Dissolved organic matter characteristics linked to bacterial community succession and nitrogen removal performance in woodchip bioreactors.

Woodchip bioreactors are an eco-friendly technology for removing nitrogen (N) pollution. However, there needs to be more clarity regarding the dissolved organic matter (DOM) characteristics and bacterial community succession mechanisms and their association with the N removal performance of bioreactors. The laboratory woodchip bioreactors were continuously operated for 360 days under three influent N level treatments, and the results showed that the average removal rate of TN was 45.80 g N/(m3·day) when the influent N level was 100 mg N/L, which was better than 10 mg N/L and 50 mg N/L. Dynamic succession of bacterial communities in response to influent N levels and DOM characteristics was an important driver of TN removal rates. Medium to high N levels enriched a copiotroph bacterial module (Module 1) detected by network analysis, including Phenylobacterium, Xanthobacteraceae, Burkholderiaceae, Pseudomonas, and Magnetospirillaceae, carrying N-cycle related genes for denitrification and ammonia assimilation by the rapid consumption of DOM. Such a process can increase carbon limitation to stimulate local organic carbon decomposition to enrich oligotrophs with fewer N-cycle potentials (Module 2). Together, this study reveals that the compositional change of DOM and bacterial community succession are closely related to N removal performance, providing an ecological basis for developing techniques for N-rich effluent treatment.

Implications of chronic hypoxia during development in red drum.

Respiratory plasticity is a beneficial response to chronic hypoxia in fish. Red drum, a teleost that commonly experiences hypoxia in the Gulf of Mexico, have shown respiratory plasticity following sublethal hypoxia exposure as juveniles, but implications of hypoxic exposure during development are unknown. We exposed red drum embryos to hypoxia (40% air saturation) or normoxia (100% air saturation) for 3 days post fertilization (dpf). This time frame encompasses hatch and exogenous feeding. At 3 dpf, there was no difference in survival and no change in size. After the 3-day hypoxia exposure, all larvae were moved and reared in common normoxic conditions. Fish were reared for ∼3 months and measured for implications of the developmental hypoxia exposure on swim performance and whole-animal aerobic metabolism. We used a cross design wherein fish from normoxia (N=24) were swam in Blazka swim tunnels in both hypoxia (40%, n=12) and normoxia (100%, n=12), and likewise for hypoxia-exposed fish (N=20, n=10 each group). Oxygen consumption, critical swim speed (Ucrit), critical oxygen threshold (Pcrit), and mitochondrial respiration were measured. Hypoxia-exposed fish had higher aerobic scope, maximum metabolic rate, and higher liver mitochondrial efficiency relative to control fish in normoxia. Interestingly, hypoxia-exposed fish showed increased hypoxia sensitivity (higher Pcrit), and recruit burst swimming at lower swim speeds relative to control fish. These data provide evidence that hypoxia exposure leads to a complex response in later life.

Study approaches mediate associations between learning environment and academic performance.

BACKGROUND: While study approaches have been directly associated with students' academic performance, learning environment factors may play a more indirect role. The aim of this study was (i) to assess learning environment factors as predictors of students' average exam grades, and (ii) whether study approaches mediated associations between learning environment factors and exam grades. METHODS: Three annual surveys (2017-2019) yielded data from a total of 263 Norwegian occupational therapy students. Learning environment factors were assessed with the Course Experience Questionnaire, and the Approaches and Study Skills Inventory for Students were used to assess study approaches. Linear regression analyses and mediation analyses were performed. RESULTS: Higher levels of 'student autonomy' were directly associated with lower averaged grades whereas higher levels of 'appropriate workload' were associated with higher averaged grades. There were statistically significant total indirect effects of 'clear goals' and 'appropriate workload' on grades; these effects occurred through the study approach variables. However, all learning environment variables showed one or more relationships with academic performance that was mediated by study approach variables. CONCLUSION: Learning environment variables appear to be complexly associated with academic performance, both directly and indirectly.

Leonhard Med, a trusted research environment for processing sensitive research data.

