327 results on '"C. Wiseman"'
Search Results
2. Existing Transplant Nephrology Compensation Models and Opportunities for Equitable Pay
- Author
-
Michelle A. Josephson, Alexander C. Wiseman, J. Kevin Tucker, Mark S. Segal, Rebecca J. Schmidt, Muhammad A. Mujtaba, Susan B. Gurley, Robert S. Gaston, Mona D. Doshi, Daniel C. Brennan, and Sharon M. Moe
- Subjects
Transplantation ,Nephrology ,Epidemiology ,Critical Care and Intensive Care Medicine - Published
- 2023
3. CKD in Recipients of Nonkidney Solid Organ Transplants: A Review
- Author
-
Alexander C, Wiseman
- Subjects
Risk Factors ,Nephrology ,Humans ,Organ Transplantation ,Renal Insufficiency ,Renal Insufficiency, Chronic ,Kidney ,Kidney Transplantation - Abstract
Chronic kidney disease (CKD) after solid organ transplant is a common clinical presentation, affecting 10% to 20% of liver, heart, and lung transplant recipients and accounting for approximately 5% of the kidney transplant waiting list. The causes of CKD are different for different types of transplants and are not all, or even predominantly, due to calcineurin inhibitor toxicity, with significant heterogeneity particularly in liver transplant recipients. Many solid organ transplant recipients with advanced CKD benefit from kidney transplantation but have a higher rate of death while waitlisted and higher mortality after transplant than the general kidney failure population. Recent organ allocation policies and proposals have attempted to address the appropriate identification and prioritization of candidates in need of a kidney transplant, either simultaneous with or after nonkidney transplant. Future research should focus on predictive factors for individuals identified as being at high risk for progression to kidney failure and death and on strategies to preserve kidney function and minimize the CKD burden in this unique patient population.
- Published
- 2022
4. Proactive Topical Maintenance Treatment of Psoriasis: Subanalysis of Canadian Patients in the Phase III PSO-LONG Trial
- Author
-
H. Chih-ho Hong, David N. Adam, Jason K. Rivers, Marni C. Wiseman, Henrik Thoning, and Clinton B. McCracken
- Subjects
Surgery ,Dermatology - Published
- 2022
5. Paraneoplastic alopecia areata surrounding a low-grade cutaneous carcinoma with squamous and trichoblastic features
- Author
-
Rachel Cecile Cogan, Jonah Wiseman Perlmutter, Ken von Kuster, and Marni C. Wiseman
- Subjects
medicine.medical_specialty ,business.industry ,AA, alopecia areata ,Case Report ,Dermatology ,Alopecia areata ,medicine.disease ,AA ,low-grade cutaneous carcinoma ,Cutaneous carcinoma ,RL1-803 ,CD8+ T ,medicine ,squamous ,alopecia areata ,business ,trichoblastic - Published
- 2021
6. Treatment of Atopic Dermatitis, Dermatophytes, and Syphilis by Indigenous Peoples Prior to 1850
- Author
-
Rachel Cecile Cogan, Marni C. Wiseman, and Jonah Wiseman Perlmutter
- Subjects
business.industry ,Arthrodermataceae ,Eczema ,Dermatology ,Atopic dermatitis ,medicine.disease ,Indigenous ,Dermatitis, Atopic ,Humans ,Ethnology ,Medicine ,Surgery ,Syphilis ,Indigenous Peoples ,Settlement (litigation) ,business - Abstract
The Iroquoian and Algonquian-speaking Peoples of North America discovered numerous natural treatments to dermatological conditions long prior to European settlement. Anthropological evidence suggests that treatments for atopic dermatitis, dermatophyte infections, and syphilitic lesions were derived from Sassafras albidum, genus Salix trees, and S assafras officinale. Literature suggests these medicinal properties are attributed to the naturally abundant safrole, salicylic acid, and ascorbic acid in these flora. Numerous instances of these natural medicinal discoveries later being implemented into European literature reaffirms the impact of Indigenous medicine on contemporary dermatology.
- Published
- 2021
7. ADC Nonlinearity Correction for the Majorana Demonstrator
- Author
-
D. C. Radford, G. K. Giovanetti, S. J. Meijer, J. M. López-Castaño, M. Clark, J. F. Wilkerson, C. D. Christofferson, A. Hostiuc, M. F. Kidd, C. Wiseman, B. R. White, B. Shanks, V. E. Guiseppe, R. J. Hegedus, A. Drobizhev, E. L. Martin, A. S. Barabash, J. Rager, T. Gilliss, H. Ejiri, Steven Elliott, B. Bos, R. D. Martin, M. P. Green, C. M. Campbell, M. Busch, G. Othman, Susanne Mertens, F. E. Bertrand, D. W. Edwins, Richard T. Kouzes, R. L. Varner, D. Tedeschi, D. Hervas Aguilar, W. Xu, Chang-Hong Yu, C. Cuesta, Ralph Massarczyk, Walter C. Pettus, Y-D. Chan, Keith Rielage, A. L. Reine, J. Gruszko, Pinghan Chu, T. K. Oli, S. Vasilyev, H. L. Crawford, N. Abgrall, I. Kim, I. J. Arnquist, N. W. Ruof, Yu. Efremenko, F. T. Avignone, I. S. Guinn, M. Buuck, Reyco Henning, A. W. P. Poon, A. M. Lopez, M. J. Stortini, J. M. Allmond, C. J. Barton, J. Myslik, J. A. Detwiler, C. R. Haufe, B. X. Zhu, Eric W. Hoppe, and T. S. Caldwell
- Subjects
Nuclear and High Energy Physics ,Physics - Instrumentation and Detectors ,Computer science ,Gamma-ray detectors ,Biomedical Engineering ,FOS: Physical sciences ,nucl-ex ,Atomic ,01 natural sciences ,Signal ,Particle and Plasma Physics ,0103 physical sciences ,Wide dynamic range ,Electronic engineering ,Waveform ,Nuclear ,Nuclear Experiment (nucl-ex) ,Electrical and Electronic Engineering ,010306 general physics ,Nuclear Experiment ,physics.ins-det ,Signal processing ,010308 nuclear & particles physics ,Dynamic range ,Detector ,Molecular ,Instrumentation and Detectors (physics.ins-det) ,Nuclear & Particles Physics ,Other Physical Sciences ,MAJORANA ,neutrinoless double-beta decay ,Nuclear Energy and Engineering ,Energy (signal processing) - Abstract
Imperfections in analog-to-digital conversion (ADC) cannot be ignored when signal digitization requirements demand both wide dynamic range and high resolution, as is the case for the Majorana Demonstrator 76Ge neutrinoless double-beta decay search. Enabling the experiment’s high-resolution spectral analysis and efficient pulse shape discrimination required careful measurement and correction of ADC nonlinearities. A simple measurement protocol was developed that did not require sophisticated equipment or lengthy data-taking campaigns. A slope-dependent hysteresis was observed and characterized. A correction applied to digitized waveforms prior to signal processing reduced the differential and integral nonlinearities by an order of magnitude, eliminating these as dominant contributions to the systematic energy uncertainty at the double-beta decay $Q$ value.
- Published
- 2021
8. Real-World Moderate-to-Severe Hidradenitis Suppurativa: Decrease in Disease Burden With Adalimumab
- Author
-
Wayne Gulliver, Afsaneh Alavi, Marni C. Wiseman, Melinda J. Gooderham, Jaggi Rao, Maryam Shayesteh Alam, Kim A. Papp, Olivier Desjardins, and Christine Jean
- Subjects
Adult ,Canada ,Treatment Outcome ,Cost of Illness ,Adalimumab ,Quality of Life ,Humans ,Pain ,Surgery ,Dermatology ,Severity of Illness Index ,Hidradenitis Suppurativa - Abstract
Background Real-world knowledge of the burden of hidradenitis suppurativa (HS) on patients remains limited. Objectives To measure the impact of adalimumab on moderate-to-severe HS patients’ health-related quality of life (HRQoL) and work productivity. Methods In 23 Canadian centres, 138 adults with moderate-to-severe HS requiring a change in ongoing therapy were treated with adalimumab for up to 52 weeks as per the physician’s practice. Patient-reported outcome measures (PROMs) were obtained at baseline, weeks 24 and 52 to measure overall HRQoL, HS severity, levels of anxiety and depression, impact and symptoms of HS, work productivity and activity impairment. A post-hoc analysis further explored the PROMs by abscess and inflammatory nodule (AN) count at baseline (≤5, low; 6–10, medium; ≥11, high). Results From baseline to weeks 24 and 52, all PRO overall scores improved significantly ( P ≤ .0023). The number of patients reporting “good disease control” and “complete disease control” increased from 9.7% to 66.4% over 52 weeks. The score in Health Utility Index Mark 3 (HUI3) pain attribute meaningfully decreased over 52 weeks (mean difference ≥.05). The HS symptoms skin “tenderness” and “itchiness” improved the most. Work productivity loss and activity impairment improved by approximately 20% over 52 weeks. Disease burden improved more in 24 week responders with low and medium AN counts at baseline than in those with high AN count or in 24 week nonresponders. Conclusion At week 24 and maintained at week 52 in a real-world setting, adalimumab meaningfully improved HRQoL, work productivity, and activity impairment in moderate-to-severe HS patients.
