Priority Allocation Research Articles

COMPARATIVE ANALYSIS OF THE TECHNOLOGY AND ENTREPRENEURSHIP CONTENT (1-3 CLASSES)

Education is one of the main factors for the socialization of adolescents on the one hand, and on the other is called upon to foster the personal development of each child. It is necessary for the modern education system not only to prepare the young generation to successfully solve problems of a different nature, but also to solve them effectively in a personal, professional and national level. This article presents results of a comparative analysis of the content of the course on technology and entrepreneurship in the first to third grade of BULVEST 2000 Publishing House, Anubis Publishing House, JUNIOR ACHIEVEMENT BULGARIA, SOFIA, publishing team Nikolay Tsanev, Genoveva Yotova, Dochka Kyuchukova, Emilia Palamarkova, Magdalena Delinesheva, Orchidea Delieva. The European education policy, which includes all eight key competences to be on an equal footing [4], is also implemented with the subject "Technology and Entrepreneurship". The law on pre-school and school education creates new, exceptional opportunities for more flexible, creative and independent planning and organization of the process of technology education in primary school age. The Technology and Entrepreneurship Curriculum for 1-3 grade is part of the cultural and educational field "Technological Education and Vocational Education". It has a common mission to progressively develop technological literacy and competence of students as an essential element of their general culture and general education. The learning process is oriented not so much to the final results of the practical work as to the processes and the technology for their achievement. The goals related to the contemporary economic life, education in initiative, entrepreneurship and responsibility are confirmed by "Ordinance №5 from 30.11.2015. for general education promulgated in the State Gazette, issue 95 of 08.12.2015 "[3]. They meet the requirements to master basic knowledge, skills and attitudes that are geared not only to work and environmental protection but also to the world of technology and technology. Emphasis is placed on textbook content and accessibility and science requirements, in line with learners' educational needs, ie the use of a variety of educational approaches and didactic technologies to achieve optimal educational outcomes. State educational standards and a syllabus on Technology and Entrepreneurship are a new challenge for primary teachers and specialists. The Ministry of Education and Science determines not only a new name, but also important priorities in curriculum content, time allocation, and technologies for learning two key competencies.

Neuro‐fuzzy based two‐stage spectrum allocation scheme to ensure spectrum efficiency in CRN–CSS assisted by spectrum agent

Cognitive radio network (CRN) is a promising technology to solve increasing spectrum scarcity problems in recent times. This study resolves the problem of cooperative spectrum sensing (CSS) and spectrum allocation in CRN-CSS in order to improve spectrum efficiency. A two-stage spectrum allocation scheme is initiated by grouping secondary users (SUs) with the knowledge of one-hop neighbor approach, which leads to minimised grouping time. These grouped SUs perform spectrum sensing in cooperative manner. Optimal channel assignment (OCA) process assigns channels to each SU in a group in a dynamic manner. Upon the assigned channel, SU performs spectrum sensing with the aid of the enhanced threshold energy detection (ETED) method. Finally, the available spectrum is allocated to SUs by a novel two-stage allocation approach. In this approach, SUs, which provide accurate spectrum sensing result, are given high priority for spectrum allocation. These SUs are detected through global decision making at the fusion centre (FC). A novel mining tree scheme with a spectrum agent is adopted for decision making at the FC. The neuro-fuzzy based spectrum allocation scheme in two-stage allocation supports effective spectrum allocation. An extensive experimental result exhibits promising improvements than in the previous approaches.

Sensory and decisional components of endogenous attention are dissociable.

