Prior Era Research Articles

Epidemiologic trends, risk factors and outcomes for pediatric myocarditis in the COVID era

BackgroundDuring the peak of the COVID pandemic, there was a high degree of awareness around myocarditis as a potential manifestation. However, it is not very clear if hospitalizations related to myocarditis increased pre- and during the COVID era and if there was an impact on outcomes of the same. ObjectivesThe objective of this study was to assess the epidemiology of hospitalizations for pediatric myocarditis between 2019 and 2022 (COVID era) compared to the prior era. An additional objective was to assess the outcomes for COVID and non-COVID myocarditis for hospitalized patients. MethodsPHIS database was utilized to identify patients diagnosed with myocarditis from 2006 to 2022 using appropriate diagnostic codes. To assess and compare the outcomes, such as in-hospital mortality, ICU hospitalization, and length of stay (LOS), mixed model multivariable logistic regression analysis was performed. ResultsA total of 5084 patients were diagnosed with myocarditis from 2006 to 2022. The incidence of myocarditis patients increased significantly from 4.23 % in 2006 to 15.2 % in 2021 (p < 0.001). Specifically, during the post-COVID era from 2020 to 2022, the incidence of myocarditis (n = 1298, 28.7 %) increased significantly. Out of which, one-third (n = 366, 28.1 %) of the patients were also diagnosed with COVID-19. Patients having COVID-19 along with myocarditis had two times (OR: 2.13 (95 % CI: 1.55–2.92), and patients utilizing mechanical ventilation had 13 times higher odds of ICU hospitalization. In contrast, patients visiting ED had 35 % lower odds of ICU hospitalization. Although patients diagnosed with COVID and myocarditis are twice as likely to be hospitalized in the ICU, there were comparable rates of discharge mortality between COVID era and non-COVID era among pediatric myocarditis cases. ConclusionDespite the increase in the incidences of myocarditis patients and increased hospitalizations during post-COVID era, rates of mortality among these patients were comparable.

Deriving and validating a protocol to determine the need for prophylactic peritoneal dialysis in neonates after cardiopulmonary bypass surgery

BackgroundProphylactic peritoneal dialysis (PD) in neonates undergoing cardiopulmonary bypass (CPB) is safe and improves outcomes. We sought to (1) derive the pre-operative characteristics of neonates who are most likely to benefit from PD after CPB and (2) validate a new prophylactic PD protocol based on our retrospective analysis.MethodsFirst, we retrospectively evaluated neonates requiring cardiac surgery with CPB from October 2012 to June 2016. We categorized neonates as those who “needed PD” and those who “did not need PD” based on prior experience with neonates requiring kidney support therapy. Pre-operative serum creatinine ≥ 0.8 mg/dL, pre-operative weight ≤ 2.5 kg, or having an open chest post-operatively were independently associated with “needed PD.” Next, beginning in March 2019, we implemented a new prophylactic PD protocol in which only those who met at least one of the three criteria derived in the retrospective analysis had a PD catheter placed in the OR.ResultsIn Era 2, after the implementation of a new prophylactic PD protocol, 100% of neonates in the “needed PD” group had a PD catheter placed in the OR, which was more than in the prior era (Era 1 = 86.6%) (p = 0.05). Only 26.1% in the “did not need PD” group had a PD catheter placed in the OR which was less than in the prior era (Era 1 = 50.6%) (p < 0.01).ConclusionsWe successfully developed and implemented an evidence-based prophylactic PD protocol that has improved our ability to provide prophylactic PD in neonates after CPB.Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

Stage 1 and 2 Palliation: Comparing Ductal Stenting and Aorto-Pulmonary Shunts in Single Ventricles with Duct-Dependent Pulmonary Blood Flow

