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Dialysis dose and malnutrition have a great impact on the clinical out come of chronic hemodialysis patients. The interrelationships between them, however, remain undefined. Thus, we performed a study to determine the effects of increasing the dialysis dose on serum albumin concentrations and mortality in hemodialysis patients. We examined urea kinetic modeling, biochemical nutritional indices, comorbid conditions, patient survival time, and annual mortality rate. Dialysis dose, measured by Kt/V, significantly increased from 1.3 +/- 0.3 in 1987 to 1.5 +/- 0.4 in 1990 and to 1.7 +/- 0.4 in 1993. Serum albumin level also increased from 3.8 +/- 0.4 g/dL in 1987 to 4.0 +/- 0.4 in 1990 and to 1.7 +/- 0.4 in 1993. In 1993, 76% of patients had Kt/V > or = 1.50 compared with 45% in 1990 and 28% in 1987, whereas 82% of patients had a serum albumin level > or 4.0 g/dL in 1993 compared with 58% in 1990 and 29% in 1987. Protein catabolic rate and hematocrit also increased from 1987 to 1993, but not serum cholesterol or triglyceride. The annual mortality rate declined from 16.1% in 1987 to 13.2% in 1990 and to 8.0% in 1993. The decrease in mortality appeared to be unrelated to differences in patient selection or comorbid conditions. Serum albumin levels, hematocrit, Kt/V, and protein catabolic rate were significantly related to patient survival after age, sex, and diabetic status had been adjusted. Furthermore, there was a positive correlation between Kt/Vs and serum albumin concentration (r = 0.216, P < 0.001). Thus it appears that increasing the dose of dialysis improves serum albumin levels and perhaps survival rate in hemodialysis patients as well.  相似文献   
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Although protocol analysis can be an important tool for researchers to investigate the process of collaboration and communication, the use of this method of analysis can be time consuming. Hence, an automatic coding procedure for coding dialogue acts was developed. This procedure helps to determine the communicative function of messages in online discussions by recognizing discourse markers and cue phrases in the utterances. Five main communicative functions are distinguished: argumentative, responsive, informative, elicitative, and imperative. A total of 29 different dialogue acts are specified and recognized automatically in collaboration protocols. The reliability of the automatic coding procedure was determined by comparing automatically coded dialogue acts to hand-coded dialogue acts by a human rater. The validity of the automatic coding procedure was examined using three different types of analyses. First, an examination of group differences was used (dialogue acts used by female versus male students). Ideally, the coding procedure should be able to distinguish between groups who are likely to communicate differently. Second, to examine the validity of the automatic coding procedure through examination of experimental intervention, the results of the automatic coding procedure of students, with access to a tool that visualizes the degree of participation of each student, were compared to students who did not have access to this tool. Finally, the validity of the automatic coding procedure of dialogue acts was examined using correlation analyses. Results of the automatic coding procedure of dialogue acts of utterances (form) were related to results of a manual coding procedure of the collaborative activities to which the utterances refer (content). The analyses presented in this paper indicate promising results concerning the reliability and validity of the automatic coding procedure for dialogue acts. However, limitations of the procedure were also found and discussed.  相似文献   
4.
半导体业务一直是道康宁公司获取更多大好商机的业务之一。目前,半导体制造技术极大地依赖于各种新兴材料,越来越多地需要道康宁这样的公司—化学和制造技术领域的  相似文献   
5.
Ss were presented with spiders running from left to right at various velocities over a structured background. Motion of the background influenced the perceived velocity of the spider: Motion of the background in the opposite direction than the spider increased the perceived velocity. The perceived position of the spider was not influenced by background motion. Ss were asked to hit the spiders as quickly as possible. Fast spiders were hit with a higher velocity than slow spiders. The same effect was found if the spiders only differed in apparent velocity, induced by motion of the background. The trajectory of the hit was not influenced by motion of the background. The authors concluded that although velocity is nothing but the change of position in time, velocity and position are processed independently. Furthermore, these two separately processed sources of information are used in both perception and action. (PsycINFO Database Record (c) 2010 APA, all rights reserved)  相似文献   
6.
In computer-supported collaborative learning research, studies examining the combined effects of individual level, group level and within-group differences level measures on individual achievement are scarce. The current study addressed this by examining whether individual, group and within-group differences regarding engagement and prior knowledge predict individual achievement. Engagement was operationalised as group members' exhibited activities in the task space (i.e., discussing domain-content) and social space (i.e., regulating ideas, actions and socioemotional processes). Prior knowledge and achievement were operationalised as group members' performance on a domain-related pre-test and post-test, respectively. Data was collected for 95 triads of secondary education students collaborating on a complex business-economics problem. Subsequently, three different multilevel models were tested to examine the combined effect. First a model with the individual level measures (model 1) was tested and in subsequent models the group level measures (model 2) and within-group levels measures (model 3) were added. Findings indicate model 2 showed the best fit; group members' individual engagement in the social space activities as well as the groups' average prior knowledge positively predicts individual achievement. No effects were found for either group members' or groups' engagement in the task space and for the within-group differences.  相似文献   
7.
The volatiles released by agar plate cultures of two strains of the myxobacterium Stigmatella aurantiaca (strains Sg a15 and DW4/3-1) were collected in a closed-loop stripping apparatus (CLSA) and analyzed by GC-MS. Large numbers of substances from different compound classes (ketones, esters, lactones, terpenes, and sulfur and nitrogen compounds) were identified; several of them are reported from natural sources for the first time. The volatiles 2-methyltridecan-4-one (17), its isomer 3-methyltridecan-4-one (20), and the higher homologue 2-methyltetradecan-4-one (18) were identified in the extracts of both strains and were synthesized. In addition, strain Sg a15 produced 2,12-dimethyltridecan-4-one (19), 2-methyltridec-2-en-4-one (23), and a series of phenyl ketones, among them 1-phenyldecan-1-one (14) and 9-methyl-1-phenyldecan-1-one (16), whereas strain DW4/3-1 emitted traces of 10-methylundecan-2-one (21). The biosynthesis of 14 and 16 was examined in feeding experiments with deuterated precursors carried out on agar plate cultures. The leucine-derived starter unit isovalerate was shown to be incorporated into 16, as was phenylalanine-derived benzoic acid into both 14 and 16. The results point to formation both of the phenyl ketones and of the structurally related aliphatic ketones through an unusual head-to-head coupling between a starter unit such as benzoyl-CoA and a fatty acyl-CoA, followed by decarboxylation.  相似文献   
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9.

