Great variability in donor heart acceptance practices across the United States.
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ABSTRACT:
SUBMITTER: Khush KK
PROVIDER: S-EPMC7261633 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ImportanceApproximately 3500 donated kidneys are discarded in the United States each year, drawing concern from Medicare and advocacy groups.ObjectiveTo estimate the effects of more aggressive allograft acceptance practices on the donor pool and allograft survival for the population of US wait-listed kidney transplant candidates.Design, setting, and participantsA nationwide study using validated registries from the United States and France comprising comprehensive cohorts of deceased donors with organs offered to kidney transplant centers between January 1, 2004, and December 31, 2014. Data were analyzed between September 1, 2018, and April 5, 2019.Main outcomes and measuresThe primary outcome was kidney allograft discard. The secondary outcome was allograft failure after transplantation. We used logistic regression to model organ acceptance and discard practices in both countries. We then quantified using computer simulation models the number of kidneys discarded in the United States that a more aggressive system would have instead used for transplantation. Finally, based on actual survival data, we quantified the additional years of allograft life that a redesigned US system would have saved.FindingsIn the United States, 156 089 kidneys were recovered from deceased donors between 2004 and 2014, of which 128 102 were transplanted, and 27 987 (17.9%) were discarded. In France, among the 29 984 kidneys recovered between 2004 and 2014, 27 252 were transplanted, and 2732 (9.1%, P < .001 vs United States) were discarded. The mean (SD) age of kidneys transplanted in the United States was 36.51 (17.02) years vs 50.91 (17.34) years in France (P < .001). Kidney quality showed little change in the United States over time (mean [SD] kidney donor risk index [KDRI], 1.30 [0.48] in 2004 vs 1.32 [0.46] in 2014), whereas a steadily rising KDRI in France reflected a temporal trend of more aggressive organ use (mean [SD] KDRI, 1.37 [0.47] in 2004 vs 1.74 [0.72] in 2014; P < .001). We applied the French-based allocation model to the population of US deceased donor kidneys and found that 17 435 (62%) of kidneys discarded in the United States would have instead been transplanted under the French system. We further determined that a redesigned system with more aggressive organ acceptance practices would generate an additional 132 445 allograft life-years in the United States over the 10-year observation period.Conclusions and relevanceGreater acceptance of kidneys from deceased donors who are older and have more comorbidities could provide major survival benefits to the population of US wait-listed patients.Trial registrationClinicalTrials.gov identifier: NCT03723668.
| S-EPMC6714020 | biostudies-literature
Project description:Background and purposeClinical outcomes in patients with acute ischemic stroke caused by large vessel occlusion depend on the speed and quality of workflows leading to mechanical thrombectomy. In the absence of universally accepted best practices for workflow, developing stroke hospitals can benefit from improved awareness of real-world workflows in effect at experienced centers. To this end, we surveyed prethrombectomy workflow practices at stroke centers throughout the United States.Materials and methodsE-mail and phone interviews were conducted with neurointerventional team members at 30 experienced, endovascular-capable stroke centers. Questions were chosen to reflect workflow components of triage, team activation, transport, case setup, and anesthesia.ResultsThere is wide variation in prethrombectomy workflows. At 53% of institutions, nonphysician staff respond to stroke alerts alongside physicians. Imaging triage involves noninvasive angiography or perfusion imaging at 97% and 63% of institutions, respectively. Neurointerventional consultation is initiated before the completion of neuroimaging at 86% of institutions, and the team is activated before a final treatment decision at 59%. The neurointerventional team most commonly arrives within 30 minutes. Patients may be transported to the neuroangiography suite before team arrival at 43% of institutions. Procedural trays are set up in advance of team arrival at 13% of centers; additional thrombectomy devices are centrally stored at 54%. A power injector for angiographic runs is consistently used at 43% of institutions. Anesthesiology routinely supports thrombectomies at 67% of institutions.ConclusionsPrethrombectomy workflows vary widely between experienced centers. Improved awareness of real-world workflows and their variations may help to guide institutions in designing their own protocols of care.
