Knowledge and Awareness Among Patients with Chronic Kidney Disease Stage 3

Knowledge is a prerequisite for changing behavior, and is useful for improving outcomes and reducing mortality rates in patients diagnosed with chronic kidney disease (CKD). The purpose of this article is to describe baseline CKD knowledge and awareness obtained as part of a larger study testing the feasibility of a self-management intervention. Thirty patients were recruited who had CKD Stage 3 with coexisting diabetes and hypertension. Fifty-four percent of the sample were unaware of their CKD diagnosis. Participants had a moderate amount of CKD knowledge. This study suggests the need to increase knowledge in patients with CKD Stage 3 to aid in slowing disease progression

Within- and between-person variability of exhaled breath condensate pH and NH4+ in never and current smokers

SummaryRecent studies have suggested that the collection of exhaled breath condensate (EBC) may be a viable method in occupational field studies to sample secretions of the lower airway because it is simple to perform and non-invasive. However, there are unresolved questions about whether certain laboratory conditions may influence the analysis of EBC biomarker measurements. A total of 12 subjects performed 116 EBC tests. The effect of short and long-term sample storage and sample volume on two biomarkers of acid stress, pH and NH4+, in EBC were investigated and did not significantly influence either marker measurement after argon deaeration. We also investigated the variability and the effect of smoking on the biomarkers by collecting six samples each from five adult never smokers and five adult current smokers over a period of 1 month (n=60 total). For pH, the within-person and between-person variability was larger in current smokers compared to never smokers. Similar results were found for NH4+. Cigarette packs smoked per day now was also associated with both pH (p=0.01) and NH4+ (p=0.04) using mixed effects regression analysis. The variability and smoking results suggest that repeated measurements of EBC pH and NH4+ from the same individual may accurately predict the biological state of the airways of current smokers when compared to never smokers

Using HCAHPS data to model correlates of medication understanding at hospital discharge

Background: Hospitals are challenged to improve hospital transitions to home and are held accountable through public reporting. Design: This cross-sectional study used patients’ self-reported experience data from the publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to describe correlates of medication understanding at hospital discharge, using data collected from adult patients discharged from one Midwestern community hospital (N=154). Results: The final logistic regression model included four correlates of medication understanding: 1) nurse always communicates well, 2) physician always communicates well, 3) new prescriptions during hospital stay, and 4) very good or better mental health, and these classified 72.6% of the cases. Significant correlates of the patient strongly agreeing that they understood discharge medications were the “nurse always communicates well” (odds ratio =3.10, 95% confidence interval: 1.25, 7.66) and “very good or better self-perceived mental health” (odds ratio =2.17, 95% confidence interval: 1.02, 4.64). Conclusion: HCAHPS data can be used to model correlates of medication understanding, which are then useful for evaluating intervention effects following quality improvement

Population assessment of the endangered Western Hoolock Gibbon Hoolock hoolock Harlan, 1834 at Sheikh Jamal Inani National Park, Bangladesh, and conservation significance of this site for threatened wildlife species

Sheikh Jamal Inani National Park (Inani) is a wildlife habitat in Bangladesh located under the Cox’s Bazar South Forest Division, Cox’s Bazar. It constitutes significant habitat for the charismatic and globally ‘Endangered’ Western Hoolock Gibbon Hoolock hoolockin Bangladesh. Here, we show that Inani is a poorly-known gibbon habitat with a population of seven groups, comprising a total of 18 individuals. Among them, 77.8% were adults (males and females), and 11.1%, 5.6%, and 5.6% were sub-adults, juveniles, and infants, respectively, indicating low reproductive output. Five of seven groups had no offspring present in the group, and the mean group size of 2.57 individuals/group is low compared to other habitats in Bangladesh. Beside Western Hoolock Gibbon, Inani is home to many threatened wildlife species. The first record of the Slaty-backed Flycatcher Ficedula erithacus in Bangladesh occurred in Inani, adding this new species to the national bird checklist of Bangladesh. The presence of the globally ‘Endangered’ Asian Elephant Elephas maximus, Phayre’s Langur Trachypithecus phayrei, & Elongated Tortoise Indotestudo elongata and the globally ‘Vulnerable’ Northern Pig-tailed Macaque Macaca leonina, Capped Langur Trachypithecus pileatus, Indian Leopard Panthera pardus, & Asiatic Softshell Turtle Amyda cartilaginea highlight the importance of Inani as a conservation area in Bangladesh. The Western Hoolock Gibbon and other threatened wildlife of Inani are now on the verge of local extinction due to a sharp increase in forest resource extraction resulting from the recent influx of large numbers of Rohingya refugees from Myanmar, many of whom have settled around Inani. Through stakeholder interviews in the area, we have identified feasible and measurable conservation actions at Inani that are urgently needed to prevent further loss of wildlife and to protect this important gibbon habitat

Structural capacity in fire of laminated timber elements in compartments with exposed timber surfaces

In compartment fires with boundaries consisting of exposed mass timber surfaces – for example in compartments with exposed cross-laminated timber (CLT) walls or floors – the thermal penetration depth, i.e. the depth of timber heated to temperatures significantly above ambient behind the char-timber interface, during fire exposure may have a significant influence on the load bearing capacity of structural mass timber buildings, particularly in the decay phase of a real fire. This paper presents in-depth timber temperature measurements obtained during a series of full-scale fire experiments in compartments with partially exposed CLT boundaries, including decay phases. During experiments in which the timber surfaces achieved auto-extinction after consumption of the compartment fuel load, the thermal penetration depth continued to increase for more than one hour, whilst the progression of the in-depth charring front effectively halted at extinction. A simple calculation model is presented to demonstrate that this ongoing progression of thermal penetration continues to reduce the structural load bearing capacity of the CLT elements, thereby increasing the potential for structural collapse during the decay phase of the fire. This issue is considered to be most important for timber compression elements. Currently utilised structural fire design methods for mass timber generally assume a fixed ‘zero strength layer’ depth to account for thermally affected timber behind the char line; however they make no explicit attempt to account for these decay-phase effects

Associations Between Methylation of Paternally Expressed Gene 3 (PEG3), Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer.

