Search

Background: Medical education, residency training, and the structure of child neurology residency training programs are evolving. We sought to evaluate how training program selection priorities of child neurology residency applicants have changed over time., Methods: An electronic survey was sent to child neurology residents and practicing child neurologists via the Professors of Child Neurology distribution list in the summer of 2018. It was requested that the survey be disseminated to current trainees and alumni of the programs. The survey consisted of seven questions assessing basic demographics and a list of factors applicants consider when choosing a residency., Results: There were 284 responses with a higher representation of individuals matriculating into residency in the last decade. More recent medical school graduates had a lower probability of considering curriculum as an important factor for residency selection (odds ratio [OR], 0.746; 95% confidence interval [95% CI], 0.568 to 0.98; P = 0.035) and higher priority placed on interaction with current residents over the course of the interview day (OR, 2.207; 95% CI, 1.486 to 3.278; P < 0.0001), sense of resident happiness and well-being (OR, 2.176; 95% CI, 1.494 to 3.169; P < 0.0001), and perception of city or geography of the residency program (OR, 1.710; 95% CI, 1.272 to 2.298; P < 0.001)., Conclusions: Over time, child neurology residency applicants are putting more emphasis on quality of life factors over curriculum. To accommodate these changes, child neurology residency programs should prioritize interactions with residents during the interview process and resident wellness initiatives throughout residency training., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Sutures are essential to approximate tissues and enable healing by first intention until a wound regains its original tensile strength. The mechanical properties of sutures are well documented, but the effects of exposing sutures to skin preparation solutions used in surgery are not. This study was performed to investigate whether 2% chlorhexidine and 70% isopropyl alcohol skin preparation, commonly used prior to incision and prior to closure, has any effect on the mechanical properties of several commonly used surgical suture types. Four suture types were soaked in either 2% chlorhexidine and 70% isopropyl alcohol or Hartmann's solution for 5 minutes. All sutures were left to dry for 11 days before being tested to failure using an Instron 3367 tensile testing machine. Testing revealed significant differences in failure load, ultimate tensile stress, and Young's modulus between suture types (P < .05). No significant differences in failure load (P = .98), ultimate tensile stress (P = .21), or Young's modulus (P = .22) were observed between the test group and the control group when comparing sutures of the same type. This study demonstrates that chlorhexidine/isopropyl skin preparation solutions do not significantly change the mechanical properties of suture materials exposed to them., (© 2020 Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.)

This paper presents the development of a tool that allows an organisation to assess its level of human factors (HF) and ergonomics integration and maturity within the organisation. The Human Factors Integration Toolset (available at: https://www.researchgate.net/project/Human-Factors-Integration-Toolset ) has been developed and validated through a series of workshops with 45 participants from industry and academia and through industry partnered field-testing. HF maturity is assessed across five levels in 16 organisational functions based on any of 31 discrete elements contributing to HF. Summing element scores in a function determines a percent of ideal HF for the function. Industry stakeholders engaged in field-testing found the tool helped to establish the status of HF in the organisation, plan projects to further develop HF capabilities, and initiate discussions on HF for performance and well-being. Improvement suggestions included adding an IT function, refining the language for non-HF specialists, including knowledge work and creating a digital version to improve usability. Practitioner summary: A tool scoring HF capability in 16 organisation functions has been developed collaboratively. Industry stakeholders expressed a need for the tool and provided validation of tool design decisions. Field-testing improved tool usability and showed that beyond scoring HF capability, the tool created opportunities for discussions of HF-related improvement possibilities. Abbreviations: HF: human factors; HFIT: Human Factors Integration Toolset.

Research has suggested that products manufactured under healthy work conditions (HWC) may provide a marketing advantage to companies. This paper explores young consumers' considerations of HWC in purchasing decisions using data from qualitative interviews with a sample of 21 university students. The results suggest that interviewees frequently considered the working conditions of those who produced the products they purchased. Participants reported a willingness to pay 17.5% more on a $100 product if it were produced under HWC compared to not. Their ability and willingness to act on this issue was, however, hampered by  a lack of credible information about working conditions in production, the limited availability of HWC goods and a presumed higher price of HWC goods. While caution should be applied when generalising from this targetable market segment to a general population, these results provide actionable direction for companies interested in using a HWC brand image to gain a strategic sales advantage. Practitioner Summary: This interview study shows that young consumers are interested in, and willing to pay a premium for, goods made under healthy working conditions (HWC). Reported barriers to acting on this impulse include a lack of credible information on working conditions. Ergonomics can help provide a strategic marketing advantage for companies.

