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What constitutes adequate dialysis has been debated in the nephrology literature over the past eight years. The mortality rate of patients on dialysis in the United States is about 20% per year. We believed that short and infrequent dialysis sessions contributed to poor outcomes. To improve the results, Lynchburg Nephrology started the nightly home hemodialysis (NHHD) program in September 1997. Ten patients were trained in the first 15 months of the program. Patients dialyzed 7 – 9 hours, 6 nights/week, using the Fresenius 2008H machine. A standard dialysis solution with 2.0 mEq/L potassium, calcium concentration of 3.0 – 3.5 mEq/L was used. Dialysis solution flow rates were 200 – 300 mL/min. Serum phosphate levels were maintained above 2.5 mg/dL by adding 0 – 45 mL Fleet's Phosphosoda to the bicarbonate bath. Patients had marked improvement in quality of life as measured with the SF-36. Blood pressure was better controlled with fewer medications. All phosphate binders were eliminated. Caloric intake and protein intake increased to normal levels as measured by three-day dietary histories pre-NHHD, and at 3, 6, and 12 months on NHHD. Epoetin alfa dosages were reduced by about 50%. Nightly home hemodialysis should be considered as a valuable modality option for end-stage renal disease patients; it is potentially superior to conventional thrice-weekly hemodialysis.  相似文献   
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Cardiovascular illness is most commonly caused by a constriction, called a stenosis. A non-linear mathematical model with a free moving boundary was introduced to study viscous flow in tapered elastic tubes with axisymmetric constrictions subject to a prescribed pressure drop and a uniform external pressure. An iterative numerical scheme using a boundary iteration method was developed to solve the model. Effects of stenosis severity and stiffness, pressure drop, external pressure and stiffness of the vessel wall on the flow and wall motion were evaluated. It was found that stenosis severity, pressure drop and external pressure played more dominant roles than tube wall stiffness and stenosis stiffness perturbation. Tubes with 71 and 78 per cent stenoses showed two areas of negative transmural pressure and complex contraction–expansion–contraction wall motion patterns. Two types of tube diameter contraction and negative transmural pressure were observed, one was just distal to the stenosis and the other was near the outlet of the tube. Experiments using stenotic silicone tubes were conducted to quantify the tube law and verify the predicted pressure–flow relationship. The agreement between the numerical results and experimental measurements is better than that from a previous model which assumed periodicity of the tube and imposed different pressure conditions. © 1998 John Wiley & Sons, Ltd.  相似文献   
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The preparations for and the implementation of the 2002 Multisite Conference on the Future of School Psychology are described. The conference goals were to (a) achieve consensus on current and future demands for school psychologists and our profession's ability to meet those demands; (b) conceptualize the practice of school psychology in the face of diminishing numbers and increasing demand for services; and (c) develop an agenda to use the resources we have to maximize the benefits to the children and schools that we serve. A problem-solving model served as the conceptual foundation of the conference. School psychologists at the host site in Indianapolis and 30 remote sites collaborated to identify threats, opportunities, strategies, and action plans to respond better to the needs of children, families and schools. The conference not only generated excitement and hope for our future, but also provided a framework to propel the current and future practice of school psychology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)  相似文献   
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Dogs were born to mothers fed commercial diets low or enriched in n-3 fatty acids and raised on those diets until they were about 50 d old. Retinas were removed, lipids were extracted, and total phospholipids were analyzed for fatty acid and molecular species composition. Animals from the low n-3 group had significantly lower retinal levels of 22:6n-3 and higher levels of n-6 fatty acids, especially 20:4n-6 and 22:5n-6. There was no difference in the retinal levels of 18:2n-6, and only small differences were found in saturated and monounsaturated fatty acids. The most dramatic differences in molecular species occurred in 22:6n-3-22:6n-3 (4.7 vs. 0.8%) and 18:0-22:6n-3 (27.6 vs. 14.4%); total molecular species containing 22:6n-3 were significantly lower in the low n-3 group (45.5 vs. 24.0%). Molecular species containing 20:4n-6 and 22:5n-6 were greater in the low n-3 animals (13.0 vs. 25.7%), as were molecular species containing only saturated and monounsaturated fatty acids (40.8 vs. 35.4%). These results show that modest differences in the amount of n-3 fatty acids in the diets of dogs can have profound effects on the fatty acid and molecular species composition of their retinas.  相似文献   
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