Policy Changes Research Articles

Racial-ethnic differences in liver transplant waitlist outcomes in patients with hepatocellular carcinoma before and after recent changes to allocation policy.

In May 2019, liver transplant (LT) allocation policy changed to limit MELD exception points for hepatocellular carcinoma (HCC) to median MELD at transplant minus three (MMaT-3). We evaluated this policy's impact on waitlist outcomes for HCC candidates, by race and ethnicity, hypothesizing that the introduction of the MMaT-3 reduced inequities in waitlist outcomes. Retrospective cohort study of the Scientific Registry for Transplant Recipients, including all adult LT candidates (N=10751) who received HCC exception points from May 17, 2017 to May 18, 2019 (pre-policy; N=6627) to May 19, 2019 to March 1, 2021 (post-policy; N=4124). We compared incidence of LT and waitlist removal for death or becoming too sick pre- and post-policy for non-Hispanic White, non-Hispanic Black, Hispanic/Latinx, and Asian patients using competing risk regression adjusted for candidate characteristics. One-year cumulative incidence of LT decreased significantly pre-/post-policy among White (77.4%vs. 64.5%; p<.01) and Black (76.2%vs. 63.1%; p<.01) candidates only, while a 1-year incidence of death/non-LT waitlist removal decreased significantly only among Hispanics (13.4%vs. 7.5%; p<.01). After covariate adjustment, the effect of the policy change was a significantly decreased incidence of LT for White (SHR:.63 compared to pre-policy; p<.001), Black (SHR:.62; p<.001), and Asian (SHR:.68; p=.002), but no change for Hispanic patients. Only Hispanic patients had a significant decrease in death/waitlist removal after the policy change (SHR: .69; p=.04). Compared to White patients in the pre-policy era, Hispanic (SHR: .88, p<.007) and Asian candidates (SHR: .72; p<.001) had lower unadjusted incidence of LT. This disparity was mitigated in the post-policy era where Hispanic patients had higher likelihood of LT than Whites (SHR: 1.22; p=.002). For the outcome of death/non-LT waitlist removal, the only significant difference was a 42% lower incidence of waitlist removal for Asian compared to White patients in the post-policy era (SHR: .58; p=.03). Among LT recipients with HCC, racial/ethnic subpopulations were differentially affected by the MMAT-3 policy, resulting in a post-policy reduction of some of the previous disparities.

Just a story? Leadership, lived experience and integrated care.

Integrated care is based around values of involvement and shared decision-making, but these are not often reflected within planning and implementation. Barriers include continued emphasis on professional and managerial perspectives, skills gaps on how best to engage people and communitiesand insufficient investment in involvement infrastructure. Despite such challenges, people with lived experience have still led changes in policy and services. Qualitative study involving 25participants with lived experience from 12countries. Participants shared their background stories and engaged in semistructured interviews relating to leadership identity, experience of influencingand personal learning. Transcripts were analysed through a framework approach informed by narrative principles. Participants were motivated by their own experiences and a wish to improve care for future individuals and communities. Sharing their story was often the entry point for such influencing. Participants gained skills and confidence in story telling despite a lack of support and development. Many felt comfortable being described as a leader whileothers rejected this identity and preferred a different title. No common alternative term to leader was identified. Influencing services required considerable personal cost but also led to new networks, skills developmentand satisfaction when change was achieved. Leadership within integrated care is often awarded to those with structural power related to management or clinical seniority. People with lived experience are though uniquely placed to identify what needs to change and can develop inspiring visions based around their personal stories. Claiming identity as leader can be challenging due to traditional notions of who is eligible to lead and unwillingness by professionals and managers to grant such identity. People with lived experience should be recognised as leaders of integrated care and have access to developmental opportunities and practical support to strengthen their skills, including that of storytelling. PATIENT ANDPUBLIC CONTRIBUTION: The research was instigated on the request of a community advisory board of people with lived experience who shaped its design, contributed to the analysisand informed the conclusions and implications.

Using Federal, State, and Grassroots Advocacy to Effect Change in Cancer Care Delivery and Patient Outcomes in the United States.

