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Background: Multiorgan transplantation is increasingly common, driving recent increased attention to multiorgan allocation policies. Methods: In this review, we summarize current multiorgan transplant allocation policies in the United States, with attention to recent and proposed changes and their impact on pediatric candidates. Results: Existing multiorgan transplant policies attempt to balance equity and utility. Currently, there are clear allocation policies for some, but not all, multiorgan transplant combinations, and there are no mandatory outcomes reporting. Multiorgan candidates are prioritized above all kidney‐alone transplant candidates, which negatively affect pediatric kidney transplant wait times. Pediatric candidates are typically exempt from multiorgan listing criteria. Conclusion: Multiorgan transplant allocation presents unique challenges for policy development. As the United States Network for Organ Sharing begins exploring continuous distribution allocation, multiorgan allocation will require special consideration and the development of clear and equitable policies. [ABSTRACT FROM AUTHOR]

Campsites represent highly sought after recreational amenities in the national parks of the United States. Equitable allocation of scarce recreational resources has long been a key management issue in U.S. national parks, but has become increasingly difficult in an era of increasing demand. At present, a growing number of national park campsites are allocated through an online reservation system well in advance of a camper's arrival at a park. Compounding the challenge of allocating these campsites is a long history of exclusivity within national park camping--institutionalized through campground design and predicated on a legacy of the leisure class's affinity for camping in national parks. Given national park camping's history of exclusivity, this exploratory study seeks to explore how online reservation systems may impact the demographics of national park campers. Using mobile device location data, estimated demographics were calculated for campers in five national park campgrounds in the U.S. that each contained some sites requiring reservations and some sites available on a first-come, first-served basis. We detail results from analyses of variance between campsites requiring reservations and those that are available on a first-come, first-served basis. Results suggest that for each of the five campgrounds, those campers camping in sites that require reservations came from areas with higher median household incomes, on average. In three of the five campgrounds, this difference was significant. Additionally, in an urban-proximate setting, those camping in sites requiring reservations came from areas with a higher portion of White residency than those campers in campsites not requiring reservations, on average. We conclude with discussion that includes management implications concerning the growing prominence of online reservation systems for outdoor recreation amenities, and a brief research agenda for diversity, equity, and inclusion (DEI) as they relate to campgrounds. Principally, the former group of implications includes the realization that online reservation systems present the unintended consequence of excluding low-income, and perhaps non-White, would-be campers--a conclusion drawn from the results of this exploratory study. This discussion includes an analysis of the distributive justice of online reservation systems. [ABSTRACT FROM AUTHOR]

Background: The United States organ allocation policies prioritize kidney–pancreas and other multiorgan candidates above pediatric kidney‐alone candidates, but the effects of these policies are unclear. Methods: We used OPTN data to describe trends in multiorgan and kidney–pancreas transplantation and identify 377 next‐sequential pediatric kidney‐alone candidates between 4/1/2015 and 10/31/2019 for individual‐level analysis. Results: Eleven percent of all kidneys were allocated as part of a multiorgan or kidney–pancreas transplant and 6% of pediatric kidney candidates were impacted. Pediatric next‐sequential candidates accrued a median of 118 days (IQR 97–135 days) of additional wait time, and this was significantly longer for children who were Hispanic (p =.02), blood type B or O (p =.01), or had a cPRA ≥20% (p <.01). Eight pediatric next‐sequential candidates (2%) were removed from the waitlist due to death or "too sick to transplant." 63% were transplanted with a kidney with a higher KDPI than the original multiorgan match (p <.01). Donor service areas with higher volumes of kidney–pancreas transplants had significantly longer additional wait times for pediatric next‐sequential candidates (p =.01). Conclusions: Current allocation policy results in longer waiting times and higher KDPI kidneys for pediatric kidney candidates. As multiorgan transplant volume is increasing, further consideration of allocation policy is necessary to maximize equality and utility. [ABSTRACT FROM AUTHOR]

Background: A new Kidney Allocation System (KAS) was implemented in the United States in 2014 with the goal of improving equity and utility. Methods: In this study, we compare outcomes for kidney‐alone candidates less than 18 years of age, at the time of listing, in the 5 years prior to and following policy implementation using Organ Procurement and Transplantation Network data. Results: While the pediatric deceased donor transplant rate increased under KAS, this increase was due solely to improved access for children aged 11–17 years; there was an 18.9% decrease in the deceased donor transplant rate among children 0–5 years old, from 117.94 to 95.8 transplants per 100 person‐years (p =.001). The cumulative incidence of deceased donor transplantation by 1 year after listing decreased from 39.3% in the pre‐KAS era to 35.5% in the post‐KAS era (p =.004), a decline that was driven entirely by longer wait times for children 0–5 years old (p =.017). Candidates with a calculated panel reactive antibody of 98%–100% experienced a significant increase in transplant rate, but there was no change in transplant rate for Black or Hispanic candidates. Conclusion: Overall, KAS increased transplantation access for teenaged and highly sensitized candidates but resulted in decreased access for the youngest children with no improvement in racial/ethnic equality. [ABSTRACT FROM AUTHOR]

For much of 2021, allocating the scarce supply of Covid‐19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, the ACIP violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy‐five years of age as the only criterion to identify individuals at high risk of death from Covid‐19 during phase 1b, failing to recommend place‐based vaccine distribution, and implicitly endorsing first‐come, first‐served allocation. More rigorous empirical work and the development of a complete ethical framework that recognizes trade‐offs between principles may have prevented these mistakes and saved lives. [ABSTRACT FROM AUTHOR]