Patent ductus arteriosus stenting (PDAS) for ductal-dependent pulmonary blood flow (DDPBF) provides a new paradigm for managing neonates with single ventricles (SV). Currently, sparse data exist regarding outcomes for subsequent palliation. We describe our experience with inter-stage care and stage 2 (S2P) conversion with PDAS in comparison to a prior era of patients who received surgical aorto-pulmonary shunts (APS). Retrospective review of 18 consecutive DDPBF SV patients treated with PDAS between 2016 and 2021 was done and compared with 9 who underwent APS from 2010 to 2016. Patient outcomes and pulmonary artery (PA) growth were analyzed. S2P was completed in all 18 with PDAS with no cardiac arrests and one post-S2P mortality. In the 9 APS patients, there was one cardiac arrest requiring ECMO and one mortality inter-stage. Off cardiopulmonary bypass strategy was utilized in 10/18 in the PDAS and 1/9 in the APS group (p = 0.005) at S2P. Shorter ventilation time, earlier PO feeding, and shorter hospital stay were noted in the PDAS group (p = 0.01, p = 0.006, p = 0.03) (S2P). Median Nakata index increase inter-stage was not significant between the PDAS and APS at 94.1 mm2/m2 versus 71.7 mm2/m2 (p = 0.94). Median change in pulmonary artery symmetry (PAS) was − 0.02 and − 0.24, respectively, which was statistically significant (p = 0.008). Neurodevelopmental outcomes were better in the PDAS group compared to the APS group (p = 0.02). PDAS provides excellent PA growth, inter-stage survival, progression along multistage single-ventricle palliation, and potentially improved neurodevelopmental outcomes. Most patients can be transitioned through 2 stages of palliation without CPB.

Abstract 14448: Graft Loss and Rejection Following COVID in Pediatric Heart Transplantation - A Pediatric Heart Transplant Society (PHTS) Propensity Matched Analysis

Introduction: While short-term outcomes following COVID among pediatric heart transplant (HT) recipients have been described, graft outcomes including the risks of subsequent graft loss and rejection following COVID are unknown. Hypothesis: We sought to determine the overall trends of post-HT survival during the COVID pandemic and determine if there was an increased risk for subsequent graft loss and/or rejection following post-HT COVID. Methods: All pediatric recipients of first HT between 1/2003-6/2022 in the Pediatric Heart Transplant Society ( PHTS) database were included. To assess if early post-HT survival changed during the COVID pandemic, 2-year HT survival was compared among those who underwent HT in 2014-2016, 2017-2019, and 2020-2022. To compare the risks of graft loss and rejection (acute cellular and/or antibody-mediated) between those with vs without post-HT COVID, a 1:2 (COVID vs non-COVID) propensity-score matched analysis using multiple pre-HT and post-HT factors (including exact matches for HT year and time post-HT) and Kaplan Meir analysis were performed. Patients with COVID within 3 months post-HT were excluded. Results: The 2-year post-HT survival was similar among patients who underwent HT across the 3 eras (Fig 1A). Among the overall 6634 patients (n = 888 [13%] with post-HT COVID), 861 patients with post-HT COVID and 1716 without post-HT COVID were included in propensity-score matching. There was no difference in the risk of subsequent graft loss (Fig 1B) or rejection (Fig 1C) among those with vs those without post-HT COVID. Conclusions: No differences were observed in early pediatric post-HT survival during the COVID pandemic compared to the immediately prior era. Post-HT COVID did not increase the risks of subsequent graft loss or rejection. Longer-term follow up is necessary to look at other potential post-HT COVID outcomes, such as coronary allograft vasculopathy.

Inner- and Outer-Sphere Cross-Coupling of High Fsp3 Fragments.

