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Abstract The strict selection of pancreas for transplant has forced the development of different documents to select the suitable organ in order to minimize the risks and complications of the transplant. In 2008, Eurotransplant published the Preprocurement Pancreas Allocation Suitability Score (P-PASS) for pretransplant selection. In 2001 the Hospital Clinic of Barcelona developed a Clinical Consensus Document (CCD). Objectives We aimed to analyze the predictive decision of the pancreas acceptance to offers received in the hospital, according to the CCD criteria and compare it with the recommended value of suitability for accepting the pancreas according to the P-PASS value. Material and Methods We performed a retrospective comparative study between the criteria of selection of the CCD for pancreas from 2016–2017 in comparison with the values obtained if the P-PASS had been used: ≤ 17, acceptance criteria and P-PASS; > 17, risk criteria. We defined the organ reported as rejected or accepted. The accepted organ could be procured and transplanted or discarded. Results With the CCD criteria, 7 more organs were transplanted than if we only applied the potential P-PASS criteria. In contrast, P-PASS would have ruled out an additional 9% of pancreases in relation to CCD criteria. Conclusions According our experience, it is difficult to find an adequate prediction model to select pancreas for transplantation. The application of the DCC criteria increases the number of organs valid for transplantation. At present, new criteria should be re-evaluated within multicenter studies. [ABSTRACT FROM AUTHOR]

Mycobacterium timonense is a non-tuberculous mycobacteria ( NTM) described in southern France in 2009, and to our knowledge, not reported again as a human pathogen in indexed literature. The aim of this work was to characterize the first clinical isolate of M. timonense in Ecuador. Time of growth, biochemical tests, thin layer growth test, PCR- RFLP analysis of the hsp65 gene and MALDI- TOF spectra analysis were not able to identify the species. The species identification was achieved through sequencing of rrs, hsp65 and rpo B genes. The results highlight the necessity to set up a sequencing method to identify emerging NTM in Ecuadorian clinical facilities. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Family denials for tissue donation are higher than denials obtained after organ donation. Objectives: To find out families'' perception toward tissue request as well as its relation with the degree of acceptance or denial. Materials and methods: Following the request for tissue donation (corneas or different tissues), a five closed-question survey was designed and immediately answered by the Transplant Coordinator. The main aim was to find out whether the request determined surprise, disapproval, understanding, knowledge, and immediacy in the decision-making process, as well as its relation with the decision to donate. Results: Of 1751 surveys, 991 were answered and collected from 2009 to 2011, which represents a 56% from the total. Data collected relate to families 510 who donated and 481 who did not (P = NS). The fact of requesting corneas only or different tissues did not influence the answers. Surprise and disapproval variables significantly predicted refusal to donation (P = .000). Conclusions: Regardless the request type (corneas or multitissue) variables influencing the decision making when approaching families are expression of surprise and disapproval. Neither understanding the application nor existence of a prior approach to donation has any influence whatsoever in the decision-making process. [Copyright &y& Elsevier]

Abstract: Introduction: Donation and transplantation is an accepted therapeutic option when organ failure or tissue replacements are needed to save or improve the quality of life. However, in most medical schools there is no specific training for it, thus disregarding the key role of university students for the future success of the process. Objectives: Knowledge diffusion about the donation procedure to clarify doubts and stimulate positive attitudes toward donation. Training university students in the donation and transplantation process. Research about the previous donation knowledge and the impact in donation indexes. Methods: Three different phases have been designed: (1) Training the University of Barcelona Health Sciences School students; (2) Training the Health Sciences School students in other faculties of Catalonia, Spain, and International; and (3) research. Results: Since 2005, we have offered yearly an Optional Credits Course to medical students with duration of 45 hours, and two Donation days opened to health sciences students. Since 2007, promotional campaigns have been carried out in medicine and other health sciences faculties. Until now, 818 answered surveys have been collected to evaluate previous knowledge among university students. Conclusion: Training medical and other health sciences students in the donation process will improve quality of medical education and develop a trainer role for future professionals to help improve donation rates. [Copyright &y& Elsevier]

