Increasing Heart Transplant Volume by Expansion of Donor Heart Selection Criteria: A Single-Center Analysis.

BACKGROUND: Our transplant center recently expanded the acceptance criteria for cardiac donors to increase heart transplant volume. Our purpose was to assess the success of this strategy while maintaining acceptable 1-year survival. METHODS: We retrospectively reviewed patients who underwent heart transplantation at our institution from January 2011 through December 2017. This time period was divided into 2 periods: 2011 to 2014 (Period A) and 2015 to 2017 (Period B) because we implemented our new donor acceptance policy at the onset of 2015. We compared recipient and donor characteristics from the 2 time periods. The primary outcomes were 1-year graft and patient survival. RESULTS: Transplant volume increased in Period B with the expanded donor acceptance policy: 128 heart transplants over 36 months compared to 52 transplants in 48 months in Period A. Mean (± SD) recipient age was significantly higher in Period B (54 ± 12 vs 50 ± 15 years; P = .04) whereas other recipient variables were similar. Donors in Period B were significantly older, more likely to be female, had larger body mass index, were located a greater distance from the transplant center, and had a higher sequence number. Female donor to male recipient occurred more often in Period B than in Period A (27% vs 10%; P = .01). Both 1-year patient survival and graft survival were unchanged between Period B (95% for both) and Period A (96% for both). CONCLUSIONS: Using a more aggressive donor acceptance policy allowed for an increase in heart transplant volume while maintaining acceptable 1-year graft and patient survival.

Successful Combined Heart and Kidney Transplantation in Patient With Fabry's Disease: A Case Report.

Fabry's disease is a X-linked hereditary disease that causes the accumulation of glycosphingolipids in tissues and organs, including the kidneys and heart. This can result in both chronic kidney disease and cardiac dysfunction, including arrhythmias and heart failure. We describe a case of a 62-year-old male with Fabry's disease undergoing successful combined heart and kidney transplantation for chronic renal failure and low-output systolic heart failure. The patient has normal cardiac function and normal renal function 7 years after transplantation, while being maintained on enzyme replacement therapy with recombinant human alpha-galactosidase A. Fabry's disease is not a contraindication for organ transplantation, even in patients presenting with both renal failure and heart failure.

Developmental milestones for productivity occupations in children and youth: An integrative review.

BACKGROUND: Limited research exists on developmental milestones for productivity occupations throughout the paediatric lifespan, and negative connotations of work for children and youth may have contributed to a paucity of literature on the topic. OBJECTIVE: To ascertain what is currently known about the timing and types of engagement in productivity occupations in children and youth aged 4-19. METHODS: Literature referencing productive occupations in children and youth aged 4-19 was searched for this integrative review. Search terms were established based on paediatric age and occupational therapy descriptors, and terminology associated with productivity. Sixty-seven peer-reviewed articles were analyzed according to the constant comparative method. RESULTS: Six core productive occupations emerged as avenues for productive engagement: paid work, school-related activities, caring for self and others, household chores, volunteering, and agricultural chores. A timeline was constructed to display common milestones for engagement in these occupations throughout the paediatric lifespan. Paediatric engagement was found to be influenced by personal (age, gender, child and youth perceptions, and safety considerations), and environmental (familial factors, parental perceptions, societal influences, and safety considerations) factors. CONCLUSIONS: Approaches to paediatric practice must account for the full spectrum of productive occupations children and youth engage in beyond the school context.

Safety of Nurse-Led Ambulation for Patients on Venovenous Extracorporeal Membrane Oxygenation.

PURPOSE: Venovenous extracorporeal membrane oxygenation (VV ECMO) is an effective therapy in patients with acute lung injury and end-stage lung disease. Although immobility increases the risk of complications, ambulation of patients on VV ECMO is not the standard of care in many institutions. Staff concerns for patient safety remain a barrier to ambulation. In this case series, we present our experience utilizing a nurse-driven ambulatory VV ECMO process to safely rehabilitate patients. METHODS: We retrospectively reviewed all VV ECMO cases at our institution between January 1, 2011, and November 1, 2013. Inclusion criteria for this study required patients to be cannulated in the right internal jugular vein and ambulated while on VV ECMO. RESULTS: During the period from January 1, 2011, to November 1, 2013, 18 patients (mean age 49 ± 15 years, 12 male) were ambulated while on ECMO. Eight received a transplant and survived to discharge. Of the remaining patients, 4 were successfully weaned from VV ECMO and 6 died following decisions by the family to withdraw care. The mean duration of VV ECMO support was 18 ± 16 days with the maximum duration being 61 days. All patients received physical therapy, range of motion at the bedside, and ambulated in the hospital. There were no patient falls, decannulations, or any other complications related to ambulation. CONCLUSION: The adoption of a nurse-driven program to ambulate patients on VV ECMO is safe and may reduce other complications associated with immobility.

