Poor Recipient Research Articles

Save the poor, shoot some bankers

Bilateral or multilateral organizations control about 90% of official overseas development assistance (ODA), much of which is wasted. This note traces aid failure to the daisy chain of principal-agent-beneficiary relationships linking rich donors to aid bureaucrats to poor recipients. Waste results when aid middlemen (un)intentionally misdirect ODA. Waste can be reduced by clarifying domestic goals for ODA, using fewer middlemen with greater intrinsic motivation, empowering recipients, and/or replacing bureaucracy with markets.

Resource allocation among worker castes of the leaf-cutting ants Acromyrmex subterraneus subterraneus through trophallaxis

The division of labor between the different worker castes of leaf-cutting ants may reflect in their capacity to exchange liquids by trophallaxis. The crop capacity of and trophallactic exchanges between different size classes of worker leaf-cutting ants of the sub-species Acromyrmex subterraneus subterraneus were investigated. Size classes were defined from head capsule widths and crop capacity of each class was determined following ad libitum feeding on dye solution. Experiments were carried out to investigate trophallactic exchanges between donor ants and recipient ants of each class size combination on a one to one basis. An experiment was also performed to investigate dye distribution within mini-colonies following introduction of three classes of donor ants. Worker ants were categorized into four size classes from their head capsule widths (C1 = 0.8–1.0 mm; C2 = 1.2–1.5 mm; C3 = 1.6–2.0 mm; C4 = 2.1–2.4 mm). C1 ants crop capacity was 0.13 μL; C2: 0.21 μL; C3: 0.52 μL; C4: 1.03 μL. Ants of each class previously fed on the dye solution (donors) were placed individually with an unfed ant of each class (recipients) and the presence of dye solution, passed from the donor to the recipient by oral trophallaxis was observed after 1 h. Results showed that all classes of donor ants performed trophallactic exchanges with all recipient classes. However, statistically fewer exchanges were seen for C2 donor ants when placed with C3 recipient ants. Ten donor ants of each of three classes (C2, C3 and C4) were introduced into mini-colonies without queen ants. It was observed that C1 and C2 ants were poor recipients, whilst C3 and C4 received the highest percentages of dye. Within 10 h of introducing the donor ants, 14 to 20% of their nest-mates had received dye solution, with 58 to 77% of dye passed to recipients. These studies show the altruistic nature of “food-laden” leaf-cutters and indicate that ants involved in garden maintenance activity are less likely to receive liquids from foraging workers.

Enforcement and capacity building in international cooperation

I examine enforcement and capacity building in international cooperation. In a game-theoretic model, a wealthy donor gives foreign aid in exchange for policy implementation by a poor recipient. The recipient has limited capacity to comply with international agreements, so the donor is not sure if cooperation failure is caused by willful disobedience or unintended error. I show that if perceived cooperation failure prompts reciprocal suspension of cooperation, the donor and recipient have a common preference for capacity building. But when the donor can request compensation for perceived cooperation failure, it only chooses to build capacity if cooperation is otherwise impossible. Consequently, the choice of enforcement mechanism shapes capacity building. This result lays a foundation for a genuine synthesis between the enforcement and managerialist schools of compliance. It generates falsifiable hypotheses and explains why reciprocal enforcement, which unfortunately inflicts collateral damage on the victim, is often considered legitimate.

