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The purpose of this paper is to capture the direct and indirect effects of COVID-19 emerging risks on construction projects' success in developing countries from the contractors' perspective. To achieve this, we collected data from Iraqi construction industry and conducted the following multistage research methodology: (1) preliminary investigation with four construction contractors to identify the success indicators of construction projects;(2) focus group session with 11 experts to identify the COVID-19 emerging risks for the construction industry;(3) semistructured interviews with seven construction experts to develop several hypotheses on the effect of COVID-19 emerging risks on project success;(4) survey data collection from 99 construction contractors;and (5) development of a structural equation model (SEM) to analyze the effects of COVID-19 emerging risks on project success. The results of the SEM analysis show that financial market (FM)-related risks, supply chain operations (SCO)-related risks, health and safety of construction workforce (HSCW)-related risks, organizational implications (OI)-related risks, and contractual implications (CI)-related risks have a significant impact on construction projects success. CI-related risks have the strongest total effects on project success, followed by OI-related risks, FM-related risks, HSCW-related risks, and SCO-related risks, respectively. The results also emphasis the significant mediation role of CI between COVID-19 emerging risks and project success. This study contributes to the body of knowledge and contracting companies by helping researchers and construction contractors to better understand how the key risk factors emerging from extreme conditions like the COVID-19 pandemic affect construction projects' success and may serve as a guideline for developing effective response strategies. © 2023 American Society of Civil Engineers.
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Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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What explains the Chinese government's differentiated response to the COVID-19 pandemic? This chapter argues that the same sources of control in authoritarian crisis response that enable the state to mobilize resources and people hamper the flexibility and nimbleness needed to adapt amid uncertainty. It analyzes how political priorities in a predominantly top-down system and experience with past infectious disease outbreaks shape the public health approach to COVID-19 and examines the response from late 2019 through mid-2022 in three approximate phases: early missteps and institutional impediments, rapid shift in response effectiveness, and top-down control and cracks in zero-COVID. Initial reactions were dispersed and incremental as local officials wrestled with how loudly to sound the alarms on the emergence of a new respiratory virus that seemed to be spreading. Beijing eventually backed a centralized, coordinated effort. The ramped-up response was effective, if authoritarian and heavy-handed at times. Since then, the scale and speed of the state's ability to assemble testing, tracing, quarantining, and isolating capacity and other measures enabled China to generally enclose inevitable flare-ups in most of 2020 and 2021. But unyielding pursuit of dynamic zero-COVID policy through mid-2022 reveals a fragile flip side of dogged top-down control. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Mining useful information to analyze knowledge-intensive business processes requires data that describes activities of knowledge workers. Emails are widely used in organizations to provide support in the functioning of knowledge-intensive processes. The recent COVID-19 pandemic has increased reliance on technologies such as email to help facilitate communication within organizations to make up for the lack of face-to-face contact. In this work, we propose an activity mining technique, which receives an incoming email message, classifies the sender's intent and translates it into a set of business process activities. Specifically, we leverage deep learning language models to first classify the email body into a group of intents, which are then mapped to related activities. To our knowledge, we propose the first transfer-learning based solution for mining activity information from emails. The effectiveness of our solution was evaluated on real-world data coming from email exchanges between knowledge workers. Our results based on unsupervised experiments and a field study show that transformer models can be used to semantically label emails and that mapping activities to matched intents is highly accurate. © 2023, Springer Nature Switzerland AG.