Natural product research originates from a desire to explore, understand, and perturb biological function with atomic precision. To reach these goals at all, let alone efficiently, requires thoughtful and creative problem solving. Often this means bold disconnections that would simplify access to complex structures, if only the methods existed to bridge these theoretical gaps. Whereas biological interrogations provide long-term intellectual value and impetus, methods come as attractive fringe benefits of natural product synthesis. This Account describes strategic, methodological solutions to the syntheses of natural products [(-)-eugenial C, Galbulimima alkaloids GB18, GB22, GB13, and himgaline] featuring new, convergent disconnections as important problem-solving steps, which themselves were inspired by recent methods that arose from our group. Each target required the invention of first-row transition metal-catalyzed cross-coupling procedures to satisfy the biological goals of the project. In these cases, synthetic strategy identified the methodological gap (the absence of stereo- and chemoselective couplings of appropriate fragments), but the tactical advantage conferred by first-row metals met the challenge. These methods were competent to handle the dense, sterically encumbered motifs common to natural products due to, in many cases, elementary steps that did not require bond formation between the hindered substrate and the metal center. Instead, these sterically lenient reactions appeared to involve metal-ligand-substrate reactions (i.e., outer-sphere steps), in contrast to the metal-substrate, coordinative reactions of precious metals (i.e., inner-sphere steps). Key observations from our previous studies, combined with the observations in seminal publications from other laboratories (Mattay, Weix, and MacMillan), led to the optimization of ligand-controlled, stereoselective reactions and the introduction of complementary catalytic cycles that revealed new modes of reactivity and generated novel structural motifs. Optimized access to bioactive natural product space accelerated our timeline of biological characterization, fulfilling a common premise of natural products research. The integration of methodology, complex natural product synthesis, diversification, and bioassay into a single Ph.D. dissertation would have been unmanageable in a prior era. The unique ability of first-row transition metals to effect Csp3-Csp3 cross-coupling with high chemo- and stereoselectivity has significantly lowered the barrier to reach the avowed goal of natural product synthesis and reduced the burden (real or perceived) of integrating natural products into functional campaigns.

Mortality in Patients With Ebstein Anomaly

BackgroundLow birth prevalence and referral bias constitute significant obstacles to elucidating the natural history of Ebstein anomaly (EA). ObjectivesAn extensive 2-country register-based collaboration was performed to investigate the mortality in patients with EA. MethodsPatients born from 1970 to 2017 and diagnosed with EA were identified in Danish and Swedish nationwide medical registries. Each patient was matched by birth year and sex with 10 control subjects from the general population. Cumulative mortality and HR of mortality were computed using Kaplan-Meier failure function and Cox proportional regression model. ResultsThe study included 530 patients with EA and 5,300 matched control subjects with a median follow-up of 11 years. In the EA cohort, 43% (228) underwent cardiac surgery. Cumulative mortality was lower for patients diagnosed in the modern era (the year 2000 and later) than for those diagnosed in the prior era (P < 0.001). Patients with isolated lesion displayed lower cumulative mortality than patients with complex lesions did (P < 0.001). Patients with a presumed mild EA anatomy displayed a 35-year cumulative mortality of 11% (vs 4% for the matched control subjects; P < 0.001), yielding an HR for mortality of 6.0 (95% CI: 2.7-13.6), whereas patients with presumed severe EA demonstrated an HR of 36.2 (95% CI: 15.5-84.4) compared with control subjects and a cumulative mortality of 18% 35 years following diagnosis. ConclusionsMortality in patients with EA is high irrespective of presence of concomitant congenital cardiac malformations and time of diagnosis compared with the general population, but overall mortality has improved in the contemporary era.

Dislocation and Surplus in Dictée's Sites of Recording

In its examination of the popular critical deployment of "postmodernism" in analyses of Theresa Hak Kyung Cha's final and most widely read text, Dictée, this essay aligns Cha's work with the modernist documentary. Readers have often suggested that Cha's postmodernist innovations highlight Dictée's radical break from a larger cultural timeline. This essay proposes, instead, that the text updates, rather than turns away from, documentary techniques of a prior era. It does so specifically, this essay argues, within the context of global economic transformations wrought by late capitalism. By mapping some of the contradictory relations of late capitalist history onto a formal intersection between the limits of historical documentation and the technics of mediation, Cha demonstrates how changes in the structure of capitalism prompt changing concepts of what it means to document history.

Changes in outcomes and factors associated with survival in melanoma patients with brain metastases.

