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List of disability-related terms with negative connotations

The following is a list of terms, used to describe disabilities or people with disabilities, which may carry negative connotations or be offensive to people with or without disabilities.

Some people consider it best to use person-first language, for example "a person with a disability" rather than "a disabled person." However identity-first language, as in "autistic person" or "deaf person", is preferred by many people and organizations.

Language can influence individuals' perception of disabled people and disability. Views vary with geography and culture, over time, and among individuals. Many terms that some people view as harmful are not viewed as hurtful by others, and even where some people are hurt by certain terms, others may be hurt by the replacement of such terms with what they consider to be euphemisms (e.g., "differently abled" or "special needs"). Some people believe that terms should be avoided if they might hurt people; others hold the listener responsible for misinterpreting terms used without harmful intent. For example, crazy should be avoided in describing persons or their behaviors, but is less likely to cause offense if used as an intensifier as in "crazy speed".

For some terms, the grammar structure of their use determine if they are harmful. The person-first stance advocates for saying "people with disabilities" instead of "the disabled" or "a person who is deaf" instead of "a deaf person". However, some advocate against this, saying it reflects a medical model of disability whereas "disabled person" is more appropriate and reflects the social model of disability. On the other hand, there is also a grammar structure called identity-first language that construes disability as a function of social and political experiences occurring within a world designed largely for nondisabled people.

A

 * A few sandwiches short of a picnic (which has numerous derivatives with no known original, e.g. "a few books short of a library"), a term meant to imply that a person has reduced or limited mental faculties
 * Able-bodied, there is an implied value judgement comparing a person with a disability versus one without
 * Abnormal
 * Addict
 * Afflicted
 * Attention-seeking, commonly used to label someone who is suffering emotionally
 * Autism or autistic, when used as an insult

B

 * Batty
 * Birth defect
 * Blind, especially when used metaphorically (e.g., "blind to criticism") or preceded by "the", although "the blind" is considered acceptable by many blind people and organizations such as the National Federation of the Blind.
 * Bonkers
 * Brain damaged

C

 * Challenged
 * Crazy
 * Crazy cat lady, derogatory term typically aimed at mentally ill and neurotic women, particularly single women, spinsters who hoard cats.
 * Cretin
 * Cripple used to mean "a person with a physical or mobility impairment". Its shortened form, "crip" has been reclaimed by some people with disabilities as a positive identity.
 * Confined to a wheelchair implies helplessness, and that someone is to be pitied.

D

 * Daft, consider nonsensical or feckless
 * "Deaf and dumb" or "deaf-mute"   or "deaf to"
 * Defect, defective
 * Deformed
 * Delusional
 * Demented, use "person with dementia"
 * Deranged or mentally deranged
 * Derp is considered by some sites to refer to those with intellectual disabilities.
 * Differently abled
 * Dim or dim-witted
 * DALYs/DFLYs/QALYs: Disability or Quality Adjusted (or Free) Life Years suggests that a nondisabled person's life years are worth more than a disabled person's
 * "The Disabled" or "Disabled people" may be offensive to some,  who may prefer "person with a disability" or "people with health conditions or impairments" instead. However, many people prefer "disabled person" or "disabled people", in part due to the social model of disability.
 * Disorder
 * Dotard
 * Downie, a Dutch profanity sometimes appearing in English as "downy", used to refer to people with Down's Syndrome and generally considered derogatory
 * Dumb, especially when preceded by "the"
 * Dummy and dumb, in the context of calling a person stupid or ignorant; used as a derogatory insult towards mentally disabled people; the term was once used to describe people incapable of speaking, suggestive of an insulting mannequin-like or ventriloquist's dummy-like appearance.
 * Dwarf

E

 * Epileptic, especially when referring to an individual
 * Exceptional

F

 * Feeble-minded, sometimes shortened in slang to "feeb"
 * Fit to refer to an epileptic seizure
 * Flid to refer to someone with phocomelia from birth mother's use of thalidomide
 * Freak

G

 * Gimp or gimpy to describe a limp

H

 * Handicapped, especially when preceded by "the" or "physically"
 * Handicapable
 * Hare lip
 * Hearing-impaired
 * Homebound
 * Hunchback, or "humpback" and "Quasimodo", especially when referring to people with scoliosis or kyphosis; generated controversy after the 1990s release of The Hunchback of Notre Dame.
 * Hyper
 * Hyper-sensitive
 * Hysterical, typically used in reference to women.