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Background: People presenting with early-stage LPCa have several treatment options. There is therapeutic equipoise with lack of randomised evidence for superiority of radiotherapy or surgery. PACE-A aimed to determine if there is improved quality of life (QoL) following SBRT compared to surgery. Method(s): PACE (NCT01584258) is a phase 3 open-label multiple-cohort RCT. In PACE-A, people with LPCa, T1-T2, Gleason<=3+4, PSA<=20ng/mL & suitable for surgery were randomised (1:1) to SBRT or surgery. SBRT dose was 36.25Gy/5 fractions in 1-2 weeks;surgery was laparoscopic or robotically assisted prostatectomy. Androgen deprivation was not permitted. Co-primary endpoints were patient reported outcomes (PROs) of Expanded Prostate Index Composite (EPIC-26) questionnaire number of absorbent pads per day & EPIC bowel subdomain score at 2 years. Target sample size was 234 participants (pts) to detect 9% difference in urinary incontinence (80% power, 5% 2-sided alpha) & 5-point difference in mean bowel subdomain score (90% power, 5% 2-sided alpha) with higher EPIC score (range 0-100) indicating better QoL. Secondary endpoints included clinician reported toxicity and additional PROs (1% significance level). Analysis is by treatment received. Result(s): From Aug 2012 to Feb 2022, 123 men from 10 UK centres were randomised. The IDMC advised stopping recruitment after a 2-year gap in during COVID. Pts had median age 66years (IQR: 61, 69), median PSA 8ng/ml (6, 11) with 52% tumours >=T2b and 79% Gleason 3+4;93% pts were of white race. 58/63 pts received SBRT as allocated (2 received surgery, 2 unknown, 1 withdrawn);48/60 received surgery as allocated (1 received SBRT, 3 received CRT, 2 unknown, 6 withdrawn). 8 laparoscopic and 42 robotic assisted operations were performed. Median follow-up is 50 months (IQR 41, 74). At 2 years, fewer SBRT pts reported use of urinary pads: 2/43 (4.5%) vs 15/32 (46.9%), p<0.001. SBRT pts had significantly worse bowel subdomain score (mean (SD) 88.4 (12.7) vs 97.3 (5.5), p<0.001). 7/45 (15.6%) SBRT and 0/31 (0%) surgery pts reported moderate/big problem with bowel symptoms (p=0.04). SBRT pts reported less EPIC sexual subdomain score (58.0 (31.9) vs 29.3 (20.5), p<0.001);there was no evidence of a difference in urinary subdomain score (85.5 (19.8) vs 80.5 (20.8), p=0.29). At 2 years, CTCAE genitourinary grade 2 or higher(G2+) toxicity was seen in 5/54 (9.3%) SBRT vs 4/42 (9.5%) surgery pts (p=0.97);there was no G2+ gastrointestinal (GI) events seen in either group. Conclusion(s): PACE-A contributes the first randomised data to the comparison of SBRT with surgery in LPCa providing PRO data relevant to informed decision making. Compared to surgery, pts receiving SBRT had better urinary continence & sexual bother score;clinician reported GI toxicity was low but SBRT pts reported more bowel bother at 2 years.
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Background and Purpose: The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong. Method(s): We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020-March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre-COVID-19: January 23, 2019-March 24, 2019). Result(s): Seventy-three patients in COVID-19 were compared with 89 patients in pre-COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups (P>0.05). The median stroke onset-to-door time was =1-hour longer in COVID-19 compared with pre-COVID-19 (154 versus 95 minutes, P=0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, P=0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, P=0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups (P>0.05 for all comparisons). Conclusion(s): During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.
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Learning outcomes: This case provides detailed information about digital technologies and business practices that may help offline retailers catch up with the trend of new retail. After studying the case and working on the assignment questions, students will be able to:▪ Understand new features of smart cash registers, including facial-recognition payment, purchase-sales-inventory management, customer profile and store management, which all are important for the long-term development of the retail business in the age of "new retail”.▪ Identify opportunities, practices and impacts of digital technologies, such as big data and artificial intelligence, on contemporary retail businesses.▪ Identify problems of traditional retail and suggest solutions by applying the concepts and tools learned above.▪ Apply digital marketing approaches and tools (e.g., social media, livestreaming and online word-of-mouth) to design marketing campaigns;students should include basic elements such as the 6Ms for effective marketing communications (market, mission, message, media, money and measure). Case overview/synopsis: This case describes difficult situations facing Leo Shoudong Pan, the founder and CEO of Yun Dong Jia Technologies Co Ltd (YDJ), in marketing communications. With a motto of "Making it easy to open stores anywhere”, YDJ develops and sells smart cash registers, which provide a self-developed operating system and cloud computing services. Pan targets small and micro retailers, who are technology laggards when digital transitions had swept the world. His goal is to build a network of 100,000 pieces of smart cash registers across China, but he has only sold 8,000 pieces since he founded YDJ in 2016. He must make a breakthrough in the business. To drive leads and sales, he feels the urgency of conducting effective marketing communications with target customers and enhance their understanding on the value that YDJ creates for them. Monetary incentives are tangible but not yet fully demonstrated YDJ's value. With the traditional retail approach, brick-and-mortar stores, especially those small-scaled ones, are not able to meet the market change;instead, they must adopt digital techniques to catch up with the trend of new retail, which is necessary for a long-term business development rather than just a temporary measure during the Covid-19 pandemic. Pan must craft more compelling messages. What customer value should be chosen as incentives to motivate the target market? How to conduct effective marketing communications correspondingly? Complexity academic level: Senior undergraduate;Postgraduate;MBA;EMBA. Supplementary materials: Teaching notes are available for educators only. Subject code: CSS 8: Marketing. © 2022, Emerald Publishing Limited.