Endogenous cueing of attention enhances sensory processing of the attended stimulus (perceptual sensitivity) and prioritizes information from the attended location for guiding behavioral decisions (spatial choice bias). Here, we test whether sensitivity and bias effects of endogenous spatial attention are under the control of common or distinct mechanisms. Human observers performed a multialternative visuospatial attention task with probabilistic spatial cues. Observers’ behavioral choices were analyzed with a recently developed multidimensional signal detection model (the m-ADC model). The model effectively decoupled the effects of spatial cueing on sensitivity from those on spatial bias and revealed striking dissociations between them. Sensitivity was highest at the cued location and not significantly different among uncued locations, suggesting a spotlight-like allocation of sensory resources at the cued location. On the other hand, bias varied systematically with cue validity, suggesting a graded allocation of decisional priority across locations. Cueing-induced modulations of sensitivity and bias were uncorrelated within and across subjects. Bias, but not sensitivity, correlated with key metrics of prioritized decision-making, including reaction times and decision optimality indices. In addition, we developed a novel metric, differential risk curvature, for distinguishing bias effects of attention from those of signal expectation. Differential risk curvature correlated selectively with m-ADC model estimates of bias but not with estimates of sensitivity. Our results reveal dissociable effects of endogenous attention on perceptual sensitivity and choice bias in a multialternative choice task and motivate the search for the distinct neural correlates of each.NEW & NOTEWORTHY Attention is often studied as a unitary phenomenon. Yet, attention can both enhance the perception of important stimuli (sensitivity) and prioritize such stimuli for decision-making (bias). Employing a multialternative spatial attention task with probabilistic cueing, we show that attention affects sensitivity and bias through dissociable mechanisms. Specifically, the effects on sensitivity alone match the notion of an attentional “spotlight.” Our behavioral model enables quantifying component processes of attention, and identifying their respective neural correlates.

SUN-122 SIX-MINUTE WALK TESTING IN PATIENTS NEARING THE TOP OF THE KIDNEY TRANSPLANT WAITLIST

Poor physical function in kidney transplant candidates is associated with frailty, decreased cardiorespiratory fitness, sub-optimal transplant outcomes and higher health care utilization. We need an instrument to objectively assess physical function in patients on the waitlist. In May 2017, our center began in-person re-evaluations of patients on the waitlist who have high allocation priority based on the new Kidney Allocation System. We used the 6-minute walk (6MWT) as a measure of cardiorespiratory fitness and 1-minute sit-to-stand tests (STS) as a measure of lower extremity strength.

Contestations around water allocation during a climate crisis in India: The case of ‘IPL vs. drought’

In this paper, we analyze a major controversy regarding the allocation of water for Indian Premier League (IPL) cricket matches during a period of extreme drought in the state of Maharashtra in India. We use a discursive approach to public policy to understand water policy production and to analyze the competing narratives on water advanced by opposing discourse coalitions during the ‘IPL vs. drought’ controversy. We find that the neoliberal view of ‘water as an economic good’ is dominant and institutionalized in the water allocation priorities determined by the Maharashtra State government. This is resisted by civil society actors like Loksatta and by the Indian judiciary, who view ‘water as a Human Right.’ Our reading of the ‘IPL vs. drought’ public interest litigation (PIL) shows that Loksatta’s decision to target water allocation for the IPL through the Courts leverages the popularity of the IPL in the Indian media, as well as the uneven unfolding of neoliberalism across institutions of the state in India. At the same time, Loksatta’s PIL focuses solely on the IPL and does not pay attention to the water allocation to larger users like industry and sugarcane cultivation that best represent the institutionalization of the neoliberal view of water in Maharashtra. We argue that the focus on the IPL makes it the site of contesting water policy on ideological grounds. We conclude by examining the challenge provided by Loksatta’s PIL to the dominant neoliberal view of water in Maharashtra.

Energy-Efficient GCSA Medium Access Protocol for Infrastructure-Based Cognitive Radio Networks

The major challenge encountered by battery-driven wireless local area networking devices is to conserve their energy for prolonged operation. This paper presents an energy-efficient medium access mechanism called group control slot allocation (GCSA) protocol for cognitive radio (CR) networks. GCSA utilizes the group priority allocation algorithm to allocate stations (STAs) into groups; subsequently STAs that have traffic buffered in an access point are assigned to a higher priority group. A management frame, namely group monitoring pointer, optimizes the sleep-awake cycle of the STAs by allocating transmission opportunities to groups based on their priority. GCSA employs publisher-subscriber and point-to-point messaging models for communication between the base station and STAs, respectively. Performance analysis of GCSA demonstrates that increasing the number of STAs which enter into sleep mode augments the percentage of energy saved. The overall system-level results show that energy saved is around 20% higher for GCSA than the IEEE 802.11e standard hybrid coordination function power-saving mode. Since GCSA benefits from history-assisted-led spectrum sensing, the paper also presents the relationship of the local storage of CRs with respect to history and suggests a hybrid approach as best option to keep a balance between the sensed data and its sharing with analytical engine database for history enrichment leading toward improved energy efficiency.