Health policy influences health and well-being for patients with cancer. Advocating for evidence-based health policies that aim to prevent cancer, promote health, and improve efficiencies in the health care system is crucial to improving care delivery and cancer outcomes nationwide. The role of the ASCO's Government Relations Committee (GRC) is to advocate for policies at a federal and state level that promote high-quality and equitable cancer care, and ASCO volunteer engagement is critical for the success of creating, changing, and adopting policies that support patients with cancer and their care team. Cancer care professionals are uniquely positioned to advocate at all levels of government, local, state, and federal and to serve as invaluable resources for lawmakers as they work to implement policy changes. Lawmakers are highly responsive to cancer care providers as most lawmakers have family or friends who have been diagnosed with cancer. Multiple advocacy strategies that are effective and efficient in their approach have been used, making advocating feasible for cancer care professionals' busy schedule. To improve patient care, ASCO's GRC and ASCO volunteers advocate for increased federal funding for research, greater health care access, value in cancer care, and payment reform. ASCO's GRC has many programs in place to support ASCO members interested in engaging in advocacy to improve the quality of care for their patients and the support for cancer care professionals to thrive in the field.

Characterizing Adaptive Changes and Patient Survival After 2018 Donor Allocation Restructuring: A UNOS Database Analysis.

We sought to characterize adaptive changes to the revised United Network for Organ Sharing donor heart allocation policy and estimate long-term survival trends for heart transplant (HTx) recipients. Patients listed for HTx between October 17, 2013 and September 30, 2021 were identified from the United Network for Organ Sharing database, and stratified into pre- and postpolicy revision groups. Subanalyses were performed to examine trends in device utilization for extracorporeal membranous oxygenation (ECMO), durable left ventricular assist device (LVAD), intra-aortic balloon pump (IABP), microaxial support (Impella), and no mechanical circulatory support (non-MCS). Survival data post-HTx were fitted to parametric distributions and extrapolated to 5 years. We identified 27,523 HTx waitlist candidates during the study period, most of whom (n = 16,376) were waitlisted in the prepolicy change period. Overall, 19,554 patients underwent HTx during the study period (pre: 12,037 and post: 7517). Listings increased after the policy change for ECMO ( P < 0.01), Impella ( P < 0.01), and IABP ( P < 0.01) patients. Listings for LVAD ( P < 0.01) and non-MCS ( P < 0.01) patients decreased. HTx increased for ECMO ( P < 0.01), Impella ( P < 0.01), and IABP ( P < 0.01) patients after the policy change and decreased for LVAD ( P < 0.01) and non-MCS ( P < 0.01) patients. Waitlist survival increased for the overall ( P < 0.01), ECMO ( P < 0.01), IABP ( P < 0.01), and non-MCS ( P < 0.01) groups. Waitlist survival did not differ for the LVAD ( P = 0.8) and Impella ( P = 0.1) groups. Post-transplant survival decreased for the overall ( P < 0.01), LVAD ( P < 0.01), and non-MCS ( P < 0.01) populations. Allocation policy revisions have contributed to greater utilization of ECMO, Impella, and IABP, decreased utilization of LVADs and non-MCS, increased waitlist survival, and decreased post-HTx survival.

Cancer registration in Iceland for 70 years - incidence, mortality and survival

The Icelandic Cancer Registry (ICR) was founded seventy years ago by the Icelandic Cancer Society. In 2007 the ICR became one of the health registers of the Directorate of Health. In this paper we present cancer incidence, mortality, and survival in Iceland over 70 years. The ICR receives information on cancer diagnoses from histopathological laboratories, the Hospital Discharge Registry and the Cause of Death Registry. Iceland participates in the Nordic cancer database NORDCAN. Because of the small population size, random variation in numbers is very prominent. Therefore, data from ICR are published as five-year averages. For all malignancies combined, age-standardized incidence (ASI) in men rose steadily until around 15 years ago when a decline started. This is in line with prostate- and lung cancer incidence trends. In women, the ASI was lower than in men, but it is still on the rise despite declining lung cancer incidence. ASI for breast cancer, the most common cancer in women, is increasing. Simultaneously, cancer mortality for both sexes has declined in recent years and cancer survival is improving. Population-based cancer registration for over 70 years makes it possible to monitor the epidemiology of cancer in Iceland and compare with other countries. The changes in trends in ASI are in line with changes of cancer risk factors and diagnostic policy. The decline in cancer mortality and improvement in survival reflects advances in cancer treatment as well as effects of early detection and prevention.