- Published
- 2022
9. Survey of Salary and Job Satisfaction of Transplant Nephrologists in the United States
- Author
-
Neeraj Singh, Mona D. Doshi, Jesse D. Schold, Luke Preczewski, Christina Klein, Enver Akalin, Nicolae Leca, Kimberly Nicoll, Todd Pesavento, Darshana M. Dadhania, John Friedewald, Milagros Samaniego-Picota, Roy D. Bloom, and Alexander C. Wiseman
- Subjects
Transplantation ,Nephrology ,Epidemiology ,Critical Care and Intensive Care Medicine - Abstract
There are no standardized benchmarks to measure productivity and compensation of transplant nephrologists in the United States, and consequently, criteria set for general nephrologists are often used.A web-based survey was sent to 809 nephrologists who were members of the American Society of Transplantation to gather data on measures of productivity, compensation, and job satisfaction. Factors associated with higher total compensation and job satisfaction were examined.Of 365 respondents, 260 were actively practicing in the United States and provided data on compensation. Clinical productivity was assessed variably, and although 194 (76%) had their work relative value units (wRVUs) reported to them, only 107 (44%) had an established RVU target; 234 (90%) had fixed base compensation, and 172 (66%) received a bonus on the basis of clinical workload (68%), academic productivity (31%), service (32%), and/or teaching responsibility (31%). Only 127 respondents (49%) filled out time studies, and 92 (35%) received some compensation for nonbillable transplant activity. Mean total compensation (base salary and bonus) was $274,460±$91,509. The unadjusted mean total compensation was higher with older age and was higher for men; Hispanic and White respondents; adult care transplant nephrologists; residents of the western United States; US medical school graduates; nonuniversity hospital employees; and those with an administrative title, higher academic rank, and a higher number of years in practice. Two hundred and nine respondents (80%) thought their compensation was unfair, and 180 (70%) lacked a clear understanding of how they were compensated. One hundred forty-five respondents (55%) reported being satisfied or highly satisfied with their job. Job satisfaction was greater among those with higher amounts of compensation and US medical school graduates.We report significant heterogeneity in the assessment of productivity and compensation for transplant nephrologists and the association of compensation with job satisfaction.
- Published
- 2022
10. Search for Spontaneous Radiation from Wave Function Collapse in the Majorana Demonstrator
- Author
-
I J, Arnquist, F T, Avignone, A S, Barabash, C J, Barton, K H, Bhimani, E, Blalock, B, Bos, M, Busch, M, Buuck, T S, Caldwell, Y-D, Chan, C D, Christofferson, P-H, Chu, M L, Clark, C, Cuesta, J A, Detwiler, Yu, Efremenko, H, Ejiri, S R, Elliott, G K, Giovanetti, M P, Green, J, Gruszko, I S, Guinn, V E, Guiseppe, C R, Haufe, R, Henning, D, Hervas Aguilar, E W, Hoppe, A, Hostiuc, I, Kim, R T, Kouzes, T E, Lannen V, A, Li, A M, Lopez, J M, López-Castaño, E L, Martin, R D, Martin, R, Massarczyk, S J, Meijer, T K, Oli, G, Othman, L S, Paudel, W, Pettus, A W P, Poon, D C, Radford, A L, Reine, K, Rielage, N W, Ruof, D, Tedeschi, R L, Varner, S, Vasilyev, J F, Wilkerson, C, Wiseman, W, Xu, C-H, Yu, and B X, Zhu
- Subjects
General Physics and Astronomy - Abstract
The Majorana Demonstrator neutrinoless double-beta decay experiment comprises a 44 kg (30 kg enriched in ^{76}Ge) array of p-type, point-contact germanium detectors. With its unprecedented energy resolution and ultralow backgrounds, Majorana also searches for rare event signatures from beyond standard model physics in the low energy region below 100 keV. In this Letter, we test the continuous spontaneous localization (CSL) model, one of the mathematically well-motivated wave function collapse models aimed at solving the long-standing unresolved quantum mechanical measurement problem. While the CSL predicts the existence of a detectable radiation signature in the x-ray domain, we find no evidence of such radiation in the 19-100 keV range in a 37.5 kg-y enriched germanium exposure collected between December 31, 2015, and November 27, 2019, with the Demonstrator. We explored both the non-mass-proportional (n-m-p) and the mass-proportional (m-p) versions of the CSL with two different assumptions: that only the quasifree electrons can emit the x-ray radiation and that the nucleus can coherently emit an amplified radiation. In all cases, we set the most stringent upper limit to date for the white CSL model on the collapse rate, λ, providing a factor of 40-100 improvement in sensitivity over comparable searches. Our limit is the most stringent for large parts of the allowed parameter space. If the result is interpreted in terms of the Diòsi-Penrose gravitational wave function collapse model, the lower bound with a 95% confidence level is almost an order of magnitude improvement over the previous best limit.
- Published
- 2022
11. High levels of dd-cfDNA identify patients with TCMR 1A and borderline allograft rejection at elevated risk of graft injury
- Author
-
Tarek Alhamad, Oyedolamu K. Olaitan, Dhiren Kumar, Irfan Agha, Nicolae Leca, Y. Qazi, Joseph K. Melancon, Hasan Fattah, Sidney J. Swanson, Erik Stites, Jonathan S. Bromberg, Gaurav Gupta, Alexander C. Wiseman, and Matthew R. Weir
- Subjects
Graft Rejection ,medicine.medical_specialty ,Banff Classification ,rejection: T cell mediated (TCMR) ,Renal function ,kidney (allograft) function/dysfunction ,clinical research/practice ,Gastroenterology ,Interquartile range ,Internal medicine ,Biopsy ,medicine ,Humans ,Immunology and Allergy ,Pharmacology (medical) ,monitoring: immune ,Subclinical infection ,Transplantation ,medicine.diagnostic_test ,business.industry ,Clinical Science ,Allografts ,Kidney Transplantation ,Tissue Donors ,kidney failure/injury ,Allograft rejection ,biomarker ,Biomarker (medicine) ,Original Article ,ORIGINAL ARTICLES ,cellular transplantation (non‐islet) ,business ,Cell-Free Nucleic Acids ,Antibody formation - Abstract
The clinical importance of subclinical, early T cell–mediated rejection (Banff TCMR 1A and borderline lesions) remains unclear, due, in part to the fact that histologic lesions used to characterize early TCMR can be nonspecific. Donor‐derived cell‐free DNA (dd‐cfDNA) is an important molecular marker of active graft injury. Over a study period from June 2017 to May 2019, we assessed clinical outcomes in 79 patients diagnosed with TCMR 1A/borderline rejection across 11 US centers with a simultaneous measurement of dd‐cfDNA. Forty‐two patients had elevated dd‐cfDNA (≥0.5%) and 37 patients had low levels (, Among patients with borderline and 1A T cell–mediated rejection, a threshold of ≥ 0.5% of donor‐derived cell‐free DNA was associated with increased risk of renal function decline, donor‐specific antibody development, and future episodes of recurrent rejection.
- Published
- 2020
12. Variable Energy X-ray Fluorescence Source
- Author
-
S.R. Elliott, E.M. Bond, B. Dodson, G. Rusev, R. Massarczyk, S.J. Meijer, M. Stortini, and C. Wiseman
- Subjects
Physics - Instrumentation and Detectors ,FOS: Physical sciences ,Instrumentation and Detectors (physics.ins-det) ,Nuclear Experiment (nucl-ex) ,Instrumentation ,Nuclear Experiment ,Mathematical Physics - Abstract
We detail the design of a variable energy, x-ray fluorescence source using a low activity (1.8$\times10^6$~dpm) \nuc{99}{Tc} $\beta$ source that irradiates thin foils. By rotating the source among foils of Ti, Zn, Nb, Ag, and Au, the device produces x rays between 4 and 70 keV at a rate near 1 Hz. When the source is placed in a storage position, the external radiation is non-detectable. The design of the shielding and rotation mechanism permits use in vacuum and at liquid nitrogen temperature. The design is intended for the study of the low energy response to radiation impinging upon Ge detector surfaces. The source will be useful for understanding the detector response in large-scale Ge arrays such as \textsc{Majorana} and LEGEND., Comment: planned submission to JINST
- Published
- 2022
- Full Text
- View/download PDF
13. Examining the trajectory and predictors of post-concussion sleep quality in children and adolescents
- Author
-
M Fisher, C Wiseman-Hakes, J Obeid, and C DeMatteo
- Subjects
Sleep Quality ,Adolescent ,Polysomnography ,Neuroscience (miscellaneous) ,Developmental and Educational Psychology ,Humans ,Female ,Neurology (clinical) ,Child ,Sleep ,Actigraphy ,Brain Concussion - Abstract
This study aimed to 1) determine if post-concussion sleep quality of children and adolescents differed from healthy sleep estimates; 2) describe the trajectory of parameters of sleep quality; 3) determine factors that predict sleep quality outcomes; and 4) compare sleep parameter outcomes between asymptomatic and symptomatic participants at 4 weeks post-concussion. Nightly actigraphy estimates of sleep in 79 children and adolescents were measured throughout 4 weeks post-concussion. Total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), number of arousals (NOA), and average arousal length (AAL) were measured. Child and adolescent participants experienced significantly poorer SE and longer WASO duration throughout 4 weeks of recovery and adolescents experienced significantly longer TST. SE significantly improved with time post-injury (p = .047). Older age was associated with longer TST (p = .003) and female sex was associated with longer WASO (p = .025) and AAL duration (p = .044). Week 4 sleep parameter outcomes were not significantly different between asymptomatic and symptomatic participants. The sleep quality of youth is adversely affected by concussion, particularly in females. Sleep quality appears to improve with time but may require more than 4 weeks to return to normal.
