Individual Recipients Research Articles

Impact of deceased-donor characteristics on early graft function: outcome of kidney donor pairs accepted for transplantation.

The impact of deceased donor characteristics on kidney transplant outcomes is controversial. Correspondingly, the predictive performance of deceased donor scores remains moderate, and many transplant centers lack validated criteria for graft acceptance decisions. To better dissect donor-related risk from recipient and periprocedural variables, we analyzed outcomes of kidney donor pairs transplanted in different individuals. This study explored (a)symmetry of early outcomes of 328 cadaveric kidney transplant recipients from 164 donor pairs transplanted at three Eurotransplant centers. The primary discriminatory factor was (a)symmetry of partner graft function, defined as early graft loss or impaired graft function [estimated glomerular filtration rate (eGFR) <30 mL/min] 3 months after transplantation. We reasoned that a relevant impact of donor factors would result in a high concordance rate of limited graft function or failure. The observed number of symmetric graft failure after transplantation was less than statistically expected (3 months: 1 versus 2, p = 0.89; and 12 months: 3 versus 5, p = 0.26). However, we found a trend toward an impaired 5-year graft survival of grafts with good function 3 months after transplantation but a failed or impaired partner graft compared to symmetrically well-functioning grafts (p = 0.09). Subsequently, we explored the impact of individual donor and recipient variables on early transplant outcomes. Generalized estimating equations after feature selection with LassoGEE bootstrap selected donor age, donor body mass index, and donor eGFR as the relevant risk factors. Our findings indicate that donor factors impact early outcomes in kidney transplantation but may have a limited role in long-term graft survival, once a graft has been accepted for transplantation. Utilizing donor-based clinical scores has the potential to aid clinicians in acceptance decisions, giving them an estimate of individual posttransplant outcomes. However, the ultimate decision for acceptance should rest with clinicians, who must consider the complex interplay of donor factors, as well as recipient and periprocedural characteristics.

Blood Bonds: Transforming Blood Donation Through Innovation, Inclusion, and Engagement.

The journey of receiving blood as a patient with transfusion-dependent beta thalassemia has profoundly shaped my understanding of the life-saving power of blood donation. This personal experience underscores the critical importance of blood donors, not just for individual recipients but for the broader community, enhancing public health, productivity, and well-being. There are several challenges to securing a blood donor pool in current health care climate. Solutions that focus on the engagement of donors, clinicians, and patients are key to improving the donor pool and utilizing the blood supply in a judicious manner.

Mitigating the risk of inflammatory type primary graft dysfunction by applying an integrated approach to assess, modify and match risk factors in lung transplantation.

Long-term outcome following lung transplantation remains one of the poorest of all solid organ transplants with a 1- and 5-year survival of 85% and 59% respectively for adult lung transplant recipients and with 50% of patients developing chronic lung allograft dysfunction (CLAD) in the first 5 years following transplant. Reducing the risk of inflammatory type primary graft dysfunction (PGD) is vital for improving both short-term survival following lung transplantation and long-term outcome due to the association of early inflammatory-mediated damage to the allograft and the risk of CLAD. PGD has a multifactorial aetiology and high-grade inflammatory-type PGD is the result of cumulative insults that may be incurred in one or more of the three variables of the transplantation continuum: the donor lungs, the recipient and intraoperative process. We set out a conceptual framework which uses a fully integrated approach to this transplant continuum to attempt to identify and, where possible, modify specific donor, recipient and intraoperative PGD risk with the goal of reducing inflammatory-type PGD risk for an individual recipient. We also consider the concept and risk-benefit of matching lung allografts and recipients on the basis of donor and recipient PGD-risk compatibility. The use of ex vivo lung perfusion (EVLP) and the extended preservation of lung allografts on EVLP will be explored as safe, non-injurious EVLP may enable extensive inflammatory testing of specific donor lungs and has the potential to provide a platform for targeted therapeutic interventions on lung allografts.

