Factors influencing transfusion-associated HLA sensitization in patients bridged to heart transplantation using ventricular assist device.

BackgroundBridging heart failure patients with mechanical ventricular assist devices (VAD) enables access to transplantation. However, VAD is associated with increased risk for anti-HLA antibodies associated with rejection of subsequent allografts. Factors determining alloantibody formation in these patients remain undefined.MethodsWe performed a single-center retrospective cohort study of 164 patients undergoing heart transplantation from 2014 to 2017. Medical records including use of VAD, transfused blood products, anti-HLA antibody testing, crossmatch, and time to transplant were evaluated.ResultsPatients received an average of 13.8 red blood cell and 1.9 single-donor platelet units associated with VAD. There was a 28.7% increase in the incidence of anti-HLA antibodies after VAD. Development of anti-HLA antibodies did not correlate with volume or type of blood products, but with pre-VAD HLA sensitization status; relative risk of new alloantibodies in patients with pre-VAD antibodies was 3.5-fold higher than those without prior antibodies (P = .008). Development of new anti-HLA antibodies was associated with an increased time to transplant (169 vs 330 days, P = .013).ConclusionsOur findings indicate that the presence of anti-HLA antibodies pre-VAD was the most significant risk factor for developing additional antibodies post-VAD, suggesting that a subset of patients may be predisposed to alloantibody formation

False-Name Manipulation in Weighted Voting Games is Hard for Probabilistic Polynomial Time

False-name manipulation refers to the question of whether a player in a weighted voting game can increase her power by splitting into several players and distributing her weight among these false identities. Analogously to this splitting problem, the beneficial merging problem asks whether a coalition of players can increase their power in a weighted voting game by merging their weights. Aziz et al. [ABEP11] analyze the problem of whether merging or splitting players in weighted voting games is beneficial in terms of the Shapley-Shubik and the normalized Banzhaf index, and so do Rey and Rothe [RR10] for the probabilistic Banzhaf index. All these results provide merely NP-hardness lower bounds for these problems, leaving the question about their exact complexity open. For the Shapley--Shubik and the probabilistic Banzhaf index, we raise these lower bounds to hardness for PP, "probabilistic polynomial time", and provide matching upper bounds for beneficial merging and, whenever the number of false identities is fixed, also for beneficial splitting, thus resolving previous conjectures in the affirmative. It follows from our results that beneficial merging and splitting for these two power indices cannot be solved in NP, unless the polynomial hierarchy collapses, which is considered highly unlikely

Determination of cutting forces based on DMG MORI CTX300 ecoline CNC lathe drive power data

Modern machine building needs demand for machines and control systems which provide higher accuracy of machining. For this purpose, setup methods are being researched and accuracy of machines and devices is being improved. The main topic of this paper is a tool path predistortion system which is necessary for improvement of shaft turning accuracy when a steady rest cannot be used on a CNC machines. Calculation of such tool path requires one to know the cutting force during turning on a CNC lathe. The research in question allowed to determine the dependence of cutting force during turning on the power consumed by the feed drive, cutting depth, cutting velocity, and feed value. An equation for further calculation applicable to a specific lathe in the turning process was derived. This equation serves as basis for adaptive turning of shafts and other parts with the aid of a mathematical model, which must account for the cutting force. Application of this formula in a CNC controlled lathe's parametric program will provide for higher accuracy of turning without special devices. © Published under licence by IOP Publishing Ltd

Neurology

Contains research objectives and reports on three research projects.Office of Naval Research (Nonr-609(39))U. S. Air Force (AF33(616)-7282)Army Chemical Corps (DA-18-108-405-Cml-942)U.S. Public Health Service (B-3055)U. S. Air Force (AF49(638)-1130)U.S. Public Health Service (B-3090

Cerebral white matter disease and functional decline in older adults from the Northern Manhattan Study: A longitudinal cohort study

Background Cerebral white matter hyperintensities (WMHs) on MRI are common and associated with vascular and functional outcomes. However, the relationship between WMHs and longitudinal trajectories of functional status is not well characterized. We hypothesized that whole brain WMHs are associated with functional decline independently of intervening clinical vascular events and other vascular risk factors. Methods and findings In the Northern Manhattan Study (NOMAS), a population-based racially/ethnically diverse prospective cohort study, 1,290 stroke-free individuals underwent brain MRI and were followed afterwards for a mean 7.3 years with annual functional assessments using the Barthel index (BI) (range 0–100) and vascular event surveillance. Whole brain white matter hyperintensity volume (WMHV) (as percentage of total cranial volume [TCV]) was standardized and treated continuously. Generalized estimating equation (GEE) models tested associations between whole brain WMHV and baseline BI and change in BI, adjusting for sociodemographic, vascular, and cognitive risk factors, as well as stroke and myocardial infarction (MI) occurring during follow-up. Mean age was 70.6 (standard deviation [SD] 9.0) years, 40% of participants were male, 66% Hispanic; mean whole brain WMHV was 0.68% (SD 0.84). In fully adjusted models, annual functional change was −1.04 BI points (−1.20, −0.88), with −0.74 additional points annually per SD whole brain WMHV increase from the mean (−0.99, −0.49). Whole brain WMHV was not associated with baseline BI, and results were similar for mobility and non-mobility BI domains and among those with baseline BI 95–100. A limitation of the study is the possibility of a healthy survivor bias, which would likely have underestimated the associations we found. Conclusions In this large population-based study, greater whole brain WMHV was associated with steeper annual decline in functional status over the long term, independently of risk factors, vascular events, and baseline functional status. Subclinical brain ischemic changes may be an independent marker of long-term functional decline