Acute-on-chronic liver failure (ACLF) is a variably defined syndrome characterized by acute decompensation of cirrhosis with organ failures. At least 13 different definitions and diagnostic criteria for ACLF have been proposed, and there is increasing recognition that patients with ACLF may face disadvantages in the current United States liver allocation system. There is a need, therefore, for more standardized data collection and consensus to improve study design and outcome assessment in ACLF. In this article, we discuss the current landscape of transplantation for patients with ACLF, strategies to optimize organ utility, and data opportunities based on emerging technologies to facilitate improved data collection., Competing Interests: Declaration of competing interest The authors of this manuscript have conflicts of interest to disclose, as described by the American Journal of Transplantation. J. Ge receives research support from Merck and Co; consults for Astellas Pharmaceuticals/Iota Biosciences and Madrigal Pharmaceuticals; and served on an advisory board for Gilead Sciences. The other authors of this manuscript have no conflicts of interest to disclose, as described by the American Journal of Transplantation., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Liver transplantation (LT) in patients with alcohol-associated hepatitis (AH) has rapidly increased following the coronavirus disease 2019 pandemic and the implementation of the Acuity Circle policy, raising questions of equity and utility. Waitlist mortality among high (≥37) Model for End-Stage Liver Disease LT candidates with AH and post-transplant survival were assessed with a semiparametric survival regression and a generalized linear mixed-effect model with LT centre- and listing date-level random intercepts. These models demonstrate a lower mortality for the candidates listed with AH (adjusted sub-hazard ratio .58&#95; .72 &#95;.90 and odds ratio .44&#95; .66 &#95;.99 ) when compared to other diagnoses (autoimmune hepatitis, metabolic dysfunction-associated fatty liver disease and primary biliary cholangitis). Post-LT survival was comparable. This study highlights the limitations of current tools in characterizing the risk of mortality, and thus need for the modifications in prioritizing LT candidates with AH. Policy revision may be needed to ensure equivalent access to LT regardless of diagnosis., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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. [ABSTRACT FROM AUTHOR]

The OPTN/SRTR 2022 Annual Data Report presents the status of the solid organ transplant system in the United States from 2011 through 2022. Organ-specific chapters are presented for kidney, pancreas, liver, intestine, heart, and lung transplant. Each organ-specific chapter is organized to present waitlist information, donor information (both deceased and living, as appropriate), transplant information, and patient outcomes. Data pertaining to pediatric patients are generally presented separately from the adult data. In addition to the organ-specific chapters, the reader will find chapters dedicated to deceased organ donation, vascularized composite allografts, and the COVID-19 pandemic. The data presented in the Annual Data Report are descriptive in nature. In other words, most tables and figures present raw data without statistical adjustment for possible confounding or changes over time. Therefore, the reader should keep in mind the observational nature of the data when attempting to draw inferences before trying to ascribe a cause to any observed patterns or trends. This introduction provides a brief overview of trends in waitlist and transplant activity from 2012 through 2022. More detailed descriptions can be found in the respective organ-specific chapters., (Copyright © 2024. Published by Elsevier Inc.)

The number of heart transplants in the United States has continued to increase. Since 2011, pediatric heart transplants have increased 31.7% to 494 and adult heart transplants have increased 85.8% to 3,668 in 2022. The numbers of new candidates for pediatric and adult heart transplants have also increased, with 703 new pediatric candidates and 4,446 new adult candidates in 2022. Adult heart transplant rates continue to rise, peaking at 122.5 transplants per 100 patient-years in 2022; however, the pediatric heart transplant rate decreased to its lowest rate in the past decade, 104.2 transplants per 100 patient-years, a decrease of 13.9% from 121 transplants per 100 patient-years in 2011. Despite this, pretransplant mortality among pediatric candidates has decreased by 52.2%, from 20.8 deaths per 100 patient-years in 2011 to 10.0 deaths per 100 patient-years in 2022, but remains excessive for candidates younger than 1 year at 25.7 deaths per 100 patient-years. Among adult candidates, pretransplant mortality declined from 15 deaths per 100 patient-years in 2011 to 8.7 deaths per 100 patient-years in 2022. Since 2011, posttransplant mortality has been stable to slightly better; among recipients who underwent transplant in 2015-2017, the 1-, 3-, and 5-year pediatric survival rates were 93.7%, 89.2%, and 85.0%, respectively, and the adult survival rates were 91.3%, 85.7%, and 80.4%. Donor trends have been favorable, with an increase in the numbers of hearts recovered and growing numbers of hearts procured after circulatory death., (Copyright © 2024. Published by Elsevier Inc.)

In 2022, liver transplant activity continued to increase in the United States, with an all-time high of 9,527 transplants performed, representing a 52% increase over the past decade (2012-2022). Of these transplants, 8,924 (93.7%) were from deceased donors and 603 (6.3%) were from living donors. Liver transplant recipients were 94.5% adult and 5.5% pediatric. The overall size of the liver transplant waiting list contracted, with more patients being removed than added, although 10,548 adult patients still remained on the waiting list at the end of 2022. Alcohol-associated liver disease continued to be the leading diagnosis among both candidates and recipients, followed by metabolic dysfunction-associated steatohepatitis. Simultaneous liver-kidney transplant was the most common multiorgan combination, with 800 liver-kidney transplants performed in 2022; in addition, there were 303 new listings for kidney transplant via the safety net mechanism. Among adults added to the liver waiting list in 2021, 39.9% received a deceased donor liver transplant within 3 months; 45.7%, within 6 months; and 54.5%, within 1 year. Pretransplant mortality decreased to 12.3 deaths per 100 patient-years in 2022, although still 15.6% of removals from the waiting list were for death or being too sick for transplant. Graft and patient survival outcomes after deceased donor liver transplant improved, approximating pre-COVID-19 pandemic levels, with 5.1% mortality observed at 6 months; 6.8%, at 1 year; 12.7%, at 3 years; 19.8%, at 5 years; and 35.7%, at 10 years. Five-year graft and patient survival rates after living donor liver transplant exceeded those of deceased donor liver transplant. Candidates receiving model for end-stage liver disease exception points for hepatocellular carcinoma constituted 15.5% of transplants performed in 2022, with similar transplant rates and posttransplant outcomes compared to cases without hepatocellular carcinoma exception. In 2022, more pediatric liver transplant candidates were added to the waiting list and underwent transplant compared with either of the preceding 2 years, with an uptick in living donor liver transplant volume. Although pretransplant mortality has improved after the recent policy change prioritizing pediatric donors for pediatric recipients, still, in 2022, 50 children died or were removed from the waiting list for being too sick to undergo transplant. Posttransplant mortality among pediatric liver transplant recipients remained notable, with death occurring in 4.0% at 6 months, 6.0% at 1 year, 8.2% at 3 years, 9.8% at 5 years, and 13.9% at 10 years. Similar to adult living donor recipients, pediatric living donor recipients had better 5-year patient survival compared with deceased donor recipients., (Copyright © 2024. Published by Elsevier Inc.)