Treatment options for patients with melanoma brain metastasis (MBM) have changed significantly in the last decade. Few studies have evaluated changes in outcomes and factors associated with survival in MBM patients over time. The aim of this study is to evaluate changes in clinical features and overall survival (OS) for MBM patients. Patients diagnosed with MBMs from 1/1/2009 to 12/31/2013 (Prior Era; PE) and 1/1/2014 to 12/31/2018 (Current Era; CE) at The University of Texas MD Anderson Cancer Center were included in this retrospective analysis. The primary outcome measure was OS. Log-rank test assessed differences between groups; multivariable analyses were performed with Cox proportional hazards models and recursive partitioning analysis (RPA). A total of 791 MBM patients (PE, n=332; CE, n=459) were included in analysis. Median OS from MBM diagnosis was 10.3months (95% CI, 8.9-12.4) and improved in the CE vs PE (14.4 vs 10.3months, P<.001). Elevated serum lactate dehydrogenase (LDH) was the only factor associated with worse OS in both PE and CE patients. Factors associated with survival in CE MBM patients included patient age, primary tumor Breslow thickness, prior immunotherapy, leptomeningeal disease, symptomatic MBMs, and whole brain radiation therapy. Several factors associated with OS in the PE were not significant in the CE. RPA demonstrated that elevated serum LDH and prior immunotherapy treatment are the most important determinants of survival in CE MBM patients. OS and factors associated with OS have changed for MBM patients. This information can inform contemporary patient management and clinical investigations.

Impact of left ventricular assist device complications on heart transplant outcomes under the 2018 heart transplant allocation policy

ObjectiveThe study objective was to determine the impact of left ventricular assist device complications on post–heart transplant survival before and after the 2018 US heart transplant allocation policy change. MethodsAdult patients (age >18 years) supported by left ventricular assist devices at the time of listing or transplantation in the United Network for Organ Sharing between October 18, 2015, and December 31, 2021, were included. Left ventricular assist device complications were defined by status at transplant (nonelective 1A in the prior era or new era status 2 or 3). Post-transplant survival (primary analysis) and baseline characteristics were compared among those with and without left ventricular assist device complications and by allocation era using multivariable Cox regression analyses. ResultsThe primary analysis included 4160 patients with left ventricular assist devices who underwent heart transplant (prior era n = 2458, new era n = 1702). Patients who underwent heart transplant with left ventricular assist device complications were on left ventricular assist device support longer under the new era (498 days vs 423 days P < .001). Post-transplant survival was highest in the prior era among those without left ventricular assist device complications. Patients who underwent transplantation in the prior era with a complication and in the new era without complications were not statistically different. Left ventricular assist device complications in the new era were associated with the highest post-transplant mortality (status 2 adjusted hazard ratio, 1.87, 95% confidence interval, 1.31-2.67, P < .001, status 3 adjusted hazard ratio, 1.50, 95% confidence interval, 1.11-2.04, P = .009). ConclusionsLeft ventricular assist device complications in the new era are associated with increased post-transplant mortality. As a heart allocation score is being considered, modeling time on left ventricular assist device support to promote heart transplant before development of left ventricular assist device–related complications may improve outcomes for patients with left ventricular assist devices.

Pregnancy in Pulmonary Arterial Hypertension: A Multidisciplinary Approach

Pulmonary arterial hypertension (PAH), a female predominant disease, carries a high maternal and fetal mortality in pregnancy despite improved insight and the development of novel therapies. The high risk is attributed to the adaptive changes that take place to promote healthy fetal development during pregnancy, which can adversely affect the already compromised right ventricle in patients with PAH. While in the prior era emphasis was placed on termination of pregnancy, here we will illustrate through a multidisciplinary approach and meticulous planning at an expert center, these high-risk women can undergo successful childbirth.

Impact of the new UNOS donor heart allocation system on waitlist outcomes and early posttransplant mortality among adults with congenital heart disease

Adults with congenital heart disease (ACHD) experience worse waitlist outcomes and higher early posttransplant mortality compared to non-ACHD patients. On October 18, 2018; the UNOS donor heart allocation system was redesigned giving unique listing status to ACHD patients. The impact of this change on outcomes in transplant-listed patients is unstudied. Using the Scientific Registry of Transplant Recipients (SRTR) we compared ACHD patients listed for the first-time for heart transplantation from two eras of equal duration. We analyzed waitlist outcomes, posttransplant mortality and length of stay among ACHD patients in both eras and between ACHD and non-ACHD patients in the new era. Of 12723listed patients, 535had ACHD (293 in the new era) and 12188 did not (6258 in the new era). A total of 163 (56%) ACHD patients in the new era versus 150 (62%) in the prior era were transplanted; 11 (3.8%) versus 15 (6.2%) died on the waitlist; 32 (11%) versus 35 (14%) were delisted and 15 (9.2%) versus 19 (12.7%) died within 30days of transplant, respectively. The new UNOS donor heart allocation system improved waitlist time and decreased the proportion not transplanted during the first 300 days after listing among ACHD patients without altering early posttransplant outcomes or significantly changing the gap in outcomes compared to non-ACHD patients.

