Using an interactive water bottle to target fluid adherence in pediatric kidney transplant recipients: A pilot study

Hydration is important post‐renal transplant to maintain adequate renal perfusion and graft function. Adherence to fluid recommendations is challenging given barriers to staying hydrated. There are no studies of adherence to fluid intake recommendations following pediatric renal transplant. Through this pilot study, we sought to determine whether the use of a commercially available interactive water bottle would lead to better adherence to recommended fluid intake and improved kidney functioning post‐transplant relative to standard of care. Participants included 32 youth ages 7–19 ≥1 month post‐kidney transplant randomized to the intervention (HydraCoach ® water bottle) or standard education control group. Laboratory records were reviewed for serum chemistries (Na, BUN , creatinine) at baseline and one‐month follow‐up, and participants recorded daily fluid intake for 28 days. Those in the intervention group were significantly more likely to meet or exceed their fluid target, but this did not translate into better kidney functioning. Participants in the intervention group largely reported satisfaction with the water bottle and were likely to continue its use. While an interactive water bottle providing real‐time feedback may be a promising intervention to help pediatric kidney transplant patients meet fluid goals, it did not appear to impact kidney function.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109912/1/petr12385.pd

Human polyomaviruses in children undergoing transplantation, United States, 2008-2010

Immunocompromised patients are at risk for disease caused by infection by some polyomaviruses. To define the prevalence of polyomaviruses in children undergoing transplantation, we collected samples from a longitudinal cohort and tested for the 9 known human polyomaviruses. All were detected; several were present in previously unreported specimen types

Perfluorocyclobutane (PFC-318, <i>c</i>-C<sub>4</sub>F<sub>8</sub>) in the global atmosphere

