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

CANcer BEhavioural nutrition and exercise feasibility trial (CanBenefit); phase I qualitative interview findings

Background: Older people with lung cancer are often frail and unfit due to their cancer and co-morbidities and may tolerate cancer treatments poorly. Physical activity (PA) and a healthy diet offer quality of life benefit to people with cancer before, during, and post treatment. However, older adults are poorly represented in the clinical trials on which recommendations were made. Objective: To assess the acceptability, usefulness, and practicality of delivering a tailored wellbeing (PA and nutrition) intervention for older adults with lung cancer before, during, and after cancer treatments (chemotherapy and/or immunotherapy). Methods: Semi-structured interviews conducted with nine patients with lung cancer and three patients with mesothelioma, ≥70 years and ten informal carers, and nine Multidisciplinary Team (MDT) members. A topic guide covered the acceptability, usefulness, and practicality of a wellbeing intervention as well as specific feedback on individual components. Data were subjected to thematic analysis. Findings: Four themes were generated: current lack of wellbeing care in clinical work; preferred “can have” dietary and “can do” PA advice; peer support as facilitating factor; and barriers to compliance including patients' psychological and physical issues as well as current cancer pathway and staffing issues. Conclusion: Older adults with lung cancer would welcome a proactive, clear and instructive, wellbeing intervention. Many barriers to compliance exist, particularly before and during cancer treatments due to the psycho-social impact of diagnosis, and the effects of cancer treatment. The intervention must be tailored to individual need and address physical limitations, psychological and social welfare in addition to PA and nutritional advice

Demographic Differences Between Sheltered Homeless Families and Housed Poor Families: Implications for Policy and Practice

This study compares homeless families with a representative sample of low income family households in St. Louis city and county to determine how they differ on key demographic variables. The research addresses methodological problems in prior research by comparing the findings of this study\u27s random sample to the findings of four previous comparison studies. Findings from this study\u27s random comparison sample are presented. Homeless families are significantly younger, never married, female-headed families of color. Housed and homeless families are not significantly different in the number of children or in the educational level of the head of household but housed families are larger and have greater income. This suggests the presence of another adult earner in poor, housed families. Research implications include addressing sampling biases in comparative research through longitudinal studies. Policy and practice recommendations center on providing social and economic supports to homeless families to increase the number of supportive adults in the home

Physical activity and nutrition interventions for older adults with cancer: a systematic review

Purpose: The aim of this review was to summarize the current literature for the effectiveness of activity and nutritional based interventions on health-related quality of life (HRQoL) in older adults living with and beyond cancer (LWBC). Methods: We conducted systematic structured searches of CINAHL, Embase, Medline, Cochrane CENTRAL databases, and bibliographic review. Two independent researchers selected against inclusion criteria: (1) lifestyle nutrition and/or activity intervention for people with any cancer diagnosis, (2) measured HRQoL, (3) all participants over 60years of age and (4) randomized controlled trials. Results: Searches identified 5179 titles; 114 articles had full text review, with 14 studies (participant n = 1660) included. Three had nutrition and activity components, one, nutrition only and ten, activity only. Duration ranged from 7days to 1year. Interventions varied from intensive daily prehabilitation to home-based gardening interventions. Studies investigated various HRQoL outcomes including fatigue, general and cancer-specific quality of life (QoL), distress, depression, global side-effect burden and physical functioning. Eight studies reported significant intervention improvements in one or more QoL measure. Seven studies reported using a psychosocial/theoretical framework. There is a gap in tailored nutrition advice. Conclusions: Among the few studies that targeted older adults with cancer, most were activity-based programmes with half reporting improvements in QoL. Future research should focus on or include tailored nutrition components and consider appropriate behaviour change techniques to maximize potential QoL improvement. Implications for Cancer Survivors: More research is needed to address the research gap regarding older adults as current recommendations are derived from younger populations

Biogenic Matter Diagenesis on the Sea Floor: A Comparison Between Two Continental Margin Transects

