71 research outputs found
Rousseau e a radicalidade democrática: um debate com a interpretação de Kevin Inston
No full textRousseau's association to the philosophical sources of democracy is not free of discussion. The author himself preferred the qualification of “republican” instead of “democrat”, and in the Social Contract he pointed out serious difficulties for the existence of democracy as a form of government, even though his theses on popular sovereignty reverberate principles typically linked to democratic constitutions. In view of this, Kevin Inston questioned that contemporary radical democrats have neglected the contribution of the Genevan philosopher, and for this reason he sought to show how much it remains relevant to face the political challenges of our times. However, to what extent are Inston’s efforts to reconcile Rousseau's political theory with contemporary democracy sustainable? Has not the commentator underestimated or ignored crucial elements that make such convergence problematic? The purpose of this paper is to try to provide some answers to such questions.A associação de Rousseau às fontes filosóficas da democracia não constitui algo livre de discussões. O próprio autor preferia a qualificação de “republicano” em vez de “democrata”, e no Contrato Social apontou sérias dificuldades para a existência da democracia como uma forma de governo, ainda que suas teses sobre a soberania popular reverberem princípios tipicamente ligados às constituições democráticas. Diante disso, Kevin Inston questionou que os democratas radicais contemporâneos tenham negligenciado a contribuição do filósofo genebrino, e por isto buscou mostrar o quanto ela continua sendo relevante para enfrentar os desafios políticos da atualidade. Todavia, em que medida se sustentam os esforços de Inston para compatibilizar a teoria política rousseauniana com a democracia contemporânea? Não terá o comentador subestimado ou ignorado elementos cruciais que tornam tal convergência problemática? O objetivo deste artigo é tentar fornecer algumas respostas para tais perguntas
Aneurysms and pseudoaneurysms in dialysis access
No full textAneurysms are a common and often difficult complication seen with arteriovenous vascular access for haemodialysis. The purpose of this narrative review is to define and describe the scale of the problem and suggested therapeutic strategies. A narrative review of the published literature illustrated by individual cases is presented with the aim of summarising the relevant literature. The definitions of aneurysm are inconsistent throughout the literature and therefore systematic review is impossible. They vary from qualitative descriptions to quantitative definitions using absolute size, relative size and also size plus characteristics. The incidence and aetiology are also ill defined but separation into true aneurysms and false, or pseudoaneurysms may be helpful in planning treatment, which may be conservative, surgical or radiological. The lack of useful definitions and classification along with the multitude of management strategies proposed make firm evidence based conclusions difficult to draw. Further robust well designed studies are required to define best practice for this common problem
Combined liver–kidney transplantation versus liver transplant alone based on KDIGO stratification of estimated glomerular filtration rate : data from the United Kingdom Transplant registry – a retrospective cohort study
No full textPatient selection for combined liver–kidney transplantation (CLKT) is a current issue on the background of organ shortage. This study aimed to compare outcomes and post-transplant renal function for patients receiving CLKT and liver transplantation alone (LTA) based on native renal function using estimated glomerular filtration rate (eGFR) stratification. Using the UK National transplant database (NHSBT) 6035 patients receiving a LTA (N = 5912; 98%) or CLKT (N = 123; 2%) [2001–2013] were analysed, and stratified by KDIGO stages of eGFR at transplant (eGFR group-strata). There was no difference in patient/graft survival between LTA and CLKT in eGFR group-strata (P > 0.05). Of 377 patients undergoing renal replacement therapy (RRT) at time of transplantation, 305 (81%) and 72 (19%) patients received LTA and CLKT respectively. A significantly greater proportion of CLKT patients had severe end-stage renal disease (eGFR < 30 ml/min/1.73 m2) at 1 year post-transplant compared to LTA (9.5% vs. 5.7%, P = 0.001). Patient and graft survival benefit for patients on RRT at transplantation was favouring CLKT versus LTA (P = 0.038 and P = 0.018, respectively) but the renal function of the long-term survivors was not superior following CLKT. The data does not support CLKT approach based on eGFR alone, and the advantage of CLKT appear to benefit only those who are on established RRT at the time of transplant
Vascular access for home haemodialysis
No full textIntroduction: Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. Method: A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. Results: Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. Conclusion: Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates. </jats:sec
Setting Priorities for Optimizing Vascular Access Decision Making--An International Survey of Patients and Clinicians.