Objectives: Using the continuous loop averaging deconvolution (CLAD) technique for conventional electrocochleography (ECochG) and auditory brainstem response (ABR) recordings, the effects of testing at high stimulus rates may have the potential to diagnose disorders of the inner ear and auditory nerve. First, a body of normative data using the CLAD technique must be established., Design: Extratympanic click ECochG and ABR to seven stimulus rates using CLAD were measured simultaneously from a tympanic membrane electrode and surface electrodes on the forehead and mastoid of 42 healthy individuals., Results: Results showed that the compound action potential (AP) of the ECochG and waves I, III, and V of the ABR decreased in amplitude and increased in latency as stimulus rate was increased from standard 7.1 clicks/s up to 507.81 clicks/s, with sharp reduction in AP amplitude at 97.66 clicks/s and reaching asymptote at 292.97 clicks/s. The summating potential (SP) of the ECochG, however, stayed relatively stable, resulting in increased SP/AP ratios with increasing rate. The SP/AP amplitude ratio showed more stability than AP amplitude findings, thus it is recommended for use in evaluation of cochlear and neural response., Conclusions: Results of both amplitude and latency data from this normative neural adaptation function of the auditory pathway serves as guide for improving diagnostic utility of both ECochG and ABR using CLAD as a reliable technique in distinguishing inner ear and auditory nerve disorders.

Identifying "druggable" targets and their corresponding therapeutic agents are two fundamental challenges in drug discovery research. The one-bead-one-compound (OBOC) combinatorial library method has been developed to discover peptides or small molecules that bind to a specific target protein or elicit a specific cellular response. The phage display cDNA expression proteome library method has been employed to identify target proteins that interact with specific compounds. Here, we combined these two high-throughput approaches, efficiently interrogated approximately 10(13) possible molecular interactions, and identified 91 small molecule compound beads that interacted strongly with the phage library. Of 19 compounds resynthesized, 4 were cytotoxic against cancer cells; one of these compounds was found to interact with EIF5B and inhibit protein translation. As more binding pairs are confirmed and evaluated, the "library-against-library" screening approach and the resulting small molecule-protein domain interaction database may serve as a valuable tool for basic research and drug development.

A unimorph flexural transducer design is proposed and tested with regard to mode shapes and frequencies. The transducers consist of a passive metal cap structure, and a thin piezoelectric disc, rigidly bonded to the inside. Extensive finite element (FE) modelling, and experimental 2D, time-resolved displacement measurements were done to characterise the transducers flexural properties, and to compare them to the analytical solutions of thin vibrating plates. Emphasis was put on characterising the passive layer of the unimorph structure, before bonding the piezoelectric element, to understand how the active element affects the behaviour of the flexing plate. A high power Nd:YAG laser was used to actuate the metal plate (non-contact), and the frequency content of the resulting displacement signal was analysed to identify the flexural modes. The non-axisymmetric modes, which are conventionally disregarded because of their unfavourable acoustic properties, were also taken into account. There was excellent agreement between the experimental results and the FE simulation data. There was good agreement with the analytical edge clamped plate model, but with some notable deviations, which have not previously been identified or commented upon. Specifically, the second axisymmetric mode is split into three separate modes, which is not explained by the traditional theory of vibrating plates., (Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.)

Background: This randomized controlled trial compared a standard patient controlled analgesic (PCA) regime with a transdermal and oral Fentanyl regime for post-operative pain management in patients undergoing total knee replacement., Methods: One hundred and ninety-six patients undergoing total knee replacement were recruited. Pre- and post-operatively Visual Analogue Score (VAS), Oxford Knee Score, Health Anxiety and Depression Score and Brief Pain Inventory Score were completed. According to the day 1, VAS score patients were randomly allocated to either a PCA regime or a Fentanyl transdermal/oral regime. Patient reported outcomes were measured until the patients were discharged., Results: The results demonstrate that in terms of analgesic effect, day of discharge and side effect profile the two regimes are comparable., Conclusions: We conclude that a Fentanyl transdermal regime provides adequate analgesic effect comparable to a standard PCA regime in conjunction with a low side effect profile. Using a transdermal analgesic system provides efficient continuous delivery enabling a smooth transition from hospital to home within the first week. Transdermal Fentanyl provides an alternative analgesic regime that can provide an equivalent analgesic effect so as to enable a satisfactory outcome for the patient in terms of function and pain., Level of Evidence: II.

