Renal transplantation

Individuals with kidney failure face a future requiring long-term treatment with either dialysis or renal transplantation. Renal transplantation is the preferred form of renal replacement therapy, and is associated with a better quality of life, and usually increased longevity. Unfortunately, owing to excessive co-morbidities, only 30% of patients who develop end-stage renal failure are fit enough for transplantation. Over 90% of kidney transplants still function after 1 year, and most function for >15 years. Improvements in transplant outcomes are attributable to advances in histocompatibility testing, organ procurement, organ preservation, surgical techniques and perioperative care. Long-term outcomes have shown only minor improvements over the last two decades, although this should be considered in the context of deteriorating organ quality as older deceased donors with increasing co-morbidity are used more often to satisfy the need for donor organs. An overall increase in deceased donor numbers has boosted transplant activity in the UK, and it is hoped this will continue with the adoption of the 'opt-out' consent system. Living donor activity remains stable, but the use of non-directed altruistic donation and the living donor exchange scheme have reduced the need for higher immunological risk incompatible transplantation. The COVID-19 pandemic has reduced transplant rates globally, although national transplant systems are now recovering.Copyright © 2022

Renal transplantation

Individuals with kidney failure face a future requiring long-term treatment with either dialysis or renal transplantation. Renal transplantation is the preferred form of renal replacement therapy, and is associated with a better quality of life, and usually increased longevity. Unfortunately, owing to excessive co-morbidities, only 30% of patients who develop end-stage renal failure are fit enough for transplantation. Over 90% of kidney transplants still function after 1 year, and most function for >15 years. Improvements in transplant outcomes are attributable to advances in histocompatibility testing, organ procurement, organ preservation, surgical techniques and perioperative care. Long-term outcomes have shown only minor improvements over the last two decades, although this should be considered in the context of deteriorating organ quality as older deceased donors with increasing co-morbidity are used more often to satisfy the need for donor organs. An overall increase in deceased donor numbers has boosted transplant activity in the UK, and it is hoped this will continue with the adoption of the 'opt-out' consent system. Living donor activity remains stable, but the use of non-directed altruistic donation and the living donor exchange scheme have reduced the need for higher immunological risk incompatible transplantation. The COVID-19 pandemic has reduced transplant rates globally, although national transplant systems are now recovering.Copyright © 2022

Training and Skills Development for the Circular Economy in the Current Geopolitical Context: A Bottom-Up Design Focused on Community Need and Social Enterprise

The rise of circular economic thinking in academic literature can be traced back to Boulding's work on open and closed systems in the 1960s. Since then, the Circular Economy (CE) has been developed as a model to facilitate environmentally sustainable production and consumption, as well as economic and social prosperity. Recent geopolitical destabilising events such as Covid-19, and the war in Ukraine, have further increased the urgency of finding practical solutions to the climate crisis. In this paper we will explore industrial transformation, and how it can best adapt to a more circular and greener landscape from the perspective of economic activity and social prosperity. Training, or retraining of the workforce with the new skills they will need must be targeted and part of a unifying strategy, locally, nationally, and ultimately, globally. We present a conceptual paper on this theme and present initial work carried out to co-design and deliver training to disadvantaged individuals;working with local authorities, community charities and social enterprises and focusing on the grassroots of the drive to promote and establish the system wide changes needed to shift from linear to circular economic practice. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Pancreas and islet transplantation in the United Kingdom during the COVID-19 era

Introduction: WHO declared a pandemic of COVID-19 in March 2020. This study analyses the impact of COVID-19 on beta-cell replacement therapy in the UK. Method(s): Pancreas and islet donation and transplant activity in the period March 2020/2021 was compared with the same period the previous year. Result(s): 2,180 patients had a functioning graft during March 2020/2021. 5.8%(n=126) tested positive for COVID-19 and two died (1%). In this period there was a 43% reduction in solid organ donors n=1,615, compared with the previous year, n=2,840. Of the 625 solid organ donors with a pancreas offered, 32% had the pancreas retrieved compared with 51% the previous period. 97 whole pancreas and islet transplants were performed in the UK down 54% from the prior period. Of the 84 pancreas transplant recipients;four tested positive for COVID-19 but none died, and two grafts failed within the first week from vascular thrombosis (neither were COVID-19 positive). Of the 13 SIK and islet alone transplant recipients, two tested positive for COVID-19 but neither died. Of these SIK transplants, one is known to have failed within a month and this is equivalent to that seen in the previous time period. To our knowledge, no patient receiving beta cell replacement therapy died of COVID during the first year of the pandemic despite immunosuppression. Conclusion(s): In the UK, pancreas, and islet transplantation have continued during the pandemic at a lower rate. Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior. Take-home message: Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior.

COVID-19: Extensive epithelial damage and ciliary dyskinesia in hospitalised patients.

