Kidney Patients’ Intention to Receive a Deceased Donor Transplant: Development of Stage of Change, Decisional Balance and Self-efficacy Measures

In order to sustain life, patients whose kidneys fail must receive dialysis or obtain a transplant. This study reports on the development and validation of measures of Stage of Change, Decisional Balance and Self-efficacy based on the Transtheoretical Model (TTM) to assess patients’ readiness to receive a deceased donor transplant. We surveyed 293 transplant-eligible kidney patients about their deceased donation readiness. Exploratory and confirmatory analyses for all measures demonstrated factor structures similar to previous application of the TTM to other health behaviors, excellent model fit and good internal and external validity. These brief, reliable instruments with good psychometric properties can guide the development of improved, individually-tailored transplant education for patients

Translation and Validation of the Patient Activation Measure in Portuguese People with Type 2 Diabetes Mellitus

Introduction: Management of diabetes mellitus is largely dependent on patients' active participation in care. The 'Patient Activation Measure 13' assesses patients' knowledge, skills, and confidence in self-care. We aimed to translate, culturally adapt, and validate the 'Patient Activation Measure 13' to Portuguese, in people with type 2 diabetes. Material and Methods: The translation and cultural adaptation occurred in six phases. A convenience sample of people with type 2 diabetes was recruited from the waiting rooms of a diabetes outpatient centre in Lisbon, between March and April 2014. The questionnaire was self-administered; medical records were reviewed to obtain glycated haemoglobin levels. Main statistical analyses were based on the Rasch rating scale model. Results: The response rate for the final questionnaire was 76%. Rasch analysis was conducted on 193 respondents. Respondents had a mean age of 67.1 (SD 10.1) years, 42.7% were women, and the mean patient activation measure score (0 - 100) in the sample was 58.5 (SD 10.1). The sample was low to moderate in terms of activation: 40.4% were low in activation (levels 1 and 2), 49.7% were in level 3, and 9.8% were in level 4, the highest level of activation. All items had good fit and the response categories functioned well. Item reliability was 0.97 and person reliability was between 0.77 (real) and 0.83 (model). Discussion: The 'Patient Activation Measure 13' was translated and culturally adapted to European Portuguese and validated in people with diabetes, showing good psychometric properties. Future research should aim at evaluating test-retest reliability of the Portuguese 'Patient Activation Measure 13', and exploring its ability to measure changes in activation over time. Conclusion: The 'Patient Activation Measure 13' is now available in European Portuguese and has good psychometric properties.Liliana Laranjo was supported by a Junior Clinical Research award from the Harvard Medical School-Portugal program (HMSP-ICJ/0005/2010; Fundacao para a Ciencia e Tecnologia)

Criopreservação de genótipos de mandioca.

Mandioca (Manihot esculenta Crantz) é um alimento básico para a alimentação humana. É a terceira mais importante fonte de carboidratos nos trópicos, ocupando a sexta posição quando considerada a produção global. Nos últimos anos vários grupos de pesquisa têm relatado métodos para cultura de tecidos vegetais de mandioca, oferecendo importantes aplicações para as coleções de germoplasma, tais como a conservação, a facilidade de intercâmbio, micropropagação, erradicação de doenças, entre outros. Assim, um dos objetivos deste estudo foi ampliar essas investigações, avaliando os fatores associados à regeneração in vitro de duas cultivares de mandioca. Segmentos uninodais de plantas de mandioca crescidas in vitro foram cultivados até a obtenção de brotações axilares alongadas. Meristemas foram excisados e cultivados em quatro diferentes meios de cultura. A regeneração, o enraizamento e a formação de calos foram avaliados. Uma diferença significativa foi encontrada entre os meios de cultura testados. Para ambas as cultivares o melhor meio de cultura foi suplementado com 0,2 mg L-1 de cinetina e 1,0 g L-1 de carvão ativado. Em sequência a isso, vários métodos de criopreservação foram testados para o desenvolvimento de um protocolo de criopreservação eficiente para a conservação dessas cultivares. Usando a técnica de vitrificação, com uma solução de pré-tratamento modificada contendo 0,5% de Tween-20, alcançamos uma taxa de regeneração superior a 50% após exposição ao nitrogênio líquido

