Impact of donor-recipient gender and race mismatching on patient survival in patients with end-stage liver diseases undergoing liver transplantation

Background. End-stage liver disease (ESLD) is an irreversible condition that leads to the imminent complete failure of the liver. Orthotopic liver transplantation (OLT) has been well accepted as the best curative option for patients with ESLD. Despite the progress in liver transplantation, the major limitation nowadays is the discrepancy between donor supply and organ demand. In an effort to alleviate this situation, mismatched donor and recipient gender or race livers are being used. However, the simultaneous impact of donor and recipient gender and race mismatching on patient survival after OLT remains unclear and relatively challenging to surgeons. ^ Objective. To examine the impact of donor and recipient gender and race mismatching on patient survival after OLT using the United Network for Organ Sharing (UNOS) database. ^ Methods. A total of 40,644 recipients who underwent OLT between 2002 and 2011 were included. Kaplan-Meier survival curves and the log-rank tests were used to compare the survival rates among different donor-recipient gender and race combinations. Univariate Cox regression analysis was used to assess the association of donor-recipient gender and race mismatching with patient survival after OLT. Multivariable Cox regression analysis was used to model the simultaneous impact of donor-recipient gender and race mismatching on patient survival after OLT adjusting for a list of other risk factors. Multivariable Cox regression analysis stratifying on recipient hepatitis C virus (HCV) status was also conducted to identify the variables that were differentially associated with patient survival in HCV + and HCV − recipients. ^ Results. In the univariate analysis, compared to male donors to male recipients, female donors to male recipients had a higher risk of patient mortality (HR, 1.122; 95% CI, 1.065–1.183), while in the multivariable analysis, male donors to female recipients experienced an increased mortality rates (adjusted HR, 1.114; 95% CI, 1.048–1.184). Compared to white donors to white recipients, Hispanic donors to black recipients had a higher risk of patient mortality (HR, 1.527; 95% CI, 1.293–1.804) in the univariate analysis, and similar result (adjusted HR, 1.553; 95% CI, 1.314–1.836) was noted in multivariable analysis. After the stratification on recipient HCV status in the multivariable analysis, HCV + mismatched recipients appeared to be at greater risk of mortality than HCV − mismatched recipients. Female donors to female HCV − recipients (adjusted HR, 0.843; 95% CI, 0.769–0.923), and Hispanic HCV + recipients receiving livers from black donors (adjusted HR, 0.758; 95% CI, 0.598–0.960) had a protective effect on patient survival after OLT. ^ Conclusion. Donor-recipient gender and race mismatching adversely affect patient survival after OLT, both independently and after the adjustment for other risk factors. Female recipient HCV status is an important effect modifier in the association between donor-recipient gender combination and patient survival.^

Discovery of "isolated" co-moving T Tauri stars in Cepheus

Context. During the course of a large spectroscopic survey of X-ray active late-type stars in the solar neighbourhood, we discovered four lithium-rich stars packed within just a few degrees on the sky. Although located in a sky area rich in CO molecular regions and dark clouds, the Cepheus-Cassiopeia complex, these very young stars are projected several degrees away from clouds in front of an area void of interstellar matter. As such, they are very good "isolated" T Tauri star candidates. Aims. We present optical observations of these stars conducted with 1-2 m class telescopes. We acquired high-resolution optical spectra as well as photometric data allowing us to investigate in detail their nature and physical parameters with the aim of testing the "runaway" and "in-situ" formation scenarios. Their kinematical properties are also analyzed to investigate their possible connection to already known stellar kinematic groups. Methods. We use the cross-correlation technique and other tools developed by us to derive accurate radial and rotational velocities and perform an automatic spectral classification. The spectral subtraction technique is used to infer chromospheric activity level in the Hα line core and clean the spectra of photospheric lines before measuring the equivalent width of the lithium absorption line. Results. Both physical (lithium content, chromospheric, and coronal activities) and kinematical indicators show that all stars are very young, with ages probably in the range 10-30 Myr. In particular, the spectral energy distribution of TYC4496-780-1 displays a strong near-and far-infrared excess, typical of T Tauri stars still surrounded by an accretion disc. They also share the same Galactic motion, proving that they form a homogeneous moving group of stars with the same origin. Conclusions. The most plausible explanation of how these "isolated" T Tauri stars formed is the "in-situ" model, although accurate distances are needed to clarify their connection with the Cepheus-Cassiopeia complex. The discovery of this loose association of "isolated" T Tauri stars can help to shed light on atypical formation processes of stars and planets in low-mass clouds.

Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty

Purpose: To report the successful outcome obtained after fitting a new hybrid contact lens in a cornea with an area of donor-host misalignment and significant levels of irregular astigmatism after penetrating keratoplasty (PKP). Materials and methods: A 41-year-old female with bilateral asymmetric keratoconus underwent PKP in her left eye due to the advanced status of the disease. One year after surgery, the patient referred a poor visual acuity and quality in this eye. The fitting of different types of rigid gas permeable contact lenses was performed, but with an unsuccessful outcome due to contact lens stability problems and uncomfortable wear. Scheimpflug imaging evaluation revealed that a donor-host misalignment was present at the nasal area. Contact lens fitting with a reverse geometry hybrid contact lens (Clearkone, SynergEyes Carlsbad) was then fitted. Visual, refractive, and ocular aberrometric outcomes were evaluated during a 1-year period after the fitting. Results: Uncorrected distance visual acuity improved from a prefitting value of 20/200 to a best corrected postfitting value of 20/20. Prefitting manifest refraction was +5.00 sphere and -5.50 cylinder at 75°, with a corrected distance visual acuity of 20/30. Higher order root mean square (RMS) for a 5 mm pupil changed from a prefitting value of 6.83 µm to a postfitting value of 1.57 µm (5 mm pupil). The contact lens wearing was referred as comfortable, with no anterior segment alterations. Conclusion: The SynergEyes Clearkone contact lens seems to be another potentially useful option for the visual rehabilitation after PKP, especially in cases of donor-host misalignment.

" Lines upon the late proceedings of the College Government" collection, 1787-1917

This collection contains various manifestations of a humorous poem, most often called "Lines upon the late proceedings of the College Government," written by classmates John Quincy Adams and John Murray Forbes in 1787. Both Adams and Forbes were members of the class of 1787, and the poem recounts events surrounding the pranks and ensuing punishment of two members of the class behind them, Robert Wier and James Prescott. Wier and Prescott had been caught drinking wine and making "riotous noise," and they were publicly reprimanded by Harvard President Joseph Willard and several professors and tutors, including Eliphalet Pearson, Eleazar James, Jonathan Burr, Nathan Read, and Timothy Lindall Jennison. The poem mocks these authority figures, but it spares Samuel Williams, whom it suggests was the only professor to find their antics humorous.

Particulars of the trial and execution of George Partridge, aged 21: who was executed at Bury-St.-Edmund's, on Monday last, for the wilful murder of George Ansell, aged 9 years, within a few miles of Polstead, the late scene of Maria Martin's murder. Also, the prisoner's confession

Date of imprint from execution date, April 13, 1829 -- Capital Punishment UK site via WWW, viewed December 14, 2007.

Cases of divorce for several causes : viz. I. Memoirs of the life of Robert Feilding esq; containing an account of his amours ... and a true copy of his last will and testament. II. The case of Barbara late Dutchess of Cleaveland, with the whole proceedings between Her Grace, and Major-General Feilding in Doctors-Commons ... III. The case of John Dormer, esq. IV. The case of Sir George Downing, bart. and Mrs. Mary Forester. V. Depositions taken in the Lady Howard's case : also the judgment of the most eminent divines, &c. concerning the dissolution of marriage.

ESTC

A series of letters on the navigation laws, addressed to the Earl of Hardwicke, and the members of the late Committee of the House of lords.

Mode of access: Internet.

An account of the origin of the Mississippi doctrine of repudiation; with a review of the arguments which His Excellency Alexander G. McNutt, late Governor of Mississippi, advanced in its vindication.

