Patients on the Waiting List for Liver Transplantation: Caregiver Burden and Stress

Over the last few decades, informal caregivers of patients with chronic diseases have received more attention, and there is a growing volume of studies demonstrating high rates of burden, stress, and mental disorders in this group of individuals. The objective of this study was to evaluate the burden, stress, and psychosocial characteristics of informal caregivers of liver transplantation candidates. Participants were assessed by individual evaluations with the following instruments: a semi-structured interview, the Caregiver Burden Scale, the Inventario de Sintomas de Stress para Adultos de Lipp, and the Beck Depression Inventory. The Mann-Whitney test was used for statistical analysis with a significance level of 0.05. The characteristics of the study group (n = 61) were similar to those of groups in other studies with respect to gender (82% were women), kinship (64% were spouses), and age (the mean age was 47.6 years). The main stressors identified by the participants were as follows: doubts about ways to react in a crisis or in emergency situations (42.6%), mood swings of the patient (29.5%), and care involving food and medications (27.9%). Approximately 25% of the caregivers reported that they felt unprepared to adequately perform their roles. Data analysis indicated a greater burden overall on caregivers when the patient`s Model for End-Stage Liver Disease score was greater than or equal to 15 points (P = 0.041). Furthermore, caregivers of patients with alcoholic liver disease showed higher depression (P = 0.034) and overall burden scores (P = 0.031) versus caregivers of patients with liver disease due to other etiologies. In conclusion, the participants showed significantly high levels of burden, stress, and depression. Support measures and caregiver preparation should be implemented by health care providers. Liver Transpl 16: 1164-1168, 2010. (C) 2010 AASLD.

How Old Is Luzia? Luminescence Dating and Stratigraphic Integrity at Lapa Vermelha, Lagoa Santa, Brazil

During an excavation in the 1970s, a disarticulated female human skeleton, later nicknamed Luzia, was discovered at 12m depth at Lapa Vermelha rockshelter in central Brazil. Radiocarbon dating of associated charcoal suggested an age of 11.4-16.4 ka for the skeleton. The scattering of the skeletal parts, some uncertainty about the exact provenience of the skeleton, and evidence of pervasive insect turbation in the archaeological layers have raised doubts about the accuracy of the age. Luminescence dates for the depositional ages of the sediments at Lapa Vermelha are reported here. Single-grain optically stimulated luminescence (OSL) of quartz along with grain-size, chemical and micro-morphological analyses of the sediments were employed to assess stratigraphic integrity, particularly the degree of sediment mixing. These various lines of evidence point to high stratigraphic integrity with little mixing at Lapa Vermelha. Sediments closest to where Luzia was recovered give OSL ages ranging from 12.7 to 16.0 ka, thus not refuting the original dates. (C) 2010 Wiley Periodicals, Inc.

Lapa das boleiras rockshelter: stratigraphy and formation processes at a paleoamerican site in Central Brazil

Lapa clas Boleiras rockshelter, a Paleoamerican archaeological site in Central Brazil, was intensely occupied by humans from 10,000 C-14 BP (11.8 cal kyr BP), until approximately 7500 C-14 BP (8.4 cal kyr BP). In this paper we present some interpretations about the formation processes operating on the site. One of our main conclusions is that the bulk of accumulated sediments at the site is of anthropogenic origin: they are constituted by volumetrically significant quantities of plant ash remains, what is somewhat unexpectedly in view of prevailing models about the lifestyle of Paleoamerican hunter-gatherers in South America. The evidence we discuss below is also consistent with paleoenvironmental data that suggest a dry period during the mid-Holocene in the region, probably leading to a decrease in human occupation [Araujo, A.G.M., Neves, W., Pilo, L.B., Atui, J.P., 2005. Holocene dryness and human Occupation in Brazil during the `Archaic Gap`. Quaternary Research 64, 298-307]. We surmise that both factors underpin a surprising reduction in sediment accumulation at the site during the mid-Holocene. (C) 2008 Published by Elsevier Ltd.