- Published
- 2022
- Full Text
- View/download PDF
14. Cardiovascular Disease and Kidney Transplantation
- Author
-
John P. Vella and Alexander C. Wiseman
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,medicine ,Disease ,medicine.disease ,business ,Kidney transplantation - Published
- 2019
15. Immunosuppression
- Author
-
John P. Vella and Alexander C. Wiseman
- Published
- 2019
16. Access to Transplantation and Outcomes
- Author
-
John P. Vella and Alexander C. Wiseman
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,medicine ,Intensive care medicine ,business - Published
- 2019
17. Malignancy After Kidney Transplantation
- Author
-
Alexander C. Wiseman and John P. Vella
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,medicine ,medicine.disease ,Malignancy ,business ,Kidney transplantation - Published
- 2019
18. Infectious Complications of Kidney Transplantation
- Author
-
Alexander C. Wiseman and John P. Vella
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,medicine.disease ,business ,Kidney transplantation ,Surgery - Published
- 2019
19. Rejection: T Cell-Mediated and Antibody-Mediated
- Author
-
John P. Vella and Alexander C. Wiseman
- Subjects
medicine.anatomical_structure ,biology ,business.industry ,T cell ,biology.protein ,medicine ,Antibody ,business ,Molecular biology - Published
- 2019
20. Deceased Donation
- Author
-
John P. Vella and Alexander C. Wiseman
- Published
- 2019
21. Overcoming Donor/Recipient Incompatibility
- Author
-
John P. Vella and Alexander C. Wiseman
- Subjects
business.industry ,Medicine ,business - Published
- 2019
22. Skin care and hygiene among healthcare professionals during and after the SARS-CoV-2 pandemic
- Author
-
Jason K Rivers, John P Arlette, Joel DeKoven, Lyn C Guenther, Channy Muhn, Vincent Richer, Nathan Rosen, Jean-François Tremblay, Marni C Wiseman, Catherine Zip, and David Zloty
- Subjects
Coronavirus ,Medicine (General) ,R5-920 ,integumentary system ,SARS-CoV-2 ,healthcare professional ,COVID-19 ,skin care ,General Medicine ,Review - Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has necessitated enhanced protection against viral transmission among healthcare professionals, particularly relating to handwashing and personal protective equipment. Some of these requirements may persist for years to come. They bring associated concerns around skin hygiene and general care, with damage to the face and hands now a well-documented consequence among healthcare professionals. This review assesses optimal skin care during the severe acute respiratory syndrome coronavirus 2 pandemic and in the “new normal” that will follow, identifies current knowledge gaps, and provides practical advice for the clinical setting. Regular, systematic hand cleaning with soap and water or an alcohol-based hand rub (containing 60%–90% ethanol or isopropyl alcohol) remains essential, although the optimal quantity and duration is unclear. Gloves are a useful additional barrier; further studies are needed on preferred materials. Moisturization is typically helpful and has proven benefits in mitigating damage from frequent handwashing. It may be best practiced using an alcohol-based hand rub with added moisturizer and could be particularly important among individuals with pre-existing hand dermatoses, such as psoriasis and eczema. Face moisturization immediately prior to donning a mask, and the use of dressings under the mask to reduce friction, can be helpful dermatologically, but more work is required to prove that these actions do not affect seal integrity. Nonetheless, such measures could play a role in institutional plans for mitigating the dermatologic impact of transmission control measures as we exit the pandemic.
- Published
- 2021
23. Emerging paradigm shift toward proactive topical treatment of psoriasis: A narrative review
- Author
-
Jensen Yeung, Kim A. Papp, Melinda Gooderham, Gurbir Dhadwal, Lyn Guenther, Marni C. Wiseman, and Irina Turchin
- Subjects
medicine.medical_specialty ,business.industry ,Administration, Topical ,Context (language use) ,Topical treatment ,Dermatology ,General Medicine ,medicine.disease ,Proactive maintenance ,Maintenance therapy ,Paradigm shift ,Psoriasis ,medicine ,Humans ,Narrative review ,Dermatologic Agents ,Intensive care medicine ,business ,Glucocorticoids ,Cholecalciferol ,Patient education - Abstract
Psoriasis (PsO) requires safe and effective long-term management to reduce the risk of recurrence and decrease the frequency of relapse. Topical PsO therapies are a cornerstone in the management of PsO though safety concerns limit the chronic, continuous use of topical corticosteroids and/or vitamin D3 analogues. Evidence-based guidelines on optimal treatment targets and maintenance therapy regimens are currently lacking. This review explores the evidence supporting approaches to maintenance topical therapy for PsO including continuous long-term therapy, chronic intermittent use, step-down therapy, sequential or pulse therapy regimens, and proactive maintenance therapy. Several unaddressed questions are discussed including how and when to transition from acute to maintenance therapy, strategies for monitoring long-term treatment, the role of topical maintenance therapy in the context of systemic and biologic therapies, risks of maintenance therapy, prescribing a topical preparation suitable for patients' preferences and skin type, and key concepts for patient education to maximize long-term outcomes. Overall, emerging evidence supports a paradigm shift towards proactive treatment once skin is completely clear as a strategy to enhance disease control without compromising safety.
- Published
- 2021
24. Systematic Review on the Efficacy and Safety of Oral Janus Kinase Inhibitors for the Treatment of Atopic Dermatitis
- Author
-
Michelle Le, Melissa Berman-Rosa, Feras M. Ghazawi, Marc Bourcier, Loretta Fiorillo, Melinda Gooderham, Lyn Guenther, Sameh Hanna, H. Chih-Ho Hong, Ian Landells, Perla Lansang, Danielle Marcoux, Marni C. Wiseman, Jensen Yeung, Charles Lynde, and Ivan V. Litvinov
- Subjects
Medicine (General) ,medicine.medical_specialty ,gusacitinib ,Baricitinib ,medicine.medical_treatment ,MEDLINE ,Disease ,Targeted therapy ,R5-920 ,Internal medicine ,medicine ,baricitinib ,Limited evidence ,atopic dermatitis ,abrocitinib ,business.industry ,janus kinase ,General Medicine ,Atopic dermatitis ,medicine.disease ,upadacitinib ,Safety profile ,JAK inhibitor ,Medicine ,Systematic Review ,eczema ,business ,Janus kinase - Abstract
Background: Atopic dermatitis is a chronic, relapsing and remitting disease that can be difficult to treat despite a recently approved biologic therapy targeting IL-4/IL-13 receptor. Oral janus kinase inhibitors (JAKi) represent a novel therapeutic class of targeted therapy to treat moderate-to-severe atopic dermatitis (AD).Objective: To review the efficacy, safety, and pharmacokinetic characteristics of oral JAKi in the treatment of AD.Methods: A PRISMA systematic review was conducted using MEDLINE, EMBASE (Ovid), and PubMed databases for studies assessing the efficacy, safety, and/or pharmacokinetic properties of oral forms of JAKi in the treatment of AD in pediatric or adult populations from inception to June 2021.Results: 496 papers were reviewed. Of 28 articles that underwent full text screening, 11 met our inclusion criteria for final qualitative review. Four studies examined abrocitinib; three studies examined baricitinib; three examined upadacitinib and one examined gusacitinib (ASN002). Significant clinical efficacy and a reassuring safety profile was reported for all JAKi agents reviewed. Rapid symptom control was reported for abrocitinib, baricitinib and upadacitinib.Limitations: Given the relatively limited evidence for each JAKi and the differences in patient eligibility criteria between studies, the data was not deemed suitable for a meta-analysis at this time.Conclusion: Given their ability to achieve rapid symptom control with a reassuring safety profile, we recommend considering the use of JAKi as a reliable systemic treatment option for adult patients with moderate-to-severe AD, who are unresponsive to topical or skin directed treatments.
