A Smartphone App for Increasing Live Organ Donation.

The incidence of live donor transplantation has declined over the past decade, and waitlisted candidates report substantial barriers to identifying a live donor. Since asking someone to donate feels awkward and unfamiliar, candidates are hesitant to ask directly and may be more comfortable with a passive approach. In collaboration with Facebook leadership (Facebook Inc., Menlo Park, CA), we developed a mobile application-an app-that enables waitlisted candidates to create a Facebook post about their experience with organ failure and their need for a live donor. We conducted a single-center prospective cohort study of 54 adult kidney-only and liver-only waitlisted candidates using the Facebook app. Cox proportional hazards models were used to describe donor referral on behalf of candidates using the app compared with matched controls. The majority of candidates who used the app reported it to be "good" or "excellent" with regard to the installation process (82.9%), readability (88.6%), simplicity (70.6%), clarity (87.5%) and the information provided (85.3%). Compared with controls, candidates using the Facebook app were 2.43 6.6117.98 times more likely to have a donor come forward on their behalf (p < 0.001). The Facebook app is an easy-to-use instrument that enables waitlisted candidates to passively communicate with their social network about their need for a live donor.

Where the Sun Shines: Industry's Payments to Transplant Surgeons.

The Open Payments Program (OPP) was recently implemented to publicly disclose industry payments to physicians, with the goal of enabling patient awareness of potential conflicts of interests. Awareness of OPP, its data, and its implications for transplantation are critical. We used the first wave of OPP data to describe industry payments made to transplant surgeons. Transplant surgeons (N = 297) received a total of $759 654. The median (interquartile range [IQR]) payment to a transplant surgeon was $125 ($39-1018), and the highest payment to an individual surgeon was $83 520; 122 surgeons received <$100, and 17 received >$10 000. A higher h-index was associated with 30% higher chance of receiving >$1000 (relative risk/10 unit h-index increase = 1.18 1.301.44 , p < 0.001). The highest payment category was consulting fees, with a total of $314 448 paid in this reported category. Recipients of consulting fees had higher h-indices, median (IQR) of 20 (10-35) versus nine (3-17) (p < 0.001). Ten of 122 companies accounted for 62% of all payments. Kidney transplant and liver transplant (LT) centers that received >$1000 had higher center volumes (p < 0.001). LT centers that received payments of >$1000 had a higher percentage of private-insurance/self-pay patients (p < 0.01). Continued surveillance of industry payments may further elucidate the relationship between industry payments and physician practices.

Early Hospital Readmission After Simultaneous Pancreas-Kidney Transplantation: Patient and Center-Level Factors.

Early hospital readmission is associated with increased morbidity, mortality, and cost. Following simultaneous pancreas-kidney transplantation, rates of readmission and risk factors for readmission are unknown. We used United States Renal Data System data to study 3643 adult primary first-time simultaneous pancreas-kidney recipients from December 1, 1999 to October 31, 2011. Early hospital readmission was any hospitalization within 30 days of discharge. Modified Poisson regression was used to determine the association between readmission and patient-level factors. Empirical Bayes statistics were used to determine the variation attributable to center-level factors. The incidence of readmission was 55.5%. Each decade increase in age was associated with an 11% lower risk of readmission to age 40, beyond which there was no association. Donor African-American race was associated with a 13% higher risk of readmission. Each day increase in length of stay was associated with a 2% higher risk of readmission until 14 days, beyond which each day increase was associated with a 1% reduction in the risk of readmission. Center-level factors were not associated with readmission. The high incidence of early hospital readmission following simultaneous pancreas-kidney transplant may reflect clinical complexity rather than poor quality of care.

A Risk Index for Living Donor Kidney Transplantation.

Choosing between multiple living kidney donors, or evaluating offers in kidney paired donation, can be challenging because no metric currently exists for living donor quality. Furthermore, some deceased donor (DD) kidneys can result in better outcomes than some living donor kidneys, yet there is no way to compare them on the same scale. To better inform clinical decision-making, we created a living kidney donor profile index (LKDPI) on the same scale as the DD KDPI, using Cox regression and adjusting for recipient characteristics. Donor age over 50 (hazard ratio [HR] per 10 years = 1.15 1.241.33 ), elevated BMI (HR per 10 units = 1.01 1.091.16 ), African-American race (HR = 1.15 1.251.37 ), cigarette use (HR = 1.09 1.161.23 ), as well as ABO incompatibility (HR = 1.03 1.271.58 ), HLA B (HR = 1.03 1.081.14 ) mismatches, and DR (HR = 1.04 1.091.15 ) mismatches were associated with greater risk of graft loss after living donor transplantation (all p < 0.05). Median (interquartile range) LKDPI score was 13 (1-27); 24.2% of donors had LKDPI < 0 (less risk than any DD kidney), and 4.4% of donors had LKDPI > 50 (more risk than the median DD kidney). The LKDPI is a useful tool for comparing living donor kidneys to each other and to deceased donor kidneys.