Floating treatment wetlands (FTWs) are a plant-based treatment technology shown to remove excess nutrients and metals from surface waters under a variety of conditions. Plants established in FTWs can accumulate and store nutrients within their tissues, but the amount of uptake and storage is dependent on plant species and nutrient influent concentration. This research was designed to quantify the influence of nutrient load and two plant species on nutrient uptake and partitioning patterns within plant tissues (shoots and roots) so that management recommendations for FTWs can be developed to better protect surface water quality. Treatments consisted of (1) two nutrient loads: a high concentration of 15 mg⋅L−1 nitrogen (N) and a low concentration of 5 mg⋅L−1 N supplied as water soluble fertilizer, and (2) four mesocosm treatments: (a) open water, (b) artificial mat only, no plants, (c) artificial mats planted with Pontederia cordata L., and (d) artificial mats planted with Juncus effusus L.. Plant growth, N, and phosphorus (P) uptake of both P. cordata and J. effusus were greater in the high nutrient treatment than in the low. Pontederia cordata facilitated the highest rates of N (0.31 mg.L.day−1) and P (0.34 mg.L.day−1) removal. The nutrient removal rates facilitated by Juncus effusus in the high nutrient treatment were much lower for both N (0.03 mg.L.day−1) and P (0.02 mg.L.day−1). Peak N and P accumulation in J. effusus occurred in September within both root (50 g N and 4.8 g P) and shoot tissues (98 g N and 12.5 g P). The uptake of N and P in P. cordata was highest in root tissues in August (307 g N and 30.5 g P) and in shoot tissues in September (1490 g N and 219.5 g P). In both species, shoots accumulated more N and P than the roots, resulting in a small root:shoot ratio at all stages of the experiment. Harvest of plants from FTWs should occur before plants senesce in the fall, which using P. cordata and J. effusus as model species, occurred from mid- to late-September in USDA Hardiness Zone 8a in the Southeastern United States. Image 1 • Plant N uptake by Pontederia cordata & Juncus effusus was >50% in high treatment. • Peak accumulation of nutrients was in August & September. • Majority of nutrients accumulated in the shoots tissues rather than the roots. • Faster remediation rate over a 7-day period at 15 mg⋅L−1 N compared to 5 mg⋅L−1 N. [ABSTRACT FROM AUTHOR]

Identifying the optimal allocation policy with regard to hepatocellular carcinoma has been a persistent and evolving challenge. The current criteria for LT for HCC endorsed by the United Network of Organ Sharing (UNOS) are based on the Milan Criteria: a solitary tumor < 5 cm, or maximum of three tumors ≤ 3 cm each, without vascular invasion or evidence of extrahepatic spread. Contraindications to HCC exception points include: stage 1 HCC, ruptured HCC, extrahepatic HCC, and main portal or hepatic vein HCC invasion. Based upon projected waitlist dropout rates due to tumor growth, patients with HCC are assigned MELD standardized exception points. In addition to tumor size and number, AFP levels are an important predictor of recurrence of HCC following liver transplantation. Standardized exception points for HCC patients are not awarded to patients with AFP levels > 1000 ng/mL that do not decrease to < 500 ng/mL with treatment. Appeals for MELD exception points for patients with HCC vary widely between UNOS regions, with success of nonstandardized exception point appeals varying from 3.1 to 21% between regions. In an effort to make prioritization for HCC more consistent, a national liver review board (NLRB)is being convened that will focus on developing a national guidance for assessing common requests and addressing exception points, including for HCC. [ABSTRACT FROM AUTHOR]

Increasing stress on the global water supply necessitates the measurement of water consumption as a sustainability metric to evaluate energy production, including the production of transportation fuels (gasoline, diesel, jet fuel) at petroleum refineries. This study estimated refinery water consumption for petroleum fuels by considering three typical refinery configurations (cracking, light coking, and heavy coking) that process different crude qualities (e.g., American Petroleum Institute Gravity (API) gravity and sulfur content). The results showed that refinery water consumption was 0.34, 0.44, and 0.47 bbl water/bbl crude (L water/L crude) for cracking, light coking, and heavy coking configurations, respectively. The water consumption for a specific refinery product was estimated using an energy allocation approach at the process unit level. The results indicated that gasoline production consumes the largest amount of water, 0.60–0.71 gal water/gal gasoline (0.60–0.71 L water/L gasoline), due to the energy-intensive (and thus water-intensive) processing of gasoline components (mainly sourced from alkylation, reformer, and fluid catalytic cracking units). In contrast, jet fuel production consumes the least water, 0.09 gal water/gal jet fuel, for all three refinery configurations, because it is sourced directly from the crude distillation unit with minimal post-treating. The consumption of diesel is most sensitive to refinery configuration with 0.20, 0.30, and 0.40 gal water/gal diesel (L water/L diesel) for cracking, light coking and heavy coking configurations, respectively. This is mainly because as configuration complexity increases to process heavier and sourer crudes, a sizable burden of hydrogen production from steam methane reforming unit is allocated to diesel fuel production (including diesel sulfur removal). The trend of water consumption associated with these refinery products is consistent with the energy consumption for their production. [ABSTRACT FROM AUTHOR]

By-product hydrogen from chlor-alkali processes can help meet the increasing demand for hydrogen fuel in early fuel cell electric vehicle markets (e.g., California) in the U.S. Hydrogen produced from chlor-alkali plants is typically combusted for process heat on site, vented to the atmosphere (i.e., wasted), or sold to the external merchant hydrogen market. Whether it is combusted, vented, or sold as a commodity, relevant information is lacking as to the life-cycle environmental benefits or trade-offs of using by-product hydrogen from chlor-alkali plants. A life-cycle analysis framework was employed to evaluate well-to-gate greenhouse gas (GHG) emissions associated with by-product hydrogen from chlor-alkali processes in comparison with hydrogen from the conventional centralized natural gas steam methane reforming (central SMR) pathway. U.S.-specific, plant-by-plant, and up-to-date chlor-alkali production characteristics were incorporated into the analysis. In addition to the venting and combustion scenarios, to deal with the multi-functionality of the chlor-alkali processes that simultaneously produce chlorine, sodium hydroxide, and hydrogen, two different co-product allocation strategies were adopted—mass allocation and market value allocation. It was estimated that by-product hydrogen production from chlor-alkali processes creates 1.3–9.8 kg CO 2 e/kg H 2 of life-cycle GHG emissions on average, which is 20–90% less than the conventional central SMR pathway. The results vary with co-product treatment scenarios, regional electric grid characteristics, on-site power generation, product prices, and hydrogen yield. Despite the variations in the results, it was concluded that the life-cycle GHG emission reduction benefits of using by-product hydrogen from chlor-alkali processes are robust. With a diverse set of scenario analyses, the study developed a comprehensive and detailed life-cycle GHG emissions inventory of the chlor-alkali by-product hydrogen pathway and quantified sensitivity indices in the context of different assumptions and input parameter values. [ABSTRACT FROM AUTHOR]