Liver function maximum capacity test during normothermic regional perfusion predicts graft function after transplantation

PurposeIn an effort to reduce waitlist mortality, extended criteria donor organs, including those from donation after circulatory death (DCD), are being used with increasing frequency. These donors carry an increased risk for postoperative complications, and balancing donor-recipient risks is currently based on generalized nomograms. Abdominal normothermic regional perfusion (aNRP) enables individual evaluation of DCD organs, but a gold standard to determine suitability for transplantation is lacking. This study aimed to incorporate individualized and predictive measurements of the liver maximum capacity (LiMAx) test to objectively grade liver function during aNRP and prevent post-op complications.MethodsaNRP was performed to salvage 18 DCD liver grafts, otherwise discarded. Continuous variables were presented as the median with the interquartile range.ResultsThe liver function maximum capacity (LiMAx) test was successfully performed within the aNRP circuit in 17 aNRPs (94%). Donor livers with good lactate clearance during aNRP demonstrated significantly higher LiMAx scores (396 (301–451) µg/kg/h versus those who did not 105 (70–158) µg/kg/h; P = 0.006). This was also true for manifesting stress hyperglycemia > 20 mmol/l (P = 0.032). LiMAx score correlated with alanine aminotransferase (ALT; R = − 0.755) and aspartate transaminase (AST; R = − 0.800) levels during perfusion and distinguished livers that were selected for transplantation (397 (346–453) µg/kg/h) from those who were discarded (155 (87–206) µg/kg/h; P < 0.001). Twelve livers were accepted for transplantation, blinded for LiMAx results, and all had LiMAx scores of > 241 µg/kg/h. Postoperatively, LiMAx during aNRP displayed correlation with 24-h lactate levels.ConclusionsThis study shows for the first time the feasibility to assess liver function during aNRP in individual donor livers. LiMAx presents an objective tool to predict donor liver function and risk of complications in the recipient, thus enabling individualized matching of donor livers for an individual recipient. The LiMAx test may present a valuable test for the prediction of donor liver function, preventing post-transplant complication, and personalizing the selection of donor livers for individual recipients.

Analysis on the Customers Usage of Gift Cards and Gift Vouchers through Online Payment in Coimbatore

In the dynamic landscape of contemporary consumer culture, the concept of gift-giving has undergone a profound transformation. Gone are the days when selecting the perfect gift involved hours of browsing crowded malls and meticulous consideration of personal preferences. Enter the era of Online Gift Cards—a revolution in the art of gifting that has not only streamlined the process but has also added a new layer of versatility and personalization to the age-old tradition of exchanging presents. A Online Gift Card, in its simplest form, is a prepaid card that carries a monetary value and is typically issued by retailers or businesses. These cards have transcended traditional gifting norms, offering recipients the freedom to choose their desired items from a vast array of products or services. The evolution of Online Gift Cards has been a fascinating journey, marked by technological advancements, shifting consumer behaviors, and a redefinition of the emotional and social aspects associated with gift-giving. The origins of Online Gift Cards can be traced back to the mid-20th century when retailers began experimenting with the idea of providing customers with a convenient alternative to traditional gift certificates. However, it wasn't until the late 20th century and the early 21st century that Online Gift Cards truly gained widespread popularity, becoming a ubiquitous and preferred choice for both gift-givers and receivers. The transition from tangible, paper-based gift certificates to sleek, plastic cards with magnetic strips or electronic chips marked a pivotal moment in the evolution of gift-giving. One of the primary reasons behind the meteoric rise of Online Gift Cards is their unparalleled convenience. Unlike traditional gifts, which may require exhaustive deliberation and might still miss the mark, Online Gift Cards empower both givers and recipients with flexibility. Givers no longer need to navigate the labyrinth of individual preferences, sizes, or colors, and recipients no longer have to feign enthusiasm for ill-fitting sweaters or mismatched kitchen appliances. Instead, the Online Gift Card offers a passport to a retail wonderland or a digital marketplace where the possibilities are as diverse as the personalities of the recipients.

Risk assessment in liver transplantation for hepatocellular carcinoma: long-term follow-up of a two-centre experience.