- Published
- 2021
25. A Review of the Efficacy and Safety for Biologic Agents Targeting IL-23 in Treating Psoriasis With the Focus on Tildrakizumab
- Author
-
Marni C. Wiseman, Marc Bourcier, Leon H Kircik, Ivan V. Litvinov, Ronald Vender, Charles Lynde, Yves Poulin, Feras M. Ghazawi, and Farhan Mahmood
- Subjects
Medicine (General) ,Tildrakizumab ,Disease ,Review ,risankizumab ,Bioinformatics ,ustekinumab ,Pathogenesis ,R5-920 ,IL-23 ,Psoriasis ,Ustekinumab ,tildrakizumab ,Interleukin 23 ,Medicine ,mirikizumab ,Risankizumab ,treatment ,business.industry ,General Medicine ,medicine.disease ,guselkumab ,Guselkumab ,psoriais ,business ,medicine.drug - Abstract
Psoriasis is a chronic and debilitating inflammatory immune-mediated skin disorder. Several cytokines including interleukin (IL)-23 were demonstrated to play a central role in the pathogenesis of this disease. Treatment options for psoriasis range from topical to systemic modalities, depending on the extent, anatomical locations involved and functional impairment level. Targeting cytokines or their cognate receptors that are involved in disease pathogenesis such as IL-12/23 (i.e., targeting the IL-12p40 subunit shared by these cytokines), IL-17A, IL-17F, IL-17RA, and TNF-α using biologic agents emerged in recent years as a highly effective therapeutic option for patients with moderate-to-severe disease. This review provides an overview of the important role of IL-23 signaling in the pathogenesis of psoriasis. We describe in detail the available IL-23 inhibitors for chronic plaque psoriasis. The efficacy, pharmacokinetic properties, and the safety profile of one of the most recent IL-23 biologic agents (tildrakizumab) are evaluated and reviewed in depth.
- Published
- 2021
26. Developing simultaneous liver-kidney transplant medical eligibility criteria while providing a safety net: A 2-year review of the OPTN's allocation policy
- Author
-
Sarah E Booker, Katrina Gauntt, Darren Stewart, Amber R. Wilk, David C. Mulligan, Richard N. Formica, and Alexander C. Wiseman
- Subjects
Adult ,medicine.medical_specialty ,Tissue and Organ Procurement ,Safety net ,medicine.medical_treatment ,Kidney ,Risk Factors ,Internal medicine ,medicine ,Simultaneous liver kidney ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Dialysis ,Deceased donor kidney ,Transplantation ,business.industry ,Significant difference ,Graft Survival ,Kidney Transplantation ,Liver Transplantation ,Kidney allocation ,medicine.anatomical_structure ,Policy ,Liver ,Graft survival ,business - Abstract
The OPTN's simultaneous liver-kidney (SLK) allocation policy, implemented August 10, 2017, established medical eligibility criteria for adult SLK candidates and created Safety Net kidney allocation priority for liver-alone recipients with new/continued renal impairment. OPTN SLK and kidney after liver (KAL) data were analyzed (registrations as of December 31, 2019, transplants pre-policy [March 20, 2015-August 9, 2017] vs. post-policy [August 10, 2017-December 31, 2019]). Ninety-four percent of SLK registrations met eligibility criteria (99% CKD: 50% dialysis, 50% eGFR). SLK transplant volume decreased from a record 740 (2017) to 676 (2018, -9%), with a subsequent increase to 728 (2019, 1.6% below 2017 volume). For KAL listings within 1 year of liver transplant, waitlist mortality rates declined post-policy versus pre-policy (27 [95% CI = 20.6-34.7] vs. 16 [11.7-20.5]) while transplant rates increased fourfold (46 [32.2-60.0] vs. 197 [171.6-224.7]). There were 234 KAL transplants post-policy (94% Safety Net priority eligible), and no significant difference in 1-year patient/graft survival vs. kidney-alone (patient: 95.9% KAL, 97.0% kidney-alone [p = .39]; graft: 94.2% KAL, 94.6% kidney-alone [p = .81]). From pre- to post-policy, the proportion of all deceased donor kidney and liver transplants that were SLK decreased (kidney: 5.1% to 4.3%; liver: 9.7% to 8.7%). SLK policy implementation interrupted the longstanding rise in SLK transplants, while Safety Net priority directed kidneys to liver recipients in need with thus far minimal impact to posttransplant outcomes.
- Published
- 2021
27. Mineral and Bone Disorders after Kidney Transplantation
- Author
-
John P. Vella and Alexander C. Wiseman
- Subjects
business.industry ,medicine ,Physiology ,medicine.disease ,business ,Kidney transplantation - Published
- 2019
28. Proteinuria After Kidney Transplantation
- Author
-
John P. Vella and Alexander C. Wiseman
- Subjects
medicine.medical_specialty ,Proteinuria ,business.industry ,medicine ,Urology ,medicine.symptom ,medicine.disease ,business ,Kidney transplantation - Published
- 2019
29. Transplantation Tolerance and Biomarkers
- Author
-
John P. Vella and Alexander C. Wiseman
- Subjects
Transplantation ,Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,Medicine ,business - Published
- 2019
30. Delayed Graft Function
- Author
-
Alexander C. Wiseman and John P. Vella
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,business ,Delayed Graft Function ,Surgery - Published
- 2019
31. Live Donors
- Author
-
John P. Vella and Alexander C. Wiseman
- Published
- 2019
32. Chronic Kidney Disease and Coronary Artery Disease
- Author
-
Mark J. Sarnak, Kerstin Amann, Sripal Bangalore, João L. Cavalcante, David M. Charytan, Jonathan C. Craig, John S. Gill, Mark A. Hlatky, Alan G. Jardine, Ulf Landmesser, L. Kristin Newby, Charles A. Herzog, Michael Cheung, David C. Wheeler, Wolfgang C. Winkelmayer, Thomas H. Marwick, Debasish Banerjee, Carlo Briguori, Tara I. Chang, Chien-Liang Chen, Christopher R. deFilippi, Xiaoqiang Ding, Charles J. Ferro, Jagbir Gill, Mario Gössl, Nicole M. Isbel, Hideki Ishii, Meg J. Jardine, Philip A. Kalra, Günther Laufer, Krista L. Lentine, Kevin Lobdell, Charmaine E. Lok, Gérard M. London, Jolanta Małyszko, Patrick B. Mark, Mohamed Marwan, Yuxin Nie, Patrick S. Parfrey, Roberto Pecoits-Filho, Helen Pilmore, Wajeh Y. Qunibi, Paolo Raggi, Marcello Rattazzi, Patrick Rossignol, Josiah Ruturi, Charumathi Sabanayagam, Catherine M. Shanahan, Gautam R. Shroff, Rukshana Shroff, Angela C. Webster, Daniel E. Weiner, Simon Winther, Alexander C. Wiseman, Anthony Yip, and Alexander Zarbock
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Psychological intervention ,CAD ,State of the art review ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Revascularization ,medicine.disease ,female genital diseases and pregnancy complications ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Prospective cohort study ,Very high risk ,Kidney disease - Abstract
Highlights •CKD is associated with very high risk of CAD. CAD management is complicated in CKD patients, due to comorbid conditions and potential side effects during interventions. •There are few trials related to CAD with focus on CKD patients, particularly in those with advanced CKD. •Additional prospective studies focusing on diagnosis, prevention, and treatment of CAD are needed in CKD.
- Published
- 2019
33. The changing landscape of live kidney donation in the United States from 2005 to 2017
- Author
-
Madeleine M. Waldram, Jane Gralla, Sile Yu, Fawaz Al Ammary, Macey L. Henderson, Alexander C. Wiseman, Abimereki D. Muzaale, Allan B. Massie, Courtenay M. Holscher, Alvin G. Thomas, Mohamud A. Qadi, Mary G. Bowring, Daniel C. Brennan, Jacqueline Garonzik-Wang, and Dorry L. Segev
- Subjects
Adult ,Male ,Risk ,Tissue and Organ Procurement ,Ethnic group ,Live kidney donation ,Psychological intervention ,symbols.namesake ,Outcome Assessment, Health Care ,Living Donors ,Humans ,Immunology and Allergy ,Medicine ,Pharmacology (medical) ,Poisson Distribution ,Registries ,Poisson regression ,Transplantation ,business.industry ,Middle Aged ,Kidney Transplantation ,United States ,Donation ,Tissue and Organ Harvesting ,symbols ,Regression Analysis ,Female ,Kidney Diseases ,National registry ,Unrelated Donors ,business ,Demography - Abstract
The number of live kidney donors has declined since 2005. This decline parallels the evolving knowledge of risk for biologically related, black, and younger donors. To responsibly promote donation, we sought to identify declining low-risk donor subgroups that might serve as targets for future interventions. We analyzed a national registry of 77 427 donors and quantified the change in number of donors per 5-year increment from 2005 to 2017 using Poisson regression stratified by donor-recipient relationship and race/ethnicity. Among related donors aged
- Published
- 2019
34. Cardiovascular disease care fragmentation in kidney transplantation: a call for action
- Author
-
Janani Rangaswami, Alexander C. Wiseman, Darshana Dadhania, Peter A. McCullough, Sripal Bangalore, Kelly A. Birdwell, and Bruce Kaplan
- Subjects
Graft Rejection ,Patient Care Team ,Postoperative Care ,Health Services Needs and Demand ,business.industry ,Disease ,Bioinformatics ,medicine.disease ,Kidney Transplantation ,Tissue Donors ,Transplant Recipients ,Transplantation ,Cardiovascular Diseases ,Risk Factors ,Nephrology ,Humans ,Kidney Failure, Chronic ,Medicine ,Fragmentation (cell biology) ,business ,Kidney transplantation - Published
- 2019
35. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section V: Consensus Statements on the Assessment and Management of Adult Patients With Moderate-to-Severe Atopic Dermatitis
- Author
-
Robert Bissonnette, Parbeer Grewal, Gordon Sussman, Perla Lansang, Jensen Yeung, Mark G. Kirchhof, Kim A. Papp, C Lynde, Robert Gniadecki, Marni C. Wiseman, Lorne Albrecht, Ian Landells, Irina Turchin, Melinda Gooderham, Yves Poulin, Chih-Ho Hong, and Gurbir Dhadwal
- Subjects
Adult ,Moderate to severe ,Document section ,medicine.medical_specialty ,Consensus ,Adult patients ,business.industry ,Treatment options ,Comorbidity ,Dermatology ,Atopic dermatitis ,medicine.disease ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Health care ,medicine ,Humans ,Surgery ,business ,Intensive care medicine ,Adult atopic dermatitis - Abstract
This document is a concise, current, and practical guide for dermatologists and other health care providers managing adult patients with moderate-to-severe atopic dermatitis (AD). The recommendations made here are based on a consensus of specialists with extensive experience managing patients with AD. Topics reviewed in this publication include AD pathophysiology, assessment, comorbidities, and treatment options.
