Gender Mismatch Research Articles

Brain potentials reveal differential processing of masculine and feminine grammatical gender in native Spanish speakers.

Studies of Spanish grammatical gender have shown that native speakers exploit gender cues in determiners to facilitate speech processing and are sensitive to gender mismatches. However, past research has not considered attested distributional asymmetries between masculine and feminine gender, collapsing performance on trials with one or the other gender into a single analysis. We use event-related potentials to investigate whether masculine and feminine grammatical gender elicit qualitatively different brain responses. Forty monolingual Spanish speakers read sentences that were well-formed or contained determiner-noun gender violations. Half of the nouns were masculine and the other half were feminine. Consistent with previous research, brain responses varied along a continuum between LAN- and P600-dominant effects for both gender categories. However, results showed that individuals' ERP response dominance (LAN/P600) systematically differed across the two genders: participants who showed a LAN-dominant response to masculine-noun violations were more likely to show a P600 effect in response to feminine-noun violations. Correlations with individual difference measures further revealed that responses to masculine-noun violations were modulated by performance on the AX-CPT, a measure of cognitive control, whereas responses to feminine-noun violations were modulated by lexical knowledge, as indexed by verbal fluency. Together, the results demonstrate that even when processing features of language that belong to the same "natural class," native speakers can exhibit patterns of brain activity attuned to distributional patterns of language use. The inherent variability in native speaker processing is, therefore, an important factor when explaining purported deviations from the "native norm" reported in other types of populations.

Cytomegalovirus Reactivation in Hematopoietic Stem Cell Transplant Recipients in High Endemic Population

Background: Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). It causes end-organ disease, multi-organ dysfunction syndrome, graft failure, increased susceptibility to infections and GVHD. According to the published western data greatest risk of CMV infection is the seropositivity of the recipient, however, in a high endemic population where seropositivity is up to 100%, risk factors for CMV reactivation are different and are analyzed in this study. Methods: It is a prospective descriptive study performed at Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan from January 2017 to March 2020. Consecutive patients who underwent allogeneic HSCT during this period were enrolled. All patients were prospectively monitored for CMV reactivation by weekly or two weekly CMV DNA quantitative PCR, from engraftment till day 100 post-transplant. CMV infection was diagnosed on detection of more than 200 copies/ml on PCR. Threshold for starting preemptive antiviral therapy was kept at 2000 copies/ml. Patients with past history of CMV infection, those who expired before day 14 post-transplant or those with less than 70% of required CMV tests were not included in the study. Factors associated with CMV reactivation, outcome of antiviral therapy and effect of CMV on post-transplant survival were studied. Results: Out of 319 transplants during this period, 230 patients fulfilled the inclusion criteria. Of these, 197 were HLA matched sibling, 18 were matched family donor and 15 were haploidentical transplants. There were 163 males and 67 females. Median age at transplant was 9.5 years (0.5-53). Eighty-three transplants were done in thalassemia, 55 in aplastic anemia, 14 in Fanconi anemia, 27 in acute leukemias, 8 in CML, 9 in MDS, 12 in HLH and 22 in other hematological disorders. All the patients and donor were CMV IgG seropositive when tested before transplantation. CMV reactivation was seen in 152 out of 230 patients (66.1%). Of 152, 95 patients had CMV viral load more than 2000 copies/ml and required antiviral treatment. Median time to reactivation since transplant was 35 days (13-90). In multivariate analysis using binary regression, risk factors for high viral load CMV reactivation included steroid administration (p=0.009), recipient age less than 10 years (p=0.003) and haploidentical transplant (p=0.048). No statistically significant association was found with the use of ATG, GVHD, underlying disease, ABO blood group or gender mismatch. Survival analysis using cox regression showed significant impact of high viral load CMV reactivation on post-transplant survival. Event-free survival (EFS) with and without CMV reactivation was 70.5 % and 89.7% respectively (p=0.004) and overall survival (OS) was 80.0 % and 97.4 % with and without CMV reactivation respectively (p=0.002). Valganciclovir was given in 89 patients and 6patients were treated with ganciclovir. Mean time to clear viremia was 19.8±9 days. Myelosuppression was seen in 41% of patients treated with valganciclovir. Renal impairment was seen in 25% of patients treated with valganciclovir. One patient had resistant disease. One patient had CMV pneumonia and she recovered. One patient died of suspected CMV pneumonia Conclusion: CMV reactivation was seen in 66.1% of the transplant recipients, this is higher compared to the western world due to high CMV seropositivity is this region. Steroids administration in post-transplant period significantly increase the risk of CMV reactivation. Preemptive therapy with valganciclovir effectively treats CMV reactivation. Viral threshold for treatment should be decided considering the regional endemicity. CMV adversely effects the transplant outcome in terms of EFS and OS. Disclosures No relevant conflicts of interest to declare.

