Immunologic risk stratification of pediatric heart transplant patients by combining HLA-EMMA and PIRCHE-II.

Human leukocyte antigen (HLA) molecular mismatch is a powerful biomarker of rejection. Few studies have explored its use in assessing rejection risk in heart transplant recipients. We tested the hypothesis that a combination of HLA Epitope Mismatch Algorithm (HLA-EMMA) and Predicted Indirectly Recognizable HLA Epitopes (PIRCHE-II) algorithms can improve risk stratification of pediatric heart transplant recipients. Class I and II HLA genotyping were performed by next-generation sequencing on 274 recipient/donor pairs enrolled in the Clinical Trials in Organ Transplantation in Children (CTOTC). Using high-resolution genotypes, we performed HLA molecular mismatch analysis with HLA-EMMA and PIRCHE-II, and correlated these findings with clinical outcomes. Patients without pre-formed donor specific antibody (DSA) (n=100) were used for correlations with post-transplant DSA and antibody mediated rejection (ABMR). Risk cut-offs were determined for DSA and ABMR using both algorithms. HLA-EMMA cut-offs alone predict the risk of DSA and ABMR; however, if used in combination with PIRCHE-II, the population could be further stratified into low-, intermediate-, and high-risk groups. The combination of HLA-EMMA and PIRCHE-II enables more granular immunological risk stratification. Intermediate-risk cases, like low-risk cases, are at a lower risk of DSA and ABMR. This new way of risk evaluation may facilitate individualized immunosuppression and surveillance.

A longitudinal study of adolescents' attitudes about assistance in the development of moral values.

A questionnaire-based study of 2,863 adolescents (ages 12 to 22 years), with data collected over 15 years, measured the extent to which informants believed that elementary, secondary, and college-age young people should receive guidance on moral issues from the family, school, clergy, peers, and/or the individual himself or herself. Averaging the ratings of all respondents over the first three categories yielded an overall authority score of 1.85, where a score of 2.00 represented a belief in moderate influence. Results showed a minimal difference in the ratings between genders, among different age groups, and across the different calendar years of questionnaire administration. Much more substantial differences existed among the actual influences investigated and across the ages of those to whom the influence was to be directed.

Reagent strip screening for sediment abnormalities identified by automated microscopy in urine from patients suspected to have urinary tract disease.

We assessed the ability of reagent strip screening to predict the finding of blood cells and bacteria using an automated urinalysis workstation (The Yellow IRIS, International Remote Imaging Systems, Chatsworth, Calif) in 427 specimens submitted for urine culture. The sensitivities of leukocyte esterase, hemoglobin, and nitrite detection on reagent strips were 71.9%, 70.8%, and 56.7%, respectively, at 5 or more white blood cells per high-power field, at 3 or more red blood cells per high-power field and bacteria observed using the IRIS. Screening results for leukocyte esterase associated with negative results using the IRIS for white blood cells represented mostly false-positive screening test results based on chart review. Positive screening test results for hemoglobin associated with negative results obtained with the IRIS for red blood cells consisted of equal numbers of false-positive screening test results and IRIS test results based on chart review. A common screening algorithm using a combination of these three reagent strip variables exhibited a false-negative rate of 30.1%: review of medical records found clinical evidence of urinary tract infection in 14 patients and genitourinary or renal disease or hypertension in another 13 patients. Adding more variables to the algorithm increases the sensitivity and decreases the specificity. Both microscopic examination and reagent strip testing of urine are necessary for the detection of abnormalities associated with disease.

Stability and change in adolescents' positive attitudes toward guidance in moral development.

A total of 1,913 junior high school and college students tested between 1978 and 1988 responded to a 15-item questionnaire on the extent and type of influence they thought desirable in developing moral judgment in elementary, secondary, and college students. The average response across subjects, year of administration, and age of individuals for whom the item was being tapped was highest for the influence of the individual him/herself (2.52 on a 3-point scale), but also relatively high for the three institutions tapped: family (2.17), school (1.85), and clergy (1.45). Peers' influence was rated at 1.84. Differences on the other dimensions (year of questionnaire, sex, and age of subject) were rarely substantial, and while yielding some significant differences, did not show clear, strong patterns.

The relationship of religious involvement to a variety of indicators of cognitive ability and achievement in college students.

A total of 635 undergraduates at a small, competitive, secular, liberal arts university in the Northeast were administered a brief questionnaire in which they reported anonymously their degree of religiousness, their Scholastic Aptitude Test (SAT) scores, and their grade point average (GPA). Religiousness was negatively related to ability as measured by SAT, and not related to achievement, as measured by GPA. The students' capacity to maximize their potential was measured by the difference (in standard score) between GPA and SAT, and revealed a strong, positive connection with degree of religiousness. A conceptual rationale for the diverse findings is presented by the author.

A cross-cultural survey of the effects of anxiety on the relationship between child rearing and cognition.

A cross-cultural study involving a basic pool of 44 societies throughout the world was conducted to analyze the effect of anxiety on the relationship between certain child-rearing variables and cultural measures of cognitive complexity and self-esteem. The research demonstrated that societies utilizing anxiety-arousing techniques did so consistently across a variety of apparently contradictory child-rearing variables. The introduction of anxiety to the rearing experience had the general effect of changing previously established patterns of interaction, sometimes with major sex differences. Thus, socialization toward group norms and away from independent activity was positively associated with indicators of cognitive development (Zern, 1983). When anxiety over the socialization experience existed, however, no systematic relationship was demonstrated for either sex. Self-esteem was also positively related to pressures to socialize when no anxiety existed. For women, when anxiety was introduced, there was a strong negative relationship. For men, anxiety caused no systematic connections of any kind between pressures to socialize and self-esteem.

The cognitive style dimension of reflectivity-impulsivity in normal and emotionally disturbed adolescents.

Thirty-two emotionally disturbed and 23 normal adolescents were given two test of cognitive style developed by Kagan (Matching Familiar Figures and the Haptic-Visual Tests). The results were analyzed to evaluate two major hypotheses: (a) that emotionally disturbed adolescents perform differently on the tests than normal adolescents; and (b) that members of both groups reveal a high degree of stability among various subtest scores, both within the same test and across different tests. In testing the first hypothesis, the authors discovered minimal differences in mean scores for the different samples on each of the five subtests involved. However, a more complex analysis was carried out on the basis of the assumption that extreme scores on the various items were a more meaningful indicator of performance than simple means. This analysis yielded the conclusion that these emotionally disturbed adolescents were more impulsive (i.e., answered more quickly and made more errors) than their counterparts in public schools. An analysis of the intercorrelations between different tests and within tests in testing the second hypothesis revealed 19 out of 40 significant correlations, with an additional 14 out of the remaining 21 in the predicted direction. Finally, nine out of the 10 correlations combining the subgroups were statistically significant.