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Burroughs, Thomas E., Amy D. Waterman, and Barry A. Hong. "One Organ Donation, Three Perspectives: Experiences of Donors, Recipients, and Third Parties with Living Kidney Donation." Progress in Transplantation 13, no. 2 (2003): 142–50. http://dx.doi.org/10.1177/152692480301300212.
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Although living kidney donors' experiences with donation have been studied, questions of potential bias in retrospective donor reports remain. This study examined the experience of living kidney donation from 3 perspectives: those of the donor, the recipient, and a third party involved with the donation (ie, a donor triad). Surveys were completed with 174 donor triads to examine triad members' perceptions of donors' concerns before transplantation, whether these concerns came true after transplantation, the donors' experiences with surgery and recovery, and whether they would make the same decision again today. Triad members all agreed that donors were highly satisfied with their donation experience and that the relationship between recipient and donor improved after transplantation. Although recipients and third parties correctly identified the donors' primary concerns, they underestimated the prevalence of 16 of 18 donor concerns, including the donors' willingness to make the same decision again. Recipients also overestimated how painful and difficult the surgery and recovery were for donors. The results suggest that retrospective studies of donors may not be marred by significant misreporting or memory biases and that better education about the donation experience for the entire donor triad might provide better social support for donors, reduce recipients' guilt about donors' pain, and increase donation rates overall.
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Hlebec, Valentina. "Family Care Experience in a Decentralized Social Home Care Context." Lex localis - Journal of Local Self-Government 15, no. 3 (2017): 495–511. http://dx.doi.org/10.4335/15.3.495-511(2017).
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This survey analyses the scope and intensity of informal care for the elderly residing in their homes in Slovenia and their determinants: the residing municipality of the care recipient, geographical distance between the informal carer and the care recipient, to the care recipients’ and the care givers’ individual characteristics. With the increasing private out-of-pocket financial contribution, which is determined by municipality, the scope and intensity of informal care shows a significant increase as shown by regression analysis. Inter-municipal cooperation and the introduction of gradual private financial contribution are proposed as tools for improving accessibility of social home care in Slovenia.
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Mourning, Alonzo. "A Transplant Recipient???s Experience." Transplantation 82, no. 12 (2006): 1563–64. http://dx.doi.org/10.1097/01.tp.0000250479.62753.b6.
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Egan, Patricia. "WHAT FAMILY CAREGIVERS THINK AND FEEL WHEN PROXY ASSESSING FROM DIFFERENT PERSPECTIVES." Innovation in Aging 3, Supplement_1 (2019): S977. http://dx.doi.org/10.1093/geroni/igz038.3540.
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Abstract Dementia family caregivers are routinely enlisted as proxy assessors of care recipient quality of life (QOL). Proxy assessment is not ideal because proxy assessments differ systematically from self-assessments and the assessment process can elicit negative affect from family caregivers. Prompting adoption of the care recipient’s perspective can enhance assessment congruence and may improve the emotional experience for assessors. This study explored family caregivers’ cognitive and affective experiences during QOL proxy assessments made from both their own and care recipients’ perspectives. Thirty-six dementia family caregivers were recruited from senior service agencies. Subjects completed the Quality of Life-Alzheimer Disease (QOL-AD), Caregiver Version using standard instructions to assess QOL across thirteen domains of their care recipient’s life without specifying the perspective to be used. Subjects were next asked to repeat the QOL-AD with instructions to adopt the perspective of their care recipient, as they imagined it to be. Subjects were then interviewed about what they thought and felt during each proxy assessment experience. Content analysis indicated that spontaneous perspective shifts and response shifts frequently occurred. Most subjects (91.7%) reported changed thinking for one or more QOL-AD domains when they were prompted to switch perspectives. Over half (61.12%) reported changed affect when switching perspectives and 90.9% of those experiencing changed affect reported affective improvement. Little or no affective change was reported by 38.89%. Findings suggest awareness of perspective can enhance clinical interpretation of proxy assessed QOL and can inform clinical response to dementia family caregivers who experience negative emotions while proxy reporting QOL.
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Shiba, Hiroaki, Shigeki Wakiyama, Yasuro Futagawa, et al. "Assessment of Graft Selection Criteria in Living-Donor Liver Transplantation: The Jikei Experience." International Surgery 100, no. 7-8 (2015): 1229–32. http://dx.doi.org/10.9738/intsurg-d-14-00300.1.
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In living-donor liver transplantation, graft selection is especially important for the safety of the live donor and an acceptable outcome for the recipient. The essential medical requirements for living liver donation at Jikei University Hospital are as follows: an adult aged 65 years or younger, in good general condition, with partial liver volume of more than 35% of the standard liver volume (SLV) for the recipient, and without severe liver steatosis. Based on our criteria, we performed 13 living-donor liver transplantations between 2007 and 2013, including 1 retransplantation. Three cases were outside our standard donor criteria, including age (18 and 66 years) and 33% graft volume (GV) to SLV ratio for the recipient on preoperative volumetry using computed tomography. In 2 cases, the actual GV to SLV ratio at transplantation was less than 35%. Median postoperative hospital stay was 11 days for the donors, and 29 days for the recipients. All donors returned to their preoperative status, and all recipients were discharged in good condition. Our medical requirements for living liver donation seem to be acceptable because of the good outcome.
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Noh, Hyunjin, Lewis Lee, and Chorong Won. "Association Between Caregivers’ and Care-Recipients’ Advance Care Planning: An Exploratory Study." Innovation in Aging 4, Supplement_1 (2020): 416–17. http://dx.doi.org/10.1093/geroni/igaa057.1343.
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Abstract Research on advance care planning (ACP) has highlighted major contributors to the completion of ACP documents. One of such contributors is knowledge about ACP, such as an advance directive or living will (LW). This study aims to 1) understand the initial exposure to ACP knowledge among informal caregivers’ of chronically or seriously ill older adults and to 2) explore an association between caregivers’ advance care planning and that of their care-recipients. Forty-four primary caregivers of cognitively impaired older adults were recruited at various community settings. A mixed-method design was used to qualitatively interview each participant face-to-face about his or her initial experience with ACP and to quantitatively ask if the participant completed a LW and if the care-recipient completed one as well. Qualitative content analysis of participant responses revealed that their initial experiences with ACP were mostly through their care-recipients, such as the care-recipient’s ACP in previous hospitalizations or legal consultations. Chi-square test for independence was conducted to explore whether there is an association between caregivers’ LW completion and that of care-recipients. The results show that there is a significant relationship between the two variables: χ2 (1, n = 44) = 8.84, p < .001, φ = .49. These findings suggest that secondary experiences with close one’s ACP may serve as facilitator to one’s ACP completion. Therefore, efforts to promote ACP should target a caregiver and care-recipient dyad so that caregivers as well as care-recipients may learn about and complete ACP documents.
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Ummel, Deborah, Marie Achille, and Jessina Mekkelholt. "Donors and Recipients of Living Kidney Donation: A Qualitative Metasummary of Their Experiences." Journal of Transplantation 2011 (2011): 1–11. http://dx.doi.org/10.1155/2011/626501.
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With the notable growth in the qualitative investigation of living kidney donation, there is value in aggregating results from this body of research to learn from accumulated experience. The present paper aims to draw a complete portrait of living donors' and recipients' experience of donation by metasummarizing published studies. We found that donors' experience, particularly the decision-making process, has been more extensively studied than the recipients' perspective. Donors differ in their initial level of motivation to donate but on the whole report positive experiences and personal benefits. They also identify difficult periods and the need for additional resources. Recipients report an often positive but more ambivalent reaction to donation. In terms of relational issues between dyads, while the topic remains understudied, the donor-recipient relationship and gift reciprocity have received the most attention. Results are discussed in terms of their implications for future practice and research.
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Sheikhalipour, Zahra, Vahid Zamanzadeh, Leili Borimnejad, Sarah E. Newton, and Leila Valizadeh. "Muslim transplant recipients’ family experiences following organ transplantation." Journal of Research in Nursing 24, no. 5 (2019): 291–302. http://dx.doi.org/10.1177/1744987118813671.
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Background Despite the importance of family and its relationship to positive transplant outcomes, little is known about family experiences following organ transplantation from the perspective of the transplant recipients. The literature is also devoid of information that describes the family experiences of Muslim transplant recipients. Aims The purpose of this study was to describe Muslim transplant recipients’ family experiences following organ transplantation. Methods A hermeneutical phenomenological approach was employed to determine the emergent themes present in the data. The sample was composed of 12 Muslim organ transplant recipients (heart, kidney and liver) living in Iran. Semi-structured interviews were conducted with each participant. Results The primary constitutive pattern that emerged from the interview data was ‘Altered Family Relationships’ and three themes: fear in relationships, abnormal relationships, and the family at the centre of organ transplant issues. Conclusions There are several important findings in this study, notably that Muslim transplant recipients describe their family experiences following organ transplantation as ‘altered’ and not as they were pre-transplant. More research is needed that focuses on the family experience post-transplant, and how Muslim transplant recipient families are impacted by the transplant experience.