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With the growing popularity of design thinking capacity building initiatives for entrepreneurship education, educators are striving to explore technology-supported learning environments and pedagogy to achieve the inter-disciplinary, easily accessible, and student-oriented entrepreneurship education innovation. The lingering effects of unfinished learning amid the COVID-19 and mixed-mode learning have become part of a new normal, we designed and implemented a novel learning framework to put co-design pedagogical structures in place that allow educators, students, and stakeholders to form new learning experiences and create innovation together. Through the case study we designed and implemented in three universities across different regions, we propose and investigate an approach that enables micro-level analysis of knowledge creation model for student's design thinking capacity building as well as macro-level understanding of learning dynamics for entrepreneurship education. This study presents a pedagogy-based template, and the findings have implications for the design of technology-empowered educational interventions and pedagogical innovation. © ISLS.
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The novel Coronavirus disease of 2019 had an acutely catastrophic effect on almost every tier of emergency medical services in the United States. The Pro Bono EMS Pandemic Response Research Lab led the national effort into the investigation of prehospital pandemic response in the US mainland, interrogating key systemic issues, infectious disease best practices, and provider safety. This chapter - led by Adj. Prof. Christian Ventura, the Co-Principal Investigator of the lab and adjunct lecturer in prehospital resuscitation science and colleagues - serves as a retrospective analysis into how EMS responded to the global pandemic in the critical year of 2020, what we did right, what we can learn, and implications for the urgently warranted paradigm shifts EMS must consider adopting to prevent infrastructural collapse. © 2021 by Nova Science Publishers, Inc.
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Aims: The ongoing uncertaintyofThe COVID-19 pandemic and recovery to re-establish elective services presents a major challenge to The NHS. Patient flow and bed capacity is now a priority for acute hospitals. We have implemented a new service model aimed at improving patient flow from A&E, where acute surgical patients are triaged and referred directly to The Advanced Nurse Practitioner (ANp) team for assessment and management. A criterion based on The presenting complaint and clinical observations was developed to identify suitable patients. The utilisation of this service was audited for its safety and impact on The Emergency General Surgical provision. Method(s): The setting is a busy University Teaching Hospital with a diverse catchment population of 75,000. A prospective audit identified The number of patients utilising The new care pathway and details of any adverse events or delays in treatment identified. All patients presenting with a General Surgical condition were included. Result(s): Between August and December 2021, 361 patients were referred directly from A&E (81% within first 2 hours of presentation) to The surgical ANp team for assessment. of these, 85 (24%) were admitted for Emergency treatment and 276 (76%) were discharged The same day for either ambulatory or outpatient follow-up, or back to Primary Care. There were no adverse events identified during The audit period. Conclusion(s): Direct streaming of acute surgical patients within a defined criteria to an ANp-led service is safe and effective in helping to improve patient flow and experience within an acute care model.
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Introduction: The COVID-19 pandemic has significantly changed outpatient clinic services which now involve virtual (telephone/video) rather than face-to-face consultations. For both new clinic patients or follow-up patients after a recent emergency admission, these changes may impact on their perceptions and confidence in The outpatient service. The aim of this service provision audit is to ascertain both patient satisfaction and confidence in virtual consultations in our unit. Method(s): A retrospective evaluation of all General Surgery virtual clinic appointments between January and March 2021 was undertaken. Patients were contacted for feedback about their surgical consultation based on questions from The National Health Service Outpatient Department Survey (2011). Result(s): In total, 151 patients were contacted. Overall satisfaction regarding telephone consultations was significantly higher when compared to survey results of face-to-face appointments in The pre-COVID era. The majority of patients were confident (51%) or confident to some extent (27%) of being listed for Surgery without further examination. only 8% of patients were not confident at The way Surgery was explained and 10% were not confident of The risks of surgery. Finally, more than a third were not happy to be discharged from clinic following a telephone consultation. Conclusion(s): Follow-up appointments are an integral part of The patient journey following an emergency admission. The COVID-19 recovery phase has necessitated a service reconfiguration towards virtual appointments. We show that patients were satisfied with virtual consultations, although further quality improvement should be undertaken to ensure outpatient discharge is satisfactory for all patients following an emergency admission.