Liver transplantation (LT) is a well-established treatment for hepatocellular carcinoma (HCC), but there are ongoing debates regarding outcomes and selection. This study examines the experience of LT for HCC at a high-volume centre. A prospectively maintained database was used to identify HCC patients undergoing LT from 2000 to 2020 with more than or equal to 3-years follow-up. Data were obtained from the centre database and electronic medical records. The Metroticket 2.0 HCC-specific 5-year survival scale was calculated for each patient. Kaplan-Meier and Cox-regression analyses were employed assessing survival between groups based on Metroticket score and individual donor and recipient risk factors. Five hundred sixty-nine patients met criteria. Median follow-up was 96.2 months (8.12years; interquartile range 59.9-147.8). Three-year recurrence-free (RFS) and overall survival (OS) were 88.6% ( n =504) and 86.6% ( n =493). Five-year RFS and OS were 78.9% ( n =449) and 79.1% ( n =450). Median Metroticket 2.0 score was 0.9 (interquartile range 0.9-0.95). Tumour size greater than 3cm ( P =0.012), increasing tumour number on imaging ( P =0.001) and explant pathology ( P <0.001) was associated with recurrence. Transplant within Milan ( P <0.001) or UCSF criteria ( P <0.001) had lower recurrence rates. Increasing alpha-fetoprotein (AFP)-values were associated with more HCC recurrence ( P <0.001) and reduced OS ( P =0.008). Chemoembolization was predictive of recurrence in the overall population ( P =0.043) and in those outside-Milan criteria ( P =0.038). A receiver-operator curve using Metroticket 2.0 identified an optimal cut-off of projected survival greater than or equal to 87.5% for predicting recurrence. This cut-off was able to predict RFS ( P <0.001) in the total cohort and predict both, RFS ( P =0.007) and OS ( P =0.016) outside Milan. Receipt of donation after brain death (DBD) grafts (55/478, 13%) or living-donor grafts (3/22, 13.6%) experienced better survival rates compared to donation after cardiac death (DCD) grafts ( n =15/58, 25.6%, P =0.009). Donor age was associated with a higher HCC recurrence ( P =0.006). Both total ischaemia time (TIT) greater than 6hours ( P =0.016) and increasing TIT correlated with higher HCC recurrence ( P =0.027). The use of DCD grafts for outside-Milan candidates was associated with increased recurrence ( P =0.039) and reduced survival ( P =0.033). This large two-centre analysis confirms favourable outcomes after LT for HCC. Tumour size and number, pre-transplant AFP, and Milan criteria remain important recipient HCC-risk factors. A higher donor risk (i.e. donor age, DCD grafts, ischaemia time) was associated with poorer outcomes.

The Endeavour scholarships program in the era of the Asian century: promise unfulfilled

PurposeThe Australian Government has long used its international scholarship programs as an instrument of soft power in international diplomacy. The paper examines an international scholarship program and its role in Australia’s soft power efforts during a period in recent history.Design/methodology/approachThe Australia in the Asian Century White Paper of 2012 is used as a lens to reveal how the Australian Government viewed the role of international scholarship programs in international diplomacy at a specific point in the recent past, and compares it with research revealing what was contemporaneously happening with one key government-funded scholarship program.FindingsThis paper is based on a comprehensive case study of the Australian Government’s Endeavour Scholarships and Fellowships program (2004–2019). Endeavour was an ambitious and expensive merit-based program with 6,600 recipients in numerous and diffuse sub-categories. The program was complex and cumbersome and lacked clear priorities, particularly in its lack of geographic focus. It missed opportunities to connect with the political zeitgeist, largely due to opaque priorities and inadequate evaluation regimes which focused entirely on outcomes for individual recipients rather than on relationships for Australia.Originality/valueThis research draws on the first academic study of the Endeavour program. Other scholarship programs (for example Australia Awards and the New Colombo Plan) have attracted considerable scholarly interest. The Endeavour research provides an additional counterpoint for studies of Australian scholarship programs and their contribution to international diplomacy. It is timely to consider this in 2024 when Australia is putting a new focus on its investment in international scholarships.

(1358) - Plasma and Bronchoalveolar Fluid Proteomes Identify Similar Pathways Associated with Allograft Dysfunction in Individual LTx Recipients with Different Underlying Conditions

(1358) - Plasma and Bronchoalveolar Fluid Proteomes Identify Similar Pathways Associated with Allograft Dysfunction in Individual LTx Recipients with Different Underlying Conditions

Transplantation: platform to study recurrence of disease.