I

 * Imbecile was the diagnostic term, used in the early 1900s, for people with IQ scores between 30 and 50. It is no longer used professionally. Before the IQ test was developed in 1905, "imbecile" was also commonly used as a casual insult towards anyone perceived as incompetent at doing something.
 * Incapacitated
 * Idiot was the diagnostic term used for people with IQ scores under 30 when the IQ test was first developed in the early 1900s. It is also no longer used professionally. Before the IQ test was developed in 1905, "idiot" was also commonly used as a casual insult towards anyone perceived as incompetent at doing something.
 * Illiterate, is now considered imprecise and blames the person for something caused by the condition of the educational system.
 * Inmate, when referring to a psychiatric admission
 * Insane
 * Inspirational or inspiring, when used about somebody doing a very ordinary activity, a phenomenon of spectacle known as "inspiration porn" that is based on pity; not to be confused with legitimate public activities of mass spectacle such as Special Olympics or Paralympics, which celebrate talent without pity or mockery.
 * Invalid

J

 * Junkie

L

 * Lame, in reference to difficulty walking or moving. The term has since been adopted into urban slang to generally refer to something or someone as "meaningless" or "without worth", e.g. "He told us a lame excuse for why he had not done the work."
 * Losing one's mind
 * Losing / Lost one's marbles
 * LPC – Likely to become a public charge
 * Lunatic or looney

M

 * Mad, madman.  Some individuals with mental illness tend to use this term to change the negative stigma surrounding it (see Mad Pride)
 * Mad as a hatter or "mad hatter", derogatory term (referring to a mentally ill person or a person with brain damage and dementia caused by heavy metal poisoning) popularized especially due to the fictional character of the same name
 * Maniac
 * Mental or mentally deficient, mental case, defective, disabled, deranged, or ill
 * Midget
 * Mong, Mongol, Mongoloid, or Mongolism for Down syndrome.
 * Moron, moronic
 * Munchkin (see "Midget" above), a term derived from the 1930s feature film The Wizard of Oz which had a cast of Little Persons; explicitly referring to a Little Person as a Munchkin is considered offensive
 * Mute
 * Mutant, referring to someone with an uncommon genetic mutation

N

 * Narc, narcissist this does not mean the same as abuser
 * Not the brightest bulb / Not the sharpest tool in the shed (mentally disabled derogatory term)
 * Nut, nuts, or nutter, nuthouse, etc.

O

 * Out to lunch (slang term for "crazy" or mentally ill)

P

 * Patient
 * Paraplegic
 * Psycho(tic)
 * Psychopath, which is an old term that used to mean a person with a mental illness

Q

 * Quasimodo, which translates to "half-formed" or more commonly "deformed", and made infamous by the fictional character Quasimodo, a deformed man with kyphosis who later appeared in a popular Disney film in the 1990s (see Hunchback above)

R

 * Retard/Retarded   although before circa the 1990s this was considered acceptable by most non-disabled people and organizations. Also known as the r-word.

S

 * Scatterbrained
 * Schizo especially as an adjective, meaning "erratic" or "unpredictable" or, for the former two, to refer to an individual.
 * Schizophrenic, when referring to an individual
 * Screw loose "(has a) screw loose", a British slang term that originally meant eccentric, neurotic or slightly mentally ill; generally considered offensive to mentally ill people
 * Senile
 * Slow
 * Sluggish
 * Sociopath
 * Spastic/Spaz,  especially in the UK and Ireland. Previously referred to muscle spasticity or a person with cerebral palsy, which may involve muscle spasms. Also used to insult someone uncoordinated or making jerking movements.
 * Special
 * Special needs
 * SPED, an acronym of "special ed" (short for "special education")
 * Stone deaf
 * Stricken
 * Stupid, in some contexts
 * Subnormal
 * Supercrip
 * Sufferer

T

 * Tard, short for "retard"; see retard above.
 * Thick
 * Tone deaf

U

 * Unclean
 * Unfortunate
 * Unhinged

V

 * Victim of an ailment
 * Vegetable

W

 * Wacko
 * Wheelchair bound and "confined to a wheelchair", use "person who uses a wheelchair"
 * Window licker

Y

 * "Yuppie flu", used as a pejorative term for chronic fatigue syndrome. This originated from the media stereotype of people with CFS as ambitious, young, and affluent, rather than having a genuine illness.


text: User talk:71.113.134.226

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: User talk:71.113.134.226


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User:Mercury McKinnon

Hello there. This page is still very much in the works.

