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In patients receiving continuous renal replacement therapy (CRRT) for acute kidney injury (AKI), excessive net ultrafiltration (NUF) rates >1.75 mL/kg/h have been associated with increased mortality, delayed AKI recovery and complications of hemodynamic instability. There is limited information on fluid removal practices and NUF rates in AKI patients treated with intermittent hemodialysis (IHD). We conducted a retrospective study of AKI patients who underwent IHD at our center between 2020 and 2023. The primary outcome was NUF rate, assessed as body weight-scaled, body surfaces area-scaled and unadjusted values. Secondary outcomes included mortality and measures of renal recovery at 90 days (estimated glomerular filtration rate [eGFR], major adverse kidney events [MAKE], IHD dependence and days to liberation from IHD). We studied 74 patients (median age 62 years [IQR 46-71], median baseline eGFR 81 mL/min/1.73 m [IQR 71-96]). The median NUF rate was 5.61 mL/kg/h (weight scaled), 228 mL/h/m (BSA-scaled), and 462 mL/h (unadjusted). Higher fluid removal rates were observed in patients with better baseline kidney function, while older age, diabetes and hypertension were associated with lower rates. No significant differences in AKI recovery, dialysis dependence, or change in renal function at 90 days were observed between high and low NUF groups. By 90 days, 45 patients (60.8%) had developed a MAKE. Among AKI patients, median NUF rates during IHD was higher than reported for CRRT and influenced by comorbidity and pre-morbid eGFR. At 90 days, MAKE was common, two thirds of patients had  > 25% eGFR reduction, and one in 12 had died.

BackgroundThe teaching of human head, neck and orbital anatomy forms a critical part of undergraduate and postgraduate medical and allied health professional training, including optometry. While still largely grounded in cadaveric dissection, this method of instruction is constrained in some countries and regional areas by access to real human cadavers, costs of cadaver bequest programmes, health and safety of students and staff and the shortage of adequate time in modern curricula. Many candidates choosing a postgraduate pathway in ophthalmological training, such as those accepted into the Royal Colleges of Ophthalmology in the UK, Australia and New Zealand programmes and the American Academy of Ophthalmologists in the USA, are compelled as adult learners to revise or revisit human orbital anatomy, ocular anatomy and select areas of head and neck anatomy. These candidates are often then faced with the issue of accessing facilities with dissected human cadaveric material.MethodsIn light of these difficulties, we developed a novel means of creating high-resolution reproductions of prosected human cadaver orbits suitable for education and training.Results3D printed copies of cadaveric orbital dissections (superior, lateral and medial views) showing a range of anatomical features were created.DiscussionThese 3D prints offer many advantages over plastinated specimens as they are suitable for rapid reproduction and as they are not human tissue they avoid cultural and ethical issues associated with viewing cadaver specimens. In addition, they are suitable for use in the office, home, laboratory or clinical setting in any part of the world for patient and doctor education.

Background Metabolic acidosis is a major complication of critical illness. However, its current epidemiology and its treatment with sodium bicarbonate given to correct metabolic acidosis in the ICU are poorly understood. Method This was an international retrospective observational study in 18 ICUs in Australia, Japan, and Taiwan. Adult patients were consecutively screened, and those with early metabolic acidosis (pH < 7.3 and a Base Excess < –4 mEq/L, within 24-h of ICU admission) were included. Screening continued until 10 patients who received and 10 patients who did not receive sodium bicarbonate in the first 24 h (early bicarbonate therapy) were included at each site. The primary outcome was ICU mortality, and the association between sodium bicarbonate and the clinical outcomes were assessed using regression analysis with generalized linear mixed model. Results We screened 9437 patients. Of these, 1292 had early metabolic acidosis (14.0%). Early sodium bicarbonate was given to 18.0% (233/1292) of these patients. Dosing, physiological, and clinical outcome data were assessed in 360 patients. The median dose of sodium bicarbonate in the first 24 h was 110 mmol, which was not correlated with bodyweight or the severity of metabolic acidosis. Patients who received early sodium bicarbonate had higher APACHE III scores, lower pH, lower base excess, lower PaCO 2 , and a higher lactate and received higher doses of vasopressors. After adjusting for confounders, the early administration of sodium bicarbonate was associated with an adjusted odds ratio (aOR) of 0.85 (95% CI, 0.44 to 1.62) for ICU mortality. In patients with vasopressor dependency, early sodium bicarbonate was associated with higher mean arterial pressure at 6 h and an aOR of 0.52 (95% CI, 0.22 to 1.19) for ICU mortality. Conclusions Early metabolic acidosis is common in critically ill patients. Early sodium bicarbonate is administered by clinicians to more severely ill patients but without correction for weight or acidosis severity. Bicarbonate therapy in acidotic vasopressor-dependent patients may be beneficial and warrants further investigation.

Lauren Vanderlinden went on to say her office recently produced a report concerning EMF that was sent to the Toronto Board of Health, and accepted by Toronto city council, that urges a precautionary approach be taken in regards to power lines and their placement. As the body responsible for our wellness here in South Delta, why has the Fraser Health Authority not impressed on B.C.'s energy minister, BCTC and Delta council that we do not have clear answers on this \"complex science,\" as Vanderlinden describes it, regarding the implications of EMF exposure on children.

While cause and effect can be difficult to establish, I can't believe decision makers wouldn't crave this kind of framework when reasonable suspicion is raised.

Early in 2002, Delta Hospital was on the verge of becoming a mere shell of what it had been. Slowly but surely, the SDHS has fought to change the direction of the Fraser Health Authority to the benefit of Delta residents. The board of directors and volunteers of the SDHS are honourable, hard working and caring people. While hospital news has given way to stories about beach access and greenhouse issues, SDHS volunteers continue to fight on our behalf, sometimes at the expense of their personal lives.

For fun, take a highlighter and go through the articles and count how many times you'll see the names of Lois Jackson, Guy Gentner, Robert Campbell, TriDelta and even George Harvie repeated. You'll be surprised. The newspaper in front of you will suddenly morph into campaign material! Lucky TriDelta; there will be little need for them to spend much money on advertising.

Often the first step is decluttering, and too often, vendors don't see it. That's where help is valuable because a fresh pair of eyes can detect the trouble spots. It's important to remember, you're not selling your stuff, you are selling your home. Clutter won't sell your home, spaciousness will. 1. Clean out closets. Storage is a big consideration for buyers, so unload half of the contents. They'll look larger. 2. A home should smell good, no pet or stale cooking smells, and no cigarette smoke. People do become accustomed to smells, so get someone else's opinion. Don't try to mask the odours with air fresheners or scented candles, get to the source of the problem. Clean carpets, replace them if necessary, scrub the house and clean air vents.

Clearing clutter, creating space and developing organizing tactics may just seem like the latest fad, but behind what you see on TV can be lives in chaos. Disorganization has many faces, ranging from mildly disorganized to severely disorganized to chronically disorganized. Depending on your ability to cope, being mildly disorganized could send you over the top; others who are severely or chronically disorganized live day to day not knowing if they're surrounded by normal clutter or creating health and safety concerns for themselves and family.