Downbeat nystagmus elicited by eyelid closure

We describe a patient with downbeat nystagmus (DBN) evoked only by eye closure. Brain and spinal cord magnetic resonance imaging revealed a T2 paramedian lesion in the left lower basis pontis and other white matter lesions consistent with multiple sclerosis. One potential mechanism for DBN in this case involves transverse ephaptic spread of excitation from areas that subserve coordinated lid closure to the decussating ventral tegmental tract.info:eu-repo/semantics/publishedVersio

Invariance of measures to understand decision-making for pursuing living donor kidney transplant

Living donor kidney transplant is the ideal treatment option for end-stage renal disease; however, the decision to pursue living donor kidney transplant is complex and challenging. Measurement invariance of living donor kidney transplant Decisional Balance and Self-Efficacy across gender (male/female), race (Black/White), and education level (no college/college or higher) were examined using a sequential approach. Full strict invariance was found for Decisional Balance and Self-Efficacy for gender and partial strict invariance was found for Decisional Balance and Self-Efficacy across race and education level. This information will inform tailored feedback based on these constructs in future intervention studies targeting behavior change among specific demographic subgroups

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Introduction: Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA. Methods: We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results: We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR–15) for T1DM and 42 years (IQR–15) for LADA (p = 0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p < 0.001). The mean BMI at diagnosis was 24.1 kg/m2 in T1DM group and 26.1 kg/m2 in LADA group (p = 0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p = 0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p < 0.001). The median daily insulin dose was 40 IU for T1DM (0.58 IU/kg) and 33.5 IU for LADA (0.57 IU/kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p = 0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p = 0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p = 0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration. Conclusion: Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome

Identificação e resistência a antibióticos de gêneros bacterianos presentes em surubins criados em tanques-rede.

O surubim é uma espécie apreciada pelo mercado consumidor, entretanto, seu cultivo intensivo em tanques-rede pode trazer problemas de sanidade devido ao estresse dos peixes, caso não sejam utilizadas boas práticas de manejo. Neste trabalho, objetivou-se identificar e verificar a resistência aos antibióticos de gêneros bacterianos isolados de Pseudoplatystoma sp. criados em tanques-rede de baixo volume

The Schwarzschild-de Sitter solution in five-dimensional general relativity briefly revisited

We briefly revisit the Schwarzschild-de Sitter solution in the context of five-dimensional general relativity. We obtain a class of five-dimensional solutions of Einstein vacuum field equations into which the four-dimensional Schwarzschild-de Sitter space can be locally and isometrically embedded. We show that this class of solutions is well-behaved in the limit of lambda approaching zero. Applying the same procedure to the de Sitter cosmological model in five dimensions we obtain a class of embedding spaces which are similarly well-behaved in this limit. These examples demonstrate that the presence of a non-zero cosmological constant does not in general impose a rigid relation between the (3+1) and (4+1)-dimensional spacetimes, with degenerate limiting behaviour.Comment: 7 page

Taub's plane-symmetric vacuum spacetime revisited

The gravitational properties of the {\em only} static plane-symmetric vacuum solution of Einstein's field equations without cosmological term (Taub's solution, for brevity) are presented: some already known properties (geodesics, weak field limit and pertainment to the Schwarzschild family of spacetimes) are reviewed in a physically much more transparent way, as well as new results about its asymptotic structure, possible matchings and nature of the source are furnished. The main results point to the fact that the solution must be interpreted as representing the exterior gravitational field due to a {\em negative} mass distribution, confirming previous statements to that effect in the literature. Some analogies to Kasner's spatially homogeneous cosmological model are also referred to.Comment: plain LaTex, four Postscript figure

Virtual Meson Cloud of the Nucleon and Intrinsic Strangeness and Charm

We have applied the Meson Cloud Model (MCM) to calculate the charm and strange antiquark distribution in the nucleon. The resulting distribution, in the case of charm, is very similar to the intrinsic charm momentum distribution in the nucleon. This seems to corroborate the hypothesis that the intrinsic charm is in the cloud and, at the same time, explains why other calculations with the MCM involving strange quark distributions fail in reproducing the low x region data. From the intrinsic strange distribution in the nucleon we have extracted the strangeness radius of the nucleon, which is in agreement with other meson cloud calculations.Comment: 9 pages RevTex, 4 figure