Kidney Donor Profile Index and allograft outcomes: interactive effects of estimated post-transplant survival score and ischaemic time

Background. The Kidney Donor Profile Index (KDPI) is routinely reported by the donation agencies in Australia.We determined the association between KDPI and short-term allograft loss and assessed if this association was modified by the estimated post-transplant survival (EPTS) score and total ischaemic time. Methods. Using data from the Australia and New Zealand Dialysis and Transplant Registry, the association between KDPI (in quartiles) and 3-year overall allograft loss was examined using adjusted Cox regression analysis. The interactive effects between KDPI, EPTS score and total ischaemic time on allograft loss were assessed. Results. Of 4006 deceased donor kidney transplant recipients transplanted between 2010 and 2015, 451 (11%) recipients experienced allograft loss within 3 years post-transplant. Compared with recipients of kidneys with a KDPI of 0–25%, recipients who received donor kidneys with a KDPI >75% experienced a 2-fold increased risk of 3-year allograft loss {adjusted hazard ratio [HR] 2.04 [95% confidence interval (CI) 1.53–2.71]}. The adjusted HRs for kidneys with a KDPI of 26–50% and 51–75% were 1.27 (95% CI 0.94–1.71) and 1.31 (95% CI 0.96–1.77), respectively. There were significant interactions between KDPI and EPTS scores (P-value for interaction <.01) and total ischaemic time (P-value for interaction <.01) such that the associations between higher KDPI quartiles and 3-year allograft loss were strongest in recipients with the lowest EPTS scores and longest total ischaemic time. Conclusion. Recipients with higher post-transplant expected survival and transplants with longer total ischaemia who received donor allografts with higher KDPI scores experienced a greater risk of short-term allograft loss compared with those recipients with reduced post-transplant expected survival and with shorter total ischemia.Janelle Prunster, Germaine Wong, Nicholas Larkins, Kate Wyburn, Ross Francis, William R. Mulley, Esther Ooi, Helen Pilmore, Christopher E. Davies and Wai H. Li

A multilevel neo-institutional analysis of infection prevention and control in English hospitals: coerced safety culture change?

Despite committed policy, regulative and professional efforts on healthcare safety, little is known about how such macro-interventions permeate organisations and shape culture over time. Informed by neo-institutional theory, we examined how inter-organisational influences shaped safety practices and inter-subjective meanings following efforts for coerced culture change. We traced macro-influences from 2000 to 2015 in infection prevention and control (IPC). Safety perceptions and meanings were inductively analysed from 130 in-depth qualitative interviews with senior- and middle-level managers from 30 English hospitals. A total of 869 institutional interventions were identified; 69% had a regulative component. In this context of forced implementation of safety practices, staff experienced inherent tensions concerning the scope of safety, their ability to be open and prioritisation of external mandates over local need. These tensions stemmed from conflicts among three co-existing institutional logics prevalent in the NHS. In response to requests for change, staff flexibly drew from a repertoire of cognitive, material and symbolic resources within and outside their organisations. They crafted 'strategies of action', guided by a situated assessment of first-hand practice experiences complementing collective evaluations of interventions such as 'pragmatic', 'sensible' and also 'legitimate'. Macro-institutional forces exerted influence either directly on individuals or indirectly by enriching the organisational cultural repertoire

Comparative genomics and the nature of placozoan species.

Placozoans are a phylum of nonbilaterian marine animals currently represented by a single described species, Trichoplax adhaerens, Schulze 1883. Placozoans arguably show the simplest animal morphology, which is identical among isolates collected worldwide, despite an apparently sizeable genetic diversity within the phylum. Here, we use a comparative genomics approach for a deeper appreciation of the structure and causes of the deeply diverging lineages in the Placozoa. We generated a high-quality draft genome of the genetic lineage H13 isolated from Hong Kong and compared it to the distantly related T. adhaerens. We uncovered substantial structural differences between the two genomes that point to a deep genomic separation and provide support that adaptation by gene duplication is likely a crucial mechanism in placozoan speciation. We further provide genetic evidence for reproductively isolated species and suggest a genus-level difference of H13 to T. adhaerens, justifying the designation of H13 as a new species, Hoilungia hongkongensis nov. gen., nov. spec., now the second described placozoan species and the first in a new genus. Our multilevel comparative genomics approach is, therefore, likely to prove valuable for species distinctions in other cryptic microscopic animal groups that lack diagnostic morphological characters, such as some nematodes, copepods, rotifers, or mites

