Challenges in decision-making support processes regarding living kidney donation: A qualitative study.

BACKGROUND: Previous studies on decision-making of living kidney donors have indicated issues regarding donors' autonomy is inherent in decision-making to donate their kidney. Establishing effective decision-making support that guarantees autonomy of living kidney donor candidates is important. OBJECTIVES: The aim of this study was to identify the difficulties in the decision-making support when clinical transplant coordinators advocating for the autonomy of donor candidates of living donor kidney transplantation and to identify the methods to deal with these difficulties. DESIGN: A qualitative descriptive study. PARTICIPANTS: Ten clinical transplant coordinators supporting living kidney donors. APPROACH: Semi-structured interviews were conducted using an interview guide. The modified grounded theory approach was utilised to analyse. RESULTS: Three categories related to difficulties were as follows: issues inherent to the interaction between coordinators, donor candidates and their families; issues regarding the environment and institutional background in which coordinators operate; and emotional labour undertaken by coordinators in the decision-making support process. Additionally, five categories related to methods were as follows: assessing the autonomy of donor candidates based on the coordinators nursing experience; interventions for the donor candidates and their family members based on the coordinators nursing experience; smooth coordination with medical staff; clarifying and asserting their views as coordinators; and readiness to protect the donor candidates. CONCLUSION: The involvement of highly experienced coordinators with excellent and assertive communication skills as well as the ability to reflect on their own practices is essential. Moreover, we may need to fundamentally review the transplant community, where power domination is inherent.

A comparison of the exposure system of glycidol-related chemicals on the formation of glycidol-hemoglobin adducts.

Glycidol fatty acid esters that are present in foods are degraded in vivo to the animal carcinogen glycidol, which binds to the N-terminal valine of hemoglobin (Hb) to form N-(2,3-dihydroxypropyl)valine (diHOPrVal) adducts. The existence of other chemicals that are converted to glycidol is unknown. To determine the effect of different exposure conditions on the formation of diHOPrVal adducts, several glycidol-related chemicals (3-monochloropropane-1,2-diol; 3-MCPD, epichlorohydrin, glyceraldehyde, acrylic acid, and 1,2-propanediol) were evaluated using in vitro and in vivo (single/repeated dose) methods. In vitro, the reaction of 3-MCPD or epichlorohydrin with human Hb produced 17% and 0.7% of diHOPrVal, as compared to equimolar glycidol, respectively. Following a single administration of glycidol-related compounds to ICR mice, diHOPrVal formation was observed only in the epichlorohydrin-treated group after day 5 of exposure. After 14 days of repeated dosing, the amounts of diHOPrVal produced by epichlorohydrin and 3-MCPD in vivo were <1% of diHOPrVal produced by an equal molar concentration of glycidol. Furthermore, glyceraldehyde group produced 0.2% of diHOPrVal at the same molar concentration of glycidol equivalents, in which diHOPrVal formation could not be confirmed by the in vitro assay. The results indicate the usefulness of diHOPrVal as an exposure marker for glycidol; however, the contribution of its formation in vivo by exposure to various chemicals will be necessary to validate and interpret the results.

Potential Role of Lipase Activity on the Internal Exposure Assessment of Glycidol Released from Its Fatty Acid Esters.

Glycidyl fatty acid esters (GEs) can be found in food, and they can be converted into genotoxic animal carcinogen glycidol in vivo by the action of lipase. This study examined whether human ingestion of charbroiled pork containing high levels of GEs (300 µg/day) increased glycidol-hemoglobin adduct (diHOPrVal), a marker of internal exposure to glycidol using LC-MS/MS. Contrary to expectation, the diHOPrVal value before ingesting charbroiled pork was 3.11 ± 1.10 pmol/g globin, which slightly decreased to 2.48 ± 0.47 pmol/g globin after 5 days of consumption. The decrease in lipase activity caused by the continuous consumption of lipid-rich foods such as meat in humans might decrease internal exposure to glycidol released from its esters. Thus, lipase activity was measured in C57/BL6J mice fed a high-fat diet (HFD) for 8 weeks, and diHOPrVal formation was measured after the administration of glycidyl oleate. Lipase activity was significantly lower in the HFD group than in the normal diet group. The amount of diHOPrVal was reduced in the HFD group. Therefore, the lipase activity was reduced by HFD, thereby decreasing the degradation of glycidol from glycidyl oleate. These results indicate that changes in lipase activity depending on the amount of lipids in the diet may affect the assessment of GEs exposure, and monitoring the lipase activity would provide a comprehensive understanding of exposure assessment.

Structure-Activity Relationships of RGD-Containing Peptides in Integrin αvß5-Mediated Cell Adhesion.