Female Gender Is Associated with Improved Long-Term Survival Following Allogeneic Hematopoietic Stem Cell Transplant

Introduction: Life expectancy for long-term survivors of allogeneic hematopoietic stem cell transplant (allo-HCT) is significantly lower compared to that of the age-matched general population, despite a relatively low primary disease relapse rate >2 years post-transplant. Long-term transplant-related complications instead account for most mortality in this patient population. These include chronic graft-versus-host disease (cGVHD), infection, organ failure, and secondary cancers. In addition, gender is emerging as a critical determinant of outcome in the immediate post-transplant setting. However, less is known regarding gender effects on outcomes of long-term survivors. We retrospectively investigated the impact of recipient gender and donor-recipient gender mismatch on outcomes of long-term survivors of allo-HCT. Methods: We performed a retrospective analysis using Duke University's Adult Blood and Marrow Transplant database, supplemented by individual patient chart review. Inclusion criteria consisted of long-term survivors of first allo-HCT, excluding syngeneic, between 1995 - 2015 for a hematologic malignancy. A long-term survivor is defined as having been alive with documented follow-up to at least five years following allo-HCT. Patient characteristics were summarized as count (%) for categorical variables and median (interquartile range) for continuous variables. Fisher's exact tests or t-tests were used to compare difference between groups. Overall survival was estimated using the Kaplan-Meier method and multivariable Cox proportional hazard model. Patients who had received cord blood allograft were excluded from donor-recipient gender survival analyses. SAS version 9.4 (SAS Institute, Cary, NC) and R 3.5.0 were used to perform statistical analyses. Results: Over this 20-year period, 1103 patients underwent allo-HCT, with 247 (22%) meeting inclusion criteria. Of these 247, males and females had similar demographic and treatment characteristics (Table 1). However, significantly more deaths after the 5-year landmark occurred in male recipients (Figure 1, p value=0.003). To estimate whether this was due to the general population-wide shorter life expectancy for males, we performed Kaplan-Meier estimates of survival for patients aged < 50 years at transplant and aged ≥ 50 years at transplant, with similar results for both groups (Figure 2, p value=0.006). Interestingly, donor gender did not have a significant impact on overall survival in multivariate analysis (Table 2), and differences in overall survival of donor-recipient gender pairs was driven by patient gender (Figure 3, p value =0.007). A separate multivariate analysis of interaction between donor-recipient gender pairs further demonstrated that significant differences in overall survival were due to patient gender (Table 3). In addition to patient gender, only cGVHD retained significance as a covariate with impact on overall survival in multivariate analysis (Table 2, Table 3). Men experienced slightly higher rates and increased severity of cGVHD, and a greater percentage of cGVHD-related mortality as compared to females, though these findings were not statistically significant (Table 1). Conclusion: In this long-term survival analysis of allo-HCT adult patients, one of the only to include follow-up to 15 years, our results show that women survive significantly longer than men irrespective of their age at transplant. This outcome is independent of other common pre-transplant prognostic indicators such as donor gender or performance status at transplant. Inferior survival for males is consistent with survival outcomes described in another large and fully risk annotated HCT cohort, and in solid organ transplants such as lung and kidney. Gathering evidence suggests a biologic basis for long-term gender-determined outcomes, possibly due to differing rates or severity of cGVHD or sustained alloimmune tolerance in females. Male patients should be counseled on their possible increased long-term risk. Prospective and larger studies are warranted to validate these retrospective clinical results. Disclosures Rizzieri: Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Jazz: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Stemline: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Kite: Honoraria, Speakers Bureau; Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; abbvie: Membership on an entity's Board of Directors or advisory committees; AROG: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Celltrion: Membership on an entity's Board of Directors or advisory committees; Mustang: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees; Teva: Membership on an entity's Board of Directors or advisory committees; Acrobiotech: Membership on an entity's Board of Directors or advisory committees.