- Published
- 2018
36. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section III: Evaluation of Atopic Dermatitis Patients for Comorbidities
- Author
-
Melinda Gooderham, Gordon Sussman, Chih-Ho Hong, Marni C. Wiseman, and Irina Turchin
- Subjects
Adult ,medicine.medical_specialty ,Consensus ,Eye Diseases ,Comorbidity ,Dermatology ,Disease ,Anxiety ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Prevalence ,medicine ,Humans ,Eosinophilic esophagitis ,Depression (differential diagnoses) ,Asthma ,Depression ,business.industry ,Atopic dermatitis ,medicine.disease ,body regions ,030228 respiratory system ,Eye disorder ,Surgery ,medicine.symptom ,business - Abstract
Atopic dermatitis (AD) is often associated with other atopic diseases, including asthma, allergic rhinitis, atopy-associated eye disorders, and eosinophilic esophagitis. Depression and anxiety are also comorbidities to AD that significantly affect quality of life and should be screened for in patients with AD. Links to other comorbidities such as cardiovascular disease and malignancy are considered inconclusive, but patient counselling and screening may be appropriate in some patients. This article highlights practical recommendations for the recognition and management of atopic and nonatopic comorbidities commonly associated with AD.
- Published
- 2018
37. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients
- Author
-
Ekamol Tantisattamo, Ronald F. Parsons, Christopher D. Blosser, Miklos Z Molnar, Deborah Adey, Tarek Alhamad, Beatrice P. Concepcion, Krista L. Lentine, Arpita Basu, Neeraj Singh, Edward S. Kraus, John J. Friedewald, Martha Pavlakis, Leonardo V. Riella, Alexander C. Wiseman, Song Ong, Arman Faravardeh, Darshana Dadhania, Michelle Lubetzky, Gaurav Gupta, Amtul Aala, and Kenneth J. Woodside
- Subjects
medicine.medical_specialty ,Allograft failure ,medicine.medical_treatment ,Kidney ,law.invention ,Randomized controlled trial ,law ,Renal Dialysis ,medicine ,Immunology and Allergy ,Humans ,Transplantation, Homologous ,Pharmacology (medical) ,Renal replacement therapy ,Patient group ,Intensive care medicine ,Dialysis ,Transplantation ,business.industry ,Immunosuppression ,Allografts ,Kidney Transplantation ,surgical procedures, operative ,medicine.anatomical_structure ,business ,Immunosuppressive Agents - Abstract
The return to dialysis after allograft failure is associated with increased morbidity and mortality. This transition is made more complex by the rising numbers of patients who seek repeat transplantation and therefore may have indications for remaining on low levels of immunosuppression, despite the potential increased morbidity. Management strategies vary across providers, driven by limited data on how to transition off immunosuppression as the allograft fails and a paucity of randomized controlled trials to support one approach over another. In this review, we summarize the current data available for management and care of the failing allograft. Additionally, we discuss a suggested plan for immunosuppression weaning based upon the availability of re-transplantation and residual allograft function. We propose a shared-care model in which there is improved coordination between transplant providers and general nephrologists so that immunosuppression management and preparation for renal replacement therapy and/or repeat transplantation can be conducted with the goal of improved outcomes and decreased morbidity in this vulnerable patient group.
- Published
- 2021
38. Long-Term Immunosuppression Management: Opportunities and Uncertainties
- Author
-
Alexander C. Wiseman and David Wojciechowski
- Subjects
Oncology ,Graft Rejection ,medicine.medical_specialty ,Time Factors ,Epidemiology ,medicine.medical_treatment ,Calcineurin Inhibitors ,030230 surgery ,Critical Care and Intensive Care Medicine ,Belatacept ,Tacrolimus ,Maintenance Chemotherapy ,Abatacept ,03 medical and health sciences ,0302 clinical medicine ,Adrenal Cortex Hormones ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Immunosuppression Therapy ,Transplantation ,business.industry ,Alloimmunity ,Immunosuppression ,Squamous cell skin cancer ,MTOR Inhibitors ,Mycophenolic Acid ,Kidney Transplantation ,Kidney Transplantation Long-Term Management Challenges ,Discontinuation ,Calcineurin ,Nephrology ,Drug Therapy, Combination ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
The long-term management of maintenance immunosuppression in kidney transplant recipients remains complex. The vast majority of patients are treated with the calcineurin inhibitor tacrolimus as the primary agent in combination with mycophenolate, with or without corticosteroids. A tacrolimus trough target 5-8 ng/ml seems to be optimal for rejection prophylaxis, but long-term tacrolimus-related side effects and nephrotoxicity support the ongoing evaluation of noncalcineurin inhibitor-based regimens. Current alternatives include belatacept or mammalian target of rapamycin inhibitors. For the former, superior kidney function at 7 years post-transplant compared with cyclosporin generated initial enthusiasm, but utilization has been hampered by high initial rejection rates. Mammalian target of rapamycin inhibitors have yielded mixed results as well, with improved kidney function tempered by higher risk of rejection, proteinuria, and adverse effects leading to higher discontinuation rates. Mammalian target of rapamycin inhibitors may play a role in the secondary prevention of squamous cell skin cancer as conversion from a calcineurin inhibitor to an mammalian target of rapamycin inhibitor resulted in a reduction of new lesion development. Early withdrawal of corticosteroids remains an attractive strategy but also is associated with a higher risk of rejection despite no difference in 5-year patient or graft survival. A major barrier to long-term graft survival is chronic alloimmunity, and regardless of agent used, managing the toxicities of immunosuppression against the risk of chronic antibody-mediated rejection remains a fragile balance.
- Published
- 2021
39. Transplant administration-A survey of the roles and responsibilities of kidney and pancreas medical directors of US transplant centers
- Author
-
Darshana Dadhania, Gwen McNatt, Mona D. Doshi, Roy D. Bloom, Millie Samaniego, Y. Qazi, Neeraj Singh, Ronald F. Parsons, Todd E. Pesavento, Muhammad Saad Naseer, Alexander C. Wiseman, Bruce Kaplan, and John J. Friedewald
- Subjects
United Network for Organ Sharing ,Adult ,Male ,medicine.medical_specialty ,Demographics ,education ,030230 surgery ,Kidney ,Physician Executives ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Fellowships and Scholarships ,Pancreas ,health care economics and organizations ,Accreditation ,Transplantation ,business.industry ,Internship and Residency ,United States ,Education, Medical, Graduate ,Family medicine ,030211 gastroenterology & hepatology ,Job satisfaction ,business ,Administration (government) - Abstract
The current American Society of Transplantation (AST) accredited transplant fellowship programs in the United States provide no structured formal training in leadership and administration which is essential for successfully running a transplant program. We conducted a survey of medical directors of active adult kidney and kidney-pancreas transplant programs in the United States about their demographics, training pathways, and roles and responsibilities. The survey was emailed to 183 medical directors, and 123 (67.2%) completed the survey. A majority of respondents were older than 50 years (61%), males (80%), and holding that position for more than 10 years (47%). Only 51% of current medical directors had taken that position after completing a one-year transplant fellowship, and 58% took on the role with no prior administrative or leadership experience. The medical directors reported spending a median 50%-75% of time in clinical responsibilities, 25%-50% of time in administration, and 0%-25% time in research. The survey also captured various administrative roles of medical directors vis-a-vis other transplant leaders. The study, designed to be the starting point of an improvement initiative of the AST, provided important insight into the demographics, training pathways, roles and responsibilities, job satisfaction, education needs, and training gaps of current medical directors.