| S-EPMC7963759 | biostudies-literature
Project description: Not available
| S-EPMC7721478 | biostudies-literature
Project description:BackgroundLung transplantation offers a survival benefit for patients with end-stage lung disease. When suitable donors are identified, centers must accept or decline the offer for a matched candidate on their waitlist. The degree to which variability in per-center offer acceptance practices impacts candidate survival is not established. The purpose of this study was to determine the degree of variability in per-center rates of lung transplantation offer acceptance and to ascertain the associated contribution to observed differences in per-center waitlist mortality.MethodsWe performed a retrospective cohort study of candidates waitlisted for lung transplantation in the US using registry data. Logistic regression was fit to assess the relationship of offer acceptance with donor, candidate, and geographic factors. Listing center was evaluated as a fixed effect to determine the adjusted per-center acceptance rate. Competing risks analysis employing the Fine-Gray model was undertaken to establish the relationship between adjusted per-center acceptance and waitlist mortality.ResultsOf 15,847 unique organ offers, 4,735 (29.9%) were accepted for first-ranked candidates. After adjustment for important covariates, transplant centers varied markedly in acceptance rate (9%-67%). Higher cumulative incidence of 1-year waitlist mortality was associated with lower acceptance rate. For every 10% increase in adjusted center acceptance rate, the risk of waitlist mortality decreased by 36.3% (sub-distribution hazard ratio 0.637; 95% confidence interval 0.592-0.685).ConclusionsVariability in center-level behavior represents a modifiable risk factor for waitlist mortality in lung transplantation. Further intervention is needed to standardize center-level offer acceptance practices and minimize waitlist mortality.
| S-EPMC7089807 | biostudies-literature
Project description:Conotruncal defects with normally related great vessels (CTD-NRGVs) occur in both patients with and without 22q11.2 deletion syndrome (22q11.2DS), but it is unclear to what extent the genetically complex etiologies of these heart defects may overlap across these two groups, potentially involving variation within and/or outside of the 22q11.2 region. To explore this potential overlap, we conducted genome-wide SNP-level, gene-level, and gene set analyses using common variants, separately in each of five cohorts, including two with 22q11.2DS (N = 1472 total cases) and three without 22q11.2DS (N = 935 total cases). Results from the SNP-level analyses were combined in meta-analyses, and summary statistics from these analyses were also used in gene and gene set analyses. Across all these analyses, no association was significant after correction for multiple comparisons. However, several SNPs, genes, and gene sets with suggestive evidence of association were identified. For common inherited variants, we did not identify strong evidence for shared genomic mechanisms for CTD-NRGVs across individuals with and without 22q11.2 deletions. Nevertheless, several of our top gene-level and gene set results have been linked to cardiogenesis and may represent candidates for future work.
| S-EPMC8306129 | biostudies-literature
Project description:Evolution is a prominent component of biology education and remains controversial among college biology students in the United States who are mostly Christian, but science education researchers have not explored the attitudes of Muslim biology students in the United States. To explore perceptions of evolution among Muslim students in the United States, we surveyed 7,909 college students in 52 biology classes in 13 states about their acceptance of evolution, interest in evolution, and understanding of evolution. Muslim students in our sample, on average, did not agree with items that measured acceptance of macroevolution and human evolution. Further, on average, Muslim students agreed, but did not strongly agree with items measuring microevolution acceptance. Controlling for gender, major, race/ethnicity, and international status, we found that the evolution acceptance and interest levels of Muslim students were slightly higher than Protestant students and students who are members of the Church of Jesus Christ of Latter-day Saints. However, Muslim student evolution acceptance levels were significantly lower than Catholic, Jewish, Buddhist, and Hindu students as well as students who did not identify with a religion (agnostic and atheists). Muslim student understanding of evolution was similar to students from other affiliations, but was lower than agnostic and atheist students. We also examined which variables are associated with Muslim student acceptance of evolution and found that higher understanding of evolution and lower religiosity are positive predictors of evolution acceptance among Muslim students, which is similar to the broader population of biology students. These data are the first to document that Muslim students have lower acceptance of evolution compared to students from other affiliations in undergraduate biology classrooms in the United States.
