Factors that affect deceased donor liver transplantation rates in the United States in addition to the model for end‐stage liver disease score

Under an ideal implementation of Model for End‐Stage Liver Disease (MELD)–based liver allocation, the only factors that would predict deceased donor liver transplantation (DDLT) rates would be the MELD score, blood type, and donation service area (DSA). We aimed to determine whether additional factors are associated with DDLT rates in actual practice. Data from the Scientific Registry of Transplant Recipients for all adult candidates wait‐listed between March 1, 2002 and December 31, 2008 (n = 57,503) were analyzed. Status 1 candidates were excluded. Cox regression was used to model covariate‐adjusted DDLT rates, which were stratified by the DSA, blood type, liver‐intestine policy, and allocation MELD score. Inactive time on the wait list was not modeled, so the computed DDLT hazard ratios (HRs) were interpreted as active wait‐list candidates. Many factors, including the candidate's age, sex, diagnosis, hospitalization status, and height, prior DDLT, and combined listing for liver‐kidney or liver‐intestine transplantation, were significantly associated with DDLT rates. Factors associated with significantly lower covariate‐adjusted DDLT rates were a higher serum creatinine level (HR = 0.92, P < 0.001), a higher bilirubin level (HR = 0.99, P = 0.001), and the receipt of dialysis (HR = 0.83, P < 0.001). Mild ascites (HR = 1.15, P < 0.001) and hepatic encephalopathy (grade 1 or 2, HR = 1.05, P = 0.02; grade 3 or 4, HR = 1.10, P = 0.01) were associated with significantly higher adjusted DDLT rates. In conclusion, adjusted DDLT rates for actively listed candidates are affected by many factors aside from those integral to the allocation system; these factors include the components of the MELD score itself as well as candidate factors that were considered but were deliberately omitted from the MELD score in order to keep it objective. These results raise the question whether additional candidate characteristics should be explicitly incorporated into the prioritization of wait‐list candidates because such factors are already systematically affecting DDLT rates under the current allocation system. Liver Transpl, 2012. © 2012 AASLD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95560/1/23548_ftp.pd

The ontogeny of career identities in adolescence

Exploration and identity formation are primary developmental tasks during adolescence and the transition to adulthood. Yet little is known about occupational identity formation and growth during this period of life. In this paper, we describe our ongoing research on this topic. First, we present our findings on the ontogeny of the complexity of career identities. Then we discuss our findings regarding the relationship between early career identity formation and psychological well-being at ages 19 and 21

EXPLAINING THE RELATIONSHIP BETWEEN EMPLOYMENT AND JUVENILE DELINQUENCY*

Most criminological theories predict an inverse relationship between employment and crime, but teenagers' involvement in paid work during the school year is positively correlated with delinquency and substance use. Whether the work-delinquency association is causal or spurious has long been debated. This study estimates the effect of paid work on juvenile delinquency using longitudinal data from the national Monitoring the Future project. We address issues of spuriousness by using a two-level hierarchical model to estimate the relationships of within-individual changes in juvenile delinquency and substance use to those in paid work and other explanatory variables. We also disentangle effects of actual employment from preferences for employment to provide insight about the likely role of time-varying selection factors tied to employment, delinquency, school engagement, and leisure activities. Whereas causal effects of employment would produce differences based on whether and how many hours respondents worked, we found significantly higher rates of crime and substance use among non-employed youth who preferred intensive versus moderate work. Our findings suggest the relationship between high-intensity work and delinquency results from preexisting factors that lead youth to desire varying levels of employment

Longitudinal correlates of changes in educational expectations during the transition to adulthood.

For several decades there has been a gap between adolescents' expectations of the amount of education they will receive and their actual educational attainment as young adults. In three studies, this dissertation examines factors external to the individual that may interfere with or support late adolescents' educational expectations and plans. The first two studies utilize data from the Monitoring the Future Project, a NIDA-funded national panel of high school seniors who are followed longitudinally into young and middle adulthood. The first study used logistic regressions and person-centered analyses to demonstrate that transition events (i.e., employment, financial independence, marriage, and parenthood) during young adulthood are related to lower graduation rates among individuals who had previously expected to graduate from a two-year college, graduate from a four-year college, or attend graduate school. The second study extended the findings of the first study by examining changes in educational expectations over the first ten years after high school. Two growth curve models revealed that transition events during young adulthood are related to differential levels of educational attainment expectations at age 22. In terms of change over time, transitions were related to changes in expectations to graduate from college, but not to changes in individuals' expectations for the amount of postsecondary education they would receive. The third study relied on qualitative data from a subset of participants in the Maryland Adolescent Development in Context Study. Interviews were conducted when participants were approximately 19 years old; qualitative coding focused on supports for meeting educational and occupational goals and risk factors for not meeting these goals. Fit between self and school or work contexts, fit between multiple goals, social support, and self-regulatory strategies were all factors that participants identified as helping them reach their goals, but each of these sources of support could also be a risk factor when there was misfit, a lack of support, or poor self-regulation. Results of all three studies suggest that adolescents and young adults are generally optimistic about their chances of meeting their goals, perhaps unrealistically so. Discussion centers around motivational and lifespan development theories.Ph.D.EducationEducational psychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/126776/2/3276245.pd

Longitudinal Correlates of Changes in Educational Expectations during the Transition to Adulthood

Ph.D.PsychologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/172116/1/Messersmith_Dissertation.pdfDescription of Messersmith_Dissertation.pdf : Restricted to UM users only

Factors that affect deceased donor liver transplantation rates in the United States in addition to the model for end‐stage liver disease score

Under an ideal implementation of Model for End-stage Liver Disease (MELD)-based liver allocation, the only factors that would predict DDLT rates are MELD score, blood type, and donation service area (DSA). We aimed to determine whether additional factors are associated with DDLT rates in actual practice. Methods: Data from the Scientific Registry of Transplant Recipients on all adult candidates waitlisted between 03/01/2002 and 12/31/2008 (n=57,503) were analyzed. Status-1 candidates were excluded. Cox regression was used to model covariate-adjusted DDLT rates, stratified by DSA, blood type, liver-intestine policy and allocation MELD. Inactive time on the waitlist was not modeled, such that the computed DDLT hazard ratios (HR) are interpreted as “among actively listed candidates”. Results: Many factors, including candidate age, gender, prior DDLT, diagnosis, hospitalization status, height, and combined listing for liver-kidney and liver-intestine were significantly associated with DDLT rates. Factors associated with significantly lower covariate-adjusted DDLT rates were higher serum creatinine (HR=0.92; p<0.0001); higher bilirubin (HR=0.996; p=0.001), and receipt of dialysis (HR=0.83; p<0.0001). Mild ascites (HR=1.15; p<0.0001) and hepatic encephalopathy (Grade 1–2, HR=1.05; p=0.0236; grade 2–3, HR=1.10, p=0.0103) were associated with significantly higher adjusted DDLT rates. Conclusions: Adjusted DDLT rates among actively listed candidates are affected by many factors aside from those integral to the allocation system; including the components of the MELD score itself, as well as candidate factors that were considered but deliberately omitted from the MELD score in order to keep it objective. These results raise the question of whether additional candidate characteristics should be explicitly incorporated into the prioritization of wait list candidates; since such factors are already systematically affecting DDLT rates under the current allocation system