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Milliken, Jennifer, Lisa A. Paul, Sapir Sasson, Abigail Porter, and Jemi Hasulube. "Sexual Assault Disclosure Recipients’ Experiences: Emotional Distress and Changes in the Relationship With the Victim." Violence and Victims 31, no. 3 (2016): 457–70. http://dx.doi.org/10.1891/0886-6708.vv-d-14-00144.
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Sexual assault victims are more likely to disclose their experience to friends and family than formal support sources (e.g., police, counselors). As such, disclosure receipt is a relatively common occurrence, but little is known about the recipients’ disclosure experience. This study examined predictors of recipient emotional distress and positive and negative changes in the victim–recipient relationship postdisclosure among 69 female undergraduates at 3 universities. Predictors of distress included greater self-rated closeness to the victim and greater confusion about how to help. Positive changes were predicted by greater closeness and less responsibility attributed to the victim, and negative changes were predicted by less closeness, greater assigned responsibility, and greater perceived ineffectiveness of one’s help. Implications for improving the disclosure experience via psychoeducational interventions are presented.
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Stubber, Claire, and Maggie Kirkman. "The experiences of adult heart, lung, and heart-lung transplantation recipients: A systematic review of qualitative research evidence." PLOS ONE 15, no. 11 (2020): e0241570. http://dx.doi.org/10.1371/journal.pone.0241570.
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Aim To review evidence about the experience of being the recipient of a donated heart, lungs, or heart and lungs. Design A systematic review (registered with PROSPERO: CRD42017067218), in accordance with PRISMA guidelines. Data sources Seven databases and Google Scholar were searched in May 2017 and July 2019 for papers reporting English-language research that had used qualitative methods to investigate experiences of adult recipients. Review methods Quality was assessed and results were analysed thematically. Results 24 papers (reporting 20 studies) were eligible and included. Their results were organised into three chronological periods: pre-transplant (encompassing the themes of ‘dynamic psychosocial impact’, ‘resources and support’), transplant (‘The Call’, ‘intensive care unit’), and post-transplant (‘dynamic psychosocial impact’, ‘management’, ‘rejection’). Sub-themes were also identified. It was evident that contemplating and accepting listing for transplantation entailed or amplified realisation of the precipitating illness’s existential threat. The period surrounding transplantation surgery was marked by profound, often surreal, experiences. Thereafter, although life usually improved, it incorporated unforeseen challenges. The transplantation clinic remained important to the recipient. The meaning of the clinic and its staff could be both reassuring (providing care and support) and threatening (representing onerous medical requirements and potential organ rejection). Conclusion This review has implications for the psychosocial care of transplant recipients and indicates the need for further research to gain insight into the experience of receiving a donated heart and/or lung. Impact Medical consequences of heart and lung transplantation are well documented; this is the first systematic review of research using qualitative methods to investigate the experience of heart, lung, and heart-and-lung transplantation. The psychosocial impact of transplantation was found to be dynamic and complex, with notable features evident before, during, and after transplantation. Clinic staff remained significant to recipients. It is clear that recipients need continuing psychosocial as well as medical support.
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Mehta, Aneesh K., Maricar Malinis, Gabriel Vece, et al. "1733. 10 Years of DTAC Experience With Donor-Derived Cryptococcus Transmission in Solid-Organ Transplantation in the United States." Open Forum Infectious Diseases 5, suppl_1 (2018): S59. http://dx.doi.org/10.1093/ofid/ofy209.139.
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Abstract Background Cryptococcosis is an important fungal complication of solid organ transplantation (SOT); cases occurring within 6 months posttransplant are often severe and sometimes donor derived. Morbidity can be related to delayed recognition of clinical symptoms or lack of communications among the SOT recipient centers. To better understand transmission of Cryptococcus (Crypto) and to identify opportunities for improved identification and communication, all potential donor-derived transmission events (PDDTE) of Crypto reported to OPTN/UNOS ad hoc Disease Transmission Advisory Committee (DTAC) over 10 years were analyzed. Methods All Crypto cases reported to DTAC between January 2008 and December 2017 were reviewed retrospectively as potential donor-derived transmission events (PDDTE). Likelihood of donor-derivation was adjudicated based on recipient and donor data. Results Fourty-six cases of Crypto were reported to DTAC during this period, involving 145 SOT recipients. Of the Proven or Probable donor-derived Crypto cases (n = 9), transmission occurred in 15 recipients; 2 donors each transmitted Crypto to 3 different recipients. Of the Possible cases, 9 recipients were affected. Six recipients with PDDTE Crypto died. Eight recipients received antifungal medications that would prevent transmission of Crypto (classified as intervention without disease transmission). UNOS Region 7 had the highest number donors with 10, with 6 and 7 from Regions 2 and 3, respectively. No cases C. gattii were reported; however, most of the reports to DTAC did not discriminate between C. neoformans and C. gattii. Conclusion This DTAC case series highlights both donor and recipient-derived cryptococcal infections and their potential to have devastating clinical impact. These data also highlight important delays in recognizing Crypto in SOT and in communicating these results to other centers when a PDDTE is possible. Transplant teams should have a high level of suspicion for Crypto in SOT, particularly in those with fever of unknown etiology, pulmonary infiltrates, headaches, and mental status changes. In the future, it may be helpful for transplant center to perform specific testing to discriminate between Cryptococcus species to understand their differential impact in SOT. Disclosures D. F. Florescu, Astellas: Grant Investigator, Grant recipient. C. R. Wolfe, Merck: Scientific Advisor, Consulting fee.
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Pristavec, Teja. "The Burden and Benefits of Caregiving: A Latent Class Analysis." Gerontologist 59, no. 6 (2018): 1078–91. http://dx.doi.org/10.1093/geront/gny022.
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Abstract Background and Objectives Informal caregiving to older adults is a key part of the U.S. long-term care system. Caregivers’ experiences consist of burden and benefits, but traditional analytic approaches typically consider dimensions independently, or cannot account for burden and benefit levels and combinations that co-occur. This study explores how benefits and burden simultaneously shape experiences of caregiving to older adults, and factors associated with experience types. Research Design and Methods 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC) data were linked to obtain reports from caregivers and recipients. Latent class and regression analysis were conducted on a nationally representative sample of U.S. informal caregivers to older persons. Results Five distinguishable caregiving experiences types and their population prevalence were identified. Subjective burden and benefits level and combination uniquely characterize each group. Primary stressors (recipient depression, medical diagnoses), primary appraisal (activities of daily living, instrumental activities of daily living, medical task assistance, hours caregiving), and background/contextual factors (caregiver age, race, relationship to recipient, mental health, coresidence, long-term caregiving) are associated with experience types. Discussion and Implications Findings highlight caregivers’ experience multiplicity and ambivalence, and identify groups that may benefit most from support services. In cases where it is not possible to reduce burden, assistance programs may focus on increasing the benefits perceptions.
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Vajentic, AnnaKay. "Correspondence and Personal Contact between Donor Families and Organ Recipients: One OPO's Procedure and Experience." Journal of Transplant Coordination 7, no. 3 (1997): 106–10. http://dx.doi.org/10.1177/090591999700700304.
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This article discusses one organ procurement organization's procedure for facilitating correspondence between donor families and recipients while respecting the needs and rights of all involved. From 1992 to 1995, a total of 542 donor family and recipient correspondences were facilitated. Recipients wrote more than 80% of the letters, with the number of donor family correspondence increasing each year. Trends are discussed including the percentage of correspondence initiated by donor families and recipients, reasons for correspondence not being forwarded by the organ procurement organization, the time frame in which correspondence occurred, and the number of families who requested personal contact.
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Wiltshire, Gareth, Nicola J. Clarke, Cassandra Phoenix, and Carl Bescoby. "Organ Transplant Recipients’ Experiences of Physical Activity: Health, Self-Care, and Transliminality." Qualitative Health Research 31, no. 2 (2020): 385–98. http://dx.doi.org/10.1177/1049732320967915.
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Physical activity (PA) is an important lifestyle component of long-term health management for organ transplant recipients, yet little is known about recipients’ experiences of PA. The purpose of this study was to shed light on this experience and to investigate the possible implications of PA in the context of what is a complex patient journey. Phenomenological analysis was used to examine interviews with 13 organ transplant recipients who had taken part in sporting opportunities posttransplantation. Findings illuminate how participants’ experiences of PA were commonly shaped by the transliminal nature of being an organ transplant recipient as well as a sense of duty to enact health, self-care, and donor-directed gratitude. This analysis underlines the potential role of PA in supporting organ transplant recipients’ attempts to live well following transplantation and makes novel connections between PA and our existing knowledge about challenges related to identity, survivorship, obligation, and patient empowerment.
