Perceived Barriers to the Pre-Transplant Evaluation: A Patient Perspective

Patients who are afforded the opportunity for a kidney transplant tend to have better short and long-term outcomes, including improved physical health, quality of life, and long-term survival over those who are treated with prolonged dialysis (Landreneau, Lee, & Landreneau, 2010; Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients (OPTN/SRTR), 2014; Wolfe et al., 1999). At the end of 2012, 402,514 people were being treated with hemodialysis while 40,605 were receiving peritoneal dialysis (USRDS, 2014). At this same time, only 92,885 people were listed on the OPTN national waitlist for kidney transplantation. The aim of this project was to identify barriers that might delay or halt progress toward waitlist placement in a midwestern hospital transplant program. A patient-focused survey was sent to 346 end stage renal disease patients referred to a kidney transplant center for a pre-transplant work-up in 2014. The survey collected demographic and health literacy data as well as data focused on patient concerns and attitudes toward kidney transplantation. Eighty-eight patients (30% response rate) completed and returned the survey (50% male, 78% White, and a mean age of 62). Data were evaluated in aggregate with further evaluation of data based on race and sex. The question “how confident are you filling out medical forms” was statistically significant (p = .002) for “sex” and “health literacy.” The greatest concerns were “length of time to wait for a kidney transplant” and issues inherent to “finding a living donor.” The survey prompt that “dialysis is not that bad” generated the most negative rating in the attitudes section of the survey. Thirty-eight percent of respondents were identified as having limited health literacy (Short Literacy Survey [SLS] score 3-9). It is recommended that the SLS be added to initial patient screenings, with findings used to create an individualized care plan designed to assist patients through the pre-transplant evaluation. All patient educational materials need to be evaluated for ease of reading and grade level. Patient education materials must also be created to address specific patient identified barriers (e.g. long wait time for a kidney transplant, finding a living donor, coping with long-term dialysis)

Odor blocking of stress hormone responses

Scents have been employed for millennia to allay stress, but whether or how they might do so is largely unknown. Fear and stress induce increases in blood stress hormones controlled by hypothalamic corticotropin releasing hormone neurons (CRHNs). Here, we report that two common odorants block mouse stress hormone responses to three potent stressors: physical restraint, predator odor, and male-male social confrontation. One odorant inhibits restraint and predator odor activation of excitatory neurons upstream of CRHNs in the bed nucleus of the stria terminalis (BNSTa). In addition, both activate inhibitory neurons upstream of CRHNs in the hypothalamic ventromedial nucleus (VMH) and silencing of VMH inhibitory neurons hinders odor blocking of stress. Together, these findings indicate that odor blocking can occur via two mechanisms: (1) Inhibition of excitatory neurons that transmit stress signals to CRHNs and (2) activation of inhibitory neurons that act directly or indirectly to inhibit stressor activation of CRHNs

Single-cell transcriptomics reveals receptor transformations during olfactory neurogenesis

The sense of smell allows chemicals to be perceived as diverse scents. We used single neuron RNA-Sequencing (RNA-Seq) to explore developmental mechanisms that shape this ability as nasal olfactory neurons mature in mice. Most mature neurons expressed only one of the roughly 1000 odorant receptor genes (Olfrs) available, and that at high levels. However, many immature neurons expressed low levels of multiple Olfrs. Coexpressed Olfrs localized to overlapping zones of the nasal epithelium, suggesting regional biases, but not to single genomic loci. A single immature neuron could express Olfrs from up to seven different chromosomes. The mature state in which expression of Olfr genes is restricted to one per neuron emerges over a developmental progression that appears independent of neuronal activity requiring sensory transduction molecules

Abdominal aortic aneurysm repair with the Zenith stent graft: Short to midterm results

