Kidney Transplant Candidate Acceptance Of Live Donor Esrd Risk

Background: We recently found that potential living kidney donors (LKDs) are willing to accept high levels of end stage renal disease (ESRD) to donate. Since receipt of a living donor kidney is also contingent recipient attitudes, we sought to explore potential recipients’ acceptance of risks to potential LKDs and their attitudes on risk acceptance. Methods: We conducted a mixed methods prospective study of ESRD patients undergoing evaluation to receive a kidney transplant. Using a novel 10,000 dot diagram, participants indicated the highest chance of a LKD getting ESRD they were willing to accept. Participants also completed demographic, risk taking, and health surveys. Ordinal logistic regression assessed factors associated with willingness to accept living donor ESRD risk. Qualitative analysis sought to understand rationale and justification of risk acceptance. Results: 57 potential kidney transplant recipients participated in the study. A third of transplant candidates accepted a maximum risk below the current level of 0.9%. In unadjusted analysis, having an interested potential LKD was associated with willingness to assume a higher chance of donor ESRD (OR 5.74, p=0.002). Adjusting for covariates, having a potential donor remained significantly associated with increased willingness to accept donor ESRD risk (OR 5.88, p=0.008). Qualitative analyses identified four main reasons for willingness to accept higher risk, and four main reasons for willingness to limit donor risk. Discussion: We found that two thirds of potential recipients accept at least the current level of ESRD risk for potential LKDs. Future work should explore why potential recipients are willing to accept greater risks if they have a potential LKD. The use of the visual aid was described as helpful and could be developed into an educational tool to explain risks associated with living donation. The visual aid may also help transplant candidates start the conversation and ask someone to consider being a living donor. Understanding recipient attitudes about risks to LKDs will enhance informed consent and facilitate dialogue between potential donors and recipients

Development and Psychometric Evaluation of Patients' Perception of Feeling Known by Their Nurses (PPFKN) Scale

Thesis advisor: Dorothy JonesThe importance of the nurse-patient relationship to the overall well- being of the person has been explored extensively by nurses. What is largely missing from this knowledge developed to date is the patient's perspective. The purpose of this study was to develop a reliable and valid measure of patients' perceptions of feeling known by their nurses during an acute, surgical, hospital admission. The development of the PPFKN Scale was guided by Newman's theoretical framework of Health as Expanding Consciousness (1994) and data from a qualitative descriptive study conducted in 2003 (Somerville). The current investigation focused on the development and psychometric testing of the PPFKN Scale. The four themes that emerged from the earlier qualitative study were used to guide the development of the 85-item scale. This scale was exposed to a panel of nurse experts to establish inter-rater agreement and content validity, item understandability and readability. The revised scale was piloted with five participants who had experienced an inpatient, surgical admission to determine content validity, item readability and understandability. The revised 77-item scale was then administered to 327 surgical inpatients across seven general care units at a large academic urban medical center. A sample size of 296 completed surveys was analyzed. A four-component solution was devised using Principal Components Analysis with Varimax rotation. This four-component solution accounted for 63.3% variance, with a total scale Cronbach's alpha coefficient of 0.99. A component loading cut-off was set at 0.3 and items not loading at this value on the expected component were dropped. This process resulted in a reliable and valid 48 item PPFKN Scale with four components and a total scale Cronbach's alpha coefficient of 0.98.Thesis (PhD) — Boston College, 2009.Submitted to: Boston College. Connell School of Nursing.Discipline: Nursing

Predicting the immediate impact of national lockdown on neovascular age-related macular degeneration and associated visual morbidity: an INSIGHT Health Data Research Hub for Eye Health report

OBJECTIVE: Predicting the impact of neovascular age-related macular degeneration (nAMD) service disruption on visual outcomes following national lockdown in the UK to contain SARS-CoV-2. METHODS AND ANALYSIS: This retrospective cohort study includes deidentified data from 2229 UK patients from the INSIGHT Health Data Research digital hub. We forecasted the number of treatment-naïve nAMD patients requiring anti-vascular endothelial growth factor (anti-VEGF) initiation during UK lockdown (16 March 2020 through 31 July 2020) at Moorfields Eye Hospital (MEH) and University Hospitals Birmingham (UHB). Best-measured visual acuity (VA) changes without anti-VEGF therapy were predicted using post hoc analysis of Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD trial sham-control arm data (n=238). RESULTS: At our centres, 376 patients were predicted to require anti-VEGF initiation during lockdown (MEH: 325; UHB: 51). Without treatment, mean VA was projected to decline after 12 months. The proportion of eyes in the MEH cohort predicted to maintain the key positive visual outcome of ≥70 ETDRS letters (Snellen equivalent 6/12) fell from 25.5% at baseline to 5.8% at 12 months (UHB: 9.8%-7.8%). Similarly, eyes with VA <25 ETDRS letters (6/96) were predicted to increase from 4.3% to 14.2% at MEH (UHB: 5.9%-7.8%) after 12 months without treatment. CONCLUSIONS: Here, we demonstrate how combining data from a recently founded national digital health data repository with historical industry-funded clinical trial data can enhance predictive modelling in nAMD. The demonstrated detrimental effects of prolonged treatment delay should incentivise healthcare providers to support nAMD patients accessing care in safe environments. TRIAL REGISTRATION NUMBER: NCT00056836

