The influence of a Healthy Welcoming Environment on participation in club sport by adolescent girls: a longitudinal study.

BACKGROUND: This study investigated the perceived influence of a Healthy Welcoming Environment (HWE) on participation in sports clubs among adolescent girls, and how these perceptions changed longitudinally. HWE was defined in terms of a set of health promotion policies advocated by a health promotion foundation as the basis of sport club health promotion practice to promote structural reform in state sporting organisations and their affiliated associations and clubs. These included sports injury prevention, smoke-free, responsible serving of alcohol, sun protection, healthy eating, and welcoming and inclusive environments. METHODS: Year 7 and 11 female students from metropolitan (n = 17) and non-metropolitan secondary schools (n = 14) in Australia were invited to participate in three annual surveys. These surveys collected information about current or past membership of a sports club and the influence of HWEs on their decision to participate (or not) in a sports club. RESULTS: Year 7 (n = 328; 74.5%) and Year 11 (n = 112; 25.5%) female students completed all three waves (19.6% response rate; 82.7 and 74.0% retention rate). Most agreed that characteristics of HWEs were a positive influence on their participation in sports clubs, except those relating to alcohol and Sunsmart. Welcoming factors had consistent high agreement among respondents. Alcohol and friendliness factors of the club were regarded as being positively influential by higher percentages of non-metropolitan than metropolitan respondents. CONCLUSIONS: Welcoming factors were the most positive influences on decisions to participate in sports clubs. These factors may be important in reducing barriers to sport participation. Strategies supporting the social environment within sports clubs should be prioritised.

OPO Strategies to Prevent Unintended Use of Kidneys Exported for High PRA (>98% cPRA) Recipients.

Since the advent of the Kidney Allocation System (KAS), matched candidates with high (>98%) panel reactive antibody (hPRA) are given priority over local candidates with lower PRA. This often leads to exporting of kidneys. Data for these kidneys are not detailed on routine reports. Twenty-two organ procurement organizations prospectively submitted data from August 2015 to July 2016, describing allocation practices of kidneys to hPRA patients and outcomes of these kidneys. Five hundred twenty out of 6924 procured kidneys were exported for hPRA recipients. Of these, 402 (77.3%) were transplanted into the intended recipient (IR); 100 (19.2%) were transplanted into unintended recipients (UR), and 18 (3.5%) were discarded. The most common reason for use in an UR was a positive crossmatch (XM) (63%). The most common reasons for discard were donor quality (44%) and ischemic time (39%). Prior to kidney export, when tissue crossmatching was done, 96.2% of the kidneys went to the IR, versus 80.7% following virtual CM, versus 56.7% when no crossmatching was performed (p < 0.0001). A significant number of kidneys exported for hPRA patients are not being used in the IR or are being discarded. The most common reason for this is positive tissue XM. We report that unintended use of the kidney was minimized when tissue was shipped and XM results were known prior to exporting the kidney.

Trends in body image of adolescent females in metropolitan and non-metropolitan regions: a longitudinal study.

BACKGROUND: Body dissatisfaction is associated with a range of adverse outcomes, including impaired psychological health, low physical activity and disordered eating. This longitudinal study used the Factors Influencing Transitions in Girls' Active Leisure and Sport (FITGALS) dataset to examine trends in body image of adolescent females. Specifically, the study examined satisfaction with body size, physical appearance and dieting behaviour for two cohorts at transitional life phases in two geographic regions longitudinally over a 3-year period. METHODS: A sample of 732 adolescent females in Grade 7 (n = 489, 66.8 %) and Grade 11 (n = 243, 33.2 %) at randomly selected Australian metropolitan and non-metropolitan secondary schools responded to a questionnaire in three successive years from 2008 to 2010. Participants reported perceptions about their body size and physical appearance and whether they were, or ought to be, on a diet. The data were analysed using a series of longitudinal logistic regression models. RESULTS: Dieting and dissatisfaction with body size significantly increased over time and more so for older than younger girls. Region significantly moderated the effect of grade level regarding dissatisfaction with body size but not dieting. In non-metropolitan regions, those in the younger cohort were significantly more likely to be dissatisfied with their body size than the older cohort; whereas in metropolitan regions, those in the older cohort were significantly more likely to be dissatisfied with their body size than the younger cohort. Adolescent female's perceptions of their appearance were unchanged over time, region and grade level. CONCLUSIONS: Differences across time, region and grade level were found among adolescent females on body size and dieting behaviour, but not physical appearance. Adolescent females experience early and increasing body size dissatisfaction and dieting as they age, but stable perceptions of physical appearance. Age and geographic region are important considerations for the timing and targeting of interventions to address body image concerns. Further investigation of regional differences in body image perceptions and factors that affect these is warranted. The findings of this study highlight the ongoing need for strategies during adolescence to promote a healthy appreciation of body size and appearance.