Abusive Supervision in Agencies: The Role of Gender in Reporting and Complaint Success

ABSTRACT Even though studies often examine supervisory acts of non-physical aggression (i.e., abusive supervision) towards subordinates, most examine either the antecedents or the adverse outcomes of abusive supervision. Similar to physical and sexual abuse, many organizations, especially in the public sector, have a process in place to handle abusive supervision. Yet research has largely ignored what happens during this process. More specifically, no studies were found to examine subordinate reporting of abusive supervision (i.e., non-violent behaviors that are non-sexual) and whether complainants were effective. Furthermore, scholars recently called for aggression research to examine the role gender plays in this process. The present study seeks to fill this lacuna in the literature, by investigating the impact of gender in reporting abusive supervision and complaint success. After examining Merit Principles Survey Path 1, several interesting findings emerged. First, the gender of the subordinate and the hierarchical aggressor were found to impact reporting decisions. Gender dissimilarity (i.e., the gender mismatch between the subordinate and the manager) did not seem to affect reporting decisions. Next, the gender of the subordinate was found to affect complaint success, while the gender of the hierarchical aggressor did not. Nevertheless, gender dissimilarity did affect complaint success. The implications of the findings are thoroughly discussed in the article.

Production of third-person direct object clitics in children with cochlear implants speaking Italian

ABSTRACT Previous research has shown that the production of third-person singular accusative object clitics (3DO clitics) might be taxing in Italian-speaking pre-school children with cochlear implants (CIs). We investigated this topic by assessing 3DO clitic production in 14 children with an average age of 8 years, who had received CI between age 1 and 4. The first goal of the study was to analyze whether school-aged children with CIs exhibit atypical behavior in 3DO clitic production. The second goal was to analyze whether children with CIs are prone to agreement errors in case of gender mismatch between the subject and the 3DO clitic, as has been shown for normal-hearing, typically developing children. To achieve this, we used two tasks in which subject and object clitic grammatical genders were manipulated so that they would or would not match. As for the first goal, the majority of children with CIs had good performance on the clitic tasks. However, some participants’ performance was poor. The pattern of deviant responses differed among the poor performers. We believe that children with CIs showing impairments in 3DO clitic production need careful individual analysis in order to plan effective speech therapy. As for the second goal, children with CIs were more prone to agreement errors in the mismatch condition compared to the match condition; this dimension needs to be considered when assessing and eventually rehabilitating clitic production.

The Relationship Between Provider Gender Preferences and Perceptions of Providers Among Veterans Who Experienced Military Sexual Trauma.

Previous research has demonstrated that most veterans who have experienced military sexual trauma (MST) have provider gender preferences. Although provider gender mismatch, defined as not receiving a provider of the gender of one's preference, may deter veterans from disclosing MST or seeking MST-related care, there is little research that has examined this issue. The current study aimed to explore how provider gender mismatch is related to veterans' comfort with providers, perception of their providers' competency, and their endorsement of perceived provider barriers when communicating about MST. The current study was conducted as part of a larger national survey of veterans' barriers to accessing MST-related care. Participants in the study were identified using Veterans Health Administration (VHA) administrative data. Criteria for inclusion in the overall study were being enrolled in VHA health care, having screened positive for MST, and having received at least one VHA outpatient service. A subset of eligible veterans who had endorsed MST, reported a provider gender preference, and endorsed discussing MST with a VHA provider (N = 1,591) were included in the current study. Results demonstrated that provider gender preference mismatch was associated with greater endorsement of perceived provider barriers, less comfort with providers, and lower perceived provider competency in women; and greater perceived provider barriers and less comfort with providers among men. The study demonstrates that provider gender preferences may affect care for veterans who have experienced MST, and that the impact may differ for men and women. These findings may be used to improve patient-centered care and inform future research regarding veterans' provider gender preferences.

A Retrospective Propensity Score Matched Analysis Reveals Superiority of Hypothermic Machine Perfusion over Static Cold Storage in Deceased Donor Kidney Transplantation.