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Aims: Over 65,000 cholecystectomies are performed each year in The United Kingdom with increasing waiting-list times due to The CoVID-19 pandemic. This study set out to understand The cost to The NHS of complications experienced whilst awaiting cholecystectomy. Method(s): A retrospective cohort study was carried out for all patients who had been awaiting elective cholecystectomy for more than 20 weeks On The 17th September 2021 at a large NHS Foundation Trust. Demographic data was collected at The time of listing. Re-admission data was collected from patient notes. It included clinical history, blood results and imaging investigations. Associated costs were calculated. Result(s): 900 patients included in The study (median age 56 years, 71.7% female). 138 patients (15.3%) re-presented to hospital whilst On The waiting list with complications of gallstone disease. Of these, 51 had more than one presentation to hospital with 18 patients having more than three presentations. This was equivalent to 625 days in hospital, with only 79 same day discharges, and multiple investigations were performed (ultrasound scan = 79;CT scan = 31, MRCp = 47, ERCp = 21). This was estimated to have cost a minimum of 364,917. Assuming an average time for an elective cholecystectomy of 90 mins at a cost of 1,200 per hour, 202 additional cholecystectomies could have been performed. Conclusion(s): This study highlights The enormous potential to reduce patient suffering by increasing The number of elective cholecystectomy lists, and at no overall additional cost to The trust.
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Introduction: In response to the COVID-19 pandemic, the World Society of Pediatric Ophthalmology and Strabismus (WSPOS) piloted strabismus surgery simulation webinars providing real-time surgical instruction using an accessible model eye. The purpose of this study was to demonstrate improvement in confidence level with strabismus surgery among ophthalmology residents who participated in the webinar. Method(s): Five strabismus surgeons (from 5 different countries) taught 10 beginning ophthalmology residents (from 5 different countries) using a homemade model eye and a cell phone streaming the surgical view. Surgical techniques taught included needle handling, scleral passes, and suturing extraocular muscles. Residents watched a video demonstrating techniques prior to the webinar. Three surveys completed Pre-Video, Post-Video, and Post-Webinar evaluated comfort level in surgical skills using Likert scales. Survey responses were analyzed using paired t tests and repeated measures ANOVA (SPSS v24). Queen's University Health Sciences Research Ethics Board approval was obtained. Result(s): Nine of 10 trainees answered the surveys: 66% were 25-29 years old;62.5% were second-year residents. Paired t test showed a statistically significant increase in comfort level in performing scleral passes, suturing an extraocular muscle, and creating a locking bite at the muscle pole between Pre-Video to Post-Webinar surveys (P < 0.05). Exploratory repeated measures ANOVA revealed improvements in scores for 4 of the 5 questions (P < 0.05). Conclusion/Relevance: Our pilot study demonstrates effective teaching of strabismus surgery techniques virtually using an accessible model eye. Virtual teaching allows delivery of world expertise teaching to trainees worldwide, diminishing barriers to learning and improving eye care to patients globally. Copyright © 2022
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This study investigates the transport of air pollutants around the Yangtze River Delta with an aim to identify if there would be a relationship towards health effects during the COVID-19 lockdown period. It is well-known that due to lockdown, the number of socio-economical activities are reduced and hence there is an observable reduction in air pollution. We would like to investigate if this consequential reduction of air pollution would lead to improvement in health amongst its population. A number of integrated methodologies are utilized, including collection and correlation of statistical data and numerical modeling to correlate the mortality rates difference with and without COVID-19 lockdown. In particular air quality changes during the COVID-19 lockdown period are compared with similar periods of the previous years using Brute Force Method. It is found that in general there is significant reduction in air-pollution related mortality, like stroke, ischemic cardio diseases, obstructive pulmonary disease, lung cancer and acute lower respiratory infection are all reduced as a result of relative improvement in PM2.5 level during the lockdown period. Further investigation of the trajectories suggests that these PM2.5 originate from afar with multiple sources, and do not suggest COVID-19 are transported to the region via long-range transport. Our results demonstrate the need for more stringent policy measure to tackle air pollution as it has strong evidence that it increases mortality rate. © 2022 Elsevier Inc. All rights reserved.