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Gallinat, Anja, Andreas Paul, Jürgen W. Treckmann, et al. "Single-center Experience with Live Kidney Donors 60 Years of Age or Older." American Surgeon 80, no. 12 (2014): 1230–36. http://dx.doi.org/10.1177/000313481408001225.
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Live donor kidney transplantation (LDKT) with elderly donors is a controversial topic. The purpose of this study was to evaluate donor and recipient outcomes involving live donors 60 years of age or older. All LDKTs performed at our institution from January 2000 to January 2011 were evaluated. Statistical analysis included t test, uni- and multivariate regression analyses, and Kaplan-Meier survival analysis. Forty-seven LDKTs were performed with donors 60 years of age or older. Median donor age was 65 years. Fifty-seven per cent were female. Forty-one recipients received their first KT (seven pre-emptive). Initial graft function was documented in 45 patients (96%). After a median follow-up of 69 months, 1-, 3-, and 5-year graft and patient survival rates were 98, 98, and 95 per cent and 96, 94, and 87 per cent, respectively. Univariate Cox proportional hazard analysis showed donor body mass index and previous KT to be predictors of graft survival. Recipient comorbidity index, HLA-B mismatches, and creatinine level at 2 years post-KT were predictors of patient survival. None of these variables remained significant by multivariate analysis. Female gender was the only positive predictor of donor postoperative creatinine levels. Satisfactory long-term donor and recipient outcomes can be achieved with live kidney donors 60 years of age or older. Careful evaluation and selection remain key to success. The role of female gender in donor long-term kidney function should be further investigated.
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Barroso, Karine Sampaio nunes, Larissa Maria Gurgel Passos Gomes, Nicole Pereira Leal, et al. "SARS-COV2 POSITIVE IN BONE MARROW TRANSPLANTATION SYMPTOMATIC PATIENTS: THE EXPERIENCE IN A SINGLE CENTER OF CEARA, BRAZIL." JBMTCT 2, no. 1 (2020): 30–32. http://dx.doi.org/10.46765/2675-374x.2020v2n1p30-32.
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The bone marrow transplantation (BMT) recipient are susceptible to virus respiratory disease and their complications. The emergence of pandemic COVID-19, adapted their routine. We are a public school hospital bone marrow transplantation center, localized in Fortaleza/ Ceará, Northeast of Brazil. Objective: In the article we are described the asymptomatic SARS-CoV2 PCR positive in recipient pre and post bone marrow transplantation. Methods: The donors and recipients with high risk disease and selected to bone marrow transplantation in April to June are submitted a nasopharyngeal and throat swab to collected PCR multiplex SARS-CoV2. Results: We have 5 patients asymptomatic with positive results. Three allogeneic recipient and two autologous. The two inpatients follow the program because we have the result after the end of condition, we use GCSF in both and none had febrile neutropenia. Conclusion: The results show us the importance of PCR multiplex SARS-CoV2 before hospital admission to avoid bone marrow transplantation at the moment of viral load and to organized the prevention precautions. This cases are important because described patients with SARS-CoV 2 PCR positive in the early transplant with asymptomatic course.
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Mitchell, George. "Experience and Impressions of an Artificial Hair Recipient." International Society of Hair Restoration Surgery 11, no. 6 (2001): 185. http://dx.doi.org/10.33589/11.6.0185.
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De Roover, Arnaud, Carla Coimbra, Olivier Detry, et al. "Pancreas Graft Drainage in Recipient Duodenum: Preliminary Experience." Transplantation 84, no. 6 (2007): 795–97. http://dx.doi.org/10.1097/01.tp.0000281401.88231.da.
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Abdel-Khalek, Ehab E., Alrefaey K. Alrefaey, Amr M. Yassen, et al. "Renal Dysfunction after Living-Donor Liver Transplantation: Experience with 500 Cases." Journal of Transplantation 2018 (December 23, 2018): 1–9. http://dx.doi.org/10.1155/2018/5910372.
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Introduction.The possible risk factors for chronic kidney disease in transplant recipients have not been thoroughly investigated after living-donor liver transplantation.Material and Methods.A retrospective cohort study of consecutive adults who underwent living-donor liver transplantation between May 2004 and October 2016, in a single center, was conducted. Kidney function was investigated successively for all the patients throughout the study period, with 12 months being the shortest follow-up. Postoperative renal dysfunction was defined in accordance with the Chronic Kidney Disease Epidemiology Collaboration criteria. The patients’ demographic data, preoperative and intraoperative parameters, and outcomes were recorded. A calcineurin inhibitor-based immunosuppressive regimen, either tacrolimus or cyclosporine, was used in all the patients.Results.Of the 413 patients included in the study, 33 (8%) who survived for ≥1 year experienced chronic kidney disease 1 year after living-donor liver transplantation. Twenty-seven variables were studied to compare between the patients with normal kidney functions and those who developed chronic kidney disease 1 year after living-donor liver transplantation. Univariate regression analysis for predicting the likelihood of chronic kidney disease at 1 year revealed that the following 4 variables were significant: operative time,P< 0.0005; intraoperative blood loss,P< 0.0005; preoperative renal impairment,P= 0.001; and graft-to-recipient weight ratio (as a negative predictor),P< 0.0005. In the multivariate regression analysis, only 2 variables remained as independent predictors of chronic kidney disease at 1 year, namely, operative time with a cutoff value of ≥714 minutes and graft-to-recipient weight ratio as a negative predictor with a cutoff value of <0.91.Conclusion.In this study, prolonged operative time and small graft-to-recipient weight ratio were independent predictors of chronic kidney disease at 1 year after living-donor liver transplantation.
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Gallagher, Genevieve, Donna E. Hogge, Thomas J. Nevill, et al. "Second Solid Cancers after Allogeneic Stem Cell Transplantation: The Vancouver Experience." Blood 106, no. 11 (2005): 1120. http://dx.doi.org/10.1182/blood.v106.11.1120.1120.
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Abstract The development of second solid cancers in recipients of hematopoietic stem cell transplants (SCT) represents a serious complication among long term survivors. To assess the incidence and associated risk factors for second solid cancers following allogeneic SCT we performed a retrospective analysis of 926 consecutive patients (pts) who underwent an allogeneic (n=918) or syngeneic (n=8) SCT between January 1985 and December 2003. Primary diagnoses were AML (235), ALL (103), CML (216), lymphoproliferative disorders (150), MDS (96), MM (80) or other (46). Median age at SCT was 39 years (range 12–65) and median time from diagnosis to SCT was 5.1 months (range 0.2–345). 640 pts had a sibling donor (602 matched/38 mismatched) and 286 had an unrelated donor (225 matched/61 mismatched). Stem cell source was bone marrow (810), peripheral blood (109) or both (7). Conditioning regimens were: TBI-based (488), BuCy +/− other (414), other (24). The graft was unmanipulated in 883 pts and T-cell depleted in 43 pts. GvHD prophylaxis consisted of CSA and MTX in 84%. With a median follow-up of 22.2 months post SCT (range 0.07–230.5) for all 926 pts and 84.2 months (range 8.4–230.5) for surviving pts, 30 solid malignancies have occurred in 28 pts at a median of 81.4 months post SCT (range 1.4–207.5). These second tumors involved skin (8 basal cell carcinoma, 4 invasive squamous cell carcinoma), lung (5), oral cavity (4), colon (2), bladder (2) breast (1), kidney (1), parotid gland (1), vulva-in situ (1) and primary unknown (1). 6 of the 28 pts died from the second cancer at a median of 6.1 months (range 0.9–36) following the diagnosis. The cumulative incidence of all second solid cancers at 10 and 15 years was 3.1% (95% CI 2–5%) and 5.7% (95% CI 3–9%), respectively. Excluding basal cell carcinoma and carcinoma in situ, the 10 and 15-year cumulative incidence rates were 2.3% (95% CI 1–4%) and 4.0% (95% CI 2–6%), respectively. Compared to age and gender adjusted cancer rates in the general population of BC, the relative risk (RR) of developing a second solid cancer after allografting excluding basal cell carcinoma and squamous cell carcinoma of the skin was 1.85 (95% CI 1.04–3.06), p =0.019. Risk factors evaluated included initial diagnosis, gender, age at SCT, donor gender, donor age, interval from diagnosis to SCT, year of SCT, source of stem cells, HLA disparity, conditioning regimen, T cell depletion, prior history of radiation therapy, incidence of aGvHD, incidence of cGvHD and aGvHD therapy. In multivariate analysis, significant risk factors were recipient age at SCT &gt;40 years (RR 4.8), p=0.01 and donor gender [female donor/male recipient (RR 5.4), female donor/female recipient (RR 2.3)] p=0.002. We conclude that allogeneic SCT recipients are at an increased risk of developing a second solid cancer as compared to the general population, particularly if the recipient is &gt;40 years at the time of allografting. It is also apparent that male recipients of a female graft have a high risk of second solid cancers. Since we did not find an association between second cancers and aGvHD or cGvHD in our analysis, is it interesting to speculate whether this is somehow related to subclinical GvHD. Regardless, longer follow-up is needed to more fully assess the incidence and risk factors for second solid tumors post-transplant due to their long latency period.