Population levels of sport participation: implications for sport policy.

BACKGROUND: Participation in sport can contribute to health-enhancing levels of leisure-time physical activity. There are recent reports that participation in sport in Australia is decreasing. However, these studies are limited to ages 15 years and over. METHODS: This study integrates sports club membership data from five popular team sports and investigates sport participation across the lifespan (4-100 years) by sex and region (metropolitan/non-metropolitan). RESULTS: Overall participant numbers per annum increased from 414,167 in 2010 to 465,403 in 2012 corresponding to a rise in the proportion of Victorian's participating in these sports from 7.5 % in 2010 to 8.3 % in 2012. The highest proportion of participants was in the 10-14 year age range, with participation rates of 36 % in 2010 and 40 % in 2012. There was a considerably lower participation rate in the 15-19 year age group compared to the 10-14 age group, in all three years studied, and the decline continued progressively with increasing age. Male and female age profiles of participation were generally similar in shape, but the female peak at age 10-14 was sharper than for the males, and conversely there were very few 4 year old female participants. Participation rates were generally higher in non-metropolitan than metropolitan areas; the difference increased with increasing age from 4 to 34 years, then steadily declined, reaching parity at around 60 years of age. CONCLUSIONS: It is a positive sign that participation in these popular sports increased by over 50,000 participants from 2010 to 2012. Large proportions of the population aged 5-14 participate in club based sport. Participation rates decline sharply in late adolescence, particularly for females, and while this may not be a concern from a broad health perspective so long as they transition into other forms of physical activity, it is certainly a matter of concern for the sport sector. It is recommended that sport policy places a higher priority on grass-roots participation and that sporting organisations are supported to prioritise the retention issues occurring during adolescence, particularly for females so as to maximise the potential for sport to maintain its positive contribution to population wellbeing.

Patterns of time use among regional and rural adolescent girls: Associations with correlates of physical activity and health-related quality of life.

OBJECTIVES: To describe patterns of time use among regional and rural adolescent girls and compare identified clusters with respect to correlates of physical activity (PA) and health-related quality of life (HRQoL). DESIGN: Cross-sectional PA and lifestyle survey. METHODS: Data were from Year 7-9 adolescent girls (aged 12-15 years) from 16 schools involved in a cluster-randomised trial in regional and rural Victoria, Australia (n=494). Time use data were collected using 24-h Previous Day Physical Activity Recall (PDPAR-24) questionnaire, collapsed into 17 categories of time use. Differences between time use clusters with regard to demographics, correlates of PA and HRQoL measured using PedsQL 4.0 Generic Core Scales, were investigated. RESULTS: Two time use clusters were identified and were associated with correlates of PA and HRQoL. Girls who spent significantly more time in teams sports, non-team sports, school classes, watching TV and sleeping had higher levels of positively aligned PA correlates (e.g. self-efficacy, perceived sports competence) and HRQoL than girls characterised with high levels of computer use and video gaming. CONCLUSIONS: These findings highlight how different activity patterns of regional and rural girls affect HRQoL and can inform future intervention strategies to improve PA levels and HRQoL. Clusters characterised by low levels of PA and high computer use and video gaming require targeted interventions to address barriers to their participation.