My contributions

title: User:Mercury McKinnon


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William Harrison Courtney

William Harrison Courtney (born July 18, 1944 in Baltimore, Maryland, USA) is an American diplomat, having served as representative for the U.S. mostly in Eastern Europe.

Career
He was appointed by President Bill Clinton as Senior Director for Russia, Ukraine and Eurasian affairs in 1997. He had previously served as Ambassador to Georgia. Prior to that, Courtney was Ambassador to Kazakhstan, and co-chair of the U.S. delegation on Safety, Security and Dismantlement of Nuclear Weapons, and head of the U.S. delegation, with rank of Ambassador, to the implementing commissions established by the Threshold Test Ban and Peaceful Nuclear Explosions Treaties. Earlier, he served in the Nuclear and Space Talks in Geneva and at the American Embassies in Moscow and Brasilia. He was an international affairs fellow at the Council of Foreign Relations and from 1972 to 1999 was a career Foreign Service Officer. He is a member of the Council, the American Academy of Diplomacy, and the board of directors of the World Affairs Council of Washington, DC.

Education and personal life
Dr. Courtney graduated from West Virginia University (B.A., 1966) and Brown University (Ph.D., 1980). He is married and has two children.

title: William Harrison Courtney


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Wikipedia:Articles for deletion/Staccatto

 This page is an archive of the proposed deletion of the article below. Further comments should be made on the appropriate discussion page (such as the article's talk page or on a Votes for Undeletion nomination). No further edits should be made to this page.

The result of the debate was DELETE and recreate as redirect, as all the redirect votes chose a target article that had nothing to do with this one. Postdlf 04:59, 23 July 2005 (UTC)

Staccatto
non-notable DC-area club. Additionally, what is written sounds like advertising. Only thing of note is that it's in a historic district, but there are other small businesses in the area as well that don't have Wiki articles.--Mitsukai 17:22, 12 July 2005 (UTC)
 * Redirect to Staccato. Dcarrano 17:34, July 12, 2005 (UTC)
 * Delete. Advertising, vanity, nn. Gamaliel 17:35, 12 July 2005 (UTC)
 * Delete; nn, ad. Jaxl 18:20, 12 July 2005 (UTC)
 * REdirect to Staccato as common mispelling. Dunc|☺ 20:29, 12 July 2005 (UTC)
 * Delete nn royblumy 23:56, July 12, 2005 (UTC)
 * Delete nn --webkid 23:59, 12 July 2005 (UTC)
 * Redirect. -Sean Curtin 00:49, July 13, 2005 (UTC)
 * Delete non notable advertising. JamesBurns 05:08, 13 July 2005 (UTC)
 * Redirect per Dunc. -- Jonel | Speak 03:11, 14 July 2005 (UTC)
 * The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in an undeletion request). No further edits should be made to this page.


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Wikipedia:WikiProject Argentina/To do

This is the to do list for WikiProject Argentina. Add, move and delete entries as you see fit. If you create a new article, please let everybody know at the notice board. Members of the project should always have this page in their watchlists.

To discuss

 * Wikipedia talk:Naming conventions (broadcasting)

To create
''This list is for articles that should exist because they are important, not for every possible article about Argentina. If you create a stub, move the item to the "fix" or "expand" list.''
 * Other people: Luis Farinello | Lucia Vehil | Juan Maggio
 * Other: Bailanta | Coordinación de Asociaciones Diocesanas de Scouts Católicos Argentinos (CADISCA), a federation of several Catholic Scout associations, exists at es:Escultismo Católico en Argentina

Skysmith's list

 * Akewa (Toba goddess)
 * Luis Alberto Caro | Juan Galiffi | Agata Cruz Galiffi
 * Missing topics about Argentine literature | Missing articles about Argentine locations

List of missing Argentine films
Hola los argentinos magnificos. A page has been established for missing Argentine film articles on wikipedia. Please help out on MASSIVE missing part of wikipedia and Argentine culture at WikiProject Film/List of films without article/List of missing Argentine Films or contact me for help in this Argetine project. See Agua (2006 film) for format. I am attempting to fill in all of these missing films and Argentine actors and film directors which should be a major part of WikiProject Argentina. Ernst Stavro Blofeld 17:00, 13 December 2006 (UTC)

To upload

 * The Mariano Moreno National Library has a hefty number of old Argentine pictures that ought to be uploaded to Commons and properly categorized and licensed (i.e. using ). You can find them here.