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Dueñas-Jurado, J. M., P. A. Gutiérrez, A. Casado-Adam, et al. "New models for donor-recipient matching in lung transplantations." PLOS ONE 16, no. 6 (2021): e0252148. http://dx.doi.org/10.1371/journal.pone.0252148.
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Objective One of the main problems of lung transplantation is the shortage of organs as well as reduced survival rates. In the absence of an international standardized model for lung donor-recipient allocation, we set out to develop such a model based on the characteristics of past experiences with lung donors and recipients with the aim of improving the outcomes of the entire transplantation process. Methods This was a retrospective analysis of 404 lung transplants carried out at the Reina Sofía University Hospital (Córdoba, Spain) over 23 years. We analyzed various clinical variables obtained via our experience of clinical practice in the donation and transplantation process. These were used to create various classification models, including classical statistical methods and also incorporating newer machine-learning approaches. Results The proposed model represents a powerful tool for donor-recipient matching, which in this current work, exceeded the capacity of classical statistical methods. The variables that predicted an increase in the probability of survival were: higher pre-transplant and post-transplant functional vital capacity (FVC), lower pre-transplant carbon dioxide (PCO2) pressure, lower donor mechanical ventilation, and shorter ischemia time. The variables that negatively influenced transplant survival were low forced expiratory volume in the first second (FEV1) pre-transplant, lower arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio, bilobar transplant, elderly recipient and donor, donor-recipient graft disproportion requiring a surgical reduction (Tailor), type of combined transplant, need for cardiopulmonary bypass during the surgery, death of the donor due to head trauma, hospitalization status before surgery, and female and male recipient donor sex. Conclusions These results show the difficulty of the problem which required the introduction of other variables into the analysis. The combination of classical statistical methods and machine learning can support decision-making about the compatibility between donors and recipients. This helps to facilitate reliable prediction and to optimize the grafts for transplantation, thereby improving the transplanted patient survival rate.
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Alfano, Gaetano, Francesco Fontana, Giovanni Guaraldi, Gianni Cappelli, and Cristina Mussini. "Successful treatment of BK virus associated-nephropathy in a human immunodeficiency virus-positive kidney transplant recipient." International Journal of STD & AIDS 31, no. 4 (2020): 387–91. http://dx.doi.org/10.1177/0956462419900853.
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BK virus (BKV) is an opportunistic pathogen in those with impaired immunity. Viral replication is generally asymptomatic but is able to induce cytopathic alterations in renal cells. If BKV infection is left untreated, it leads to BKV-associated nephropathy (BKVAN) and graft loss. There is scarce experience in the management of BKV infection in kidney transplant recipients living with HIV. We report the successful treatment of BKVAN in an HIV-positive kidney transplant recipient who experienced BKV replication in the immediate post-transplantation period. A change in therapy from calcineurin inhibitor to sirolimus, steroid withdrawal and a short course of an immunomodulatory agent (leflunomide) controlled BKV viremia in the absence of drug side-effects or impairment of graft function.
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Voskanyan, S. E., I. Yu Kolyshev, M. V. Shabalin, et al. "Full-split liver transplantation. The first experience in Russian Federation." Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery 26, no. 1 (2021): 66–75. http://dx.doi.org/10.16931/1995-5464.2021166-75.
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Aim. To present the first successful full-split liver transplantation for two adults recipients in Russia.Materials and methods. The first successful full-split liver transplantation for two adults in ex situ way in Russia was made on 26th of September 2014 in the Burnasyan Federal Medical Biophysical Center of FMBA. The deceased donor was inside UNOS, Lee. The GRWR index in both recipients was near 1. The first recipient had been in a waiting list for 1 year, the second for 4 months. Both recipients had got liver cirrhosis in terminal stage.Results. The surgical procedure length was 650 and 660 min. The overall time of cold ischemia was 510 min. We observed a primary function of each graft. ISGLS B and Clavien-Dindo 3A biliary leak complications were observed in both recipients. Both patients were discharged after 33 and 34 days. Overall survival for this moment is 68 months.Conclusion. Full-split liver transplantation for two adults in ex situ way seems to be a complicated procedure both from the technical and organizing points of view. It demanding good mastership and coordination between surgical team members. At the same time, that treatment method has to be spread widely to improve treatment of patients with end-stage cirrhosis results.
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Fahrenkopf, Erin, Jerry Guo, and Linda Argote. "Personnel Mobility and Organizational Performance: The Effects of Specialist vs. Generalist Experience and Organizational Work Structure." Organization Science 31, no. 6 (2020): 1601–20. http://dx.doi.org/10.1287/orsc.2020.1373.
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This study advances understanding of the conditions under which a new worker improves organizational performance. We argue that the extent to which new group members have experience working as specialists or generalists is a critical factor in explaining performance after the new member joins. We conceptualize specialists as those who concentrate on a particular component of an organization’s task, whereas generalists perform all components of the task. As such, a specialist must coordinate with other group members to complete the group’s task, which makes a specialist more interdependent with other members and in possession of more organization-specific knowledge than a generalist. We predict that (1) groups receiving specialist new members do not perform as well after the new member joins as compared with groups receiving generalist new members and (2) groups with new members whose work experience and recipient group structure are aligned (i.e., generalist movers into generalist groups and specialist movers into specialist groups) perform better than groups with new members whose experience and recipient group structure are not aligned. We test our hypotheses using a laboratory study in which we manipulate the extent to which new members and incumbent members of recipient groups work as specialists or generalists. Participants work as generalists or specialists in three-person groups and receive a new member who acquired experience as a specialist or generalist in another group. We find support for our hypotheses and provide evidence on mechanisms through which potential new members’ backgrounds enable them to contribute significantly to their recipient groups. New members who acquire experience in a structure similar to that of their recipient organizations report that they experience greater fit with their new groups, which enables their recipient groups to perform better than groups where new members’ experience and recipient group structure are not aligned. Additionally, our results suggest generalists may be more likely than specialists to transfer knowledge to their new groups.
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Kizhakkeveettil, Anupama, David Sikorski, Gene Tobias, and Christos Korgan. "Prevalence of adverse effects among students taking technique classes: A retrospective study." Journal of Chiropractic Education 28, no. 2 (2014): 139–45. http://dx.doi.org/10.7899/jce-14-1.
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Objective The main objective of this study was to determine characteristics of injuries experienced by students while learning chiropractic procedures in the classroom. Methods Injury was defined as any physical adverse effect such as pain, stiffness, headache, and muscle spasm. Survey questions included age, sex, role, anatomical areas of injury, adjustive technique utilized, types of injury, treatment (if any), and recovery time. The survey was administered among the students in the 5th, 6th, and 8th trimesters of our doctor of chiropractic program. Only students who had completed one or more chiropractic procedures courses at the institution were asked to participate in the study. Results Female recipients had a higher prevalence of adverse effects as the recipient of the adjustment than did male recipients. The most common site for injury overall was the lower back. The relationship between recipient role and sacroiliac joint injury and the relationship between adjustor role and wrist/hand injury were statistically significant. Students were more likely to be injured in the beginning of their technique education. Conclusion This study suggests that students in technique courses learning adjustive procedures experience minor adverse physical effects related to the physical skills being learned. Strategies for prevention need to be considered.
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Bishop, Penny. "From the Editors, November 2003." Microbiology Australia 24, no. 4 (2003): 3. http://dx.doi.org/10.1071/ma03403.
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The guest editor for this issue is Cheryl Power who is the convenor of the ASM Education SIG. Cheryl has many years of experience in education and is a recipient of the ASM David White Award for Excellence in Teaching. She has invited a number of other educators to contribute to this issue, many of whom are recipients of teaching awards from this society or their own teaching institutions.
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Lee, Hyejin. "Comparison between Korea’s Grants-based ODA in Agriculture and Status of Food Security of its Recipient Countries in Asia." Open Agriculture Journal 13, no. 1 (2019): 19–26. http://dx.doi.org/10.2174/1874331501913010019.