Hypothermic machine perfusion (HMP) has been introduced as an alternative to static cold storage (SCS) in kidney transplantation, but its true benefit in the clinical routine remains incompletely understood. The aim of this study was to assess the effect of HMP vs. SCS in kidney transplantation. All kidney transplants performed between 08/2015 and 12/2019 (n = 347) were propensity score (PS) matched for cold ischemia time (CIT), extended criteria donor (ECD), gender mismatch, cytomegalovirus (CMV) mismatch, re-transplantation and Eurotransplant (ET) senior program. A total of 103 HMP and 103 SCS instances fitted the matching criteria. Prior to PS matching, the CIT was longer in the HMP group (17.5 h vs. 13.3 h; p < 0.001), while the delayed graft function (DGF) rates were 29.8% and 32.3% in HMP and SCS, respectively. In the PS matched groups, the DGF rate was 64.1% in SCS vs. 31.1% following HMP: equivalent to a 51.5% reduction of the DGF rate (OR 0.485, 95% CI 0.318–0.740). DGF was associated with decreased 1- and 3-year graft survival (100% and 96.3% vs. 90.8% and 86.7%, p = 0.001 and p = 0.008) or a 4.1-fold increased risk of graft failure (HR = 4.108; 95% CI: 1.336–12.631; p = 0.014). HMP significantly reduces DGF in kidney transplantation. DGF remains a strong predictor of graft survival.

A corpus study of child heritage speakers’ Spanish gender agreement

Objectives:This study investigates (a) whether child heritage speakers produce more gender mismatches in Spanish ( un piedra “a-masc. stone-fem.”) than monolingual children, (b) whether older child heritage speakers mismatch more than younger ones, and (c) linguistic contexts in which mismatches occur.Methodology:3893 agreement forms were extracted from corpora of Spanish spoken by six monolingual children, ages 5–6 years, and three groups of US child heritage speakers: ten 5–6-year-olds, fifteen 7–8-year-olds, and twenty-one 9–11-year-olds.Data and analysis:Logistic regressions measured the impact of agreement form type, noun gender, noncanonical noun ending, and noun frequency on gender matching. One regression included 5–6-year-olds only (monolingual and heritage); the second included child heritage speakers only (5–11-year-olds).Findings:There were no significant differences between monolingual and heritage 5–6-year-olds; for these children, adjectives, direct object clitics, noncanonical nouns, and feminine nouns increased the likelihood of mismatches. Among the 5–11-year-old heritage speakers, direct object clitics referring to feminine nouns and noncanonical nouns increased the likelihood of mismatches. The 9–11-year-olds produced more gender mismatches referring to feminine nouns than the younger child heritage speakers, especially with direct object clitics.Originality:This corpus study provides evidence for high rates of gender matching and clarifies the contexts that increase the likelihood that children will mismatch.Implications:Gender matching remains an intact part of child heritage speakers’ Spanish grammars. The distribution of mismatches found provides evidence of a strong article–noun association and a weaker noun–direct object clitic association. The oldest child heritage speakers’ use of masculine clitic lo to refer to feminine nouns may reflect an association between English “it” and Spanish lo. More generally, the finding that mismatches tend to involve masculine forms referring to feminine nouns supports the idea that masculine is the default, unmarked form in Spanish.

Perceived Gender Match and Accepting Alcohol Offers From Peers in Emerging Adulthood.

Emerging adulthood (ages 18-25) has been associated with elevated alcohol use, yet little is known regarding gender identity and drinking contexts in this population. Our goals were to examine the effects of perceived gender match on alcohol use decision-making in social settings among emerging adults. Participants (N=135; 64% white, 11 transgender) completed measures of alcohol consumption, alcohol expectancies and motives, and the Collegiate-Simulated Intoxication Digital Elicitation using an established Internet panel. We conducted a series of univariate analyses to examine the relation between perceived gender match and behavioral willingness (BW) to accept alcohol in a social context. Participants identifying as men were significantly more likely to accept offers of alcohol when compared with women. While men and women did not differ in terms of BW when participants perceived a gender-matched actor making the offer, when there was a gender mismatch, women had significantly lower BW when compared with men. Though transgender participants were more likely to endorse hazardous drinking behaviors, there were no observable effects of transgender identity on BW. In this sample, we found that men have a higher BW for alcohol than women and that trans identified persons are at increased risk for alcohol misuse. These findings support the need for more research examining the effect of gender identity on patterns of alcohol use and decision-making in mixed-gender contexts for emerging adults.

Influence of donor and recipient gender on liver transplantation outcomes in Europe.

