Are American transplant centers willing to transplant prisoners.

INTRODUCTION: The United Network for Organ Sharing (UNOS) is tasked with ensuring fair and equitable access to organs for patients seeking transplant. Despite UNOS' position statement clearly stating that prisoner status should not preclude transplant evaluation, prisoners continue to face significant barriers. The goal of this survey was to discover how many American transplant centers are willing to evaluate, list, and transplant prisoners. MATERIALS AND METHODS: All adult kidney transplant centers listed as active on the UNOS website were contacted to participate in a survey asking if they were willing to evaluate, list, and transplant prisoners, and why or why not. RESULTS: A total of 122 centers responded. Forty-nine were willing to evaluate, 43 willing to list, and 42 willing to transplant prisoners. Fourteen centers said yes, but on a case-by-case basis only. Things they reported considering were type of crime, length of sentence, and likelihood of release. Frequently cited reasons for not treating inmates were: inadequate follow up (28), insurance/funding (16), transportation (12), medication compliance (9), security (8), patient safety (8), and lack of social support (5). Twenty-four centers refused to disclose their policy or did not have one. CONCLUSIONS: Prisoners continue to face barriers to evaluation, listing, and receiving kidney transplants. A lack of understanding of contraindications to transplant or a lack of knowledge about the prisoner system on behalf of transplant centers may contribute to these barriers. We feel as transplant professionals it is our responsibility to assist vulnerable patients in overcoming barriers to transplantation and work to ensure equitable access to organs, regardless of prisoner status.

Robotic treatment of ureteropelvic junction obstruction in Eagle-Barrett Syndrome.

Eagle-Barrett Syndrome (EBS) is a rare congenital condition characterized by the triad of absent or defective abdominal wall muscles, urinary tract abnormalities, and bilateral cryptorchidism. Ureteropelvic junction obstruction (UPJO) is seldom reported in these patients, despite it being a common cause of childhood obstructive uropathy. We present the case of a patient with EBS who was subsequently identified as having symptomatic UPJO that was successfully treated with robotic pyeloplasty.

A pronounced uterine pro-inflammatory response at parturition is an ancient feature in mammals.

Regulating maternal immunity is necessary for successful human pregnancy. Whether this is needed in mammals with less invasive placentation is subject to debate. Indeed, the short gestation times in marsupials have been hypothesized to be due to a lack of immune regulation during pregnancy. Alternatively, the maternal marsupial immune system may be unstimulated in the absence of a highly invasive placenta. Transcripts encoding pro-inflammatory cytokines were found to be overrepresented in the whole uterine transcriptome at terminal pregnancy in the opossum, Monodelphis domestica To investigate this further, immune gene transcripts were quantified throughout opossum gestation. Transcripts encoding pro-inflammatory cytokines remained relatively low during pre- and peri-attachment pregnancy stages. Levels dramatically increased late in gestation, peaking within 12 h prior to parturition. These results mirror the spike of inflammation seen at eutherian parturition but not at attachment or implantation. Our results are consistent with the role of pro-inflammatory cytokines at parturition being an ancient and conserved birth mechanism in therian mammals.

Scholarly Activity and Research Training in Urology Residency Programs: Assessment of Current Practice and Barriers.

OBJECTIVE: To identify factors associated with effective scholarly activity and identify barriers to research during urology residency. METHODS: An online survey was sent to 134 urology residency program directors in the United States. The survey assessed program characteristics, available support, and barriers for scholarly activity. Logistic regression analysis was used to identify characteristics of programs in the top quintile for success in scholarly activity. RESULTS: There was a 40% response rate (n = 40). The majority of programs (86%) were university affiliated. Nearly all programs (98%) require participation in scholarly activity as a requirement for graduation. There were 3 primary outcomes evaluated: participation in original research, published scholarly activity and presentation of scholarly activity. Factors significantly associated with participation in original research were required research time (P = 0.06), lack of experienced faculty (P = 0.006), statistical and IRB support (P = 0.03, P = 0.01), funding (P = 0.02), and research curriculum (P = 0.006). Factors significantly associated with publication in peer reviewed journals were lack of funding and experienced faculty (P = 0.07, P = 0.01). Factors significantly associated with presentation of scholarly activity included research director (P = 0.05), chairman support (P = 0.02), research training (P = 0.03), protected time for faculty (P = 0.07), and faculty /resident attitudes toward conducting scholarly activity (P = 0.08, P = 0.02) and resident promotion linked to scholarly activity (P = 0.01). CONCLUSION: Training urology residents in research is essential. Current methods and available resources are variable. Programs should identify resources and barriers that have the greatest impact on resident success in scholarly activity, and may implement changes to improve productivity within their program.