Tree height integrated into pantropical forest biomass estimates

Aboveground tropical tree biomass and carbon storage estimates commonly ignore tree height (H). We estimate the effect of incorporating H on tropics-wide forest biomass estimates in 327 plots across four continents using 42 656 H and diameter measurements and harvested trees from 20 sites to answer the following questions: 1. What is the best H-model form and geographic unit to include in biomass models to minimise site-level uncertainty in estimates of destructive biomass? 2. To what extent does including H estimates derived in (1) reduce uncertainty in biomass estimates across all 327 plots? 3. What effect does accounting for H have on plot- and continental-scale forest biomass estimates? The mean relative error in biomass estimates of destructively harvested trees when including H (mean 0.06), was half that when excluding H (mean 0.13). Power- and Weibull-H models provided the greatest reduction in uncertainty, with regional Weibull-H models preferred because they reduce uncertainty in smaller-diameter classes (< 40 cm D) that store about one-third of biomass per hectare in most forests. Propagating the relationships from destructively harvested tree biomass to each of the 327 plots from across the tropics shows that including H reduces errors from 41.8 Mg ha(-1) (range 6.6 to 112.4) to 8.0 Mg ha(-1) (-2.5 to 23.0).

Endophthalmitis: A Rare but Devastating Metastatic Bacterial Complication of Hemodialysis Catheter-Related Sepsis

There are many infectious complications related to vascular access in patients undergoing maintenance hemodialysis. We report two cases of endophthalmitis as a metastatic infection associated with a tunneled catheter and a temporary dual lumen catheter. Both patients were diabetic. A 61-year-old female on maintenance hemodialysis by a jugular tunnelized catheter during the past year was receiving parenteral antibiotics for catheter salvage due to fever episodes in the last 3 months. She was admitted to the hospital presenting pain, proptosis, conjunctival hyperemia, corneal infiltrate, and visual acuity of no light perception (NLP). A 51-year-old male recently undergoing hemodialysis by a temporary dual lumen catheter presented fever. His catheter was removed, but he was admitted to the hospital presenting fever, decreased vision, edema, and pain in his left eye. On examination, eyelid edema, conjunctival hyperemia, purulent secretion, hypopyon in the pupils, and visual acuity of NLP were verified. A diagnosis of endogenous endophthalmitis was made in both patients on clinical grounds and computed tomography. Evisceration of the left eye was the first option of treatment for both patients due to poor vision. Cultures of the eviscerated ocular globes showed Staphylococcus hemolyticus and Staphylococcus aureus, respectively. After evisceration, both patients received treatment, had a good outcome, and were discharged to continue their hemodialysis program. Metastatic bacterial endophthalmitis is a rare complication of dialysis catheter-related bacteremia. When suspected, urgent ophthalmologic evaluation and treatment are needed to reduce the risk of losing vision in the affected eye.

Multibrane solutions in cubic superstring field theory

Using the elements of the so-called KBc gamma subalgebra, we study a class of analytic solutions depending on a single function F(K) in the modified cubic superstring field theory. We compute the energy associated to these solutions and show that the result can be expressed in terms of a contour integral. For a particular choice of the function F(K), we show that the energy is given by integer multiples of a single D-brane tension.

A serological follow-up of toxocariasis patients after chemotherapy based on the detection of IgG, IgA, and IgE antibodies by enzyme-linked immunosorbent assay.

A serological follow-up study was carried out on 27 children (1–12 years old) with visceral and/or ocular toxocariasis, after treatment with thiabendazole. A total of 159 serum samples were collected in a period ranging from 22–116 months. Enzyme-linked immunosorbent assays (IgG, IgA, and IgE ELISA) were standardized, using excretory–secretory antigens obtained from the second-stage larvae of a Toxocara canis culture. The sensitivity found for the IgG, IgA, and IgE ELISA, as determined in visceral toxocariasis patients, was 100%, 47.8%, and 78.3%, respectively. Approximately 84% of the patients presented single or multiple parasitosis, as diagnosed by stool examination, yet such variables did not appear to affect the anti-Toxocara immune response. Titers of specific IgE antibody showed a significant decrease during the first year after treatment, followed by a decrease in the IgA titers in the second year, and in the IgG titers from the fourth year onwards. Sera from all patients presented high avidity IgG antibodies, indicating that they were in the chronic phase of the disease. Moreover, 1 year after treatment, the level of leukocytes, eosinophils, and anti-A isohemagglutinin in patients decreased significantly. The present data suggest that IgE antibodies plus eosinophil counts are helpful parameters for patient followup after chemotherapy.