This article develops and explores the 'Ergo-Brand' proposition, which posits that consumers may prefer to buy goods that are made under good working conditions (GWCs). This preference would enhance a differentiation strategy for companies, thereby fostering the application of ergonomics in production. This proposition is developed in the context of a narrative review of the literature on 'ethical consumerism'. This is supplemented with a survey study, conducted in both Canada and Sweden (n = 141) to explore this proposition. Results indicate that consumers would prefer goods made under GWCs, but not unconditionally as quality and price concerns were ranked higher. Access to information on the working conditions in production was seen as a barrier. Nevertheless, the Ergo-Brand concept may be a viable avenue in promoting attention towards ergonomics in companies - particularly if consumer habits are subject to intervention by advertising. Further research on this strategy is warranted.

Few evaluation tools are available to assess knowledge-transfer and exchange interventions. The objective of this paper is to develop and demonstrate a theory-based knowledge-transfer and exchange method of evaluation (KEME) that synthesizes 3 theoretical frameworks: the promoting action on research implementation of health services (PARiHS) model, the transtheoretical model of change, and a model of knowledge use. It proposes a new term, keme, to mean a unit of evidence-based transferable knowledge. The usefulness of the evaluation method is demonstrated with 4 occupational health and safety knowledge transfer and exchange (KTE) implementation case studies that are based upon the analysis of over 50 pre-existing interviews. The usefulness of the evaluation model has enabled us to better understand stakeholder feedback, frame our interpretation, and perform a more comprehensive evaluation of the knowledge use outcomes of our KTE efforts.

This paper presents the case for the need for 'Action Research' (AR) approaches to gain understanding of how ergonomics considerations can best be integrated into the design of new work systems. The AR researchers work collaboratively with other stakeholders to solve a real-world problem: gaining insight into the problem and factors influencing solution building from an embedded position in the development process. This experience is interpreted in terms of available theory and can support further theory development. This non-experimental approach can help provide practical new approaches for integrating ergonomics considerations into real work system design processes. The AR approach suffers from a lack of acceptance by conventionally trained scientists. This paper aims to help overcome this weakness by developing the underlying theory and rationale for using AR approaches in ergonomics research. We propose further development of hybrid approaches which incorporate other evaluation techniques to extend the knowledge gains from AR projects., Practitioner Summary: Researchers should engage directly with organisations in ergonomics projects so that they can better understand the challenges and needs of practitioners who are trying to apply available scientific knowledge in their own unique context. Such 'Action Research' could help develop theory and approaches useful to improve mobilisation and application of ergonomics knowledge in organisations.

This article provides an analysis of the evolution of the division of labour in participatory ergonomics (PE) programmes in two worksites. The analysis is based on interviews and field observations in the worksites. In both settings there was meaningful participation by both worker and management members of ergonomic change teams (ECTs) in the hazard assessment and solution identification stages, but as the teams moved to the implementation stage, worker representatives were marginalised and the participatory nature of the programmes was severely curtailed. The removal of workers from the process was the outcome of the interplay among the type of activities pursued in the implementation stage, the skills and knowledge required to carry out those activities, and workers' limited influence in the organisational hierarchies. Findings highlight the salience of the social context in which participatory programmes are located and the importance of examining participatory programmes as they evolve over time. STATEMENT OF RELEVANCE: This article contributes to a growing literature on the process and implementation of PE programmes. The article's focus on social and organisational factors that affect the division of labour and attention to the evolution of involvement over time extend current understandings of participation in ergonomics programmes.

Chorismate-utilizing enzymes are attractive antimicrobial drug targets due to their absence in humans and their central role in bacterial survival and virulence. The structural and mechanistic homology of a group of these inspired the goal of discovering inhibitors that target multiple enzymes. Previously, we discovered seven inhibitors of 4-amino-4-deoxychorismate synthase (ADCS) in an on-bead, fluorescent-based screen of a 2304-member one-bead-one-compound combinatorial library. The inhibitors comprise PAYLOAD and COMBI stages, which interact with active site and surface residues, respectively, and are linked by a SPACER stage. These seven compounds, and six derivatives thereof, also inhibit two other enzymes in this family, isochorismate synthase (IS) and anthranilate synthase (AS). The best binding compound inhibits ADCS, IS, and AS with K(i) values of 720, 56, and 80 microM, respectively. Inhibitors with varying SPACER lengths show the original choice of lysine to be optimal. Lastly, inhibition data confirm the PAYLOAD stage directs the inhibitors to the ADCS active site.