Effect of Common Faults on the Performance of Different Types of Vapor Compression Systems.

The effect of faults on the cooling capacity, coefficient of performance, and sensible heat ratio, was analyzed and compared for five split and rooftop systems, which use different types of expansion devices, compressors and refrigerants. The study applied multivariable polynomial and normalized performance models, which were developed for the studied systems for both fault-free and faulty conditions based on measurements obtained in a laboratory under controlled conditions. The analysis indicated differences in responses and trends between the studied systems, which underscores the challenge to devise a universal FDD algorithm for all vapor compression systems and the difficulty to develop a methodology for rating the performance of different FDD algorithms.

Energy Use Consequences of Ventilating a Net-Zero Energy House.

A Net-Zero Energy Residential Test Facility (NZERTF) has been constructed at the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland to demonstrate that a home similar in size, aesthetics, and amenities to those in the surrounding communities can achieve net-zero energy use over the course of a year while meeting the average electricity and water use needs of a family of four in the United States. The facility incorporates renewable energy and energy efficient technologies, including an air-to-air heat pump system, a solar photovoltaic system, a solar thermal domestic hot water system, and a heat recovery ventilation system sized to meet American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) Standard 62.2-2010 ventilation requirements. The largest energy end use within the home was space conditioning, which included heat loss through the building envelope, ventilation air supplied by the heat recovery ventilator (HRV), and internal loads. While HRVs are often described as being able to save energy when compared to ventilating without heat recovery, there have been no studies using a full year of measured data that determine the thermal load and energy impacts of HRV-based ventilation on the central heating and cooling system. Over the course of a year, continuous operation of the HRV at the NZERTF resulted in an annual savings of 7 % in heat pump energy use compared with the hypothetical case of ventilating without heat recovery. The heat pump electrical use varied from an increase of 5 % in the cooling months to 36 % savings in the heating months compared with ventilation without heat recovery. The increase in the cooling months occurred when the outdoor temperature was lower than the indoor temperature, during which the availability of an economizer mode would have been beneficial. Nevertheless, the fan energy required to operate the selected HRV at the NZERTF paid for itself in the heat pump energy saved compared with ventilation without heat recovery.

Biomechanical comparison of the Latarjet procedure with and without a coracoid bone block.

PURPOSE: The aim of this study was to biomechanically evaluate the Latarjet procedure, with and without a bone block, on glenohumeral range of motion, translation, and kinematics after creation of a bony Bankart lesion. METHODS: Eight cadaveric shoulders were tested for range of motion, translation, and kinematics in 90° shoulder abduction in both the scapular and coronal planes with the following conditions: intact, Bankart lesion with 20 % glenoid bone loss, Latarjet procedure and soft tissue only conjoined tendon transfer. RESULTS: There was a significant increase in range of motion in both the scapular and coronal planes with both the Latarjet and conjoined tendon transfer compared to the intact state. The Latarjet procedure restored anterior and inferior translation in both planes. The conjoined tendon transfer restored anterior and inferior translation at lower translational loads, but not with higher loads. Both reconstructions shifted the humeral head apex posteriorly in external rotation. CONCLUSIONS: The increase in range of motion suggests that the Latarjet procedure does not initially over-constrain the joint. At higher loads, there was improved stability with the Latarjet procedure compared to the conjoint tendon transfer. Both Latarjet and conjoined tendon transfer procedures alter normal joint kinematics by shifting the humeral head apex posteriorly in external rotation.

Annual Performance of a Two-Speed, Dedicated Dehumidification Heat Pump in the NIST Net-Zero Energy Residential Test Facility.