Deceased donor kidney allocation was reorganized in the United States to address several problems, including the highly sensitized patients disadvantaged with large, diverse repertoires of antibodies. Here, five transplant surgeons review their center’s experience with the new allocation changes: highlighting areas of accomplishment, opportunities for improvement and, in some cases, stark differences in practice. Across these five centers the highly sensitized patients (CPRA ⩾98%) range from 5.5 to 9.2% of the 12,364 candidates on their collective waitlist. All centers reported greater rates of kidney transplantations in highly sensitized patients (12.4–27%). Three of the programs (Emory, UCSF, UW) relied upon the virtual crossmatch prior to organ acceptance in a majority of cases (70–86%)—the mere presence of antibody on HLA antibody screen was sufficient to exclude the donor in most cases at Emory and UCSF. Penn and UAB relied upon the physical flow crossmatch in almost all cases prior to proceeding with transplantation. Current or historical donor-specific antibody was occasionally crossed in certain cases at UW and UAB necessitating IVIG/plasmapheresis and/or B cell depletion perioperatively. Some authors raised concerns for cost efficiency given the increased need for organ/specimen transportation, and extensive use of hospital resources and ancillary services. In general, we found that the new allocation system has successfully achieved one of its primary goals—increased kidney transplantation in the disadvantaged, highly sensitized patients; the long-term outcomes in all patients and the cost ramifications of these changes will require continued reassessment and clarification. [ABSTRACT FROM AUTHOR]

The CDC crossmatch test is being phased out in solid organ donor allocation, and standard luminex single antigen bead assays do not differentiate complement activating function of HLA antibodies. The current study investigated the LIFECODES C3d-binding assay to determine if it could accurately predict actual T and B cell CDC results in a cohort of highly sensitised patients. Nineteen serum samples from different highly sensitised solid organ patients were crossmatched against cells from 62 unique donors, with 174 total T and B cell crossmatches performed. The sera also underwent SAB assay using OLI and LC platforms, and C3d-binding assay. Complement activating ability of each unique HLA antibody specificity detected using SAB was assigned based on the actual CDC results, which was then used to determine the accuracy of the C3d-binding assay. The C3d-binding assay was found to be highly accurate, with sensitivity of 95%, specificity 89% and negative predictive value 97% for class I DSA and the T cell CDC crossmatch results. Furthermore, we found 100% accuracy for prediction of the complement activating function of HLA-C antibodies. Negative predictive value of above 90% was also found for HLA class II DSA. C3d-binding proved more accurate than virtual crossmatch alone to predict CDC results. This study confirms that the C3d-binding assay predicts actual CDC crossmatch results accurately. In particular, the high negative predictive value of the C3d-binding assay may be extremely useful to define HLA antibodies that do not activate complement in highly sensitised recipients., (© 2023 The Authors. HLA: Immune Response Genetics published by John Wiley & Sons Ltd.)

Pediatric lung transplantation (LTX) remains limited by the scarcity of small donor lungs, particularly in less populated parts of the world. Optimal organ allocation, including the prioritization and ranking of pediatric LTX candidates, and the appropriate matching of pediatric donors to recipients have been crucial elements in improving pediatric LTX outcomes. We aimed to elucidate the various pediatric lung allocation practices worldwide. A global survey of current pediatric solid organ transplantation deceased donation allocation practices was conducted by the International Pediatric Transplant Association (IPTA), and these policies were subsequently analyzed if publicly available, with focus on pediatric lung transplantation. Significant variation was found in lung allocation systems worldwide both in terms of prioritization and distribution for children. Definition of pediatrics varied from <12 years of age to <18 years of age. While several countries performing LTX for young children do not have a formal system to prioritize pediatric candidates, many countries that perform LTX at higher rates do offer prioritization methods for children: including the United States, United Kingdom, France, Italy, Australia, and countries serviced by Eurotransplant. Certain lung allocation practices for pediatrics are highlighted herein, including the newly instituted Composite Allocation Score (CAS) system in the United States, pediatric matching with Eurotransplant, and pediatric prioritization in Spain. The systems highlighted here explicitly aim to provide judicious and high quality LTX care for children., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The upstream environmental impacts of petroleum-derived materials are vital to the life-cycle assessment of many complex systems because petroleum products are used in countless applications as fuels or raw inputs. Currently, there exists no transparent data source for these upstream impacts that account for critical regional differences in crude oil sources and refinery fuels within the United States. This study describes the framework for a streamline life-cycle inventory (LCI) model that can be used to calculate the upstream environmental impacts of major petroleum products in five U.S. regions. The system boundaries considered in the model include crude oil extraction and flaring, crude oil transportation, oil refining, refined oil transportation, and product storage. High-level activity data for production stages are compiled along with supplementary inventory data that can be used to develop an LCI model. Two case studies demonstrate applications of the LCI model and the effect of methodological choices in the model. A case study investigating regional effects on asphalt binder production, as a road paving material, found a 15% average difference in the overall energy consumption and global warming potential (GWP) from producing asphalt mixtures due to geographical variation. A second case study considering the effects of varying refinery allocation on the production of diesel fuel used by the U.S. trucking industry found a difference of up to 0.3 billion tons of CO 2 eq of GWP (2.1%) and 4.7 trillion MJ of energy (2.5%) over a projected 36 years due to allocation choice. The LCI model outlined in this study can be readily implemented in larger product systems, with the ability to capture critical regional and methodological differences in material production. [ABSTRACT FROM AUTHOR]

Some philosophers and physicians have argued that alcoholic patients, who are responsible for their liver failure by virtue of alcoholism, ought to be given lower priority for a transplant when donated livers are being allocated to patients in need of a liver transplant. The primary argument for this proposal, known as the Responsibility Argument, is based on the more general idea that patients who require scarce medical resources should be given lower priority for those resources when they are responsible for needing them and when they are competing with patients who need the same resources through no fault of their own. Since alcoholic patients are responsible for needing a new liver and are in direct competition with other patients who need a new liver through no fault of their own, it follows that alcoholic patients ought to be given lower priority for a transplant. In this article, I argue against the Responsibility Argument by suggesting that in order for it to avoid the force of plausible counter examples, it must be revised to say that patients who are responsible for needing a scarce medical resource due to engaging in behavior that is not socially valuable ought to be given lower priority. I'll then argue that allocating organs according to social value is inconsistent or in tension with liberal neutrality on the good life. Thus, if one is committed to liberal neutrality, one ought to reject the Responsibility Argument. [ABSTRACT FROM AUTHOR]