We report a fatal pulmonary fat embolism syndrome arising consequent to an above knee amputation in a child. Pre-existing poor respiratory reserves, as a result of severe scoliosis, may have contributed to the fatal outcome.

Between January 2003 and December 2004, 13 patients underwent bilateral resurfacing arthroplasty via a Ganz trochanteric osteotomy. This bilateral group was mobilised fully weight-bearing with crutches. During the same period 139 Ganz trochanteric osteotomies were performed for unilateral hip resurfacing. These patients were mobilised with crutches, weight-bearing up to 10 kg on the operated leg. Nine osteotomies (32%) in the bilateral group subsequently developed a symptomatic non-union requiring revision of fixation. This compares with 10 patients (7%) in the unilateral group. Applying the Fisher's exact test, the difference reached significance (P=0.0004). In two patients a second revision was required to achieve union. In one patient, revision of trochanteric fixation precipitated a deep infection. Protected weight-bearing following a Ganz trochanteric osteotomy is important to the success of the procedure. Simultaneous bilateral hip arthroplasty through a Ganz approach should be avoided. If it is undertaken, we recommend that patients should be non weight-bearing for 6 weeks following surgery. Non-union following a Ganz trochanteric osteotomy for arthroplasty carries a significant morbidity.

We report a 10% failure rate for aseptic loosening and overall revision rate of 15% at 5 years mean follow up in 190 patients using the Cormet 2000 Dual coat acetabular component. Between 2001 and 2004, the original Dual coat component was used in our region by 4 experienced arthroplasty surgeons. 142 were used with resurfacing heads. The average age was 54 and 99 were male. Revision for aseptic loosening was required in 20 cups (10%) at a mean interval of 23 months including five within 2 months. Persistent groin pain was seen in a further three patients who have declined further surgery. Failure of the backing of this implant to integrate reliably with bone has led to an unacceptably high early loosening rate of the original design which was phased out in 2003.

Evaluations of participative ergonomics (PE) interventions have reported mixed results, potentially due to both program and theory deficits. In a multiple case study of four worksites in different companies using a quasi-experimental approach, we examined process, implementation, and effects. The process evaluation was based upon fieldwork and interviews with approximately 90 persons. Implemented changes were documented by PE teams and intensity judged by the research team. The effect evaluation was performed using questionnaire-based measures (physical effort, influence, pain and potential confounders) among cohorts present both before and after the changes (N=258). Ergonomic change teams (ECTs) faced challenges securing employees' time, varying management commitment and significant production pressures. Nevertheless they actively introduced between 10 and 21 changes over 10-20 months of activity. Limited intensity of exposure reduction was observed, resulting in no discernible effects on physical effort or pain among the employees. Potential reasons that may account for limited effects and lessons for workplace parties, practitioners, and intervention researchers are discussed.

An efficient, multigram synthesis of a spiroisoxazolinoproline-based amino acid, 7, requiring minimal purification, delivering good cis:trans diastereoselectivity (approximately 1:4), and providing good yields is reported. Surface-bound studies of the reduction of an arylnitro group in the presence of an isoxazoline ring with tin(II) dichloride dihydrate were undertaken to confirm the stability of the isoxazoline ring. Full derivitization of this spiroisoxazolinoproline-based amino acid scaffold was performed during the synthesis of a sample library with high yields and high purity that validated the efficiency of the chemistry that was employed in resin-bound library synthesis. A 129,600 member one-bead-one-compound (OBOC) library based on the scaffold 7 was synthesized utilizing a dual amino acid encoding method and bifunctionalization of TentaGel resin.