| S-EPMC8357111 | biostudies-literature
Project description:The full scope of the impact of The Great Recession on individuals' mental health has not been quantified to date. This study aimed to determine whether financial, job-related, and housing impacts experienced by individuals during the recession predicted changes in the occurrence of symptoms of depression, generalized anxiety, panic attacks, and problematic alcohol or other substance use. Longitudinal survey data (n = 2,530 to n = 3,293) were analyzed from the national Midlife in the United States (MIDUS) study collected before (2003-2004) and after (2012-2013) The Great Recession. The population-level trend was towards improvements in mental health over time. However, for individuals each recession impact experienced was associated with long-lasting and transdiagnostic declines in mental health. These relationships were stronger for some sociodemographic groups, suggesting the need for additional support for people who suffer marked losses during recessions and for those without a strong safety net.
| S-EPMC7413622 | biostudies-literature
Project description:ObjectiveTo survey current practices for the treatment of neonatal abstinence syndrome (NAS) among institutions in the United States to identify changes in national practice over time.MethodsPrevious NAS management reports were referenced in the development of our 26-question electronic survey, which was distributed in the fall of 2019 to pediatric practitioners of 2 national clinical pharmacy organizations via email list servers. Not all questions required a response and responses from incomplete surveys were included. Institution demographics and NAS management strategies, including location of care, observation period, and inpatient and outpatient pharmacotherapy, were queried.ResultsSeventy respondents representing institutions from all US geographic regions participated in the survey The most commonly reported inpatient observation durations were 3 (18 of 61, 29%) and 5 (22 of 61, 36%) days. Respondents indicated that neonates were typically transferred to the NICU if pharmacologic management was required (38 of 56, 68%). According to participants, first-line agents used for NAS management were morphine (45 of 56, 80%), methadone (5 of 56, 9%), clonidine (2 of 56, 4%), and buprenorphine (2 of 56, 4%). Among respondents, only 20% (11 of 56) reported that infants may be discharged home on pharmacotherapy, including morphine (n = 6), phenobarbital (n = 3), clonidine (n = 1), and methadone (n = 1).ConclusionsOpioids are the most commonly used first-line agents for NAS management in the United States. The primary site of NAS management is the inpatient setting, as only 20% of institutions report discharging patients on pharmacotherapy.
| S-EPMC8372852 | biostudies-literature
Project description:The annual frequency of tornadoes during 1950-2018 across the major tornado-impacted states were examined and modeled using anthropogenic and large-scale climate covariates in a hierarchical Bayesian inference framework. Anthropogenic factors include increases in population density and better detection systems since the mid-1990s. Large-scale climate variables include El Niño Southern Oscillation (ENSO), Southern Oscillation Index (SOI), North Atlantic Oscillation (NAO), Pacific Decadal Oscillation (PDO), Arctic Oscillation (AO), and Atlantic Multi-decadal Oscillation (AMO). The model provides a robust way of estimating the response coefficients by considering pooling of information across groups of states that belong to Tornado Alley, Dixie Alley, and Other States, thereby reducing their uncertainty. The influence of the anthropogenic factors and the large-scale climate variables are modeled in a nested framework to unravel secular trend from cyclical variability. Population density explains the long-term trend in Dixie Alley. The step-increase induced due to the installation of the Doppler Radar systems explains the long-term trend in Tornado Alley. NAO and the interplay between NAO and ENSO explained the interannual to multi-decadal variability in Tornado Alley. PDO and AMO are also contributing to this multi-time scale variability. SOI and AO explain the cyclical variability in Dixie Alley. This improved understanding of the variability and trends in tornadoes should be of immense value to public planners, businesses, and insurance-based risk management agencies.
| S-EPMC7814142 | biostudies-literature
Project description:Changes in the frequency of occurrence of atmospheric circulation patterns under a changing climate system has important implications for regional climate variability. While many studies have focused on understanding the trends in the atmospheric pattern amplitudes and probabilities of occurrence, little attention has been given to how the linkages between climate variables and the large-scale patterns have been changing. Here we first document the strengthening relationship between an important North Pacific teleconnection - the East Pacific/North Pacific (EP/NP) pattern - and United States (US) temperature variability since the 1950s. The EP/NP pattern is linked to tropical convection, and consistently the coherence between US temperature anomalies and tropical convection anomalies has also been increasing during the same time period. This upward trend in convection-temperature alignment is most notable during autumn and winter and is absent during the summer. The relationship strengths and trends further suggest that the EP/NP pattern should be incorporated into monthly and seasonal outlooks that are of broad importance to agriculture, industry, and fisheries.
| S-EPMC5427841 | biostudies-literature