Isolated Durable LVAD Bridge to Transplant: Institutional Review Following 2018 Allocation Changes

<h3>Purpose</h3> The purpose of this study was to compare our institutional experience using durable left ventricular assist devices (dLVADs) as a bridge to transplant before and after the 2018 heart allocation policy change. <h3>Methods</h3> Since the allocation change, 29 patients have been bridged to heart transplantation with an isolated dLVAD at our institution. We matched these patients with the most recent 29 consecutive patients bridged to heart transplantation with isolated dLVAD. Baseline pretransplant characteristics and comorbidities were compared between cohorts. Incidence of posttransplant complications, intensive care unit and hospital lengths of stay were compared, as well as 90-day mortality. <h3>Results</h3> Annual number of recipients bridged to transplant using a dLVAD declined after the first year following the allocation policy change (Figure A). Median age, body mass index, and distributions of primary heart failure etiology and dLVAD usage were similar between cohorts. The new policy cohort had a higher incidence of female recipients (21% vs 3%; P=0.044), but a lower incidence of patients maintained on intravenous inotropic therapy at time of transplant (3% vs 21%; P=0.044). Rates of prolonged mechanical ventilation, re-intubation, stroke and renal failure were comparable between cohorts. Intensive care unit length of stay and hospital length of stay were also similar. At 90 days, the new policy cohort experienced higher mortality (21% vs 3%; P=0.044) (Figure B). <h3>Conclusion</h3> From our institutional experience, there appears to be continual decline in patients bridged with dLVAD following the allocation policy change. While rates of many postoperative complications appear comparable to the prior era, short-term mortality appears to be higher. Changes in the heart transplant allocation system have resulted in changes in donor availability and selection for recipients with durable LVADs. These changes, along with the impact of the COVID-19 pandemic, may be responsible for these observations.

“We Foreigners Lived In Our Foreign Bubble”: Understanding Colorblind Ideology In Expatriate Narratives1

Racial colorblindness—the desire to not “see color”—or avoiding any use of the term “race” itself, has been an antiracist imperative in post‐WWII Sweden in order to leave behind the prior era of eugenics and racial thinking. Through a multi‐sited linguistic ethnographic study, this article examines how 46 returning Swedish expatriate women talk about race and whiteness in race‐related experiences and interactions, using colorblind language. By analyzing the implicit contextual associations and dissociations made between race, language, subjectivity, and nation, a system of ideas and cognitive structures mapping perceptions and constructions of the world is exposed; of national belonging, racialized bodies, racial hierarchies, and perceptions of the West itself. In their migrant narratives, however, the categories used could be ascribed opposite meanings, depending on subjectivity and context. In this logic, language and nationality becomes “visible” or “hidden” depending on time and place, while “visible whiteness” can be associated with either an undesirable sense of difference or a set of unspoken privileges.

Felsic Tesserae on Venus Permitted by Lithospheric Deformation Models

AbstractVenus tessera terrain contains the oldest rocks preserved on the surface of the planet. The composition of the tesserae is unknown, but recent observations of near‐infrared emissivity from orbit suggest that they are silica rich. This contrasts with previous interpretation that silica‐rich rheologies are too weak to produce tessera folds. We examine the range of compositions consistent with the observed folds in the tessera. We map folds in Tellus Regio tessera using the highest resolution Magellan radar images (∼100 m) and stereo topography (∼1 km). We use fold spacings as input into a buckling analysis that simulates power law rheology using contemporary dry‐mineral flow laws and modeled igneous rock compositions, consistent with a predicted dry lithosphere for Venus in the recent era. The folds have dominant wavelengths of 6–19 km with amplitudes of 500–1,000 m, consistent with low strains (1%–12%). We confirm that observed folds require heat flows of ≥40 K/km and strain rates faster than 10−16s−1, higher than today. These low strain folds are unlikely to have significantly modified the preexisting tessera surface, thus older impact craters must have been removed by an earlier geologic process. We demonstrate that the folds can form in dry crust with a SiO2 content ranging from 48% to 72%. Dry felsic rheologies could explain low emissivity signatures of tesserae that are attributed to a low Fe2+. If felsic, tessera materials may have formed in a prior era via partial melting of hydrous materials derived from recycling of surface waters into the Venus mantle.

