Update on the Development of a New U.S. Kidney Transplant Allocation System

A substantial revision of the adult kidney allocation system in the U.S. is currently underway. The proposed revised system combines the new concepts of life years from transplant (LYFT), the donor profile index (DPI), and dialysis time (DT) into an overall kidney allocation score (KAS). The KAS for the first time integrates a measure of medical utility into kidney allocation. A KAS-based system holds the promise of improved efficiency, increased waitlist access and a gain in the number of life-years achieved from transplantation. This article discusses the rationale for the development of a new system, the state of the KAS proposal, and the challenges that remain to implementation of a new kidney allocation system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64332/1/20377_ftp.pd

Development of Enantioselective Palladium‐Catalyzed Alkene Carboalkoxylation Reactions for the Synthesis of Tetrahydrofurans

The Pd‐catalyzed coupling of γ‐hydroxyalkenes with aryl bromides affords enantiomerically enriched 2‐(arylmethyl)tetrahydrofuran derivatives in good yield and up to 96:4 e.r. This transformation was achieved through the development of a new TADDOL/2‐arylcyclohexanol‐derived chiral phosphite ligand. The transformations are effective with an array of different aryl bromides, and can be used for the preparation of products bearing quaternary stereocenters.The construction of enantiomerically enriched tetrahydrofurans is accomplished by asymmetric Pd‐catalyzed cross‐coupling reactions between γ‐hydroxyalkenes and aryl bromides. Use of a palladium catalyst supported by a new TADDOL‐derived chiral phosphite ligand provides the tetrahydrofuran products in good yield with up to 96:4 e.r. (see scheme).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115961/1/anie_201506884_sm_miscellaneous_information.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/115961/2/13390_ftp.pd

Acquired von Willebrand Syndrome in IgM Monoclonal Gammopathy as the Presentation of Lymphoplasmacytic Lymphoma

Acquired von Willebrand syndrome (AVWS) is an increasingly recognized entity with numerous potential underlying etiologies. Most commonly implicated are lymphoproliferative, myeloproliferative, cardiovascular, and autoimmune disorders. Unlike inherited von Willebrand disease (vWD), AVWS tends to present at an older age and without a family history of vWD. Treatment is directed at the underlying etiology if one is uncovered, as well as treatment and prevention of bleeding. Here, we present a rare case of AVWS secondary to Waldenström macroglobulinemia which went unrecognized for several years but resolved promptly with treatment. The potential mechanisms of AVWS secondary to monoclonal gammopathies are discussed as well as strategies to treat and prevent bleeding in these patients

Project Shearwater Ground Effect UAV

The Shearwater unmanned aerial vehicle is a maritime fixed-wing drone that is designed to use ground effect force generated between the aircraft and a body of water to efficiently propel itself near the surface of a body of water. Shearwater features a virtual reality pilot interface and will act as a hybrid underwater vehicle that will eventually be able to operate both above and beneath the ocean’s surface. The Shearwater team developed existing design work to produce major subsystems that culminated in a flyable functioning prototype. An existing airframe was updated with working control surfaces tested in simulation and in practice, an electrical control system, and a working virtual reality (VR) pilot view. The Shearwater team tested a practical prototype and developed an optimized virtual reality command and control system

Transplantable human motor networks as a neuron-directed strategy for spinal cord injury

To repair neural circuitry following spinal cord injury (SCI), neural stem cell (NSC) transplantation has held a primary focus; however, stochastic outcomes generate challenges driven in part by NSC differentiation and tumor formation. The recent ability to generate regionally specific neurons and their support cells now allows consideration of directed therapeutic approaches with pre-differentiated and networked spinal neural cells. Here, we form encapsulated, transplantable neuronal networks of regionally matched cervical spinal motor neurons, interneurons, and oligodendrocyte progenitor cells derived through trunk-biased neuromesodermal progenitors. We direct neurite formation in alginate-based neural ribbons to generate electrically active, synaptically connected networks, characterized by electrophysiology and calcium imaging before transplantation into rodent models of contused SCI for evaluation at 10-day and 6-week timepoints. The in vivo analyses demonstrate viability and retention of interconnected synaptic networks that readily integrate with the host parenchyma to advance goals of transplantable neural circuitry for SCI treatment

Evaluation of thrombophilia testing in the inpatient setting: A single institution retrospective review