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Introduction: Agriculture tends to be the main employer and income source in many developing countries. Recognizing the value of agriculture for food security and poverty reduction, major donors invest in the agricultural development through the Official Development Assistance or ODA. Of the donors, the Republic of Korea stands out with its historical experience from being a recipient to donor. However, it is not very clear with what criteria Korea would select its recipient countries to disburse its agricultural ODA. Thus, the main objective of this study is to examine a following hypothesis; Korea disburses its agricultural ODA in Asia based on the recipient country’s level of food insecurity. Materials and Methods: To test the hypothesis, collected data are analyzed and comparisons are made between Korea’s grants-based agricultural ODA disbursements and the status of food insecurity of its major recipients in Asia. Results: Although limited to the grants-based agricultural ODA, the results reveal that distribution of the agricultural ODA across the select recipient countries in Asia does not correspond to their severity of food insecurity. Rather, the least food insecure country or the Philippines received the largest agricultural ODA. Conclusion: It appears that at least at a recipient-country level, Korea may have other selection criteria for its grants-based agricultural ODA disbursement or more likely consider a combination of underlying factors that combine both Korea’s national interest and a recipient country’s sociopolitical environment.
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Signorini, Lucia, Maria Dolci, Evaldo Favi, et al. "Viral Genomic Characterization and Replication Pattern of Human Polyomaviruses in Kidney Transplant Recipients." Viruses 12, no. 11 (2020): 1280. http://dx.doi.org/10.3390/v12111280.
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Human Polyomavirus (HPyV) infections are common, ranging from 60% to 100%. In kidney transplant (KTx) recipients, HPyVs have been associated with allograft nephropathy, progressive multifocal leukoencephalopathy, and skin cancer. Whether such complications are caused by viral reactivation or primary infection transmitted by the donor remains debated. This study aimed to investigate the replication pattern and genomic characterization of BK Polyomavirus (BKPyV), JC Polyomavirus (JCPyV), and Merkel Cell Polyomavirus (MCPyV) infections in KTx. Urine samples from 57 KTx donor/recipient pairs were collected immediately before organ retrieval/transplant and periodically up to post-operative day 540. Specimens were tested for the presence of BKPyV, JCPyV, and MCPyV genome by virus-specific Real-Time PCR and molecularly characterized. HPyVs genome was detected in 49.1% of donors and 77.2% of recipients. Sequences analysis revealed the archetypal strain for JCPyV, TU and Dunlop strains for BKPyV, and IIa-2 strain for MCPyV. VP1 genotyping showed a high frequency for JCPyV genotype 1 and BKPyV genotype I. Our experience demonstrates that after KTx, HPyVs genome remains stable over time with no emergence of quasi-species. HPyVs strains isolated in donor/recipient pairs are mostly identical, suggesting that viruses detected in the recipient may be transmitted by the allograft.
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Saunders, Peter. "Selectivity and Targeting in Income Support: The Australian Experience." Journal of Social Policy 20, no. 3 (1991): 299–326. http://dx.doi.org/10.1017/s0047279400018900.
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ABSTRACTThe Australian income support system is often characterised as one of the most selective in the Western industrialised world. This paper examines the sense in which the Australian system is selective, and discusses the distinction between selectivity and targeting in income support provisions. Developments in social security outlays and recipient numbers over the last two decades are compared with those occurring since 1983, in order that the nature and impact of recent policies introduced to increase targeting can be identified. The analysis indicates that increases in recipient numbers have been the dominant factor underlying the past growth in social security expenditure. The distinction between selectivity and targeting of income support provisions is then explained with reference to the concepts of eligibility and entitlement. A framework is developed to illustrate how recent policies have restrained the growth in social security recipient numbers by policies which have increased income support targeting. These moves have not always produced a consistently more selective system of income support, an issue which is explored with the use of an index of the degree of selectivity of social security expenditures developed specifically for this purpose.
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Schaible, Alexandra, Allison Mays, Can-Lan Sun, et al. "Delayed Cytomegalovirus (cmv) Infection Following Hematopoietic Cell Transplantation (HCT): City of Hope (COH) Experience." Blood 112, no. 11 (2008): 1155. http://dx.doi.org/10.1182/blood.v112.11.1155.1155.
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Abstract Patients undergoing HCT are at an increased risk of developing primary and/or reactivated CMV infection, although the magnitude of risk of CMV disease has decreased with the widespread use of preemptive ganciclovir. Most episodes of reactivation occur within the first year post-HCT and are associated with risk factors such as CMV serostatus of donor and recipient, development of acute graft vs. host disease (GVHD): and the immunosuppressive therapy used for its management. Because of prolonged periods of immunosuppression post-HCT, patients may be at risk for delayed CMV infection one or more years after HCT. However, the magnitude of risk of delayed CMV infection and characteristics of those at increased risk has not been described. Given the high morbidity and mortality associated with post-HCT CMV infection, identifying patients at high risk of delayed CMV could be useful for effective management. This report includes 2700 consecutive patients who survived more than one year after undergoing HCT at COH between 1976 and 2003; these included 1404 autologous HCT recipients and 1296 allogeneic HCT recipients (1043 related donor; 253 unrelated donor recipients). Median age at HCT was 38 years (range, 0.6 to 79 years) and 59% of the cohort was males. Median follow-up time from HCT until delayed CMV infection/disease, death, or end of study period (12/31/2006), whichever occurred first, was 4.3 years (range:1–26.6 years). Medical records from COH and/or outside facilities were the main source of data for CMV occurrences. In total, 33 patients (1%) developed delayed CMV infection after surviving at least one year post-HCT (1 autologous and 32 allogeneic [20 related donor and 12 unrelated donor HCT]) developed a total of 40 episodes of delayed CMV that included pneumonia (n=16), gastrointestinal disease (n=8), retinitis (n=2), hepatitis (n=1), concurrent pneumonia and hepatitis (n=1), and asymptomatic reactivation (n=12). The overall cumulative incidence of delayed CMV infection was 1.3% (95% Confidence Interval [CI], 0.9–1.8%) at 5 years from HCT. For autologous HCT recipients, the incidence was 0.07% at 1 year based on 1 event. Among allogeneic HCT recipients, the cumulative incidence at 5 years post-HCT was 2.1% [95%CI, 1.2–3.0%] for related donor HCT recipients; and 5.0% [95%CI, 2.2–7.7%] for unrelated donor HCT recipients. Among allogeneic HCT recipients, the risk factors for the development of delayed CMV infection included unrelated donor HCT (hazard ratio [HR] = 2.5, 95% CI, 1.1–5.7) and CMV seropositive status of the recipient (HR=7.7, 95% CI 1.0–57.0) (Figure). Interestingly, donor CMV status was not associated with increased risk of delayed CMV. All 32 allogeneic HCT recipients experienced chronic GVHD, with prolonged exposures to corticosteroids (median=494 days), and cyclosporine (median=380 days). Thirty patients with delayed CMV infection (94% of the allogeneic HCT recipients with delayed CMV) were receiving immunosuppressive therapy for management of chronic GVHD at onset of delayed CMV. A total of eight patients with delayed CMV did not have a history of CMV infection in the first year, and were characterized by the following clinical and demographic features: 6 (75%) were male; median age at HCT was 35 years; one was an autologous HCT recipient, who relapsed 10 months post-HCT for non-Hodgkin lymphoma, received further chemotherapy and radiation, including Rituximab and then developed late CMV, just over one year post-HCT. The seven allogeneic HCT recipients had chronic GVHD, and were CMV serostatus positive prior to HCT, with 4 also having CMV seropositive donors. Of the 33 patients with delayed CMV in this study, 26 expired; median survival after the development of delayed CMV was 46 days. This study describes the magnitude of risk of delayed CMV infection in autologous and allogeneic HCT recipients and identifies at risk patients as those who are seropositive for CMV, undergoing unrelated HCT, and those with prolonged exposures to immunosuppressive therapy for cGVHD (Figure), suggesting the need for a close surveillance of these patients at high risk. Figure Figure
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Yamin, Stephanie, and Cassandre Gratton. "NEEDS AND EXPERIENCES OF CAREGIVERS TO PERSONS WITH DEMENTIA WHO HAVE LOST THEIR DRIVING PRIVILEGES." Innovation in Aging 3, Supplement_1 (2019): S111—S112. http://dx.doi.org/10.1093/geroni/igz038.414.
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Abstract The ability to drive a motor vehicle for most older adults is associated with a sense of independence, well-being, quality of life and identity. For many older adults, driving cessation eventually becomes inevitable. This is especially the case for older adults with a diagnosis of dementia. Driving cessation has been shown to negatively impact individuals’ mobility and, consequently, quality of life. Informal caregivers (i.e., family caregivers) can mitigate the negative consequences associated with driving cessation in persons with dementia (PWD) by meeting their mobility needs and by offering emotional support. The purpose of this study was to examine the experience and needs of informal caregivers of PWD who had recently lost their driving privileges. Ten informal caregivers of PWD were recruited from a tertiary memory disorders clinic. Semi-structured interviews were conducted and transcribed. Transcripts of interviews were thematically analyzed using a grounded theory approach. The major themes emerging from the experience of caregivers included being overwhelmed by responsibility, overwhelmed by the emotional response of their care recipient and feeling resentment towards their care recipient. Similarly, the major themes emerging from the needs of caregivers included having the need for mobility training, psychoeducation on how to best attend to the emotional needs of their care recipient and the need for coping strategies. These experiences and needs expressed by caregivers indicate that driving cessation of the care recipient is a difficult experience for caregivers and that a therapeutic intervention based on the reported needs may be beneficial.