To fix
This list is for articles that 1) need English checking, NPOV, sources, wikiformat, etc., or 2) are so short that they don't make justice to the topic.
 * People: Osvaldo Soriano | Roberto Fontanarrosa | Luis Palau | Juan de Garay
 * Topics: Immigration in Argentina | Foreign relations of Argentina | Education in Argentina | Military history of Argentina | Subdivisions of Argentina
 * Places: Barrios of Buenos Aires | 9 de Julio Avenue
 * Institutions: List of hospitals in Argentina | Universidad Nacional de Córdoba
 * Sports: Argentine Basketball Federation | Argentina–Brazil football rivalry
 * Other: Tehuelche | Chacarera | Bourbon reforms | Rebelde Way | Constitution of Argentina

To expand
''This list is for articles that cover the topic more or less sufficiently, but which could use some expansion. Most new articles should fit in this category.''
 * Presidents and politicians: Chacho Álvarez | Marcelo T. de Alvear | Nicolás Avellaneda | Reynaldo Bignone | Eduardo Camaño | Ramón Castillo | Victorino de la Plaza | Edelmiro Farrell | José Figueroa Alcorta | José María Guido | Miguel Juárez Celman | Agustín P. Justo | Carlos Lacoste | Alejandro Lanusse | Roberto Levingston | Eduardo Lonardi | Vicente López y Planes | Enrique Martínez | Bartolomé Mitre | Juan Carlos Onganía | Roberto M. Ortiz | Isabel Perón | Juan Pistarini | Manuel Quintana | Ramón Puerta | Pedro Pablo Ramírez | Carlos Ruckauf | Carlos Pellegrini | Luis Sáenz Peña | Roque Sáenz Peña | Alfredo Saint-Jean | Daniel Scioli | Felipe Solá | José Evaristo Uriburu | José Félix Uriburu | Justo José de Urquiza
 * Other people: Axel Blumberg | Enrique Pinti | Julio Alak | Lola Mora | Susana Blaustein Muñoz | Carlos Manuel Baldomir | Luis Brandoni | Cristina Perez | Paco Jamandreu | Gauchito Gil | Pappo | Luis Federico Leloir | Juan Bautista Bailoretto
 * History: AMIA bombing | Israeli Embassy attack in Buenos Aires | 1944 San Juan earthquake
 * Geography: Isla de los Estados | Huemul Island
 * Topics: List of number-one hits of 1961 (Argentina) (and the rest of the articles about the number-one songs)(Página 12]] Tourism in Argentina | Culture of Argentina | Religion in Argentina | Argentine sports | Argentine tennis | Football in Argentina | Argentine rock | Climate change in Argentina
 * Places: San Telmo | Península Valdés | Puerto Madryn | List of national parks of Argentina | Quebrada de Humahuaca | House of Tucumán | Villa Traful | Traful Lake | Huinca Renancó
 * Academic: Universidad Tecnológica Nacional | Instituto Balseiro
 * Institutions: CONICET | Policía Federal Argentina | Policía Bonaerense | Policía de Seguridad Aeroportuaria | Gendarmería Nacional Argentina | Prefectura Naval Argentina | Servicio Penitenciario Federal
 * Sports: Argentina national rugby union team | Argentina and England football rivalry | Seasons in Argentine football
 * Stadiums: would be interesting to add a list of important matches played in them, specially 1978 World Cup ones: Estadio Monumental | Estadio José Amalfitani | Estadio José Maria Minella | Estadio Gigante de Arroyito | Estadio Chateau Carreras | Estadio Malvinas Argentinas
 * Television stations: Telefe | Telefe Internacional | El Trece Internacional | TyC Sports
 * Other: The Official Story | Jewish gauchos | Chiquititas | Cámara en Mano | 2006 Argentine truckers' boycott of Chinese store-owners | Asociación Guías Argentinas | Mujeres Asesinas (Argentina) | List of Argentine Primera División broadcasters | Página 12

To incorporate sources in Spanish

 * Cueva de las Manos - Cave of the Hands
 * Heroine (1972 film)

title: Wikipedia:WikiProject Argentina/To do


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Monon

Monon may refer to:
 * Monon Bell, locomotive bell that symbolizes the DePauw-Wabash football rivalry
 * Monon, Indiana, United States
 * Monon Township, White County, Indiana,
 * Monon Railroad, a former railroad in Indiana
 * Monon Commercial Historic District
 * Monon Trail, a rail trail in Indiana
 * Saint Monon (died c. 645), a Scottish hermit and martyr
 * Salinta Monon (1920–2009), a Filipino textile weaver
 * Eudesmia monon, a moth

title: Monon


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Galyuu

Galyuu (雅流) is the second studio album by Miyavi. It was released on December 2, 2003.

title: Galyuu


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Dorsal nerve cord

The dorsal nerve cord is an anatomical feature found in chordate animals, mainly in the subphyla Vertebrata and Cephalochordata, as well as in some hemichordates. It is one of the five embryonic features unique to all chordates, the other four being a notochord, a post-anal tail, an endostyle, and pharyngeal slits.