Simulation of resonant tunneling heterostructures: numerical comparison of a complete Schr{ö}dinger-Poisson system and a reduced nonlinear model

Two different models are compared for the simulation of the transverse electronic transport through an heterostructure: a $1D$ self-consistent Schr{ö}dinger-Poisson model with a numerically heavy treatment of resonant states and a reduced model derived from an accurate asymptotic nonlinear analysis. After checking the agreement at the qualitative and quantitative level on quite well understood bifurcation diagrams, the reduced model is used to tune double well configurations for which nonlinearly interacting resonant states actually occur in the complete self-consistent model

Interactions between donor age and 12-month estimated glomerular filtration rate on allograft and patient outcomes after kidney transplantation

Reduced estimated glomerular filtration rate (eGFR) at 12-months after kidney transplantation is associated with increased risk of allograft loss, but it is uncertain whether donor age and types modify this relationship. Using Australia and New Zealand registry data, multivariable Cox proportional modelling was used to examine the interactive effects between donor age, types and 12-month eGFR on overall allograft loss. We included 11,095 recipients (4,423 received live-donors). Recipients with lowest 12-month eGFR (60 ml/min/1.73 m²) was 0.67 [0.62–0.74]. The association of 12-month eGFR and allograft loss was modified by donor age (but not donor types) where a higher risk of allograft loss in recipients with lower compared with higher 12-month eGFR being most pronounced in the younger donor age groups (p 60 ml/min/1.73 m², and the magnitude of the increased risk is most marked among recipients with younger donors. Careful deliberation of other factors including donor age when considering eGFR as a surrogate for clinical endpoints is warranted.Wai H. Lim, Esther Ooi, Helen L. Pilmore, David W. Johnson, Stephen P. McDonald, Philip Clayton, Carmel Hawley, William R. Mulley, Ross Francis, Michael G. Collins, Bryon Jaques, Nicholas G. Larkins, Christopher E. Davies, Kate Wyburn, Steve J. Chadban and Germaine Won

Responsive in-season nitrogen management for cereals

Current nitrogen (N) management strategies for worldwide cereal production systems are characterized by low N use efficiency (NUE), environmental contamination, and considerable ongoing debate regarding what can be done to improve N fertilizer management. Development of innovative strategies that improve NUE and minimize off-field losses is crucial to sustaining cereal-based farming. In this paper, we review the major managerial causes for low NUE, including (1) poor synchrony between fertilizer N and crop demand, (2) uniform field applications to spatially variable landscapes that commonly vary in crop N need, and (3) failure to account for temporally variable influences on crop N needs. Poor synchronization is mainly due to large pre-plant applications of fertilizer N, resulting in high levels of inorganic soil N long before rapid crop uptake occurs. Uniform applications within fields discount the fact that N supplies from the soil, crop N uptake, and crop response are spatially variable. Current N management decisions also overlook year-to-year weather variations and sometimes fail to account for soil N mineralized in warm, wet years, ignoring indigenous N supply. The key to optimizing tradeoffs amongst yield, profit, and environmental protection is to achieve synchrony between N supply and crop demand, while accounting for spatial and temporal variability in soil N. While some have advocated a soil-based management zones (MZ) approach as a means to direct variable N applications and improve NUE, this method disregards yearly variation in weather. Thus, it seems unlikely that the soil-based MZ concept alone will be adequate for variable application of crop N inputs. Alternatively, we propose utilizing emerging computer and electronic technologies that focus on the plant to assess N status and direct in-season spatially variable N applications. Several of these technologies are reviewed and discussed. One technology showing promise is ground-based active-light reflectance measurements converted to NDVI or other similar indices. Preliminary research shows this approach addresses the issue of spatial variability and is accomplished at a time within the growing season so that N inputs are synchronized to match crop N uptake. We suggest this approach may be improved by first delineating a field into MZ using soil or other field properties to modify the decision associated with ground-based reflectance sensing. While additional adaptive research is needed to refine these newer technologies and subsequent N management decisions, preliminary results are encouraging.We expect N use efficiency can be greatly enhanced using this plant-based responsive strategy for N management in cereals