Beyond the direct benefit that a transplanted organ provides to an individual recipient, the study of the transplant process has the potential to create a better understanding of the pathogenesis, etiology, progression and possible therapy for recurrence of disease after transplantation while at the same time providing insight into the original disease. Specific examples of this include: 1) recurrence of focal segmental glomerulosclerosis (FSGS) after kidney transplantation, 2) recurrent autoimmunity after pancreas transplantation, and 3) recurrence of disease after orthotopic liver transplantation (OLT) for cirrhosis related to progressive steatosis secondary to jejuno-ileal bypass (JIB) surgery. Our team has been studying these phenomena and their immunologic underpinnings, and we suggest that expanding the concept to other pathologic processes and/or transplanted organs that harbor the risk for recurrent disease may provide novel insight into the pathogenesis of a host of other disease processes that lead to organ failure.

Longevity Matching for Living Donor Renal Transplantation

This study identifies the effect of individual donor and recipient characteristics on graft survival in living-donor kidney transplantation (LDKT) using a recently described novel measure, kidney life years (KLYs). The Organ Procurement and Transplantation Network/United Network for Organ Sharing database was used to identify first-time kidney-only LDKT recipients between 1987 and 2020 who did not experience death with a functioning graft (DWFG) and were not missing relevant information (n=87,290). Patient characteristics were evaluated using Cox and multiple regression analyses, with the dependent variable being KLYs. An equation for expected KLYs based on patient characteristics was created using regression coefficients. The equation was validated using bootstrapped Pearson correlations and then applied to the DWFG group for comparison. Based on statistical significance from Cox and multiple linear regression analyses, 9 of the original 18 variables were selected for inclusion in the equation. Variables with notable impact included HLA match points (0.021 KLYs; 95% CI: [0.019,0.024]; P ≤ .001), Donor Age (-0.030 KLYs; 95% CI: [-0.035,-0.025]; P ≤ .001), and Donor African American Ethnicity (-2.356 KLYs; 95% CI: [-2.552,-2.159]; P ≤ .001). Equation validation was supported, given a negative correlation (r=-0.071; P ≤ .001) between expected KLY change and observed graft failure. Expected KLY change was found to be greater in those who eventually DWFG when compared with all other LDKTs (t=-5.735, P ≤ .001). Increasing HLA match points may be more beneficial for graft longevity than minimizing donor age in comparisons using realistic between-donor differences. Additionally, greater average expected KLYs in those who ultimately DWFG may illustrate an opportunity for improved donor-recipient matching.

University-Industry Collaboration For Manpower Planning And The Challenges Of Economic Development

The development of manpower aimed at addressing the prevailing and future needs of a given society is a good reason for designing and structuring collaboration between universities and industries. Using a qualitative research design, this article explored the university-industry collaboration for manpower planning and the challenges of economic development in Nigeria. It looked at the concept of university education as a private and social investment that has a limitless rate of returns to both the individual recipient and the society. It also discussed the relationship between economic development and manpower development planning and highlighted that economic development which is a deliberate process of sustained quality improvement of the people requires proper planning, at the center of which is manpower development planning. Furthermore, the critical roles universities and industries in Nigeria have to play in producing the skills needed for industries and national development were also examined. These roles include producing high-level and middle level manpower in order to address socio-economic challenges, boosting the acquisition of skills to tackle the mismatch between skills of the available workforce and job vacancies, and championing ideas and innovations to facilitate access to new markets. The article suggested a number of strategic approaches to foster a stronger collaboration of universities with industry. These strategies include among others an establishment of a consultative process where the voice of relevant business managers is given adequate consideration in curriculum development in order to ensure that the academic programs of universities are tailored to the needs of the industries.