Background and purpose

Adverse events and medical errors can have severe consequences for patients (“first victims”), but also for the involved health care professionals (“second victims”). Don Berwick, former director of the Boston Institute for Healthcare Improvement (USA), highlighted the support for “second victims” as an “ethical issue”. But there is no clarity about what “ethical issue” implies. This article aims to clarify this question from the perspective of organizational ethics.

Method

Starting with data from the literature, challenges are described and evaluated from the perspective of organizational ethics.

Results

Evidence suggests that current approaches for supporting “second victims” are not sufficiently effective to help professionals to cope with the psychological consequences of adverse patient events and medical errors. This not only has negative consequences for the involved professionals, but can also put patient safety again at risk. In the light of these data, an organizational ethics approach is needed to comply with Don Berwick’s claim to consider the support of “second victims” as an “ethical issue”. This approach fosters the congruence of the organization’s values that are declared and those that are practiced. Its normative foundation is rooted in the organization’s duty of care both for the patients and for the employees.

Conclusions

Using organizational ethics it is possible to conceptualize and visualize the support for “second victims” as a binding component of the safety culture of the organization. It is translated into the organization’s obligation to raise the awareness for the phenomenon and to provide the resources necessary to deal effectively with it, e.?g., evidence-based ethical guidelines, standardized procedures, staff training, and low-threshold coaching programs.
  相似文献   
10.
To enable the evolution towards electronically assisted healthcare, future medical implants require sensors and processing circuitry to inform patient and doctor on the rehabilitation status. An important branch of systems are those where implant strain is monitored through strain gauges. Since batteries inside the human body are avoided as much as possible, a transcutaneous power link is used to wirelessly power the implant. The same RF link provides an elegant way of establishing bi-directional data communication between the external base station and the medical device. This paper describes a front-end IC that manages both power reception and bi-directional data communication. It has a clock generation circuit on board to drive additional digital processing circuits. A new architecture that uses a current driven data demodulation principle is introduced. It is able to detect an AM signal with modulation depth of a mere 4%, which is better than recent similar systems in the field. The IC is fabricated in a solid 0.35 μm HVCMOS technology and consumes only 0.56 mA.  相似文献   
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