- Published
- 2021
40. Real-world effectiveness of adalimumab in patients with moderate-to-severe hidradenitis suppurativa: the 1-year SOLACE study
- Author
-
Afsaneh Alavi, C Jean, Melinda Gooderham, Wayne Gulliver, Kim Papp, M S Alam, Jaggi Rao, Marni C. Wiseman, and O Desjardins
- Subjects
medicine.medical_specialty ,Canada ,business.industry ,Adalimumab ,Nodule (medicine) ,Dermatology ,Disease ,medicine.disease ,Severity of Illness Index ,Hidradenitis Suppurativa ,Infectious Diseases ,Treatment Outcome ,Internal medicine ,Severity of illness ,Post-hoc analysis ,Medicine ,Humans ,Hidradenitis suppurativa ,Female ,medicine.symptom ,Stage (cooking) ,business ,Abscess ,medicine.drug - Abstract
Background Long-term, real-word data are needed to help manage patients with hidradenitis suppurativa (HS) through this recurrent, painful and debilitating disease. Objectives To primarily measure real-world effectiveness of adalimumab in HS and to secondarily observe clinical course of HS in the light of patients' response. Methods In SOLACE, adults with moderate-to-severe HS in need for change in ongoing therapy were treated with adalimumab for up to 52 weeks as per physician's medical practice. Treatment effectiveness was measured by Hidradenitis Suppurativa Clinical Response (HiSCR). Inflammatory nodules, abscesses and draining fistulas were counted, Hurley stage was assessed, and disease severity was rated using the International HS Severity Scoring System (IHS4). A post hoc analysis further explored the HiSCR response by abscess and inflammatory nodule (AN) count at baseline (low, medium and high) and gender. Spontaneously reported safety events were collected. Results From 23 Canadian centres, 69% of the 138 patients achieved HiSCR at week 24, which increased to 82% and 75% at week 52 in patients with medium and high AN counts, respectively. Gender (4 times the odds for female) and age at HS onset (5% decrease with each additional year) had an effect on achieving HiSCR. Treatment with adalimumab led to an important decrease in number of lesions in responders, with most gains observed in inflammatory nodules, more frequently in the lower body area of patients in the high AN count group. The IHS4 scores of responders were substantially lowered, with a larger decrease in patients of the high AN count group. No new safety signal was detected. Conclusions The effectiveness of adalimumab was maintained during this 1-year period, and an optimal gain was documented for patients with medium and high AN counts. These real-world data support a prompt treatment of HS patients and the use of IHS4 to monitor treatment.
- Published
- 2021
41. Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers
- Author
-
John J. Friedewald, Michelle Lubetzky, Arpita Basu, Miklos Z Molnar, Beatrice P. Concepcion, Ekamol Tantisattamo, Ronald F. Parsons, Gaurav Gupta, Leonardo V. Riella, Arman Faravardeh, Deborah Adey, Emmanuel Edusei, Martha Pavlakis, James C. Rice, Krista L. Lentine, Alexander C. Wiseman, Kenneth J. Woodside, Tarek Alhamad, Song Ong, Darshana Dadhania, Edward S. Kraus, Christopher D. Blosser, Neeraj Singh, and Su-Hsin Chang
- Subjects
medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,MEDLINE ,030230 surgery ,Kidney ,Antimetabolite ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Immunology and Allergy ,Humans ,Transplantation, Homologous ,Pharmacology (medical) ,Transitional care ,Intensive care medicine ,Dialysis ,Transplantation ,business.industry ,Risk of infection ,Immunosuppression ,Allografts ,Kidney Transplantation ,Transplant Recipients ,Calcineurin ,medicine.anatomical_structure ,Kidney Failure, Chronic ,business - Abstract
Kidney allograft failure and return to dialysis carry a high risk of morbidity. A practice survey was developed by the AST Kidney Pancreas Community of Practice workgroup and distributed electronically to the AST members. There were 104 respondents who represented 92 kidney transplant centers. Most survey respondents were transplant nephrologists at academic centers. The most common approach to immunosuppression management was to withdraw the antimetabolite first (73%), while only 12% responded they would withdraw calcineurin inhibitor (CNI) first. More than 60% reported that the availability of a living donor is the most important factor in their decision to taper immunosuppression, followed by risk of infection, risk of sensitization, frailty, and side effects of medications. More than half of respondents reported that embolization was either not available or offered to less than 10% as an option for surgical intervention. Majority reported that ≤50% of failed allograft patients were re-listed before dialysis, and less than a quarter of transplant nephrologists performed frequent visits with their patients with failed kidney allograft after they return to dialysis. This survey demonstrates heterogeneity in the care of patients with a failing allograft and the need for more evidence to guide improvements in clinical practice related to transition of care.
- Published
- 2021
42. Search for double- β decay of Ge76 to excited states of Se76 with the majorana demonstrator
- Author
-
C. D. Christofferson, I. J. Arnquist, N. W. Ruof, C. J. Barton, J. Myslik, A. L. Reine, B. Bos, C. R. Haufe, J. M. López-Castaño, I. Kim, I. S. Guinn, T. K. Oli, C. Wiseman, G. Othman, C. Cuesta, F. E. Bertrand, T. R. Edwards, D. J. Tedeschi, Matthew Busch, V. E. Guiseppe, Ralph Massarczyk, D. W. Edwins, Yu. Efremenko, Eric W. Hoppe, T. Gilliss, A. Hostiuc, S. Vasilyev, C.-H. Yu, B. Sayki, J. F. Wilkerson, R. D. Martin, J. Gruszko, S. R. Elliott, P. H. Chu, Alan Poon, S. Mertens, J. A. Detwiler, D. Hervas Aguilar, Keith Rielage, A. Drobizhev, W. Xu, L. S. Paudel, M. F. Kidd, B. X. Zhu, M. P. Green, Y-D. Chan, H. Ejiri, M. Buuck, Walter C. Pettus, E. Blalock, S. J. Meijer, E. L. Martin, G. K. Giovanetti, Richard T. Kouzes, A. S. Barabash, D. C. Radford, T. S. Caldwell, M. Clark, F. T. Avignone, R. L. Varner, Reyco Henning, A. M. Lopez, and M. J. Stortini
- Subjects
High probability ,Physics ,MAJORANA ,Particle physics ,010308 nuclear & particles physics ,Excited state ,0103 physical sciences ,Detector array ,010306 general physics ,01 natural sciences - Abstract
Author(s): Arnquist, IJ; Avignone, FT; Barabash, AS; Barton, CJ; Bertrand, FE; Blalock, E; Bos, B; Busch, M; Buuck, M; Caldwell, TS; Chan, YD; Christofferson, CD; Chu, PH; Clark, ML; Cuesta, C; Detwiler, JA; Drobizhev, A; Edwards, TR; Edwins, DW; Efremenko, Y; Ejiri, H; Elliott, SR; Gilliss, T; Giovanetti, GK; Green, MP; Gruszko, J; Guinn, IS; Guiseppe, VE; Haufe, CR; Henning, R; Hervas Aguilar, D; Hoppe, EW; Hostiuc, A; Kidd, MF; Kim, I; Kouzes, RT; Lopez, AM; Lopez-Castano, JM; Martin, EL; Martin, RD; Massarczyk, R; Meijer, SJ; Mertens, S; Myslik, J; Oli, TK; Othman, G; Paudel, LS; Pettus, W; Poon, AWP; Radford, DC; Reine, AL; Rielage, K; Ruof, NW; Saykl, B; Stortini, MJ; Tedeschi, D; Varner, RL; Vasilyev, S; Wilkerson, JF; Wiseman, C; Xu, W; Yu, CH; Zhu, BX | Abstract: The majorana demonstrator is a neutrinoless double-β decay search consisting of a low-background modular array of high-purity germanium detectors, ∼2/3 of which are enriched to 88% in Ge76. The experiment is also searching for double-beta decay of Ge76 to excited states (e.s.) in Se76. Ge76 can decay into three daughter states of Se76, with clear event signatures consisting of a ββ-decay followed by the prompt emission of one or two γ rays. This results with high probability in multi-detector coincidences. The granularity of the demonstrator detector array enables powerful discrimination of this event signature from backgrounds. Using 41.9 kg yr of isotopic exposure, the demonstrator has set world leading limits for each e.s. decay of Ge76, with 90% CL lower half-life limits in the range of (0.75-4.0)×1024 yr. In particular, for the 2ν transition to the first 0+ e.s. of Se76, a lower half-life limit of 7.5×1023 yr at 90% CL was achieved.