A 2715 ft2 (252 m2), two story, residential home of the style typical of the Gaithersburg, Maryland area was constructed in 2012 to demonstrate technologies for net-zero energy (NZE) homes (or ZEH). The NIST Net-Zero Energy Residential Test Facility (NZERTF) functions as a laboratory to support the development and adoption of cost-effective NZE designs, technologies, construction methods, and building codes. The primary design goal was to meet the comfort and functional needs of the simulated occupants. The first annual test period began on July 1, 2013 and ended June 30, 2014. During the first year of operation, the home's annual energy consumption was 13039 kWh (4.8 kWh ft-2, 51.7 kWh m-2), and the 10.2 kW solar photovoltaic system generated an excess of 484 kWh. During this period the heating and air conditioning of the home was performed by a novel air-source heat pump that utilized a reheat heat exchanger to allow hot compressor discharge gas to reheat the supply air during a dedicated dehumidification mode. During dedicated dehumidification, room temperature air was supplied to the living space until the relative humidity setpoint of 50% was satisfied. The heat pump consumed a total of 6225 kWh (2.3 kWh ft-2, 24.7 kWh m-2) of electrical energy for cooling, heating, and dehumidification. Annual cooling efficiency was 10.1 Btu W-1h-1 (2.95 W W-1), relative to the rated SEER of the heat pump of 15.8 Btu W-1h-1 (4.63 W W-1). Annual heating efficiency was 7.10 Btu W-1h-1 (2.09 W W-1), compared with the unit's rated HSPF of 9.05 Btu W-1h-1 (2.65 W W-1). These field measured efficiency numbers include dedicated dehumidification operation and standby energy use for the year. Annual sensible heat ratio was approximately 70%. Standby energy consumption was 5.2 % and 3.5 % of the total electrical energy used for cooling and heating, respectively.

The contribution of sport participation to overall health enhancing physical activity levels in Australia: a population-based study.

BACKGROUND: The contribution of sport to overall health-enhancing leisure-time physical activity (HELPA) in adults is not well understood. The aim was to examine this in a national sample of Australians aged 15+ years, and to extend this examination to other ostensibly sport-associated activities. METHODS: The 2010 Exercise, Recreation and Sport Survey (ERASS) was conducted by telephone interview in four quarterly waves. Data from this survey were analysed to categorise leisure-time physical activity (LTPA) as HELPA or non-HELPA, and to categorise HELPA activities and sessions of HELPA activity by setting and frequency. The contribution of sport to HELPA was estimated, both directly through activities and settings classified as sport per se, and indirectly through other fitness activities ostensibly related to preparation for sport and enhancement of sport performance. RESULTS: Of 21,602 respondents, 82 % reported some LTPA in the 12 months prior to the survey. In aggregate, respondents reported 37,020 activity types in the previous 12 months, of which 94 % were HELPA. Of HELPA activities, 71 % were non-organised, 11 % were organised but not sport club-based, and 18 % were sport club-based. Of all sport activities, 52 % were HELPA. Of sport HELPA, 33 % was sport club-based and 78 % was undertaken ≥12 times/year. Sport club members were significantly more likely to have participated in running, but significantly less likely to have participated in walking or aerobics/fitness training, than non-club members. CONCLUSIONS: Club sport participation contributes considerably to LTPA at health enhancing levels. Health promotion policies, and more specifically physical activity policies, should emphasize the role of sport in enhancing health. Sport policy should recognise the health-promoting role of community-based sport in addition to the current predominant focus on elite pathways.

Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients.

Prospective randomized trial of maintenance immunosuppression with rapid discontinuation of prednisone in adult kidney transplantation.