Perioperative Complications After Living Kidney Donation: A National Study.

We integrated the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012) to identify predonation comorbidity and perioperative complications captured in diagnostic, procedure, and registry sources. Correlates (adjusted odds ratio, aOR) of perioperative complications were examined with multivariate logistic regression. Among 14 964 living kidney donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% were planned open procedures. Overall, 16.8% of donors experienced a perioperative complication, most commonly gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), surgical/anesthesia-related injuries (2.4%), and "other" complications (6.6%). Major Clavien Classification of Surgical Complications grade IV or higher affected 2.5% of donors. After adjustment for demographic, clinical (including comorbidities), procedure, and center factors, African Americans had increased risk of any complication (aOR 1.26, p = 0.001) and of Clavien grade II or higher (aOR 1.39, p = 0.0002), grade III or higher (aOR 1.56, p < 0.0001), and grade IV or higher (aOR 1.56, p = 0.004) events. Other significant correlates of Clavien grade IV or higher events included obesity (aOR 1.55, p = 0.0005), predonation hematologic (aOR 2.78, p = 0.0002) and psychiatric (aOR 1.45, p = 0.04) conditions, and robotic nephrectomy (aOR 2.07, p = 0.002), while annual center volume >50 (aOR 0.55, p < 0.0001) was associated with lower risk. Complications after live donor nephrectomy vary with baseline demographic, clinical, procedure, and center factors, but the most serious complications are infrequent. Future work should examine underlying mechanisms and approaches to minimizing the risk of perioperative complications in all donors.

Impact of microbiology cascade reporting on antibiotic de-escalation in cefazolin-susceptible Gram-negative bacteremia.

Cascade reporting (CR) involves reporting the susceptibilities of broad-spectrum agents only when the organism is resistant to more narrow-spectrum agents. The purpose of this study is to evaluate the impact of CR on antibiotic de-escalation practices and to characterize the impact of CR on clinical outcomes. CR rules were implemented in the microbiology laboratory at Atlantic Health System (AHS) in June 2013. A retrospective chart review was conducted at two community teaching hospitals in adult patients who had a blood culture positive for a Gram-negative organism susceptible to cefazolin and who were empirically treated with broad-spectrum beta-lactam (BSBL) antibiotics. De-escalation practices were compared in the pre-CR (July 2012-December 2012) and post-CR (July 2013-December 2013) periods. The primary endpoint was the percentage of patients whose BSBL agent was de-escalated to agents listed on the post-CR antibiotic susceptibility report within 48 h of the final report. Secondary endpoints include the difference in pre-CR and post-CR periods in terms of hospital length of stay, in-hospital mortality, 30-day readmission, Clostridium difficile infections, and re-initiation of a BSBL agent within 7 days. A total of 73 patients were included; 31 in the pre-CR and 42 in the post-CR period. Patients had similar baseline characteristics. Therapy was de-escalated in 48 % of pre-CR vs 71 % of post-CR patients (p = 0.043). No significant differences were observed in secondary endpoints between patients in the pre-CR and post-CR periods. CR resulted in significant improvements in de-escalation practices without affecting safety outcomes.

Loss of pediatric kidney grafts during the "high-risk age window": insights from pediatric liver and simultaneous liver-kidney recipients.

Pediatric kidney transplant recipients experience a high-risk age window of increased graft loss during late adolescence and early adulthood that has been attributed primarily to sociobehavioral mechanisms such as nonadherence. An examination of how this age window affects recipients of other organs may inform the extent to which sociobehavioral mechanisms are to blame or whether kidney-specific biologic mechanisms may also exist. Graft loss risk across current recipient age was compared between pediatric kidney (n = 17,446), liver (n = 12,161) and simultaneous liver-kidney (n = 224) transplants using piecewise-constant hazard rate models. Kidney graft loss during late adolescence and early adulthood (ages 17-24 years) was significantly greater than during ages <17 (aHR = 1.79, 95%CI = 1.69-1.90, p < 0.001) and ages >24 (aHR = 1.11, 95%CI = 1.03-1.20, p = 0.005). In contrast, liver graft loss during ages 17-24 was no different than during ages <17 (aHR = 1.03, 95%CI = 0.92-1.16, p = 0.6) or ages >24 (aHR = 1.18, 95%CI = 0.98-1.42, p = 0.1). In simultaneous liver-kidney recipients, a trend towards increased kidney compared to liver graft loss was observed during ages 17-24 years. Late adolescence and early adulthood are less detrimental to pediatric liver grafts compared to kidney grafts, suggesting that sociobehavioral mechanisms alone may be insufficient to create the high-risk age window and that additional biologic mechanisms may also be required.