- Published
- 2021
43. A D$_{2}$O detector for flux normalization of a pion decay-at-rest neutrino source
- Author
-
G.C. Rich, R. Rapp, J. Daughhetee, D Hoang, G. Sinev, C. J. Virtue, A. Gallo Rosso, S. R. Elliott, Seppo Penttila, K. Mann, T. Wongjirad, M.R. Heath, P. S. Barbeau, P. An, J Ross, Kate Scholberg, S. Hedges, V. Sosnovstsev, A. V. Kumpan, Belkis Cabrera-Palmer, Diana Parno, D. Akimov, E. Day, E. Conley, J Mastroberti, I. Bernardi, P. E. Mueller, W. M. Snow, E.M. Ward, Michael Febbraro, E Ujah, A.V. Khromov, J. Zettlemoyer, Gerard Visser, V. Belov, E. S. Kozlova, Matthew A Blackston, J. Koros, O. Razuvaeva, J. M. Link, J. Vanderwerp, B. Becker, C.-H. Yu, K. Tellez-Giron-Flores, D. M. Markoff, A. Konovalov, H. Ray, Yu. Efremenko, B. Suh, A. Galindo-Uribarri, Lorenzo Fabris, AM Salyapongse, Tyler Johnson, C. Wiseman, J. Runge, D.J. Salvat, C. Awe, A. Shakirov, Rex Tayloe, G. Simakov, Liang Li, Jing Liu, D. Rudik, J. A. Detwiler, Jason Newby, J. Raybern, Y.-R. Yen, K Ding, D. Pershey, M.R. Durand, M. P. Green, Alexander Bolozdynya, R. L. Varner, Jaeun Yoo, I. Tolstukhin, D. Chernyak, David Reyna, and M. Hughes
- Subjects
Physics ,Physics - Instrumentation and Detectors ,Physics::Instrumentation and Detectors ,Physics beyond the Standard Model ,Astrophysics::High Energy Astrophysical Phenomena ,Detector ,Flux ,FOS: Physical sciences ,Instrumentation and Detectors (physics.ins-det) ,Oak Ridge National Laboratory ,High Energy Physics - Experiment ,Nuclear physics ,High Energy Physics - Experiment (hep-ex) ,Pion ,Neutrino detector ,Physics::Accelerator Physics ,High Energy Physics::Experiment ,Neutrino ,Nuclear Experiment (nucl-ex) ,Nuclear Experiment ,Instrumentation ,Mathematical Physics ,Spallation Neutron Source - Abstract
We report on the technical design and expected performance of a 592 kg heavy-water-Cherenkov detector to measure the absolute neutrino flux from the pion-decay-at-rest neutrino source at the Spallation Neutron Source (SNS) at Oak Ridge National Laboratory (ORNL). The detector will be located roughly 20 m from the SNS target and will measure the neutrino flux with better than 5% statistical uncertainty in 2 years. This heavy-water detector will serve as the first module of a two-module detector system to ultimately measure the neutrino flux to 2-3% at both the First Target Station and the planned Second Target Station of the SNS. This detector will significantly reduce a dominant systematic uncertainty for neutrino cross-section measurements at the SNS, increasing the sensitivity of searches for new physics., Comment: As accepted to JINST
- Published
- 2021
- Full Text
- View/download PDF
44. Defining the roles and responsibilities of the kidney transplant medical director: A necessary step for future training, mentoring, and professional development
- Author
-
Angelo M DeMattos, Millie Samaniego, Mona D. Doshi, Alexander C. Wiseman, Christina Klein, Todd E. Pesavento, John J. Friedewald, Kim Nicoll, Luke Preczewski, Nicolae Leca, Neeraj Singh, Enver Akalin, Roy D. Bloom, and Darshana Dadhania
- Subjects
Nephrology ,United Network for Organ Sharing ,medicine.medical_specialty ,Tissue and Organ Procurement ,Job description ,030230 surgery ,Kidney transplant ,Physician Executives ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Multidisciplinary approach ,Internal medicine ,Immunology and Allergy ,Medicine ,Humans ,Pharmacology (medical) ,Transplantation ,business.industry ,Professional development ,Mentoring ,medicine.disease ,Kidney Transplantation ,United States ,Kidney Failure, Chronic ,business ,Kidney disease - Abstract
The management of a kidney transplant program has evolved significantly in the last decades to become a highly specialized, multidisciplinary standard of care for end-stage kidney disease. Transplant center job descriptions have similarly morphed with increasing responsibilities to address a more complex patient mix, increasing medical and surgical therapeutic options, and increasing regulatory burden in the face of an ever-increasing organ shortage. Within this evolution, the role of the Kidney Transplant Medical Director (KTMD) has expanded beyond the basic requirements described in the United Network for Organ Sharing bylaws. Without a clear job description, transplant nephrology trainees may be inadequately trained and practicing transplant nephrologists may face opaque expectations for the roles and responsibilities of Medical Director. To address this gap and clarify the key areas in which the KTMD interfaces with the kidney transplant program, American Society of Transplantation (AST) formed a Task Force of 14 AST KTMDs to review and define the role of the KTMD in key aspects of administrative, regulatory, budgetary, and educational oversight of a kidney transplant program.
- Published
- 2020
45. LEGEND $^{\bf 76}$Ge Detectors: Production, Characterization, and Performance
- Author
-
A. Reine, R. Brugnera, J. F. Wilkerson, T. Comellato, Bjoern Lehnert, L. Hauertmann, J. Detwiler, D. Radford, A. Poon, A. Alexander, T. Mathew, C. Gooch, M. Clark, G. Othman, I. Guinn, X. Liu, C.-A. Christofferson, K. Gusev, O. Schulz, J. Thompson, C. Wiseman, A. Engelhardt, V. Biancacci, S. Mertens, I. Abt, T. Caldwell, Y. Kermaidic, M. Hult, G. Lutter, M. Busch, L. Pertoldi, P. Barton, K. Warnello, A. Garfagnini, R. Martin, F. Edzards, A. Zschocke, G. Marissens, J. Gruszko, B. Bos, and S. Schoenert
- Subjects
Physics::Instrumentation and Detectors ,High Energy Physics::Experiment - Abstract
LEGEND searches for lepton number violation in neutrinoless double beta (0νββ) decay using $^{76}$Ge-enriched high-purity germanium (HPGe) detectors immersed in liquid argon. The first stage, LEGEND-200, will operate 200 kg of detectors, a significant fraction of which are the new large Inverted Coaxial Point Contact (ICPC) detectors currently under production. An extensive characterization campaign to determine the basic operational parameters of the newly produced detectors is performed in vacuum cryostats at two underground sites in order to reduce the internal creation of cosmogenic radionuclides. Other dedicated scanning setups are used to obtain a detailed understanding of alpha and beta surface events on the p+ and n+ contacts which are projected to be the dominant backgrounds for the 0νββ decay search. This poster will present the production experience of the new ICPC detectors, the ongoing characterization campaigns, and the projected detector performances based on recent measurements.
- Published
- 2020
- Full Text
- View/download PDF
46. Tacrolimus Intrapatient Variability, Time in Therapeutic Range, and Risk of De Novo Donor-Specific Antibodies
- Author
-
James E. Cooper, Patrick Klem, Scott Davis, Alexander C. Wiseman, Jane Gralla, and Erik Stites
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Coefficient of variation ,medicine.medical_treatment ,Calcineurin Inhibitors ,Time in therapeutic range ,chemical and pharmacologic phenomena ,030230 surgery ,Gastroenterology ,Risk Assessment ,Tacrolimus ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Therapeutic index ,HLA Antigens ,Isoantibodies ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Transplantation ,biology ,business.industry ,Graft Survival ,nutritional and metabolic diseases ,Immunosuppression ,Middle Aged ,Kidney Transplantation ,stomatognathic diseases ,Transthyretin ,Treatment Outcome ,Cohort ,biology.protein ,030211 gastroenterology & hepatology ,Female ,Drug Monitoring ,business ,Biomarkers ,Immunosuppressive Agents - Abstract
Tacrolimus (TAC) is the most important agent for maintenance immunosuppression and prevention of immunologic injury to the renal allograft, yet there remains no consensus on how best to monitor drug therapy. Both high TAC intrapatient variability and low TAC time in therapeutic range (TTR) have been associated with risk of de novo donor-specific antibodies (dnDSA). In this study, we hypothesized that the risk associated with high TAC coefficient of variation (CV) is a result of low TAC TTR rather than the variability itself.We analyzed the risk of dnDSA, acute rejection, or death-censored graft loss by non-dosed-corrected TAC CV and TAC TTR during the first posttransplant year in a cohort of 538 patients with a median follow-up period of 4.1 years.Patients with CV44.2% and TTR40% (high intrapatient variability and low TTR) had a high risk of dnDSA (adjusted OR = 4.93, 95% confidence interval = 2.02-12.06, P0.001) and death-censored graft loss by 5 years (adjusted HR = 4.00, 95% confidence interval = 1.31-12.24, P = 0.015) when compared with patients with CV44.2% and TTR ≥40% (high intrapatient variability and optimal TTR), while the latter patients had similar risk to patients with CV44.2% (lower intrapatient variability).These data suggest that previously reported immunologic risk associated with high TAC intrapatient variability is due to time outside of therapeutic range rather than variability in and of itself when evaluating absolute non-dose-corrected TAC levels irrespective of reason or indication.