Abstract: It has been shown using in vitro techniques that BDNF and NGF evoke neurotransmitter release in the hippocampus but this phenomenon has not been demonstrated in vivo to date. We therefore performed in vivo microdialysis in urethane-anesthetized Fischer 344 rats. The microdialysis probe was implanted stereotaxically into the CA1 area of the hippocampus. Three hours after the implantation of the probe, glutamate (Glu) and dopamine (DA) levels had reached a stable baseline. Four baseline samples were collected every 15 min at a flow rate of 1 μL/min. The growth factors were delivered (1 μL/10 min) using a microinjector attached to the microdialysis probe. We found that BDNF and NGF, when administered into the hippocampus, evoked dopamine and glutamate release in a dose-dependent fashion. NGF produced a biphasic response in the release of Glu, and a uniphasic response in the release of DA, both of which were calcium dependent. The neurotransmitter release induced by NGF was blocked by tetrodotoxin, indicating neuronal origin of this response. The BDNF induced release of DA and Glu was decreased in low calcium conditions, indicating that it is at least partially calcium dependent. Furthermore, BDNF-induced neurotransmitter release was partially blocked by pre-treatment with K252a, an antagonist for tyrosine kinase receptors, indicating that BDNF is acting through Trk receptors to induce neurotransmitter release. These results demonstrate a close relationship between the growth factors BDNF and NGF and the neurotransmitters DA and Glu in the hippocampus of intact animals. [Copyright &y& Elsevier]

Abstract: Introduction: The presence of bloodstream infection in the donor is a common finding that could be transmitted to the recipient. To safely expand the donor pool, we examined its relevance. Materials and methods: We described the clinical characteristics of organ donors grafted in our center between 1997 and 2006 who had bacteremia detected in blood cultures obtained during organ procurement. Results: Among 1353 organ donors, 75 were non–heart-beating donors type II and the others brain-dead donors. Only 186 donors (14%) showed bacteremia during retrieval. This mean age was 49.8 years (range 12 to 86 years, SD 18) including 63% men. Causes of death were cerebrovascular accident in 60%; craneoencephalic trauma, 25%; and other causes, 15%. The average length of the intensive care unit stay was 3 days (interquartile range: 2 to 7 days). Twenty-nine percent of donors presented previous infectious complications (90% from respiratory origin). The most prevalent pathogen isolated in blood cultures was coagulase negative Staphylococci (46,2%), followed by S aureus (15%), Streptococcus group viridans (9.1%), enterobacteria (9%), Enterococcus faecalis (7.5%) and gram-negative bacilli nonfermentative (6.2%). In 3.1%, the bloodstream infections were polymicrobial. The bronchial aspiration cultures were positive in 50% of cases and the urine culture in 8,6%. In 17% of donors the isolated microorganism was coincident between blood and bronchial cultures. Pseudomonas spp and S aureus were more common than the others (P = .004 and P = .058, respectively). Conclusions: The incidence of bacteremia in our cohort was 14%. The respiratory tract was the most common clinical focus. Pseudomonas spp or S aureus isolated in bronchial cultures are risk factors to develop bacteremia. According to these findings, it is important to start specific antibiotics against those microorganisms in the donor and the recipients. [Copyright &y& Elsevier]

Out of all these sources the Explicit Current Productivity (ECP), Real Productivity (RP) and Maximum Mean Expected Productivity (MMEP) was obtained. Financing gaps were measured according to Explicit Current Financing (ECF), Implicit Financing (IF) and Total Current Financing (TCF), ECP, RP and MMEP. The financing gap to solve MMEP in BS would be similar to prioritized diseases (brain carcinoma, cardiac stenosis, etc.). [Extracted from the article]

Available treatments for IS due to Large Vessel Occlusion (LVO) are Thrombolysis (IV-tPA) and Mechanical Thrombectomy (MT). Results Over a lifetime period, MT after IV-tPA is estimated to be cost-effective leading to a gain of +2.63 QALYs and +1.19 life years (LY), with an Net Monetary Benefit (NMB) of $37,289,874 and an ICER of $3,807,413/QALY. After adding Physical Therapy costs, MT after IV-tPA remains cost-effective (+2.54 QALYs, +1,13 LY, NMB is $35,670,319, and ICER is $3,960,624/QALY). [Extracted from the article]