Nuclear reprogramming in zygotes

Nuclear reprogramming, the conversion of the epigenome of a differentiated cell to one that is similar to the undifferentiated embryonic state, can be facilitated by several methods, such as nuclear transfer, cell fusion, use of embryonic stem cell extracts, and more recently, by the introduction of exogenous transcription factors. Amongst these various strategies, somatic cell nuclear transfer (SCNT) is, by far, the most effective method of nuclear reprogramming. The majority of SCNT studies have been carried out using enucleated mature oocytes, as reprogramming is efficient and can be completed within hours following the introduction of the somatic cell nuclei into the recipient oocyte. Fertilized eggs, on the other hand, were regarded as poor recipients for nuclear transfer, as previous studies showed that embryonic blastomeres transferred into enucleated zygotes were unable to develop to blastocysts. However, more recent studies have demonstrated that the method of enucleation and the cell cycle phase of the embryos can impact the success of somatic cell reprogramming when zygotes were used as nuclear recipients. It is, therefore, timely to revisit and further explore the nuclear reprogramming capacity of zygotes as recipients for SCNT. Assessment of the various factors that influence the reprogramming capacity of zygotes in SCNT also provide hints of the mechanistic nature of nuclear reprogramming.

Transplant Outcomes and Economic Costs Associated with Patient Noncompliance to Immunosuppression

We describe factors associated with immunosuppression compliance after kidney transplantation and examine relationships between compliance with allograft outcomes and costs. Medicare claims for immunosuppression in 15 525 renal transplant recipients with at least 1 year of graft function were used to calculate compliance as medication possession ratio. Compliance was categorized by quartiles as poor, fair, good and excellent. We modeled adjusted associations of clinical factors with the likelihood of persistent compliance by multiple logistic regressions (aOR), and estimated associations of compliance with subsequent graft and patient survival with Cox proportional hazards (aHR). Adolescent recipients aged 19-24 years were more likely to be persistently noncompliant compared to patients aged 24-44 years (aOR 1.49 [1.06-2.10]). Poor (aHR 1.80 [1.52-2.13]) and fair (aHR 1.63[1.37-1.93]) compliant recipients were associated with increased risks of allograft loss compared to the excellent compliant recipients. Persistent low compliance was associated with a $12 840 increase in individual 3-year medical costs. Immunosuppression medication possession ratios indicative of less than the highest quartile of compliance predicted increased risk of graft loss and elevated costs. These findings suggest that interventions to improve medication compliance among kidney transplant recipients should emphasize the benefits of maximal compliance, rather than discourage low compliance.

Fat and Bone Marrow Embolization in a Donor as the Cause of Death in a Lung Recipient

The cause of death in organ donors may have a great impact on organ recipient outcomes. Trauma is the prevailing cause of death among brain-dead patients in Iran and many other countries. Such patients may have many complications, among them vascular embolization with fat and other tissues. We have described herein a case of vascular embolization in a donor and its consequence on the recipient's outcome. The recipient was a 36-year-old woman with pulmonary fibrosis, who received a single lung transplant from a patient brain dead due to trauma. Donor had no obvious fractures; the oxygen challenge test was ideal. The harvested lung was normal upon bronchoscopy and it was clear on plain chest radiography. The day after lung transplantation, the recipient was extubated successfully with normal O(2) saturation. On computed tomography scan, there was a fixed infiltration at the base of the transplanted lung. On day 5 posttransplantation, the infiltrate expanded and the patient developed acute respiratory distress syndrome (ARDS). The patient's condition deteriorated rapidly and she expired on day 10 posttransplantation due to ARDS. The pathologic examination of the brain-dead patient, which was obtained from another patient's lung, was available after our recipient's death, showed massive vascular fat and bone marrow embolization. In the mentioned case, all criteria for lung harvest from the brain-dead patient were met. Looking for embolization is not among the criteria for lung transplantation if chest radiography is clear and O(2) challenge test is acceptable, but we observed a poor recipient outcome due to bone and fat embolization in the donor's lung. When transplanting from a traumatic patients, such complications should be kept in mind.

Die vaskularisierte Knochentransplantation

Vascularized pedicled bone grafts are known since the beginning of the last century. Microvascular bone grafts (free vascularized bone transfer) are known since the beginning of the seventies. In many experimental and clinical studies vascularized bone grafts were compared to their non-vascularized analogues. Because of their own non-interrupted blood supply and thus nearly normal vitality vascularized bone grafts show more rapid fracture healing, more pronounced adaptation to the new mechanical loadings (e. g. graft hypertrophy), higher survival and consolidation rate in poor or bad recipient bed conditions (infection, bad vascularization) and some neovascularization potential on the surrounding tissue. Because of those properties, it became possible to successfully treat a large segmental bone defect by only few operations. As the treatment of complicated combined soft tissue/bone defects led to high complication rate up to 40 to 60% the indications of this method were altered.

