Pancreas Transplantation: Personal Factors Associated with Good and Poor Post-Transplant Adaptive Response

Notable differences in patient adaptation after pancreas transplant cause some to thrive and return to independent living, while others struggle with emotional and social problems. In order to prepare vulnerable individuals to better cope after transplant, we investigated pre-transplant factors associated with post-transplant adaptive capacity. The pancreas transplant team de ned; good adaptive response (GAR) in patients who were responsible, resourceful, and optimistic. Poor adaptive response (PAR) was associated with patients who tended to complain and were emotionally dependent. METHODS: Experts included 3 nurse coordinators and 3 social workers. A modified Delphi approach was used to achieve consensus on the de nition of GAR and PAR. 200 of the last transplanted pancreas recipients were selected if they: received a pancreas transplant for type 1 DM, with, or without a kidney, and survived a minimum of six months post-transplant. The experts classified cases into GAR and PAR, contextualized by confidence. We completed a chart abstraction of all 200 cases using pre-transplant data and the extracted variables were regressed on the 54 top weighted GAR cases and the top 40 weighted PAR cases. RESULTS: In the final model, past smoker, currently on disability, simultaneous pancreas and kidney (SPK), and less than high school education significantly predicted probability of having a PAR (p<0.05). The model was a well-fitting model with a Hosmer and Lemeshow goodness of t test of (p=0.8250 < 0.05). Given the lack of inclusion of any of the predicted social variables for PAR patients we looked at predictors of GAR. The goodness of fit test was a well-fitting model (p= 0.6294 < 0.05). In addition to pancreas after kidney (PAK) having an odds ratio of 10.39, past smoker was 10.99 and current disability was 5.8. Discussion: The association of PAK with GAR and SPK with PAR suggests a possible effect from prior experience with transplant aiding in coping afterwards. Our findings support the need for a prospective study of coping with pancreas transplant and points to more intensive pre-transplant preparation of recipients, particularly those with lesser education

Home range, habitat selection and diet of foxes (vulpes vulpes) in a semi-urban riparian environment

Between 2000 and 2002 the home range, habitat selection and diet of foxes were examined in the Dandenong Creek Valley, Melbourne, Australia. The mean home range was 44.6 ha (range 19.2&ndash;152.6 ha). A significant selection towards blackberry and gorse used as diurnal shelter was found during the day with an active avoidance of less structurally complex vegetation types. Although there was obvious selection of certain habitats, the diet of the foxes was highly general and opportunistic and thus offers little potential as a factor to manipulate in order to reduce fox abundance. Given the strong preference for blackberry and gorse as a shelter resource, a habitat-manipulation strategy is suggested whereby patches of blackberry and gorse are removed and replaced with less structurally complex vegetation. Such a strategy has the potential to influence the density of foxes in semi-urban riparian environments such as those discussed in this study.<br /

Is Fairtrade in commercial farms justifiable?: its impact on commercial and small-scale producers in South Africa

Fairtrade initially was limited to improving the lives of small-scale and peasant farmers, but later on it embraced commercial farmers, which attracted criticism. While there are a number of justifications for the Fairtrade organization's decision, there are authors who feel that meaningful “fair trade” cannot be achieved with the inclusion of commercial farms. This paper investigates the impact of Fairtrade on commercial farms and small-scale farmer cooperatives in South Africa. Fairtrade on South African commercial farms embraces a number of policy concerns related to land reform, BEE and sustainable development. The results of the study show that when commercial farms are included in the Fairtrade model, communities in which these farmers live benefit from developmental projects. In addition, in some instances, farm workers gain shares in the commercial farms, and benefit from the farm owners’ knowledge and capital

Shared socio-economic pathways extended for the Baltic Sea: exploring long-term environmental problems