The dorsal nerve cord is located dorsal to the notochord and thus also to the gut tube (hence the name). It is formed from clustered neuronal differentiation at the axial region of the ectoderm, known as the neural plate. During embryonic development, the neural plate first invaginates longitudinally to form the neural groove, whose edges (neural folds) fuse over to form a hollow neural tube. This is an important feature as it distinguishes chordates from other invertebrate phyla such as annelids and arthropods, who have solid nerve cords that are located ventral to the gut tube and often separated into a ladder-like series of segmental ganglia. The process by which neural tube is performed from the ectoderm is called neurulation. The evolutionary explanation to this adaptation from a solid cord to a hollow tube is unknown.

In vertebrates, the dorsal nerve cord (and the subsequent neural tube) gives rise to the brain (via vesicular enlargements at the rostral end) and spinal cord, which together form a highly centralized central nervous system. All the structures developed from the dorsal nerve cord are covered by meninges and enclosed by the bony (sometimes cartilaginous) axial endoskeleton, namely the cranium (hence a synonym word for vertebrates, the craniates) and the spinal canal. The hollow cavity inside the neural tube is filled with cerebrospinal fluid (CSF), and further develops into the cerebral ventricles, aqueduct and central canal, which communicate with the also CSF-filled subarachnoid space via the median and lateral apertures.

Terminologies
The word "dorsal" originates from Old French dorsalis, which in turn is from Latin dorsum, meaning "the back". This is as opposed to the term "ventral", which is etymologically from Latin ventralis or venter meaning "belly, stomach". In anatomical and embryological nomenclatures, "dorsal" refers to structures more towards the side of the embryonic epiblast, and "ventral" more towards the hypoblast side, regardless of the organism's posture and physical orientation.

Other terms such as "anterior", "posterior", "front", "back" and so on are body relative directions that are also often used, sometimes to describe a ventral-dorsal relationship among an organism's structures. Such terms are based on an frame of reference of where the subject is facing, and their meanings are dependent on the organism's current posture and orientation.
 * In bipedal organisms with upright posture, "dorsal" is often synonymous with "posterior", "back" or "rear", and "ventral" with "anterior" or "front", in reference to the direct the organism is facing.
 * In quadrupedal organisms that walk and stand on four limbs, the dorsal surface is often the top surface, and the ventral surface is the bottom (or lower) surface, as their torso is often orientated in a horizontal (or slightly slanted) prone position. The term "anterior" is synonymous with "rostral" (towards the nose) or "cranial" (towards the head), while "posterior" means "caudal" (towards the tail).

title: Dorsal nerve cord


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Kt/V

In medicine, Kt/V is a number used to quantify hemodialysis and peritoneal dialysis treatment adequacy.
 * K – dialyzer clearance of urea
 * t – dialysis time
 * V – volume of distribution of urea, approximately equal to patient's total body water

In the context of hemodialysis, Kt/V is a pseudo-dimensionless number; it is dependent on the pre- and post-dialysis concentration (see below). It is not the product of K and t divided by V, as would be the case in a true dimensionless number. In peritoneal dialysis, it isn't dimensionless at all. It was developed by Frank Gotch and John Sargent as a way for measuring the dose of dialysis when they analyzed the data from the National Cooperative Dialysis Study. In hemodialysis the US National Kidney Foundation Kt/V target is ≥ 1.3, so that one can be sure that the delivered dose is at least 1.2. In peritoneal dialysis the target is ≥ 1.7/week.

Despite the name, Kt/V is quite different from standardized Kt/V.

Rationale for Kt/V as a marker of dialysis adequacy
K (clearance) multiplied by t (time) is a volume (since mL/min × min = mL, or L/h × h = L), and (K × t) can be thought of as the mL or L of fluid (blood in this case) cleared of urea (or any other solute) during the course of a single treatment. V also is a volume, expressed in mL or L. So the ratio of K × t / V is a so-called "dimensionless ratio" and can be thought of as a multiple of the volume of plasma cleared of urea divided by the distribution volume of urea. When Kt/V = 1.0, a volume of blood equal to the distribution volume of urea has been completely cleared of urea.

