Peritoneal dialysis (PD) technique training: what features influence learning time?

BACKGROUND: Within peritoneal dialysis (PD) complications, peritonitis remains a primary challenge for the long-term success of the technique. Proper technique training is essential, since it reduces peritonitis rates, but the adequacy of training has not been standardized. Furthermore, factors influencing training duration have not been well identified. METHODS: We retrospectively analyzed all consecutive training sessions of incident PD patients in our Unit from January 2001 to December 2018. RESULTS: Our analysis included 135 patients, 25.9% were diabetic and median Charlson index (CCI) was 4 (IQR 2-6). Above 13 sessions was chosen as the cut off between usual and prolonged training, as it was our cohort's 75th percentile: 23% (31) had an extended training duration as per our study definition and 77% (104) had a usual training duration. The number of training sessions required increased with age (Spearman Rho 0.404; p = 0.000001), diabetic status (p = 0.001), unemployment status (p = 0.046) and CCI (Spearman Rho 0.369; p = 0.00001). Neither gender, cohabitation status, scheduled PD start, education level nor referral origin, were significant factors impacting training duration. Requiring longer training (> 13 sessions) was a significant risk factor for higher peritonitis risk, but extended training was not related to a shorter technique survival. CONCLUSION: Number of PD training sessions depends on the patient's age and comorbidities, but is not related to social, educational or employment status. Prolonged training duration was a statistically significant predictor of higher peritonitis risk, but it was not related to shorter permanence in PD in our series. Identifying these patients since the training period would be useful to adapt training schedule as an early prevention strategy to minimize the risk of peritonitis and plan a preemptive retraining.

Recrystallisation behaviour of a fully austenitic Nb-stabilised stainless steel.

We have performed an in-depth characterisation of the microstructure evolution of 20Cr-25Ni Nb-stabilised austenitic stainless steel during 1 h isochronal annealing up to 1100°C using scanning electron microscopy. This steel grade is used as cladding material in Advanced Gas-cooled fission reactors, due to its resistance to thermal creep and oxidation. The initial deformed microstructure undergoes recrystallisation via a strain-induced boundary migration mechanism, attaining a fully recrystallised microstructure at 850°C. A number of twins are observed in the vicinity of deformation bands prior to the start of recrystallisation. New Nb(C, N) particles form gradually in the microstructure, and the particle dispersion presents a maximum volume fraction of 2.7% at 930°C. At higher temperatures, the smaller particles become unstable and gradually dissolve in the matrix. Consequently, the Zener pinning pressure exerted on the grain boundaries is progressively released, triggering the growth of the austenite grains up to an average size of ∼47 µm at 1100°C. The observed temperature window for recrystallisation and grain growth can be predicted by a unified model based primarily on the migration of high- and low-angle grain boundaries. LAY DESCRIPTION: Austenitic stainless steel containing high percentage of chromium and nickel is currently used as fuel cladding material in the British Advanced Gas-cooled Reactors (AGR). This material has been chosen because of its high resistance to thermal creep and corrosion, both enhanced by the presence of a fine dispersion of carbonitrides precipitated during the cladding thermomechanical processing. During the time spent in the reactor core, few fuel cladding elements can become susceptible to local chromium depletion at grain boundaries, which is ascribed to the time evolution of the microstructural damage caused by the neutron bombardment in the reactor core. This depletion might increase the susceptibility of this steel to intergranular corrosion attacks during medium-to-long term storage of spent fuel elements in water ponds. The severity of the local chromium depletion depends not only on the irradiation conditions, but also on the grain boundary geometry. We have investigated the recovery, recrystallisation and grain growth of AGR stainless steel during 1 h annealing at selected temperatures relevant for the thermomechanical processing of the steel claddings, focusing on the formation and evolution of grain boundaries and second phases. These two features play a key role in the progression of the neutron damage and the subsequent development of local chromium depletion during reactor service operations. A deep understanding of the mechanisms and conditions behind their formation during the thermomechanical processing of the cladding material and their interaction with each other constitutes the foundation to evaluate, and potentially mitigate, the effect of irradiation on the cladding material.

Characterisation of lattice damage formation in tantalum irradiated at variable temperatures.

The formation of radiation-induced dislocation loops and voids in tantalum at 180(2), 345(3) and 590(5)°C was assessed by 3MeV proton irradiation experiments and subsequent damage characterisation using transmission electron microscopy. Voids formed at 345(3)°C and were arranged into a body centred cubic lattice at a damage level of 0.55 dpa. The low vacancy mobility at 180(2)°C impedes enough vacancy clustering and therefore the formation of voids visible by TEM. At 590(5)°C the Burgers vector of the interstitial-type dislocation loops is a<100>, instead of the a/2 <111> Burgers vector characteristic of the loops at 180(2) and 345(3)°C. The lower mobility of a<100> loops hinders the formation of voids at 590(5)°C up to a damage level of 0.55 dpa.

Dataset concerning the analytical approximation of the Ae3 temperature.

In this paper we present a new polynomial function for calculating the local phase transformation temperature (Ae3 ) between the austenite+ferrite and the fully austenitic phase fields during heating and cooling of steel:[Formula: see text] The dataset includes the terms of the function and the values for the polynomial coefficients for major alloying elements in steel. A short description of the approximation method used to derive and validate the coefficients has also been included. For discussion and application of this model, please refer to the full length article entitled "The role of aluminium in chemical and phase segregation in a TRIP-assisted dual phase steel" 10.1016/j.actamat.2016.05.046 (Ennis et al., 2016) [1].

[Burnout syndrome in different intensive care units]. / Síndrome de burnout en distintas Unidades de Cuidados Intensivos.

