Pre-transplant residual diuresis and oxalic acid concentration influence kidney graft survival

Background and hypothesisOxalic acid, a toxic metabolic end product, accumulates when kidney function deteriorates. Apart from its direct tubulotoxicity, it crystallizes at concentrations above 30–40 µmol/L. High oxalic acid concentrations at transplantation might negatively influence kidney transplant function. The influence of the concentrations of oxalic acid and its precursors and residual diuresis on kidney transplant outcomes was studied.MethodsIn this prospective cohort study, patients who received a kidney transplant between September 2018 and January 2022 participated. Concentrations of oxalic acid and precursors were determined in pre-transplant blood samples. Data on residual diuresis and other recipient, donor or transplant related variables were collected. Follow-up lasted until July 1st 2023.Results496 patients were included, 154 were not on dialysis. Median residual diuresis was 1000 mL/day (IQR 200; 2000 mL/day). There were 230 living donor transplantations. Oxalic acid concentrations exceeded the upper normal concentration in 99% of patients, glyoxylic acid in all patients. There were 52 (10%) graft failures. As the influence of oxalic acid on the risk of graft failure censored for death was non-linear, it was categorized into two groups: ≤ 60 and > 60 μmol/L. In multivariable Cox analysis the graft failure censored for death risk was significantly influenced by residual diuresis, donor type (living versus deceased), donor age and oxalic acid. In 180 patients oxalic acid concentration shortly after transplantation was significantly lower than pre-transplant concentrations, suggesting excretion by the new graft. A better eGFR at day 7 was associated with lower oxalic acid concentration. Oxalic acid and residual diuresis did not influence patient survival.ConclusionResidual diuresis and oxalic acid concentration are important and independent predictors of graft survival censored for death. These results underline the importance of pre-emptive transplantation, or optimizing the pre-transplant patients’ condition regarding waste product concentrations

Dissecting the planetary nebula NGC 4361 with MUSE

Context. Optical integral field spectroscopy of planetary nebulae (PNe) offers a unique tool to explore the spatial relationships between the complex mixture of the many components (neutral, low- and high-ionisation gas, dust, and the central star) and their underlying physical conditions. Aims. The optical line and continuum emission in the very-high-ionisation Galactic PN, NGC 4361, were mapped to study the distribution of ionisation, extinction, electron temperature, and density. Methods. Based on commissioning data, MUSE Wide Field (60×60″) normal-mode (4750–9300 Å) observations of NGC 4361 were reduced. The PN is larger than a single MUSE field and only the central 1 arcmin2 of the PN was observed in good conditions. Emission images in recombination and collisionally excited lines were extracted and the line ratios provided the dust extinction, electron density and temperature, and ionic abundances using standard techniques. A family of compact low-ionisation knots (dubbed ‘freckles’) was discovered and techniques developed to measure their spectra, independently of the extended high-ionisation medium. Results. The nebula is confirmed as optically thin in the H-ionising continuum, based on its very low He 

The role of goal cognitions, illness perceptions and treatment beliefs in self-reported adherence after kidney transplantation: A cohort study

Objective: Nonadherence to immunosuppressive medication (IM) after kidney transplantation is related to poorer patient and graft outcomes; therefore research into modifiable factors associated with nonadherence is a priority. In this prospective cohort study we investigated whether changes in goal cognitions, illness perceptions, and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation. Methods: Interviews were conducted with patients in the out-patient clinic six weeks (T1: n = 113) and six months (12: n = 106) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS (c) Interview). The Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire and questions on goal cognitions were also administered at both time points. Results: Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17% to 27%. Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time. Perceived necessity of immunosuppressive medication was high but significantly decreased over time. Concerns about the medicines were low. There were no significant changes in illness perceptions or concerns overtime. An increase Conclusion: The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes. Changes in (unrealistic) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients. (C) 2013 Elsevier Inc All rights reserved

Assessment of campus community readiness for tailoring implementation of evidence-based online programs to prevent risky substance use among university students in Germany

Abstract Research suggests that online interventions preventing risky substance use can improve student health. There is an increasing interest in transferring evidence-based online programs into university health promotion practice. However, little is known about how to best tailor the implementation process to capacities and context of individual universities. The purpose of this study was to assess the level of readiness (capacity) of German universities concerning the implementation of evidence-based online programs for risky substance use prevention employing an adapted Community Readiness Assessment (CRA) and to develop tailored action plans for implementation. The CRA involved 43 semi-structured interviews with key persons at 10 German universities. The interviews addressed five dimensions (knowledge of efforts, leadership, community climate, knowledge of the issue, and resources) at nine possible readiness stages (no awareness—ownership) and additional contextual factors. Overall, readiness for implementing online interventions across universities was rather low. Universities readiness levels ranged between the denial stage with a score of 2.1 and the preplanning stage with a score of 4.4. University-specific readiness was very heterogeneous. On the basis of the results of the CRA, universities received feedback and options for training on how to take the necessary steps to increase readiness and to prepare program implementation. The adapted version of the CRA was well suited to inform future implementation of evidence-based online programs for the prevention of risky substance use at participating universities.</jats:p

Assessment of campus community readiness for tailoring implementation of evidence-based online programs to prevent risky substance use among university students in Germany

Research suggests that online interventions preventing risky substance use can improve student health. There is an increasing interest in transferring evidence-based online programs into university health promotion practice. However, little is known about how to best tailor the implementation process to capacities and context of individual universities. The purpose of this study was to assess the level of readiness (capacity) of German universities concerning the implementation of evidence-based online programs for risky substance use prevention employing an adapted Community Readiness Assessment (CRA) and to develop tailored action plans for implementation. The CRA involved 43 semi-structured interviews with key persons at 10 German universities. The interviews addressed five dimensions (knowledge of efforts, leadership, community climate, knowledge of the issue, and resources) at nine possible readiness stages (no awareness—ownership) and additional contextual factors. Overall, readiness for implementing online interventions across universities was rather low. Universities readiness levels ranged between the denial stage with a score of 2.1 and the preplanning stage with a score of 4.4. University-specific readiness was very heterogeneous. On the basis of the results of the CRA, universities received feedback and options for training on how to take the necessary steps to increase readiness and to prepare program implementation. The adapted version of the CRA was well suited to inform future implementation of evidence-based online programs for the prevention of risky substance use at participating universities