Human and mouse essentiality screens as a resource for disease gene discovery

The identification of causal variants in sequencing studies remains a considerable challenge that can be partially addressed by new gene-specific knowledge. Here, we integrate measures of how essential a gene is to supporting life, as inferred from viability and phenotyping screens performed on knockout mice by the International Mouse Phenotyping Consortium and essentiality screens carried out on human cell lines. We propose a cross-species gene classification across the Full Spectrum of Intolerance to Loss-of-function (FUSIL) and demonstrate that genes in five mutually exclusive FUSIL categories have differing biological properties. Most notably, Mendelian disease genes, particularly those associated with developmental disorders, are highly overrepresented among genes non-essential for cell survival but required for organism development. After screening developmental disorder cases from three independent disease sequencing consortia, we identify potentially pathogenic variants in genes not previously associated with rare diseases. We therefore propose FUSIL as an efficient approach for disease gene discovery. Discovery of causal variants for monogenic disorders has been facilitated by whole exome and genome sequencing, but does not provide a diagnosis for all patients. Here, the authors propose a Full Spectrum of Intolerance to Loss-of-Function (FUSIL) categorization that integrates gene essentiality information to aid disease gene discovery

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Critical thinking skills in the International Baccalaureate’s “Theory of Knowledge” subject

There is considerable debate both in Australia and internationally about the best way for schools to deliver the thinking skills required for university study and professional work life – skills that are often referred to by the term “critical thinking”. This article reviews the literature on the effective teaching of critical thinking and looks at one example of a secondary school subject aimed at developing critical thinking skills in its graduates, namely the Theory of Knowledge (ToK) subject in the International Baccalaureate Diploma Program (DP). ToK, a core element of the DP, has no set curriculum. Instead, ToK requires students to think deeply about knowledge problems and to formulate coherent views on the nature of knowledge. This article reports on an Australian study into the teaching and learning of ToK and presents associated outcomes in cohorts of both secondary and tertiary students

Evaluation of the Widening Participation Student Ambassadors Initiative: Project Report for Office of Widening Participation, Western Sydney University

The Office of Widening Participation at Western Sydney University delivers more than 50 programs in schools and around the university that aim to increase young people's educational engagement and aspirations for higher study. These programs are particularly focused on students from low SES backgrounds, and equity groups identified by the Bradley Review (2008) into higher education. These are supported by WSU students who have received training as Student Ambassadors. Although evaluations of specific programs and impacts on school students have been undertaken, there has never been a focus on the Student Ambassadors themselves, on their experiences and perceptions of the program, and the impact of their contributions. This evaluation aims to fill that gap. The Student Ambassadors deliver programs to ensure that educational and life pathways are open to young people of all backgrounds and circumstances; however Student Ambassadors’ own experiences within these programs and the impact of program participation on their own academic, social and civic outcomes has, thus far, been overlooked. Many of the Student Ambassadors themselves have experienced challenges to participation in higher education that parallel those of the school students with whom they work. Further, participation in the program as Student Ambassadors is likely to enhance their own engagement in higher education. Accordingly, the purpose of this project was to evaluate the impact of Western Sydney University students’ participation in the WP Student Ambassadors program in terms of their self-efficacy beliefs, academic and professional resilience, professional skill development, civic and social awareness, connectedness to community and academic outcomes. These dimensions of impact were evaluated through a mixed-method, multi-cohort evaluation over the course of the 2016 academic year. As one of the aims of this research project was to explore how engaging with low-SES/high-need primary and secondary school students as role models may have influenced their sense of civic and social responsibility, this research can directly inform the future practice of WP program in increasing students' sense of community connections with the Western Sydney University academic community as well as the broader Western Sydney region

Bolstering graduates’ success through working as student ambassadors in university widening participation programs

Since 2010, the Higher Education Participation and Partnerships Program (HEPPP) has provided funding for Australian universities to ‘raise aspiration’ among under-represented groups. Underpinned by utilitarian discourses of human capital and individual capacitation, these resources have transformed the ways that universities seek to engage prospective students. This paper turns to an overlooked cohort that is integral to widening participation initiatives, but has rarely been the focus of research. These are the student ambassadors – university students who work within HEPPP programs. This paper reports findings from the alumni component of a mixed-method study which examines how widening participation programs, which are ostensibly directed at future university enrolments, might also help university students who work as student ambassadors to become successful professionals and citizens once they graduate from university. Alumni accounts of their experiences and self-reported impact of their ambassador work advocate a more holistic view of graduate success and how activities beyond mandatory coursework can contribute to success beyond university graduation. Evidence from student ambassador alumni suggests that these positive impacts are broad and long-lasting, contributing to students’ professional successes and personal lives

Supplemental Material - Relationships between student mobility and academic and behavioural outcomes in Western Australian public primary schools

Supplemental Material for Relationships between student mobility and academic and behavioural outcomes in Western Australian public primary schools by Jacqueline Gannon, Charley A. Budgeon and Ian W. Li in Australian Journal of Education</p

Sociality, resilience and agency : how did young Australians experience online learning during Covid-19?

In 2020 when schooling was abruptly reconfigured by the pandemic, young people were required to demonstrate new capabilities to manage their learning and their wellbeing. This paper reports on the feelings, thoughts and experiences of eight Year 9 and 10 students in NSW and Victoria about the initial period of online learning in Australian schools that resulted from the Covid-19 pandemic. Beyond dominant narratives of vulnerability and losses in learning, our participants offered counternarratives that stressed their capacities to rise and meet the times. We trace three central themes on how they: found moments of agency that increased their confidence, reconfigured resilience as a socially responsible set of practices, deployed sociality as a resource for the benefit of themselves and others. The pandemic opened up conversations with young people about where and how learning takes place and how schools might adapt and respond to young people’s growing sense of urgency about the future of schooling