Impact of the New UNOS Heart Transplant Allocation System on Waitlist and Early Post-Transplant Mortality among Adults with Congenital Heart Disease

<h3>Purpose</h3> Adults with congenital heart disease (ACHD) are more likely to die or be delisted while awaiting heart transplant, less likely to receive a heart transplant and more likely to die in the early (30-day) post-transplant period compared to non-ACHD patients. On October 18, 2018; the UNOS heart allocation system was redesigned providing unique listing status for ACHD patients. The impact of this change on outcomes is unstudied. <h3>Methods</h3> Using the Scientific Registry of Transplant Recipients we compared ACHD patients listed for the first-time for heart transplant from 2 eras of equal duration (new era: October 18, 2018 to June 2, 2020 and prior era: March 3, 2017 to October 17, 2020). Patients with transplants occurring in the new era who were initially listed in the prior era were excluded. We compared baseline characteristics, Kaplan Meier curves and log-rank tests to assess differences in early post-transplant mortality and the composite of waitlist mortality or delisting due to clinical worsening among those with CHD between both eras. <h3>Results</h3> Out of 535 ACHD patients listed, 293 were in the new era (4.7% of total listings) and 242 were in the prior era (3.7%). Age, sex, racial distribution, renal function, hemodynamics and need for ECMO were identical between the two groups. 163 (56%) ACHD patients in the new era versus 150 (62%) in the prior era were transplanted; 11 (3.8%) versus 15 (6.2%) died on the waitlist; 32 (11%) versus 35 (14%) were delisted and 15 (9.2%) versus 19 (12.7%) died within 30 days of transplant respectively. In the new era, ACHD patients were significantly less likely to experience waitlist mortality or delisting due to clinical worsening but had similar early post-transplant mortality compared to the prior era. <h3>Conclusion</h3> The new UNOS heart transplant allocation system improved waitlist outcomes among ACHD patients listed for heart transplant.

Authoritarian Roads Not Taken: Institutional Trajectories and Authoritarian Constitutionalism in Interwar Eastern Europe

Contemporary authoritarian regimes are more alike than they have been in decades, with most conforming to a constitutional structure that imitates liberal democracies, although many seek to innovate beyond this framework. This paper explores a prior era of authoritarian constitutional innovation, the twenty years of postwar independence among the states of Interwar Eastern Europe. This paper attempts a systematic conceptual categorization among Interwar-era authoritarian regimes in the Baltic states, East-Central Europe, and the Balkans over the period 1919-1939, identifying models akin to modern electoral authoritarianism as well as more unusual schemas conceptualized here as ‘authoritarian constitutionalism.’ Instead of asking why Eastern European states fell away from democracy during the interbellum, this paper asks what forms of authoritarianism took hold in a period when authoritarian institutional creativity was at an historic high. Leveraging data on regime, political system, and institutional configurations across all Eastern European authoritarian regimes, the paper groups institutional patterns and tracks their evolution over the Interwar era, introducing the concept of ‘authoritarian constitutionalism,’ a form of institutionalized authoritarian rule often left as a residual category or marked by ideological signifiers, to better explain the congruence of political and constitutional order across regional cases. Dynamics of authoritarian institutional experimentation are further illustrated with vignette case studies of the electoral authoritarian regime in Poland and the authoritarian constitutionalist regime of Konstantin Pats’ Estonia.