- Published
- 2020
47. First Measurement of Coherent Elastic Neutrino-Nucleus Scattering on Argon
- Author
-
D. Rudik, T. Wongjirad, J. Raybern, J. T. Librande, Belkis Cabrera-Palmer, Y.-R. Yen, J. Yoo, C. J. Virtue, G.C. Rich, S. I. Penttilä, D. Chernyak, D. C. Radford, M. P. Green, A. Kumpan, A. Konovalov, Yu. Efremenko, Kathryn Mann, P. S. Barbeau, M. del Valle Coello, B. Suh, David Reyna, E. Kozlova, R. L. Cooper, J. M. Link, B. Becker, A. Shakirov, M.R. Heath, Gerard Visser, Rex Tayloe, J. B. Albert, J. Daughhetee, D. M. Markoff, C.-H. Yu, M. Hughes, D. Akimov, V. Belov, Diana Parno, O. Razuvaeva, I. Bernardi, J. A. Detwiler, Jason Newby, L. Blokland, Tyler Johnson, R. L. Varner, H. Ray, G. Sinev, Alexander Bolozdynya, W. Fox, A. Khromov, K. S. Hansen, Liang Li, S. Hedges, J. Yang, P. An, E. Conley, R. T. Thornton, C. Wiseman, K. Tellez-Giron-Flores, Lorenzo Fabris, C. Awe, Jing Liu, Michael Febbraro, D. Pershey, W. M. Snow, Matthew A Blackston, H. Moreno, A. Galindo-Uribarri, V. Sosnovtsev, O. McGoldrick, Kate Scholberg, J. Zettlemoyer, J. Runge, M.R. Durand, D.J. Salvat, N. Chen, P. E. Mueller, J. Vanderwerp, M. Kaemingk, L. J. Kaufman, S. R. Elliott, G. Simakov, I. Tolstukhin, R. Rapp, and A. Gallo Rosso
- Subjects
Physics ,Argon ,Scattering ,Physics::Instrumentation and Detectors ,Detector ,FOS: Physical sciences ,General Physics and Astronomy ,Flux ,chemistry.chemical_element ,01 natural sciences ,Standard Model ,High Energy Physics - Experiment ,Nuclear physics ,High Energy Physics - Experiment (hep-ex) ,Cross section (physics) ,chemistry ,0103 physical sciences ,Nuclear Experiment (nucl-ex) ,Neutrino ,010306 general physics ,Nuclear Experiment ,Spallation Neutron Source - Abstract
We report the first measurement of coherent elastic neutrino-nucleus scattering (\cevns) on argon using a liquid argon detector at the Oak Ridge National Laboratory Spallation Neutron Source. Two independent analyses prefer \cevns over the background-only null hypothesis with greater than $3\sigma$ significance. The measured cross section, averaged over the incident neutrino flux, is (2.2 $\pm$ 0.7) $\times$10$^{-39}$ cm$^2$ -- consistent with the standard model prediction. The neutron-number dependence of this result, together with that from our previous measurement on CsI, confirms the existence of the \cevns process and provides improved constraints on non-standard neutrino interactions., Comment: 8 pages, 5 figures with 2 pages, 6 figures supplementary material V3: fixes to figs 3,4 V4: fix typo in table 1, V5: replaced missing appendix, V6: fix Eq 1, new fig 3, V7 final version, updated with final revisions
- Published
- 2020
48. The Transplant Nephrology Workforce in the United States: Current State and Future Directions
- Author
-
Priyamvada Singh, Alexander C. Wiseman, Swee Ling Levea, Sami Alasfar, and Beatrice P. Concepcion
- Subjects
Nephrology ,medicine.medical_specialty ,Scope of practice ,Referral ,media_common.quotation_subject ,Population ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Nephrologists ,03 medical and health sciences ,0302 clinical medicine ,State (polity) ,Multidisciplinary approach ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Health Workforce ,Fellowships and Scholarships ,education ,Referral and Consultation ,Kidney transplantation ,media_common ,Postoperative Care ,education.field_of_study ,business.industry ,Scope of Practice ,medicine.disease ,Kidney Transplantation ,United States ,surgical procedures, operative ,Family medicine ,Workforce ,Insurance, Health, Reimbursement ,business - Abstract
The population of patients with kidney transplants in the United States is growing. The delivery of transplant care is complex, involves a multidisciplinary transplant team, and care coordination between transplant and community providers. The transplant nephrologist is central to the delivery of this care and assumes a multitude of clinical and nonclinical roles and responsibilities. With a growing population of patients requiring transplant care that spans a continuum from pretransplant referral to long-term posttransplant management, an understanding of the current state of the transplant nephrology workforce in the United States and the future that it faces is important in ensuring that current and future needs of both patients and physicians are met. In this article, we (1) review the scope of practice of the transplant nephrologist, (2) discuss the state of training in the field of transplant nephrology, (3) review the role of the referring primary nephrologist in the care of patients undergoing kidney transplant, and (4) discuss challenges and opportunities facing the transplant nephrology workforce.
- Published
- 2020
49. To kidney or not to kidney: Applying lessons learned from the simultaneous liver-kidney transplant policy to simultaneous heart-kidney transplantation
- Author
-
Xingxing S. Cheng, Jeffrey J. Teuteberg, Kiran K. Khush, Jane C. Tan, and Alexander C. Wiseman
- Subjects
medicine.medical_specialty ,Economic shortage ,030230 surgery ,Kidney ,Kidney transplant ,03 medical and health sciences ,0302 clinical medicine ,Simultaneous liver kidney ,medicine ,Humans ,Intensive care medicine ,Kidney transplantation ,Transplantation ,business.industry ,medicine.disease ,Comorbidity ,Kidney Transplantation ,United States ,surgical procedures, operative ,medicine.anatomical_structure ,Policy ,Liver ,Heart Transplantation ,030211 gastroenterology & hepatology ,business - Abstract
As the medical community is increasingly offering transplantation to patients with increasing comorbidity burdens, the number of simultaneous heart-kidney (SHK) transplants is rising in the United States. How to determine eligibility for SHK transplant versus heart transplant alone is unknown. In this review, we situate this problem in the broader picture of organ shortage. We critically appraise available literature on outcomes in SHK versus heart transplant alone. We posit staged kidney-after-heart transplantation as a plausible alternative to SHK transplantation and review the pros and cons. Drawing lessons from the field of simultaneous liver-kidney transplant, we argue for an analogous policy for SHK transplant with standardized minimal eligibility criteria and a modified Safety Net provision. The new policy will serve as a starting point for comparing simultaneous versus staged approaches and refining the medical eligibility criteria for SHK.
- Published
- 2020
50. Spectral analysis for the Majorana Demonstrator experiment
- Author
-
B. X. Zhu, V. Yumatov, J. Gruszko, Yu. Efremenko, M. Buuck, G. K. Giovanetti, Keith Rielage, B. Shanks, V. E. Guiseppe, T. Gilliss, R. D. Martin, R. G. H. Robertson, A. W. Bradley, T. Bode, C-H. Yu, Eric W. Hoppe, J. A. Detwiler, M. Shirchenko, M. P. Green, C. J. Barton, C. Dunagan, T. S. Caldwell, Ralph Massarczyk, Walter C. Pettus, C. R. Haufe, C.M. O'Shaughnessy, S. I. Alvis, A. L. Reine, S. Vasilyev, N. Abgrall, I. Zhitnikov, R. L. Varner, F. E. Bertrand, I. J. Arnquist, N. W. Ruof, Anne-Marie Suriano, I. S. Guinn, C. Cuesta, W. Xu, J. E. Trimble, Pinghan Chu, G. Othman, A. W. P. Poon, Y-D. Chan, K. J. Keeter, D. Tedeschi, L. Hehn, S. I. Konovalov, J. Myslik, M. A. Howe, Richard T. Kouzes, J. Rager, H. Ejiri, Steven Elliott, Kai Vetter, C. D. Christofferson, M. F. Kidd, Susanne Mertens, E. Yakushev, J. F. Wilkerson, S. J. Meijer, B. R. White, K. Vorren, V.B. Brudanin, F. T. Avignone, Reyco Henning, A. M. Lopez, C. Wiseman, A. S. Barabash, D. C. Radford, and M. Busch
- Subjects
Physics ,History ,Physics - Instrumentation and Detectors ,FOS: Physical sciences ,Molecular ,Instrumentation and Detectors (physics.ins-det) ,nucl-ex ,Condensed Matter Physics ,Atomic ,Computer Science Applications ,Education ,Combinatorics ,Other Physical Sciences ,Monte carlo data ,MAJORANA ,Particle and Plasma Physics ,Background suppression ,Statistical analysis ,Spectral analysis ,Nuclear ,Nuclear Experiment (nucl-ex) ,Nuclear Experiment ,physics.ins-det - Abstract
The MAJORANA DEMONSTRATOR is an experiment constructed to search for neutrinoless double-beta decays in germanium-76 and to demonstrate the feasibility to deploy a ton-scale experiment in a phased and modular fashion. It consists of two modular arrays of natural and $^{76}\textrm{Ge}$-enriched germanium detectors totaling 44.1 kg (29.7 kg enriched detectors), located at the 4850' level of the Sanford Underground Research Facility in Lead, South Dakota, USA. Data taken with this setup since summer 2015 at different construction stages of the experiment show a clear reduction of the observed background index around the ROI for $0\nu\beta\beta$-decay search due to improvements in shielding. We discuss the statistical approaches to search for a $0\nu\beta\beta$-signal and derive the physics sensitivity for an expected exposure of $10\,\textrm{kg}{\cdot}\textrm{y}$ from enriched detectors using a profile likelihood based hypothesis test in combination with toy Monte Carlo data., Comment: 5 page, 2 figures, to appear in Proceedings of TAUP 2017 - XV International Conference on Topics in Astroparticle and Underground Physics, 24 - 28 July 2017, Sudbury, ON, Canada
- Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.