians. The students did not display a marked change in their behaviour during or after the program implementation, but they were better able to speak about their actions, the source of their aggression, and the alternatives which were available. Although they were not yet transferring their knowledge into positive action,a heightened awareness was evident. Finally, staff reports and my own journal led me to a deeper understanding ofhow perception frames reality. The perception that the program was working led everyone to feel more empowered when a violent incident occurred, and efforts were made to address the cause rather than merely to offer consequences. A general feeling that we were addressing the problem in a productive way was prevalent among the staff and students involved. The findings from this investigation have many implications for research and practice. Further study into the realm of violence prevention is greatly needed, using a balance of quantitative and qualitative methodologies. Such a serious problem can only be effectively addressed with a greater understanding of its complexities. This study also demonstrates the overall positive impact of the Second Step Violence Prevention Curriculum and, therefore, supports its continued use in our schools.

An international investigation on the validity of the CSAPPA scale in screening for developmental coordination disorder /

The main objective of the present investigation was to continue the research initiated by Hay and colleagues (2004) in examining the efficacy of the Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity (CSAPPA) scale as a proxy for the short form of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-SF) in screening for Developmental Coordination Disorder (DCD) in children. To better appreciate DCD knowledge outside Canada, the measurements of this investigation were expanded in Greece. A translated Greek CSAPP A scale and the BOTMP-SF were administered for the first time in Greek children. A second objective was to investigate the relationship between DCD and various risk factors of coronary artery disease (CAD) in Canadian and Greek children. A sample of 591 (Ms=322; Fs=269) Canadian and 392 (Ms=211; Fs=181) Greek children, aged 9 to 13 years, consented to the BOTMP-SF, CSAPP A Scale, participation in physical activity questionnaire, Leger 20-meter Multistage Shuttle Run test, and body fat using bioelectric impedance. Prevalence of DCD in Canada and Greece was 8% and 19%, respectively. Significant agreement (p