Challenges for a Brazilian Amazonian bioeconomy based on forest foods

The creation of a forest bioeconomy based on the extraction of non-timber forest products (NTFP) is being recommended to create wealth from standing forests and halt deforestation in Amazonia. Current proposals do not recognize the limits of this system, nor the impacts of capitalism that drive NTFPs with elastic demand into monoculture plantations. We use a narrative review to revisit the history of these ideas and examine public policies. Among 2,253 Amazonian NTFPs, 1,037 produce edible fruits and 131 of these are extremely abundant (hyperdominant) across the biome and common in the extractive economy. Low productivity per hectare in the forest, low return on labor to harvest the production, and scarcity of labor are three critical limits to expanding supply, with the last being the most critical in forest areas. Overcoming these limitations requires changes in public policies and public investment for health care, communication, logistics, and especially for quality education designed for rural areas and a forest bioeconomy. A mix of public policies to alleviate market failures and increase supply, efficiency, and demand via R&D, minimum prices, payment for environmental services, distinct types of certifications may be able to make food NTFP harvesting, processing, and commercialization lucrative enough to halt rural exodus and keep forest specialists in standing forests. An Amazonian forest bioeconomy depends upon both social and biodiversity, and the full participation and collaboration of Indigenous People and local communities in developing these value chains that can contribute to food security.

Veterinary Issues: a course in social change and public policy

Veterinary Issues: a course in social change and public policy

Public Interest Litigation and the Protection of Women against Rape: A Comprehensive Study

Abstract: Public Interest Litigation (PIL) has emerged as a powerful tool for social justice, particularly in cases concerning the protection of women against sexual violence. This article provides a comprehensive study of PIL in the context of rape cases, focusing on its impact on legal frameworks, judicial activism, and societal attitudes towards women's rights. The article begins by tracing the historical development of PIL in India and its evolution as a mechanism for addressing systemic issues, including gender-based violence. It then examines landmark cases where PIL has been instrumental in shaping legal precedents and driving policy changes aimed at enhancing the protection of women against rape. Furthermore, the article explores the role of PIL in expanding the definition of rape, enhancing access to justice for survivors, and promoting gender-sensitive reforms in the criminal justice system. It also highlights the challenges and criticisms associated with PIL, including concerns about judicial overreach and the need for balanced decision-making.

신규위탁 원장의 국공립어린이집 운영에서의 공공성 저해 요인 탐색

Objectives The purpose of this study is to find out the motivation and background for consignment support of new entrusted public child care center to support consignment, and to exploration of disturbance factors of publicness in the new entrusteded directors’s public child care centers management. Methods The participants in this study were three directors who entrusted a new public child care center in H-si, Gyeonggi-do. Data were collected through a total of three sessions of in-depth interviews, data on the experi-ences of in the new entrusteded directors’s were transcribed, read repeatedly, extracted with meaningful key-words, and analyzed qualitatively to derive research results. Results The results of this study are as follows. First, the motivation and background of the director of the new entrusted public child care center for fostering support was found to be support for entrustment to a stable public child care center due to changes in child care policy and anxiety about operating private daycare centers. Second, the directors of a newly entrusted public child care center found that the factors disturbance the publicness of run-ning the child care center after being appointed include concerns about systematic management of the newly en-trusted public child care center, recruiting and managing teachers, difficulties for parents trying to resolve com-plaints, found that the factors disturbance the and difficulties responding to related organizations. Conclusions In order to ensure the publicness of the management of public child care centers, it is necessary to continuously investigate the factors disturbance that the director of a newly entrusted public child care centers finds difficult, establish a system and training course to provide systematic support from new entrustment. A edu-cation program for new directors should be developed to overcome the difficulties that new directors face when running a public child care center for the first time and to solve the problems that directors face.

The influence of food tax on island places

Noncommunicable diseases (NCDs) are the primary cause of premature mortality in Pacific Island Countries and Territories (PICTs), as well as in numerous other jurisdictions worldwide. The Pacific region has declared an NCD crisis and has recommended the implementation of food taxation policies to address the dietary risk factors associated with these diseases. However, the progress in this regard remains uncertain.The review focused on food taxation policies, including excise taxes and tariffs, that were implemented between 2000 and 2020 in 22 PICTs. The key characteristics of these policies were examined. The search for relevant information was conducted using databases, government legal repositories, and broad-based search engines. The identified documents for screening included legislation, reports, academic literature, news articles, and grey literature. Additionally, key informants from each PICT were contacted to gather further data and validate the findings. The results were analyzed through narrative synthesis. Out of the 22 PICTs included in the study, 14 had implemented food taxation policies, and 5 had introduced excise taxes. Processed foods, sugar, and salt were the primary targets of these excise taxes. A total of 84 changes in food taxation policies were identified across all food groups. Among these changes, a total of 279 taxes were identified based on food groups, with 85% being tariffs and 15% being excise taxes. The individual tax rates varied significantly. The most common tax design was ad valorem, followed by volumetric.

