Comprehensive health assessment and five-yr follow-up of allogeneic islet transplant recipients.

In patients with type 1 diabetes mellitus (T1DM) complicated by severe hypoglycemic episodes, fear of hypoglycemia can significantly impact daily life. We evaluated whether restoration of glycemic awareness and prevention of hypoglycemia by islet allotransplant could reduce fear and improve health status. We conducted a comprehensive evaluation of patient-based outcomes in 48 T1DM subjects screened for allogeneic islet transplant alone (ITA) and 27 subjects who received an ITA. A battery of generic health status and diabetes-specific measures were used to assess ITA at evaluation, six months, and then annually after ITA. Allogeneic islet transplant was associated with a reduction in behaviors adopted in avoiding hypoglycemia (p Value < 0.001) and attenuation in concerns about hypoglycemic episodes (p Value < 0.001). Changes in hypoglycemia fear tracked most closely with insulin use. While there was a trend toward global improvement in health as measured by the EQ-5D (p Value = 0.002) and in depression symptoms as measured by the Beck (p Value = 0.003), physical health remained unchanged following ITA. Our findings support the socioemotional benefits of ITA during the five years after ITA, which to some extent remains dependent on preservation of islet graft function.

Structuring the meaning of hope in health and illness.

The purpose of this paper is to describe a conceptual model for hope that captures the personal meaning of this construct within the context of health and illness. To identify this model, a research tool was created based on the semantic differential technique, a well-validated and often used approach for quantifying personal or connotative meaning. This tool was distributed in the form of a questionnaire to a voluntary sample (n = 550), consisting of three primary subsamples: a healthy adult subsample (n = 146), a chronic and life-threatening illness subsample (n = 159) and a nursing subsample (n = 206). A multidimensional structure for the concept, Hope, was identified, using principal components analysis. Three primary factors defined this structure: personal spirit (personal dimension), risk (situational dimension) and authentic caring (interpersonal dimension). Personal spirit, a dominant factor, is characterized by a holistic configuration of hope elements, revolving around a core theme of meaning. Risk is primarily a predictability factor, targeted with an underlying component of boldness. The authentic caring factor has a substantial credibility component, linked with the theme of comfort. Three distinctive features characterize this model: (a) its ability to capture the dynamic qualitative experience of hope within a holistic multidimensional quantitative framework, (b) its representation of hope as a location in three-dimensional space and (c) its sensitivity to individual and group variability. This integrative model deepens our understanding of the experience of hope within health and illness at the theoretical, clinical and methodological levels.

The effect of a Fusarium roseum culture and diacetoxyscirpenol on reproduction of White Leghorn females.

White Leghorn females in egg production (36 weeks old) were fed a culture of Fusarium roseum containing 15 ppm diacetoxyscirpenol (DAS) and other unidentified toxins at culture levels of 0, 1, and 2% of the diet for 8 weeks. Following this, all hens were placed on control (0% toxins) feed for 6 weeks. Birds were inseminated weekly with .05 ml of pooled semen from males given normal diets. The F. roseum had no significant effect on body weight change or egg weights. During the initial 8 weeks, egg production was significantly depressed by both the 1 and 2% levels whereas feed consumption, fertility, and hatchability of fertile eggs was reduced only by the 2% level of F. roseum. Moreover, the majority of embryo mortality occurred prior to the 7th day of incubation. All production levels returned to normal when the toxins were removed during the final 6 weeks. In a second experiment, control (0%), .5 ppm purified DAS, and 3% F. roseum culture were fed to White Leghorn females (50 weeks old) for 4 weeks followed by a 2-week withdrawal period when all birds were given control diets. In 4 weeks, hatchability of fertile eggs was reduced 24% by DAS and 99% by the culture of F. roseum but returned to normal after the toxins were removed. Other production indices were unaffected by dietary treatment. The DAS appears to be only partially responsible for the reduced hatchability; the major toxicant has not been identified.