The relationship between Kt/V and the concentration of urea C at the end of dialysis can be derived from the first-order differential equation that describes exponential decay and models the clearance of any substance from the body where the concentration of that substance decreases in an exponential fashion:

where From the above definitions it follows that $$\frac{dC}{dt}$$ is the first derivative of concentration with respect to time, i.e. the change in concentration with time.
 * C is the concentration [mol/m3]
 * t is the time [s]
 * K is the clearance [m3/s]
 * V is the volume of distribution [m3]

This equation is separable and can be integrated (assuming K and V are constant) as follows:

After integration,

where
 * c is the constant of integration

If one takes the antilog of equation $$ the result is:

where
 * e is the base of the natural logarithm

By integer exponentiation this can be written as:

where
 * C0 is the concentration at the beginning of dialysis [mmol/L] or [mol/m3].

The above equation can also be written as

Normally we measure postdialysis serum urea nitrogen concentration C and compare this with the initial or predialysis level C0. The session length or time is t and this is measured by the clock. The dialyzer clearance K is usually estimated, based on the urea transfer ability of the dialyzer (a function of its size and membrane permeability), the blood flow rate, and the dialysate flow rate. In some dialysis machines, the urea clearance during dialysis is estimated by testing the ability of the dialyzer to remove a small salt load that is added to the dialysate during dialysis.

Relation to URR
The URR or Urea reduction ratio is simply the fractional reduction of urea during dialysis. So by definition, URR = 1 − C/C0. So 1−URR = C/C0. So by algebra, substituting into equation ($$) above, since ln C/C0 = − ln C0/C, we get:

Sample calculation
Patient has a mass of 70 kg (154 lb) and gets a hemodialysis treatment that lasts 4 hours where the urea clearance is 215 mL/min.

 * K = 215 mL/min
 * t = 4.0 hours = 240 min
 * V = 70 kg × 0.6 L of water/kg of body mass = 42 L = 42,000 mL

Therefore:

 * Kt/V = 1.23

This means that if you dialyze a patient to a Kt/V of 1.23, and measure the postdialysis and predialysis urea nitrogen levels in the blood, then calculate the URR, then −ln(1−URR) should be about 1.23.

The math does not quite work out, and more complicated relationships have been worked-out to account for the fluid removal (ultrafiltration) during dialysis as well as urea generation (see urea reduction ratio). Nevertheless, the URR and Kt/V are so closely related mathematically, that their predictive power has been shown to be no different in terms of prediction of patient outcomes in observational studies.

Post-dialysis rebound
The above analysis assumes that urea is removed from a single compartment during dialysis. In fact, this Kt/V is usually called the "single-pool" Kt/V. Due to the multiple compartments in the human body, a significant concentration rebound occurs following hemodialysis. Usually rebound lowers the Kt/V by about 15%. The amount of rebound depends on the rate of dialysis (K) in relation to the size of the patient (V). Equations have been devised to predict the amount of rebound based on the ratio of K/V, but usually this is not necessary in clinical practice. One can use such equations to calculate an "equilibrated Kt/V" or a "double-pool Kt/V", and some think that this should be used as a measure of dialysis adequacy, but this is not widely done in the United States, and the KDOQI guidelines (see below) recommend using the regular single pool Kt/V for simplicity.

Peritoneal dialysis
Kt/V (in the context of peritoneal dialysis) was developed by Michael J. Lysaght in a series of articles on peritoneal dialysis.

The steady-state solution of a simplified mass transfer equation that is used to describe the mass exchange over a semi-permeable membrane and models peritoneal dialysis is

where
 * CB is the concentration in the blood [ mol/m3 ]
 * KD is the clearance [ m3/s ]
 * $$\dot{m}$$ is the urea mass generation [ mol/s ]

This can also be written as:

The mass generation (of urea), in steady state, can be expressed as the mass (of urea) in the effluent per time:

where
 * CE is the concentration of urea in effluent [ mol/m3 ]
 * VE is the volume of effluent [ m3 ]
 * t is the time [ s ]

Lysaght, motivated by equations $$ and $$, defined the value KD:

Lysaght uses "ml/min" for the clearance. In order to convert the above clearance (which is in m3/s) to ml/min one has to multiply by 60 × 1000 × 1000.

Once KD is defined the following equation is used to calculate Kt/V:

where
 * V is the volume of distribution. It has to be in litres (L), as the equation is not really non-dimensional.

The 7/3 is used to adjust the Kt/V value so it can be compared to the Kt/V for hemodialysis, which is typically done thrice weekly in the USA.