Chryseobacterium indologenes subcutaneous port-related bacteremia in a liver transplant patient.

Chryseobacterium indologenes is a rare cause of infection in select immunosuppressed hosts. Most prior reports are from Taiwan, in patients with diabetes mellitus or malignancies. Infections caused by C. indologenes are generally associated with indwelling devices, and the organism may be resistant to many commonly utilized broad-spectrum antibiotics. We report the first case, to our knowledge, of C. indologenes subcutaneous port-related bacteremia in a liver transplant recipient. The isolates were resistant to antibiotics previously reported as active, and device removal was required for treatment success.

Implementation of the EU environmental noise directive: lessons from the first phase of strategic noise mapping and action planning in Ireland.

The first phase of noise mapping and action planning in Ireland, in accordance with EU Directive 2002/49/EC, is now complete. In total this included one agglomeration, one airport and approximately 600 km of major roads outside the agglomeration. These noise maps describe the level of noise exposure of approximately 1.25 million people. The first phase of noise mapping was dealt with by five noise mapping bodies while 26 action planning authorities were involved in the development of the associated action plans. The second phase of noise mapping, due to be completed in 2012, sees a reduction in the defined thresholds describing the required agglomerations, roads and railways that have to be mapped. This will have a significant impact on the extent of mapping required. In Ireland this will result in an increased number of local authorities being required to develop strategic noise maps for their area along with the further development of associated action plans. It is appropriate at this point to review the work process and results from the first phase of noise mapping in Ireland in order to establish areas that could be improved, throughout the noise mapping project. In this paper a review of the implementation procedures focussing on (dominant) road traffic noise is presented. It is identified that more standardisation is needed and this could be achieved by the establishment of a national expert steering group.

Size frequency distribution of martian craters and relative age of light and dark terrains.

Light and dark terrains in and around Meridiani Sinus, mapped on the imagery from Mariner 6 and Mariner 7, were found to have significantly different cumulative size frequency distributions of craters. The light terrain on a mosaic of frames 6N11, 6N13, and 6N19 has a greater proportion of large craters and a lesser proportion of smaller craters than the dark terrain on the same frames. The light terrain is interpreted to be generally older than the dark terrain. The filling or partial filling of the smaller craters on the light terrain by surface detritus is suggested. Several wide-angle frames have remarkably similar cumulative crater size frequency distributions that may be representative of a large portion of the martian surface.

Mossbauer investigation of shocked and unshocked iron meteorites and fayalite.

Mössbauer spectra of several iron meteorites have been measured by a resonant scattering technique rather than by the conventional transmission method, thereby eliminating the necessity for the preparation of thin samples. No significant differences were observed in the spectra of specimens of mechanically deformed, shocked, and unshocked iron meteorites, nor in the absorption spectra of artificially shocked and unshocked fayalite.

Mineralogy and petrology of coarse particulate material from lunar surface at tranquillity base.

Five grams of coarse fines (10085,11) contains 1227 grains, mostly mafic holocrystalline rock fragments, microbreccia, and glass spatter and agglomerates with less abundant anorthosite fragments and regularly shaped glass. The crystalline lithic fragments in the coarse fines and microbreccias represent a closely related suite of gabbroid igneous rocks that have a wider range of modal analyses and textures than seen in the larger crystalline rock samples returned by Apollo 11. Petrographic evidence of shock metamorphism is common, and the abundant glass is almost all shock-produced. None of the glass observed is similar to tektite glass.

Chondrules in apollo 14 samples: implications for the origin of chondritic meteorites.

Chondrules have been observed in several breccia samples returned by the Apollo 14 mission. These lunar chondrules are believed to have formed during a large impact event, perhaps the one that formed the Imbrian Basin. This suggests that some meteoritic chondrules are also formed by impact processes such as crystallization after shock melting and abrasion and diffusion in base-surge and fall-back deposits generated by impacts on planetary surfaces.

Meteorite fail at pueblito de allende, chihuahua, Mexico: preliminary information.

Specimens from the meteorite fall at 1:05 a. m., on 8 February 1969 at Pueblito de Allende, Chihuahua, Mexico, have been recovered. The meteorite is a chondrite (C3 and C4) with both opaque and microcrystalline matrices. Specimens were brought to a low background gamma counter less than 4 (1/2) days after the fall, and gamma rays from short-lived isotopes have been observed.

Lunar receiving laboratory.