Collaborative governance and role of the Grantee in HIV/AIDS health services: the Broward County of South Florida experience

ABSTRACTThis research examines the collaborative engagement of target populations, service providers, and non-elected community leaders following a legislative mandate to provide care and treatment to human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS)-infected and HIV/AIDS-affected populations with the Grantee as the critical variable. The study relies mainly on in-depth interviews of key stakeholders in 2016 and is complemented by observations in 2013–2014 to generate relevant data for analysis and interpretation. Findings point to the Grantee’s essential role in allocation priorities, stakeholders’ capacity building, conflict resolution, strategic engagement and planning, contracts with a network of providers, and attendant execution and performance measures. The study highlights the Grantee’s pivotal role in the convergence of community and county administration in collaborative governance toward purposeful ends with collective impact on some vulnerable segments of the population. The study also exemplifies a rare case of public policy addressing a public problem consistently over the years despite some resource challenges.

Cost of Illness of Paraquat Poisoning in Colombia

IntroductionParaquat (PQ) poisoning is a public health problem that affects developing countries. The lack of information regarding the economic impact generated by this problem in the country constitutes a barrier to the correct allocation of health priorities. ObjectiveEstimate the annual cost of PQ poisoning in Colombia. MethodsA cost-disease study was made, using a decision tree model from the perspective of society, taking an approach based on prevalence. A probabilistic sensitivity analysis was made using the Monte Carlo technique with a simulation of a hypothetical cohort of 10,000 patients intoxicated by PQ. ResultsAn average cost per patient of US$ 2.642 (CI 95% 2.237-6.638 US$) was estimated for acute PQ poisoning. Taking into account the national report during 2017 of 344 cases to national surveillance system; the total cost of PQ poisoning in Colombia amounts to US $ 892 336 per year. ConclusionsThe average cost per patient intoxicated by PQ exceeds that of various chronic diseases prevalent in our country. This reveals the impact not only clinical, but also economical, of this poisoning in our country, necessitating strategies that regulate commercialization to avoid premature deaths.

SWOT ANALYSIS OF THE TECHNIQUES AND ENTREPRENEURSHIP FOR THE FIRST CLASS OF PUBLICATIONS "PROSVETA", SOFIA and "PROSVETA PLUS", SOFIA

This article presents results of a SWOT analysis of an educational package / textbooks, teaching aids and notebooks / on technologies and entrepreneurship in the initial educational degree of two Bulgarian publishers. Emphasis is placed on the curriculum content, the accessibility requirements and the science, in line with learners' educational needs. The diversity of educational approaches used and didactic technologies to achieve optimal educational outcomes is taken into account. The law on pre-school and school education creates new, exceptional opportunities for more flexible, creative and independent planning and organization of the process of technology education in primary school age. The curricula of the subject Technology and Entrepreneurship are aimed at building the technological literacy and competence of the students, as an essential element of their general culture and general education. The Ministry of Education and Science determines not only a new name, but also important priorities in curriculum content, time allocation, and technology for learning two key competencies. Along with the requirements for acquiring basic knowledge, skills and relationships oriented towards the world of technology and technology, goals are set with regard to the contemporary economic life, education in initiative, entrepreneurship and responsibility (Ordinance № 5 of 30.11.2015 on general education preparation (Promulgated in the State Gazette, issue 95 of 08.12.2015). At the same time, the Law on Pre-school and School Education creates new, exceptional opportunities for more flexible, creative and independent planning and organization of the learning process. Teachers can freely construct and realize their vision for more effective teaching and learning to cover the expected results at the curriculum level. Emphasis is placed on positive attitude to work, to modern technology and technology. It is very clear that the traditional tradition of training, the new concepts are being introduced on a practical basis and provide an initial level of technological and economic literacy as a basis for building an entrepreneurial culture. There are also conditions for a wide variety of textbooks, methodologies and treks that seek to showcase different didactic technologies to achieve these results. This is a prerequisite for diversity in teaching and learning that each school and teacher can accomplish. They are seen as an essential element of general education. Thus, the European education policy is implemented and all eight key competences are equal (National Strategy for Lifelong Learning 2014-2020 Sofia: MES, 2014). State educational standards and curriculum on the subject are a new challenge for primary teachers and specialists. The learning process is oriented not so much to the final results of the practical work as to the processes and the technology for their achievement.

