Improving arteriovenous fistula rate: Effect on hemodialysis quality

Vascular access (VA) is the lifeline for patients with end‐stage renal disease on regular hemodialysis (HD). Tunneled catheters have been associated with increased risk of luminal thrombosis, infection, hospitalization, and high cost. Our aims were to follow the “Fistula First Initiative,” avoid or reduce the rate of catheter insertion, improve the rate of arteriovenous fistula (AVF) use, and study the effect of increased AVF use on quality of dialysis and patient's outcome. A VA program has been established in collaboration with an enthusiastic and professional vascular surgery team to manage 358 patients who have been on regular HD treatment for a period ranging from 1 to 252 months. The mean ± standard deviation age of patients was 52 ± 15 years with 62% male patients. Over a period of 2 years, 408 procedures were performed. These include 293 AVFs and 56 arteriovenous grafts (AVGs). Other procedures include 39 permanent catheter insertions, 8 AVF aneurysmectomy, removal of 6 AVGs, embolectomy of 4 AVGs, excision of 1 AVG lymphocele, and ligation of 1 AVF. This program resulted in significant increase in AVF rate from 35% to 82%; reduction in catheter rate from 62% to 10.9%; infection rate down from 6.6% to 0.6%; VA clotting down from 5.1% to 1.0%; and increase in average blood flow rate from 214 ± 32 to 298 ± 37 mL/min (P < 0.01). These results have been associated with improved average single pool Kt/V from 0.88 ± 0.19 to 1.28 ± 0.2 (P < 0.01); increased hemoglobin from 9.2 ± 1.2 to 10.9 ± 0.9 g/dL (P < 0.01); improved serum albumin from 3.2 ± 0.5 to 3.7 ± 0.4 g/dL (P < 0.05); reduction in administered erythropoietin dose by 19%; and significant drop in hospitalization rate from 6.1% to 3.8%. These results confirm the great benefits of AVF on quality of HD and patient outcome, and clearly affirm that AVF should always be considered first.     

Physically cross-linked polyvinyl alcohol for the topical delivery of fluconazole

The aim of this study was to develop fluconazole in an ultrapure polyvinyl alcohol (PVA) hydrogel able to deliver the drug in a sustained release pattern for local treatment of skin fungal infections. The topical fluconazole hydrogels were prepared using PVA hydrogels physically cross-linked by freeze-thaw technique. Polyethylene glycol (PEG) was added as a hydrophilic excipient as a release enhancer of fluconazole. The effects of PVA molecular weight, PEG molecular weight, and PEG concentration were studied using a 2 x 4 x 2 factorially designed experiment. The selected fluconazole hydrogel proved to be physically stable over a period of 6 months and to be effective in the topical treatment of cutaneous candidiasis. Therefore, it could be concluded that the formula composed of 10% PVA 205000 and 1.5% PEG 4000 and 2% fluconazole and prepared by three cycles of freezing, and thawing is very promising in the local treatment of skin fungal infection as an alternative to the systemic use of fluconazole.     

Motivational and equipping functions of interpretation in counseling.

Tested the hypotheses that interpretations increase clients' motivation to change and that interpretations identifying causal factors clients can directly control lead to greater client change than interpretations identifying causes clients cannot directly control. 36 students who were experiencing problems with procrastination were assigned to 1 of 12 conditions defined by 3 interview conditions and 4 interviewers. Ss received 2 interviews 1 wk apart. In one interpretation condition the interviewers worked from a causal framework of procrastination as caused by a lack of effort, poor self-discipline, and ambiguous goals. In the other interpretation condition the interviewers saw procrastination as a symptom of underlying conflicts and resentments stemming from unresolved conflict with parents. In the 3rd condition the interviewers refrained from any statements of opinion but reflected the students' ideas about the nature and causes of their procrastination. The results generally support the hypotheses. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A maximum efficiency-photovoltaic-induction motor pump system

It is not economically viable to connect remote areas to the national electric grid, so pumping systems based on photovoltaic energy sources are suitable for these areas. The induction motor is more rugged, reliable, and maintenance free than d.c. motors. In this paper, a pumping system based on an induction motor driven by a voltage source inverter is investigated. Two control strategies are considered. First, the system is controlled to operate on the maximum power line of the PV array, with variable water discharge Q. Second, the induction machine is controlled to operate at maximum efficiency. The operating characteristic of the array is thus controlled to match the voltage and current required by the motor. Comparison is carried out between the two operating schemes.     

Gender and the effectiveness of leaders: A meta-analysis.

This article presents a synthesis of research on the relative effectiveness of women and men who occupy leadership and managerial roles. Aggregated over the organizational and laboratory experimental studies in the sample, male and female leaders were equally effective. However, consistent with the assumption that the congruence of leadership roles with leaders' gender enhances effectiveness, men were more effective than women in roles that were defined in more masculine terms, and women were more effective than men in roles that were defined in less masculine terms. Also, men were more effective than women to the extent that leader and subordinate roles were male-dominated numerically. These and other findings are discussed from the perspective of social-role theory of sex differences in social behavior as well as from alternative perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Direct Imaging of Chiral Domain Walls and Néel-Type Skyrmionium in Ferrimagnetic Alloys

The evolution of chiral spin structures is studied in ferrimagnetic Ta/Ir/Fe/GdFeCo/Pt multilayers as a function of temperature using scanning electron microscopy with polarization analysis (SEMPA). The GdFeCo ferrimagnet exhibits pure right-handed Néel-type domain wall (DW) spin textures over a large temperature range. This indicates the presence of a negative Dzyaloshinskii–Moriya interaction that can originate from both the top Fe/Pt and the Co/Pt interfaces. From measurements of the DW width, as well as complementary magnetic characterization, the exchange stiffness as a function of temperature is ascertained. The exchange stiffness is surprisingly more or less constant, which is explained by theoretical predictions. Beyond single skyrmions, it is identified by direct imaging a pure Néel-type skyrmionium, which due to the expected vanishing skyrmion Hall angle, is a promising topological spin structure to enable applications by next generation of spintronic devices.