Hemodialysis in the United Kingdom

Hemodialysis was a neglected aspect of nephrology in the UK. At the request of the Renal Association, the first UK Haemodialysis Masterclass was organized in 2007. The articles in this supplement arose from that meeting. Here, an overview of UK hemodialysis services and nephrology training is presented as background. Government‐funded dialysis should be provided to all UK citizens who require it. In 2005, there were 17,645 patients receiving hemodialysis, 5057 on peritoneal dialysis and 19,074 with kidney transplants, looked after by 359 nephrologists working in 73 National Health Service renal units. Renal replacement therapy incidence and prevalence remain comparatively low, at 108 and 694 per million population, respectively. Whether this represents inadequate provision or genuinely lower need remains unclear. The Renal Association sets clinical practice guidelines for dialysis, and audits performance via the UK Renal Registry. Postgraduate medical education is undergoing radical change in the UK. This is driven by the reduction in trainee doctors' working hours to 48 hr/week (mandated by the European Working Time Directive), and the governments' wish to reduce the duration of training, but also by a desire to formalize training, Our challenge is to continue to produce talented clinical nephrologists educated in breadth and depth, despite the reduced emphasis on clinical experience and omission of period of scientific research. The future for hemodialysis services in the UK is, however, promising with an expansion in the number of specialists and dialysis centers, and a growing interest in dialysis practice and research.     

Alternatives to standard hemodialysis

Survival of patients on hemodialysis remains poor, but the benefits of increasing urea clearance have probably been maximized within our current treatment schedules. Long dialysis sessions (8 hr) produce impressive outcomes, with mortality 53% to 55% lower than conventional schedules. Even increasing from 4 to 5 hr may improve survival. Increased frequency of dialysis (6 times weekly) produces impressive reductions in left ventricular mass and could conceivably be implemented in‐center. Preliminary data suggest a 61% reduction in mortality with increased frequency. Nightly dialysis combines longer sessions with increased frequency and has produced remarkable clinical gains in blood pressure, left ventricular mass, serum phosphate, and sleep apnea. However, the data are mainly from case series and impact on mortality remains unknown. Expansion of home hemodialysis would be necessary for this modality to grow. Convective therapies remove middle molecules more effectively, and observational data suggest hemodiafiltration has the potential to improve mortality by 35% to 36%. Hemodiafiltration has the advantage of being relatively easy to implement. The uremic milieu is complex and further investigation of the underlying pathophysiology is needed to inform future dialysis interventions. The survival data above are from observational studies, and hence benefits are likely to be exaggerated. Randomized trials of dialysis interventions are desperately needed. They remain difficult to perform, because of the complexity of both the patient population and the interventions, and because of limited available funding.     

Systems that Should Have Failed: Critical Infrastructure Protection in an Institutionally Fragmented Environment

Recent years have witnessed major governmental initiatives regarding critical infrastructure protection (CIP). During that same time, critical infrastructures (CIs) have undergone massive institutional restructuring under the headings of privatization, deregulation and liberalization. Little research has gone into understanding the interactions between these two developments. In this article, we outline the consequences of institutional restructuring for the changing ways in which CIs ensure the reliability and security of their networks and services. Neither Normal Accident Theory nor High‐Reliability Theory can account for reliability under these conditions. We then investigate the implications of these findings for CIP.     

Assessment of Highway Bridge Upgrading by Dynamic Testing and Finite-Element Model Updating

The Land Transport Authority of Singapore has a continuing program of highway bridge upgrading for refurbishing and strengthening bridges to allow for increasing vehicle traffic and increasing axle loads. One subject of this program has been a short-span bridge taking a busy main road across a coastal inlet near a major port facility. Experiment-based structural assessments of the bridge were conducted before and after upgrading works including strengthening. Each assessment exercise comprised three separate components: (1) a strain and acceleration monitoring exercise lasting approximately one month; (2) a full-scale dynamic test carried out in a single day without closing the bridge; and (3) a finite-element model updating exercise to identify structural parameters and mechanisms. This paper presents the dynamic testing and the modal analysis used to identify the vibration properties and the quantification of the effectiveness of the upgrading through the subsequent model updating. Before and after upgrade, similar sets of vibration modes were identified, resembling those of an orthotropic plate with relatively weak transverse bending stiffness. Conversion of bearings from nominal simple supports to nominal full fixity was shown via model updating to be the principal cause of natural frequency increases of up to 50%. The utility of the combined experimental and analytical process in direct identification of structural properties has been proven, and the procedure can be applied to other structures and their capacity assessments.     

Interstate forensic psychology consultations: A call for reform and proposal of a model rule.