Digital sovereignty - Rhetoric and reality

ABSTRACT In recent years, the language of digital sovereignty has become ubiquitous in Europe. However, we still lack systematic knowledge if and to what extent the discourse on digital sovereignty is accompanied by actual policy change in different areas of EU policymaking. Drawing on a range of both qualitative and quantitative methods, the various contributions to this special issue examine discursive and policy change in nine major areas of EU digital policymaking. While they find policy change towards more control of the digital across all policy areas examined, this shift is only sometimes accompanied by discursive change towards digital sovereignty. This, we argue, is the result of ideational trade-offs actors face when using the language of digital sovereignty in different venues, policy areas, or countries. Considering current geo-political and geo-economic challenges, this special issue sheds light on recent transformations of EU digital policymaking and its discursive politics in the digital age.

Liver Transplant Costs and Activity After United Network for Organ Sharing Allocation Policy Changes.

A new liver allocation policy was implemented by United Network for Organ Sharing (UNOS) in February 2020 with the stated intent of improving access to liver transplant (LT). There are growing concerns nationally regarding the implications this new system may have on LT costs, as well as access to a chance for LT, which have not been captured at a multicenter level. To characterize LT volume and cost changes across the US and within specific center groups and demographics after the policy implementation. This cross-sectional study collected and reviewed LT volume from multiple centers across the US and cost data with attention to 8 specific center demographics. Two separate 12-month eras were compared, before and after the new UNOS allocation policy: March 4, 2019, to March 4, 2020, and March 5, 2020, to March 5, 2021. Data analysis was performed from May to December 2022. Center volume, changes in cost. A total of 22 of 68 centers responded comparing 1948 LTs before the policy change and 1837 LTs postpolicy, resulting in a 6% volume decrease. Transplants using local donations after brain death decreased 54% (P < .001) while imported donations after brain death increased 133% (P = .003). Imported fly-outs and dry runs increased 163% (median, 19; range, 1-75, vs 50, range, 2-91; P = .009) and 33% (median, 3; range, 0-16, vs 7, range, 0-24; P = .02). Overall hospital costs increased 10.9% to a total of $46 360 176 (P = .94) for participating centers. There was a 77% fly-out cost increase postpolicy ($10 600 234; P = .03). On subanalysis, centers with decreased LT volume postpolicy observed higher overall hospital costs ($41 720 365; P = .048), and specifically, a 122% cost increase for liver imports ($6 508 480; P = .002). Transplant centers from low-income states showed a significant increase in hospital (12%) and import (94%) costs. Centers serving populations with larger proportions of racial and ethnic minority candidates and specifically Black candidates significantly increased costs by more than 90% for imported livers, fly-outs, and dry runs despite lower LT volume. Similarly, costs increased significantly (>100%) for fly-outs and dry runs in centers from worse-performing health systems. Based on this large multicenter effort and contrary to current assumptions, the new liver distribution system appears to place a disproportionate burden on populations of the current LT community who already experience disparities in health care. The continuous allocation policies being promoted by UNOS could make the situation even worse.

Assessing the Feasibility of Climate Policies of Japan, Latvia and Lithuania to Reach the Targets of the Paris Agreement

