The influential physicist Richard Feynman became interested in the relationship between religion and science during a mid-career phase. He proposed that their interface was embroiled in unresolvable difficulties. He felt that science demanded an attitude of uncertainty for its claims, while religion contrarily required certain belief in its core doctrines. Though possessing several non-contradictory dimensions, Feynman felt that the nature of the truth claims of science and religion suffered from insurmountable elemental conflicts. This was by contrast to Karl Popper, the leading critical rationalist of the 20th century, who argued that there could be no tension between science and religion. This paper will argue that the ‘Feynman Problem’ is not as insoluble as it appears. Rather, several solutions exist within critical rationalism. Two will be presented-the first revolves around the conjectural basis of knowledge and is already a well characterised critical rationalist notion. The second is a novel solution based on the separate categorisation of psychological, pragmatic, and epistemological attitudes to religion and science. Karl Popper’s view of religion-science dissimilarity was a minimalist point of departure for critical rationalists, who have developed increasingly sophisticated frameworks for investigating the relationship between faith and reason. Critical rationalism represents an equally inspirational methodology for the pursuit of scientific and religious truth. Though both Feynman and Popper’s views on religion were underdeveloped, they foreshadowed the religion-science frameworks advocated by many late 20th century scientists, especially in the form of New Atheism and Gould’s NOMA theory.

Background: hemodialysis as a solution for patients with chronic renal failure is a stressful process. Anxiety and depression after hemodialysis could have negative impacts on quality of life, treatment and prognosis of the disease. Some studies indicated that educating patients prior to hemodialysis could enhance patients’ quality of life and increase the likelihood of their survival. Objectives: This study investigated psychological impacts of psycho education on anxiety and depression symptoms in patients under dialysis. Patients and Methods: This was a prospective, experimental intervention study with pretest and post-test. Eligible patients (n = 60) were selected randomly from dialysis center of Imam Khomeini Hospital in Sari in 2009. Hospital Anxiety Depression Scale (HADS) score of patients were eight or greater. They were divided into two matched groups. In one group, patients were given psycho education during three sessions of one-hour, while patients in the control group did not receive any education. HADS was completed for both groups before dialysis and one month after the end of educational sessions. The data were compared and analyzed using paired t-test and Chi-square test. Results: Psycho education decreased depression score (P < 0. 001) and the HADS (P = 0. 008) significantly. These decreases were not significant for anxiety scores of patients (P = 0. 185). Conclusion: This research indicated that psycho education based on the designed protocol decreased the scores of depression and total scores of HADS.

Background: Cooling the dialysate is an important factor that contributes to the hemodynamic stability in patients during hemodialysis. The aim of this study was to determine the effect of cool dialysate on vital signs, and the adequacy and common complications of hemodialysis. Materials and Methods: The present crossover, triple-blind, clinical trial was performed on 62 dialysis patients, who were selected through stratified block randomization. First, one group underwent hemodialysis using a cool dialysate (35° C), and the other received routine hemodialysis (36. 5° C). Each patient received a total of eight hemodialysis sessions. Then, treatment methods were swapped, and each group received the other group's method. The patients' blood pressure, pulse rate, and temperature were measured before dialysis, and in the first, second, third, and fourth hours of dialysis. The frequency of common complications of hemodialysis and dialysis efficacy were measured. The marginal model and Generalized Estimating Equations (GEE) were used to analyze the data. Results: The participants' systolic (p = 0. 01) and diastolic blood pressures significantly increased with a decrease in temperature (p = 0. 005). The patients' pulse rate (p = 0. 143), adequacy of dialysis (p = 0. 922), and common complications of hemodialysis did not significantly differ between the two temperatures (p > 0. 05). Conclusions: Reducing dialysate temperature from 36. 5 to 35° C led to hemodynamic stability; the blood pressure of the patients undergoing hemodialysis was more stable with the cool dialysate method and the number of drops in the blood pressure during the hemodialysis was reduced.