This paper provides an overview of the development and operation of the Leonhard Med Trusted Research Environment (TRE) at ETH Zurich. Leonhard Med gives scientific researchers the ability to securely work on sensitive research data. We give an overview of the user perspective, the legal framework for processing sensitive data, design history, current status, and operations. Leonhard Med is an efficient, highly secure Trusted Research Environment for data processing, hosted at ETH Zurich and operated by the Scientific IT Services (SIS) of ETH. It provides a full stack of security controls that allow researchers to store, access, manage, and process sensitive data according to Swiss legislation and ETH Zurich Data Protection policies. In addition, Leonhard Med fulfills the BioMedIT Information Security Policies and is compatible with international data protection laws and therefore can be utilized within the scope of national and international collaboration research projects. Initially designed as a "bare-metal" High-Performance Computing (HPC) platform to achieve maximum performance, Leonhard Med was later re-designed as a virtualized, private cloud platform to offer more flexibility to its customers. Sensitive data can be analyzed in secure, segregated spaces called tenants. Technical and Organizational Measures (TOMs) are in place to assure the confidentiality, integrity, and availability of sensitive data. At the same time, Leonhard Med ensures broad access to cutting-edge research software, especially for the analysis of human -omics data and other personalized health applications.

Attenuated responses to attention-modulating drugs in the neuroligin-3R451C mouse model of autism.

Attention deficits are frequently reported within the clinical autism population. Despite not being a core diagnostic feature, some aetiological theories place atypical attention at the centre of autism development. Drugs used to treat attention dysfunction are therefore increasingly prescribed to autistic patients, though currently off-label with uncertain efficacy. We utilised a rodent-translated touchscreen test of sustained attention in mice carrying an autism-associated R451C mutation in the neuroligin-3 gene (Nlgn3R451C). In doing so, we replicated their cautious but accurate response profile and probed it using two widely prescribed attention-modulating drugs: methylphenidate (MPH) and atomoxetine (ATO). In wild-type mice, acute administration of MPH (3 mg/kg) promoted impulsive responding at the expense of accuracy, while ATO (3 mg/kg) broadly reduced impulsive responding. These drug effects were absent in Nlgn3R451C mice, other than a small reduction in blank touches to the screen following ATO administration. The absence of drug effects in Nlgn3R451C mice likely arises from their altered behavioural baseline and underlying neurobiology, highlighting caveats to the use of classic attention-modulating drugs across disorders and autism subsets. It further suggests that altered dopaminergic and/or norepinephrinergic systems may drive behavioural differences in the Nlgn3R451C mouse model of autism, supporting further targeted investigation.

Survey on caregiver competency and retraining needs.

OBJECTIVES: This study investigated caregivers' job image, abilities, and educational needs, which are rapidly increasing owing to an aging society. DESIGN: A self-administered written survey was conducted at 12 general hospitals in Korea from February 1, 2022 to March 15, 2023. SAMPLE: A total of 451 caregivers participated in the survey as subjects of analysis, and 560 nurses participated as external observers. MEASUREMENTS: The caregivers' self-assessment results regarding job performance, educational needs, and retraining needs were compared with those of external observers. RESULTS: Caregivers evaluated themselves significantly higher in all areas of job performance compared to the evaluations of external observers. In particular, the caregivers' self-evaluation of their abilities in "Recording and Reporting," "Basic Resuscitation," "Safety and Infection Control," and "Understanding Major Illnesses" was different from the evaluation of nurses. Both the caregivers and external observers agreed on the need for caregiver retraining, with 1-2 hours of supplementary training every 12 months being the most preferred amount of retraining. CONCLUSIONS: There was a significant difference between caregivers' self-evaluations of their capabilities and the external observers' evaluations. Therefore, systematic professional caregiver retraining is necessary.

Effects of Intermittent Hypoxia Protocols on Cognitive Performance and Brain Health in Older Adults Across Cognitive States: A Systematic Literature Review.

Background: The rise in the aging population highlights the need to address cognitive decline and neurodegenerative diseases. Intermittent hypoxia (IH) protocols show promise in enhancing cognitive abilities and brain health. Objective: This review evaluates IH protocols' benefits on cognition and brain health in older adults, regardless of cognitive status. Methods: A systematic search following PRISMA guidelines was conducted across four databases (PubMed, Scopus, Web of Science, and Cochrane Library) and two registers, covering records from inception to May 2024 (PROSPERO: CRD42023462177). Inclusion criteria were: 1) original research with quantitative details; 2) studies involving older adults, with or without cognitive impairment; 3) studies including IH protocols; 4) articles analyzing cognition and brain health in older adults. Results: Seven studies and five registered trials met the criteria. Findings indicate that Intermittent Hypoxia Training (IHT) and Intermittent Hypoxia-Hyperoxia Training (IHHT) improved cognitive functions and brain health. Intermittent Hypoxic Exposure (IHE) improved cerebral tissue oxygen saturation, middle cerebral arterial flow velocity, and cerebral vascular conductance, particularly in cognitively impaired populations. IHT and IHHT had no significant effect on BDNF levels. There is a lack of studies on IHHE in older adults with and without cognitive impairment. Conclusions: IH protocols may benefit cognition regardless of cognitive status. IHT and IHE positively affect cerebral outcomes, with all protocols having limited effects on BDNF levels. Future research should standardize IH protocols, investigate long-term cognitive effects, and explore neuroprotective biomarkers. Combining these protocols with physical exercise across diverse populations could refine interventions and guide targeted therapeutic strategies.

