"Suboptimal" kidney donors: The experience with tacrolimus-based immunosuppression

Female, pediatric, and older donors have been associated with inferior graft survival after renal transplantation. We analyzed these three subgroups in 397 patients receiving tacrolimus-based immunosuppression. There were no differences in recipient age, incidence of retransplantation, or percentage of sensitized patients. Female donors, compared with male donors, were associated with comparable 1- and 3-year patient survival rates (96% and 93% vs. 95% and 92%, respectively) and comparable 1- and 3-year graft survival rates (90% and 80% vs. 88% and 81%, respectively). Renal function was also similar. Recipients of pediatric en bloc kidneys, when compared with recipients of other cadaveric kidneys, also had comparable 1- and 3-year patient survival rates (94% and 94% vs. 95% and 91%, respectively) and comparable 1- and 3-year graft survival rates (84% and 84% vs. 89% and 79%, respectively). Renal function was better in recipients of en bloc kidneys, with a mean serum creatinine level of 1.4±1.8 mg/dl vs. 2.0±1.5 mg/dl (P=0.01). In contrast to the first two subgroups, donors over 60 years of age, when compared with donors under 60 years of age, were associated with worse 1- and 3-year patient survival rates (88% and 80% vs. 96% and 94%, respectively; P<0.03) and worse 1- and 3-year graft survival rates (74% and 62% vs. 91% and 83%, respectively; P<0.0001). Renal function was worse in the older donor group, with a serum creatinine level of 2.7±1.2 mg/ml vs. 1.9±1.5 mg/dl (P=0.01). We conclude that, under tacrolimus-based immunosuppression, kidneys from female or very young pediatric donors are not associated with adverse outcomes, whereas kidneys from donors over 60 years of age are associated with inferior outcomes

Zinc in innate and adaptive tumor immunity

Zinc is important. It is the second most abundant trace metal with 2-4 grams in humans. It is an essential trace element, critical for cell growth, development and differentiation, DNA synthesis, RNA transcription, cell division, and cell activation. Zinc deficiency has adverse consequences during embryogenesis and early childhood development, particularly on immune functioning. It is essential in members of all enzyme classes, including over 300 signaling molecules and transcription factors. Free zinc in immune and tumor cells is regulated by 14 distinct zinc importers (ZIP) and transporters (ZNT1-8). Zinc depletion induces cell death via apoptosis (or necrosis if apoptotic pathways are blocked) while sufficient zinc levels allows maintenance of autophagy. Cancer cells have upregulated zinc importers, and frequently increased zinc levels, which allow them to survive. Based on this novel synthesis, approaches which locally regulate zinc levels to promote survival of immune cells and/or induce tumor apoptosis are in order

Pediatric renal transplantation under tacrolimus-based immunosuppression

Background. Tacrolimus has been used as a primary immunosuppressive agent in adult and pediatric renal transplant recipients, with reasonable outcomes. Methods. Between December 14, 1989 and December 31, 1996, 82 pediatric renal transplantations alone were performed under tacrolimus-based immunosuppression without induction anti-lymphocyte antibody therapy. Patients undergoing concomitant or prior liver and/or intestinal transplantation were not included in the analysis. The mean recipient age was 10.6±5.2 years (range: 0.7-17.9). Eighteen (22%) cases were repeat transplantations, and 6 (7%) were in patients with panel-reactive antibody levels over 40%. Thirty-four (41%) cases were with living donors, and 48 (59%) were with cadaveric donors. The mean donor age was 27.3±14.6 years (range: 0.7-50), and the mean cold ischemia time in the cadaveric cases was 26.5±8.8 hr. The mean number of HLA matches and mismatches was 2.8±1.2 and 2.9±1.3; there were five (6%) O-Ag mismatches. The mean follow-up was 4.0±0.2 years. Results. The 1- and 4-year actuarial patient survival was 99% and 94%. The 1- and 4-year actuarial graft survival was 98% and 84%. The mean serum creatinine was 1.1±0.5 mg/all, and the corresponding calculated creatinine clearance was 88±25 ml/min/1.73 m2. A total of 66% of successfully transplanted patients were withdrawn from prednisone. In children who were withdrawn from steroids, the mean standard deviation height scores (Z-score) at the time of transplantation and at 1 and 4 years were - 2.3±2.0, -1.7±1.0, and +0.36±1.5. Eighty-six percent of successfully transplanted patients were not taking anti-hypertensive medications. The incidence of acute rejection was 44%; between December 1989 and December 1993, it was 63%, and between January 1994 and December 1996, it was 23% (P=0.0003). The incidence of steroid-resistant rejection was 5%. The incidence of delayed graft function was 5%, and 2% of patients required dialysis within 1 week of transplantation. The incidence of cytomegalovirus was 13%; between December 1989 and December 1992, it was 17%, and between January 1993 and December 1996, it was 12%. The incidence of early Epstein- Barr virus-related posttransplant lymphoproliferative disorder (PTLD) was 9%; between December 1989 and December 1992, it was 17%, and between January 1993 and December 1996, it was 4%. All of the early PTLD cases were treated successfully with temporary cessation of immunosuppression and institution of antiviral therapy, without patient or graft loss. Conclusions. These data demonstrate the short- and medium-term efficacy of tacrolimus-based immunosuppression in pediatric renal transplant recipients, with reasonable patient and graft survival, routine achievement of steroid and anti- hypertensive medication withdrawal, gratifying increases in growth, and, with further experience, a decreasing incidence of both rejection and PTLD