AbstractPurpose: The purpose of this study was to assess the short-term and mid-term results of endovascular aneurysm repair with the Zenith stent graft in a single-center prospective study. Method: Between October 1998 and July 2001, we used the Zenith stent graft for elective endovascular aneurysm repair in 116 patients, six of whom were women. The mean age was 75 years, and the mean aneurysm diameter was 60.3 ± 8.8 mm. Stent grafts were oversized 10% to 20% relative to computed tomographic (CT) scan-based diameter measurements. All repairs were performed in the operating room through surgically exposed femoral arteries. The results were assessed before discharge with three-phase, contrast-enhanced CT scan and plain abdominal radiograph. These studies were repeated at 1, 6, 12, and 24 months after operation. Follow-up periods ranged from 1 to 34 months. Results: No failed insertions and no conversions to open surgery occurred. The diameter of the main body of the stent graft was 28 mm or more in 73 patients (63%). Additional stents were inserted during surgery to treat kinking in eight patients (6.9%) and renal artery encroachment in two patients (1.7%). Mean fluoroscopy time was 35.1 ± 18.3 minutes, contrast load was 146 ± 53 mL (350 mg/mL), and estimated blood loss was 249 ± 407 mL. The major complication rate was 9.5%, and the minor complication rate was 10.3%. The perioperative complications were myocardial infarction in four patients, arrythmia in four patients, and pulmonary embolism, renal failure, stroke, small bowel obstruction, femoral stenosis, digital embolism, and graft limb thrombosis in one patient each. All 116 patients went home from the hospital, but one patient died 2 weeks later of a combination of pulmonary embolism and myocardial infarction. Endoleak was seen on the first CT scan in 16 patients (15%); 15 were type II, and one was type III. No endoleaks of type I or IV were seen. Additional interventions were performed for each of the following conditions: type II endoleak (n = 4), type III endoleak (n = 1), femoral clamp injury (n = 1), renal artery stenosis (n = 1), and graft limb occlusion (n = 1). One patient had acute aneurysm dilatation and rupture caused by a type II endoleak through the inferior mesenteric artery 6 months after stent graft implantation. No cases were seen of late graft occlusion, stent graft migration, stent fracture, barb fracture, or secondary endoleak. Conclusion: The Zenith device is safe, versatile, and effective in the short to medium term. Most patients need wide stent grafts (≥28 mm proximally and ≥16 mm distally) to achieve 10% to 20% oversizing to prevent type I endoleak. (J Vasc Surg 2002;36:217-25.

NPAL04 OBS data analysis part 1 : kinematics of deep seafloor arrivals

These notes provide supporting information for a JASA (Journal of the Acoustical Society of America) LttE (Letter to the Editor) manuscript, "Deep seafloor arrivals: A new class of arrivals in long-range ocean acoustic propagation" (Stephen et al., submitted). It addresses five issues raised by the co-authors: 1) incorrect processing for the time-compressed traces at T2300 and T3200 that appeared in an early version of the LttE (T2300, T3200 … refer to transmissions at 2300, 3200km etc from the DVLA (Deep Vertical Line Array)), 2) processing issues, including the trade-offs between coherent and incoherent stacking and corrections for the effects of moving sources and receivers and tidal currents (Doppler), 4) the distinction between "deep shadow zone arrivals", which occur below the turning points in Parabolic Equation (PE) models, and "deep seafloor arrivals", which appear dominantly on the Ocean Bottom Seismometer (OBS) but are either very weak or absent on the deepest element in the DVLA and do not coincide with turning points in the PE model (some of these OBS late arrivals occur after the finale region), 4) the role of surface-reflected bottomreflected (SRBR) paths in explaining the late arriving energy, and 5) generally reconciling the OBS analysis with work by other North Pacific Acoustic Laboratory (NPAL) investigators and Dushaw et al (1999).Funding was provided by the Office of Naval Research through Contract No. N00014-06-1-0222

Deep seafloor arrivals : an unexplained set of arrivals in long-range ocean acoustic propagation

Author Posting. © Acoustical Society of America, 2009. This article is posted here by permission of Acoustical Society of America for personal use, not for redistribution. The definitive version was published in Journal of the Acoustical Society of America 126 (2009): 599-606, doi:10.1121/1.3158826.Receptions, from a ship-suspended source (in the band 50–100 Hz) to an ocean bottom seismometer (about 5000 m depth) and the deepest element on a vertical hydrophone array (about 750 m above the seafloor) that were acquired on the 2004 Long-Range Ocean Acoustic Propagation Experiment in the North Pacific Ocean, are described. The ranges varied from 50 to 3200 km. In addition to predicted ocean acoustic arrivals and deep shadow zone arrivals (leaking below turning points), “deep seafloor arrivals,” that are dominant on the seafloor geophone but are absent or very weak on the hydrophone array, are observed. These deep seafloor arrivals are an unexplained set of arrivals in ocean acoustics possibly associated with seafloor interface waves.The LOAPEX source deployments, the moored DVLA receiver deployments, and some post-cruise data reduction and analysis were funded by the Office of Naval Research under Award Nos. N00014-1403-1-0181, N00014-03-1-0182, and N00014-06-1-0222. Additional post-cruise analysis support was provided to RAS through the Edward W. and Betty J. Scripps Chair for Excellence in Oceanography. The OBS/Hs used in the experiment were provided by Scripps Institution of Oceanography under the U.S. National Ocean Bottom Seismic Instrumentation Pool (SIO-OBSIP—http://www.obsip.org). To cover the costs of the OBS/H deployments funds were paid to SIO-OBSIP from the National Science Foundation and from the Woods Hole Oceanographic Institution Deep Ocean Exploration Institute