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JO, SUSAN, KEVIN BRAZIL, LYNNE LOHFELD, and KATHLEEN WILLISON. "Caregiving at the end of life: Perspectives from spousal caregivers and care recipients." Palliative and Supportive Care 5, no. 1 (2007): 11–17. http://dx.doi.org/10.1017/s1478951507070034.
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Objective: The purpose of this study is to examine the perspectives of both the spousal caregiver and care recipient on the caregiving experience in home-based palliative care.Methods: A qualitative research strategy involving home-based face-to-face interviews with older palliative care patients and their spousal caregivers was used to examine the caregiving experience.Results: Ten spousal caregivers and care recipient dyads participated in the study. Most informal caregivers viewed caregiving as an extension of the family relationship where caregiving responsibilities evolved over time. Spousal caregivers identified many negative reactions to caregiving, such as fatigue or weariness, depression, anger and sadness, financial stresses, and lack of time. Care recipients acknowledged the emotional and financial strain and expressed concern for their spouses. Both caregivers and care recipients were appreciative of home care services although they identified the need for additional services. They also identified difficulties in communication with formal providers and poor coordination of care among the various services. Both caregivers and care recipients disclosed some challenges with informal supports, but on the whole felt that their presence was positive. Additional positive aspects of caregiving reported by spouses included strengthened relationship with their spouse and discovering emotional strength and physical abilities in managing care.Significance of results: Health care and social service professionals need to recognize and understand both caregiver and care recipient perspectives if they are to successfully meet the needs of both members of the dyad.
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Raudeliunaite, Rita. "The specifics in the work of social workers when rendering social services at the person's home." SHS Web of Conferences 68 (2019): 03003. http://dx.doi.org/10.1051/shsconf/20196803003.
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The objective of the study is to highlight the specifics of the work of a social worker when rendering social services at the person's home on the basis of the experience of social workers. Qualitative research strategy was used, including semi-structured interview. The study revealed a wide spectrum of the activities of the social worker when organising the provision of social services at home: the identification and assessment of the need for a service, the planning, provision, coordination and assessment of the assistance or care at the person's home, the involvement of the service recipient in decision-making, the involvement of close relatives of the service recipient, teamwork, cooperation with other institutions, and improvement of skills of the employees. The study revealed the benefit of social services at the person's home to the recipients of the services: living at their homes, they do not feel so lonely, they feel safe, needful, capable of benefiting from the needed assistance. Difficulties, which arise when cooperating with the recipients of social services at home, are the following: people provide false information when identifying the need for a service, mental disorders of the service recipient, dissatisfaction with the rotation of the visiting care workers, complaints regarding the lack of communication. Organisational limitations of bodies providing services are linked to formalism, shortage of the staff, time restrictions for services, lack of transport, unavailability of services due to the limited financial resources of service recipients.
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Weinland, Jo Ann. "The Lived Experience of Informal African American Male Caregivers." American Journal of Men's Health 3, no. 1 (2007): 16–24. http://dx.doi.org/10.1177/1557988307305916.
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Informal caregivers play a major role in providing care to loved ones within the home and demands for dependent care are likely to increase. Informal caregivers are likely to continue to be responsible for the majority of care for loved ones living well into late stages of life. This article describes the lived experience of African American men providing care to a relative within the home and explores their definition of caregiver distress. The phenomenological study was conducted using face-to-face interviews with 10 Christian African American men. Demographic data about the caregiver and the care recipient were collected. Common themes included: commitment, support (family support and formal health-related support), spirituality, and caregiver burden (stress, time strain and financial strain). Implications include the need for health care providers to expand their knowledge related to the diversity of caregivers and to use culturally relevant comprehensive assessments of caregivers and recipients, discharge planning tools, and community resources.
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Galas, M. L. "Prospects of Investment Migration in Russia as a Preventive Factor of social and Economic Risks and Threats." Humanities and Social Sciences. Bulletin of the Financial University 9, no. 5 (2019): 06–112. http://dx.doi.org/10.26794/2226-7867-2019-9-5-106-112.
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This article discusses investment opportunities and business migration in the Russian Federation in the context of the experience of foreign countries . The author treated investment migration as an aggregate of the cost of materials, labour and money in artificial body and/or natural foreign persons, legitimate and free-roaming in the recipient country, aimed at expanded reproduction, fixed assets of all branches of the host economy . In this regard, analyses the mechanism of regulation of economic migration in Russia . Attention is paid to the innovations of migration law and public policy objectives of the Russian migration policy . Investment migration of individuals is stimulated by the recipient in modern states preferences in obtaining a temporary residence permit, residence permit or citizenship . Legal entity investing abroad, encouraged by the tax, credit preferences, banking programs, favourable economic conditions, legal regimes, the reduction of administrative barriers . Each recipient country strives to create favourable conditions for foreign investment in the priority areas of economic and social development . Each recipient country seeks to create favourable conditions for foreign investment in the priority areas of economic and social development . The Russian Federation, as one of the leading contemporary recipients, poses a strategic task of creating an effective model of economic migration, which directly involves labour and migration investment .
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REMUZZI, GIUSEPPE, JOSEP GRINYÒ, PIERO RUGGENENTI, et al. "Early Experience with Dual Kidney Transplantation in Adults using Expanded Donor Criteria." Journal of the American Society of Nephrology 10, no. 12 (1999): 2591–98. http://dx.doi.org/10.1681/asn.v10122591.
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Abstract. Dual transplant of marginal kidneys otherwise not considered for single transplant may give access to an expanded pool of cadaveric organs without exposing recipients to the drawbacks of a limited nephron mass supply. This prospective, case-control study compares adverse events and graft outcome in 24 recipients of two marginal kidneys from donors who were >60 yr old or who had diabetes, hypertension, or non-nephrotic proteinuria (cases), with that of 48 age- and gender-matched control subjects who received single ideal grafts at the same center and were given the same immuno-suppressive therapy. Marginal kidneys with no macroscopic abnormalities were selected for the double transplant on the basis of a predefined score of histologic damage. Six-month patient and kidney survival was 100% with both of the procedures. Incidence (20.8% versus 20.8%) and median (range) duration of posttransplant anuria (5 [2 to 12] versus 7 [2 to 13] days) were comparable in cases and control subjects, respectively. Time to normal serum creatinine and mean serum creatinine values at each time visit were comparable as well, but with significantly lower levels in cases compared with control subjects from month 2 to last follow-up (1.56 ± 0.65 versus 1.74 ± 0.73 mg/dl, P = 0.04). Diastolic BP values averaged during the entire posttransplant period were significantly lower in cases than in control subjects (83.2 ± 11.5 versus 85.1 ± 12.5 mmHg, respectively, P = 0.008). Donor/recipient body weight ratio was the only covariate significantly associated at univariate (P = 0.002) and multivariate (P = 0.001) analysis with last available serum creatinine concentrations. Incidence of acute allograft rejections (20.8% versus 18.8%) and of major surgical complications was comparable in the two groups. No renal artery or vein thrombosis was reported in either group. Dual transplants of marginal kidneys are as safe and tolerated as single transplants, and possibly offer an improved filtration power without exposing the recipient to enhanced risk of delayed renal function recovery, acute allograft rejection, or major surgical complications.
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Cosgun, Tugba, Sandra Tomaszek, Isabelle Opitz, et al. "Single-center experience with intraoperative extracorporeal membrane oxygenation use in lung transplantation." International Journal of Artificial Organs 41, no. 2 (2017): 89–93. http://dx.doi.org/10.5301/ijao.5000645.
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Background: Studies have shown that survival after lung transplantation is impaired if extracorporeal membrane oxygenation (ECMO) support is implemented. We investigated the outcome and potential independent risk factors on survival in recipients undergoing lung transplantation with intraoperative ECMO support. Materials and methods: Medical records of recipients were retrospectively evaluated (January 2000-December 2014). Retransplantation and bridge to transplantation on ECMO were excluded. Recipients (n = 291) were divided into 2 groups: those who needed intraoperative ECMO support (Group 1, n = 134) and those who did not receive intraoperative ECMO support (Group 2, n = 157). Independent risk factors were identified by a stepwise backward regression analysis. Results: 1-year survival was 84.2% in Group 1 vs. 90.4% in Group 2, and 5-year survival was 52.8% in Group 1 vs. 70.5% in Group 2 (p = 0.002). Multivariate analysis indicated that recipient age (p = 0.001), renal replacement therapy (p = 0.001) and intraoperative ECMO support (p = 0.03) were significant risk factors for overall survival. The rate of postoperative early surgical complications was comparable between the two groups (p = 0.09). The number of patients requiring renal replacement therapy and experiencing late pulmonary complications was significantly higher in Group 1 (p = 0.02). Conclusions: Our data showed that lung transplantation with intraoperative ECMO support is associated with poor outcomes.