Y-a-t-il un « effet-manuel » ? : observations et réflexions à partir de l’utilisation des manuels Français Langue Étrangère (FLE) en Israël

This thesis focuses on the field of teaching FLE (French as a foreign language) and more specifically in the field of school textbooks. Despite being often criticized, the textbook remains the preferred tool of teachers. However, few studies have been devoted to it since the 1980s.To delimit its field of study, this research chosed to analyze the most commonly used textbooks in Israeli colleges, namely the Israeli textbook Ça va bien! and two textbooks from major French publishers, Le Kiosque and Adosphère. The objective is to identify similarities in teaching practices from different contexts. This thesis also focuses on the polymorphic nature of the school textbook, which allows it to reinvent itself to support, guide or even anticipate the necessary learning for 21st century learners, especially during the pandemic.In Israel, the school textbook, based on an explicit approach to teaching, has changed the way of teaching and has had a positive impact on learning. This research also aims to understand the relationship between didactic design and pedagogical application, as well as to explore how knowledge circulates among the various actors involved. It also examines the implications of contextualization on the theoretical level and the extent of cultural, intercultural, and language skills.Cette thèse s’inscrit dans le domaine de l’enseignement du FLE (français langue étrangère) et s’intéresse plus précisément au manuel scolaire. Celui-ci, souvent décrié, reste cependant l’outil de prédilection des enseignants. Or, peu de travaux depuis les années 1980 lui ont été consacrés.Afin de délimiter son champ d'étude, cette recherche a choisi d'analyser les manuels scolaires les plus couramment utilisés dans les collèges israéliens, à savoir le livre israélien Ça va bien! et deux méthodes provenant d’une grande maison d'édition française, Le Kiosque et Adosphère. L'objectif est d'identifier les similitudes dans les pratiques d'enseignement issues de contextes variés. Cette thèse s'intéresse également à la nature polymorphe du manuel scolaire, qui lui permet de se réinventer pour accompagner, guider voire anticiper les apprentissages nécessaires aux apprenants du XXIème siècle, en particulier en période de pandémie.En Israël, le manuel scolaire, qui se base sur une approche explicite de l'enseignement, a modifié la façon d'enseigner et a eu un impact positif sur l'apprentissage. Cette recherche vise également à comprendre la relation entre la conception didactique et l'application pédagogique, ainsi qu'à explorer la manière dont les savoirs circulent entre les différents acteurs impliqués. Elle examine en outre les implications d'une contextualisation sur le plan théorique et sur le plan des compétences culturelles, interculturelles et langagières

Y-a-t-il un « effet-manuel » ? : observations et réflexions à partir de l’utilisation des manuels Français Langue Étrangère (FLE) en Israël