Cytology-based screening for invasive cervical cancer (ICC) lacks sensitivity and specificity to discriminate between cervical intraepithelial neoplasia (CIN) likely to persist or progress from cases likely to resolve. Genome-wide approaches have been used to identify DNA methylation marks associated with CIN persistence or progression. However, associations between DNA methylation marks and CIN or ICC remain weak and inconsistent. Between 2008-2009, we conducted a hospital-based, case-control study among 213 Tanzania women with CIN 1/2/3 or ICC. We collected questionnaire data, biopsies, peripheral blood, cervical scrapes, Human papillomavirus (HPV) and HIV-1 infection status. We assessed PEG3 methylation status by bisulfite pyrosequencing. Multinomial logistic regression was used to estimate odds ratios (OR) and confidence intervals (CI 95%) for associations between PEG3 methylation status and CIN or ICC. After adjusting for age, gravidity, hormonal contraceptive use and HPV infection, a 5% increase in PEG3 DNA methylation was associated with increased risk for ICC (OR = 1.6; 95% CI 1.2-2.1). HPV infection was associated with a higher risk of CIN1-3 (OR = 15.7; 95% CI 5.7-48.6) and ICC (OR = 29.5, 95% CI 6.3-38.4). Infection with high risk HPV was correlated with mean PEG3 differentially methylated regions (DMRs) methylation (r = 0.34 p<0.0001), while the correlation with low risk HPV infection was weaker (r = 0.16 p = 0.047). Although small sample size limits inference, these data support that PEG3 methylation status has potential as a molecular target for inclusion in CIN screening to improve prediction of progression. Impact statement: We present the first evidence that aberrant methylation of the PEG3 DMR is an important co-factor in the development of Invasive cervical carcinoma (ICC), especially among women infected with high risk HPV. Our results show that a five percent increase in DNA methylation of PEG3 is associated with a 1.6-fold increase ICC risk. Suggesting PEG3 methylation status may be useful as a molecular marker for CIN screening to improve prediction of cases likely to progress

Suitability of maize crop residue fermented by Pleurotus ostreatus as feed for edible crickets: growth performance, micronutrient content, and iron bioavailability

Small-scale farming of edible insects could help combat public health challenges such as protein energy malnutrition and anemia, but reliable low-cost feeds for insects are needed. In resource-limited contexts, where grains such as maize are prohibitively costly for use as insect feed, the feasibility of insect farming may depend on finding alternatives. Here, we explore the potential to modify plentiful maize crop residue with edible mushroom mycelium to generate a low-cost feed adjunct for the farmed two-spotted cricket, Gryllus bimaculatus. Mushroom farming, like insect agriculture, is versatile; it can yield nutritious food while increasing system circularity by utilizing lignocellulosic residues from row crops as inputs. Pleurotus ostreatus, is an edible basidiomycete capable of being cultivated on corn stover (Zea mays). Mushroom harvest results in abundant “spent” substrate, which we investigated as a candidate feed ingredient. We created six cricket feeds containing fermented Pleurotus substrate plus an unfermented control, measuring cricket mass, mortality, and maturation weekly to evaluate cricket growth performance impacts of both fungal fermentation duration and mushroom formation. Pasteurized corn stover was inoculated with P. ostreatus mycelium and fermented for 0, 2, 3, 4, or 8 weeks. Some 4 and 8-week substrates were induced to produce mushrooms through manipulations of temperature, humidity, and light conditions. Dried fermented stover (40%) was added to a 1:1 corn/soy grain mix and fed to crickets ad libitum for 44 days. The unfermented control group showed higher survivorship compared to several fermented diets. Control group mass yield was higher for 2 out of 6 fermented diets. Little variation in cricket iron content was observed via ICP-spectrometry across feeds, averaging 2.46 mg/100 g. To determine bioavailability, we conducted in vitro Caco-2 human colon epithelial cell absorption assays, showing that iron in crickets fed fruiting-induced substrates was more bioavailable than in unfruited groups. Despite more bioavailable iron in crickets reared on post-fruiting substrates, we conclude that Pleurotus-fermented stover is an unsuitable feed ingredient for G. bimaculatus due to high mortality, variability in growth responses within treatments, and low mass yield

Improving Benefit-harm Assessment of Therapies from the Patient Perspective: OMERACT Premeeting Toward Consensus on Core Sets for Randomized Controlled Trials

Objective: Outcome Measures in Rheumatology (OMERACT) convened a premeeting in 2018 to bring together patients, regulators, researchers, clinicians, and consumers to build upon previous OMERACT drug safety work, with patients fully engaged throughout all phases. Methods: Day 1 included a brief introduction to the history of OMERACT and methodology, and an overview of current efforts within and outside OMERACT to identify patient-reported medication safety concerns. On Day 2, two working groups presented results; after each, breakout groups were assembled to discuss findings. Results: Five themes pertaining to drug safety measurement emerged. Conclusion: Current approaches have failed to include data from the patient’s perspective. A better understanding of how individuals with rheumatic diseases view potential benefits and harms of therapies is essential

Using Optimal Test Assembly Methods for Shortening Patientâ Reported Outcome Measures: Development and Validation of the Cochin Hand Function Scaleâ 6: A Scleroderma Patientâ Centered Intervention Network Cohort Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134498/1/acr22893_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134498/2/acr22893.pd