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Older candidates for kidney transplantation:Who to refer and what to expect?

World Journal of Transplantation 2016年第4期6卷 650-657页

作者： Beatrice P Concepcion Rachel C Forbes heidi m schaefer Department of medicine Division of Nephrology and Hypertension Vanderbilt University Medical Center Division of Kidney and Pancreas Transplantation Vanderbilt University Medical Center

The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. Transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systemsbased medical evaluation with particular focus given to cardiovascular health. more recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new Kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.

关键词： Kidney transplant outcomes Frailty Elderly Expanded criteria donor Quality of life

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Effects of temperature and hydric environment on survival of the Panamanian Golden Frog infected with a pathogenic chytrid fungus

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Integrative Zoology 2010年第2期5卷 143-153页

作者： heidi m.BUSTAmANTE Lauren J.LIVO Cynthia CAREY Department of Integrative Physiology University of ColoradoBoulderColoradoUSA

Considerable controversy exists concerning whether or not climate changes(particularly global warming)are causing outbreaks of a lethal amphibian pathogen,the chytrid fungus Batrachochytrium dendrobatidis(Longcore,Pessier&*** 1999).In the present study,groups of Panamanian golden frogs(Atelopus zeteki Dunn,1993),a critically endangered amphibian thought to be nearly extinct in Panama,were exposed to varying dosages of zoospores of Batrachochytrium dendrobatidis,temperatures and hydric environments in order to learn whether this species is susceptible to this pathogen and,if so,how environmental factors affect *** pathogen proved to be highly lethal for *** exposed to a dosage of 100 Bd zoospores survived significantly(Pmate change and the decline of these frogs in the field,but they inform the discussion about how environmental conditions can have an impact on the interaction between a susceptible amphibian and this *** data do not support the contention that rising global temperatures are necessary to cause the death of amphibians infected with this pathogen because the pathogen was equally lethal at 17 as at 23℃,and frogs at the warmer temperature lived significantly longer than those at the cooler one.

关键词： amphibian declines Atelopus zeteki Batrachochytrium dendrobatidis chytridiomycosis climatelinked-epidemic hypothesis

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Applied and Environmental Chemistry of Animal manure:A Review

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Pedosphere 2016年第6期26卷 779-816页

作者： Zhongqi HE Paulo H.PAGLIARI heidi m.WALDRIP USDA-ARS Southern Regional Research Center Department of Soil Waterand ClimateUniversity of MinnesotaSouthwest Research and Outreach Center USDA-ARS Conservation and Production Research Laboratory

Animal manure consists of predominantly urine and feces, but also may contain bedding materials, dropped feed, scurf, and other farming wastes. manure is typically applied to soils as fertilizer for agricultural production. The estimated amount of manure produced in 12 major livestock-producing countries is 9 × 10^9 mg of manure annually. manure is rich in plant nutrients. However, manure is also considered as an environmental pollutant when it is over-applied to cropland or following runoff into surface water. manure can also influence global climate change via emissions of methane （CH4） and nitrous oxide （N2O）. Thus, increased and updated knowledge of applied and environmental chemistry of animal manure is needed to shed light on the research and development of animal manure utilization and minimization of its adverse environmental concerns. The advances in basic and applied studies of manure major components, organic matter, phosphorus, and nitrogen, primarily related to US livestock production are summarized in this review. Detailed focus was placed on three notable challenges for future manure research： 1） soil application of animal manure, 2） manure phytate phosphorus, and 3） manure nitrogen availability. This review may contribute to the global effort in sustainable and environmentally sound agriculture by stimulating new ideas and directions in animal manure research, and promoting application of knowledge and insight derived from manure research into improved manure management strategies.

关键词： environmental pollutant fertilizer nitrogen availability organic matter phosphorus phytate plant nutrients

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Population differentiation at a regional scale in spadefoot toads： contributions of distance and divergent selective environments

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Current Zoology 2016年第2期62卷 193-206页

作者： Amber m. RICE michael A. mCQUILLAN heidi A. SEEARS Joanna A. WARREN Department of Biological Sciences Lehigh University BethLehem PA 18015 USA

The causes of population differentiation can provide insight into the origins of early barriers to gene flow. Two key drivers of population differentiation are geographic distance and local adaptation to divergent selective environments. When reproductive isolation arises because some populations of a species are under selection to avoid hybridization while others are not, population differentiation and even speciation can result. Spadefoot toad populations Spea multiplicata that are sympatric with a congener have undergone reinforcement. This reinforcement has resulted not only in increased reproductive isolation from the congener, but also in the evolution of reproductive isolation from nearby and distant conspecific allopatric populations. We used multiple approaches to evaluate the contributions of geographic distance and divergent selective environments to population structure across this regional scale in S. multiplicata, based on genotypes from six nuclear microsatellite markers. We compared groups of populations varying in both geographic location and in the presence of a congener. Hierarchical F-statistics and results from cluster analyses and discriminant analyses of principal components all indicate that geographic distance is the stronger contributor to genetic differentiation among S. multiplicata populations at a regional scale. However, we found evidence that adaptation to divergent selective environments also contributes to population structure. Our findings highlight how variation in the balance of evolutionary forces acting across a species＇ range can lead to variation in the relative contributions of geographic distance and local adaptation to population differentiation across different spatial scales.