OBJECTIVES: To determine the prevalence of the professional burnout syndrome in health care personnel of different Intensive Care Units (ICUs). To know the association between burnout, its dimensions and sociodemographic-laboral variables. To compare the dimensions of burnout, characteristics of the personnel and of the patients of the different ICUs. MATERIAL AND METHODS: Analytic, comparative, cross-sectional study performed in the ICU of a tertiary hospital in November 2006 performed in a sample of 289 professionals. The Maslach Burnout Inventory questionnaire and sociodemographic-laboral variables were provided. The following were evaluated in the ICUs: Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortality, stay, isolations and travel of third parties. The chi2 test, Fischer test, Kruskall-Wallis test and multivariate logistic regression analysis were used. RESULTS: A total of 73% of the workers answered. Ages ranged from 37 +/- 9 and 81% were women. The prevalence of burnout was 14%, this affecting 16% of the nurses, 14% of residents, 13% physicians and 10% auxiliary workers. Burnout was associated to low professional satisfactions, relationship with regular colleagues, low work recognition and time worked and experience in the ICU to high emotional tiredness, with a p < 0.05. In a polyvalent ICU, higher values of the following were obtained: TISS 42 +/- 11, NEMS 35 +/- 10, mortality 18%, stay 5 +/- 9, isolation 21%, burnout syndrome 17%, elevated emotional tiredness 49%, elevated depersonalization 63% and low professional performance 44%. CONCLUSIONS: The prevalence of the burnout syndrome in our sample was 14%, those being affected most being the nursing professionals. We detected elevated levels of depersonalization and middle levels of emotional tiredness and professional performance. The variables related with professional burnout syndrome were low professional satisfaction, relationship with regular colleagues, low work recognition, and elevated emotional tiredness in the more expert personnel. The ICU with the greatest prevalence of burnout during the month studied attended patients with greater TISS, NEMS, mortality, stay and isolations.

Síndrome de burnout en distintas Unidades de Cuidados Intensivos / Burnout syndrome in different Intensive Care Units

Objetivos. Determinar la prevalencia del síndrome de desgaste profesional (burnout) enel personal sanitario de distintas Unidades de Cuidados Intensivos (UCI).Conocer la asociaciónentre el burnout, sus dimensiones y variables sociodemográficas-laborales. Comparardimensiones del burnout, características del personal y de los pacientes de distintas UCI.Material y métodos. Estudio analítico comparativo transversal, realizado en UCI de un hospitalterciario, en noviembre de 2006. La muestra fue 289 profesionales. Se entregó el cuestionarioMaslach Burnout Inventory y variables sociodemográficas-laborales. Se valoró en UCI:Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower UseScore (NEMS), mortalidad, estancia, aislamientos y desplazamientos terciarios. Se empleó laprueba de la χ2, Fischer, Kruskall-Wallis y análisis multivariable de regresión logística.Resultados. Contestaron el 73% de los trabajadores, edad 37 ± 9 y un 81% eran mujeres.Prevalencia de burnout 14%, afectados el 16% de enfermeros, 14% de residentes, 13% demédicos y 10% de auxiliares. El burnout se asoció a satisfacción profesional baja, relacióncon compañeros regular, reconocimiento laboral bajo, y tiempo trabajado y experienciaen UCI a un cansancio emocional elevado, con una p < 0,05. En la UCI Polivalente se obtuvieronvalores más elevados de: TISS 42 ± 11, NEMS 35 ± 10, mortalidad 18%, estancia5 ± 9, aislamientos 21%, síndrome burnout 17%, cansancio emocional elevado 49%, despersonalizaciónelevada 63% y realización profesional baja 44%.Conclusiones. La prevalencia del síndrome de burnout en nuestra muestra fue del 14%,siendo los profesionales de enfermería los más afectados. Detectamos niveles elevadosde despersonalización y niveles medios de cansancio emocional y de realización profesional.Las variables relacionadas con el (..) (AU)

Objectives. To determine the prevalence of the professional burnout syndrome inhealth care personnel of different Intensive Care Units (ICUs). To know the associationbetween burnout, its dimensions and sociodemographic-laboral variables. To comparethe dimensions of burnout, characteristics of the personnel and of the patients of thedifferent ICUs.Material and methods. Analytic, comparative, cross-sectional study performed in the ICUof a tertiary hospital in November 2006 performed in a sample of 289 professionals. TheMaslach Burnout Inventory questionnaire and sociodemographic-laboral variables wereprovided. The following were evaluated in the ICUs: Therapeutic Intervention ScoringSystem (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortality, stay,isolations and travel of third parties. The χ2 test, Fischer test, Kruskall-Wallis test andmultivariate logistic regression analysis were used.Results. A total of 73% of the workers answered. Ages ranged from 37 ± 9 and 81% werewomen. The prevalence of burnout was 14%, this affecting 16% of the nurses, 14% ofresidents, 13% physicians and 10% auxiliary workers. Burnout was associated to lowprofessional satisfactions, relationship with regular colleagues, low work recognition andtime worked and experience in the ICU to high emotional tiredness, with a p < 0.05. In apolyvalent ICU, higher values of the following were obtained: TISS 42 ± 11, NEMS 35 ± 10,mortality 18%, stay 5 ± 9, isolation 21%, burnout syndrome 17%, elevated emotionaltiredness 49%, elevated depersonalization 63% and low professional performance 44%.Conclusions. The prevalence of the burnout syndrome in our sample was 14%, those beingaffected most being the nursing professionals. We detected elevated levels ofdepersonalization and middle levels of emotional tiredness and professional performance. (..) (AU)