Forensic psychology has made important gains in professional recognition and stature in the courts, resulting in increasing demands for mobility of expertise. Current regulations regarding the interjurisdictional temporary forensic practice of psychology, however, are characterized by variability of regulations, ambiguity and inaccessibility, and continuing total barriers. A uniform, well-reasoned policy is needed. A conceptual basis for such a policy is provided by a discussion of licensing rationales and the application of these to forensic practice. Uniformity, public and professional protection, and practicability are identified as fundamental regulatory criteria. A Model Rule Regarding the Temporary Forensic Practice of Psychology is proposed for adoption by state licensing boards on a nationwide basis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of Three Measures of Communication for Predicting Relationship Adjustment and Stability Among a Sample of Young Couples.

The goal of this study was to examine whether data from 3 different measures of communication (i.e., self-report, quasi-observational, and observational) can predict relationship adjustment and stability 1 year later when used conjointly in a sample of 62 young couples. The 3 measures of communication were the Communication Skills Test-Revised (CST-R), the Communication Box (CB), and the Demand/Withdraw Pattern Questionnaire (DWPQ). Through hierarchical multiple regression analyses, results revealed that the CST-R and the DWPQ predict both genders' relationship adjustment 1 year later when used conjointly. Logistic regression analyses revealed that none of the measures of communication significantly predicted relationship stability. In conclusion, the combination of the CST-R and the DWPQ appears to be useful for longitudinally predicting relationship adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surfactant behavior and its influence on the viscosity of associative thickeners solutions, thickened latex dispersions, and waterborne latex coatings

Surfactants, varying in their chemical composition and hydrophobic behavior, are used in the formulation of a waterborne coating. These differences influence their aggregation in micellar structures, their interaction with associative thickeners, and in particular, the synergies present in their competitive adsorptions on the disperse phases in a waterborne coating. Adsorption of HEUR thickeners on latexes and the ability of surfactants to displace them from those surfaces is an important variable in the dispersion’s viscosity. With large particle latexes, viscosity increases arise primarily from the network built through the interaction of HEURs with surfactants in the aqueous phase. Fluorescence is used to verify the mechanism by which surfactants enhance associative thickener viscosities. That is best achieved with nonionic surfactants, because of their synergies with large hydrophobe HEURs at low concentration. With decreasing latex particle size the adsorbed species is an important contributor to the dispersion’s viscosity through its contribution to the latex’s effective volume fraction increase and when the size of the adsorbed HEUR is matched to the separation distances of the latex at 0.25 volume fraction. Achieving controlled shear-thinning behavior in small particle size latex paints with the economic constraints on the amount of HEUR required to obtain 90 KU viscosities are discussed. Presented at the 80th Annual Meeting of the Federation of Societies for Coatings Technology, October 30–November 1, 2002, in New Orleans, LA. Polymer and Coatings Dept., Fargo, ND 58103.     

Does anticipation training affect drivers' risk taking?

Skill and risk taking are argued to be independent and to require different remedial programs. However, it is possible to contend that skill-based training could be associated with an increase, a decrease, or no change in risk-taking behavior. In 3 experiments, the authors examined the influence of a skill-based training program (hazard perception) on the risk-taking behavior of car drivers (using video-based driving simulations). Experiment 1 demonstrated a decrease in risk taking for novice drivers. In Experiment 2, the authors examined the possibilities that the skills training might operate through either a nonspecific reduction in risk taking or a specific improvement in hazard perception. Evidence supported the latter. These findings were replicated in a more ecological context in Experiment 3, which compared advanced and nonadvanced police drivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dMARS Architecture: A Specification of the Distributed Multi-Agent Reasoning System

The Procedural Reasoning System (PRS) is the best established agent architecture currently available. It has been deployed in many major industrial applications, ranging from fault diagnosis on the space shuttle to air traffic management and business process control. The theory of PRS-like systems has also been widely studied: within the intelligent agents research community, the belief-desire-intention (BDI) model of practical reasoning that underpins PRS is arguably the dominant force in the theoretical foundations of rational agency. Despite the interest in PRS and BDI agents, no complete attempt has yet been made to precisely specify the behaviour of real PRS systems. This has led to the development of a range of systems that claim to conform to the PRS model, but which differ from it in many important respects. Our aim in this paper is to rectify this omission. We provide an abstract formal model of an idealised dMARS system (the most recent implementation of the PRS architecture), which precisely defines the key data structures present within the architecture and the operations that manipulate these structures. We focus in particular on dMARS plans, since these are the key tool for programming dMARS agents. The specification we present will enable other implementations of PRS to be easily developed, and will serve as a benchmark against which future architectural enhancements can be evaluated.     

THE OPTIMUM SPEED OF VISUAL INSPECTION USING A RANDOM SEARCH STRATEGY

Choosing a standard speed for visual inspection is difficult using standard work measurement techniques. This paper uses a different approach, taking a model of human functioning in inspection and deriving an optimum speed of working so as to balance the cost of time against the cost of errors. Random search is used as the model and both self-paced and externally-paced conditions are derived for multiple fault types. Optimization using a Golden Section search is used to provide optimum inspection speed.