Understanding the relationship between water and energy systems is important for effective management of both resources. Improved data availability has made more comprehensive modeling of hydropower and its water use possible, even as droughts and climate change have made questions about reservoir evaporation responsiveness more timely. This work makes three main contributions: first, it presents national and regional estimates of gross evaporation and evaporation net of evapotranspiration from local land cover (“net evaporation”) for U.S. hydroelectricity, arguing that net evaporation is more consistent with other measures of energy-related water intensity; second, it introduces and validates a method for estimating system-wide evaporation based on primary purpose allocation that reduces data requirements by two orders of magnitude; and third, it makes available for public use a full Penman–Monteith model with multiple built-in sensitivity analyses. Based on this model, the U.S. hydropower system consumes an estimated average of 1.7 m 3 of net freshwater per GJ electricity produced (11 m 3 /GJ gross). [ABSTRACT FROM AUTHOR]

In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569 (6.2%) from living donors. There were 8,733 (94.6%) adult and 501 (5.4%) pediatric liver transplant recipients. An increase in the number of deceased donor livers corresponded to an increase in the overall transplant rate and shorter waiting times, although still 10.0% of livers that were recovered were not transplanted. Alcohol-associated liver disease was the leading indication for both waitlist registration and liver transplant in adults, outpacing nonalcoholic steatohepatitis, while biliary atresia remained the leading indication for children. Related to allocation policy changes implemented in 2019, the proportion of liver transplants performed for hepatocellular carcinoma has decreased. Among adult candidates listed for liver transplant in 2020, 37.7% received a deceased donor liver transplant within 3 months, 43.8% within 6 months, and 53.3% within 1 year. Pretransplant mortality improved for children following implementation of acuity circle-based distribution. Short-term graft and patient survival outcomes up to 1 year worsened for adult deceased and living donor liver transplant recipients, which is a reversal of previous trends and coincided with the onset of the COVID-19 pandemic in early 2020. Longer-term outcomes among adult deceased donor liver transplant recipients were unaffected, with overall posttransplant mortality rates of 13.3% at 3 years, 18.6% at 5 years, and 35.9% at 10 years. Pretransplant mortality improved for children following implementation of acuity circle-based distribution and prioritization of pediatric donors to pediatric recipients in 2020. Pediatric living donor recipients had superior graft and patient survival outcomes compared with deceased donor recipients at all time points., (Copyright © 2023. Published by Elsevier Inc.)

The OPTN/SRTR 2021 Annual Data Report presents the status of the solid organ transplantation system in the United States from 2010 through 2021. Organ-specific chapters are presented for kidney, pancreas, liver, intestine, heart, and lung transplant. Each organ-specific chapter is organized to present waitlist information, donor information (both deceased and living, as appropriate), transplant information, and patient outcomes. Data pertaining to pediatric patients are generally presented separately from the adult data. In addition to the organ-specific chapters, you will find chapters dedicated to deceased organ donation, vascularized composite allograft, and the COVID-19 pandemic. The data presented in the Annual Data Report are descriptive in nature. In other words, most tables and figures present raw data without statistical adjustment for possible confounding or changes over time. Therefore, the reader should keep in mind the observational nature of the data when attempting to draw inferences before trying to ascribe a cause to any observed patterns or trends. This introduction provides a brief overview of trends in waitlist and transplant activity. More detailed descriptions can be found in the respective organ-specific chapters., (Copyright © 2023. Published by Elsevier Inc.)

The past 5 years have posed challenges to the field of heart transplantation. The 2018 heart allocation policy revision was accompanied by anticipated practice adjustments and increased use of short-term circulatory support, changes that may ultimately serve to advance the field. The COVID-19 pandemic also had an impact on heart transplantation. While the number of heart transplants in the United States continued to increase, the number of new candidates decreased slightly during the pandemic. There were slightly more deaths following removal from the waiting list for reasons other than transplant during 2020, and a decline in transplants among candidates listed as status 1, 2, or 3 compared with the other statuses. Heart transplant rates decreased among pediatric candidates, most notably among those younger than 1 year. Despite this, pretransplant mortality has declined for both pediatric and adult candidates, particularly candidates younger than 1 year. Transplant rates have increased in adults. The prevalence of ventricular assist device use has increased among pediatric heart transplant recipients, while the prevalence of short-term mechanical circulatory support, particularly intra-aortic balloon pump and extracorporeal membrane oxygenation, has increased among adult recipients., (Copyright © 2023. Published by Elsevier Inc.)

Recently, many studies have assessed the carbon footprint of bovine milk production. However, due to the complexity of life cycle assessment, most studies have analyzed research farms or "representative" farms, which do not capture farm variability. Furthermore, the lack of consistency in most studies means that we can seldom compare the footprint between different countries. To address this issue, we performed a systematic review of the literature, removing inconsistencies in life cycle assessment papers, namely the functional unit, allocation to milk, and global warming potential. We analyzed papers that accounted for many farms to address the variability of production systems within the countries. We found 21 papers from 19 countries; footprint recalculations were necessary for 16 papers. New Zealand, Uruguay, the United Kingdom, Australia, and the United States had a footprint <1 kg of carbon dioxide equivalents (CO 2 e) per kilogram of fat- and protein-corrected milk, whereas 5 countries had a footprint >2 kg CO 2 e·kg -1 fat- and protein-corrected milk. The change in functional unit resulted in a small effect on the final footprint, whereas the global warming potential change was dependent in on the greenhouse gas profile for each country. Countries where milk is produced mainly as a pasture-based system had most of their footprint (>50%) associated with the emission of methane from enteric fermentation, whereas other countries (especially from Europe and North America) had a significant share of emissions from manure management, feed production, and fertilizer use. This different greenhouse gas profile allow decision makers to tailor mitigation options specific for each country. The choice of the allocation method had a strong influence in the final footprint. We suggest that for future studies, authors adhere to the International Dairy Federation guidelines. When this is not possible, we suggest a set of extra information to be reported, allowing recalculations as done in this review., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Invasive species continue to alter the plant communities of the eastern United States. To better understand the mechanisms and characteristics associated with invasive success, we studied competition between two Acer species. In a greenhouse, we tested (1) the effect of forest soil type (beneath an invasive and native stand) on seedling growth of the invasive Acer platanoides (Norway maple) and native A. rubrum (red maple), and the (2) effects of full (above- and below-ground) and partial inter-specific competition on species growth. We found A. rubrum growth was negatively affected by soil from the invaded stand, as it had lower above-ground (32%) and below-ground (26%) biomass, and number of leaves (20%) than in the native soil. The root:shoot resource allocations of A. platanoides depended on soil type, as it had 14% greater root:shoot mass allocation in the native soil; this ability to change root:shoot allocation may be contributing to the ecological success of the species. Widely published as having a large ecological amplitude, A. rubrum may be a useful species for ecological restoration where A. platanoides has been present, but the impacts of A. platanoides on soil functioning and subsequent plant interactions must be addressed before protocols for native reintroductions are improved and implemented. [ABSTRACT FROM AUTHOR]