Feasibility of compensatory growth in early juveniles of “red claw” crayfish Cherax quadricarinatus under high density conditions

The aim of this work is to study the feasibility to induce compensatory growth in Cherax quaricarinatus crayfish at an early stage of development under high density, the typical conditions of nursery phase. An advantageous characteristic of this species is the capacity to face temporary starvation, especially at early stages of development. This would help to design feeding strategies avoiding overfeeding, and diminishing operating costs in aquaculture. In this sense, during the last 8 years it was analyzed in this species the application of intermittent feeding, known as unfavorable feeding condition followed by daily feeding (favorable feeding condition). This alternative feeding protocol was used in the present study to trigger compensatory growth. Juveniles weighing 0.07 ± 0.01 g were distributed in 2 feeding regimes: C (control): juveniles fed daily during 60 days, and IF (intermittent feeding): juveniles deprived of food for 4 days and then fed for the following 4 days, these 4 days’ cycles were repeated during the first 20 days, on day 21 they were daily fed until day 60. Juveniles were stocked in each tank under 0.0096 crayfish/cm2 density, and zootechnical and biochemical parameters were evaluated throughout 60 days. A very suitable and similar survival (~ 65%) was maintained between feeding regimes, and the previously unfavorable feeding condition did not promote greater aggression among juveniles. There was a small compensatory response, but no recovery occurred probably because the favorable feeding condition was too short to trigger a strong compensatory response. Hyperphagia and improvement of feed conversion were not observed in juveniles of IF, suggesting that the high density was the key for these primary compensatory mechanisms to be absent. The competition for food, could have affected and changed the priority in allocating energy resources for accelerated growth. Lipids and glycogen content from body mass were strongly depleted after unfavorable feeding condition, but there was almost a 100% recovery during favorable feeding condition. We suggest that this response was detrimental to body mass as a priority and as a strategy for juveniles to extend survival during the ‘double’ nutritional stress caused by intermittent feeding and high density. The applicability of this alternative feeding strategy during an intensive production system can be viable, however, some changes must be considered in order to trigger compensatory growth. We suggest that a long-term of the favorable feeding condition could trigger a strong compensatory response if the high density tested in the study is maintained. We believe that juveniles of the current study had to face two nutritionally stressful factors: food restriction and high density. This could change the priority in allocation of energetic reserves and then the other suggestion would be to reduce the density if the same alternative feeding protocol is maintained.

ORGANIZATION OF GASIFICATION OF THE REPUBLIC OF CRIMEA

The problems of gasification of the population of the Republic of Crimea have been considered. It has been revealed, that the lack of gas in the settlements of the Republic hinders the development of social infrastructure, as gas fuel provides significant saving money for consumers. The priority aspects of gasification in the regions and in the Republic of Crimea have been listed. The conditions of priority allocation of investments for gasification of the region have been named. Solutions to the problems between the regional government and business representatives have been offered. The existing examples of gasification have been adduced.