"Reprinted from the Law reporter for March MDCCCXLII."

The biographical history of Sir William Blackstone, late one of the justices of both benches ... and A catalogue of Sir William Blackstone's work, manuscript, as well as printed. With a Nomenclature of Westminster-Hall. The whole illustrated with notes, observations, and references. Also, a preface and index to each part /

Includes index.

The late effects of poliomyelitis in Queensland

This paper reports an investigation of new health problems reported by Queensland residents with a prior history of poliomyelitis. 126 people with a past history of paralytic poliomyelitis were recruited from the waiting list for the trial Post Polio Clinic at Queen Elizabeth II Hospital, Brisbane. A self-administered postal questionnaire was used to examine a number of variables including acute poliomyelitis histories; presence, duration and severity of new symptoms consistent with the late effects of poliomyelitis; changes in functional status between the maximal recovery period and the time of the survey and the impact of post-polio symptoms on lifestyle and employment. The most frequent new symptoms reported were muscle weakness (87 per cent), unusual tiredness (79 per cent), joint pain (79 per cent), muscle pain (61 per cent) and muscle cramps (71 per cent). Subjects reported an increased reliance on assistive devices and a decreased level of independence with activities of daily living, particularly with mobility-related tasks. Eight three per cent of subjects had made lifestyle changes as a result of post-polio symptoms and 67 per cent of those subjects in the workforce reported making changes to their employment, such as reduced hours of work. (author abstract)

Beyond the numbers of maternal near-miss in Rwanda - a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy.

BACKGROUND: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. METHODS: A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. RESULTS: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. CONCLUSION: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.

The roots of punitive damages at common law: a longer history

This Article aims to revisit the historical development of the doctrine ofexemplary or punitive damages. Punitive damages are anomalous in that they lie in both tort and crime, a matter that has led to much criticism by modern commentators. Yet, a definitive history of punitive damages does not exist to explain this anomaly. The main contribution of this Article, then, is to begin such a history by way of a meta-narrative. It identifies and links the historically significant moments that led to punitive damages, beginning with the background period of classical Roman law, its renewed reception in Western Europe in the twelfth and thirteenth centuries that coincided with the emergence of the English common law,the English statutes of the late thirteenth century, to the court cases of Wilkes v. Wood and Huckle v. Money in the eighteenth century that heralded the "first explicit articulation" of the legal principle of punitive damages. This Article argues that this history is not linear in nature but historically contingent. This is a corrective to present scholarship, which fails to adequately connect or contextualize these historical moments, or over-simplifies this development over time.

Site survey and analysis of highway trucks overloading status quo in Anhui

In 2004, with the increasing overloading restriction requirements of society in Anhui, a provincial comprehensive overloading transportation survey has been developed to take evaluations on overloading actuality and enforcement efficiency with the support of the World Bank. A total of six site surveys were conducted at Hefei, Fuyang, Luan, Wuhu, Huainan and Huangshan Areas with four main contents respectively: traffic volume, axle load, freight information and registration information. Via statistical analysis on the survey data, conclusions were gained that: vehicle overloading are very universal and serious problems at arterial highways in Anhui now. The traffic loads have far exceeded the designed endure capacity of highways and have caused prevalent premature pavement damage, especially for rigid pavement. The overloading trucks are unimpeded engaged in highway freight transportation actually due to the disordered overloading enforcement strategies and the deficient inspecting technologies.

Similarity not favourability : the role of donor prototypes in predicting willingness to donate organs while living

Using an extended Prototype/Willingness Model, we examined the predictors of willingness to donate an organ to a partner/family member and a stranger while living. A questionnaire assessed university students’ (N = 284) attitudes, subjective norm, prototype favourability, prototype similarity, moral norm, and willingness to donate organs in each recipient scenario. All variables, except prototype favourability, predicted willingness to donate organs in both situations. Future strategies should emphasise perceived approval from important others for living donation, the consistency of living donation with one’s own morals, and encourage perceptions of similarity between oneself and living donors to increase acceptance of living donation.