关键词： cascade reinforcement character displacement reproductive isolation spatial scale Spea multipficata speciation

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Tuberculosis in kidney transplant recipients:A case series

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World Journal of Transplantation 2017年第3期7卷 213-221页

作者： manish Anand Ekta Nayyar Beatrice Concepcion megha Salani heidi schaefer Department of medicine Division of NephrologyUniversity of Cincinnati Trihealth Infectious Disease Good Samaritan Hospital De-partment of medicine Division of NephrologyVanderbilt University

Solid organ transplant recipients have an elevated risk of tuberculosis(TB) with high mortality. Data about TB in this population in the United States is sparse. We present four cases of active tuberculosis in kidney transplant recipients at our center. All patients had possible TB exposure prior to transplant and all were diagnosed with active TB within the first year of transplant. Disseminated TB was seen in half of the patients with extra-pulmonary TB being more common affecting lymph nodes, pericardium, and the kidney allograft. Delay in diagnosis from onset of symptoms ranged from fifteen days to two months. Two patients died from TB. TB is a largely preventable and curable disease. However, challenges remain in the diagnosis due to most recipients presenting with atypical symptoms. Physicians should maintain a high degree of suspicion for TB to promptly diagnose and treat posttransplant thereby minimizing complications. A review of the literature including the epidemiology, pathogenesis, clinical presentation, diagnosis and treatment options are discussed.

关键词： mycobacterium tuberculosis Kidney transplant Disseminated disease Tuberculosis

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Improved source assessment of Si,Al and related mineral components to Pm_(10) based on a daily sampling procedure

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Journal of Environmental Sciences 2010年第4期22卷 582-588页

作者： Ge Peng Hans Puxbaum heidi Bauer Nicole Jankowski Yao Shi Chemical Engineering College Ningbo University of Technology Ningbo 315016 China. Institute for Chemical Technologies and Analytics Vienna University of Technology Vienna 1060 Austria College of Environmental and Resource Sciences Zhejiang University Hangzhou 310027 China

Samples obtained from an industrialized valley in the East Alpine region were collected daily for a half year and analyzed using X-ray fluorescence to examine the elements Si, Al, Fe, Ca, mg, Na, K, Zn, P, S and Cl. Some factors affecting the changes of these elements were considered, including time, elemental correlations, weekday, weekend and seasonal changes. Diagnostic analysis provided an insight into a decoupling behavior that occursin siliceous and carbonates minerals. A decrease in Si and Al and an increase in carbonates, Na, K, Zn and P were observed during the cold season. However, a consistently high correlation of Si and Al was observed in all seasons. It was established that such high levels originated from street surface abrasion. The increase in variability and absolute levels of carbonates during the cold season was demonstrated by adding carbonates to the street surface as gritting material to increase the grip on snowy surfaces. A marked increase in Na and Cl was observed in winter which may have been caused by thaw salt that is widely used in winter in Austria. This was associated with a significant increase in K, Zn, and P in the cold season that was the result of domestic space heating with wood. Pm10 levels in December were 12 μ/m^3 and were higher than levels detected in July. It was established that such high levels originated from mineral oxides, wood smoke, and inorganic ionic material（s）.

关键词： particulate matter Pm10 mineral aerosol silicates carbonates street dust wood combustion thaw salt

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mental Illness Education through Stories of Lived Experience: Validation Review of the DoNOHarm Framework

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International Journal of mental Health Promotion 2021年第4期23卷 455-469页

作者： Debra Rickwood Kerry Thomas Patricia m.Brown heidi Prowse Faculty of Health University of CanberraCanberra2600Australia mental Illness Education ACT Canberra2601Australia

The lived experience of people with mental illness is a powerful way to promote mental health literacy and reduce the stigma associated with mental ***,there is little guidance on how to do this *** Illness Education ACT is an Australian organisation that since 1993 has supported volunteer educators to share their individual stories of lived experience to school and community *** 2011,they developed the DoNOHarm Framework to assist volunteers to be able to talk about their experiences in a way that is safe for them and for their audience,a gap that they recognised in *** study reports a review of the Framework,considering the extent to which it is supported by the current literature and how it is being implemented and experienced by the volunteer *** research questions were addressed by a literature review and interviews with 14 volunteer educators and the staff that support *** review of published literature over the past 10 years showed strong evidence for three of the six principles of the Framework:Context and Purpose,Recovery Emphasis,and Safe *** the principle of Respectful and Inclusive Language is widely promoted in the mental healthfield,no recent studies investigated the benefits of this ***,there was no recent research into the two principles of Limits to Helping and Self *** interviews revealed strong support for the Frame-work among *** was seen to be effective to protect the safety of both presenter and audience,ensure the relevance of the presentation,give educators confidence in their message and delivery,convey a hopeful message,and make certain that presentations were engaging for the ***,this review shows that the DoNO-Harm Frameworkfills an important gap for mental health education,with a sound evidence base where there is published evidence available.