Water budgets as a tool for landfill owners and decision makers

According to the outcome of a United Nations conference in Johannesburg, 2002, manycountries of the world are facing large water management challenges that requiregroundwater and surface water resources to be protected. Leachate from landfills and citydumps is a significant source of groundwater and surface water contamination. LocalEnvironmental Protection Authorities have, during recent years, increased theirrequirements on the municipalities, the waste management companies and the industriesthat are running solid waste landfills. These requirements include having a goodknowledge of and control over the water budget and the geohydrological position of thelandfill area and its surroundings. In the case of new landfills, the demands are higher.According to the Waste Council Directive 1999/31 /EC on landfilling of waste, theMember States should set up a national strategy for pollution reduction, water control andleachate management at landfill areas. A meteorological station should be located on site.In order to ensure a proper and optimized design of the facilities, it is of the highestimportance to know the seasonal and short-time variations of the different terms of thewater balance, from both a quantitative and a qualitative point of view. Water budgets foran entire area can give a picture of water conservation, water allocation priorities,groundwater and stream flow, pollution tracking and ecosystem requirements in thewhole region around the landfill. These budgets can easily be made as hand calculations.In order to ensure adequate designs that are practical and economical, it is essential tohave reliable and accurate design tools and models available to estimate the waterbalance components and to predict liquid movement into, through, and out of landfills ofvarious designs. There are a number of models, such as HELP, PREFLO, MOBYDECand FILL, available. However, this paper presents water budget calculations on varioustime bases that can easily be carried out by hand and by the landfill owner.

A Quasi-Perfect Resource Allocation Scheme for Optimizing the Performance of Cell-Edge Users in FFR-Aided LTE-A Multicell Networks

A quasi-perfect resource allocation scheme for optimizing the performance of cell-edge users (CEUs) in FFR-aided LTE-A multicell networks (Q-PRAFFR) is proposed, which splits the cell-edge region, cell-edge bandwidth, and CEUs into six parts and allocates the resource to CEUs with the predefined resource allocation priority. Therefore, better performance for inter-cell interference (ICI) coordination is achieved, which results from the more uniform distance distribution among the CEUs allocated with the same bandwidth in different cells. Numerical results show that the outage probability of the fifth-percentile users is dropped by around 70% and the cell throughput is increased by about 10% compared with the state-of-the-art FFR technology.

Spatial distribution and determinants of acute respiratory infection among under-five children in Ethiopia: Ethiopian Demographic Health Survey 2016.

BackgroundChildhood acute respiratory infection remains the commonest global cause of morbidity and mortality among under-five children. In Ethiopia, it remains the highest burden of the health care system. The problem varies in space and time, and exploring its spatial distribution has supreme importance for monitoring and designing effective intervention programs.MethodsA two stage stratified cluster sampling technique was utilized along with the 2016 Ethiopian Demographic and Health Survey (EDHS) data. About 10,006 under-five children were included in this study. Bernoulli model was used to investigate the presence of purely spatial clusters of under-five acute respiratory infection using SaTScan.ArcGIS version 10.1 was used to visualize the distribution of pneumonia cases across the country. Mixed-effect logistic regression model was used to identify the determinants of acute respiratory infection.ResultIn this study, acute respiratory infection among under-five children had spatial variations across the country (Moran’s I: 0.34, p < 0.001). Acute respiratory infection among under-five children in Tigray (p < 0.001) and Oromia (p < 0.001) National Regional States clustered spatially. History of diarrhoea (Adjusted Odds Ratio (AOR) = 4.71, 95% CI: (3.89–5.71))), 45–59 months of age (AOR = 0.63, 95% CI: (0.45–0.89)), working mothers (AOR = 1.27, 95% CI: (1.06–1.52)), mothers’ secondary school education (AOR = 0.65; 95% CI: (0.43–0.99)), and stunting (AOR = 1.24, 95% CI: (1.00–1.54)) were predictors of under-five acute respiratory infection.Conclusion and recommendationIn Ethiopia, acute respiratory infection had spatial variations across the country. Areas with excess acute respiratory infection need high priority in allocation of resources including: mobilizing resources, skilled human power, and improved access to health facilities.