No full textBackgroundMany decisions around vascular access for haemodialysis warrant a collaborative treatment decision-making process, involving both clinician and patient. Yet, patients' experiences in this regard have been suboptimal. Although clinical practice guidelines could facilitate collaborative decision making, they often focus on the clinicians' side of the process, while failing to address the patients' perspective. The objective of this study was to explore and compare kidney patients' and clinicians' views on what vascular access-related decisions deserved priority for developing guidelines that will contribute to optimizing collaborative decision making.MethodsIn the context of updating their vascular access guideline, European Renal Best Practice surveyed an international panel of 85 kidney patients, 687 nephrologists, 194 nurses, and 140 surgeons/radiologists. In an electronic questionnaire, respondents rated 42 vascular access-related topics on a 5-point Likert scale. Based on mean standardized ratings, we compared priority ratings between patients and each clinician group.ResultsSelection of access type and site, as well as prevention of access infections received top priority across all respondent groups. Patients generally assigned higher priority to decisions regarding managing adverse effects of arteriovenous access and patient involvement in care, while clinicians more often prioritized decisions around sustaining patients' access options, technical aspects of access creation, and optimizing fistula maturation and patency.ConclusionApart from identifying the most pressing knowledge gaps, our study provides pointers for developing guidelines that may improve healthcare professionals' understanding of when to involve patients along the vascular access pathway
Hypervolemia and blood pressure in prevalent kidney transplant recipients
No full textBackground: The prevalence and consequences of hypervolemia in kidney transplant recipients (KTRs) have not been investigated. Specifically, its impact on blood pressure (BP) and relationship with N-terminal fragment of prohormone B-type natriuretic peptide (NT-proBNP) are unknown. The objectives of this study were to establish the prevalence of hypervolemia among clinically stable KTRs, investigate the predictors of posttransplant hypervolemia, assess its impact on blood pressure, and determine its relationship with NT-proBNP. Methods: This single-center cross-sectional study enrolled 123 clinically stable KTRs. Extracellular volume status was determined by multifrequency bioimpedance analysis. Mild and severe hypervolemia were defined as percentage volume expansion of greater than 7% and greater than 15%, respectively. Systolic BP (SBP) and diastolic BP (DBP) were measured, with mean arterial pressure (MAP) calculated. Serum NT-proBNP was quantified using a noncompetitive immunoluminometric assay. Potential demographic, nutritional, and clinical predictors of extracellular volume status, BP, and NT-proBNP levels were assessed. Results: Hypervolemia was present in 30% of KTRs, with 5% classified as severe hypervolemia. Significant predictors of volume expansion were increased sodium intake, advancing age, and reduced fat mass (P<0.01 for all associations). Hypervolemia was the only independent predictor of elevated MAP, SBP, and DBP (P<0.001 for all associations). Raised NT-proBNP levels were independently associated with both hypervolemia (P=0.01) and allograft dysfunction (P=0.03). Conclusions: Hypervolemia is unexpectedly common among clinically stable KTRs. It is closely associated with elevated BP. The relationship with increased sodium intake signals potential therapeutic focus. Further study is warranted to prospectively investigate objective measures of extracellular volume status among KTRs
Investigation into the Effects of Wire Mesh on Tensile and Impact Properties of Fiber Metal Laminates
No full textAn investigational study was conducted into the tensile and impact behavior of Fiber Metal Laminates by combining 5052 aluminum mesh or2024-T3 aluminum sheets,2.47 N (8.9 oz) or 6.67 N (24 az) ShieldStand® S fiberglass, and Hysol EA 9313 epoxy. Testing was performed under the guidelines of ASTM D3039-00 utilizing an lnstron 8802 Servohydraulic Materials Testing Instrument for tensile tests and ASTM D3763-06 utilizing an Inston 9250 HV Dynatup Impulse Impact Testing System for impact tests. Samples were strained at arate of 2 mrn/min for tensile tests and impacted with enetgies of 10 to 40 J in l0 J increments for impact tests. It was found that the 6.67 N Q4 oz) ShieldStand ® S with 2024-T3 aluminum alloy sheet samples performed best when compared to the other fabricated samples. When compared to GLARE 3 there was a 24.7o/o decrease in ultimate tensile strength with 6.07% decrease in ultimate shain. 6.67 N Q4 oz) ShieldStand® S with 5052 aluminum mesh samples were extremely flexible, had the same density and stress-strain curve shape as the fiberglass/epoxy only samples, but behaved like a fiber metal laminate when impacted. Though not as strong when compared to GLARE 5, this material can be used advantageously to create complex shapes and is more cost effective to manufacture
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