The Impact of Financial Aid Programmes on Access to Higher Education in Ugandan Universities

In Uganda, limited financial resources often obstruct higher education opportunities, particularly for those with modest incomes. Various financial aid initiatives have been introduced in an attempt to rectify this issue for equitable access. This study aimed to investigate the impact of financial aid initiatives on higher education accessibility, guided by two main research questions: (1) To what extent do financial aid programmes bolster access to higher education? (2) What challenges do students face in accessing financial aid for higher education? Employing a mixed-methods approach, data on enrollment into higher education institutions in Uganda were extracted from a National Council for Higher Education (NCHE) 2020 report for an overview into impacts of financial aid on access to higher education. For contextual and in-depth insight into the impacts of financial aid programmes on access to higher education, secondary data on loan schemes in two public universities and the Kabaka Education Fund in a private university were obtained and analysed using descriptive statistics. To understand the experiences and perspectives of financial aid programme recipients, qualitative interviews were conducted with a sample of 138 beneficiaries, including 12 individual recipients and 13 focus group discussions (FGDs) that involved 126 progressing recipients with about 9–10 persons per group from the three selected universities, whose responses were analysed using thematic content analysis. The results revealed that much as financial aid programmes have improved access to higher education in Ugandan universities, most financial services remain accessible primarily to wealthier individuals owing to barriers including application procedures, expenditure, discriminatory practices, limited information, a negative attitude towards aid and demotivation. The study recommends prioritising strategies that address the needs of a diverse student population to ensure equitable access to higher education, thereby promoting human progress, economic development, and the achievement of sustainable development goals.

Approaches to optimize outcomes in transplant recipients.

Curative therapy with an allogeneic hematopoietic cell transplant (HCT) can now be offered to a wider patient population due to improvements in donor selection, transplant conditioning regimens, and supportive care measures. However, risk of transplant-related morbidity and mortality remains, and thus appropriate transplant candidate workup pre-HCT for risk stratification and a management plan after HCT is crucial for success of the procedure. These include understanding and identifying risk of underlying malignant disease relapse, graft-versus-host disease, and infectious complications a patient may be predisposed toward, irrespective of allogeneic donor type. Progress in these domains with new therapeutic paradigms allows for development of a treatment plan prior to HCT to mitigate these potential risks tailored to the patient's case. Herein, we present case studies to focus on factors that influence decision-making in HCT and the approaches and strategies used to optimize post-HCT outcomes based on the individual HCT recipient's clinical scenario to improve on these high-risk scenarios.

The Impact of Financial Aid Programmes on Access to Higher Education in Ugandan Universities

In Uganda, limited financial resources often obstruct higher education opportunities, particularly for those with modest incomes. Various financial aid initiatives have been introduced in an attempt to rectify this issue for equitable access. This study aimed to investigate the impact of financial aid initiatives on higher education accessibility, guided by two main research questions: (1) To what extent do financial aid programmes bolster access to higher education? (2) What challenges do students face in accessing financial aid for higher education? Employing a mixed-methods approach, data on enrolment into higher education institutions in Uganda were extracted from a National Council for Higher Education (NCHE) 2020 report for an overview into impacts of financial aid on access to higher education. For contextual and in-depth insight into the impacts of financial aid programmes on access to higher education, secondary data on loan schemes in two public universities and the Kabaka Education Fund in a private university were obtained and analysed using descriptive statistics. To understand the experiences and perspectives of financial aid programme recipients, qualitative interviews were conducted with a sample of 138 beneficiaries, including 12 individual recipients and 13 focus group discussions (FGDs) that involved 126 progressing recipients with about 9–10 persons per group from the three selected universities, whose responses were analysed using thematic content analysis. The results revealed that much as financial aid programmes have improved access to higher education in Ugandan universities, most financial services remain accessible primarily to wealthier individuals owing to barriers including application procedures, expenditure, discriminatory practices, limited information, a negative attitude towards aid and demotivation. The study recommends prioritising strategies that address the needs of a diverse student population to ensure equitable access to higher education, thereby promoting human progress, economic development, and the achievement of sustainable development goals.

Muzakki’ Preferences and Relevant Factors in Padang

This paper explores muzakki’ preferences in Padang and describes the existing conditions of some relevant factors that need to be considered (i.e. religiosity and zakat awareness of zakat payers; trust on zakat institutions and perception on governance of zakat institutions). This research was exploratory and descriptive in nature. Data was collected through an online survey involved 123 respondents in 11 sub-districts in Padang during the period of September – October 2020. The findings of the study show that muzakki in Padang have a considerably high religiosity and zakat awareness. The trust to zakat institution, however was only moderate which related to considerably low perception on governance of zakat institutions in Padang. High education and high zakat awareness did not necessarily lead to complete compliance to the recommended zakat payment method (i.e. through authorized zakat institutions). In fact, Muzakki in Padang still used both channels: zakat institutions and direct payment to individual recipients. The findings of this study suggested that more need to be done by zakat institutions to improve governance quality, to socialize their existence and programs to wider groups of society. The research also indicates that preference of zakat payers to pay zakat through online method increases since the Covid-19 pandemic.