The study compares the most recent developments in energy policies of Japan, Lithuania and Latvia as a way to mitigate climate change. Latvia, Lithuania and Japan have all pledged to reach net zero by 2050 but face significant challenges, namely the dependence on energy imports in the form of fossil fuels, as they keep dominating the final energy supply. All three countries have a goal to sharply reduce this dependence, with Lithuania and Latvia even striving to become net energy exporters by focusing almost entirely on renewable energy. Japan, on the other hand, also aim to boost a renewable energy share, yet focuses more on the diversification of imported energy sources. The study attempts to discuss the differing approaches in climate change mitigation in Japan as compared to Latvia and Lithuania. The ambition of each country is estimated by Intended Nationally Determined Contributions (INDCs), the roadmap to reduce the emissions in different sectors as enshrined in the climate strategy of each country, and the penetration of the renewable energy sector, estimating the scope of the ambition and implementation gaps compared to the goals set by the Paris Agreement. The study also estimates the impact of external impacts, namely the COVID-19 pandemic and the Russian invasion of Ukraine in shaping climate change policies. Therefore, this study offers a comprehensive outlook on what needs to be achieved so that all three countries could be role models to follow in the climate policy. All three countries could collaborate on solar power, off-shore wind power, and hydrogen technologies. There have already been joint projects between Japan and the EU on advanced biofuels and the new generation of concentrator photovoltaics. However, there are significant differences regarding the role of ammonia and hydrogen production in the Climate change policy strategies of the three countries. Some contributing sectors are left behind and the current climate change strategies, even if properly implemented, may not be 2°C-compatible, let alone 1.5°C-compatible. The policies look even direr for a fair share target, and the implementation gap generally remains wide for the 2024-2030 period.

Industrial relations as power, place and time: the case of Queensland coal mining

ABSTRACT How has the coal mining industry been changing as employers and unions organise their power resources to control and remake spaces of working and living? The most obvious likely changes are those driven by climate change policies. These are, however, only the most obvious, albeit fundamental, transformations facing coal mining workforces and unions. In the massive export coalfields of the State of Queensland, which have been central to the Australian politics of climate change, a less discussed phenomenon has been unfolding, a remaking of place and power in industrial relations. Employer-driven changes, namely automation, the geography of work and bargaining processes, and workforce composition, have presented themselves as the immediate threats to local traditions of work and social practice, not climate policy. ‘Power resources approaches’, when spatialised, historicised and entwined with labour process analysis, help to explain the breadth of employer-driven change and the unevenness of union responses.

A Stock Index Futures Price Prediction Approach Based on the MULTI-GARCH-LSTM Mixed Model

As a type of financial derivative, the price fluctuation of futures is influenced by a multitude of factors, including macroeconomic conditions, policy changes, and market sentiment. The interaction of these factors makes the future trend become complex and difficult to predict. However, for investors, the ability to accurately predict the future trend of stock index futures price is directly related to the correctness of investment decisions and investment returns. Therefore, predicting the stock index futures market remains a leading and critical issue in the field of finance. To improve the accuracy of predicting stock index futures price, this paper introduces an innovative forecasting method by combining the strengths of Long Short-Term Memory (LSTM) networks and various Generalized Autoregressive Conditional Heteroskedasticity (GARCH)-family models namely, MULTI-GARCH-LSTM. This integrated approach is specifically designed to tackle the challenges posed by the nonstationary and nonlinear characteristics of stock index futures price series. This synergy not only enhances the model’s ability to capture a wide range of market behaviors but also significantly improves the precision of future price predictions, catering to the intricate nature of financial time series data. Initially, we extract insights into the volatility characteristics, such as the aggregation of volatility in futures closing prices, by formulating a model from the GARCH family. Subsequently, the LSTM model decodes the complex nonlinear relationships inherent in the futures price series and incorporates assimilated volatility characteristics to predict future prices. The efficacy of this model is validated by applying it to an authentic dataset of gold futures. The empirical findings demonstrate that the performance of our proposed MULTI-GARCH-LSTM hybrid model consistently surpasses that of the individual models, thereby confirming the model’s effectiveness and superior predictive capability.

Preparing Vulnerable Communities: Disaster Mitigation Strategies for Economically Depressed Areas in Oklahoma

