Acute Kidney Injury Aki Health And Social Care Essay

Acute Kidney Injury Aki Health And Social Care Essay The first description of ARF, then termed ischuria renalis, was by William Heberden in 1802.25 At the beginning of the twentieth century, ARF, then named Acute Brights disease, was well described in William Oslers Textbook for Medicine (1909), as a consequence of toxic agents, pregnancy, burns, trauma, or operations on the kidneys. During the First World War the syndrome was namedwar nephritis26, and was reported in several publications. The syndrome was forgotten until the Second World War, when Bywaters and Beall published their classical paper on crush syndrome.27 However, it is Homer W. Smith who is credited for the introduction of the term acute renal failure, in a chapter on Acute renal failure related to traumatic injuries in his textbook The kidney-structure and function in health and disease (1951). Unfortunately, a precise biochemical definition of ARF was never proposed and, until recently, there was no consensus on the diagnostic criteria or clinical definition of ARF, re sulting in multiple different definitions. DEFINITION AND CLASSIFICATION Acute kidney injury (AKI) is a protean syndrome of varied severity. It is characterized by a rapid (hours to weeks) decline in the glomerular filtration rate (GFR) and retention of nitrogenous waste products such as blood urea nitrogen (BUN) and creatinine.2,3 In recent years, it has been recognized that the time-honored term acute renal failure (ARF) fails to adequately describe what is a dynamic process extending across initiation, maintenance, and recovery phases, each of which may be of variable duration and severity. The term acute renal failure suggests that the syndrome is dichotomous and places an undue emphasis on whether or not renal function has overtly failed. This belies the now well-established fact that even mild decrements in glomerular filtration may be associated with adverse clinical outcomes.28-32 The alternative proposed term acute kidney injury has much to recommend it, perhaps better captures the diverse nature of this syndrome, and has entered into widespread clinical use. Historically, patients with AKI have been classified as being nonoliguric (urine output >400 mL/day), oliguric (urinary out-put 26.5 mmol/l) when they occur within a 48-hour period.24 Two recent studies examining large databases in the USA40 and Europe41 validated these modified criteria. Thakar et al. found that increased severity of AKI was associated with an increased risk of death independent of comorbidity.40 Diagnostic criteria for acute kidney injury24 An abrupt (within 48 hours) reduction in kidney function currently defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg/dl (≠¥ 26.4 ÃŽ ¼mol/l), a percentage increase in serum creatinine of more than or equal to 50% (1.5-fold from baseline), or a reduction in urine output (documented oliguria of less than 0.5 ml/kg per hour for more than six hours). A major challenge in the investigation and management of AKI is the timely recognition of the syndrome. It remains difficult to easily and reliably measure rapid changes in the GFR. Although the severity in decline in GFR correlates with the onset of oliguria, the latter is insensitive marker of the syndrome because many subjects with severe renal failure remain nonoliguric. In AKI, there is poor agreement between serum creatinine and GFR, at least until a serum creatinine steady state is reached, and even then, the absolute rise in serum creatinine must take into account differences in creatinine generation rates.42 As a result, definitions of AKI that are based on a fixed increment in serum creatinine would be expected to be biased toward making an early diagnosis in well-muscled as compared with malnourished subjects or in men as compared with women. Creatinine clearances, especially when measured over a short time frame such as 2 to 4 hours, has some utility but may substantially overestimate GFR at low levels of renal function owing to a relatively high proportion of tubular secretion. Even the use of markers such as iothalamate to estimate GFR may be less precise in the acute as compared with the chronic setting owing to alterations in their volume of distribution as well as issues relating to tubular obstruction and backleak. INCIDENCE Acute kidney injury is a common and important diagnostic and therapeutic challenge for clinicians.43The incidence of AKI is difficult to estimate because no registry of its occurrence exists and because up until recently there was no standardized definition. From a variety of predominantly single center studies it is estimated that 5% to 7% of hospitalized patients develop AKI.44-47 More detailed information is available regarding its development in the intensive care unit (ICU) environment, where approximately 25% to 30% of unselected patients develop some degree of AKI, although again estimates vary considerable depending on the definition used and the population casemix. Renal replacement therapy is typically required in 5% to 6% of the general ICU population or 8.8 to 13.4 cases per 100,000 population/year.30,43,48-53 AKI is also a major medical complication in the developing world, particularly in the setting of diarrheal illnesses, infectious diseases like malaria and leptospir osis, and natural disasters such as earthquakes. The incidence of AKI has grown by more than fourfold in the United States since 1988 and is estimated to have a yearly incidence of 500 per 100,000 population, higher than the yearly incidence of stroke. AKI is associated with a markedly increased risk of death in hospitalized individuals, particularly in those admitted to the ICU where in-hospital mortality rates may exceed 50%.44 AKI IN THE DEVELOPING WORLD The epidemiology of AKI differs tremendously between developed and developing countries, owing to differences in demographics, economics, geography, and comorbid disease burden. While certain features of AKI are common to both-particularly since urban centers of some developing countries increasingly resemble those in the developed world-many etiologies for AKI are region-specific such as envenomations from snakes, spiders, caterpillars, and bees; infectious causes such as malaria and leptospirosis; and crush injuries and resultant rhabdomyolysis from earthquakes.44Factors responsible for this higher incidence of AKI in the tropics include hot climate in conjunction with excessive sweating, increased predisposition to hypovolemic insults, poor nutritional status and increased susceptibility to infections.