The impact of gender and donor/recipient gender mismatch on LT outcomes is controversial. The aim of this study was to compare outcomes of LT in Europe, using the ELTR database, between male and female recipients, including donor/recipient gender mismatch. Recipient, donor and transplant characteristics were compared between male and female patients. Patient survival was compared between groups, and the impact of donor/recipient gender matching as well as donor and recipient anthropometric characteristics were evaluated as potential risk factors for post-LT death/graft loss. A total of 46,334 LT patients were evaluated (70.5% men and 29.5% women). Ten-year survival rate was significantly higher in female than in male recipients (66% vs 59%, P<.0001). At multivariate analysis, adjusted for indication to LT and type of graft, donor/recipient gender mismatch (HR 1.12, 95% CI 1.04-1.2; P=.003), donor age>60years (HR 1.09, 95% CI 1.01-1.18; P=.027) and recipient age (HR 1.02, 95% CI 1.1-1.02; P<.0001) were significantly associated with post-LT lower survival rate in men. Conversely in female recipients, donor BMI>30 (HR 1.32, 95% CI 1.09-1.6; P=.005), donor age>60years (HR 1.15, 95% CI 1.01-1.32; P=.027) and recipient age (HR 1.02, 95% CI 1.01-1.02; P<.0001) were significantly associated with lower post-LT survival rate. Donor/recipient gender mismatch in male recipients and the use of obese donor in female recipients are associated with reduced survival after LT. Therefore, the incorporation of donor and recipient anthropometric quantities in the allocation process should be a matter of further studies, as their matching can significantly influence long-term outcomes.

4364 Ethicists’ Viewpoints on Face Transplant: A survey study to guide clinical practice

OBJECTIVES/GOALS: Face transplant can offer functional and aesthetic restoration to patients who have exhausted reconstructive options. Ethical issues in face transplant still abound, including that of patient selection. The goal of this study was to assess ethicists’ viewpoints on face transplant. METHODS/STUDY POPULATION: A large-scale online survey of attendees of the International Conference on Clinical Ethics Consultation (N = 401) was performed to assess ethicists’ opinions on issues in face transplant. Questions were asked regarding the risk-benefit ratio of immunosuppression, permissibility of face transplant for more recipient subpopulations (including children and blind patients), donor-recipient age, gender, and ethnicity mismatches, and ethics committee make-up. RESULTS/ANTICIPATED RESULTS: Among 84 respondents, 84% agreed it is permissible to perform a face transplant on an adult with no medical contraindications. The majority of respondents agreed that it is permissible to perform a face transplant on a child or blind recipient. An issue of continued concern was risk of immunosuppression. Respondents had a high threshold of permissibility for ethnic mismatches between donor and recipient, and 43% reported it is permissible to have a gender mismatch. A 10 year age difference between donor and recipient was the most commonly accepted. Questions regarding the ideal composition of a face transplant ethics committee demonstrated consensus on the roles that should be represented. DISCUSSION/SIGNIFICANCE OF IMPACT: This study provides insight into ethicists’ viewpoints on face transplant, which demonstrates a high level of permissibility towards the procedure. This may be due to the early success of face transplants and the shifting ethical issues in the field to practical aspects of the procedure. This research also provides guidance to programs regarding questions of donor and recipient selection, ethics committee composition, and offers insight into strengthening the ethical framework of the field.

Gender Agreement Attraction in Greek Comprehension.

This work explores gender agreement attraction in comprehension. Attraction occurs when an agreement error (such as, “the key to the cabinets are rusty”) goes unnoticed, leading to the illusion of grammaticality due to a mismatch between the value of the head and the value of a local intervening phase (attractor). According to retrieval accounts, these errors occur during cue retrieval from memory and predict illusions of grammaticality. Alternatively, representational accounts predict that the errors occur due to the faulty representation of certain features, thus, illusions of ungrammaticality are also expected. In four experiments we explore: (a) whether gender agreement attraction occurs in Greek and the strategy/-ies employed, (b) the role of the agreement target, (c) the timing of gender agreement attraction, (d) the role of phonological matching between the nominal inflectional morphemes of the attractor and the agreement target, and (e) participants’ sensitivity to agreement when there is no conflict from the attractor. In all four experiments, the grammaticality of the sentence and the attractor value (match or mismatch with the head) and also the phonological matching between the attractor and the agreement target in ungrammatical sentences were manipulated. The agreement target was either an adjectival predicate or an object-clitic and the gender value of the head was feminine or neuter. Attraction was found in all measures during the time-course of adjectival predicates (Experiment 1) and object-clitics (Experiment 2), and in timed (Experiment 3), and untimed (Experiment 4) judgments. Even more, both gender values showed attraction and the results mainly suggest that participants experience illusions of grammaticality, confirming retrieval accounts. Phonological matching did not modulate attraction in any of the experiments, suggesting that the similarity in the morphophonological realization between the agreement target and the attractor does not increase attraction. Furthermore, participants were sensitive to gender agreement violations in the absence of gender mismatch between the head and the attractor, suggesting that they respect agreement rules and have both neuter and feminine available in their feature content repertoire, although with some tendency in favor of neuter in feminine agreement contexts. The impact of these findings is discussed within the concept of attraction and sensitivity to agreement violations.