Hypothermic Liver Machine Perfusion With EKPS-1 Solution vs Aqix RS-I Solution: In Vivo Feasibility Study in a Pig Transplantation Model

Objective Hypothermic machine perfusion (HMP) is superior to simple cold storage for kidney preservation. We previous observed in a porcine liver transplantation model increased tumor necrosis factor–α (TNF-α) production eventually leading to poor recipient survival after HMP using standard kidney perfusion solution (KPS-1) compared with simple cold storage. We compared two solutions for HMP preservation of the liver: enriched KPS-1 (EKPS-1) and Aqix RS-I. Methods Pig livers were obtained after cold flushing with histidine-tryptophan-ketoglutarate solution. Subsequently, the livers were subjected to dual-vessel perfusion with two preservation solutions: EKPS-1 (n = 6) and Aqix RS-I (n = 3). After HMP preservation and transplantation, graft and recipient survival, hepatocellular damage (aspartate aminotransferase concentration), TNF-α production, and endothelial cell damage (hyaluronic acid clearance) were recorded. Results No primary graft nonfunction was observed. Recipient survival at postoperative day 3 was similar in both groups (33%). Aspartate aminotransferase concentration measured in serum samples after reperfusion was similar in both groups. After reperfusion, TNF-α concentration was higher and hyaluronic acid clearance was lower in the EKPS-1 group vs the Aqix RS-I group at 60, 120, and 180 minutes (all P < .05). Conclusion Hypothermic machine perfusion provided adequate longer term graft survival. After reperfusion, TNF-α production seems to be reduced, and endothelial cell dysfunction remains pronounced with Aqix RS-1 solution compared with EKPS-1 solution.

Distal revascularisation/replantation using the reversed radial artery

We describe a technique using the reversed radial artery for distal revascularisation or replantation in the hand. This technique has been used for revascularisation following crush avulsion injuries associated with a large zone of trauma and polydigit replantation. The technique involves dividing the radial artery and venae comitantes proximally and mobilising it distally into the hand for anastomosis. Temporary 'syndactylisation' of adjacent digits is also described. This can be used to convert multiple digits into a single vascular unit and to provide a bed for the transposed radial vessels. These techniques are an option when there is extensive injury to distal vessels such that end-to-end anastomosis is not possible and interposition venous micrografting may be difficult or prone to failure due to poor quality recipient vessels and the need to place grafts in a traumatised bed.

On the relation between impulses to help and causes of neediness: An experimental study

A novel two-person “charity game”, related to the “Samaritan’s Dilemma” [Buchanan, J.M., 1975. The samaritan’s dilemma. In: Phelps, E.S. (Ed.), Altruism, Morality and Economic Theory. Russel Sage Foundation, New York, pp. 71–85], is used to experimentally investigate the relation between helpers’ behavior and poor recipients’ reaction to aid. We distinguish two treatments differing in whether the causes of neediness are verifiable or not. Helping behavior does not vary significantly between treatments, but is positively correlated with dictator giving, suggesting idiosyncratic attitudes to help. Needy subjects are unaffected by anticipated help, but react optimally to chance.

The SXT/R391 Family of Integrative Conjugative Elements Is Composed of Two Exclusion Groups

Conjugative elements often encode entry exclusion systems that convert host cells into poor recipients for identical or similar elements. The diversity of exclusion systems within families of conjugative elements has received little attention. We report here the most comprehensive study to date of the diversity of exclusion determinants within a single family of conjugative elements. Unexpectedly, our analyses indicate that there are only two exclusion groups among the diverse members of the SXT/R391 family of integrative conjugative elements.