When disasters strike, vulnerable areas that are economically disadvantaged are adversely affected economically, culturally, and healthily, as the lack of resources and vulnerabilities amplify their problems. This research focuses on the population specifics of disaster vulnerabilities and targeted policies for economically depressed neighborhoods in Oklahoma. Relative to less susceptible entities, poor people are likelier to take damage from tornados, winter storms, wildland fires, and flooding because they lack the resources required for preparation, response, and recovery. Through an equity-focused lens, the study examines four key factors amplifying disaster risk: those due to aging critical infrastructure, lack of insurance and savings, health disparities, or the failure to plan adequately. Collapsed stormwater drainage systems, roads, bridges, and water pipes in financially deprived communities experience cracks in a hurry during duresses. With little or no funds, families earning every paycheck cannot afford to purchase rescue insurance or, in the case of names, save money to build an emergency fund, including money to cover repair costs, temporary housing, and other costs. This is, of course, made even worse by any previously existing medical, disability, or mental health issues as well, with poorer health outcomes than might usually be expected since access to healthcare services, treatments, and medications is also disrupted. Lastly, language and education barriers lead to the lower development of disaster plans; the delays include access to early warning systems and a need for more awareness of risks among vulnerable groups. Given these weaknesses, the study offers policymakers, funders, and resilience practitioner’s implementable policy, investment, and community-oriented intervention recommendations. The hazards can be lessened by prioritizing infrastructure upgrades, insurance reduction, and commitment to spread-out shelters and relief supplies. Long-term recovery programs financed specifically by equal aid promote program equity of rebuilding. Regarding inclusive messaging on public preparation and early warnings, local trusted institutions should be appropriated to reach a diverse population. Collaborative networks among government agencies, relief organizations, businesses, and grassroots associations can bolster response capacity. Their unified efforts on localized resilience initiatives advance strategic plans for the state's most economically fragile neighborhoods. Implementation should focus on those with the highest vulnerability markers and the least ability to prepare, respond, and recover independently— metrics assessing community functionality, equity factors, and recovering spending offer evidence-based progress milestones. With climate change projected to increase disaster severity in Oklahoma, research-driven and equitable resilience policies for marginalized communities can reduce prolonged suffering. Tailored preparation, outreach, critical system backups, and financial support lessen acute shocks and accelerate recovery. However, sustainable policy change relies on addressing root socioeconomic inequalities through systemic interventions beyond immediate disaster management.

Advancing carbon capture in hard-to-abate industries: technology, cost, and policy insights

AbstractIndustrial emissions are significant and need to be addressed in the fight against climate change. To achieve carbon emission reduction targets in line with climate change policies while maintaining the competitiveness of the industry, hard-to-abate sectors are exploring efficient carbon reduction technologies and striving to reduce associated costs. Carbon capture technology presents a large-scale CO2 reduction solution with immense potential. In promoting the application of carbon capture in hard-to-abate industries, it is essential to comprehensively analyze the feasibility and economics of carbon capture technology. This paper conducts a review of the technical feasibility and economics of carbon capture technologies in several industrial sectors, namely iron and steel, cement, and coal chemical industries. A vast amount of data on the costs of industrial carbon capture technologies has been gathered for comparison. This study also specifically addresses policy incentives that have been discussed and are currently being implemented to cut costs and promote industrial carbon capture projects. Graphical abstract

Between Freedom and Order: Evolution logic of urban-rural population mobility Policy from the perspective of historical institutionalism

Urban-rural population flow is the key element and important driving force for urban-rural integration development and rural revitalization. The pattern of urban-rural population flow in China is restricted and guided by policies. From the perspective of historical institutionalism, this paper analyzes the evolution context, structural logic and dynamic mechanism of the change of urban and rural population mobility policy. The urban and rural population mobility policy has gone through five historical stages: the order reconstruction period at the beginning of the founding of New China, the political call period after the Great Leap Forward Movement, the free flow period after the reform and opening up, the period of making the best use of the situation under the economic system reform and the accelerated integration period under the background of the new era. The institutional choice under different paths, the institutional evolution under the key nodes and the institutional continuation under the path dependence constitute the structural logic of the policy change of urban-rural population mobility. The situation coupling under the action of exogenous variables, the value coupling promoted by the change of ideas, and the subject coupling under the interaction of actors’ game constitute the dynamic mechanism of policy change, which promotes the historical change and realistic development of policy.

The impact of the OPTN policy change on patients with a durable left ventricular assist device and chronic kidney disease: Analysis of the UNOS database.