Limbo, Nothings Changed, and Blessing Essay -- Poetry Tatamkhulu Afrik

Limbo, Nothings Changed, and Blessing â€Å"Write about the various ways in which the poets present their ideas and give the reader an insight into different cultures.† The three poems that will be studied are: Limbo by Edward Kamau Braithwaite Nothings changed by Tatamkhulu Afrika Blessing by Imtiaz Dharker The cultural location and inspiration (for the writers) of these poems is of great curiosity (to many readers) and also of high deviation, thus the way in which we are given an insight into the different cultures will be considered very carefully. Limbo Edward Kamau Braithwaite, the writer of Limbo is creating tension and anxiety, while at the same time expressing his view of slavery in the poem, he is trying to create the effect of a ship filled with evil and is trying to make the reader see that slavery is far from good but actually very, very cruel, he tells the story of afro Caribbean slavery in a rhyming & rhythmic dance. He has made it a very motivating and complex poem. I feel that there are two meanings or storylines to the poem the first and main narrative being a play being acted out on the ship showing the cruel and evil history of Afro Caribbean slavery, and the second being a more upbeat and blissful side to the poem which is portraying the actions of the limbo dance. The first three quarters of the poem deal with slavery and the limbo dance combined together while the last quarter of the poem is like the sun breaking and light coming out, it only deals with the happiness that there is around the limbo dance in much more detail and describes how their is light at the end of the tunnel for the slaves. The poem has a very strong beat, signifying the dance that is being po... ...heme that has been incorporated into the poem. Rhythm has not been used in the poem, it is very brief, and gives the effect of ordinary speech. We have a clear sense of Imtiaz Dharker’s culture; water is valued very highly, (as people’s lives depend on this supply). Personally I feel that In Britain we constantly take water for granted and should not and that the poet maybe trying to convey to us a very important message. The poem ends with a picture of the littlie children naked and screaming. The sense of their beauty is overshadowed by the idea of how weak, fragile and helpless they are. Overall I feel this poem is the best poem (of the three) to give the reader an insight into different cultures in a brief and logical way, however I feel that Tatamkhulu Afrika Who wrote â€Å"Nothings Changed† present his ideas in the most vivid and original way.

Guidelines For Assignment

Define Organizational Culture What Is meant by Organizational Culture? Characteristics of Organizational Culture ? Positive (good) and Negative (bad) Provide relevant examples Research can be done by referring to similar researches that were conducted previously. The sources of references can be obtained from books, Journals, magazines or newspapers. Related research materials such as graphs, charts or pictures can also be used to support a statement. Students are also encouraged to give their opinions and their own understanding of the research topic.Provide examples of outcomes from previous researches (done by another searcher) regarding topics that are similar or almost similar. – relationship between Organizational Culture and the success or failure of an organization. Gather the information needed from books, magazines, newspapers or Journals relevant to the topic being discussed. From the gathered information, identify how elements of Organizational Culture affect the s uccess or failure of an organization. Provide examples. 1 State the outcome of the research based on the gathered Information.Relate between the theories learned with the real situation. Is It true Organizational Culture Is a factor that determines the success and failure of an organization? Yes or No Provide a conclusion from the overall research and give your suggestions for the development of a better Organizational Culture to enhance the success of the organization. Format for preparing the assignment: Paper Use Ã'›white-bond† quality paper Paper size : AAA (210 mm x 297 mm) Paper weight : 80 MGM Method of typing The text should be typed on one side of the page only.For text : black-colored ribbon or ink cartridge that produces an even black color. For diagrams, tables and charts : black or colored ink. Line Spacing For text : double-spacing For references (refer vii), appendices and tables: single-spacing Font Times New Roman Size: 12 2 Margin Left margin : at least 4. 0 CM (1. 5†³) Top, bottom and right margin : 2. 5 CM (1. 0†³) Section New major sections must begin on a new page. A new paragraph must begin with a Ã'›tab† from the left margin. V) Page numbering Excerpts, references, appendices and tables a) In the text.If an excerpt is taken from a reference material, the reference must be stated. Ex : Stoner and Yankee define strategy as, â€Å"†¦ The broad program for defining and achieving an organization†s objectives; the organization†s response to its environment over time. † (Stoner and Yankee, 1986) b) List of References At the end of the assignments, all references or bibliography must be stated in alphabetical order according to the name of the author. Book:Name of author.

Choosing The Risk By The Business Visionaries - 1749 Words

Abstract: The risk implies the likelihood of presence of one circumstance in which the acquired results are a long way from the focused on targets. Accepting the risk by the business visionaries turns into the wellspring of benefit with in the economy; this is the motivation behind why its investigation is an earlier target in substantiating choices related on the project proficiency. In this paper there are exhibited a few classifications of risks that can show up inside the speculation movement and is exemplified the risk investigation on the base of examining the tasks affectability Introduction Choice examination embodies the reasoning, hypothesis, system, and expert practice important to formally and methodically address imperative choice that must be made under state of vulnerability. This order incorporates numerous technique, strategy, and apparatuses for recognizing, unmistakably speaking to, and formally surveying the imperative goals and properties of a choice circumstance, and for prescribing choices in light of the most extreme expected utility activity adage. At last, choice investigation brings about interpreting the formal representation of a choice and its comparing suggestion into sight for the leader and different stakeholders. Hazard investigation is the methodical investigation of instabilities and potential mischief that may be experienced in such ranges as nature, business, building, and open approach. 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