Challenges in Using Cultured Primary Rodent Hepatocytes or Cell Lines to Study Hepatic HDL Receptor SR-BI Regulation by Its Cytoplasmic Adaptor PDZK1

Background: PDZK1 is a four PDZ-domain containing cytoplasmic protein that binds to a variety of membrane proteins via their C-termini and can influence the abundance, localization and/or function of its target proteins. One of these targets in hepatocytes in vivo is the HDL receptor SR-BI. Normal hepatic expression of SR-BI protein requires PDZK1 - <5% of normal hepatic SR-BI is seen in the livers of PDZK1 knockout mice. Progress has been made in identifying features of PDZK1 required to control hepatic SR-BI in vivo using hepatic expression of wild-type and mutant forms of PDZK1 in wild-type and PDZK1 KO transgenic mice. Such in vivo studies are time consuming and expensive, and cannot readily be used to explore many features of the underlying molecular and cellular mechanisms. Methodology/Principal Findings: Here we have explored the potential to use either primary rodent hepatocytes in culture using 2D collagen gels with newly developed optimized conditions or PDZK1/SR-BI co-transfected cultured cell lines (COS, HEK293) for such studies. SR-BI and PDZK1 protein and mRNA expression levels fell rapidly in primary hepatocyte cultures, indicating this system does not adequately mimic hepatocytes in vivo for analysis of the PDZK1 dependence of SR-BI. Although PDZK1 did alter SR-BI protein expression in the cell lines, its influence was independent of SR-BI’s C-terminus, and thus is not likely to occur via the same mechanism as that which occurs in hepatocytes in vivo. Conclusions/Significance: Caution must be exercised in using primary hepatocytes or cultured cell lines when studying the mechanism underlying the regulation of hepatic SR-BI by PDZK1. It may be possible to use SR-BI and PDZK1 expression as sensitive markers for the in vivo-like state of hepatocytes to further improve primary hepatocyte cell culture conditions.National Institutes of Health (U.S.) (Grant HL052212)National Institutes of Health (U.S.) (Grant HL066105)National Institutes of Health (U.S.) (Grant ES015241)National Institutes of Health (U.S.) (Grant GM068762

Wordless intervention for epilepsy in learning disabilities (WIELD):study protocol for a randomized controlled feasibility trial

Epilepsy is the most common neurological problem that affects people with learning disabilities. The high seizure frequency, resistance to treatments, associated skills deficit and co-morbidities make the management of epilepsy particularly challenging for people with learning disabilities. The Books Beyond Words booklet for epilepsy uses images to help people with learning disabilities manage their condition and improve quality of life. Our aim is to conduct a randomized controlled feasibility trial exploring key methodological, design and acceptability issues, in order to subsequently undertake a large-scale randomized controlled trial of the Books Beyond Words booklet for epilepsy

A blended knowledge translation initiative to improve colorectal cancer staging [ISRCTN56824239]

BACKGROUND: A significant gap has been documented between best practice and the actual practice of surgery. Our group identified that colorectal cancer staging in Ontario was suboptimal and subsequently developed a knowledge translation strategy using the principles of social marketing and the influence of expert and local opinion leaders for colorectal cancer. METHODS/DESIGN: Opinion leaders were identified using the Hiss methodology. Hospitals in Ontario were cluster-randomized to one of two intervention arms. Both groups were exposed to a formal continuing medical education session given by the expert opinion leader for colorectal cancer. In the treatment group the local Opinion Leader for colorectal cancer was detailed by the expert opinion leader for colorectal cancer and received a toolkit. Forty-two centres agreed to have the expert opinion leader for colorectal cancer come and give a formal continuing medical education session that lasted between 50 minutes and 4 hours. No centres refused the intervention. These sessions were generally well attended by most surgeons, pathologists and other health care professionals at each centre. In addition all but one of the local opinion leaders for colorectal cancer met with the expert opinion leader for colorectal cancer for the academic detailing session that lasted between 15 and 30 minutes. DISCUSSION: We have enacted a unique study that has attempted to induce practice change among surgeons and pathologists using an adapted social marketing model that utilized the influence of both expert and local opinion leaders for colorectal cancer in a large geographic area with diverse practice settings