Weekly Kt/V
To calculate the weekly Kt/V (for peritoneal dialysis) KD has to be in litres/day. Weekly Kt/V is defined by the following equation:

Sample calculation
Assume:
 * $$C_{B\mbox{ mean}}=22.817\mbox{ mmol/L}$$
 * $$C_{D}=17.524\mbox{ mmol/L}$$
 * $$V_{D}=3.75\mbox{ L per exchange or }15\mbox{ L/day}$$
 * $$V_{B}=40.6\ \mathrm{L}$$

Then by equation $$, KD is: $$ or 8.00 mL/min or 11.52 L/d.

Kt/V and the weekly Kt/V by equations $$ and $$ respectively are thus: 0.45978 and 1.9863.

A simplified analysis of Kt/V in PD
On a practical level, in peritoneal dialysis the calculation of Kt/V is often relatively easy because the fluid drained is usually close to 100% saturated with urea, i.e. the dialysate has equilibriated with the body. Therefore, the daily amount of plasma cleared is simply the drain volume divided by an estimate of the patient's volume of distribution.

As an example, if someone is infusing four 2 liter exchanges a day, and drains out a total of 9 liters per day, then they drain 9 × 7 = 63 liters per week. If the patient has an estimated total body water volume V of about 35 liters, then the weekly Kt/V would be 63/35, or about 1.8.

The above calculation is limited by the fact that the serum concentration of urea is changing during dialysis. So ideally this should not be used as it has not taken in account the urea level in dialysate or serum...so it cannot be labelled as urea clearance In automated PD this change cannot be ignored; thus, blood samples are usually measured at some time point in the day and assumed to be representative of an average value. The clearance is then calculated using this measurement.

Reason for adoption
Kt/V has been widely adopted because it was correlated with survival. Before Kt/V nephrologists measured the serum urea concentration (specifically the time-averaged concentration of urea (TAC of urea)), which was found not to be correlated with survival (due to its strong dependence on protein intake) and thus deemed an unreliable marker of dialysis adequacy.

Criticisms/disadvantages of Kt/V

 * It is complex and tedious to calculate. Many nephrologists have difficulty understanding it.
 * Urea is not associated with toxicity.
 * Kt/V only measures a change in the concentration of urea and implicitly assumes the clearance of urea is comparable to other toxins. (It ignores molecules larger than urea having diffusion-limited transport - so called middle molecules).
 * Kt/V does not take into account the role of ultrafiltration.
 * It ignores the mass transfer between body compartments and across the plasma membrane (i.e. intracellular to extracellular transport), which has been shown to be important for the clearance of molecules such as phosphate. Practical use of Kt/V requires adjustment for rebound of the urea concentration due to the multi-compartmental nature of the body.
 * Kt/V may disadvantage women and smaller patients in terms of the amount of dialysis received. Normal kidney function may be modeled as optimal Glomerular filtration rate or GFR.  GFR is usually normalized in people to body surface area.  A man and a woman of similar body surface areas will have markedly different levels of total body water (which corresponds to V).  Also, smaller people of either sex will have markedly lower levels of V, but only slightly lower levels of body surface area.  For this reason, any dialysis dosing system that is based on V may tend to underdose smaller patients and women.  Some investigators have proposed dosing based on surface area (S) instead of V, but clinicians usually measure the URR and then calculate Kt/V.  One can "adjust" the Kt/V, to calculate a "surface-area-normalized" or "SAN"-Kt/V as well as a "SAN"-standard Kt/V.  This puts a wrapper around Kt/V and normalizes it to body surface area.

Importance of total weekly dialysis time and frequency
Kt/V has been criticized because quite high levels can be achieved, particularly in smaller patients, during relatively short dialysis sessions. This is especially true for small people, where "adequate" levels of Kt/V often can be achieved over 2 to 2.5 hours. One important part of dialysis adequacy has to do with adequate removal of salt and water, and also of solutes other than urea, especially larger molecular weight substances and phosphorus. Phosphorus and similar molecular weights remain elusive to filtration of any degree. A number of studies suggest that a longer amount of time on dialysis, or more frequent dialysis sessions, lead to better results. There have been various alternative methods of measuring dialysis adequacy, most of which have proposed some number based on Kt/V and number of dialysis sessions per week, e.g., the standardized Kt/V, or simply number of dialysis sessions per week squared multiplied by the hours on dialysis per session; e.g. the hemodialysis product by Scribner and Oreopoulos  It is not practical to give long dialysis sessions (greater than 4.5 hours) thrice a week in a dialysis center during the day. Longer sessions can be practically delivered if dialysis is done at home. Most experience has been gained with such long dialysis sessions given at night. Some centers are offering every-other-night or thrice a week nocturnal dialysis. The benefits of giving more frequent dialysis sessions is also an area of active study, and new easy-to-use machines are permitting easier use of home dialysis, where 2–3+ hour sessions can be given 4–7 days per week.