Long-term scenario analyses can be powerful tools to explore plausible futures of human development under changing environmental, social, and economic conditions and to evaluate implications of different approaches to reduce pollution and resource overuse. Vulnerable ecosystems like the Baltic Sea in North-Eastern Europe tend to be under pressure from multiple, interacting anthropogenic drivers both related to the local scale (e.g. land use change) and the global scale (e.g. climate change). There is currently a lack of scenarios supporting policy-making that systematically explore how global and regional developments could concurrently impact the Baltic Sea region. Here, we present five narratives for future development in the Baltic Sea region, consistent with the global Shared Socioeconomic Pathways (SSPs) developed for climate research. We focus on agriculture, wastewater treatment, fisheries, shipping, and atmospheric deposition, which all represent major pressures on the Baltic Sea. While we find strong links between the global pathways and regional pressures, we also conclude that each pathway may very well be the host of different sectoral developments, which in turn may have different impacts on the ecosystem state. The extended SSP narratives for the Baltic Sea region are intended as a description of sectoral developments at regional scale that enable detailed scenario analysis and discussions across different sectors and disciplines, but within a common context. In addition, the extended SSPs can readily be combined with climate pathways for integrated scenario analysis of regional environmental problems.Peer reviewe

Moral economies of consumption

The aim of this article is twofold: first, to bring together debates about enduring normative concerns surrounding the morality of consumption with more recent concerns about the ways specific moralities are constituted in and through markets. The second aim is to develop the concept of ‘moral economy’ and call for an approach to its study, attentive to how moralities of consumption develop through interactions between instituted systems of provision, forms of state regulation, customs within communities and the everyday reflections of consumers about the things that matter to them. As consumers are increasingly asked to factor environmental and fair labour concerns into their purchase and post-purchase habits, there is a real need to understand how moralities of consumption are both formatted through institutional frameworks and shaped everyday by actors from within. After developing a framework for the study of moral economies, this article explores in depth the experiences of one couple in relation to the cessation of a cardboard recycling collection in Shropshire (England) to show why a multilevel perspective is needed to appreciate the place of morality within the market

Protocol: Personality assessment as a support for referral and case-work in treatment for substance use disorders (PASRC-study)

<p>Abstract</p> <p>Background</p> <p>Assessment of co-morbid personality disorders in substance use disorders may lead to important insights concerning individual patients. However, little is known about the potential value of routine personality disorder assessment in a clinical context.</p> <p>Methods</p> <p>Patients are adults with past-year substance dependence seeking treatment at a centralized intake unit for substance abusers in the City of Copenhagen. A randomized controlled trial of assessment of personality disorders and individual feedback vs. a general life situation interview. Patients are followed at 3 and 6 months post-treatment</p> <p>Discussion</p> <p>If routine personality assessment improves outcomes of substance abuse treatment, the clinical implication is to increase the use of personality disorder assessment in substance abuse treatment settings.</p> <p>Trial registration</p> <p>Current controlled trials ISRCTN39851689</p

No influence of oxygen levels on pathogenesis and virus shedding in Salmonid alphavirus (SAV)-challenged Atlantic salmon (Salmo salar L.)

<p>Abstract</p> <p>Background</p> <p>For more than three decades, diseases caused by salmonid alphaviruses (SAV) have become a major problem of increasing economic importance in the European fish-farming industry. However, experimental infection trials with SAV result in low or no mortality i.e very different from most field outbreaks of pancreas disease (PD). This probably reflects the difficulties in reproducing complex biotic and abiotic field conditions in the laboratory. In this study we looked at the relationship between SAV-infection in salmon and sub-lethal environmental hypoxia as a result of reduced flow-through in tank systems.</p> <p>Results</p> <p>The experiment demonstrated that constant reduced oxygen levels (60-65% oxygen saturation: 6.5-7.0 mg/L) did not significantly increase the severity or the progress of pancreas disease (PD). These conclusions are based upon assessments of a semi-quantitative histopathological lesion score system, morbidities/mortalities, and levels of SAV RNA in tissues and water (measured by 1 MDS electropositive virus filters and downstream real-time RT-PCR). Furthermore, we demonstrate that the fish population shed detectable levels of the virus into the surrounding water during viraemia; 4-13 days after i.p. infection, and prior to appearance of severe lesions in heart (21-35 dpi). After this period, viral RNA from SAV could not be detected in water samples although still present in tissues (gills and hearts) at lasting low levels. Lesions could be seen in exocrine pancreas at 7-21 days post infection, but no muscle lesions were seen.</p> <p>Conclusions</p> <p>In our study, experimentally induced hypoxia failed to explain the discrepancy between the severities reported from field outbreaks of SAV-disease and experimental infections. Reduction of oxygen levels to constant suboptimal levels had no effect on the severity of lesions caused by SAV-infection or the progress of the disease. Furthermore, we present a modified VIRADEL method which can be used to detect virus in water and to supplement experimental infection trials with information related to viral shedding. By using this method, we were able to demonstrate for the first time that shedding of SAV from the fish population into the surrounding water coincides with viraemia.</p