Aldose reductase (AKR1B1; ALR2; E.C. 1.1.1.21) is an NADPH-dependent carbonyl reductase which has long been associated with complications resulting from the elevated blood glucose often found in diabetics. The development of effective inhibitors has been plagued by lack of specificity which has led to side effects in clinical trials. To address this problem, a library of bead-immobilized compounds was screened against fluorescently labeled aldose reductase in the presence of fluorescently labeled aldehyde reductase, a non-target enzyme, to identify compounds which were aldose reductase specific. Picked beads were decoded via novel bifunctional bead mass spec-based techniques and kinetic analysis of the ten inhibitors which were identified using this protocol yielded IC50 values in the micromolar range. Most importantly, all of these compounds showed a preference for aldose reductase with selectivities as high as approximately 7500-fold. The most potent of these exhibited uncompetitive inhibition versus the carbonyl-containing substrate D/L-glyceraldehyde with a Ki of 1.16 microM.

One-bead one-compound combinatorial chemistry together with a high-throughput screen based on fluorescently labeled enzyme allowed the identification of slow binding inhibitors of human serine racemase (hSR). A peptide library of topographically segregated encoded resin beads was synthesized, and several hSR-binding compounds were isolated, identified, and resynthesized for further kinetic study. Of these, several showed inhibitory effects with moderate potency (high micromolar K(I)s) toward hSR. A clear structural motif was identified consisting of 3-phenylpropionic acid and histidine moieties. Importantly, the inhibitors identified showed no structural similarities to the natural substrate, L-serine. Detailed kinetic analyses of the properties of selected inhibitors show that the screening protocol used here selectively identifies slow binding inhibitors. They provide a pharmacophore for the future isolation of more potent ligands that may prove useful in probing and understanding the biological role of hSR.

Conspecific sperm precedence takes place when females inseminated by both conspecific and heterospecific sperm preferentially produce conspecific rather than hybrid offspring. Although many studies have documented conspecific sperm precedence, most have only identified it between taxa that are already considered to be good species. Here, we test for sperm precedence between two Drosophila pseudoobscura subspecies and between two Drosophila melanogaster races to evaluate how early in evolutionary divergence sperm precedence evolves. We found evidence of weak conspecific sperm precedence between the Drosophila subspecies but none between the Drosophila races. These pairs of taxa are already separated by mating discrimination and/or hybrid sterility, so our observation suggests that conspecific sperm precedence does not always evolve before other barriers to gene exchange.

Purpose: The purpose of this study was to determine the outcome of endovascular aneurysm repair in a defined geographic region during the first 2 years after Food and Drug Administration approval of a new endovascular device., Method: Clinical results of all attempted endovascular aneurysm repairs from 1999 to 2001 with the AneuRx stent graft in the northern California/Nevada region were reviewed. All cases performed in 23 hospitals by 21 endovascular treatment teams were included on an intent-to-treat basis. Community physician training, proctoring, and assistance in case selection was provided by the manufacturer, with outcome monitored by external physician observers and clinical vascular specialists. Results in 22 community hospitals were compared with concurrent results in the regional university hospital training center and with results from the controlled, multicenter AneuRx clinical trial., Results: Endovascular aneurysm repair was attempted in 257 patients by 20 endovascular teams working in 22 community hospitals. The mean number of cases per team was 13 +/- 2 (range, 1 to 36). Patient age was 74.1 +/- 6.5 years (89% men and 11% women), and 29% of patients were not candidates for open surgical repair because of multiple medical comorbidities. Mean aneurysm diameter was 5.7 +/- 0.8 cm. The endoluminal stent graft was successfully deployed in 254 patients (98.8%). In two patients, iliac access could not be obtained, and in one case, the iliac limb was misdeployed and the patient underwent successful open surgical repair. The surgical conversion rate was two of 257 patients (0.8%). The 30-day mortality rate was 1.2%, with one patient dying of stroke, one of multisystem organ failure, and one of cerebral hemorrhage. No device-related deaths occurred. Secondary procedures were performed in 8% of patients. Primary graft patency rate was 98%, and secondary graft patency rate was 100%. Concurrent university training center experience with 100 patients with similar characteristics and aneurysm size was not statistically different (deployment success rate, 100%; 30-day mortality rate, 0%; surgical conversion rate, 0%; secondary procedure rate, 8%). No aneurysm ruptures and no late surgical conversions have been seen in either the community or university experience, with follow-up periods extending to 2 years., Conclusion: Early results of endovascular aneurysm repair introduced into community practice are favorable. Initial community experience, with clinical support from the manufacturer, does not appear to differ significantly from concurrent results in the university training center or from results reported from the multicenter controlled clinical trial with the same device.