Kt/V minimums and targets for hemodialysis
One question in terms of Kt/V is, how much is enough? The answer has been based on observational studies, and the NIH-funded HEMO trial done in the United States, and also, on kinetic analysis. For a US perspective, see the KDOQI clinical practice guidelines and for a United Kingdom perspective see: U.K. Renal Association clinical practice guidelines According to the US guidelines, for thrice a week dialysis a Kt/V (without rebound) should be 1.2 at a minimum with a target value of 1.4 (15% above the minimum values). However, there is suggestive evidence that larger amounts may need to be given to women, smaller patients, malnourished patients, and patients with clinical problems. The recommended minimum Kt/V value changes depending on how many sessions per week are given, and is reduced for patients who have a substantial degree of residual renal function.

Kt/V minimums and targets for peritoneal dialysis
For a US perspective, see: For the United States, the minimum weekly Kt/V target used to be 2.0. This was lowered to 1.7 in view of the results of a large randomized trial done in Mexico, the ADEMEX trial, and also from reanalysis of previous observational study results from the perspective of residual kidney function.

For a United Kingdom perspective see:  This is still in draft form.

Hemodialysis

 * Hemodialysis Dose and Adequacy – a description of URR and Kt/V from the Kidney and Urologic Diseases Clearinghouse.
 * Kt/V and the adequacy of hemodialysis – UpToDate.com

Peritoneal dialysis

 * Advisory on Peritoneal Dialysis – American Association of Kidney Patients
 * Peritoneal Dialysis Dose and Adequacy – a description of URR and Kt/V from the Kidney and Urologic Diseases Clearinghouse.

Calculators

 * spKt/V,eKt/V,URR,nPCR,GNRI etc. dialysis calculation – hdtool.net.
 * free Kt/V calculators, single pool and equilibrated HD, PD, no login needed, site used by dozens of dialysis centers around the world for over 10 years – kt-v.net
 * Web/javascript program that does formal 2-pool urea kinetics in multiple patients – ureakinetics.org
 * Kt/V calculator – medindia.com
 * Kt/V – HDCN

title: Kt/V


text:
Scottish sundial

Scottish sundials of the renaissance period are not just more numerous than in any other country—they are also stylistically unique. This is particularly notable when the size and wealth of Scotland at the time are taken into account. They are free standing stone sculptures of the 17th and 18th centuries with many small dials inscribed on them. Accurate time telling is clearly not the aim. Precision is sacrificed for decorative effect. Unlike the sundials of similar date on the continent where baroque decoration may be added, the mathematical complexity of the Scottish dials is decoration enough. The ancient sundials of Scotland can be grouped into three main styles: lectern, obelisk and facet-head.

Lectern dials
These are noticeable for their sloping top like a reading desk or lectern, in the equatorial plane, usually with a star on top having dials in all its angles, and at 90 degrees to this a hemi-cylinder with a polar dial inscribed in it. The lectern usually has hollow dials on the south, east and west faces, and hour lines are inscribed in every available angle.

One of the more complicated was formerly at Mid Calder House and is now at Culzean Castle.

Lectern dials have some counterparts in continental Europe. This is particularly true of the Netherlands which was Scotland's primary trading partner of the time and where several lectern dials survive.

Obelisk dials
Obelisk dials are unique to Scotland and there are only 26 of them known. The first is meant to be that at Drummond Castle. It was carved in 1630 by John Mylne the King's Master Mason.

Obelisk dials are made up of three parts. The base element is a square shaft with four or five square panels on each side. In these panels are often sunken dials of bowl-hollows, hearts or triangular and rectangular shapes. The middle element is an octagonal section boss. The corners may be cut away and have dials inscribed in the hollows. The crowning element is a square tapering finial which when viewed with the lower square shaft produces the obelisk appearance. This finial also has panelled sides with up to seven or eight on each side. There can be 70 or 80 surfaces in total available for dials.

Facet-head dials
This term includes a wide variety of other types ranging from a simple cube to complex polyhedrals. The most dramatic of these is at Glamis Castle.

title: Scottish sundial


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title: Template:Inclusionist


text: User talk:134.2.147.103

title: User talk:134.2.147.103