BACKGROUND: Thrombophilia workup is typically inappropriate in the inpatient setting as testing may be skewed by anticoagulation, acute thrombosis, or acute illness. OBJECTIVE: To determine adherence of inpatient thrombophilia testing with institutional guidelines. PATIENTS AND METHODS: A retrospective study to evaluate thrombophilia testing practices of adult patients who were admitted to Lehigh Valley Hospital at Cedar Crest with either venous thromboembolism or ischemic stroke in 2019. Testing included inherited and acquired thrombophilia. Patient charts were individually reviewed for three measured outcomes: 1) the number of appropriate thrombophilia testing in the inpatient setting; 2) the indications used for thrombophilia testing; 3) the proportion of positive thrombophilia tests with change in clinical management. RESULTS: 201 patients were included in our study. 26 patients (13%) were tested appropriately in accordance with institution guidelines and 175 (87%) patients were tested inappropriately. The most common reason for the inappropriate testing was testing during acute thrombosis. 28 of the 201 patients had positive thrombophilia tests, but the reviewers only noted 7 patients with change in clinical management-involving anticoagulation change. CONCLUSION: Our study revealed that a majority of inpatient thrombophilia testing did not follow institutional guidelines for appropriate testing and did not change patient management. These thrombophilia tests are often overutilized and have minimal clinical utility in the inpatient setting

Evaluating the Efficacy of Training Programs for Community Health Workers in Rural Uganda

Background: The Ministry of Health and Omnimed, a non-profit U.S.-based organization that works with international communities to provide basic health education, have partnered to provide health training to community health workers (henceforth referred to as village health workers or VHWs) in rural villages in Uganda. The training is provided via an intensive five-day long session that introduces a wide variety of themes in basic health education taught by experts in the respective fields. The participants are selected by the local government based on their age, reliability, level of education and availability. On the first day, the participants are given a pre-test that evaluates their level of knowledge about the subjects that will be taught during the training session, and are given the same questions as a post-test on the last day of training. This is done to evaluate how much information the participants learned about basic health during the training. The participants are followed after this training by quarterly meetings, focus groups and further, more specific, training sessions. We analyzed data from the pre- and post-tests to evaluate the amount of information learned through the training sessions and we also evaluated feedback from the focus groups to determine how trainees thought the program was affecting their community and to analyze the challenges facing the VHWs. Objectives: The objective of this project was two-fold: 1) to evaluate the amount of information about basic health retained by VHWs who participated in a week-long training session; and 2) to follow-up with VHWs to see what changes they noticed in their communities and determine what challenges they face in disseminating health information in their villages. Methods: The study sample consisted of 110 participants who were asked to complete the pre- and post-tests. The pre- and post-training test consisted of 49 multiple choice questions, written in Luganda, with a total possible score of 105. The pre-test was distributed to the participants on the first day of the training session. Participants were administered post-tests on the last day of the training session. The questions and the delivery of the exams were the same at both points in time. The grading of the tests was as follows: each correct answer received one point, incorrect answers received no points, and questions with more than one answer received no points. We compared the percentage of correct answers of the pre- and post-tests to determine any changes in knowledge as a result of the training session. A total of 99 trainees were recruited to participate in focus groups. Focus groups were conducted three and six months after the original training session and involved five to ten VHWs per session. Questionnaires were distributed to the groups and questions were read aloud with discussion about each topic. We asked the VHWs: 1) Have you noticed healthy changes in your community?; 2) What changes have you noticed; 3) How does the community view a VHW?; and 4) What support could you use as a VHW? Results: The VHWs selected from the communities were aged 25-40, were more likely to be female than male, and generally had a non-health related occupation. One hundred and two participants completed both the pre- and post-tests. The average difference between test scores at the two points in time was an improvement of 20.25 points, or 19.3%. The range of differences between the scores was -5 to +61. Given that the VHWs were not previously educated about basic health, this was viewed a marginal improvement. However, the data from the focus groups indicates that the VHWs were enacting changes in their community. The participants in the focus group were also aged 25-40 and 43 were males and 56 were females. The focus groups demonstrated that 86% of the VHWs noticed positive changes in the community; including the creation of latrines (34%), more drying racks (16%), more hand-washing (11%), increased usage of boiled water (9%) and the newfound creation and usage of “tippy-taps” (8%). When asked if the community viewed the VHWs as a positive asset, 81% answered yes. Lastly, when queried as to what support VHWs could use to facilitate their work, the majority answered some type of transport (51%); while other popular answers were gumboots and raingear, more training, cell phones or a stipend to compensate them for their work. Conclusion: The increased mean score of the post-tests indicates that the VHWs did learn basic health information during the training session. However, the improvement in score was not as notable as one would expect given the intense nature of the trainings and the baseline level of knowledge being somewhat low. The data from the focus groups, however, indicated that VHWs are creating positive change in their communities. This could mean that the simple act of appointing one person to educate their community imbues in them a responsibility to spread the knowledge that they do possess; however basic it may be. It also could indicate that the VHWs learned more at the training sessions than the test scores reveal. This could be due to a multitude of factors, including difficulty with reading, the advanced nature of the test questions, difficulty with multiple choice questions, or difficulty applying knowledge to the test, especially considering that most of the VHWs were adults many years out of school. In light of this information, one could consider a different method of evaluation, and more focus on the follow-up to assess what the VHWs are actually able to do in their communities. Moving forward, it would be ideal to evaluate the villages themselves via a system of door-to-door surveys that ask the villagers about changes they have or have not made and if they have seen any improvement in their health. This information will provide further evidence as to whether VHWs are an ideal model in the field of health education