Self-management education for rehabilitation inpatients suffering from inflammatory bowel disease: a cluster-randomized controlled trial.

Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management skills, delivered in an interactive manner, and evaluated it in a large, cluster-randomized trial. We assigned 540 rehabilitation inpatients suffering from IBD (mean age 43 years, 66% female) to either the new intervention or a control group comprising the same overall intensity and the same medical information, but only general psychosocial information. The primary outcome was patient-reported IBD-related concerns. Secondary outcomes included disease knowledge, coping, self-management skills, fear of progression, anxiety, depression and quality of life. Assessments took place at baseline, end of rehabilitation and after 3 and 12 months.The psychoeducational self-management program did not prove superior to the control group regarding primary and secondary outcomes. However, positive changes over time occurred in both groups regarding most outcomes. The superior effectiveness of the newly developed psychoeducational program could not be demonstrated. Since the intervention and control groups may have been too similar, this trial may have been too conservative to produce between-group effects.

Pre-transplant emotional support is associated with longer survival after allogeneic hematopoietic stem cell transplantation.

Emerging evidence suggests that psychosocial factors pre-transplant predict survival in cancer patients undergoing hematopoietic stem cell transplantation (HSCT). These studies, however, typically have small sample sizes, short-term follow ups or a limited panel of medical covariates. We extend this research in a large, well-characterized sample of transplant patients, asking whether patients' perceived emotional support and psychological distress predict mortality over 2 years. Prior to transplant, 400 cancer patients (55.5% males; 82.8% White; Mage=50.0 years; 67.0% leukemia, 20.0% lymphoma) were interviewed by a social caseworker, who documented the patients' perceived emotional support and psychological distress. Subsequently, patients received an allogeneic HSCT (51.0% matched-related donor, 42.0% matched-unrelated donor and 7.0% cord blood). HSCT outcomes were obtained from medical records. Controlling for demographic characteristics (age, sex, race/ethnicity and marital status) and medical confounders (disease type, conditioning regimen, remission status, cell dosage, donor and recipient CMV seropositivity, donor sex, comorbidities and disease risk), ratings of good emotional support pre-transplant predicted longer overall survival (hazard ratio (HR)=0.61, 95% confidence interval (CI), 0.42-0.91; P=0.013). Pre-transplant psychological distress was unrelated to survival, however (Ps>0.58). Emotional support was marginally associated with lower rates of treatment-related mortality (HR=0.58, CI, 0.32-1.05; P=0.073). These findings are consistent with the hypothesis that emotional support contributes to better outcomes following HSCT. Future studies should examine whether intervention efforts to optimize emotional resources can improve survival in cancer patients.

Immobilized catalase: deactivation and reactor stability.

The quasi-steady behavior of a continuous flow reactor in which hydrogen peroxide is decomposed by immobilized catalase is investigated. Under certain conditions, reactors involving such substrate-inhibited, self-poisoning reactions are susceptible to sudden failure and the reactor moves catastrophically from high- to low-conversion quasi-steady states. This exchange-of-steady-states phenomenon is examined in the light of experimental evidence for the enzyme catalase from bovine liver.

Deactivation of catalase by hydrogen peroxide.

When a mechanism is used to determine possible deactivation kinetics, a certain consistency with the kinetics of the main reaction is found. This result is examined in the light of experimental evidence obtained with bovine liver and Aspergillus catalases.

Studies on the deactivation of immobilized urease.

The results of experiments in a fixed-bed reactor and a CSTR containing urease immobilized on a nonporous support and conducted in the absence of diffusional limitations are reported. Kinetic parameters were established by separate batch experiments. The key observation was that the product ammonia attacked the free form of the enzyme and thereby illustrates the importance of mechanism in determining deactivation kinetics.

On the mechanism of immobilized glucose oxidase deactivation by hydrogen peroxide.

The result of experiments in a fixed-bed reactor containing glucose oxidase immobilized on a nonporous support and conducted in the absence of diffusional limitations are reported. Kinetic parameters were established by separate batch experiments. The key observation was that, in every case, poisoning by product hydrogen peroxide resulted in a minimum in enzyme activity in the interior of the bed, well away from the ends. The deactivation data were interpreted by fitting the rate constant for poisoning, the only free parameter, to a previously reported theory. The theory postulates several deactivation mechanisms each of which leads to self-consistent kinetics, but the only mechanism which fitted the data assumes that peroxide attack the enzyme when it is the from complexed with glucose. Theory and experiment agreed to within the accuracy (+/- 2%) of the activity measurements.

Concomitant determination of folar nitrogen loss, net carbon dioxide uptake, and transpiration.

A closed system was designed for concomitant determination of net CO(2) uptake, transpiration, and foliar nitrogen (N) loss in soybeans (Glycine max [L.] Merr.). The CO(2) uptake was monitored by infrared analysis of system air removed periodically in aliquots. Leaf vapors were trapped in calibrated tubes at Dry Ice temperature, and transpiration rate was determined from the quantity of condensate. Subsequent pyrochemiluminescent analysis of this condensate revealed reduced N forms, although a [ill] percentage (4 to 15%) of oxidized forms was found.Maximum CO(2) uptake (22.3 milligrams per square decimeter per hour), transpiration (2.5 grams H(2)O per square decimeter per hour), and the total (4.9 micrograms per square decimeter per hour), reduced (4.1 micrograms per square decimeter per hour), and oxidized (0.7 microgram per square decimeter per hour) N loss rates were measured between 6.5 and 10.5 hours (30 C) of a simulated 13-hour photoperiod in leaves of V4 to V5 (three to four trifoliolate stage) soybeans. During a temperature study (20, 25, 30, and 35 C) with these plants and several leaf positions of older vegetative soybeans (V9 to V11), total and reduced N loss were maximum at 30 C (V4 to V5: 9.8 and 9.3 micrograms per square decimeter per hour; V9 to V11: 3.3 and 2.9 micrograms per square decimeter per hour); transpiration was maximal at 30 C in V4 to V5 plants (2.6 grams H(2)O per square decimeter per hour) and at 35 C in V9 to V11 plants (2.4 grams H(2)O per square decimeter per hour); and CO(2) uptake was maximal at 25 and 30 C during both sampling dates (V4 to V5: 22.7 to 23.5 milligrams CO(2) per square decimeter per hour: V9 to V11: 14.1 to 14.5 milligrams CO(2) per square decimeter per hour). At 30 and 35 C these parameters were highest in the youngest tissue of V9 to V11 plants.In V9 to V11 plants at all four temperatures, reduced N loss was correlated with total N loss (r = 0.99 at 20, 25, and 30 C and 0.97 at 35 C), and CO(2) uptake with transpiration (r = 0.47 at 20 C, 0.75 at 25 C, 0.85 at 30 C, and 0.81 at 35 C). Transpiration was correlated with both total and reduced N loss at 30 C (total N: r = 0.69; reduced N: r = 0.70) and 35 C (total N: r = 0.58; reduced N: r = 0.54). In addition, CO(2) uptake was directly related to total (r = 0.69 at 30 C and 0.56 at 35 C) and reduced (r = 0.67 at 30 C and 0.56 at 35 C) N loss at these two temperatures.