Characteristics of the Early Immune Response Following Transplantation of Mouse ES Cell Derived Insulin-Producing Cell Clusters

Background The fully differentiated progeny of ES cells (ESC) may eventually be used for cell replacement therapy (CRT). However, elements of the innate immune system may contribute to damage or destruction of these tissues when transplanted. Methodology/Principal Findings Herein, we assessed the hitherto ill-defined contribution of the early innate immune response in CRT after transplantation of either ESC derived insulin producing cell clusters (IPCCs) or adult pancreatic islets. Ingress of neutrophil or macrophage cells was noted immediately at the site of IPCC transplantation, but this infiltration was attenuated by day three. Gene profiling identified specific inflammatory cytokines and chemokines that were either absent or sharply reduced by three days after IPCC transplantation. Thus, IPCC transplantation provoked less of an early immune response than pancreatic islet transplantation. Conclusions/Significance Our study offers insights into the characteristics of the immune response of an ESC derived tissue in the incipient stages following transplantation and suggests potential strategies to inhibit cell damage to ensure their long-term perpetuation and functionality in CRT

Preliminary Identification of Coping Profiles Relevant to Surrogate Decision Making in the ICU.

The Intensive Care Unit (ICU) is a stressful environment for families of critically ill patients and these individuals are at risk to develop persistent psychological morbidity. Our study objective was to identify individual differences in coping with stress and information presentation preferences of respondents exposed to a simulated ICU experience.Participants were recruited from a university and two community populations. Participants completed questionnaires that measured demographic information and characteristics that may be relevant to an individual's ICU experience. Quality of life was measured by the EQ-5D, personality dimensions were examined with the abbreviated Big Five inventory, coping with stress was assessed with Brief COPE. Shared decision making preferences were assessed by the Degner Control Preferences Scale (CPS) and information seeking style was assessed with the Miller Behavioral Style Scale (MBSS). Social support was examined using an abbreviated version of the Social Relationship Index. Participants also completed a vignette-based simulated ICU experience, in which they made a surrogate decision on behalf of a loved one in the ICU.Three hundred forty-three participants completed the study. Three distinct coping profiles were identified: adaptive copers, maladaptive copers, and disengaged copers. Profiles differed primarily on coping styles, personality, quality of their closest social relationship, and history of anxiety and depression. Responses to the simulated ICU decision making experience differed across profiles. Disengaged copers (15%) were more likely to elect to refuse dialysis on behalf of an adult sibling compared to adaptive copers (7%) or maladaptive copers (5%) (p = 0.03). Notably, the MBSS and the CPS did not differ by coping profile.Distinct coping profiles are associated with differences in responses to a simulated ICU experience. Tailoring communication and support to specific coping profiles may represent an important pathway to improving ICU experience for patients and families

Validation of the Intermountain patient perception of quality (PPQ) survey among survivors of an intensive care unit admission: a retrospective validation study

Background: Patients’ perceptions of the quality of their hospitalization have become important to the American healthcare system. Standard surveys of perceived quality of healthcare do not focus on the Intensive Care Unit (ICU) portion of the stay. Our objective was to evaluate the construct validity and internal consistency of the Intermountain Patient Perception of Quality (PPQ) survey among patients discharged from the ICU. Methods: We analyzed prospectively collected results from the ICU PPQ survey of all inpatients at Intermountain Medical Center whose hospitalization included an ICU stay. We employed principal components analysis to determine the constructs present in the PPQ survey, and Cronbach’s alpha to evaluate the internal consistency (reliability) of the items representing each construct. Results: We identified 5,680 patients who had completed the PPQ survey. There were three basic domains measured: nursing care, physician care, and overall perception of quality. Most of the variability was explained with the first two principal components. Constructs did not vary by type of respondent. Conclusions: The Intermountain ICU PPQ survey demonstrated excellent construct validity across three distinct constructs. This, in addition to its previously established content validity, suggests the utility of the PPQ survey as an assay of the perceived quality of the ICU experience. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0828-x) contains supplementary material, which is available to authorized users

Demographics by Coping Profile.

<p>Demographics by Coping Profile.</p

Average Standardized Coping Profile Component Scores.

<p>The dots represent the average standardized scores for each instrument subscale. Black solid lines represent Adaptive Copers, red dashed lines represent Maladaptive Copers, and blue long dashed lines represent Disengaged Copers. Abbreviations: Religion, Mental Health, and QOL, Religion, Mental Health, and Quality of Life; RDI, Religion Daily Importance; RA, Religious Attendance; Anx, Anxiety; Dep, Depression; QOL, Quality of Life; BFI, Big Five Inventory; Ext, Extraversion; Ag, Agreeableness; Con, Conscientiousness; Ne, Neuroticism; Op, Openness; COPE, Brief COPE; SD, Self-distraction; AC, Active Coping; De, Denial; SU, Substance Use; ES, Emotional Support; IS, Instrumental Support; BD, Behavioral disengagement; Ve, Venting; PR, Positive Reframing; Pl, Planning; Hu, Humor; Acc, Acceptance; Re, Religion; SB, Self-blame; CPS, Degner Control Preference Scale; Sub, Subject; LO, Loved One; MBSS, Miller Behavioral Style Scale; M, Monitoring; B, Blunting; SRI, Social Relationship Index; Imp, Importance; Help, Helpfulness; Up, Upsetting.</p

Demographic Characteristics of Respondents by Recruitment Cohort.

<p>Demographic Characteristics of Respondents by Recruitment Cohort.</p

Coping ProfileSeparation.

<p>Participants are represented by a different colored shape for each coping profile. Black circles represent the Adaptive Copers’, red triangles represent the Maladaptive Copers’, and blue squares represent the Disengaged Copers’.</p