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Gustafsson, Christine, Margareta Asp, and Ingegerd Fagerberg. "Municipal Night Nurses’ Experience of the Meaning of Caring." Nursing Ethics 16, no. 5 (2009): 599–612. http://dx.doi.org/10.1177/0969733009106652.
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The aim of this study was to elucidate municipal night registered nurses’ (RNs) experiences of the meaning of caring in nursing. The research context involved all night duty RNs working in municipal care of older people in a medium-sized municipality located in central Sweden. The meaning of caring in nursing was experienced as: caring for by advocacy, superior responsibility in caring, and consultative nursing service. The municipal night RNs’ experience of caring is interpreted as meanings in paradoxes: ‘being close at distance’, the condition of ‘being responsible with insignificant control’, and ‘being interdependently independent’. The RNs’ experience of the meaning of caring involves focusing on the care recipient by advocating their perspectives. The meaning of caring in this context is an endeavour to grasp an overall caring responsibility by responding to vocational and personal demands regarding the issue of being a RN, in guaranteeing ethical, qualitative and competent care for older people.
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Booth, Sue, Christina Pollard, John Coveney, and Ian Goodwin-Smith. "‘Sustainable’ Rather Than ‘Subsistence’ Food Assistance Solutions to Food Insecurity: South Australian Recipients’ Perspectives on Traditional and Social Enterprise Models." International Journal of Environmental Research and Public Health 15, no. 10 (2018): 2086. http://dx.doi.org/10.3390/ijerph15102086.
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South Australian (SA) food charity recipients’ perspectives were sought on existing services and ideas for improvement of food assistance models to address food insecurity. Seven focus groups were conducted between October and November 2017 with 54 adults. Thematically analysed data revealed five themes: (1) Emotional cost and consequences of seeking food relief; (2) Dissatisfaction with inaccessible services and inappropriate food; (3) Returning the favour—a desire for reciprocity; (4) Desiring help beyond food; and, (5) “It’s a social thing”, the desire for social interaction and connection. Findings revealed that some aspects of the SA food assistance services were disempowering for recipients. Recipients desired more empowering forms of food assistance that humanise their experience and shift the locus of control and place power back into their hands. Some traditional models, such as provision of supermarket vouchers, empower individuals by fostering autonomy and enabling food choice in socially acceptable ways. Improvement in the quality of existing food assistance models, should focus on recipient informed models which re-dress existing power relations. Services which are more strongly aligned with typical features of social enterprise models were generally favoured over traditional models. Services which are recipient-centred, strive to empower recipients and provide opportunities for active involvement, social connection and broader support were preferred.
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Jahanyar, Jama, Michael M. Koerner, Ali Ghodsizad, Matthias Loebe, and George P. Noon. "Heterotopic Heart Transplantation: The United States Experience." Heart Surgery Forum 17, no. 3 (2014): 132. http://dx.doi.org/10.1532/hsf98.2014328.
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<p><b>Introduction:</b> More than 3 decades have passed since the first heterotopic heart transplantation (HHT) was reported. Nowadays, this surgical technique is used rarely, and only in patients who do not qualify for standard orthotopic heart transplantation (OHT). Current indications mainly comprise refractory pulmonary hypertension and a donor-recipient size mismatch (>20%). The objective of this study was to analyze the United States experience with HHT.</p><p><b>Patients and Methods:</b> The United Network for Organ Sharing (UNOS) database between 1987 and 2007 was analyzed. Patients who underwent heart transplantation were enrolled in this study. Patients with missing transplant dates or history of retransplantation were excluded.</p><p><b>Results:</b> A total of 41,379 patients underwent OHT and 178 HHT; 32,361 and 111 patients, respectively, were enrolled. Overall 1-, 5-, and 10-year survival was significantly (<i>P</i> < .001) better in OHT (87.7%, 74.4%, 54.4%) than HHT patients (83.8%, 59%, 35.1%). Survival in patients with transpulmonary gradients (TPG) >15 mmHg was 86.6 %, 73.3%, and 57.4% in the OHT and 93.8%, 64.8%, and 48.6% in the HHT group (<i>P</i> = .35). Pretransplant criteria (HHT versus OHT) with statistically significant differences (<i>P</i> < .05) were as follows (mean + SD): recipient weight, 78.9 + 19.9 versus 74.1 + 23.4 kg; recipient height, 174.9 + 13.9 versus 168 + 25.1 cm; and TPG 12.1 + 7.2 versus 9.6 + 6.3 mmHg.</p><p><b>Conclusions:</b> The results show that HHT remains a feasible option in a highly selected patient population, with overall good results.</p>
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Studer, Jamie M., Zoe E. Kiefer, Rafael Gianluppi, et al. "79 Direct and Indirect Effects of Heat Stress on the Hepatic and Ovarian Proteome in Gilts." Journal of Animal Science 99, Supplement_1 (2021): 106–7. http://dx.doi.org/10.1093/jas/skab054.173.
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Abstract Seasonal infertility (SI) caused by heat stress (HS) impacts the US swine industry by reducing litter size, farrowing rates, and production efficiency. Identifying the biological underpinnings of SI is a foundational step towards developing mitigation strategies to reduce the nearly $1 billion annual revenue losses to the swine industry. The study objective was to investigate the direct and indirect effects of HS via HS conditioned serum infusion in swine. We hypothesized gilts housed in thermoneutral (TN) conditions receiving gradual infusions of serum obtained from HS gilts would experience altered endocrine and metabolic function compared to gilts receiving serum from TN gilts. Prepubertal gilts (n = 18) were assigned to donor or recipient groups and donors were allocated to TN or HS environments. Blood was collected from HS donors and TN donors exposed to 24-hours of HS or TN conditions, respectively. Serum was infused into recipients housed in TN conditions via indwelling jugular catheters. Over a 24-hour period approximately 20% of the estimated recipient gilt serum volume from donors (pooled by treatment) was infused into recipients. After infusions were completed, gilts were euthanized and tissues collected. Increased rectal temperatures were observed in HS recipients compared to TN recipients (P ≤ 0.05). Protein extracts from liver and ovary underwent proteomic analysis via liquid-chromatography with tandem mass-spectrometry (LC-MS/MS) to assess protein abundance. In the liver and ovary, we identified 135 and 264 proteins, respectively, that were differentially abundant between TN and HS recipients (P &lt; 0.10). Gene Ontology enrichment analysis identified alterations to pathways involved in hormone regulation, immune response, and apoptosis. Collectively, these data demonstrate gilts receiving HS serum experienced altered endocrine and metabolic function compared to gilts receiving TN serum. This project was supported in part by the Iowa Pork Producers Association. USDA is an equal opportunity provider and employer.
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van den Wijngaard, Jeroen P. H. M., Asli Umur, Raymond T. Krediet, Michael G. Ross, and Martin J. C. van Gemert. "Modeling a hydropic recipient twin in twin-twin transfusion syndrome." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 288, no. 4 (2005): R799—R814. http://dx.doi.org/10.1152/ajpregu.00635.2004.
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We developed a mathematical model of twin-twin transfusion syndrome (TTTS) that includes a hydropic recipient twin, adding interstitial and intracellular fluid compartments, fetal congestive cardiac failure, and the dynamics of renin-angiotensin system (RAS) mediators to our previous TTTS model. Ten differential equations for each twin, coupled by the net fetofetal transfusion of blood and blood components, i.e., colloids, osmoles, and RAS mediators, describe the development of fetal arterial and venous blood volumes, blood osmolality and colloid osmotic pressure (COP), interstitial fluid volume and COP, intracellular fluid volume, amniotic fluid volume and osmolality, and RAS mediator concentration. We included varying placental anastomoses, placental sharing, and amnionicity. The 20 differential equations were solved numerically from 0 to 40 wk with a 0.6-s time step. Consistent with clinical experience, model predictions are as follows. Unidirectional arteriovenous anastomoses and arteriovenous anastomoses inadequately compensated by oppositely directed anastomoses cause severe TTTS that includes a hydropic recipient. Adequately compensated arteriovenous anastomoses simulated TTTS without hydrops. The probability that oppositely directed anastomoses prevent onset of a hydropic recipient after TTTS onset, i.e., the largest interval between onset of TTTS and onset of hydrops in the recipient, was best for a venovenous anastomosis, closely followed by an arterioarterial and finally an oppositely directed arteriovenous anastomosis. Hydropic recipients have decreased amniotic fluid volume. Unequal placental sharing and amnionicity modify hydrops onset. In conclusion, our model simulates a sequence of events that results in a hydropic recipient twin in severe TTTS. The model may allow an assessment of the efficacy of current therapeutic interventions for TTTS cases that include a hydropic recipient twin.