Telehealth for Home Dialysis in COVID-19 and Beyond: A Perspective From the American Society of Nephrology COVID-19 Home Dialysis Subcommittee

The coronavirus disease 2019 (COVID-19) pandemic, technological advancements, regulatory waivers, and user acceptance have converged to boost telehealth activities. Due to the state of emergency, regulatory waivers in the United States have made it possible for providers to deliver and bill for services across state lines for new and established patients through Health Insurance Portability and Accountability Act (HIPAA)- and non–HIPAA-compliant platforms with home as the originating site and without geographic restrictions. Platforms have been developed or purchased to perform videoconferencing, and interdisciplinary dialysis teams have adapted to perform virtual visits. Telehealth experiences and challenges encountered by dialysis providers, clinicians, nurses, and patients have exposed health care disparities in areas such as access to care, bandwidth connectivity, availability of devices to perform telehealth, and socioeconomic and language barriers. Future directions in telehealth use, quality measures, and research in telehealth use need to be explored. Telehealth during the public health emergency has changed the practice of health care, with the post–COVID-19 world unlikely to resemble the prior era. The future impact of telehealth in patient care in the United States remains to be seen, especially in the context of the Advancing American Kidney Health Initiative.

Measuring the Antitrust Revolution

Although antitrust always evolved with the economics of its time, economic analysis was not central to the antitrust enterprise until Continental T.V. Inc. v. GTE Sylvania. In doing so, the Court abandoned the multiple goals of the prior era to embrace a singular economic goal. With a singular goal, antitrust had become revolutionary. How to measure the antitrust revolution has been difficult. In this article, we focus on published case law, which provides a broad set of observations that includes government enforcement actions and private antitrust suits. We use the Caselaw Access Project database and its associated “Historical Trends” tool to track the usage of certain words and phrases in judicial opinions. This article is the first to measure antitrust terms in court cases that combine big data with data visualization techniques to better understand, based on the usage of common antitrust terms, the impact economics has had on decided cases.

Measuring the Antitrust Revolution

Though antitrust always evolved with the economics of its time, economic analysis was not central to the antitrust enterprise until Continental T.V. Inc. v. GTE Sylvania. In doing so, the Court abandoned the multiple goals of the prior era to embrace a singular economic goal. With a singular goal, antitrust had become revolutionary. How to measure the antitrust revolution has been difficult. In this article, we focus on published caselaw, which provides a broad set of observations that includes government enforcement actions and private antitrust suits. We use the Caselaw Access Project (“CAP”) database and its associated “Historical Trends” tool to track the usage of certain words and phrases in judicial opinions. This article is the first to measure antitrust terms in court cases that combines big data with data visualization techniques to better understand, based on usage of common antitrust terms, the impact economics has had on decided cases.

Macrosteatotic Allografts and Obese Recipients Have Nearly Equal Negative Impact on Liver Transplant Survival.

Our aim was to evaluate liver transplant outcomes involving donors with high macrosteatosis grafts in the obese modern liver transplant recipient population. A high-steatosis graft was defined as donor graft macrosteatosis ≥30% on biopsy. Recipient obesity was defined as body mass index (BMI) >35 adjusted for ascites. Raw and adjusted recipient liver transplant survival were evaluated and compared between 4 cohorts: (1) high-steatosis graft in high-BMI recipient; (2) low-steatosis graft in high-BMI recipient; (3) high-steatosis graft in normal-BMI recipient; and (4) low-steatosis graft in normal-BMI recipient. After adjustment for multiple factors, recipient high-BMI remained an independent predictor of posttransplant mortality at 30 days (P < 0.0001) and persisted at 1 year (P = 0.009). A high-steatosis graft was the strongest independent predictor of mortality at 30 days (hazard ratio 2.05, 1.66-2.53; P < 0.0001) and that effect was diminished but persistent at 1 year (1.27, 1.10-1.46; P = 0.001). Recipient high-BMI and a high-steatosis graft are both significant independent and equally powerful predictors of mortality after modern liver transplant. High-steatosis grafts transplanted into obese recipients have the highest mortality. The increase in mortality associated with a high-steatosis graft into a normal-BMI recipient is similar in magnitude to a low-steatosis graft placed into a high-BMI recipient.