Infection with SARS-CoV-2 can cause severe respiratory disease and it is predicted that the COVID-19 pandemic will leave a substantial number of patients with long-term respiratory complications (1).

CHALLENGE: A phase III study of the impact of a physical activity program on disease-free survival in patients with high-risk stage II or stage III colon cancer: A randomized controlled trial (NCIC CTG CO.21)

Aims: To determine the efficacy of physical activity (PA) in reducing disease recurrence in patients with localised colon cancer. Our primary hypothesis is that a PA program will improve disease-free survival (DFS) in patients with resected stage II (high risk) and III colon cancer who have completed adjuvant therapy. In addition, we hypothesise that exercise can improve fatigue, quality of life (QOL), physical functioning and body composition. Methods : An international multi-centre phase 3 RCT primarily between Australia and Canada. Subjects are randomised to PA program or standard care. Primary objective compares DFS between patients in PA and control arms. Key secondary objectives are to compare: 1. fatigue, QOL, depression, anxiety, sleep, body composition, exercise behaviour and fitness;2. overall survival (OS);3. association of cytokines, and insulin axis levels with PA, fatigue, and DFS;4. Health economic evaluation of the PA intervention. The study intervention is a 36-month PA programme aiming to achieve > 10 metabolic equivalent rates/week above baseline. Study assessments include: Disease status, fitness, body composition, QOL questionnaires at 0/6/12/18/24/30/36 months. Then annual patient reported outcomes and disease status until study closure. Interim analysis (n = 273 with 12 months follow up) showed good intervention adherence, significant difference in PA with 10.5 MET hours/week difference between groups, and objective fitness improvements in PA group. Adaptations due to COVID: In 2020, rapid amendments were made in response to COVID-19 to provide alternative modes for intervention delivery (via phone or virtual) and assessments conducted virtually where possible, with option of electronic completion of patient-reported outcomes. Current Status: Number of randomisations = 792 (82% of planned sample size);270 from Australia (from 24 sites). Five sites continue recruitment in Australia: Concord, Royal Brisbane and Women's, Tamworth, Newcastle Private, and Northern Cancer Institute.

Why do people remain in hospital after mastectomy?

Aims: Mastectomy is established as a safe day-case procedure. Amidst the ongoing COVID-19 pandemic it is essential to find ways to continue elective surgery with greater efficiency. The aim of this study is to establish factors associated with overnight admission after simple mastectomy, enabling more effective pre-operative planning. Methods: All patients undergoing simple mastectomy in our unit between January and October 2020 were included. Those undergoing immediate reconstruction were excluded. The electronic case notes were reviewed to include procedure performed and patient characteristics. Basic statistical analysis was performed. Results: 95 patients underwent simple mastectomy (28 with axillary clearance and 58 with sentinel node biopsy). 56% of procedures were day-case. Axillary clearance was more common in the inpatient compared to the day-case surgery group (24% vs 45%). Both average age and ASA were significantly lower in the day-case compared to the inpatient group (p<0.05). There was no significant difference in BMI or specimen weight between groups. 16 patients underwent simple mastectomy without drain insertion, none required admission. Of the patients admitted overnight following surgery, 50% were pre-planned admissions. 57% of these were for patients identified as high surgical or anaesthetic risk at pre-operative assessment. Overall 5 patients stayed in hospital due to patient preference. Conclusions: In addition to axillary surgery performed, age, ASA and perceived pre-operative risk are associated with overnight admission following simple mastectomy. Knowledge of these factors can better inform pre-operative planning. Providing enhanced post-operative support at home may enable more patients to be discharged on day of surgery.

Allelic variation in class I HLA determines CD8(+) T cell repertoire shape and cross-reactive memory responses to SARS-CoV-2

[Figure: see text].

The local and systemic response to SARS-CoV-2 infection in children and adults

T1 Figure 1ConclusionsOverall, this largest paediatric single cell COVID-19 study to date showed significant differences in response to SARS-CoV-2 between children and adults, reflecting the changes of the immune landscape over developmental time, which in children are dominated by naïve and innate responses.

Rapidly Converting a Project-Based Engineering Experience for Remote Learning: Successes and Limitations of Using Experimental Kits and a Multiplayer Online Game

To provide a project-based learning experience during the COVID-19 outbreak, we mailed experimental kits to 285 undergraduate students and developed curriculum for a multi-player online robot simulation game. Students successfully achieved cognitive objectives and rated the remote learning experience comparably to the prior-year in-person implementation. However, there was a 10% decrease in self-reported motivation for the project and only 15% of students endorsed offering the course online in the future. Students most frequently felt that reduced quality of interaction was a key difficulty (43%) and seldom identified reduced hands-on experiences (7%) as a difficulty, a course aspect they identified as the most motivating. Preserving the known benefits of project-based learning for engineering retention will likely require improving remote collaboration strategies for hands-on activities. © 2020