Intralingual Variation in Acceptability Judgments and Production: Three Case Studies in Russian Grammar.

This paper contributes to the task of defining the relationship between the results of production and rating experiments in the context of language variation. We address the following research question: how may the grammatical options available to a single speaker be distributed in the two domains of production and perception? We argue that previous studies comparing acceptability judgments and frequencies of occurrence suffer from significant limitations. We approach the correspondence of production and perception data by adopting an experimental design different from those used in previous research: (i) instead of using a corpus we use production data obtained experimentally from respondents who are later asked to make judgments, (ii) instead of pairwise phenomena we examine language variation, (iii) judgments are collected formally using the conditions and materials from the production experiment, (iv) we analyze the behavior of each participant across the production and acceptability judgment experiments. In particular, we examine three phenomena of variation in Russian: case variation in nominalizations, gender mismatch, and case variation in paucal constructions. Our results show that there is substantial alignment between acceptability ratings and frequency of occurrence. However, the distribution of frequencies and acceptability scores do not always correlate. Speakers are not consistent in choosing a single variant across the two types of experiment. Importantly, the types of inconsistency they display differ, which means that the variation can be characterized from this point of view. We conclude that the degree of coherence of the two experiments reflects the effects of the evolution of variation over time. Another result is that elicited production and acceptability judgments vary with respect to how they reveal variation in language. In the case of the development or disappearance of variants, production indicates this earlier than judgments, and the rating task has the effect of restricting the choices available to respondents. However, the production method should not thereby be considered more sensitive. We argue that only a combination of production and judgment data makes it possible to estimate the directionality of changes in variability and to see the full distribution of different variants.

The role of semantics and repair processes in article-noun gender disagreement in Italian: An ERP study

In this sentence reading study, we used event-related potentials (ERPs) to investigate the processing mechanism of article-noun gender disagreement in two kinds of nouns in Italian. The first are nouns with syntactic gender (il trenoM ‘train’; la sediaF ‘chair’) for which the processing and repair of gender disagreement entails only one repair option, namely for the article (morphosyntactic repair). The second kind are nouns with semantic gender (il bambinoM ‘boy’, la bambinaF ‘girl’). Here, there are two options for processing and repairing gender mismatch: repairing the article (morphosyntactic repair) or repairing the noun (both morphosyntactic and semantic repair). Both classes of nouns elicited the LAN, indicating that gender disagreement is always registered at the morphosyntactic level. In addition, the P600 was elicited in both conditions, but was larger for semantic gender, reflecting a more complex repair for this class of nouns.

Outcomes of Heart Transplantation from Hepatitis C Seropositive Donors: An Updated Analysis of the United Network for Organ Sharing Registry

Hepatitis C (HCV) has become readily treatable in the modern era. The use of HCV+ organs for transplant has shown promising results and increases donor availability. This study is an updated analysis of outcomes after HCV+ heart transplantation in the United States. The United Network for Organ Sharing registry was queried for adult patients who received heart transplants from 2015-2018. Excluded multiorgan transplants, incomplete HCV data, and loss to follow-up. HCV status was classified by serology (Ab+ vs Ab-). Median follow-up was 24 months. During the study period, 7529 patients received heart transplants: 136 from HCV Ab+ donors and 7393 from HCV Ab- donors. Seven recipients (5.1%) of HCV Ab+ hearts had HCV+ serology prior to transplant, compared to 129 recipients (1.7%) of HCV Ab- organs (p=0.018). There was no difference in donor age (p=0.489), ejection fraction (p=0.221), gender mismatch (p=0.341), or ABO compatibility (p=0.707). HCV Ab+ transplants involved further travel (mean: 323 vs 149 miles, p<0.001) with longer ischemic times (mean: 3.55 vs 3.03 hours, p<0.001) due to regional variation in use of HCV+ organs. Kaplan Meier analysis showed no effect of HCV status on overall survival (p=0.960), and no difference in graft failure (p=0.700). On multivariate Cox regression, HCV status was not a significant predictor of mortality (HR 0.85, 95% CI 0.47-1.56, p=0.601), while overall mortality was affected by HLA mismatch (HR 1.07, 95% CI 1.00-1.14, p= 0.037), donor age (HR 1.01, 95% CI 1.00-1.02, p=0.002), recipient creatinine (HR 1.07, 95% CI 1.04-1.12, p<0.001), and use of ECMO (HR 3.27, 95% CI 2.08-5.12, p<0.001) or a ventricular assist device (HR 1.23, 95% 1.08-1.41, p=0.003) at the time of transplant. Transplantation of HCV+ donor hearts has demonstrated promising outcomes thus far, with comparable overall survival and graft outcomes. Ongoing investigation is warranted to observe long-term outcomes.