The Organ Procurement and Transplantation Network (OPTN) implemented modifications in 2018 to the adult heart transplant allocation system to better stratify the most medically urgent transplant candidates. We evaluated the impact of these changes on patients supported by a durable left ventricular assist device (LVAD) with chronic kidney disease (CKD). To evaluate the impact of the OPTN policy change on patients supported by durable left ventricular assist devices (LVAD) with chronic kidney disease (CKD). We performed an analysis of patients from the United Network of Organ Sharing Database supported by durable LVAD listed for a heart transplant (HT) between October 17, 2016 and September 30, 2021. Patients were divided into two groups: pre- and postpolicy, depending on whether they were listed on or prior to October 17, 2018. Patients who were on dialysis prior to surgery or discharge were excluded from the analysis. Patients with simultaneous heart and kidney transplants were excluded. Patients who were listed for transplant prepolicy change but transplanted postpolicy change were excluded. This cohort was then subdivided into degrees of CKD based on estimated glomerular filtration rate (eGFR), which resulted in 678 patients (23.7%) in Stage 1 (GFR ≥89.499) (Prepolicy: 345, Postpolicy: 333), 1233 (43.1%) in Stage 2 (89.499 > GFR ≥ 59.499) (Prepolicy: 618, Postpolicy: 615), 613 (21.4%) in Stage 3a (59.499 > GFR ≥ 44.499) (Prepolicy: 291, Postpolicy: 322), 294 (10.3%) in Stage 3b (44.499 > GFR ≥ 29.499) (Prepolicy: 143, Postpolicy: 151), 36 (1.3%) in Stage 4 (29.499 > GFR ≥ 15) (Prepolicy: 21, Postpolicy: 15), and 9 (0.3%) in Stage 5 (15 > GFR) (Prepolicy: 4, Postpolicy: 5). The primary outcome was 1-year and 2-year post-HT survival. There were 2863 patients who met the study criteria (1422 prepolicy, 1441 postpolicy). Overall survival, regardless of CKD stage, was lower following the policy change (p < 0.01). There was a similar risk of primary graft failure (PGF) in the pre- and postpolicy period (1.8% vs. 1.2%, p = 0.26). 1-year overall survival was 93% (91, 94) and 89% (87, 91) in the pre- and postpolicy periods, respectively. 2-year overall survival was 89% (88, 91) and 85% (82, 87) in the pre- and postpolicy periods, respectively. For CKD Stages 1, 2, 3a, 3b, 4, and 5, 1 -year survival was 93% (91, 95), 92% (90,93), 89% (86, 91), 89% (86, 93), 80% (68, 94), and 100% (100, 100), respectively. For CKD Stages 1, 2, 3a, 3b, 4, and 5, 2-year survival was 91% (88, 93), 88% (86, 90), 84% (81, 88), 84% (80, 89), 73% (59, 90), and 100% (100, 100), respectively. Patients with CKD 1 and 2 had better survival compared to those with CKD 3 (p < 0.01) and CKD 4 and 5 (p = 0.03) in the pre- and postpolicy periods. Patients with CKD 3 did not have a survival advantage over those with CKD 4 and 5 (p = 0.25). On cox regression analysis, advancing degrees of CKD were associated with an increased risk of mortality. Patients with LVAD support had decreased overall survival after the OPTN policy change. Patients with more advanced CKD had lower survival than patients without advanced CKD, though they were not impacted by the OPTN policy change.

Listening to Stakeholders’ Voices on Funding Social Inclusion in Sport for People with Disabilities—Proposal for Criteria

The value of sport is extensively documented; however, there are still groups who do not have the opportunity to enjoy the benefits of sport due to lack of investment, particularly important for people with disabilities. A gap persists in understanding the effectiveness of inclusive sport programs in addressing equity-related targets, particularly on the effective methods of financing inclusion in sport for individuals with disabilities. Therefore, providing a platform for stakeholders to express their perspectives becomes crucial. Through focus groups and the World Café approach, the aim of this study was to gather insights from athletes, parents, professionals, and sport club managers regarding the funding of inclusive sport for people with disabilities. A total of 72 participants took part in nine focus groups in Portugal, Slovenia, and Hungary: 27 athletes with disabilities, 22 coaches, other technicians and parents, and 23 club managers/directors. Findings were divided into five topics: (1) perspectives on current funding satisfaction; (2) perspectives on sources and criteria for funding; (3) perspectives on ideal funding; (4) perspectives on ideas to reach decision-makers; and (5) proposals on ideal criteria for funding. Based on these findings, six measurable criteria for fair funding allocation were suggested that could develop a properly weighted system of criteria for decision-makers to assess the allocation of funding among inclusive sport organizations with the potential to catalyze broader policy and societal changes. Additionally, there is a pressing need to develop a funding model for inclusive sport for individuals with disabilities.