Introduction. It has been suggested that a dialysate calcium concentration of 1. 5 mmol/L is a compromise between bone protection and cardiovascular risk. This study aimed to investigate the effect of reducing dialysate calcium concentration to 1. 5 mmol/L on mineral metabolism and hemodynamic parameters. Materials and Methods. Dialysate calcium concentration was changed from 1. 75 mmol/L to 1. 5 mmol/L for 9 months and observed the effects on mineral metabolism and dialysis outcome parameters in 52 hemodialysis patients. Results. The results at 9 months demonstrated that postdialytic serum calcium level decreased significantly from 109 ± 7 mg/L to 102 ± 6 mg/L, intact parathyroid hormone (PTH) increased from 372 ± 52 pg/mL to 606 ± 80 pg/mL, and the oral alfacalcidol increased from 1. 4 ± 0. 3 µ g/w to 3. 3 ± 0. 4 µ g/w. In patients with low PTH levels, continuous increase of PTH was observed. There were no significant variation in the oral calcium carbonate dose and serum levels of alkaline phosphatase, predialytic calcium, and pre-and postdialytic phosphorus. The ultrafiltration rate and postdialysis systolic blood pressure were significantly lower after reducing the dialysate calcium concentration to 1. 5 mmol/L. Intradialytic hypotension and cramps were more frequent with this dialysate calcium concentration. Conclusions. These findings demonstrated that a decrease in dialysate calcium concentration from 1. 75 mmol/L to 1. 5 mmol/L improved mineral metabolism by prevention of postdialytic hypercalcemia and releasing oversuppression of PTH, but it was associated with more use of oral alfacalcidol and more hemodynamic impairment.

Background: The chemical quality of water used for dialysis fluid is a vital factor in the overall care received by dialysis patients. Therefore, water used for this purpose should be treated with advanced methods before use for dialysis. The objective of this study was to assess the efficiency of reverse osmosis systems to improve water quality used for dialysis fluid.Methods: In this descriptive study, 40 water samples were collected from inlet and outlet of reverse osmosis systems of 5 hemodialysis services of Isfahan hospitals, Iran, during April to August 2011. The samples were analyzed for physicochemical parameters including residual chlorine, chloramines, pH, hardness, Al, F, Cu, Mn, Cd, Cr, Pb, Ni concentration according to the standard methods for examining water and waste water.Findings: The results of this study showed that the reverse osmosis systems significantly reduce the amount of residual chlorine, chloramines, hardness, Na, K, F, NO3, SO4 and Mn, but it could not significantly reduce the amount of Cu, Zn, Cd, Cr, Pb and Al. However, the results also showed that the amount of NO3, hardness, Pb, Cd, Cr and Al in outlet samples of reverse osmosis systems was higher than the value given by association for the advancement of medical instrumentation (AAMI).Conclusion: Reverse osmosis systems could improve the quality of water used for hemodialysis but they do not reduce the level of some contaminant to the recommended values for dialysis fluid. This condition may be unsafe for hemodialysis patients. So a rigorous control of chemical contaminants is necessary in order to ensure that hemodialysis therapy is in a good quality.