PSXIII-21 Effects of Bacterial Direct-Fed Microbial Mixtures on Beef Cattle Feeding Behavior

Abstract The effects of bacterial direct-fed microbial (DFM) mixtures on beef cattle feeding behavior were evaluated. Six ruminally cannulated crossbred Angus steers (BW = 520 ± 30 kg) were used in a replicated 3 × 3 Latin Square design. Steers were offered a steam-flaked corn-based finishing diet to ad libitum during three, 28 d periods (21-d adaptation and 7-d collection). Treatments assigned were: 1) Control (no DFM, lactose carrier only); 2) Treat-A [L. animalis, P. freudenreichii; B. subtilis; and B. licheniformis, at 1:1:1:3 ratio, respectively; totaling 6 × 109 CFU (50mg)/animal-daily minimum (Chr.Hansen]; and 3) Treat-B, the same DFM combination, but with doses at 1:1:3:1 ratio. Bacterial counts were approximately 30% greater than the minimum expected. The DFM diluted mixtures and carrier (Control) were pre-weighed and stored at -20°C until incorporated into the diet (2 g· animal-1· /day-1) 10 min prior to feeding. For mixing, approximately 1 kg (as is) of the diet being offered was removed from the individual recipient, DFM was mixed by hand, and the mixture was incorporated into the feed allocated for the day. The feeding behavior assessment consisted of a 24 h continuous visual observation (every 5 min) performed by trained personnel. Animals were assessed on d 26 of each period (no other management other than cleaning of the stall), while time spent eating, ruminating, resting, active, and drinking were taken. Time spent chewing was accounted for by adding time spent eating and ruminating. In addition, records allowed the count of the number of meals taken, as well as the time spent on each meal. Data were analyzed using the GLIMMIX procedure of SAS, with animal considered as the experimental unit, the fixed effects of treatment, and random effect of square, period, and animal (square). F-test protected pre-planned orthogonal contrasts was used to compare Control vs. Treat-A and Control vs. Treat-B. Meal number (16/d) and length (8 min/meal) were not affected by treatments (P ≥ 0.54). Main feeding behavior variables consisting of rumination (198 min/d), eating (117 min/d), chewing (315 min/d), drinking (22 min/d), resting (929 min/d), and active (174 min/d) were not affected (P ≥ 0.24) by treatments. A tendency was observed (P = 0.08) where animals offered the Treat-B spent numerically less time ruminating per unit of digestible DM and OM intake compared with Control (13.5 vs. 15.5, and 13.7 vs 15.6 min/kg, respectively). Other behaviors measured in min/kg of DM, NDF, and ADF intake were not affected (P ≥ 0.17) by treatments [rumination (11.5, 60.2, and 181), eating (6.5, 34.4, and 104), chewing (18, 94.6, and 285), and drinking (1.2, 6.6, and 19.8) min/kg, respectively]. The bacterial DFM mixtures offered appear not to directly affect the feeding behavior of beef cattle consuming a steam-flaked corn-based finishing diet.

The ways of interpreting green energy by young Polish individual recipients vs. their gender

The purpose of this article is to identify the ways in which young Polish individual recipients interpret green energy, taking into account their gender, and to segment the respondents on the basis of this demographic feature. Based on the results of the literature analysis, a cognitive gap and a research gap with regard to the ways in which young individual recipients interpret green energy can be confirmed. Moreover, these aspects have not been analysed in the approach proposed in this article. In order to reduce the identified gaps, four research hypotheses were formulated and empirically verified. For this purpose, empirical studies were carried out. The survey method was used to collect primary data. The research covered 311 representatives of Polish young individual recipients aged 18–24. Primary data were subjected to quantitative analysis including tests and methods of statistical analysis. The most important results of this analysis include the discovery of: 1/a hierarchy of ways of interpreting green energy, taking into account the gender of the respondents, 2/the existence of dependencies between the four ways of interpreting green energy and the gender of the respondents, 3/homogeneous groups of respondents showing analogous ways of interpreting green energy among all respondents, as well as among the surveyed women and men. The conclusions drawn from research show a high cognitive and application value. They contribute to the theory of marketing, especially to the theory of experience marketing. They also offer important clues to managers, facilitating making the proper marketing decisions that can strengthen positive associations of green energy supporters and change the negative associations of sceptics.