Purpose - Study the firm-level and country-level determinants of US institutional investors' holdings in American Depositary Receipts (ADRs) from emerging markets. Methodology/approach - We use a sample of 112 firms from emerging markets that listed as ADRs between 1990 and 2005. Rather than adopting the issuer's perspective, we take in this study the point of view of the investor and we focus on the US institutional investors' participation in ADR firms. Findings - We find that institutional investors hold higher stakes in foreign firms that are listed on more restrictive exchanges, in large, privatized, more liquid, and more transparent firms. Mutual investors and other institutional investors also prefer firms from countries with weaker institutional environments and from civil law legal tradition. Controlling for country-level determinants increases significantly the explanatory power of the model. Social implications - Our results have important implications for firms from emerging markets seeking to attract foreign institutional investors. Originality/value of the chapter - We focus on the motivations of investors when they choose to invest in the ADR, rather than on the ADR issuer motivation. In addition, we consider all types of institutional investors that acquire a participation in an firm. [ABSTRACT FROM AUTHOR]

The United Nations Framework Convention on Climate Change envisions that all countries will follow the principle of 'common but differentiated responsibility' in terms of their responsibility to protect the earth's climate system. However, its concrete application has always been controversial. The Kyoto Protocol framed this allocation issue in terms of quantified emission reduction and limitation objectives (QERLOs) in its Annex B, but this also triggered the refusal of the United States to ratify the Protocol. This article identifies some of the problems associated with allocation, and its problems inter-linked with governance architecture, by examining the case of the allocation of reduction commitments for greenhouse gas emissions in the context of climate governance beyond 2012. Three broad criteria are used in the discussion, namely, responsibility, capability, and efficiency. Target numbers for individual countries differ with the criteria used, but they also differ even within the same criteria category, due to different ways these conceptual criteria are translated into quantitative calculation formulas. Sometimes this makes a large difference for individual targets. Our calculations using different criteria and formula to come up with medium-term targets for selected developed countries show that differences in results are caused by the choice of allocation principle, differences in allocation formula under a given allocation principle, and different calculation criteria used under a given allocation formula. Assumptions in modeling and the choice of data also affect results. Importantly, interests are often embedded explicitly or implicitly behind these different ideas. Although allocation and architecture seems to be different problems of governance at first glance, there is also a link between limited data availability for allocation calculations and the form of governance architecture proposed. This is an area where further scientific research is required. [ABSTRACT FROM AUTHOR]

Young AL, Peters CJ, Pocock PV, Millson CE, Prasad KR. Do smaller adults wait longer for liver transplantation? A comparison of the UK and the USA data. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01037.x © 2009 John Wiley & Sons A/S. The number of patients on the UK and the USA liver transplant list is increasing. As size match is an important factor in the UK organ allocation, we studied the effect of recipient size on liver transplantation in the UK and the USA. Methods: The UK Transplant and United Network for Organ Sharing databases were used to assess difference in access to transplantation between smaller adult patients and their larger counterparts over three time periods. Subsequently, proportions of split, NHBD and living-donor transplants were analyzed. Results: There were 1576 UK and 29 150 USA patients in our analysis. The UK small patients have been significantly disadvantaged in access to transplantation particularly in early years and in adult only transplant units. This contrasts to the USA where smaller patients have never been disadvantaged and transplantation rates are steadily increasing. Split-liver transplants are being carried out in increasing numbers in the UK but not the USA. Conclusions: Small adults are still less likely to be transplanted at six months in adult only units in the UK. The lack of size matched organs for smaller adults and the overall decrease in rates of transplantation in the UK may be remedied by careful consideration of allocation policy and increased use of innovative techniques. [ABSTRACT FROM AUTHOR]

The design and implementation of the allocation of CO2 emissions allowances in recent bills in the U.S. Congress introduces a new source of uncertainty to the climate policy debate. We examine the Waxman-Markey bill (H.R. 2454) with scenarios that vary outcomes associated with allocations to electricity local distribution companies, investments in energy efficiency and technology development. The average net household burden in 2016 ranges from $133, with a CO2 allowance price of $13.19, to $418, with an allowance price of $23.41. The uncertainty about average burdens does not carry over to the distribution of those burdens; both scenarios impose the greatest burden as a percentage of income on middle-income households. A third scenario that allocates a substantial portion of allowance value as lump-sum payments imposes an average net household burden of $206, with a price of $17.37 and with highly progressive distributional impacts. [ABSTRACT FROM AUTHOR]

The use of cap-and-trade to regulate air pollution promises to achieve environmental goals at lower cost than traditional prescriptive approaches. Cap-and-trade has been applied to various air pollutants including sulphur dioxide, nitrogen oxides and volatile organic compounds in the United States and carbon dioxide (CO2) in the European Union. This corresponds to what is likely to become the most expensive environmental undertaking in history – the effort to reduce the heating of the planet. However, the efficacy of a cap-and-trade policy for CO2 depends in large part on the design of the program. In addition to the level of the cap, the most important decision facing policymakers will be the initial allocation of emissions allowances. The method used to allocate tradable emissions allowances will have significant influence on the distributional impact and efficiency of the program. [ABSTRACT FROM AUTHOR]