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Savitch, Stephanie, Robin Gilmore, and Denetta L. Dowler. "An Investigation of the Psychological and Psychosocial Challenges Faced by Post-Transplant Organ Recipients." Journal of Applied Rehabilitation Counseling 34, no. 3 (2003): 3–9. http://dx.doi.org/10.1891/0047-2220.34.3.3.
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Organ transplantation offers to some terminally ill people the opportunity to have their lives extended with the gift of an organ(s). Following transplantation, the organ recipient is given extensive medical care, but the psychological, psychosocial, and occupational needs of the person are rarely addressed. This study identified and defined these emotional and occupational challenges and presents the current and prospective role of the Rehabilitation Counselor. Fifty-four organ transplant recipients completed a two-page questionnaire covering the post-transplant experience. Analysis of the results identified the challenges faced by the recipients post-transplant as well as the need for counseling during the first year following the transplant procedure.
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Miglinas, M., and K. Mateikaite. "Proteinuria Affecting Kidney Allograft and Recipient Survival: Single Centre Experience." Transplantation 98 (July 2014): 471. http://dx.doi.org/10.1097/00007890-201407151-01569.
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Zuck, TF, GA Rose, UJ Dumaswala, and NJ Geer. "Experience with a transfusion recipient education program about hepatitis C." Transfusion 30, no. 8 (1990): 759–61. http://dx.doi.org/10.1046/j.1537-2995.1990.30891020339.x.
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Arya, Aman, Roberto Hernandez-Alejandro, Paul Marotta, Julia Uhanova, and Natasha Chandok. "Recipient ineligibility after liver transplantation assessment: a single centre experience." Canadian Journal of Surgery 56, no. 3 (2013): E39—E43. http://dx.doi.org/10.1503/cjs.004512.
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Pugliese, Orsola, Francesca Quintieri, Dino Alberto Mattucci, Sante Venettoni, Emanuela Taioli, and Alessandro Nanni Costa. "Kidney Graft Survival in Italy and Factors Influencing it." Progress in Transplantation 15, no. 4 (2005): 385–91. http://dx.doi.org/10.1177/152692480501500411.
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Purpose National registry data are often a suitable basis for examination of transplant outcomes. Using data supplied by the Italian National Transplant Registry, established in 1995, we performed the first nationwide analysis of this kind. Methods A retrospective analysis of 4893 recipients of cadaveric kidneys transplanted in all Italian centers from 1995 through 2000 was done to study 5-year graft survival. The association between some donor and recipient variables and outcomes in renal transplantation was analyzed. Graft survival was 93% at 3 months, 89% at 1 year, 82% at 3 years, and 80% at 5 years after transplantation. Results A significant association between graft survival and donor age (old vs young, relative risk [RR] = 1.62, 95% CI 1.27–2.06) and recipient age (old vs young, RR = 1.25, 95% CI 1.02–1.53). Graft survival was also associated with cold ischemia time (24–36 hours, RR=1.39, 95% CI 1.05–1.85 and >36 hours, RR=1.94, 95% CI 1.32–2.86 vs 0–24 hours) and donor/recipient sex mismatch (female/male vs male/male, RR=1.50, 95% CI 1.17–1.93). Conclusion The quality of kidney transplantation in Italy is satisfactory and is comparable to that in other developed countries. Furthermore, our experience confirms that both donor and recipient factors are major determinants of renal allograft function.
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Melenhorst, J. Joseph, Ann M. Leen, Catherine M. Bollard, et al. "Allogeneic Virus-Specific T Cells with HLA Alloreactivity Do Not Produce Graft-Versus-Host Disease In Human Subjects." Blood 116, no. 21 (2010): 1252. http://dx.doi.org/10.1182/blood.v116.21.1252.1252.
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Abstract Abstract 1252 We and others have recently established that T cell reactivity with non-self HLA (HLA alloreactivity) arises not only from naive T cells but also from the antigen-experienced T cell pool, including Epstein-Barr virus (EBV) and cytomegalovirus (CMV)-specific T cells. Virus-specific T cells could therefore mediate graft-versus-host disease (GvHD) if infused into partially HLA mismatched recipients. We reviewed our clinical experience with adoptive transfer of allogeneic hematopoietic stem cell transplant donor-derived virus-specific T cell lines in 153 recipients who received donor-derived EBV-specific CTLs (N=114), bivirus CTLs specific for adenovirus and EBV (n=14), and trivirus CTLs specific for CMV, adenovirus and EBV (n=25). Seventy three donor-recipient pairs were partially HLA-mismatched, with the degree of HLA mismatching varying from one allele to a full haplotype. De novo GvHD did not develop after infusion of cytotoxic T lymphocytes (CTL), and the incidence of GvHD reactivation was 6.5% and not significantly different between recipients of HLA matched or mismatched CTL. Thus, virus-specific CTL did not mediate GvHD, even in recipients of partially matched CTL. Next we analyzed the HLA alloreactivity of four donor-infused bivirus-specific T cell lines, using activated T cells, that are known to lack CMV and EBV antigen expression, as antigen presenting cells (TAPC). We used a panel of 44 TAPC covering the most frequent HLA class I and II alleles. The CTL lines were labeled with CFSE and stimulated with TAPC for 6 hours, after which production of TNFα and IFNγ/IL-2 by CD4+ and CD8+ T cells in the CFSE-positive fraction was analyzed by flow cytometry. All CTLs responded to a number of TAPC, with some APC being recognized strongly. The majority elicited only weak or no response from the CTLs. We then assessed whether the CTLs recognized TAPC expressing the recipient's HLA alleles. We found moderate reactivity of the CTL with 1–5 TAPC expressing recipient HLA alleles. Taken together, our data indicate that reactivity of virus-specific CTLs with hematopoietic APC does not correlate with the risk of developing GvHD, and that virus-specific CTL can safely be infused into HLA class I and/or II mismatched recipients. Disclosures: No relevant conflicts of interest to declare.
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Bäckman, Olof, and Åke Bergmark. "Escaping welfare? Social assistance dynamics in Sweden." Journal of European Social Policy 21, no. 5 (2011): 486–500. http://dx.doi.org/10.1177/0958928711418855.
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The article analyses temporal patterns in social assistance receipt in Sweden in the 2000s by looking at which circumstances facilitate versus reduce the possibilities of a person ceasing to be a recipient of social assistance. The analysis is guided by the following questions: What conditions lead people to terminate periods of social assistance receipt? Which factors are central to exits with different subsequent income patterns? How do these explain the different situations of recipients prior to termination? We focus particularly on income maintenance prior to spells of social assistance. We use event history data on monthly social assistance take-up covering the total adult Swedish population for the years 2002–2004. We adopt a gamma mixture model to control for unobserved heterogeneity. The results suggest that previous experience of both employment and social assistance receipt are important determinants for all types of exits from social assistance recipiency. A negative duration dependence is found also when unobserved heterogeneity is controlled for.
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Ruiz-Delgado, Guillermo Jose, Avril Lopez-Otero, Ana Hernandez-Arizpe, Aura Ramirez-Medina, and Guillermo Jose Ruiz-Argüelles. "POOR HEMOPOIETIC STEM CELL MOBILIZERS IN MULTIPLE MYELOMA : A SINGLE INSTITUTION EXPERIENCE." Mediterranean Journal of Hematology and Infectious Diseases 2, no. 2 (2010): e2010016. http://dx.doi.org/10.4084/mjhid.2010.016.
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In a single institution, in a group of 28 myeloma patients deemed eligible for autologous transplant, stem cell mobilization was attempted using filgrastim: 26 individuals were given 31 autografts employing 1-4 (median three) apheresis sessions, to obtain a target stem cell dose of 1 x 106 CD34 viable cells / Kg of the recipient. The median number of grafted CD34 cells was 7.56 x 106 / Kg of the recipient; the range being 0.92 to 14.8. By defining as poor mobilizers individuals in which a cell collection of < 1 x 106 CD34 viable cells / Kg was obtained, a subset of eight poor mobilizers was identified; in two patients the autograft was aborted because of an extremely poor CD34 cell yield (< 0.2 x 106 CD34 viable cells / Kg of the recipient) after four apheresis sessions. The long-term overall survival of the patients grafted with > 1 x 106 CD34 viable cells / Kg was better (80% at 80 months) than those grafted with < 1 x 106 CD34 viable cells / Kg (67% at 76 months). Methods to improve stem cell mobilization are needed and may result in obtaining better results when autografting multiple myeloma patients.