Not All Antibodies Are Created Equal: Factors That Influence Antibody Mediated Rejection.

Consistent with Dr. Paul Terasaki's "humoral theory of rejection" numerous studies have shown that HLA antibodies can cause acute and chronic antibody mediated rejection (AMR) and decreased graft survival. New evidence also supports a role for antibodies to non-HLA antigens in AMR and allograft injury. Despite the remarkable efforts by leaders in the field who pioneered single antigen bead technology for detection of donor specific antibodies, a considerable amount of work is still needed to better define the antibody attributes that are associated with AMR pathology. This review highlights what is currently known about the clinical context of pre and posttransplant antibodies, antibody characteristics that influence AMR, and the paths after donor specific antibody production (no rejection, subclinical rejection, and clinical dysfunction with AMR)

Utah Accessible Tutorials: Creating a Collaborative Project between a Public and Academic Library

This article describes collaboration between a research librarian and application developer at the University of Utah with a teen services librarian at Salt Lake County Libraries. Our group came together as part of the Innovative Librarians Explore, Apply, and Discover-Utah (ILEAD Utah) program. We discuss how we worked together to create and develop a project, the opportunities and difficulties we faced, and offer suggestions for how to build similar partnerships successfully

Mapeando o processo de pesquisa colaborativa

Despite significant federal investments in the production of high-quality education research, the direct use of that research in policy and practice is not evident. Some education researchers are increasingly employing collaborative research models that use structures and processes to integrate practitioners into the research process in an effort to produce more relevant and useful work. This article presents and describes the logic model developed by researchers at American Institutes for Research (AIR) to guide their work on the Regional Educational Laboratory Midwest. Under this program, AIR researchers have developed eight research alliances. The alliance members, who represent districts, state education agencies, and other organizations with a vested interest in education, partner with researchers to develop three- to five-year research agendas. These agendas drive the research and technical assistance projects that the alliance members and AIR researchers do together. It contributes to the emergent literature on research-practice partnerships, providing a theory-based approach to the work that others might model, build upon, or revisit.A pesar de las inversiones federales significativas en la producción de investigaciones en educación de alta calidad, el uso directo de que la investigación en la política y la práctica no es evidente. Algunos investigadores en el área de educación están empleando cada vez más modelos de investigación en colaboración que utilizan estructuras y procesos para integrar los profesionales en el proceso de investigación, en un esfuerzo para producir un trabajo más relevante y útil. Este artículo presenta y describe el modelo lógico desarrollado por investigadores de la American Institutes for Research (AIR) para orientar su trabajo en el Laboratorio Educativo Regional del Medio Oeste. Bajo este programa, los investigadores de AIR han desarrollado ocho alianzas de investigación. Los miembros de la alianza, que representan a los distritos, las agencias estatales de educación y otras organizaciones interesados en la educación, forman un equipo con investigadores para desarrollar programas de investigación de tres a cinco años de duración. Estos programas de investigación y de asistencia técnica orientan a los miembros de la alianza e investigadores AIR en su colaboración. Este trabajo contribuye a la literatura sobre las asociaciones de investigación-práctica, proporcionando un enfoque teórico que otros podrían modelar, utilizar o modificar.Apesar dos investimentos federais significativos na produção de pesquisas em educação de alta qualidade, o uso direto de investigação na política e na prática não é clara. Alguns pesquisadores no campo da educação estão cada vez mais usando modelos colaborativos de pesquisa que utilizem estruturas e processos para integrar os profissionais no processo de pesquisa em um esforço para produzir um trabalho mais relevante e útil. Este artigo apresenta e descreve o modelo lógico desenvolvido por pesquisadores do Instituto Americano de Pesquisa (AIR) para orientar o seu trabalho no Laboratório Educacional Regional do Centro-Oeste. No âmbito deste programa, os pesquisadores de AIR desenvolveram oito parcerias de investigação. Os membros da aliança, que representam distritos, agências estaduais de educação e outras organizações interessadas em educação, formaram parcerias com pesquisadores para desenvolver programas de investigação  de três a cinco anos de duração. Estes programas de pesquisa e assistência técnica orientou a colaboração dos membros da aliança e pesquisadores da AIR. Este artigo contribui para a literatura sobre parcerias de investigação e prática, proporcionando uma abordagem teórica de modelagem que outros poderiam construir ou modificar

Occupational Therapy Students’ and Graduates’ Perspectives of Traditional and Nontraditional Level I Fieldwork Experiences

Among occupational therapy students and recently graduated practitioners, what are the perceptions of Level I fieldwork in understanding the role of an occupational therapist, application to didactic coursework, and impact on overall skills? Quantitative findings suggest that students and graduates perceived traditional Level I FW settings to be the most effective for understanding the role of an OT, application to didactic coursework, and impact on overall skills in comparison to respondents who experienced non-traditional Level I fieldwork settings. Qualitative data supports this finding as the most common theme reported was participants\u27 desire to work alongside an OT during fieldwork, as required in traditional fieldwork settings. Additionally, participants found FW to be most effective when given the opportunity to be hands-on with clients.These findings can help inform OT to meet ACOTE standards. Future research should focus on investigating FW educator and coordinator perspectives on traditional and nontraditional FW and compare the difference in perspectives between students and educators. This will help determine if there is a disconnect or misunderstanding between stakeholder groups in OT FW education

Parent and Provider Perspectives on Early Intervention in Ohio: A Community Collaborative Approach