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Introduction: Viral upper respiratory tract infections (URTI) such as respiratory syncytial virus, rhinoenterovirus coronavirus, and others are common in children, and they can have serious effects on the pediatric airway. The literature is limited on how often ear, nose, and throat (ENT) clinician involvement is required in patients admitted with a URTI. This project aims to characterize and identify factors associated with ENT involvement in care of pediatric patients with positive respiratory virus panels (RVP) and if any require airway interventions. Method(s): A retrospective study was conducted collecting information on patient demographics, comorbidities, course of treatment, incidence of ENT consultation, and incidence of airway interventions (flexible laryngoscopy, intubation, tracheostomy, direct laryngoscopy, etc) for all pediatric patients with a positive RVP who were treated either inpatient or in the emergency department from January 2018 to January 2020 at a tertiary care academic facility. Result(s): A total of 1019 of 1317 consecutive charts with a positive RVP over a 2-year period were reviewed. Preliminary result analysis was completed for the 1019 completed charts. Twenty-eight patients (2.7%) required an ENT consultation. Congenital birth defects were significantly associated with ENT consultation (odds ratio [OR]=3.75;P=.001). Length of stay was significantly associated with higher rate of ENT consultation per day of stay (OR=1.07 per day of stay;P<.001). All other factors studied were not significantly associated with higher rate of ENT consult. Conclusion(s): The incidence of ENT consultation in inpatients with URTIs is relatively uncommon. The preliminary data of this study suggest congenital birth defects and longer length of stay could be used as potential markers to help identify patients who may be at increased risk for worse airway outcomes and need for further airway intervention.
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Purpose: The demand for kidney transplant continues to rise, and limited supply has encouraged acceptance of marginal donor organs, such as those at risk for acute kidney injury (AKI). We evaluated the utilization of such organs (defined as donation after cardiac death, pediatric donors, kidneys with a cold ischemic time >24 hrs, terminal serum creatinine (SCr) >2mg/dL or rising SCr with decreasing urine output at donation) at our center who were discharged on belatacept based maintenance immunosuppression with mycophenolate and steroids (BBMS). Method(s): This retrospective, descriptive study examined kidney transplant recipients (KTR) who received AKI organs and were discharged on BBMS between 1/2019-4/2021. Primary outcome assessed graft function and rejection at 6 & 12 months (mos) post-transplant (txp). Secondary outcomes evaluated graft failure, mortality, infection, DSA & changes to BBMS. All outcomes were evaluated at 1yr if records were available. Result(s): 68 KTR w/1 yr results & 52 w/6 mo results on BBMS were included. Baseline characteristics (Table 1) show most KTR received a DCD or en bloc organ and lymphocyte depleting induction. Mean eGFR improved from 1 to 6 mo post-txp and was stable through 1yr. Episodes of biopsy proven rejection were more common during the first 6mos post-txp. There were 2 deaths during the study period, due to COVID, and no graft failures. Twelve KTR developed DSA. There were 21 KTR with CMV viremia, mostly in moderate risk group, & 12 with BK viremia. Table 4 shows changes to BBMS occurred in 32 KTR. Most KTR required multiple BBMS changes with most common dose adjustments to mycophenolate due to leukopenia or neutropenia. Conclusion(s): Utilization of AKI organs with BBMS in KTR at our center resulted in no graft failures & sustained eGFR despite more rejection episodes during the first 6mos post-txp. Although 32 KTR had changes to BBMS, only 5 KTR had rejection following a change. Incidence of CMV was common but did not impact KTR outcomes. Overall, BBMS could be a promising option in AKI organs to avoid nephrotoxicity associated with CNI based regimens. These findings suggest the need to further evaluate the impact of long-term outcomes associated with changes made to BBMS in AKI donor organs.