The Lunar Receiving Laboratory will be the permanent depository of a portion of the collection of lunar samples; it will safeguard the collection, providing continuing security and ensuring scientific integrity. In carrying out the time-dependent experiments and continuing functions of the laboratory, NASA will rely on visiting expert scientists supplementing a relatively small resident staff; outside scientists will be relied upon for most investigations and detailed analyses of samples. It is believed that the designed procedures and facilities provided will ensure the maximum scientific return from the Apollo Program in the way of information from lunar samples.

Frailty and Health-Related Quality of Life in End Stage Renal Disease Patients of All Ages.

BACKGROUND: Frailty is associated with worse health-related quality of life (HRQOL) in older adults and worse clinical outcomes in adults of all ages with end stage renal disease (ESRD). It is unclear whether frail adults of all ages with ESRD are more likely to experience worse HRQOL. OBJECTIVE: The goal of this study was to identify factors associated with worsening HRQOL in this population. DESIGN, SETTING AND MEASUREMENTS: We studied 233 adults of all ages with ESRD enrolled (11/2009-11/2013) in a longitudinal cohort study. Frailty status was measured at enrollment and HRQOL was reported (Excellent, Very Good, Good, Fair or Poor) at the initial assessment and follow-up (median follow-up 9.4 months). We studied factors associated with Fair/Poor HRQOL at follow-up using logistic regression and factors associated with HRQOL change using multinomial regression. All models were adjusted for age, sex, race, education, BMI, diabetes status, history of a previous transplant, type of dialysis and time between assessments. RESULTS: Fair/Poor HRQOL was reported by 28% at initial assessment and 33% at follow-up. 47.2% of participants had stable HRQOL, 22.8% better HRQOL, and 30.0% worse HRQOL at follow-up (P<0.001). In adjusted models, only frailty was associated with Fair/Poor HRQOL at follow-up (OR: 2.79, 95% CI: 1.32-5.90) and worsening HRQOL at follow-up (RR: 2.91, 95%CI: 1.08-7.80). CONCLUSIONS: Frail adults of all ages with ESRD are more likely to experience fair/poor HRQOL and worsening HRQOL over time. Frailty represents a state of decreased physiologic reserve that impacts not only clinical outcomes but also the patient-centered outcome of HRQOL.

Signal-to-noise ratio improvement in multiple electrode recording.

Recordings of spike trains made with microwires or silicon electrodes include more noise from various sources that contaminate the observed spike shapes compared with recordings using sharp microelectrodes. This is a particularly serious problem if spike shape sorting is required to separate the several trains that might be observed on a particular electrode. However, if recordings are made with an array of such electrodes, there are several mathematical methods to improve the effective signal (spikes) to noise ratio, thus considerably reducing inaccuracy in spike detection and shape sorting. We compare the theoretical basis of three such methods and evaluate their performance with simulated and real data.

The Seasonal Pattern Assessment Questionnaire for identifying seasonal affective disorders.

The SPAQ is a widely used tool for identifying possible cases of recurrent major depressive disorders with a seasonal pattern. However, its test-retest reliability, sensitivity, specificity, positive predictive value, negative predictive value, efficiency and predictive validity have not previously been formally assessed. Forty-seven subjects who fulfilled the DSMIIIR criteria for a major depressive disorder with a seasonal pattern were traced and re-interviewed after five to eight years. The SPAQ was found to have a positive predictive value of 48% and an efficiency of 57% in identifying cases of SAD confirmed by follow-up. The test-retest reliability was low. There was a mean difference in seasonality score between the first and second test of 3.17 +/- 4.7 (mean +/- 1 S.D.). Although the SPAQ is a rapid method of collecting information about recent seasonal variation, it has low test-retest reliability and on its own is unable to predict the seasonality of the future course of illness.

Bacterial vaginosis and Chlamydia trachomatis among pregnant abused and nonabused Hispanic women.

OBJECTIVE: To compare the prevalence of bacterial vaginosis (BV) and Chlamydia trachomatis (CT) among abused and nonabused pregnant Hispanic women. DESIGN: Retrospective audit of charts of 233 pregnant, abused Hispanic women and 468 pregnant, nonabused Hispanic women. SETTING: Three urban prenatal clinics of a public health department in the southwestern United States. SAMPLE: The medical records of 701 pregnant Hispanic women. MAIN OUTCOME MEASURE: Diagnosis of BV and/or CT among abused and nonabused pregnant women. RESULTS: Combined prevalence of BV and CT was significantly higher for abused women (z score = 2.55; df = 138; p < .05). There was no significant difference between abused and nonabused women for CT alone (z score = .96; df = 33; p < .05); however, prevalence of BV was significantly higher for abused women (z score = 1.99; df = 104; p < .05). CONCLUSION: In this sample of pregnant Hispanic women prevalence of BV was significantly higher in those who had been abused, indicating the need for targeted screening of all abused pregnant women for BV.