Ischemic-Stroke (IS) is a prevalent disease, responsible for long-term disability, premature deaths, and high-expenditure in Chile. Available treatments for IS due to Large-Vessel Occlusion (LVO) are Thrombolysis (IV-tPA) and Mechanical Thrombectomy (MT) with stent retrievers. A Budget-Impact Analysis (BIA) was conducted to estimate the financial impact of adding MT after IV-TPA in Chile. [Extracted from the article]

Heart Failure (HF) is present in 10% of elderly. To solve the current gap in baseline data for these patients and the need of leveraging pilots in the private sector, an analytic study of baseline characteristics was conducted in a private provider (PP): Clínica Dávila. During-treatment: Patients experiment 0.59 non-HF hospitalizations/year. [Extracted from the article]

Background Systemic inflammation affects kidney function in a wide range of diseases. Even in kidney transplant recipients, higher levels of C-reactive protein (CRP) are invariably associated with both worse short- and long-term graft outcomes. However, little is known about systemic inflammation in kidney donors and, notably, brain death causes a strong systemic inflammatory response. Objective To analyze the role of systemic inflammation of brain-dead donors on short-term kidney graft outcomes (ie, delayed graft function [DGF], defined as the need of dialysis during the first week after transplantation). Materials and methods Retrospective analysis of clinical and biochemical characteristics of all brain-dead kidney donors generated in the Hospital Clínic of Barcelona in the 2006 to 2015 period (n = 194). Donors who were tested for CRP in the 24 hours before BD declaration were included (n = 97, 50% of initial population). Clinical and biochemical features of their respective recipients (n = 165) were analyzed, comparing recipients who developed DGF (n = 30) with recipients who did not (n = 135). Results Donors whose recipients later developed DGF had much higher CRP values (10.58 [5.1-18.21] vs 4.81 [1.42-12.2] mg/dL, P = .025). Other characteristics associated with the development of DGF were renal biopsy score and recipient dialysis vintage ( P = .025 and P = .002, respectively). In logistic regression analysis, PCR maintained significance in the non–expanded criteria donor (ECD) group (odds ratio [OR], 1.102; P = .027), but it lost significance in the ECD group ( P = .67). Conclusions Terminal donor CRP was associated with DGF in kidney transplant recipients and proved to be mostly significant in younger donors. [ABSTRACT FROM AUTHOR]

Objectives: Chile is a post-transitional country evolving towards a stationary population pyramid, which may be associated with increasing preterm birth (PTB) rates. This study aimed to compare maternal sociodemographic characteristics between the start of the post-transition phase (1994) and an established stage (2013) and to evaluate associations between these characteristics and PTB. Study design: An observational analytic design was conducted using national birth records (n = 4,956,311). Methods: Variables analysed in the 20 birth cohorts from 1994 to 2013 were: length of gestation (preterm <37 weeks) subdivided by gestational age (extreme, moderate/severe and late); maternal age (≤19, 20-35 and >35 years); education level (<8, 8-12 and >12 years of education); employment; marital status; area of residence; and type of birth (singleton, twins, and triplets or higher order). The prevalence of PTB was expressed as a percentage, and associations between PTB and predictor variables were analysed using logistic regression models. Results: Education level, age >35 years, maternal employment, unmarried status, twin delivery and urban residency rates increased between 1994 and 2013. According to the adjusted models, age >35 years and delivery of more than two foetuses were risk factors for all PTB subtypes. Maternal employment was a risk factor for moderate/severe, late and total PTB, and a low level of education was a risk factor for late and total PTB. On the other hand, age ≤19 years was protective against all PTB subtypes. Conclusions: All maternal characteristics changed between 1994 and 2013. Furthermore, the prevalence of PTB increased for all predictor variables studied over this period. [ABSTRACT FROM AUTHOR]