Overtime work and Chinese workers' physical and mental health: The mediating role of social support and work value awareness.

BACKGROUND: China was once called the world's factory. Chinese workers had long weekly working hours. However, the empirical results of the relationship between overtime work and workers' health are mixed and remain inconclusive. OBJECTIVE: This study aimed to investigate how overtime work influenced workers' physical and mental health and the role of lifestyles, social support, and work value awareness. METHODS: Data from the China Labor-force Dynamics Survey 2016 (N = 14,205) was used. The instrumental variable approach was employed to overcome the endogeneity problem between overtime work and workers' health. The bootstrapping method was conducted to elicit the role of lifestyles, social support, and work value awareness. RESULTS: The results indicated that overtime work significantly and negatively influenced Chinese workers' physical and mental health. The results of the bootstrapping suggested that workers' social support and work value awareness partially mediated the relationship between overtime work and their physical and mental health. However, the mediating role of lifestyles was insignificant. CONCLUSION: Through using big data with national representativeness, this study suggests that overtime work negatively influences Chinese workers' physical and mental health. Our findings provide policy implications for improving workers' health rights and well-being in emerging economies.

Development of a new accurate lateral flow immunoassay for diagnosis of human leptospirosis.

PURPOSE: The current diagnostic methods for leptospirosis diagnosis are technically complex and expensive, with limited applicability to specialized laboratories. Furthermore, they lack diagnostic accuracy in the acute stage of the disease, which coincides with a period when antibiotics are highly effective. New simple and accurate tests are mandatory to decentralize and improve diagnosis. Here, we introduced a new lateral flow immunoassay (Lepto-LF) for human leptospirosis. METHODS: We conducted a double-blinded assay using 104 serum samples from patients with confirmed or discarded diagnosis for leptospirosis. The diagnostic performance of Lepto-LF was estimated across different ranges of days from onset of symptoms (dpo), considering the diagnostic algorithm as reference standard. Additionally, it was compared with the screening methods enzyme-linked immunosorbent assay (IgM-ELISA) and the slide agglutination test using temperature-resistant antigen (SATR). RESULTS: Lepto-LF exhibited perfect diagnostic performance with a Youden´s index J = 1 from 6 dpo in the acute phase. IgM-ELISA gave slightly lower accuracy with J = 0.91 and 95.5% of both sensitivity and specificity; while SATR showed a markedly inferior yield (J = 0.41, sensitivity = 95.5%, specificity = 45.5%). The performances remained consistent in the convalescence phase of the disease (> 10 dpo). CONCLUSION: Lepto-LF was found to be a reliable test for simple, rapid and early diagnosis of leptospirosis, resulting a promising tool for decentralizing leptospirosis diagnosis and enabling timely treatment of patients. In addition, Lepto-LF may be employed as confirmatory test, especially in remote areas and vulnerable contexts where the standard MAT is not available.

Measuring Cognitive Impairments Associated With Schizophrenia in Clinical Practice: Overview of Current Challenges and Future Opportunities.

BACKGROUND: Cognitive impairment associated with schizophrenia (CIAS) negatively impacts daily functioning, quality of life, and recovery, yet effective pharmacotherapies and practical assessments for clinical practice are lacking. Despite the pivotal progress made with establishment of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) for clinical research, implementation of the full MCCB is too time-consuming and cost-ineffective for most clinicians in clinical practice. STUDY DESIGN: Here we discuss current assessments in relation to delivery format (interview-based and performance-based), validity, ease of use for clinicians and patients, reliability/reproducibility, cost-effectiveness, and suitability for clinical implementation. Key challenges and future opportunities for improving cognitive assessments are also presented. STUDY RESULTS: Current assessments that require 30 min to complete would have value in clinical settings, but the associated staff training and time required might preclude their application in most clinical settings. Initial profiling of cognitive deficits may require about 30 min to assist in the selection of evidence-based treatments; follow-up monitoring with brief assessments (10-15 min in duration) to detect treatment-related effects on global cognition may complement this approach. Guidance on validated brief cognitive tests for the strategic monitoring of treatment effects on CIAS is necessary. CONCLUSIONS: With increased advancements in technology-based and remote assessments, development of validated formats of remote and in-person assessment, and the necessary training models and infrastructure required for implementation, are likely to be of increasing clinical relevance for future clinical practice.