Does Mobility Undermine Income Redistribution? A Political-Support Approach to Redistribution in a Federation

Does Mobility Undermine Income Redistribution? A Political-Support Approach to Redistribution in a Federation, 10.1628/001522107X220071, Jahrgang 63 (2007) / Heft 2, 0015-2218 (1614-0974), Public Finance Analysis

Delayed integration as a possible remedy for the race to the bottom

It has been a long-standing concern in the literature that household mobility implies a serious threat to redistributive taxation. This paper considers the effects of delayed integration of migrants into the redistributive system of the target country. We argue that delayed integration may introduce a time consistency problem into governments' tax plans that reduces a region's incentive to undercut other regions' tax rates and can bring tax competition to a halt. Due to delayed integration, rich migrants cease to benefit from the lower tax rate in the current period. At the same time, the region's promise of a low rate in the future lacks credibility, since delayed integration locks in migrants once they are settled. We also explore the case where poor recipients of social assistance are mobile, while the rich are immobile.

The case for a regulated system of living kidney sales

The Iranian model of kidney transplantation, whereby donors are paid by a government-sponsored agency, has eliminated the waiting list completely. Elsewhere, black markets for kidneys encourage exploitation of the poor and harm both donors and recipients. As the buying and selling of organs increases relentlessly despite legislation, this author argues that failure to regulate these practices could be considered unethical.

Recurrence of Primary Sclerosing Cholangitis in Patients After Liver Transplantation

Background Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease that progresses to end-stage liver disease. There are several specific problems related to the posttransplantation period in these patients. The aim of this study was to analyze a single center experience with 17 orthotopic liver transplantations (OLT) due to PSC. Patients and Methods Seventeen patients were included (10 men, 7 women). Actuarial patient and graft survival rates and the incidence of recurrent sclerosing cholangitis were determined at 1, 5, and 7 years. Results Fifteen patients received single grafts, whereas two patients required retransplants. Patients received either cyclosporine (n = 7) or tacrolimus (n = 10) based immunosuppression. The 1-, 5-, and 7-year patient survival rates were 80%, 60%, and 60%, respectively, whereas the graft survival rates were 88%, 65%, and 65%, respectively. Two patients had cholangiocarcinomas (CCA) diagnosed during OLT; both recurred within 6 months and had a fatal outcome. Two patients (12%) developed recurrent sclerosing cholangitis, as assessed by liver histology and imaging of biliary tree. Conclusions Liver transplantation provides good patient and graft survival rates in cases affected with PSC. CCA is associated with poor recipient survival. Recurrent PSC occurs in approximately 12% of cases but does not significantly affect patient survival.

Grafts and flaps

‘Grafts' and ‘flaps’ are the terms used to describe pieces of tissue that are transferred from one part of the body to another during reconstructive procedures. A graft is a piece of tissue that is detached from its site (and, most importantly, blood supply) of origin, and transferred to a different site, where it relies on the local blood supply to survive. Skin is the most commonly grafted tissue, but a graft may be of any tissue (e.g. fascia, fat, tendon, nerve, vessel, bone, composite tissue). The recipient bed must consist of healthy, well-vascularized tissue. Grafts cannot survive on poorly vascularized, densely scarred or irradiated tissue, tendon denuded of paratenon, bone denuded of periosteum, or infected tissue. The process of a graft acquiring a blood supply from its new recipient bed is termed ‘take’. A flap is a piece of tissue that has an integral blood supply. Flaps can be classified according to their site, geometry, composition or blood supply. Flaps can be used to cover poor recipient beds, joint contractures, to cover open fractures or joints, and to import blood supply in infected or irradiated wounds. Flaps can also be used to reconstruct specific structures, such as the thumb (toe transfer), breast (latissimus dorsi or free abdominal flap), mandible (fibular flap) and pharynx (jejunal flap). If there are several reconstructive options, the composition of the defect morbidity of the, donor site, patient preference and the surgeon's experience should be considered when choosing which flap to use.