This thesis focuses on the field of teaching FLE (French as a foreign language) and more specifically in the field of school textbooks. Despite being often criticized, the textbook remains the preferred tool of teachers. However, few studies have been devoted to it since the 1980s.To delimit its field of study, this research chosed to analyze the most commonly used textbooks in Israeli colleges, namely the Israeli textbook Ça va bien! and two textbooks from major French publishers, Le Kiosque and Adosphère. The objective is to identify similarities in teaching practices from different contexts. This thesis also focuses on the polymorphic nature of the school textbook, which allows it to reinvent itself to support, guide or even anticipate the necessary learning for 21st century learners, especially during the pandemic.In Israel, the school textbook, based on an explicit approach to teaching, has changed the way of teaching and has had a positive impact on learning. This research also aims to understand the relationship between didactic design and pedagogical application, as well as to explore how knowledge circulates among the various actors involved. It also examines the implications of contextualization on the theoretical level and the extent of cultural, intercultural, and language skills.Cette thèse s’inscrit dans le domaine de l’enseignement du FLE (français langue étrangère) et s’intéresse plus précisément au manuel scolaire. Celui-ci, souvent décrié, reste cependant l’outil de prédilection des enseignants. Or, peu de travaux depuis les années 1980 lui ont été consacrés.Afin de délimiter son champ d'étude, cette recherche a choisi d'analyser les manuels scolaires les plus couramment utilisés dans les collèges israéliens, à savoir le livre israélien Ça va bien! et deux méthodes provenant d’une grande maison d'édition française, Le Kiosque et Adosphère. L'objectif est d'identifier les similitudes dans les pratiques d'enseignement issues de contextes variés. Cette thèse s'intéresse également à la nature polymorphe du manuel scolaire, qui lui permet de se réinventer pour accompagner, guider voire anticiper les apprentissages nécessaires aux apprenants du XXIème siècle, en particulier en période de pandémie.En Israël, le manuel scolaire, qui se base sur une approche explicite de l'enseignement, a modifié la façon d'enseigner et a eu un impact positif sur l'apprentissage. Cette recherche vise également à comprendre la relation entre la conception didactique et l'application pédagogique, ainsi qu'à explorer la manière dont les savoirs circulent entre les différents acteurs impliqués. Elle examine en outre les implications d'une contextualisation sur le plan théorique et sur le plan des compétences culturelles, interculturelles et langagières

Immunity to change: how to overcome IT and unlock the potential in yourself and your organization

A recent study showed that when doctors tell heart patients they will die if they don't change their habits, only one in seven will be able to follow through successfully. Desire and motivation aren't enough: even when it's literally a matter of life or death, the ability to change remains maddeningly elusive. Given that the status quo is so potent, how can we change ourselves and our organizations? In Immunity to Change, authors Robert Kegan and Lisa Lahey show how our individual beliefs--along with the collective mind-sets in our organizations--combine to create a natural but powerful immunity to change. By revealing how this mechanism holds us back, Kegan and Lahey give us the keys to unlock our potential and finally move forward. And by pinpointing and uprooting our own immunities to change, we can bring our organizations forward with us. This persuasive and practical book, filled with hands-on diagnostics and compelling case studies, delivers the tools you need to overcome the forces of inertia and transform your life and your work

Family Medicine Resident Perceptions on Racial Justice Training in Residency: A CERA Study.

Introduction: Structural racism is a root cause of health disparities. While family medicine residency programs recognize the importance of addressing race in medicine, it is unclear how many programs have established racial justice training (RJT). This study examines residents\u27 views on the current state of RJT in their respective programs. Methods: This survey was part of the Council of Academic Family Medicine Educational Research Alliance (CERA) 2021 national survey of family medicine residents. Questions addressed RJT, resident reported barriers to implementing such training, and recommendations for change. Results: Of the family medicine residents who responded (n=266), the majority of individuals (91.5%) and their residency programs (65.0%) stated that addressing racism in medicine is an educational priority. Residents reported a minority of their programs (17.3%) have a longitudinal curriculum. Residents who received RJT in residency are more likely to be in communities of color (P=.03). The top requests included recruiting faculty and residents of color, and establishing community-based partnerships. Conclusions: Few residencies have been able to implement RJT to the extent that residents\u27 desire. Lack of curricular time and faculty training were commonly cited barriers. Strategies to address these barriers and implement RJT across residencies are needed to combat structural racism