The intra- and interrater reliability of isometric muscle contractions using a novel fixation system for a hand-held dynamometer.

A novel fixation system for a hand-held dynamometer (HHD) was designed to enable isometric muscle measurements on various muscle groups of strong, healthy individuals in a field setting. The objective of this study was to evaluate the intra- and interrater reliability of the system and determine its suitability for use by multiple researchers within large-scale data collections during field activities. Four researchers tested eight healthy subjects, who each completed eight different maximal isometric muscle strength assessments using the HHD fixation system. Intraclass correlation coefficients (ICC) results were evaluated with a 95% confidence interval. ICC results for interrater reliability demonstrated excellent agreement of all eight measurements tested. ICC results for intrarater reliability demonstrated excellent agreement for six out of eight measurements. This system provides a new opportunity for several different high-quality maximal muscle strength measurements to be collected by multiple data collectors on large numbers of strong, healthy individuals in a field setting.

Differential performance on a motor task according to the preference for task-irrelevant elements that are chosen or assigned: A randomized controlled study.

This study explored the impact of choice and preference for what is chosen or assigned on performance on a motor task. Using an experimental design with a dart-throwing task, 90 novice participants were randomized into four groups: Choice-Like condition, Choice-Dislike condition, Assigned-Like condition, and Assigned-Dislike condition, resulting of the manipulation of choice (vs. assignation) of a task-irrelevant element and preference (irrelevant element: darts color and design). The study found that participants who were given the opportunity to choose their own dart for a throwing task performed better than those who were not given the choice. Participants who threw a dart they preferred also had better scores than those who threw a dart they did not like. However, the interactive effects of choice and preference on performance were inconclusive, and whereas being assigned with a disliked element was the worst condition for performance, and being allowed to choose preferred elements the most facilitatory one, nothing else can be concluded on the impact of both conditions alone or in combination. These results suggest that both choice and preference can positively impact performance in closed motor learning tasks and have practical applications for training and execution in athletic performance. Further investigations are warranted to delve into the interplay of choice and preference in diverse contexts and populations.

Simultaneous determination of total homocysteine, methionine, methylmalonic acid and 2-methylcitric acid in dried blood spots by ultra-performance liquid chromatography-tandem mass spectrometry.

Homocysteine, methionine, methylmalonic acid and 2-methylcitric acid are clinically relevant markers in the methionine, propionate, and cobalamin metabolism. This study aimed to develop and validate an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for simultaneously determining total homocysteine, methionine, methylmalonic acid and 2-methylcitric acid in dried blood spots. Three 3.2 mm discs were punched from each calibrator, quality control, and sample dried blood spot into a 96-well U-plate. Each sample was spiked with internal standards and extracted. Then the supernatant was transferred to another 96-well U-plate. After nitrogen drying, the dried residues were reconstituted, centrifuged, and the resulting supernatant was transferred to another 96-well plate for analysis. The method was performed using UPLC-MS/MS within 3 min, validated according to guidance documents, and applied to 72 samples from confirmed patients with methionine, propionate, and cobalamin metabolism disorders. The UPLC-MS/MS method provided satisfactory separation of the four analytes. The R2 values were ≥ 0.9937 for all analytes. The recoveries ranged from 94.17 to 114.29 %, and the coefficients of variation for intraday and interday precision were 0.19 % to 5.23 % and 1.02 % to 6.89 %, respectively. No significant carry-over was detected for the four analytes, and most of confirmed samples exhibited biomarker patterns characteristic of the relevant disorders. A simple and fast UPLC-MS/MS method was successfully developed, validated, and applied to clinical samples for the simultaneous determination of total homocysteine, methionine, methylmalonic acid, and 2-methylcitric acid in dried blood spots.

Optimal synchronization with L2-gain performance: An adaptive dynamic programming approach.