Abstract: One reason for the loss of donors is the impossibility to contact family members for an interview. We sought to determine the effectiveness [(donors/total deaths) × 100] and efficiency [(donors/potential donors) × 100] of the telephone interview to obtain tissue for transplant purposes. Methods: A prospective, comparative cross-sectional study was performed on the personal and telephone interviews with family members during the tissue donation application process from January 1, 2004 to December 31, 2005. Results: Of the 3625 deaths hospital registered, we obtained 770 potential donors (21%). On 65% of occasions (503/770), the interview was held personally; on 29% (222/770), it had to be held over the telephone; and on 6% (45/770), family members could not be located. The refusals by family members over the telephone represented 48% (106/222), and the refusals during personal interviews were 37% (188/503). A positive family answer was obtained over the telephone on 116/431 donations (27%), and in the physical presence of the coordinator for 315/431 donors (73%). The donations obtained over the telephone were only for corneas in 83% (96/116) of cases, and for multiple tissues in 17% (20/116). The donor-generation effectiveness reached 9% in personal interviews and 12% if the telephone interviews were included. The donor generation efficiency reached 43% for personal interviews and 59% when telephone interviews were included. The use of the telephone enabled a 16% increase in tissue generation with a year-on-year increase of 4%. Conclusions: The telephone has shown itself to be a useful tool for obtaining tissues postmortem. [Copyright &y& Elsevier]

This paper focuses on feature selection problems that arise in renewable energy applications. Feature selection is an important problem in machine learning, both in classification and regression problems. In renewable energy systems, feature selection appears related to prediction systems in the most important sources such as wind, solar and marine resources. The objective of the paper is twofold: first, a review of the most important prediction systems for renewable energy applications involving feature selection is carried out. Analysis and discussion of different feature selection problems in prediction systems are considered. We show that wrapper FSP approaches are those mostly used due to their higher performance. They include a diversity of algorithms, prevailing fast-training approaches. The lack of an uniform framework for FSP and the diversity of tackled problems impede a systematic assessment of the performance and properties of the applied methods. Thus, the simultaneously use of several global search mechanisms should be the preferred option. In a second part of the paper, we explore this possibility, by introducing a novel approach for feature selection based on a novel meta-heuristic, the Coral Reefs Optimization algorithm with Substrate Layer. This approach is able to combine different search mechanisms into a single algorithm, providing a global search procedure of high quality. We use an Extreme Learning Machine for prediction within this novel approach. The performance of the system is evaluated in a problem of wind speed prediction from numerical models input, using real data from a wind farm in Spain, where comparison with alternative regression algorithms is carried out. Improvements up to 20% in hourly and daily wind speed prediction are obtained with the proposed system versus the algorithms without the feature selection process considered. [ABSTRACT FROM AUTHOR]

Detailed knowledge on migratory routes connecting distant breeding, developmental and foraging areas is a key prerequisite for the successful management of marine vertebrates. The present study combines stable isotopes analysis of carapace scutes and satellite tracking of juvenile green turtles as an experimental approach to understand the pre and post settlement (recruit to neritic habitats) movements in the Southwestern Atlantic Ocean. To this end, carapace scute biopsies were collected from 20 turtles foraging on coastal rocky outcrops in East Uruguay and sliced in successive 30-μm layers using a cryostat. The δ 15 N and δ 13 C values of the newest layer increased significantly with turtle size and they also increased from the oldest to the newest layer in most of the individuals. According to the regional isoscape, such a pattern was consisted with the shift from tropical, oceanic habitats to neritic habitats in northern Brazil and the subsequent southward movement along the coast. Using the δ 15 N values of the scute layers, seven turtles were considered new-settlers and 13 residents, as only the latter had δ 15 N and δ 13 C values consistent with those of local potential prey. According to satellite tracking, some resident turtles perform short seasonal migrations to northern Brazilian waters during the austral winter. This behaviour is also recorded in scute layers as a small drop of δ 15 N values. The present study thus provides empirical evidence supporting the hypothesis that turtles reaching 40–45 cm of curved carapace length arrive to Uruguayan waters following a coastal migratory route along the Brazilian coast and confirms the existence of seasonal movements between Uruguayan and South-Brazilian waters and a high fidelity for feeding grounds in the Southwestern Atlantic Ocean. [ABSTRACT FROM AUTHOR]