Kidney transplant in diabetic patients: modalities, indications and results

<p>Abstract</p> <p>Background</p> <p>Diabetes is a disease of increasing worldwide prevalence and is the main cause of chronic renal failure. Type 1 diabetic patients with chronic renal failure have the following therapy options: kidney transplant from a living donor, pancreas after kidney transplant, simultaneous pancreas-kidney transplant, or awaiting a deceased donor kidney transplant. For type 2 diabetic patients, only kidney transplant from deceased or living donors are recommended. Patient survival after kidney transplant has been improving for all age ranges in comparison to the dialysis therapy. The main causes of mortality after transplant are cardiovascular and cerebrovascular events, infections and neoplasias. Five-year patient survival for type 2 diabetic patients is lower than the non-diabetics' because they are older and have higher body mass index on the occasion of the transplant and both pre- and posttransplant cardiovascular diseases prevalences. The increased postransplant cardiovascular mortality in these patients is attributed to the presence of well-known risk factors, such as insulin resistance, higher triglycerides values, lower HDL-cholesterol values, abnormalities in fibrinolysis and coagulation and endothelial dysfunction. In type 1 diabetic patients, simultaneous pancreas-kidney transplant is associated with lower prevalence of vascular diseases, including acute myocardial infarction, stroke and amputation in comparison to isolated kidney transplant and dialysis therapy.</p> <p>Conclusion</p> <p>Type 1 and 2 diabetic patients present higher survival rates after transplant in comparison to the dialysis therapy, although the prevalence of cardiovascular events and infectious complications remain higher than in the general population.</p

Structural Studies of the Tandem Tudor Domains of Fragile X Mental Retardation Related Proteins FXR1 and FXR2

Expansion of the CGG trinucleotide repeat in the 5′-untranslated region of the FMR1, fragile X mental retardation 1, gene results in suppression of protein expression for this gene and is the underlying cause of Fragile X syndrome. In unaffected individuals, the FMRP protein, together with two additional paralogues (Fragile X Mental Retardation Syndrome-related Protein 1 and 2), associates with mRNA to form a ribonucleoprotein complex in the nucleus that is transported to dendrites and spines of neuronal cells. It is thought that the fragile X family of proteins contributes to the regulation of protein synthesis at sites where mRNAs are locally translated in response to stimuli.Here, we report the X-ray crystal structures of the non-canonical nuclear localization signals of the FXR1 and FXR2 autosomal paralogues of FMRP, which were determined at 2.50 and 1.92 Å, respectively. The nuclear localization signals of the FXR1 and FXR2 comprise tandem Tudor domain architectures, closely resembling that of UHRF1, which is proposed to bind methylated histone H3K9.The FMRP, FXR1 and FXR2 proteins comprise a small family of highly conserved proteins that appear to be important in translational regulation, particularly in neuronal cells. The crystal structures of the N-terminal tandem Tudor domains of FXR1 and FXR2 revealed a conserved architecture with that of FMRP. Biochemical analysis of the tandem Tudor doamins reveals their ability to preferentially recognize trimethylated peptides in a sequence-specific manner