This paper studies an optimal synchronous control protocol design for nonlinear multi-agent systems under partially known dynamics and uncertain external disturbance. Under some mild assumptions, Hamilton-Jacobi-Isaacs equation is derived by the performance index function and system dynamics, which serves as an equivalent formulation. Distributed policy iteration adaptive dynamic programming is developed to obtain the numerical solution to the Hamilton-Jacobi-Isaacs equation. Three theoretical results are given about the proposed algorithm. First, the iterative variables is proved to converge to the solution to Hamilton-Jacobi-Isaacs equation. Second, the L2-gain performance of the closed loop system is achieved. As a special case, the origin of the nominal system is asymptotically stable. Third, the obtained control protocol constitutes an Nash equilibrium solution. Neural network-based implementation is designed following the main results. Finally, two numerical examples are provided to verify the effectiveness of the proposed method.

Lower physical activity levels in youth with Cystic Fibrosis compared to healthy controls: a multicentre comparative study.

BACKGROUND: Regular physical activity (PA) offers significant health benefits on both short (i.e., emotional well-being) and long term (i.e., fewer hospitalizations) in Youth with Cystic Fibrosis (YwCF). Regardless, evidence on PA levels in YwCF compared to healthy controls (HC) is inconsistent. Additionally, PA is a multidimensional outcome influenced by several factors such as Quadriceps strength and functional performance. Therefore, we aimed to assess whether PA, Quadriceps strength and functional performance differ between YwCF and HC across different age groups (i.e., children and adolescents). METHODS: YwCF aged 6-17 from two Belgian CF centres and age- and sex-matched HC were recruited. PA was measured with an ActiGraph GT3X+BT during 7 consecutive days. Isometric Quadriceps strength was assessed with a Hand Held Dynamometer and functional performance with a sit-to stand test (STS) and standing long jump (SLJ). RESULTS: A total of 49 YwCF (44% male; 11.3±3.3 years) and 49 HC (48% male; 11.9±3.5 years) were included. On average days, YwCF performed 4±6.4 minutes less light PA and 7.5±6.7 minutes less moderate-to-vigorous PA compared to HC (p=0.04; p=0.01). The differences in moderate-to-vigorous PA seem more pronounced in children (6-11 years)(p=0.04). Furthermore, YwCF had similar Quadriceps strength to HC but had lower scores on the STS and SLJ (p=0.50, p=0.08; p=0.02). CONCLUSIONS: This study shows lower PA levels and functional performance for YwCF, indicating that there is an urgent need for interventions promoting PA in YwCF. PA promotion will become increasingly important in the post modulator area to prevent health risks associated with low PA.

Sleep Characteristics, Magnetic Resonance Imaging- and Dual-Energy X-Ray Absorptiometry-Based Morphological Parameters, Muscle Strength, and Risk of Falls in Sedentary Older Subjects.

BACKGROUND: The aims of this cross-sectional study were to (a) assess actigraphy-based sleep parameters (total sample and gender differences), (b) assess differences in morphological parameters and physical function between short- versus normal-sleepers and poor- versus good-sleepers, and (c) assess the possible correlations between sleep variables and morphological and physical function parameters in older subjects. METHODS: This study enrolled 42 healthy older participants (60-80 years). Participants completed the following clinical evaluations: (1) whole-body dual-energy X-ray absorptiometry to assess the appendicular skeletal muscle mass index; (2) magnetic resonance imaging acquisition to determine the cross-sectional muscle area of thigh muscles and intermuscular adipose tissue; (3) risk of fall assessment through the mini-Balance Evaluation Systems Test; (4) strength assessment: (a) chair stand test and (b) handgrip strength test; (5) sleep monitoring by actigraphy to assess total sleep time, sleep efficiency, wake after sleep onset, sleep latency, fragmentation index, mobile time, and subjective sleep quality. RESULTS: 31.0% of subjects were short-sleepers (total sleep time < 6 hr), 19.1% were poor-sleepers (sleep efficiency < 85%), and gender differences were detected in mobile time (males: 15.8 ± 6.0 and females: 13.4 ± 6.8; p < .001) and fragmentation index (males: 35.3 ± 14.3 and females: 29.6 ± 14.6; p < .001); no significant differences were observed between groups (short- vs. normal-sleepers and poor- vs. good-sleepers) in morphological and physical function variables; correlation analysis showed that sleep latency negatively correlated with Mini-Balance Evaluation Systems Test (r = -.352; p = .022) and a positive correlation was detected between cross-sectional muscle area and mobile time (r = .349, p = .023). CONCLUSION: No differences were observed in morphological and function parameters between good- versus poor-sleepers, those subjects with worse sleep onset latency (i.e., longer time to fall asleep) registered higher for risk of fall. The potential role of sleep in the physiological mechanisms of muscular aging must be explored through cross-sectional cohort studies with a larger population.