: ObjectiveTo evaluate both the opinion that living liver donors have of the process and the psychological, economic, and social consequences of donation.: Material and methodsSix months after the donation, an anonymous survey was sent to 22 donors of the right liver lobe between March 2000 and December 2002.: Results15 surveys were returned with all of the questions answered. Almost all the donors had no prior knowledge of living donation. When they were considered to be suitable donors, all of them felt happy, 21% were scared and 15% felt joy and insecurity. The information provided was well understood and accurately described the experiences of 93% of donors. All donors understood the vital risk, and 93% understood that transplantation is not always completely successful. All donors would repeat the experience. Mean hospital stay was 12.6 days. Mean convalescence was 50.6 days. Salaried donors were on sick leave for a mean of 96.4 days (21–150 days), causing financial problems in six cases (36%), due to no financial compensation and compulsory redundancy in one case. All donors had completely recovered at six months after donation.: DiscussionAdult living donation of the right liver lobe is an accepted therapeutic alternative. In order to regulate medical and economic protection to avoid additional disturbances after donation, the public, patients, and physicians require more complete information about living donation. [Copyright &y& Elsevier]

The process of obtaining organs and tissues includes a series of procedures and skills that are fundamental to obtain a large number and high quality of transplants. Health professionals involved in transplant coordination require robest and comprehensive training to integrate the donation-transplantation process within the clinical health care field. Based on a learning-through-experience model, Transplant Procurement Management (TPM) designed various courses adapted to local educational need to train transplant coordinators, to increase active donor detection, and to promote a positive attitude towards donation; namely, Advanced, Introductory and New Life Cycle courses respectively. Moreover, TPM has coordinated international programs (INTERCATT and INTERITALY). Since 1991, the model has included 29 Advanced courses (1215 participants), 22 Introductory courses (575 pupils), and 7 New Life Cycle courses (more than 400 attendees). The Advanced courses were attended by medical (intensive care unit, nephrology, and others) and nursing professionals. Assessment of the educational program showed achievement of teaching objectives. The evaluation averages above 3.5 (scale, 1–5) for content, presentation, and ability to answer questions. Likewise, the program''s organization showed an average score of 4.4. The acquired knowledge was assessed by means of a self-evaluation test (correct answers >69%). Practical skills assessed through direct observation showed an average of 7 (scale, 1–10). The TPM educational program offers a range of necessary knowledge and skills to increase organ donation. Health professionals concerned about the organ shortage may find TPM training useful to increase their knowledge. [Copyright &y& Elsevier]

Introduction Postmortem tissue donation (TD) requires the establishment of strategies for family approach to clearly explain the characteristics of multi-tissue donation. In a tertiary university hospital with a long tradition of tissue generation, we designed a survey to be applied to tissue donor families to evaluate global hospital care, care from Transplant Coordinators (TC), quality and content of information given about TD, experience, and motivations after TD process. Methodology A prospective phone survey of 10 multiple-choice items was conducted to all TD relatives that agreed to donate one or more tissues. Results From the 166 calls made to TD relatives, 75 (45%) were answered: 50 were cornea donors and 25 were multiple-tissues donors. None of the relatives denied participating, the rest were not found. No statistical differences in demographical variables were found between both types of TD. The hospital and TC care perception, the quality of the given information about the processes of TD, the postdonation experiences in terms of procedures, and the impression about body appearance for relatives regardless of the type of donation, corneas or multiple tissues, were evaluated as good or very good for most of the TD relatives. Our study showed that 83% of the family members would agree to donate again; 40% of the relatives were surprised to be offered the option to donate; 10% did not know if they would donate again. Solidarity was the leading reason for TD. Conclusion The relatives' perception of care is a critical component of the quality evaluation of the TD process. The global evaluation results support our strategies for family approach. [ABSTRACT FROM AUTHOR]

Abstract: The appropriate clinical management of the integrated process of Donation and Transplantation implies the participation of the Transplant Coordinator. The aim of this article is to present the process of Certification of Transplant Coordinators in Europe since 2001, in accordance with the Council of Europe Recommendations and the evolving model implemented in 2008 under the auspices of the UEMS, reporting the longest running European standardized assessment of Transplant Coordination skills and knowledge. It includes the rationale for development of a certification process, how the examinations were developed and updated, eligibility to take the examination, and relationship with standards of practice for Transplant Coordinators. A total of 455 healthcare professionals were certified in two phases: 1st ETCO certification since 2001 to 2007 (390) and 2nd ETCO/UEMS certification from 2008 to 2011 (65). [Copyright &y& Elsevier]