Exploring infant &amp; young child feeding (IYCF) practices &amp; perceptions in the London Borough of Tower Hamlets

Introduction: The aim of the research was to gain a greater understanding of infant and young child feeding perceptions and practices in the London Borough of Tower Hamlets and the role of early years’ providers in supporting healthy feeding practices. The research was used to feed into ongoing commissioning and resource allocation priorities, taking into consideration continuing budget restrictions, to achieve nutrition outcomes through effective early years’ public health interventions.&#x0D; Methodology: A qualitative methodology was applied. The target groups were mothers with children under five years old, early years ‘service providers and carers. The participants were selected using purposeful, convenience and snowball sampling methods. In total 18 focus group discussions, 36 interviews and 3 direct observation sessions were carried out with 144 participants across the borough.&#x0D; Findings: There was generally widespread knowledge that breastfeeding is best for infants, however, there was less clarity on the best time for introducing complementary food and drinks to infants. Mothers trust health providers for information, but most used the internet, family and friends for information as it was easier to access. Some mothers reported mixed messages, pain, and pressure from the media, families and friends as the main reasons for changing from exclusive breastfeeding to mixed feeding. Some mothers reported lack of support postnatally and inconsistent advice such as service providers giving mixed messages, especially regarding feeding in public, mixed feeding and when to introduce other fluids and foods. The borough’s infant and young child feeding support workers were valued, but not all mothers knew about the service. Certain groups, such as those with English as a second language, teenage mothers and mothers without childcare reported not using services routinely. &#x0D; Conclusions: Following presentation of the key findings, and a discussion with early years’ service providers, the Tower Hamlets Public Health Division suggested practice changes which were adopted by the LBTH council. The council committed to continue supporting the Infant Feeding &amp; Wellbeing Service (known as the Baby Feeding Service) to continue to improve infant and young child feeding practices. Health visitors are encouraged to use their new 3-4 month contact with post-natal mothers, in addition to the five mandated universal contacts, as an opportunity to offer nutrition support to mothers. The council also approved increased nutrition capacity within the Health Visiting and Public Health team. More information is now available on the Tower Hamlets website to support mothers with clear nutrition and infant feeding information with details of the many services mothers can access in the borough.

The Impact of Increased Allocation Priority for Children Awaiting Liver Transplant: A Liver Simulated Allocation Model (LSAM) Analysis.

The aim of the study was to investigate the impact of prioritizing infants, children, adolescents, and the sickest adults (Status 1) for deceased donor livers. We compared outcomes under two "SharePeds" allocation schema, which prioritize children and Status 1 adults for national sharing and enhanced access to pediatric donors or all donors younger than 35 years, to outcomes under the allocation plan approved by the Organ Procurement and Transplant Network in December 2017 (Organ Procurement and Transplantation Network [OPTN] 12-2017). The 2017 Liver Simulated Allocation Model and Scientific Registry of Transplant Recipients data on all US liver transplant candidates and liver offers 7/2013 to 6/2016 were used to predict waitlist deaths, transplants, and post-transplant deaths under the OPTN 12-2017 and SharePeds schema. Prioritizing national sharing of pediatric donor livers with children (SharePeds 1) would decrease waitlist deaths for infants (<2 years, P = 0.0003) and children (2-11 years, P = 0.001), with no significant change for adults (P = 0.13). Prioritizing national sharing of all younger than 35-year-old deceased donor livers with children and Status 1A adults (SharePeds 2) would decrease waitlist deaths for infants, children, and all Status 1A/B patients (P < 0.0001 for each). SharePeds 1 and 2 would increase the number of liver transplants done in infants, children, and adolescents compared to the OPTN-2017 schema (P < 0.00005 for all age groups). Both SharePeds schema would increase the percentage of pediatric livers transplanted into pediatric recipients. Waitlist deaths could be significantly decreased, and liver transplants increased, for children and the sickest adults, by prioritizing children for pediatric livers and with broader national sharing of deceased donor livers.

Resource Allocation Priority for Water Flow Monitoring in Reservoirs using Data Analytics

Resource Allocation Priority for Water Flow Monitoring in Reservoirs using Data Analytics

LVAD Patients with RV Failure Pre-Heart Transplant Have Reduced Post-Transplant Survival

