Context Dialysis patients’ lifestyles are associated with low levels of physical activity, increasing the chances of being removed from kidney waiting lists or dying while awaiting transplant because of increased cardiovascular risk factors and deteriorating health conditions. Personalized mobile health (mHealth) delivered programs may support their engagement in healthier lifestyles, maintain transplant eligibility, and reduce premature mortality. Objective To explore barriers and perceptions of physical activity behaviors and gauge interest in using mHealth in a physical activity wellness program for dialysis patients on the kidney transplant waiting list. Participants and Design In-depth key informant interviews were conducted with 22 randomly selected dialysis patients during dialysis treatment in an urban Southeastern coastal city. A theory-guided community-based participatory research approach was used to develop the interview content. Constructivist grounded theory guided the data analysis using NVIVO 10 (QSR Int). The 32-item checklist from the Consolidated Criteria for Reporting Qualitative Studies was used in the qualitative reporting. Results Dialysis patients had a mean age of 46 (SD, 10.7) years, 45% were female, and 82% were African American. Their mean duration on transplant waiting lists was 6.7 (SD 4.3) years, and 73% owned smartphones. After saturation was reached, predominant themes included (1) physical activity was perceived as optional, (2) social support both encouraged and limited physical activity, (3) chronic stress and coping influenced physical activity, (4) spirituality provided strength to engage in physical activity, (5) self-care management practices varied considerably, and (6) high interest (95%) for using mHealth to promote physical activity was found. Patients preferred their home and neighborhood environments to intradialytic settings for engaging in physical activity.
Pooled human serum, unheated (UU) and heated at 56°C for 30 (HU-30) and 60 (HU-60) min, and these media diluted 1:1 with broth (UD, were used to assess the effects of supraphysiologic temperature and broth dilution on the serum protein binding of ceftriaxone. Protein binding was determined by ultrafiltration and subsequent high-performance liquid chromatography analysis. Significant differences in protein binding between UU and HU-60 (P < 0.05), UD and HD-60 (P < 0.01), HD-30 and HD-60 (P < 0.01), and all undiluted and diluted media (P < 0.01) were found. These alterations in protein binding may influence the in vitro microbiologic testing of highly protein-bound antibiotics.Many variables have been reported to influence the in vitro determination of antimicrobial activity, including time (8,15,19) and temperature (7) of incubation, inoculum size (15,18,20), and medium composition (1,6,9,12,17 (10,16).Although the heating process eliminates an important confounding variable and potentially protects the investigator, an additional variable may be introduced-the effect of supraphysiologic temperature on serum proteins, which may result in alterations in protein binding. Also, dilution of serum with broth during an in vitro experiment may alter the protein binding of an antibiotic. The objectives of this study were to determine the effects of supraphysiologic temperature and broth dilution on serum protein binding.The undiluted media consisted of three 19-ml samples of pooled serum collected from four healthy male volunteers (ages 26 to 32 years). One sample was not heated (UU). Two of the samples were heated at 56°C, one for 30 min and the other for 60 min (HU-60). The diluted media (UD, HD-30, HD-60) consisted of three 10-ml samples of the pooled serum, heated as described above, with 9 ml of Mueller-Hinton broth (Difco Laboratories, Detroit, Mich.) supplemented with 50 jig of calcium per ml and 25 jig of magnesium per ml (CS-MHB) added to each (17). Immediately before use, a stock solution of ceftriaxone sodium (Rocephin; potency, 832 jig/mg; Hoffmann-La Roche Inc., Nutley, N.J.) was prepared. A 1-ml portion of this solution (2,000 ,ug/ml) was used to spike each medium to achieve a final concentration of 100 ,ug/ml and a final volume of 20 ml. A concentration of 100 ,ug/ml is easily achieved in humans after a 1-g dose (11).After the addition of ceftriaxone, the pHs of all serumcontaining media were measured (Ionalyzer, model 811; Orion Research, Inc., Cambridge, Mass.) and corrected to physiologic pH (7.4 + 0.05) by gently bubbling and vortexing CO2 gas through each sample. Each medium (1 ml) was * Corresponding author.promptly pipetted in triplicate into separate ultrafiltration devices (Centrifree Micropartition System, lot no. MU 0531 FFAA; Amicon Corp., Danvers, Mass.) and capped sterile polypropylene test tubes for free (ultrafiltrate) and total ceftriaxone concentration determinations, respectively. Three samples of CS-MHB alone, spiked with ceftriaxone (100 ,ug/ml), were used to ascertain recovery of ce...
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