Prospective Psychosocial Evaluation of Related Kidney Donors: Indian Perspective

With increasing acceptance of living organ transplantation and growing numbers of organ donors, it becomes important to look for any adverse outcomes in this population. Prospective psychosocial evaluation of living related donors and assessment of the outcome of donation process was done. We also tried to identify any risk factors associated with any adverse event. Between January 2003 and December 2003, 75 consecutive donors (mean age 42.8 ± 11.6 years; M:F 54:21) were interviewed preoperatively and at 3 months postoperatively based on a 57-item questionnaire. Objective assessment of anxiety, depression, and social support was done with “modified Beck’s depression inventory,” “Speilberg’s state and trait anxiety,” and “social support” questionnaires. The majority (85.3%) of donors had volunteered for donation. There were no major depressive or anxiety disorders following donation. Though 21.3% donors perceived some negative impact on their health, none regretted the decision to donate and most (96%) would encourage organ donation. Prolonged donor hospitalization, persistent pain, poor recipient reciprocation, or recipient death were associated with a poor psychosocial outcome.

Conjugational genetic exchange in the hyperthermophilic archaeon Sulfolobus acidocaldarius: intragenic recombination with minimal dependence on marker separation.

In Sulfolobus acidocaldarius conjugation assays, recombinant frequency was relatively constant for marker separations from 1,154 bp down to about 50 bp and readily detectable at 10 bp. Three-factor crosses revealed little, if any, genetic linkage over distances of 500 to 600 bp, and large deletion mutants were good donors but poor recipients in matings. The results indicate that most intragenic recombination events occur at one of the mutations, not in the interval between them.

Artificial Time Inconsistency as a Remedy for the Race to the Bottom

A long-standing concern in the literature has been that household mobility implies a serious threat to the viability of redistributive taxation. This paper considers the effects of deferred integration of migrants into the redistributive system of the target country. In a model of symmetric regions, deferred integration introduces a time consistency problem into governments' tax plans that reduces a region's incentive to undercut other regions' tax rates and can bring tax competition to a halt. On the one hand, rich migrants cease to benefit from the lower tax rate in the current period. On the other hand, the region's promise of a continuing low rate in the future is not credible. We also explore the case where poor recipients of social assistance are mobile while the rich are immobile.

A Matched Pair Retrospective Comparison of Adult Unrelated and Sibling Donor Allogeneic Transplantation for AML.

Aim: Recent studies have shown equivalent survival outcomes for unrelated donor transplants for CML compared to siblings. This study compares outcomes for a set of unrelated donor transplants for AML and a strictly selected matching set of sibling donor transplants.Method: A set of 100 adult first 6/6 compatible unrelated donor transplant recipients with AML were selected from the ABMTRR database. A set of 100 adult first 6/6 compatible sibling donor controls were selected, matched with the subjects on disease stage, sex and age. Additional data was collected from participating centres on conditioning, prophylaxes, GVHD and other outcome factors.Results: A total of 162 forms were returned: 22 for good risk (CR1 - 15 siblings, 7 unrelated) and 140 for poor risk (past CR1 - 77 siblings, 63 unrelated). A Kaplan-Meier comparison of post transplant disease free survival between good risk sibling and unrelated donor recipients was not statistically significant (p=0.2). However the 5-year DFS of poor risk unrelated recipients was significantly worse than sibling recipients (sibling 29.5%, unrelated 14.1%, p=0.01). In a multivariate Cox regression model, the independent risk factors for DFS among all patients were unrelated donor (p=0.003), disease stage beyond CR1 (p=0.04), recipient male (p=0.04), aged 40 and over (p=0.04) and CMV positive (p=0.03).Conclusion: Adult unrelated donor allograft recipients in poor risk AML have poorer DFS probability than sibling recipients. However in good risk AML allograft recipients, donor type is not a significant DFS risk factor. The ABMTRR is an important national data resource providing a large and readily accessible sample frame for retrospective studies on specific transplant indications.