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BackgroundSupporting patients to self-manage their chronic kidney disease (CKD) has been identified as a research priority by patients with CKD and those who care for them. Self-management has been shown to slow CKD progression and improve the quality of life of individuals living with the disease. Previous work has identified a need for a person-centered, theory-informed, web-based tool for CKD self-management that can be individualized to a patient’s unique situation, priorities, and preferences. We addressed this gap using an integrated knowledge translation method and patient engagement principles. ObjectiveThe aim of this study is to conduct systematic co-design and usability testing of a web-based self-management prototype for adults with CKD (nondialysis and nontransplant) and their caregivers to enhance self-management support. MethodsA multistep, iterative system development cycle was used to co-design and test the My Kidneys My Health prototype. The 3-step process included creating website features and content using 2 sequential focus groups with patients with CKD and caregivers, heuristic testing using the 10 heuristic principles by Nielsen, and usability testing through in-person 60-minute interviews with patients with CKD and their caregivers. Patients with CKD, caregivers, clinicians, researchers, software developers, graphic designers, and policy makers were involved in all steps of this study. ResultsIn step 1, 18 participants (14 patients and 4 caregivers) attended one of the 2 sequential focus groups. The participants provided specific suggestions for simplifying navigation as well as suggestions to incorporate video, text, audio, interactive components, and visuals to convey information. A total of 5 reviewers completed the heuristic analysis (step 2), identifying items mainly related to navigation and functionality. Furthermore, 5 participants completed usability testing (step 3) and provided feedback on video production, navigation, features and functionality, and branding. Participants reported visiting the website repeatedly for the following features: personalized food tool, my health care provider question list, symptom guidance based on CKD severity, and medication advice. Usability was high, with a mean system usability score of 90 out of 100. ConclusionsThe My Kidneys My Health prototype is a systematically developed, multifaceted, web-based CKD self-management support tool guided by the theory and preferences of patients with CKD and their caregivers. The website is user friendly and provides features that improve user experience by tailoring the content and resources to their needs. A feasibility study will provide insights into the acceptability of and engagement with the prototype and identify preliminary patient-reported outcomes (eg, self-efficacy) as well as potential factors related to implementation. This work is relevant given the shift to virtual care during the current pandemic times and provides patients with support when in-person care is restricted.

WHEN MY wife and I moved away from the Midwest some fifteen years ago, we began an age of perpetual homesickness. I'd tear up at the sight of Notre Dame's [...]

A reported increase of hookworm and strongyloidiasis transmission in rural Alabama, USA, in 2017 (1) has led to more interest in isolated cases of autochthonous transmission of soil-transmitted helminths in [...]

We describe a previously unappreciated role for Bruton's tyrosine kinase (BTK) in fungal immune surveillance against aspergillosis, an unforeseen complication of BTK inhibitors (BTKi) used for treating B cell lymphoid malignancies. We studied BTK-dependent fungal responses in neutrophils from diverse populations, including healthy donors, patients who were treated with BTKi, and X-linked agammaglobulinemia patients. Upon fungal exposure, BTK was activated in human neutrophils in a TLR2-, Dectin-1-, and Fc[gamma]R-dependent manner, triggering the oxidative burst. BTK inhibition selectively impeded neutrophil-mediated damage to Aspergillus hyphae, primary granule release, and the fungus-induced oxidative burst by abrogating NADPH oxidase subunit [p40.sup.phox] and GTPase RAC2 activation. Moreover, neutrophil-specific Btk deletion in mice enhanced aspergillosis susceptibility by impairing neutrophil function, not recruitment or lifespan. Conversely, GM-CSF partially mitigated these deficits by enhancing [p47.sup.phox] activation. Our findings underline the crucial role of BTK signaling in neutrophils for antifungal immunity and provide a rationale for GM-CSF use to offset these deficits in patients who are susceptible., Introduction Invasive aspergillosis (IA), most often caused by the ubiquitous inhaled mold Aspergillus fumigatus, is an opportunistic fungal infection that exploits numeric or functional neutrophil defects (1-3). IA affects over [...]

The deleterious nature of U.S. economic recessions over the last several decades highlight a need to investigate the role of family economic strain on families. The current study explored the impact of family economic strain on marital quality and marital stability through dyadic associations of marital support and work-family conflict of 370 married couples over a 12-year period (1989-2001) through an actor-partner interdependence model, encompassing two major U.S. recessions. Guided by family stress and coping theory, findings are consistent with past research indicating the negative impact of family economic strain on marital quality and marital stability; however, this impact may be mitigated through the mediation of positive perceptions of marital support and work-family conflict. Implications suggest financial counselors should consider the lasting influence of economic strain on families, and how the psychosocial resources of martial support and managing work-family conflict may promote relationship quality and stability.

We describe a case of a 2-year-old child who expelled a single adult female Ascaris lumbricoides worm. The patient is from a rural county in Mississippi, USA, with no reported travel outside of the United States. The caregivers in the home practice good sanitation. Exposure to domestic pigs is the likely source of infection.

The Caco-2 cell model is considered the gold standard when analysing drug permeability and risk-assessing bioavailability. The use of Simulated Intestinal Fluid (SIF) as a tool in the Caco-2 models is beneficial as this generates a more physiologically relevant model. Existing work using biorelevant media in Caco-2 cells has not fully captured the large-scale variability that can exist within the GI fluids. Furthermore, there is some evidence that the composition of biorelevant fluids can disrupt the Caco-2 monolayer, particularly when high levels of bile and cholesterol are present in these media. Therefore, understanding the compatibility of the simulated intestinal media with the Caco-2 cells is essential to determine its use as transport media in a Caco-2 assay.