Background: Occult hepatitis B infection (OBI) is a major public health problem worldwide, which harbors potential risk of hepatitis B virus (HBV) transmission through blood transfusion and transplantation. OBI is characterized by the presence of HBV-DNA in the blood or liver tissue without detectable hepatitis B surface antigen (HBsAg) in the serum. An important cause of OBI is the occurrence of mutations in the HBV genome, especially in the S region.Objectives: The study aims to analyze mutations in S and pre-core/core regions of HBV-DNA in hemodialysis patients.Patients and Methods: Sera of 216 hemodialysis patients were tested for HBsAg and hepatitis B core antibody (HBcAb) by ELISA. Sera of patients that tested negative for HBsAg were evaluated by PCR for the detection of HBV-DNA in the S and pre-core/core regions. In total, six PCR products were sequenced, aligned, and compared with the HBV reference sequence. Amino acid deletion and nucleotide substitution were considered mutations in S and pre-core/core regions of HBV-DNA.Results: Among 216 patients, 203 (93.98%) and 175 (81.01%) sera samples tested negative for HBsAg and HBcAb, respectively. Among all HBsAg-negative samples, six (2.9%) tested positive for HBV-DNA, including four (1.97%) for S and two (0.98%) for pre-core regions. All four (1.97%) samples that tested positive for the S region belonged to HBV-subtype awy. The amino acid sequence of all four samples showed the YMDD motif in position 204 (rtM204). There were three amino acid substitutions in the S region (T127P, P153L, and F170S) and one substitution in the RT region (Y135S). Moreover, two (0.98%) pre-core/core positive patients had an unexpected stop codon in position 1896.Conclusions: This study indicates that 2.9% of hemodialysis patients had OBI, which is considered as a major public health problem worldwide. Moreover, we observed three mutations in S region, including T127P, P153L, and F170S, which caused OBI. This study is first to report a mutation analysis of HBV in hemodialysis patients in southwestern Iran. These results indicate that current screening tests based on HBsAg detection are not reliable for detection of HBV infection in dialysis patients.

Introduction: End-stage renal disease causes impairment of all body organs including the heart and the lung. The main problems in the afflicted patients are pulmonary edema due to increased permeability of the capillaries, intravascular and interstitial volume overload, hypertension, and congestive heart failure. These changes cause altered physiologic and mechanical function of the lungs and subsequently increase in airway resistance. We aimed to study the impact of hemodialysis on spirometry parameters. Materials and Methods: In a cross-sectional study performed on 41 patients on maintenance hemodialysis, spirometry was done before and after the dialysis session. The patients were on either acetate or bicarbonate hemodialysis with the same method, dialysis machine, and duration of dialysis. Alterations in spirometry parameters including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and maximal midexpiratory flow rate were determined and their relation with serum electrolytes, serum creatinine, blood urea nitrogen, and hemoglobin were analyzed. Results: Twenty-nine patients undergoing dialysis with bicarbonate dialysate and 21 on dialysis with acetate were compared. Improvement in spirometry parameters was only significant in patients undergoing dialysis with bicarbonate dialysate. All spirometry parameters showed significant increases in the bicarbonate group except for the FEV1/FVC ratio. Furthermore, significant increase in these parameters was only prominent in the men. Postdialysis weight reduction and laboratory indexes had no significant correlation with improvement of spirometry parameters. Conclusions: Dialysis with bicarbonate dialysate causes significant improvement in spirometry parameters in men on maintenance dialysis. This effect might be independent of the effect of removing the volume overload by dialysis.

Introduction: Uremic pruritus is one of the most common and debilitating complications of hemodialysis patients which affects 50 to 90 percent of them. Pruritus can lead to skin infections, scaling, anxiety, sleep disorders, social dysfunction and so on in patient. The aim of study was to evaluate the effect of hemodialysis with cold dialysis fluid on reducing the level of uremic pruritus in hemodialysis patients.Methods: This study was a pre and post-test double-blind clinical trial performed in summer 2012 in hemodialysis department of Fatemieh hospital, Semnan. Of all patients in the hemodialysis department, 35 people were eligible. To collect data, demographic questionnaire, medical records and itching scale were used. Patients were hemodialized three times per week and each session was four hours, for one month with standard hemodialysis(37oc) and then in the second month with cold hemodialysis(35oc). Data were analyzed by Paired t-test and Wilcoxon tests at a significant level of 5%.Results: The results showed that the mean and standard deviation of pruritus in standard and cool hemodialysis stage were 23.0±10.3 and 8.8±1.3, respectively. The data indicate that the patients' pruritus in the cold stage of hemodialysis was significantly reduced (P<0.001).Conclusion: Cold hemodialysis can relieve uremic pruritus among hemodialysis patients.