Benthic chamber measurements of the reactants and products involved with biogenic matter diagenesis (oxygen, ammonium, nitrate, silicate, phosphate, TCO2, alkalinity) were used to define fluxes of these solutes into and out of the sediments off southern and central California. Onshore to offshore transects indicate many similarities in benthic fluxes between these regions. The pattern of benthic organic carbon oxidation as a function of water depth, combined with published sediment trap records, suggest that the supply of organic carbon from vertical rain can just meet the sedimentary carbon oxidation + burial demand for the central California region between the depths 100-3500 m. However, there is not enough organic carbon raining through the upper water column to support its oxidation and burial in the basins off southern California. Lateral transport and focusing of refractory carbon within these basins is proposed to account for the carbon buried. The organic carbon burial efficiency is greater off southern California (40-60%) compared to central California (2-20%), even though carbon rain rates are comparable. Oxygen uptake rates are not sensitive to bottom water oxygen concentrations nor to the bulk wt. % organic carbon in surficial sediments. Nitrate uptake rates are well defined by the depth of oxygen penetration into the sediments and the overlying water column nitrate concentration. Nitrate uptake accounts for about 50% of the total denitrification taking place in shelf sediments and denitrification (0.1-1.0 mmolN/m2d) occurs throughout the entire study region. The ratio of carbon oxidized to opal dissolved on the sea floor is constant (0.8 ± 0.2) through a wide range of depths, supporting the hypothesis that opal dissolution kinetics may be dominated by a highly reactive phase. Sea floor carbonate dissolution is negligible within the oxygen minimum zone and reaches maximal rates just above and below this zone (0.2-2.0 mmol/m2d)

Problem-Solving Intervention for Caregivers of Children with Mental Health Problems

Building Our Solutions and Connections (BOSC) focused on enhancing problem-solving skills (PSS) of primary caregivers of children with mental health problems. Aims were determining feasibility, acceptability, and effect size (ES) estimates for depression, burden, personal control, and PSS. Methods—Caregivers were randomized to BOSC (n=30) or wait-list control (WLC) groups (n=31). Data were collected at baseline, post-intervention, and 3 and 6 months post-intervention. Results—Three-months post-intervention, ES for burden and personal control were .07 and .08, respectively. ES for depressed caregivers for burden and personal control were 0.14 and 0.19, respectively. Conclusions—Evidence indicates that the intervention had desired effects

Preliminary Report on Stone Breakage and Lesion Size Produced by a New Extracorporeal Electrohydraulic (Sparker Array) Discharge Device

Objective To determine if an innovative extracorporeal electrohydraulic shock wave device (sparker array) can effectively fracture artificial stones in vitro and in vivo, and if sparker array treatment produces a renal lesion in our pig model of lithotripsy injury. Results of these experiments will be used to help evaluate the suitability of this device as a clinical lithotripter. Methods Utracal-30 artificial stones were placed in a holder at the focus of the sparker array and treated with 600 shock waves (21.6 kV, 60 shocks/min). Stone fragments were collected, dried and weighed to determine stone breakage. In vivo stone breakage entailed implanting stones into pigs. These stones were treated with 600 or 1200 shock waves and the fragments collected for analysis. Lesion analysis consisted of treating the left kidney of pigs with 1200 or 2400 shock waves and quantitating the hemorrhagic lesion. Results In vitro, 71±2% of each artificial stone was fractured to < 2 mm in size. In vivo stone breakage averaged 63%. Renal injury analysis revealed that only 1 out of 7 kidneys showed evidence of hemorrhagic injury in the treated area. Conclusions The sparker array consistently comminuted artificial stones demonstrating its ability to fracture stones like other lithotripters. Also, the sparker array caused little to no renal injury at the settings used in this study. These findings suggest further research is warranted to determine the potential of this device as a clinical lithotripter

Degradation of the Disease-Associated Prion Protein by a Serine Protease from Lichens

The disease-associated prion protein (PrPTSE), the probable etiological agent of the transmissible spongiform encephalopathies (TSEs), is resistant to degradation and can persist in the environment. Lichens, mutualistic symbioses containing fungi, algae, bacteria and occasionally cyanobacteria, are ubiquitous in the environment and have evolved unique biological activities allowing their survival in challenging ecological niches. We investigated PrPTSE inactivation by lichens and found acetone extracts of three lichen species (Parmelia sulcata, Cladonia rangiferina and Lobaria pulmonaria) have the ability to degrade prion protein (PrP) from TSE-infected hamsters, mice and deer. Immunoblots measuring PrP levels and protein misfolding cyclic amplification indicated at least two logs of reductions in PrPTSE. Degradative activity was not found in closely related lichen species or in algae or a cyanobacterium that inhabit lichens. Degradation was blocked by Pefabloc SC, a serine protease inhibitor, but not inhibitors of other proteases or enzymes. Additionally, we found that PrP levels in PrPTSE-enriched preps or infected brain homogenates are also reduced following exposure to freshly-collected P. sulcata or an aqueous extract of the lichen. Our findings indicate that these lichen extracts efficiently degrade PrPTSE and suggest that some lichens could have potential to inactivate TSE infectivity on the landscape or be a source for agents to degrade prions. Further work to clone and characterize the protease, assess its effect on TSE infectivity and determine which organism or organisms present in lichens produce or influence the protease activity is warranted