The network of early intervention (EI) for families with children who are deaf or hard of hearing (D/HH) consists of multiple professionals that partner with parents. As part of a community collaborative initiative, diverse perspectives were gathered via online surveys as part of a state-wide needs assessment to evaluate the landscape of EI in Ohio. The qualitative and quantitative feedback were analyzed in light of the Joint Committee on Infant Hearing’s (2007) goals and the 2013 early intervention supplement to those goals. Care coordination and equitable access emerged as top priorities across all three stakeholder groups queried (audiologists, EI providers, and parents). Through a theory of change framework, these results offer a pathway to strengthening EI in order to promote the well-being of families and children who are D/HH

Influenza-like Illness, the Time to Seek Healthcare, and Influenza Antiviral Receipt During the 2010–2011 Influenza Season— United States

Background. Few data exist describing healthcare-seeking behaviors among persons with influenza-like illness (ILI) or adherence to influenza antiviral treatment recommendations. Methods. We analyzed adult responses to the Behavioral Risk Factor Surveillance System in 31 states and the District of Columbia (DC) and pediatric responses in 25 states and DC for January–April 2011 by demographics and underlying health conditions. Results. Among 75 088 adult and 15 649 child respondents, 8.9% and 33.9%, respectively, reported ILI. ILI was more frequent among adults with asthma (16%), chronic obstruction pulmonary disease (COPD; 26%), diabetes (12%), heart disease (19%), kidney disease (16%), or obesity (11%). Forty-five percent of adults and 57% of children sought healthcare for ILI. Thirty-five percent of adults sought care ≤2 days after ILI onset. Seeking care ≤2 days was more frequent among adults with COPD (48%) or heart disease (55%). Among adults with a self-reported physician diagnosis of influenza, 34% received treatment with antiviral medications. The only underlying health condition with a higher rate of treatment was diabetes (46%). Conclusions. Adults with underlying health conditions were more likely to report ILI, but the majority did not seek care promptly, missing opportunities for early influenza antiviral treatment

Use of cumulative incidence of novel influenza A/H1N1 in foreign travelers to estimate lower bounds on cumulative incidence in Mexico

Background: An accurate estimate of the total number of cases and severity of illness of an emerging infectious disease is required both to define the burden of the epidemic and to determine the severity of disease. When a novel pathogen first appears, affected individuals with severe symptoms are more likely to be diagnosed. Accordingly, the total number of cases will be underestimated and disease severity overestimated. This problem is manifest in the current epidemic of novel influenza A/H1N1. Methods and Results: We used a simple approach to leverage measures of incident influenza A/H1N1 among a relatively small and well observed group of US, UK, Spanish and Canadian travelers who had visited Mexico to estimate the incidence among a much larger and less well surveyed population of Mexican residents. We estimate that a minimum of 113,000 to 375,000 cases of novel influenza A/H1N1 have occurred in Mexicans during the month of April, 2009. Such an estimate serves as a lower bound because it does not account for underreporting of cases in travelers or for nonrandom mixing between Mexican residents and visitors, which together could increase the estimates by more than an order of magnitude. Conclusions: We find that the number of cases in Mexican residents may exceed the number of confirmed cases by two to three orders of magnitude. While the extent of disease spread is greater than previously appreciated, our estimate suggests that severe disease is uncommon since the total number of cases is likely to be much larger than those of confirmed cases

Development and validation of statistical models of femur geometry for use with parametric finite element models

Statistical models from a previous study that predict male and female femur geometry as functions of age, body mass index (BMI), and femur length were updated as part of an effort to develop lower-extremity finite element models with geometries that are parametric with subject characteristics. The process for updating these models involved extracting femur geometry from clinical CT scans of an additional 8 men and 36 women (previous models used CT scans from 62 men and 36 women for a new total of 70 men and 72 women), using all of the scans for fitting a template finite element femur mesh to the surface geometry of each patient, and then programmatically determining thickness at each nodal location. Principal component analysis was then performed on the thickness and geometry nodal coordinates, and linear regression models were developed to predict principal component scores as functions of age, BMI, and femur length. The results from the updated models were compared to the previous study, and the only improvement was in the R2 value for the female models (0.74 to 0.82). The largest differences between the original models and the previous models occurred in the ends of the femur, where the largest errors in model predictions occurred.National Highway Traffic Safety Administrationhttp://deepblue.lib.umich.edu/bitstream/2027.42/116208/1/103222.pdfDescription of 103222.pdf : Final repor

Cost-Effectiveness of 2009 Pandemic Influenza A(H1N1) Vaccination in the United States

Pandemic influenza A(H1N1) (pH1N1) was first identified in North America in April 2009. Vaccination against pH1N1 commenced in the U.S. in October 2009 and continued through January 2010. The objective of this study was to evaluate the cost-effectiveness of pH1N1 vaccination.A computer simulation model was developed to predict costs and health outcomes for a pH1N1 vaccination program using inactivated vaccine compared to no vaccination. Probabilities, costs and quality-of-life weights were derived from emerging primary data on pH1N1 infections in the US, published and unpublished data for seasonal and pH1N1 illnesses, supplemented by expert opinion. The modeled target population included hypothetical cohorts of persons aged 6 months and older stratified by age and risk. The analysis used a one-year time horizon for most endpoints but also includes longer-term costs and consequences of long-term sequelae deaths. A societal perspective was used. Indirect effects (i.e., herd effects) were not included in the primary analysis. The main endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted.For vaccination initiated prior to the outbreak, pH1N1 vaccination was cost-saving for persons 6 months to 64 years under many assumptions. For those without high risk conditions, incremental cost-effectiveness ratios ranged from $8,000-$52,000/QALY depending on age and risk status. Results were sensitive to the number of vaccine doses needed, costs of vaccination, illness rates, and timing of vaccine delivery.Vaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination. We also found that the delays in vaccine availability had a substantial impact on the cost-effectiveness of vaccination