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.     

Occurrence of Lawn Care and Agricultural Pesticides in the Don River and Humber River Watersheds (1998–2002)

Between 1998 and 2002, surface water samples were collected from several sites in the Don River and Humber River watersheds, both tributaries to Lake Ontario, and analyzed for a variety of pesticides, including those used for urban lawn care. Analyses included 152 pesticide active ingredients and eight metabolites. Samples were collected during base flow periods (i.e., dry events) and rainfall events (i.e., wet events). The objectives of the study were to determine which pesticides were detectable, whether there was a difference in the detection frequency between the two watersheds and between upstream and downstream in each river, and whether precipitation influenced the frequency of detection. Eleven pesticides and one metabolite were detected in surface waters of the Don and Humber rivers or their tributaries, with approximately 72% of samples containing at least one pesticide attributable to lawn care use. The pesticides and pesticide metabolite detected in this study included 2,4-D, atrazine, bromacil, carbofuran, chlorpyrifos, cypermethrin, diazinon, dicamba, MECOPROP, metolachlor, metribuzin, and an atrazine metabolite (des-ethyl atrazine). Four pesticides exceeded federal or provincial water quality guidelines/objectives. Diazinon exceeded the provincial water quality objective in 28% of the samples taken. For the three other pesticides (atrazine, carbofuran and chlorpyrifos) exceedance of a water quality criteria occurred in less than 1% of the samples.     

Long-term recovery of pressurized water reactors following a large break loss-of-coolant accident

The U.S. Nuclear Regulatory Commission recently identified a possible safety concern for pressurized water reactors. Following the reflood phase of a large break loss-of-coolant accident, long-term cooling of the reactor core may not be ensured. Specifically, the concern is that, for a pump discharge cold leg break, the loop seals in the reactor coolant pump suction piping will refill with liquid and the post-reflood steam production may depress the liquid levels in the downflow sides of the loop seals. A loop seal depression would cause a corresponding depression of the core liquid levels and possibly a fuel rod heatup in the upper core region. This paper is intended as an introduction of the safety issue that: (1) describes the important aspects of the problem, (2) provides an initial analysis of the consequences, and (3) discusses ongoing work in this area. Because the elevation of the loop seals is near the mid-core elevation in plants of Westinghouse design, the concern is greatest for those plants. There is less concern for most plants of Combustion Engineering design, and likely no concern for plants of Babcock and Wilcox design. This issue was addressed by employing both steady-state and transient systems analysis approaches. Two approaches were used because of uncertainties regarding actual reactor coolant system behavior during the post-reflood period. The steady-state approach involved the development and application of a simple computer program to investigate reactor coolant system behavior assuming quiescent post-reflood conditions. The transient systems approach involved investigating this behavior using the RELAP5/MOD2 computer code and a comprehensive RELAP5 model of a Westinghouse pressurized water reactor. The steady-state analysis indicated only a moderate fuel rod heatup is possible. The transient systems analysis indicated boiling and condensation-induced flow oscillations are sufficient to prevent fuel rod heatup. Analysis uncertainties are discussed.     

An experimental investigation of triboelectrification in cohesive and non-cohesive pharmaceutical powders

A detailed experimental investigation has been undertaken of the triboelectrification process of the pharmaceutical excipient alpha-lactose monohydrate and selected drugs. Particle charge studies involved the design and construction of an apparatus to incorporate pneumatic powder feed, triboelectric charging via a cyclone separator and simultaneous powder charge (Q) and mass (M) measurements using a modified Faraday well. Preliminary studies showed the charging of the selected materials to be unaffected by relative humidity up to 84%, due to the very low hygroscopicity of the powders. Experiments using lactose size fractions with brass, steel and cellulose contact charging surfaces conducted at different feeder gas pressures, gave net electronegative specific charge values (Q/M) for the metal surfaces, and electropositive values for cellulose. Specific charge increased linearly with gas pressure for the metals, and non-linearly for cellulose. Samples of micronised lactose and beclomethasone dipropionate (BDP) showed more tendency than unmicronised samples to adhere to the contact surface which resulted in more complex charging processes. A novel system to analyse the charge and mass data in further detail was developed, giving relative Q/M values at unit time intervals. It is proposed that this will overcome the limitations of reliance on the final net specific charge value. Preliminary results indicated differences in the charging mechanism for lactose in contact with the two metal surfaces.     

Results of treatment of inferior vena cava syndrome with expandable metallic stents

A 73-year-old male was admitted to our hospital because of detection of Shigella flexneri 2a from his stool. Antimicrobial treatment with levofloxacin (LVFX) was started, but could not eliminate the organism in the stool. In the examination of drug susceptibility, this strain was highly resistant to all new quinolones. The minimal inhibitory concentration of norfloxacin, ofloxacin and ciprofloxacin to this strain was 12.5 micrograms/ml, 6.25 micrograms/ml and 6.25 micrograms/ml, respectively. The dual mutations were detected in the codon 83 and 87 of the gyrA gene by sequencing the quinolone-resistance determining region (QRDR). There was, however, no significant difference between the intracellular uptake of ciprofloxacin in this strain and in the ciprofloxacin-sensitive strain. The amount of ciprofloxacin in this strain unchanged when carbonyl cyanide m-chlorophenyl hydrazone (CCCP) was added. These results suggest that the advanced resistance in Shigella flexneri against new quinolones could be acquired by only this dual mutations without the change of the active efflux mechanism.     

Tower of London performance in relation to Magnetic Resonance Imaging following closed head injury in children.

To investigate the relationship of severity of pediatric closed head injury (CHI), the contribution of frontal lobe lesions, and age at testing (6–10 yr olds vs 11–15 yr olds) to cognitive deficit, 134 head-injured patients were given the Tower of London (TOL) task and underwent magnetic resonance imaging. 89 normal controls were given the TOL for comparison. Severity of CHI and age at testing were strongly related to cognitive performance on the TOL, including the frequency of breaking the rules. Volume of frontal lobe lesion (but not extrafrontal lesion) contributed to the prediction of perfomance on the TOL even after severity of injury was taken into account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)