Seladelpar treatment reduces interleukin-31 and pruritus in patients with primary biliary cholangitis

BACKGROUND AND AIMS: Pruritus is a debilitating symptom for many people living with primary biliary cholangitis (PBC). In studies with seladelpar, a selective PPAR-delta agonist, PBC patients experienced significant improvement in pruritus and reduction of serum bile acids. Interleukin-31 (IL-31) is a cytokine known to mediate pruritus and blocking IL-31 signaling provides relief in pruritic skin diseases. This study examined the connection between seladelpar's anti-pruritic effects, IL-31 and bile acid levels in PBC patients. APPROACH AND RESULTS: IL-31 levels were quantified in serum samples from the ENHANCE study of PBC patients receiving daily oral doses of placebo (n=55), seladelpar 5 mg (n=53) or 10 mg (n=53) for 3 months and for healthy volunteers (n=55). IL-31 levels were compared with pruritus using a numerical rating scale (NRS, 0-10) and with bile acid levels. Baseline IL-31 levels closely correlated with pruritus NRS (r=0.54, p<0.0001), and total (r=0.54, p<0.0001) and conjugated bile acids (up to 0.64, p<0.0001). Decreases in IL-31 were observed with seladelpar 5 mg (-30%, p=0.0003) and 10 mg (-52%, p<0.0001) versus placebo (+31%). Patients with clinically meaningful improvement in pruritus (NRS≥2 decrease) demonstrated greater dose-dependent reductions in IL-31 compared to those without pruritus improvement (NRS<2 decrease). Strong correlations were observed for the changes between levels of IL-31 and total bile acids (r=0.63, p<0.0001) in the seladelpar 10 mg group. CONCLUSIONS: Seladelpar decreased serum IL-31 and bile acids in PBC patients. The reductions of IL-31 and bile acids correlated closely with each other and pruritus improvement suggesting a mechanism to explain seladelpar's anti-pruritic effects

Zebulon, Wake County : a community diagnosis including secondary data analysis and qualitative data collection

This document was created to identify and clarify points of interest and concern that are of significance to community members of Zebulon, North Carolina. The document is divided into two main sections. The first is a compilation of secondary data collected for Zebulon, and when possible, for Wake County and the State of North Carolina to use as comparisons. The second section addresses various topics brought to light during interviews with both community members and service providers within the Town. In essence, this document examines the congruence and differences between secondary data and the community’s perceptions concerning various topics of interest. Over the course of the interviewing process, many members of the Zebulon community shared their thoughts, beliefs, and experiences to help illuminate the most salient issues. The subsequent characteristics were identified as some of the most important, and hence, contributed greatly to the completion of this document: Community Characteristics: The small town of Zebulon is known as “The Town of Friendly People” and does a great deal to live up to its name. Many of the Town residents have lived there for a long period of time. Consequently, many residents enjoy familiarity with one another, close family ties, and a sense of history and community in the area. There is widespread community support within the Town from both individuals and community organizations such as churches, civic groups, and service agencies. Although Zebulon is a rural town, it now faces some issues more typical of urban centers. These issues are rapid and expansive growth, ethnic and language diversity within the population, public housing, increased crime and drugs, and growing industry and commercialization. The rapid change and growth that Zebulon has experienced in the last several years brings with it many needs and challenges, many demanding the attention of the Town and County governments. There is significant interest among residents and Town officials in handling the change and growth in Zebulon, especially concerning meeting the needs of the community through the provision, improvement, and assurance of services. Directions and Challenges: Zebulon is in the midst of a period of growth and change that the Town never before experienced. The recent annexation of Wakefield is an example of the community’s expansion, and one that illustrates some of the concerns facing Town Hall. The addition of more people means an increase in need for existing services and perhaps the development of new services. While growth is a welcomed sight for some members of Zebulon, many see it as a movement away from the traditionally held values and familiarity that come from living in a small town. The adjustment period has already started for some individuals in the community, but many steps have yet to be taken to make the Town accessible to everyone who calls it home. Several of the churches and civic organizations have offered their services to help new members to the community feel welcome, namely the growing Hispanic population. In addition, the new police chief has made a commitment to actively involving the police department in the community, thus showing one example of how the Town and its residents can work together to make Zebulon a better place for everyone. As continued growth and change face the Town, community members and service providers are preparing to address the challenges these bring. Many of the people interviewed have strong feelings and opinions about their Town and the direction in which it is moving. The greatest endeavor for Zebulon may focus on communication among Town officials, services providers, and community members to ensure a future that benefits all living and working within Zebulon.Master of Public Healt