The RGD motif is a cell adhesion sequence that binds to integrins, a receptor family for extracellular matrix proteins. We previously reported that the RGDX1X2 sequence, where X1X2 is VF or NY, is required for integrin αvß5-mediated cell adhesion. However, the importance and applications of the X1X2 combinations and their surrounding sequences of integrin αvß5-binding RGDX1X2-containing peptides have not been comprehensively elucidated. Therefore, we aimed to identify an RGD-containing peptide with enhanced integrin αvß5 binding activity. We synthesized various peptides based on the RGDVF and RGDNY peptides to optimize the N-terminal, C-terminal, and X1X2 combinations of the RGDX1X2 sequence. These peptides were immobilized on maleimide-functionalized bovine serum albumin-coated plates via a thiol-maleimide reaction, and cell adhesion was evaluated using HeLa cells and human dermal fibroblasts. Consequently, CPPP-RGDTF and CPPP-RGDTFI were identified as highly active peptides for integrin αvß5-mediated cell adhesion. CPPP-RGDTF and CPPP-RGDTFI are expected to serve as cell adhesion molecules for developing culture substrates and biomaterials. Furthermore, these findings provide important novel insights into the interaction between the RGD motifs and integrins.

On the Direct and Indirect Effects of the Great East Japan Earthquake on Self Rated Health through Social Connections: Mediation Analysis.

The Great East Japan Earthquake created health hazards for many people. Using Panel Data gathered in Iwanuma city, Japan, at two points in time (in 2010 before the quake, and in 2013 after the quake), we found that the high degree of housing damage negatively affected victims' self rated health (SRH) (direct effect), and decreased the levels of their social connections, which in turn also had a harmful effect on their SRH (indirect effect). We also found that although the direct impacts of earthquakes disappear relatively quickly, the harmful indirect effects associated with a decrease in social connections are slower to dissipate. We conducted a first-difference two-step GMM estimation to consider the possible problem of endogeneity. The results support the above conclusion, and show that in the short-term, the indirect impacts of the earthquake accounted for 55% of all the impacts experienced.

Which part of community social capital is related to life satisfaction and self-rated health? A multilevel analysis based on a nationwide mail survey in Japan.

This paper aims to clarify the association between various social capital components at the municipal level (community social capital) and two quality-of-life factors at the individual level [individual self-rated life satisfaction and self-rated health (SRH)] based on data from a nationwide social capital survey that the authors carried out in 2013 in Japan (N = 3406 in 99 municipalities). The survey covers residents in Japan between the ages of 20 and 79 years. We focus on both contextual social capital and household income inequality in terms of the Gini coefficient at the municipality level since, to the best of our knowledge, no paper has explicitly dealt with municipalities in Japan as the units of contextual social capital and the Gini. Our analyses show that the subjective life satisfaction of individuals, after controlling for socioeconomic status and health at the individual level, is associate with both an income gap and social capital at the municipal level. Every component of community social capital in this study except for generalized reciprocity, both cognitive (generalized trust, particularized trust, and particularized reciprocity), and structural (three types of group participation and daily contacts with neighbors, friends/acquaintances, and colleagues), and the Gini coefficient on earned income were associated with self-rated life satisfaction at the individual level with statistical significance. However, SRH is associated only with cognitive social capital at the community level. SRH has no significant association with structural components of community social capital or with a community income gap in terms of the Gini coefficient on personal income. Judging from the results of estimates in the study, most of the components of community social capital at the municipal level seem to play an important role in enhancing self-rated life satisfaction. Life satisfaction may be associated with the broad atmosphere of the municipal level where one resides, while SRH is associated with cognitive social capital rather than structural social capital. However, the difference in the impact of contextual social capital between the two QOL indices may indicate the importance of considering a proper contextual level that is suitable for the outcome.

[Readers' beliefs about text comprehension affect the quality of their summaries of a scientific article].

Readers' beliefs about text comprehension affect how they read texts. A previous study showed two types of readers' beliefs; one is a "transmission belief' which emphasizes the importance of understanding an author's intended meaning, while the other is a "transaction belief' which emphasizes the importance of reader-generated meaning. We expect that these beliefs also affect summarization, where readers need to effectively elicit important information from the text and reconstruct it. The present study examined how readers' beliefs were related to the quality of summaries they made for a scientific article. We used the followings as indicators of the quality of the summaries: how information from a scientific article was elicited and reconstructed, and to what extent the summaries were comprehensible. The results suggest that the stronger the transmission belief of a reader was, the less effectively the reader elicited and reconstructed information and the less comprehensible the summary was. Although it cannot reveal the relationships between the transaction belief and the quality of summaries, the present study suggests that readers' beliefs about text comprehension affect summarization.