Reoperation to remove an aortic graft was performed in 18 patients. The need for removal was infection in the majority. A changing flora was seen in aortic graft infection with gram-negative organisms predominating. Despite a standardized approach with total graft removal, aortic closure, and extraanatomic reconstruction, amputation and mortality rates remain unacceptably high. A new approach to this problem is needed, and further trials with autogenous reconstruction appear warranted.

Individuals with unstable hemoglobins may become more anemic during episodes of intercurrent viral or bacterial infections. Pathophysiologic mechanisms that are responsible for this phenomenon have not been elucidated. Recently we observed a patient with Hb Zürich [His E7(63)beta leads to Arg] whose anemia worsened during a febrile episode characterized by temperatures ranging between 40 degrees and 41 degrees C, splenomegaly, and the appearance of Heinz bodies in the circulating erythrocytes. There was no history of self-medication and no drugs were administered during hospitalization. To determine the effect of a 3 degrees to 4 degrees temperature elevation above the physiologic range on the rate and degree of Heinz body formation, normal (Hb A) and Hb Zürich bloods were incubated in vitro at 4 degrees C, 37 degrees C, and 41 degrees C for 3, 6, 12, and 24 hours and stained for two minutes at the end of each incubation period with rhodanile blue. No Heinz bodies appeared at 4 degrees C. The rate of Heinz body formation was significantly greater in Hb Zürich than normal blood, both at 37 degrees C and 41 degrees C. These observations suggest that in vivo exposure of red cells to temperatures in the biologic range of fever may contribute to the worsening of anemia that occurs during infections in individuals with unstable hemoglobins. Incubating whole blood at 41 degrees C for three hours and staining with rhodanile blue for two minutes appears to be a simple and effective screening test for Hb Zürich and possibly the other unstable hemoglobins. Also the technique is semi-quantitative and may be useful as a research tool for defining factors altering the in vivo stability of the unstable hemoglobins.

We used laboratory studies to examine the role of predation risk and cost of anti-predator behaviour in determining the behavioural response of several larval instars of Ischnura verticalis to a fish predator (Lepomis gibbosus). Smaller larvae were less susceptible to fish predation than larger larvae. Smaller larvae depressed movement to a greater degree in the presence of fish than did larger larvae; large larvae were generally less active than small larvae regardless of fish presence. Reduced feeding resulted in smaller larvae suffering more in terms of reduced growth than did large larvae. In general, our results tend to support the hypothesis that individuals that suffer high costs of anti-predator behaviour but little risk of predation may only exhibit anti-predator behaviours in the presence of predators, whereas individuals with a higher risk of predation and a lower cost of anti-predator behaviour may evolve anti-predator mechanisms that are in effect even in the absence of predators.

In 400 patients who underwent major aortography, acute renal dysfunction (ARD) occurred in 11.3%. Of the group with normal renal function before the procedure, 8.2% had ARD and 0.8% required dialysis. Patients with prior abnormal renal function had a 41.7% incidence of ARD, and 8.3% required dialysis as a result of angiography. Vigorous intravenous hydration was used in all patients but did not completely prevent renal problems. Two risk factors not previously emphasized were the injection site (higher risk with abdominal aortic studies) and presence of congestive heart failure requiring treatment with digoxin. Other notable risk factors included contrast load and age. These results emphasized that even with modern contrast agents and application of current concepts of treatment, there remains a risk of renal injury with major angiography.

The incidence of acute renal dysfunction (ARD) after major arteriography was evaluated by assessment of the change in serum creatinine in 364 patients undergoing arteriography. Major arteriography was defined as abdominal aortography, abdominal aortography with lower-extremity runoff, aortic arch studies, or aortic arch plus selective carotid angiography. The influence of the volume of contrast material received, hydration, and associated risk factors was evaluated. In the entire group, the frequency of postarteriographic ARD was 7.1%. Although most patients recovered, 1.4% required renal dialysis. The frequency of renal dysfunction was significantly higher in patients with preexisting renal disease (14.8%), and 3.7% of these patients went on to require dialysis. In the total group and in those with normal renal function prearteriographically, the frequency of ARD was found to be related to the volume of iodinated contrast material received. Hydration before, during, and after angiography did not prevent this complication. Several risk factors, namely preexisting renal disease, advanced age, volume of contrast material used, type of study performed, diabetes mellitus, and coexistent heart disease were found to be associated with a statistically significant increased risk of postangiographic ARD.