We reconstruct atmospheric abundances of the potent greenhouse gas span classCombining double low line inline-formula span classCombining double low line inline-formula perfluorocyclobutane, perfluorocarbon PFC-318) from measurements of in situ, archived, firn, and aircraft air samples with precisions of span classCombining double low line inline-formula reported on the SIO-14 gravimetric calibration scale. Combined with inverse methods, we found near-zero atmospheric abundances from the early 1900s to the early 1960s, after which they rose sharply, reaching 1.66ppt (parts per trillion dry-air mole fraction) in 2017. Global span classCombining double low line inline-formula span classCombining double low line inline-formula emissions rose from near zero in the 1960s to span classCombining double low line inline-formula (1span classCombining double low line inline-formula gyrspan classCombining double low line inline-formula in the late 1970s to late 1980s, then declined to span classCombining double low line inline-formula classCombining double low line inline-formula in the mid-1990s to early 2000s, followed by a rise since the early 2000s to span classCombining double low line inline-formula 2.20±0.05 Ggyrspan classCombining double low line inline-formula in 2017. These emissions are significantly larger than inventory-based emission estimates. Estimated emissions from eastern Asia rose from 0.36Ggyrspan classCombining double low line inline-formula in 2010 to 0.73Ggyrspan classCombining double low line inline-formula in 2016 and 2017, 31% of global emissions, mostly from eastern China. We estimate emissions of 0.14Ggyrspan classCombining double low line inline-formula from northern and central India in 2016 and find evidence for significant emissions from Russia. In contrast, recent emissions from northwestern Europe and Australia are estimated to be small (span classCombining double low line inline-formula % each). We suggest that emissions from China, India, andspan idCombining double low line page10336 Russia are likely related to production of polytetrafluoroethylene (PTFE, Teflon ) and other fluoropolymers and fluorochemicals that are based on the pyrolysis of hydrochlorofluorocarbon HCFC-22 (span classCombining double low line inline-formula) in which span classCombining double low line inline-formula classCombining double low line inline-formula is a known by-product. The semiconductor sector, where span classCombining double low line inline-formula span classCombining double low line inline-formula is used, is estimated to be a small source, at least in South Korea, Japan, Taiwan, and Europe. Without an obvious correlation with population density, incineration of waste-containing fluoropolymers is probably a minor source, and we find no evidence of emissions from electrolytic production of aluminum in Australia. While many possible emissive uses of span classCombining double low line inline-formula span classCombining double low line inline-formula are known and though we cannot categorically exclude unknown sources, the start of significant emissions may well be related to the advent of commercial PTFE production in 1947. Process controls or abatement to reduce the span classCombining double low line inline-formula span classCombining double low line inline-formula by-product were probably not in place in the early decades, explaining the increase in emissions in the 1960s and 1970s. With the advent of by-product reporting requirements to the United Nations Framework Convention on Climate Change (UNFCCC) in the 1990s, concern about climate change and product stewardship, abatement, and perhaps the collection of span classCombining double low line inline-formula span classCombining double low line inline-formula by-product for use in the semiconductor industry where it can be easily abated, it is conceivable that emissions in developed countries were stabilized and then reduced, explaining the observed emission reduction in the 1980s and 1990s. Concurrently, production of PTFE in China began to increase rapidly. Without emission reduction requirements, it is plausible that global emissions today are dominated by China and other developing countries. We predict that span classCombining double low line inline-formula span classCombining double low line inline-formula emissions will continue to rise and that span classCombining double low line inline-formula span classCombining double low line inline-formula will become the second most important emitted PFC in terms of span classCombining double low line inline-formula equivalent emissions within a year or two. The 2017 radiative forcing of span classCombining double low line inline-formula span classCombining double low line inline-formula 0.52mWmspan classCombining double low line inline-formula) is small but emissions of span classCombining double low line inline-formula span classCombining double low line inline-formula and other PFCs, due to their very long atmospheric lifetimes, essentially permanently alter Earth's radiative budget and should be reduced. Significant emissions inferred outside of the investigated regions clearly show that observational capabilities and reporting requirements need to be improved to understand global and country-scale emissions of PFCs and other synthetic greenhouse gases and ozone-depleting substances.United States. National Aeronautics and Space Administration (Grant NNX07AE89G)United States. National Aeronautics and Space Administration (Grant NNX07AF09G)United States. National Aeronautics and Space Administration (Grant NNX07AE87G)Great Britain. Department for Business, Energy & Industrial Strategy (Grant 1028/06/2015)United States. National Oceanic and Atmospheric Administration (Grant RA-133-R15-CN-0008)National Natural Science Foundation of China (Grant 41575114)National Science Foundation (U.S.) (Grant ARC-1203779)National Science Foundation (U.S.) (Grant ARC-1204084)Natural Environment Research Council (Great Britain) (Grant NE/I027282/1

Measuring family management of transplant tasks: T he transplant responsibility questionnaire

Little is known about how parents and youth perceive their roles in post‐transplant management and how this relates to post‐transplant adherence. The goals of this study are to (1) describe a new measure, the TRQ , (2) to describe parent and child performance on the TRQ , and to (3) determine the relationship between the TRQ and adherence. We hypothesized that older youth would describe higher post‐transplant self‐care behaviors, parents would underestimate youth self‐care, and greater parent involvement would be associated with better adherence. Participants included 59 parent–child dyads. Inclusion criteria included: (i) youth aged 7–18 yr and (ii) at least three months post‐kidney or post‐liver transplant. Parents and youth completed the TRQ , and adherence was measured by s.d. of sequential immunosuppressant blood levels. Youth perceived greater levels of self‐care than their parents perceived. Older youth reportedly engaged in more self‐care than younger youth. Less than 25% of the sample was non‐adherent, and non‐adherence was unrelated to performance on the TRQ . The TRQ may have utility as a clinical tool to address areas for improvement in youth self‐care. The high degree of parental involvement likely explains the high degree of adherence in this sample.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97501/1/petr12064.pd

Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study

Rates of early AR in pediatric kidney transplantation have declined in every era but the most recent NAPRTCS cohort has shown an increase in late first AR rates. We hypothesized this was due to an increased proportion of deceased donor utilization and early steroid taper utilization. Using the NAPRTCS database, we compared the most recent three cohorts of patients transplanted between 2002-2006, 2007-2011, and 2012-2017. To determine variables that predict late first AR, we used two multivariable models: a standard Cox regression model and LASSO model. From the LASSO model, deceased donor source (P = .002), higher recipient age (P = .019), black race (P = .010), and transplant cohort 2012-17 (P = .014) were all significant predictors of more late first AR. On standard Cox regression analysis, those same variables, minus donor source, were significant, in addition to mycophenolates usage (P = .007) and lower eGFR at 12 months (P = .02). The most recent 2012-2017 cohort remains an independently significant risk factor for late first AR, suggesting unmeasured variables. Further research is needed to determine whether these higher late first AR rates will impact long-term graft survival in the most recent cohort

Perfluorocyclobutane (PFC-318, c-C4F8) in the global atmosphere

We reconstruct atmospheric abundances of the potent greenhouse gas c-C4F8 (perfluorocyclobutane, perfluorocarbon PFC-318) from measurements of in situ, archived, firn, and aircraft air samples with precisions of ∼1 %–2 % reported on the SIO-14 gravimetric calibration scale. Combined with inverse methods, we found near-zero atmospheric abundances from the early 1900s to the early 1960s, after which they rose sharply, reaching 1.66 ppt (parts per trillion dry-air mole fraction) in 2017. Global c-C4F8 emissions rose from near zero in the 1960s to 1.2±0.1 (1σ) Gg yr−1 in the late 1970s to late 1980s, then declined to 0.77±0.03 Gg yr−1 in the mid-1990s to early 2000s, followed by a rise since the early 2000s to 2.20±0.05 Gg yr−1 in 2017. These emissions are significantly larger than inventory-based emission estimates. Estimated emissions from eastern Asia rose from 0.36 Gg yr−1 in 2010 to 0.73 Gg yr−1 in 2016 and 2017, 31 % of global emissions, mostly from eastern China. We estimate emissions of 0.14 Gg yr−1 from northern and central India in 2016 and find evidence for significant emissions from Russia. In contrast, recent emissions from northwestern Europe and Australia are estimated to be small (≤1 % each). We suggest that emissions from China, India, and Russia are likely related to production of polytetrafluoroethylene (PTFE, “Teflon”) and other fluoropolymers and fluorochemicals that are based on the pyrolysis of hydrochlorofluorocarbon HCFC-22 (CHClF2) in which c-C4F8 is a known by-product. The semiconductor sector, where c-C4F8 is used, is estimated to be a small source, at least in South Korea, Japan, Taiwan, and Europe. Without an obvious correlation with population density, incineration of waste-containing fluoropolymers is probably a minor source, and we find no evidence of emissions from electrolytic production of aluminum in Australia. While many possible emissive uses of c-C4F8 are known and though we cannot categorically exclude unknown sources, the start of significant emissions may well be related to the advent of commercial PTFE production in 1947. Process controls or abatement to reduce the c-C4F8 by-product were probably not in place in the early decades, explaining the increase in emissions in the 1960s and 1970s. With the advent of by-product reporting requirements to the United Nations Framework Convention on Climate Change (UNFCCC) in the 1990s, concern about climate change and product stewardship, abatement, and perhaps the collection of c-C4F8 by-product for use in the semiconductor industry where it can be easily abated, it is conceivable that emissions in developed countries were stabilized and then reduced, explaining the observed emission reduction in the 1980s and 1990s. Concurrently, production of PTFE in China began to increase rapidly. Without emission reduction requirements, it is plausible that global emissions today are dominated by China and other developing countries. We predict that c-C4F8 emissions will continue to rise and that c-C4F8 will become the second most important emitted PFC in terms of CO2-equivalent emissions within a year or two. The 2017 radiative forcing of c-C4F8 (0.52 mW m−2) is small but emissions of c-C4F8 and other PFCs, due to their very long atmospheric lifetimes, essentially permanently alter Earth's radiative budget and should be reduced. Significant emissions inferred outside of the investigated regions clearly show that observational capabilities and reporting requirements need to be improved to understand global and country-scale emissions of PFCs and other synthetic greenhouse gases and ozone-depleting substances