Differences in Dialysis Practice Are the Main Reasons for the High Mortality Rate in the United States Compared to Japan

The cumulative survival of Japanese hemodialysis patients is more than 2.5 times better than that of dialysis patients in the United States (U.S.). The difference is particularly pronounced in older patients, being 4 times better in patients over the age of 50 years. The mortality in U.S. patients has increased from 10 to 25% over the last three decades, but has remained stable at around 10% in Japan.
There is no obvious difference in patient selection. The Japanese accept almost as high a proportion of diabetic patients as does the United States, and the mean age of incident patients is higher in Japan.
Renal transplantation, virtually absent in Japan, should increase mortality in U.S. dialysis patients by removing patients with the highest probability of survival, but even if one adds surviving transplant patients and studies prevalent populations, the survival rate is much better in Japan. Genetic factors are unlikely to explain differences in mortality, as older Americans live much longer than older Japanese.
We speculate that the difference lies in the practice of dialysis. Patients in the United States are generally treated by much faster and shorter dialysis than in Japan. This puts a severe burden on the cardiovascular system of older patients, leading to the poorer survival rate. Japanese physicians also appear to be better trained in dialysis and to spend more time with their patients. The nursing shortage in the United States may also contribute to the increased mortality. Whatever the explanations, the U.S. dialysis community must work to equal and, hopefully, surpass the now superior survival of Japanese dialysis patients.     

Effects of growth with ethanol on fermentation and membrane fluidity of Saccharomyces cerevisiae

Saccharomyces cerevisiae HSc was grown with ethanol at concentrations up to 10% (v/v). The immediate effects of additions of externally added ethanol on CO₂ production and O₂ consumption of washed organisms were studied by stopped-flow membrane inlet quadrupole mass spectrometry. Fermentative activities of organisms grown with ethanol (0–5% v/v) showed similar sensitivities to inhibition by ethanol, whereas those grown with 10% (v/v) ethanol had become protected and were markedly less sensitive. The fluidity of subcellular membrane fractions was measured by determination of the temperature dependence of the rotational order parameter of the spin label 5-doxyl stearic acid (free radical) by electron spin resonance. Mitochondria prepared from yeasts grown with 0, 7 and 9% (v/v) ethanol showed similar overall fluidity, although differences in temperature-dependent behaviour indicate altered lipid composition or lateral phase separations. On the other hand the microsomal fraction from organisms grown with 9% ethanol showed a remarkable increase in fluidity. These data suggest that the protective effects of growth with ethanol near the limit of tolerance on fermentative activities may arise from altered plasma membrane fluidity properties.     

High-Temperature Chemical Stability of Plasma-Sprayed Ca05Sr05Zr4P6O24 Coatings on Nicalon/SiC Ceramic Matrix Composite and Ni-Based Superalloy Substrates

The potential application of Ca05Sr05Zr4P6O24 (CS50) as a corrosion-resistant coating material for Si-based ceramics and as a thermal barrier coating material for Ni-based superalloys was explored. A ∼200 (xm thick CS50 coating was prepared by air plasma spray with commercially available powder. A Nicalon/SiC ceramic matrix composite and a Ni-based superalloy coated with a ∼200 (xm thick metallic bond coat layer were used as substrate materials. Both the powder and coating contained ZrP2O7 as an impurity phase, and the coating was highly porous as-deposited. The coating deposited on the Nicalon/SiC substrate was chemically stable upon exposure to air and Na2SO4/O2 atmospheres at 1000°C for 100 h. In contrast, the coating sprayed onto the superalloy substrate significantly reacted with the bond coat surface after similar oxidation in air.     

Quantitative studies on the movement of fluid and lymphocytes through periodontal tissue and into the draining lymph.

Chronic lymph drainage techniques in sheep have been used to map the pathways and to quantify the fluid and cell traffic through periodontal tissues. The continuous collection of cervical and prescapular lymph has demonstrated that 65% of labelled protein tracer injected into the periodontal tissues could be found in lymph over a period of 7.5 hours. Nearly 90% of the total radioactivity could be accounted for between the lymph and the tissue site. When silk was impregnated with radiolabelled albumin and a tooth ligated, the kinetics of the subsequent appearance of the tracer in lymph emphasized the ease with which macromolecules surrounding the teeth gain access to the lymphatics, regional lymph nodes, and immune apparatus. Animals were primed with BCG and then tuberculin (delayed hypersensitivity) lesions were simultaneously induced in the skin, bowel, and periodontium. When T cells were labelled with radioisotopes and their migration from blood to lymph measured, the periodontal tissue traffic pattern was distinct from the traffic pattern through DTH in the skin and also distinct from the pattern through the small intestine. This indicates that the lymphocyte traffic through the inflamed periodontium has unique features. This tissue specificity was not apparent when lesions were induced with TNFalpha. The static assessment of lymphocyte subsets within the tissues was also assessed with immunohistochemistry.     

Automated zebrafish chorion removal and single embryo placement: optimizing throughput of zebrafish developmental toxicity screens

The potential of the developing zebrafish model for toxicology and drug discovery is limited by inefficient approaches to manipulating and chemically exposing zebrafish embryos-namely, manual placement of embryos into 96- or 384-well plates and exposure of embryos while still in the chorion, a barrier of poorly characterized permeability enclosing the developing embryo. We report the automated dechorionation of 1600 embryos at once at 4 h postfertilization (hpf) and placement of the dechorionated embryos into 96-well plates for exposure by 6 hpf. The process removed ≥95% of the embryos from their chorions with 2% embryo mortality by 24 hpf, and 2% of the embryos malformed at 120 hpf. The robotic embryo placement allocated 6-hpf embryos to 94.7% ± 4.2% of the wells in multiple 96-well trials. The rate of embryo mortality was 2.8% (43 of 1536) from robotic handling, the rate of missed wells was 1.2% (18 of 1536), and the frequency of multipicks was <0.1%. Embryo malformations observed at 24 hpf occurred nearly twice as frequently from robotic handling (16 of 864; 1.9%) as from manual pipetting (9 of 864; 1%). There was no statistical difference between the success of performing the embryo placement robotically or manually.     

Assessing Optimal Digital Elevation Model Selection for Active River Area Delineation Across Broad Regions

Water Resources Management - The Active River Area (ARA) is a spatial approach for identifying the extent of functional riparian area. Given known limitations in terms of input elevation data...     

A new model of job design: Initial evidence and implications for future research

Clegg and Spencer's (2007) model of job design synthesizes and extends recent conceptions of the job design process by incorporating variables such as knowledge, motivation, and trust into a cyclical and dynamic system. The objective of this study was to examine the sequential organization of variables that comprise the model, as a basis from which to justify further investigations of the model's dynamic properties. Data were collected via questionnaires from 432 participants in two work organizations. Results obtained from structural equation modeling are broadly supportive of the proposed relationships between the variables. Implications of this initial study for future research and practice are discussed. © 2011 Wiley Periodicals, Inc.