Advances in Hemoglobinopathies and Thalassemia Evaluation.

Hemoglobin (Hb) disorders are among the most prevalent inherited diseases. Despite a limited number of involved genes, these conditions represent a broad clinical and prognostic spectrum. The menu of laboratory tests is extensive. From widely available modalities, for example, complete blood count to rather sophisticated molecular technologies, the investigation of Hb disorders recapitulates an increasing complexity of laboratory workup in other medical fields. This review highlights a current state of biochemical and molecular investigation of Hb disorders and offers a glimpse on technologies that are yet to be fully embraced in clinical practice.

Effects of Lactobacillus plantarum on Broiler Health: Integrated Microbial and Metabolomics Analysis.

Given China's prohibition on the utilization of antibiotics as feed additives in 2020, we aim to investigate nutrition additives that are both efficient and safe. Lactobacillus, a well-recognized beneficial probiotic, has explicitly been investigated for its effects on health status of the host and overall impact on food industry. To evaluate effects of Lactobacillus plantarum (LW) supplementation on broiler chicken, we conducted comprehensive multi-omics analysis, growth performance evaluation, RT-qPCR analysis, and immunofluorescence. The findings revealed that LW supplementation resulted in a substantial progress in growth performance (approximately 205 g increase in final body weight in comparison to the control group (p < 0.01)). Additionally, LW exhibited promising potential for enhancing antioxidant properties of serum and promoting gut integrity and growth as evidenced by improved antioxidant indices (p < 0.01), intestinal villus morphology (p < 0.01), and enhanced gut barrier function (p < 0.01). Meanwhile, the multi-omics analysis, including 16S rRNA sequencing and liquid chromatography-tandem mass spectrometry, revealed an enrichment of beneficial microbes in the gut of broilers that were supplemented with LW, while simultaneously depleting harmful microorganisms. Moreover, a noteworthy modification was observed in gut metabolic profiling subsequent to the execution of the probiotic strategy. Specifically, variations were noticed in the levels of metabolites and metabolic pathways such as parathyroid hormone synthesis, inflammatory mediator regulation of TRP channels, oxidative phosphorylation, and mineral absorption. Taken together, our findings validate that LW administration produces valuable effects on the health and growth performance of broilers owing to its capability to boost the gut microbiota homeostasis and intestinal metabolism. Present findings signify the potential of LW as a dietary additive to promote growth and development in broiler chickens.

Highly Sensitized Kidney Transplant Outcomes After the 2014 Kidney Allocation System Change.

Introduction: Kidney Allocation System (KAS) was implemented by United Network for Organ Sharing in 2014 to reduce allocation disparities. Research Questions: Outcomes of highly sensitized patients (calculated panel reactive antibody (cPRA) ≥ 97%) before and after KAS were compared to low-risk recipients (cPRA <10%) in the post-KAS era were examined. The impact on racial disparities was determined. Design: This was a retrospective study of national registry data. Two cohorts of adult candidates waitlisted for deceased donor transplantation during 3-year periods before and after KAS were identified. Results: Highly sensitized patients (N = 1238 and 4687) received a deceased donor kidney transplant between January 1, 2011 and December 31, 2013 and between January 1, 2015 and December, 31, 2017. Racial disparity for highly sensitized patients improved, yet remained significant (P < 0.001), with Black patients comprising 40% and 41% of the highly sensitized candidates and 28% and 34% of the recipients pre- and post-KAS. While posttransplant death-censored graft failure for highly sensitized recipients was similar overall, post-KAS was associated with improved graft survival in the first year after transplant (HR 0.56, 95% CI 0.40-0.78). When compared to contemporaneous lowrisk recipients, both death-censored and all-cause graft failure were similar for highly sensitized recipients and was associated with increased risk for death-censored graft failure beyond the first year (HR 1.39, 95% CI 1.11-1.73). Conclusion: The allocation system led to an increase in transplantation in highly sensitized candidates without compromising outcomes. Although KAS has led to more balanced transplant rates between highly sensitized Black and White patients, racial inequalities persist.