Do Expanded Donor Criteria Impact Outcomes in Pediatric Heart Transplantation? A UNOS Registry Analysis

Donor utilization rates continue to be low for pediatric heart transplantation (pHT) however efforts to expand the donor acceptance criteria have shown mixed results in single institution studies in pediatric and adult transplantation. We analyzed pHT UNOS data (2008-2018) to compare the recipient characteristics, donor characteristics and outcomes, based on donor ejection fraction of less than 50% (low EF) and or ischemic time of greater than 4 hours (prolonged IT). A total of 4345 pHT were performed of which 1309 (30.1%) were with prolonged IT and 122 (2.8%) in low EF. Additionally, 58 (1.3%) were performed with both low EF and prolonged IT (combined risk). Recipients of combined risk were more likely to be younger, have post-surgical congenital heart disease, be on ECMO or ventilator but less likely on VAD (all p &lt; 0.01). Figure 1. There was no significant difference in donor characteristics such as mode of death, gender mismatch, race mismatch or inotrope use. Waitlist time was significantly lower for low EF (mean 39 days, range 15-109) or combined risk group (36 days, 15-80) compared to other groups (60 days, 23-125) (p=0.01). 1 year mortality was 8% in low risk group, 12% in prolonged IT, 14% in reduced EF and 28% in combined risk patients (p &lt; 0.01). Additionally, 9% of low risk patients had episode of treated rejection, while 15% of prolonged IT, 5% of low EF and 15% in combined group had rejection (p&lt;0.01).The KM survival analysis performed is shown in the figure 1. Lower EF donors performed similar to prolonged IT donor, but were uncommonly used. Acceptance of risk was common in recipients deemed higher risk for waitlist mortality and led to shorter wait times. However, episodes of treated rejection as well as 1 year mortality was higher with the higher risk transplants, specifically with combined risk donors. Caution should be used in accepting combined risk transplants and further analysis will help balance the waitlist mortality with post-transplant outcomes.

Mitigating Risks of Primary Graft Dysfunction with Antegrade Myocardial Perfusion

Primary Graft Dysfunction (PGD) is the leading cause of early mortality after heart transplantation. Several risk factors of PGD have been identified, including; prolonged warm ischaemic time, advanced donor age, gender mismatch and recipient diabetes mellitus. We adopted a novel method of implantation using "antegrade myocardial perfusion (AMP)" during implantation and compared this to the conventional approach. We obtained the retrospective data retrospectively from the Golden Jubilee National Hospital heart transplant database, ClinicalPortal and CIS databases from January/2012-May/2018. Missing data were obtained from the hard copy case notes. We performed AMP utilising continuous cold blood (4-6°C) antegrade cardioplegia to achieve aortic root pressures of 60-70 mmHg. Leucocyte filer was utilised. The infusion would continue with an LV vent insitu until the left atrial and aortic anastomoses were complete. "Hotshot" warm blood was then infused prior to removal of the cross clamp. Multivariable logistic regression with moderate/severe PGD as the outcome measure. Confounders were adjusted for recipient age, total ischaemic time, bypass time, predicted left ventricular (LV) mass mismatch, recipient diabetes mellitus and donor age. A total of 75 patients were included in this study. 44% (n=33) underwent AMP and 56 % (n=42) had orthotopic heart transplantation with the conventional approach. There was no statistically significant difference in age, gender, incidence of diabetes mellitus, preoperative utilisation of mechanical circulatory support between the AMP and the control group. We found that total ischaemia time was significantly shorter in the AMP cohort (154+/-50.2 vs. 181+/-47.1 min, p=0.018). The rate of postoperative VA ECMO support was significantly lower in the AMP cohort (15% vs. 54%, p<0.001). The rate of moderate-severe PGD was significantly lower in the AMP cohort (21% vs. 69%, p<0.001). The odds ratio of PGD in patients in the historical cohort vs AMP was 4.15 (1.21-14.24). Our implantation technique utilising AMP significantly lowers the rate of moderate and severe PGD when compared to the standard implantation technique employed by the historical cohort.