Quantum accountability: when does enough become too much in top pay decision-making?

PurposeThe purpose of this paper is to examine how and why individuals involved in executive remuneration (top pay) decision-making consider quantum as being appropriate rather than excessive, theorised under the rubric of accountability.Design/methodology/approachIn-depth interviews were conducted with non-executive directors (NEDs) serving on remuneration committees (Remcos), institutional investors, their external advisers and internal HR reward experts. Transcripts were analysed using NVivo and the Gioia qualitative methodology.FindingsDefining, measuring and applying performance conditionality in the determination of top pay quantum such that it aligns with company strategy/culture and values, as well as individual recipient motivations, is difficult. While creative approaches to setting top pay so as to attract, retain and motivate key personnel are welcomed, these risk Remco members' personal/organisational reputations. Members recognise disconnection between top pay quantum and general pay levels and how the media highlights social inequality leading to public distrust. They believe they can contribute to more socially acceptable quantum by applying their own values in top pay decision-making.Originality/valueSanctions-based, trust-based and selection/peer networks/felt-based accountability theory is used to explain decision-makers’ actions when determining top pay quantum. This paper extends felt accountability theory to encompass public/societal accountability in the context of the appropriateness of top pay quantum decisions.

A single center Israeli experience in pregnancy post lung transplantation: Feasibility of successful two or more full-term pregnancies in individual lung transplant recipients.

Female lung transplant recipients (LTRs) of reproductive age are increasingly considering pregnancy due to advances in post-transplant management and improved survival. We report our experience with pregnancy in LTRs, with an emphasis on two or more successful full-term pregnancies in individual transplant recipients. We conducted a retrospective analysis of pregnancies in LTRs at our transplant center and collected maternal and fetal outcomes. In our patient cohort, eight female LTRs conceived a total of 17 pregnancies, resulting in 13 newborns, 12 at full term, and 11 with a birth weight>2.5kg. Three of the LTRs had two or more successful full-term pregnancies. LTRs required a significant tacrolimus dose increase to maintain target trough levels during pregnancy. Six recipients are currently clinically stable and active, three with lung function comparable to pre-pregnancy values, and three with evidence of chronic lung allograft dysfunction (CLAD), but stable lung function. Two of the eight LTRs died subsequent to childbirth secondary to chronic respiratory failure due to CLAD, at a mean of 11years post-transplantation and a mean of 4.5years after childbirth. Pregnancy following lung transplantation is feasible and can be achieved with acceptable maternal and newborn outcomes. Importantly, LTRs can successfully have two or more full-term pregnancies.

Incomplete tissue product tracing during an investigation of a tissue-derived tuberculosis outbreak

In the United States, there is currently no system to track donated human tissue products to individual recipients. This posed a challenge during an investigation of a nationwide tuberculosis outbreak that occurred when bone allograft contaminated with Mycobacterium tuberculosis (Lot A) was implanted into 113 patients in 18 US states, including 2 patients at 1 health care facility in Colorado. A third patient at the same facility developed spinal tuberculosis with an isolate genetically identical to the Lot A outbreak strain. However, health care records indicated this patient had received bone allograft from a different donor (Lot B). We investigated the source of this newly identified infection, including the possibilities of Lot B donor infection, product switch or contamination during manufacturing, product switch at the health care facility, person-to-person transmission, and laboratory error. The findings included gaps in tissue traceability at the health care facility, creating the possibility for a product switch at the point of care despite detailed tissue-tracking policies. Nationally, 6 (3.9%) of 155 Lot B units could not be traced to final disposition. This investigation highlights the critical need to improve tissue-tracking systems to ensure unbroken traceability, facilitating investigations of recipient adverse events and enabling timely public health responses to prevent morbidity and mortality.