Purpose LVAD patients with right ventricular (RV) dysfunction are prioritized on the heart transplant waiting list, however the post-transplant survival of this group is less well characterized. We aimed to determine RV dysfunction effect on post-operative survival. Methods We performed a retrospective review of the 2005-2018 OPTN/UNOS registry for candidates ≥ 18 years of age waitlisted for first-time isolated heart transplantation post LVAD implantation. Candidates were stratified based upon having RV dysfunction defined as having liver dysfunction or by the need for RVAD or IV inotropes. Results 8,379 candidates met inclusion criteria including 978 LVAD BTT patients with RV dysfunction and 7,401 BTT patients without. Compared with non-RV dysfunction patients, LVAD BTT patients with RV dysfunction were younger (median age 53 vs 56, p 0.05). Pre-transplant liver dysfunction, however, was an independent predictor of worse survival (HR 1.56, 95% CI 1.30-1.86, p Conclusion Pre-heart transplant RV failure in LVAD BTT patients is associated with decreased post-transplant survival. This survival difference is driven primarily by pre-transplant liver failure likely reflecting increased severity of RV dysfunction. While these patients currently have priority in organ allocation, future studies should evaluate candidate optimization prior to organ acceptance to improve post-transplant outcomes, particularly among patients showing signs of liver failure

High Calculated Panel Reactive Antigen (cPRA) is Associated with Decreased Rates of Transplantation and Increased Waitlist Mortality in Lung Transplantation: A UNOS/OPTN Registry Analysis

Purpose Sensitized candidates with unacceptable antigens are a group that demands special attention in lung transplantation . While calculated panel reactive antigen (cPRA) is used to assign allocation priorities in some solid organ transplants, this is not the case in lung transplantation. The association between cPRA and lung transplant outcomes is unknown, as well as the impact of cPRA on waiting list time and mortality. Methods We performed a retrospective cohort review from May, 2005 to 2018 of the SRTR registry with additional unacceptable antigen (UA) data provided by UNOS, that was used to calculate the pre-transplant cPRA (for candidates that provided UA data), for candidates ≥ 12 years of age waitlisted for first-time isolated lung transplantation. Candidates were stratified based upon lack of unacceptable antigen or cPRA for patients with any unacceptable antigens reported. Unadjusted competing risks and adjusted sub-distribution hazard models were fit. Results 29,008 candidates met inclusion criteria including 23,490 with no cPRA, 3,470 with cPRA Conclusion Sensitized lung transplant candidates experience longer waitlist times, lower rates of transplantation, and higher rates of waitlist mortality. Further evaluation of allocating organs with consideration of candidate cPRA may be warranted in order to optimize equity in access to transplants.

The Benefit of Heart Transplant Among Candidates Assigned Lower Priority in the New 6-Status US Heart Allocation System

Purpose In order to better rank-order candidates by medical urgency, the US has adopted a 6-status therapy-based system that reduces allocation priority for three groups that previously were Status 1A: candidates with 1) left ventricular assist devices (LVAD) listed with “elective” time, 2) LVAD complications and 3) intra-aortic balloon pump or high-dose inotrope treatment without cardiogenic shock. However, the potential impact of these priority reductions is unknown. Methods Using Scientific Registry of Transplant Recipients data on all US adult heart-alone transplant candidates from 2006-2015, We estimated the survival benefit of heart transplantation for each of the three targeted candidate groups using a mixed-effects proportional hazards model with transplantation as a time-dependent covariate, accounting for center-effects and adjusting for year of transplantation, donor quality and ischemic time Results A total of 29,095 adult candidates were listed at 113 centers during the study period and 19,507 (67%) received a heart transplant. Relative to remaining on the waitlist, Status 1A candidates in cardiogenic shock or respiratory failure had a dramatic survival benefit with transplantation, HR for death of 0.09 (95% CI 0.08-0.01). Compared to this group, all three targeted candidate groups had significantly lower benefit from heart transplantation, non-shock Status 1A candidates HR 0.20 (95% CI 0.17-0.24), LVAD complications HR 0.26 (95% CI 0.22-0.30), and LVAD elective 1A time HR 0.62 (95% CI 0.47-0.8) (Fig, p Conclusion All three of the targeted populations (LVAD elective time, LVAD complications, and non-shock 1A candidates) had lower estimated benefit of heart transplantation than Status 1A recipients in cardiogenic shock or respiratory failure, supporting the priority reductions implemented in the new 6-status system.