Spontaneous Restoration of Sinus Rhythm during Heart Transplantation is Associated with a Reduced Incidence of Primary Graft Dysfunction and Early Mortality

Insults to the donor heart during heart transplantation (HT) include ischemia and reperfusion injury after release of the aortic cross-clamp in the recipient. Restoration of heart beat after aortic unclamping can be by spontaneous resumption of sinus rhythm, pacing for atrioventricular (AV) block, or direct-current (DC) cardioversion for ventricular fibrillation. We investigated the association between mode of heart beat restoration and primary graft dysfunction (PGD). HT recipients between 1997-2017 were grouped by mode of heart beat restoration after aortic unclamping into: spontaneous (S; 126 pts), pacing (P; 17 pts) or DC (58 pts) groups. Endpoints were 30-day mortality and PGD (defined by the ISHLT consensus statement). Baseline characteristics differing among the groups included proportion of women, pre-HT amiodarone and gender mismatch (Table). PGD was significantly higher for the P-group (71%) >DC-group (59%) >S-group (21%, p<0.001). Multivariable analysis consistently showed that restoration of sinus by DC, and pacing for AV block, were independently associated with significant ∼5-fold and ∼10-fold increased risk for PGD, respectively (Figure) compared to spontaneous sinus restoration. Consistently, 30-day mortality was significantly lower for S- (6%) than for DC- (17%) patients and highest for the P group (22%, p<0.001). Spontaneous restoration of sinus after aortic unclamping at HT is associated with a reduced risk for PGD and early mortality, whereas pacing for AV block and DC are associated with an increased risk.

Transforming growth factor beta 1 levels in the blood of pediatric liver recipients: Clinical and biochemical correlations.

TGF-β1 is a cytokine with profibrogenic and immunosuppressive activities, which suggest the clinical significance of TGF-β1 for the assessment of graft function after LT. We analyzed the dynamics of TGF-β1 levels in the blood after LDLT in 135 pediatric liver recipients and examined the relationship between the cytokine levels and the laboratory and clinical variables. We found that TGF-β1 levels in the blood of patients with ESLD were lower than that in healthy children of the same age, P=.001. Moreover, blood levels of TGF-β1 were associated with liver disease etiology (r=.23) and hepatic fibrosis severity (r=.33). Before LDLT, TGF-β1 levels were significantly higher in children with good outcomes than in recipients who developed graft dysfunction early in the post-transplant period, P=.047. One month after LDLT, TGF-β1 levels in blood plasma increased in pediatric recipients, P=.002. Cytokine levels were significantly correlated with gender (r=.21) and HLA (r=-.24) mismatches, as well as with TAC dosage (r=-.32) later in the post-transplant period. One year after LDLT, TGF-β1 plasma levels were higher (P=.01) than those before LDLT and did not correlate with most of the investigated biochemical and clinical variables. Conclusion: Blood levels of TGF-β1 are associated with hepatic fibrosis severity, graft dysfunction development, and TAC dosage and can be regarded as a potential prognostic biomarker for the assessment of graft function and the optimization of immunosuppressant dosage in pediatric recipients after LDLT.

Prediction of phonological and gender information: An event-related potential study in Italian

Do people predict different aspects of a predictable word to the same extent? We tested prediction of phonological and gender information by creating phonological and gender mismatches between an article and a predictable noun in Italian. Native Italian speakers read predictive sentence contexts followed by the expected noun (e.g., un incidente: ‘accident’) or another plausible, but unexpected noun, either beginning with a different phonological class (consonant vs. vowel, e.g., uno scontro: ‘collision’; phonological mismatch) or belonging to a different gender class (e.g., un'inondazione: ‘flooding’; gender mismatch). Phonological mismatch articles elicited greater negativity than expected articles at posterior channels around 450–800 ms post-stimulus. In contrast, gender mismatch articles elicited greater negativity than expected articles at left posterior channels around 250–800 ms. Unexpected nouns showed an N400 effect followed by frontal positivity relative to expected nouns. The earlier effect for the gender mismatch articles suggests that people are quicker or more likely to pre-activate gender information vs. phonological information of a predictable word. We interpret the results with respect to production-based prediction accounts.