Abstract: This paper models the allocation of energy inputs in the US petroleum and coal products industry by allocating combustible fuel and renewable energy inputs among generic end-uses, including intermediate conversions through onsite power and steam generation. This analysis, called an energy end-use model, showed that 72% of the fuel input in the US petroleum and coal products industry goes to onsite steam and power generation, whereas 28% goes directly to end-uses. Eight percent of the boiler output is used for power generation, 72% goes directly to end-uses, and 20% is waste heat. Among the end-uses, process heating is the biggest energy user with a total energy consumption of 2338PJ, whereas machine drive is the biggest electricity consumer with a consumption of 168PJ. This paper also provides estimates of the uncertainty of the data. The approach to create this model is applicable to all other industries for which data is available and the model is consistent with US Department of Energy data for 1998. When used in conjunction with similar models for other years, it can be used to identify the changes and trends in energy utilization even at the prime mover level of detail. [Copyright &y& Elsevier]

Lower area one (LAO), a level section of the floodplain of Silver Bow Creek in Butte, Montana, was used for the disposal of tailings and wastes from a number of milling and smelting operations starting in the 1870s. Several entities including the Colorado Smelter, Butte Reduction Works, Domestic Manganese Development Company (all Butte, MT), and the United States government contributed a variety of milling, smelting, and stockpiling wastes to LAO. In addition to the direct disposal of waste, fluvial deposition of Ag tailings and alluvium from Missoula Gulch also occurred at LAO. Determination of relative volumetric contribution from remaining/successor Potentially Responsible Party (PRPs) arose as part of a larger Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) litigation of the Butte-Clark Fork River Superfund complex. Historical documents, aerial photographs, and geochemical and stratigraphic data were used to develop a four-component linear mixing model based on the concentrations of Cu, Pb, and Mn in the apportionable units. Following the four-component division of Cu, Mn, and Ag/Zn wastes, Ag and Zn were discriminated from each other based on Hg concentrations. The calculations resulted in a quantitative volumetric apportionment of LAO, consisting of 34% Cu tailings, 32% Mn tailings and ore, 27% Ag tailings, and 7% Zn tailings. [ABSTRACT FROM AUTHOR]

Question: We present a general structural carbon — nutrient balance hypothesis parallel to Bryant et al.'s defensive chemistry hypothesis. Our hypothesis suggests that because herb species require a lower investment of carbon per unit length of stem than do woody plants, herbs should be at a competitive advantage where the leaf area of plants in the ground layer is limited by light (or fixed carbon, C) rather than soil resources (R) such as nutrients or water. We test the derivative predictions that in temperate deciduous forests (1) herb cover and species richness increase as soil resources increase, and (2) woody ground-layer cover, density, and species richness increase as soil resources decrease. Location: To maximize generality, the eight temperate deciduous forest sites were dispersed along an 800 km band from the Coastal Plain of eastern North Carolina to the Central Basin of middle Tennessee, USA. Methods: Soil nutrients and moisture, herb cover and woody stem densities were observed in six plots at each site, randomly located in high, medium, and low herb cover areas. Multiple regression, correlation, and Redundancy Analysis ordination were used to test predictions. Results: Plants with herbaceous (low C:R) stems are generally abundant where soil moisture and basic cations (Ca, Mg) are high (low C:R environments), and woody (high C:R) plant cover, basal area, stem density, and species richness are all greatest on dry or nutrient-poor soils (high C:R environments). Plots with intermediate soil resource availability and herb cover have the most species, and maximum herb species richness occurs at higher soil resource levels than maximum woody species richness. Conclusions: Our observations are consistent with our structural carbon — nutrient balance hypothesis. [ABSTRACT FROM AUTHOR]

Abstract: No health system in the world can provide all patients with the best possible care. Nevertheless, different countries spend different proportions of their gross domestic expenditure on health care – the UK spends 6.9%, Italy 7.6%, France 9.6%, Germany 10.5% and the USA 14.2%. Perhaps the key question is: ‘How much should we spend on health care?’ However, this contribution focuses on the question: ‘Given that there is only a limited amount of money available for health care, how should we spend it?’ Resource allocation decisions involve a bewildering array of possible criteria. Some resource allocation theorists have attempted to formulate general theories or principles that can help us think through allocation decisions. This contribution begins by distinguishing different levels of allocation decision, then examines a hypothetical case study to illustrate the range of factors that can be appealed to in allocation decisions. Three theoretical attempts that have been made to deal with the complexity of allocation factors are also discussed – the quality-adjusted life-year (QALY), lottery theory and needs theory. [Copyright &y& Elsevier]

The problem of allocating liability cleanup costs is an arduous task when more than one potentially responsible party has contributed to the groundwater plume. This problem is most likely to be encountered when dealing with methyl- tert -butyl-ether (MTBE) contamination, as MTBE is seen to travel large distances in underlying aquifers. There has been a signi®cant effort in the recent past to develop liability allocation methodologies that incorporate fate and transport behavior and toxicological characteristics of the contaminants. The application of such methods often requires estimation of contaminant input from the vadose zone into the underlying aquifer. A screening level analysis is presented here to develop preliminary insights on relative mass contributions arising from different source types. The analysis illustrates how different vadose zone conceptualizations lead to vastly different contaminant loadings. Parametric studies indicate that the contaminant flux into the aquifer is very sensitive to changes in water infiltration rates. Hence, a reliable estimate of this parameter is critical for equitable allocation of remedial costs. Conceptual model formulation, should focus on identifying whether the fuel present in the aquifer can flow as a separate phase. It is also important to obtain reliable estimates for fluid saturations at the site. [ABSTRACT FROM AUTHOR]

Because there is no specific legislative or regulatory guidance, there is no "right" way to allocate liability at Superfund sites. Allocation based on the cost of a remedy, and allocation based on the need for a remedy, i.e. risk-based allocation, represent two possibilities. Other allocation schemes can be located between these two philosophical poles. When waste streams and environmental impacts are qualitatively similar, allocation based solely on costs may make the most sense. When one or more potentially responsible parties (PRPs) have qualitatively different wastes or impacts, an allocation scheme based on both contribution to cost and to risk may be able to incorporate all PRPs. In any case, dissident PRPs, whose contribution to remedy costs is large but whose contribution to risk is small, may find satisfaction in the courts where there is precedent for risk-based allocation. [ABSTRACT FROM AUTHOR]