Rapid discontinuation of prednisone (RDP) has minimized steroid-related complications following kidney transplant (KT). This trial compares long-term (10-year) outcomes with three different maintenance immunosuppressive protocols following RDP in adult KT. Recipients (n=440; 73% living donor) from March 2001 to April 2006 were randomized into one of three arms: cyclosporine (CSA) and mycophenolate mofetil (MMF) (CSA/MMF, n=151); high-level tacrolimus (TAC, 8-12 µg/L) and low-level sirolimus (SIR, 3-7 µg/L) (TACH/SIRL, n=149) or low-level TAC (3-7 µg/L) and high-level SIR (8-12 µg/L) (TACL/SIR(H) , n=140). Median follow-up was ∼7 years. There were no differences between arms in 10-year actuarial patient, graft and death-censored graft survival or in allograft function. There were no differences in the 10-year actuarial rates of biopsy-proven acute rejection (30%, 26% and 20% in CSA/MMF, TACH/SIRL and TACL/SIRH) and chronic rejection (38%, 35% and 31% in CSA/MMF, TACH/SIRL and TACL/SIRH). Rates of new-onset diabetes mellitus were higher with TACH/SIRL (p=0.04), and rates of anemia were higher with TACH/SIRL and TACL/SIRH (p=0.04). No differences were found in the overall rates of 16 other post-KT complications. These data indicate that RDP-based protocol yield acceptable 10-year outcomes, but side effects differ based on the maintenance regimen used and should be considered when optimizing immunosuppression following RDP.

Pack hike test finishing time for Australian firefighters: pass rates and correlates of performance.

The pack hike test (PHT, 4.83 km hike wearing a 20.4-kg load) was devised to determine the job readiness of USA wildland firefighters. This study measured PHT performance in a sample of Australian firefighters who currently perform the PHT (career land management firefighters, LMFF) and those who do not (suburban/regional volunteer firefighters, VFF). The study also investigated the relationships between firefighters' PHT performance and their performance across a range of fitness tests for both groups. Twenty LMFF and eighteen age-, body mass-, and height-matched VFF attempted the PHT, and a series of muscular endurance, power, strength and cardiorespiratory fitness tests. Bivariate correlations between the participants' PHT finishing time and their performance in a suite of different fitness tests were determined using Pearson's product moment correlation coefficient. The mean PHT finishing time for LMFF (42.2 ± 2.8 min) was 9 ± 14% faster (p = 0.001) than for VFF (46.1 ± 3.6 min). The pass rate (the percentage of participants who completed the PHT in under 45 min) for LMFF (90%) was greater than that of VFF (39%, p = 0.001). For LMFF, VO(2peak) in L min(-1)(r = -0.66, p = 0.001) and the duration they could sustain a grip 'force' of 25 kg (r = -0.69, p = 0.001) were strongly correlated with PHT finishing time. For VFF, VO(2peak) in mL kg(-1) min(-1)(r = -0.75, p = 0.002) and the duration they could hold a 1.2-m bar attached to 45.5 kg in a 'hose spray position' (r = -0.69, p = 0.004) were strongly correlated with PHT finishing time. This study shows that PHT fitness-screening could severely limit the number of VFF eligible for duty, compromising workforce numbers and highlights the need for specific and valid firefighter fitness standards. The results also demonstrate the strong relationships between PHT performance and firefighters' cardiorespiratory fitness and local muscular endurance. Those preparing for the PHT should focus their training on these fitness components in the weeks and months prior to undertaking the PHT.

A framework for the design and development of physical employment tests and standards.

Because operational tasks in the uniformed services (military, police, fire and emergency services) are physically demanding and incur the risk of injury, employment policy in these services is usually competency based and predicated on objective physical employment standards (PESs) based on physical employment tests (PETs). In this paper, a comprehensive framework for the design of PETs and PESs is presented. Three broad approaches to physical employment testing are described and compared: generic predictive testing; task-related predictive testing; task simulation testing. Techniques for the selection of a set of tests with good coverage of job requirements, including job task analysis, physical demands analysis and correlation analysis, are discussed. Regarding individual PETs, theoretical considerations including measurability, discriminating power, reliability and validity, and practical considerations, including development of protocols, resource requirements, administrative issues and safety, are considered. With regard to the setting of PESs, criterion referencing and norm referencing are discussed. STATEMENT OF RELEVANCE: This paper presents an integrated and coherent framework for the development of PESs and hence provides a much needed theoretically based but practically oriented guide for organisations seeking to establish valid and defensible PESs.

Transition in participation in sport and unstructured physical activity for rural living adolescent girls.