A Protocol for Collecting Human Cardiac Tissue for Research.

This manuscript describes a protocol at the University of Kentucky that allows a translational research team to collect human myocardium that can be used for biological research. We have gained a great deal of practical experience since we started this protocol in 2008, and we hope that other groups might be able to learn from our endeavors. To date, we have procured ~4000 samples from ~230 patients. The tissue that we collect comes from organ donors and from patients who are receiving a heart transplant or a ventricular assist device because they have heart failure. We begin our manuscript by describing the importance of human samples in cardiac research. Subsequently, we describe the process for obtaining consent from patients, the cost of running the protocol, and some of the issues and practical difficulties that we have encountered. We conclude with some suggestions for other researchers who may be considering starting a similar protocol.

B'More Healthy Communities for Kids: design of a multi-level intervention for obesity prevention for low-income African American children.

BACKGROUND: Childhood obesity rates in the U.S. have reached epidemic proportions, and an urgent need remains to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component interventions are needed due to the multi-factorial nature of obesity, and its proven links to both the social and built environment. However, there are huge gaps in the literature related to doing these kinds of interventions among low-income, urban, minority groups. METHODS: The B'More Healthy Communities for Kids (BHCK) intervention is a multi-level, multi-component intervention, targeting low-income African American youth ages 10-14 and their families in Baltimore, Maryland. This intervention prevents childhood obesity by working at multiple levels of the food and social environments to increase access to, demand for, and consumption of healthier foods. BHCK works to create systems-level change by partnering with city policy-makers, multiple levels of the food environment (wholesalers, corner stores, carryout restaurants), and the social environment (peers and families). In addition, extensive evaluation will be conducted at each level of the intervention to assess intervention effectiveness via both process and impact measures. DISCUSSION: This project is novel in multiple ways, including: the inclusion of stakeholders at multiple levels (policy, institutional, and at multiple levels of the food system); that it uses novel computational modeling methodologies to engage policy makers and guide informed decisions of intervention effectiveness; it emphasizes both the built environment (intervening with food sources) and the social environment (intervening with families and peers). The design of the intervention and the evaluation plan of the BHCK project are documented here. TRIAL REGISTRATION: NCT02181010 (July 2, 2014).

Directions for advancing the study of work transitions in the 21st century.

OBJECTIVES: The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

Topical glycolic acid enhances photodamage by ultraviolet light.

BACKGROUND: Alpha-hydroxy acids (AHAs) are widely used as ingredients in cosmetics. Several studies suggest that AHAs can increase the sensitivity of skin to ultraviolet (UV) light. PURPOSE: This study was performed in order to determine whether short-term dermal treatment with glycolic acid, a representative AHA, can enhance the damaging effects of UV light. The duration of the effect of AHAs on the sensitivity of skin to UV light was also examined. METHODS: The backs of 29 Caucasian subjects were treated, once daily, 6 days per week with either 10% glycolic acid (pH 3.5) or placebo in a randomized double-blinded study. At the end of 4 weeks, sites within each treated area were exposed to 1.5 MED of UV light, determined on previously untreated skin. Specimens were obtained for enumeration of sunburn cells (SBCs) in the first group of subjects (n = 16), whereas cyclobutyl pyrimidine dimers (CPDs) in DNA were determined in the second group (n = 13). The minimal erythema dose (MED) in each site was also determined in the first group of subjects. Sunburn cells and MEDs were re-evaluated in the first group 1 week after discontinuing AHA applications. RESULTS: Glycolic acid caused enhanced sensitivity to UV light measured as increased SBC induction and lowered MEDs. Cyclobutyl pyrimidine dimers were elevated but not to a statistically significant level. No differences in SBCs or MEDs were evident after a week of discontinued treatments. CONCLUSION: Short-term application of 10% glycolic acid sensitizes the skin to the damaging effects of UV light. This photosensitivity is reversed within a week of terminating treatments.