Proportional Rankings

In this paper we extend the principle of proportional representation to rankings. We consider the setting where alternatives need to be ranked based on approval preferences. In this setting, proportional representation requires that cohesive groups of voters are represented proportionally in each initial segment of the ranking. Proportional rankings are desirable in situations where initial segments of different lengths may be relevant, e.g., hiring decisions (if it is unclear how many positions are to be filled), the presentation of competing proposals on a liquid democracy platform (if it is unclear how many proposals participants are taking into consideration), or recommender systems (if a ranking has to accommodate different user types). We study the proportional representation provided by several ranking methods and prove theoretical guarantees. Furthermore, we experimentally evaluate these methods and present preliminary evidence as to which methods are most suitable for producing proportional rankings

Physical inactivity is a strong risk factor for stroke in the oldest old: Findings from a multi-ethnic population (the Northern Manhattan Study)

Background The fastest growing segment of the population is those age ≥80 who have the highest stroke incidence. Risk factor management is complicated by polypharmacy-related adverse events. Aims To characterize the impact of physical inactivity for stroke by age in a multi-ethnic prospective cohort study (NOMAS, n = 3298). Methods Leisure time physical activity was assessed by a validated questionnaire and our primary exposure was physical inactivity (PI). Participants were followed annually for incident stroke. We fit Cox-proportional hazard models to calculate hazard ratios and 95% confidence intervals (HR 95% CI) for the association of PI and other risk factors with risk of stroke including two-way interaction terms between the primary exposures and age (<80 vs. ≥80). Results The mean age was 69 ± 10.3 years and 562 (17%) were ≥80 at enrolment. PI was common in the cohort (40.8%). Over a median of 14 years, we found 391 strokes. We found a significant interaction of age ≥80 on the risk of stroke with PI (p = 0.03). In stratified models, PI versus any activity (adjusted HR 1.60, 95%CI 1.05–2.42) was associated with an increased risk of stroke among those ≥80. Conclusion Physical inactivity is a treatable risk factor for stroke among those older than age 80. Improving activity may reduce the risk of stroke in this segment of the population

Stigma narratives: LGBT transitions and identities in Malta

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 A B Academic Publishers.This article considers narratives of transition experiences of a group of Lesbian, Gay, Bisexual and Transgender (LGBT) young people in Malta. The article draws on Goffman's concept of stigma and uses this to explore transitions in a society that retains some traditional characteristics, particularly the code of honour and shame, although mediated by aspects of modernity. Interviews were undertaken with 15 young people with the goal of producing narratives. The article analyses the experience of stigma, its effects and how young people manage its consequences. It concludes by drawing attention to the pervasive nature of stigma and the importance of structure, agency and reflexivity in youth transitions. In particular stigma remains an important feature of societies in which hetero-normative sexuality remains dominant

Has education lost sight of children?

The reflections presented in this chapter are informed by clinical and personal experiences of school education in the UK. There are many challenges for children and young people in the modern education system and for the professionals who support them. In the UK, there are significant gaps between the highly selective education provided to those who pay privately for it and to the majority of those educated in the state-funded system. Though literacy rates have improved around the world, many children, particularly boys, do not finish their education for reasons such as boredom, behavioural difficulties or because education does not ‘pay’. Violence, bullying, and sexual harassment are issues faced by many children in schools and there are disturbing trends of excluding children who present with behavioural problems at school whose origins are not explored. Excluded children are then educated with other children who may also have multiple problems which often just make the situation worse. The experience of clinicians suggests that school-related mental health problems are increasing in severity. Are mental health services dealing with the consequences of an education system that is not meeting children’s needs? An education system that is testing- and performance-based may not be serving many children well if it is driving important decisions about them at increasingly younger ages. Labelling of children and setting them on educational career paths can occur well before they reach secondary schools, limiting potential very early on in their developmental trajectory. Furthermore, the emphasis at school on testing may come at the expense of creativity and other forms of intelligence, which are also valuable and important. Meanwhile the employment marketplace requires people with widely different skills, with an emphasis on innovation, creativity, and problem solving. Is education losing sight of the children it is educating

Creatinine- versus cystatin C-based renal function assessment in the Northern Manhattan Study

Background Accurate glomerular filtration rate estimation informs drug dosing and risk stratification. Body composition heterogeneity influences creatinine production and the precision of creatinine-based estimated glomerular filtration rate (eGFRcr) in the elderly. We compared chronic kidney disease (CKD) categorization using eGFRcr and cystatin C-based estimated GFR (eGFRcys) in an elderly, racially/ethnically diverse cohort to determine their concordance. Methods The Northern Manhattan Study (NOMAS) is a predominantly elderly, multi-ethnic cohort with a primary aim to study cardiovascular disease epidemiology. We included participants with concurrently measured creatinine and cystatin C. eGFRcr was calculated using the CKD-EPI 2009 equation. eGFRcys was calculated using the CKD-EPI 2012 equation. Logistic regression was used to estimate odds ratios and 95% confidence intervals of factors associated with reclassification from eGFRcr≥60ml/min/1.73m2 to eGFRcys<60ml/min/1.73m2. Results Participants (n = 2988, mean age 69±10yrs) were predominantly Hispanic, female, and overweight/obese. eGFRcys was lower than eGFRcr by mean 23mL/min/1.73m2. 51% of participants’ CKD status was discordant, and only 28% maintained the same CKD stage by both measures. Most participants (78%) had eGFRcr≥60mL/min/1.73m2; among these, 64% had eGFRcys65 years, obesity, current smoking, white race, and female sex. Conclusions In a large, multiethnic, elderly cohort, we found a highly discrepant prevalence of CKD with eGFRcys versus eGFRcr. Determining the optimal method to estimate GFR in elderly populations needs urgent further study to improve risk stratification and drug dosing