Physical activity (PA) is important for lifelong health; however, participation is lower in rural compared with metropolitan areas and declines during adolescence, particularly for girls. It is likely that this decline is related to the number of life transitions that occur during adolescence. This qualitative study examined the views of active rural living girls regarding the factors affecting their sport and PA participation, using the socioecological model. Twenty-seven girls aged 16-17 from four schools participated in semi-structured focus group discussions. Content and thematic analysis was conducted from verbatim transcripts using NVivo. The girls enjoyed involvement in community club sport with friends and they reported living in communities where participation in sport was a major form of social interaction. However, the desire to succeed educationally was a critical factor affecting their participation in sport and PA and influenced their movement from structured club sport to more flexible, but socially isolated individual activities. It is recommended that future longitudinal research should track rural living adolescent females as they complete secondary school, in order to better understand the influence of educational priorities upon sport and PA participation and to identify practical strategies for both schools and community organizations to foster continuing participation throughout this crucial period of life transition.

Retroviral delivery of RNA interference against Marek's disease virus in vivo.

The process of RNA interference (RNAi) has been exploited in cultured chicken cells and in chick embryos to assess the effect of specific gene inhibition on phenotypes related to development and disease. We previously demonstrated that avian leukosis virus-based retroviral vectors are capable of delivering effective RNAi against Marek's disease virus (MDV) in cell culture. In this study, similar RNAi vectors are shown to reduce the replication of MDV in live chickens. Retroviral vectors were introduced into d 0 chick embryos, followed by incubation until hatching. Chicks were challenged with 500 pfu of strain 648A MDV at day of hatch, followed by assays for viremia at 14 d postinfection. Birds were monitored for signs of Marek's disease for 8 wk. A stem-loop PCR assay was developed to measure siRNA expression levels in birds. Delivery of RNAi co-targeting the MDV gB glycoprotein gene and ICP4 transcriptional regulatory gene significantly reduced MDV viremia in vivo, although to lesser extents than were observed in cell culture. Concomitant reductions in disease incidence also were observed, and the extent of this effect depended on the potency of the MDV challenge virus inoculum. Successful modification of phenotypic traits in live birds with retroviral RNAi vectors opens up the possibility that such approaches could be used to alter the expression of candidate genes hypothesized to influence a variety of quantitative traits including disease susceptibility.

Selective retransplant after graft loss to nonadherence: success with a second chance.

Nonadherence (NA) is a difficult posttransplant problem that can lead to graft loss. A retransplant is controversial because of a fear of recurrent NA. We reviewed our center's data base and identified 114 kidney recipients who lost their graft to overt NA; of this group, 35 (31%) underwent a retransplant after a thorough reevaluation. We compared this NA retransplant group to a control group of second transplant recipients who did not lose their first graft to overt NA (non-NA) (n = 552). After 8 years of follow-up, we found no significant differences between the groups in actuarial graft or patient survival rates, renal function, or the incidence of biopsy-proven chronic rejection. However, 5 of 35 (14%) NA recipients versus 10 of 552 (2%) non-NA recipients lost their retransplant to NA (p = 0.0001). Twenty of 35 (57%) of the NA group exhibited repeat NA behavior after retransplant. We conclude that prior graft loss to NA is associated with increased graft loss to NA after retransplant. However, the majority of NA retransplant recipients did well-with overall long-term outcomes similar to those of the non-NA group. With careful patient selection and aggressive intervention, prior overt NA should not be an absolute contraindication to retransplantation.

2202 kidney transplant recipients with 10 years of graft function: what happens next?