关键词： mental illness education lived experience storytelling harm safety framework

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Echocardiography in centenarians： characteristics, utility and follow-up

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Journal of Geriatric Cardiology 2018年第5期15卷 328-333页

作者： Jorge A Brenes-Salazar Jaime de la Fuente Punnaiah marella Hari Chaliki Christopher Scott heidi m Connolly Roger L Click Department of Cardiovascular Diseases Mayo Clinic Rochester USA Department of Internal medicine Mayo Clinic Rochester USA Department of Cardiovascular Diseases Mayo Clinic Arizona USA Division of Biostatistics Mayo Clinic Rochester USA

Background Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocar- diography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. methods A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. Results 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years （101 - 1.4 years）. In 82 of the centenarians evaluated （72%）, no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% （n = 26） of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% （n = 5） of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure （P = 0.02）. After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months （range 0.03 to 145 months）, with no difference if there was a change or no change in manage- ment （P = 0.21）. Conclusions Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardio- grams in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic ass

关键词： Centenarian Echocardiography Geriatric

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Dietary mitigation of enteric methane emissions from ruminants:A review of plant tannin mitigation options

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Animal Nutrition 2020年第3期6卷 231-246页

作者： Byeng R.min Sandra Solaiman heidi m.Waldrip David Parker Richard W.Todd David Brauer United States Department of Agriculture(USDA) Agricultural Research Service(ARS)BushlandTX79012USA Tuskegee University TuskegeeAL36088USA

methane gas from livestock production activities is a significant source of greenhouse gas(GHG)emissions which have been shown to influence climate *** technologies offer a potential to manipulate the rumen biome through genetic selection reducing CH4 *** production may also be mitigated to varying degrees by various dietary intervention *** to reduce GHG emissions need to be developed which increase ruminant production efficiency whereas reducing production of CH4 from cattle,sheep,and *** emissions may be efficiently mitigated by manipulation of natural ruminal microbiota with various dietary interventions and animal production efficiency *** some CH4 abatement strategies have shown efficacy in vivo,more research is required to make any of these approaches pertinent to modern animal production *** objective of this review is to explain how anti-methanogenic compounds(e.g.,plant tannins)affect ruminal microbiota,reduce CH4 emission,and the effects on host ***,this review provides information relevant to understanding the impact of tannins on methanogenesis,which may provide a cost-effective means to reduce enteric CH4 production and the influence of ruminant animals on global GHG emissions.

关键词： Feed efficiency Greenhouse gas(GHG)emission methanogenesis Tannin Ruminant

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Treatment of refractory diabetic macular edema with a fluocinolone acetonide implant in vitrectomized and non-vitrectomized eyes

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International Journal of Ophthalmology(English edition) 2018年第12期11卷 1951-1956页

作者： Alberto La mantia Alan Hawrami heidi Laviers Sudeshna Patra Hadi Zambarakji Eye Treatment Centre Whipps Cross University Hospital Barts Health National Health System Foundation Trust

AIm: To report real-life data on the use of an intravitreal fluocinolone acetonide implant in the treatment of refractory diabetic macular edema(DmE) in pars plana vitrectomized(PPV) and non-PPV ***: This was a comparative retrospective observational study of 23 eyes with chronic DmE. Bestcorrected visual acuity(BCVA) and central macular thickness(CmT) were recorded at baseline, 1, 4 and 12 mo. Descriptive statistics and non-parametric tests were performed to analyze and compare PPV and non-PPV eyes. RESULTS: Seven PPV and 16 non-PPV eyes were included in the study. median BCVA in the non-PPV group varied from 0.65 logmAR [Interquartile range(IQR): 0.40] at baseline to 0.42 logmAR(IQR: 0.40) at 12 mo. median CmT varied from 430 μm(IQR: 131.3) at baseline to 317 μm(IQR: 107.5) at 12 mo. median BCVA in the PPV group varied from 0.60 logmAR(IQR: 0.62) at baseline to 0.74 logmAR(IQR: 0.34) at 12 mo. median CmT varied from 483 μm(IQR: 146) at baseline to 397 μm(IQR: 132) at 12 mo. Of 0/7 eyes and 1/16 eyes in the PPV and non-PPV eyes respectively had a baseline visual acuity of 6/12 or better(0.3 logmAR). At last follow up, 1/7 and 5/16 eyes in the PPV and non-PPV group respectively achieved a visual acuity of 6/12 or ***: Visual outcomes are modest following the use of the fluocinolone acetonide implant for chronic DmE. The steroid implant is a useful treatment option in the management of refractory DmE in vitrectomized and non-vitrectmized eyes.

关键词： diabetic macular edema fluocinolone acetonide intravitreal implant steroid vitrectomy

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