The ultimate goal of clinical transplantation is for the recipients to achieve long-term survival, with continuing graft function, that is equivalent to that of the age-matched general population. We studied subsequent outcome in kidney transplant recipients with 10 years of graft function. In all, 2202 kidney transplant recipients survived with graft function >10 years. For 10-year survivors, the actuarial 25-year patient survival rate for primary transplant living donor (LD) recipients was 57%; graft survival, 43%. For primary transplant deceased donor (DD) recipients, the actuarial 25-year patient survival rate was 39%; graft survival, 27%. The two major causes of late graft loss were death (with graft function) and chronic allograft nephropathy (tubular atrophy and interstitial fibrosis). The two major causes of death with function were cardiovascular disease (CVD) and malignancy. For nondiabetic recipients, the mean age at death with function from CVD was 54 +/- 13 years; for diabetic recipients, 53 +/- 7 years. By 20 years posttransplant, morbidity was common: >40% recipients had skin cancer (mean age for nondiabetic recipients, 53 +/- 13 years; for diabetics, 49 +/- 8 years), >10% had non-skin cancer (mean age for nondiabetic recipients, 53 +/- 16 years; for diabetics, 46 +/- 9 years), and >30% had CVD (mean age for nondiabetic recipients, 53 +/- 15 years; for diabetics, 47 +/- 9 years). We conclude that long-term transplant recipients have a high rate of morbidity and early mortality. As short-term results have improved, more focus is needed on long-term outcome.

Steroid avoidance regimens: a comparison of outcomes with maintenance steroids versus continued steroid avoidance in recipients having an acute rejection episode.

Roughly 15% of kidney transplant recipients on a rapid discontinuation of prednisone (RDP) protocol have > or =1 episode of acute rejection (AR). One clinically important question is whether long-term maintenance steroids should be introduced in those recipients having AR. Of 842 adult kidney transplant recipients on an RDP protocol, 149 (17.7%) have had at least 1 AR episode. Of these, 51 (34%) started on maintenance prednisone (5 mg/day) after treatment of the AR, while 98 (66%) remained steroid free. Demographics for the two groups were similar. With mean follow-up of 26 months, 48 (32%) of the recipients have had a 2nd AR episode: 15 (29.4%) in those on maintenance steroids vs. 33 (33.7%) in those remaining steroid free (p = 0.12). Graft survival was not significantly different between the two groups. Multivariate analysis of risk factors for a 2nd episode found the histologic appearance of the initial AR episode to be the most significant risk factor. But, whether steroids were added to the maintenance regimen or not, also seemed to have an impact (RR = 2.1, p = 0.07). At present there is evidence to suggest that some SA patients should start on maintenance steroids after AR. However, longer follow-up with more patients is necessary.

The albino chick as a model for studying ocular developmental anomalies, including refractive errors, associated with albinism.

Albinism is associated with a variety of ocular anomalies including refractive errors. The purpose of this study was to investigate the ocular development of an albino chick line. The ocular development of both albino and normally pigmented chicks was monitored using retinoscopy to measure refractive errors and high frequency A-scan ultrasonography to measure axial ocular dimensions. Functional tests included an optokinetic nystagmus paradigm to assess visual acuity, and flash ERGs to assess retinal function. The underlying genetic abnormality was characterized using a gene microarray, PCR and a tyrosinase assay. The ultrastructure of the retinal pigment epithelium (RPE) was examined using transmission electron microscopy. PCR confirmed that the genetic abnormality in this line is a deletion in exon 1 of the tyrosinase gene. Tyrosinase gene expression in isolated RPE cells was minimally detectable, and there was minimal enzyme activity in albino feather bulbs. The albino chicks had pink eyes and their eyes transilluminated, reflecting the lack of melanin in all ocular tissues. All three main components, anterior chamber, crystalline lens and vitreous chamber, showed axial expansion over time in both normal and albino animals, but the anterior chambers of albino chicks were consistently shallower than those of normal chicks, while in contrast, their vitreous chambers were longer. Albino chicks remained relatively myopic, with higher astigmatism than the normally pigmented chicks, even though both groups underwent developmental emmetropization. Albino chicks had reduced visual acuity yet the ERG a- and b-wave components had larger amplitudes and shorter than normal implicit times. Developmental emmetropization occurs in the albino chick but is impaired, likely because of functional abnormalities in the RPE and/or retina as well as optical factors. In very young chicks the underlying genetic mutation may also contribute to refractive error and eye shape abnormalities.