Background: The US adult heart allocation policy was changed on October 18, 2018. This study aims to evaluate its impact on orthotopic heart transplantation (OHT) for adults with congenital heart disease (ACHD)., Methods: The United Network for Organ Sharing database was used to perform 2 comparisons: waitlist outcomes among listed ACHD candidates, and post-transplant outcomes in those transplanted. Waitlisted candidates were stratified by date of waitlisting: Period 1: 2010 to 2013; Period 2: 2014 to October 17, 2018 and Period 3: October 18, 2018 to March 20, 2020. Transplanted ACHD patients were similarly stratified but by date of transplantation. Competing risk regression for waitlist outcomes was performed. Post-transplant survival was analyzed using the Kaplan-Meier method and multivariable Cox regression., Results: Nine hundred and seventy-six patients with ACHD were waitlisted for OHT in our study: 343(35.1%), 466(47.8%), and 167(17.1%) in periods 1, 2, and 3. Post-policy change, 1-year cumulative incidence of waitlist mortality or deterioration decreased (p = 0.02). Six hundred and forty-eight patients were transplanted: 221(34.1%), 329(50.8%) and 98(15.1%) respectively. In those transplanted, post-policy median waitlist time (174, 161 and 38 days, p < 0.001) decreased and the use of intra-aortic balloon pumps increased (1.4%, 4.9% and 19.4%, p < 0.001). Compared to periods 1 and 2, risk-adjusted post-transplant 1-year mortality was similar to period 3 (HR 1.10, 95% CI 0.52-2.32; p = 0.81) (HR 1.19, 95% CI 0.58-2.46, p = 0.63)., Conclusions: The recent US allocation policy change may have resulted in reduced waitlist times and 1-year waitlist mortality for OHTs in ACHD patients. Early post-transplant outcomes appear comparable post-policy change., (Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

This year was marked by the COVID-19 pandemic, which altered transplant program activity and affected waitlist and transplant outcomes. Still, 8906 liver transplants were performed, an all-time high, across 142 centers in the United States, and pretransplant as well as graft and patient survival metrics, continued to improve. Living donation activity decreased after several years of growth. As of June 30, 2020, 98989 liver transplant recipients were alive with a functioning graft, and in the context of increasing liver transplant volume, the size of both the adult and pediatric liver transplant waitlists have decreased. On February 4, 2020, shortly before the pandemic began, a new liver distribution policy based on acuity circles was implemented, replacing donor service area- and region-based boundaries. A policy change to direct pediatric livers to pediatric recipients led to an increase in deceased donor transplant rates and a decrease in pretransplant mortality rate among children, although the absolute number of pediatric transplants did not increase in 2020. Among adults, alcohol-associated liver disease became the predominant indication for liver transplant in 2020. After implementation of the National Liver Review Board and lower waitlist priority for most exception cases in 2019, fewer liver transplants were being performed via exception points, and the transplant rate between those with and without hepatocellular carcinoma has equalized. Women continue to experience higher pretransplant mortality and lower rates of liver transplant than men., (.)

Water marketing, which involves the purchase or transfer of water supplies or rights between a willing buyer and seller, represents one strategy for redistributing water resources among competing users. Most frequently, municipalities purchase agricultural water rights to augment their existing supply and help meet projected water demand. In Texas, the most active water market is in the lower Rio Grande Valley where the cities of Brownsville, Harlingen, and McAllen have acquired surface water rights for converting water from agricultural to municipal and industrial uses. The existence of the Rio Grande Watermaster simplifies the producer for transferring surface water rights, help address problems such as the maintenance of instream flow and protection of senior water rights holder, and serves as an administrative model for water resource management. [ABSTRACT FROM AUTHOR]

Fertilizer recommendations for peach cultivation in the southeastern United States were developed decades ago and may not reflect the peach trees' needs under current cultivation practices. Adequate fertilization for young peach trees induces a balanced vegetative/reproductive growth, ensures efficient resource use, and is environmentally sound. Droughts in the region are becoming more common. Supplemental irrigation for peaches from the time of field establishment serves as insurance in case drought conditions occur and can increase/advance the yield of young peach trees. Our objective was to determine the influence of different fertilizer levels (25, 50, 100, and 200% of the recommended rate), irrigation levels (irrigated vs. non-irrigated), and irrigation systems (drip vs. micro-sprinkler) on nitrogen partitioning and concentration in different organs of young peach trees. The cumulative nitrogen (N) removal per tree was not affected by the different fertilizer levels. Most of the N allocation was accounted for by summer pruning and defoliation (68% of the total N removed). Irrigated trees had higher cumulative N removal after three years than non-irrigated trees, with differences between irrigated vs. non-irrigated trees in most vegetative removal events (winter and summer pruning, and defoliation). Drip-irrigated trees had higher cumulative N removal after three years than micro-sprinkler-irrigated tress, with differences in N removal found in vegetative and reproductive removal events. Differences in N removal were mainly driven by differences in dry weight rather than the N concentration of the organs. These results suggest that different fertilizer levels did not alter the N partitioning in young peach trees, indicating that reduction in fertilizer applications can be done without negative effects. Furthermore, irrigation induced greater vegetative growth, especially under drought conditions, which may result in greater canopy volume and fruit yield compared to non-irrigated trees. Differences between irrigation systems are not consistent; however, drip is more efficient than micro-sprinkler irrigation, with ~38% water savings. [ABSTRACT FROM AUTHOR]

Background: The Kidney Allocation System (KAS) was developed to improve equity and utility in organ allocation. We examine the effect of this change on kidney graft distribution and survival., Methods: UNOS data was used to identify first-time adult recipients of a deceased donor kidney-alone transplant pre-KAS (Jan 2012-Dec 2014, n = 26,612) and post-KAS (Jan 2015-Dec 2017, n = 30,701), as well as grafts recovered Jan 2012-Jun 2019., Results: Post-KAS, kidneys were more likely to experience cold ischemia time >24 h (20.0% vs. 18.8%, p < 0.001) and experienced more delayed graft function, though competing risks modeling demonstrated a lower hazard of graft loss post-KAS, HR 0.90 (95% CI 0.84-0.97, p = 0.007). Post-policy, KDPI >85% kidneys were more likely to be shared regionally (37% vs. 14%), and more likely to be discarded (60.6% vs. 54.9%) after the policy change. KDPI >85% graft and patient survival did not change., Conclusions: Implementation of the KAS has increased sharing of high-KDPI kidneys and has decreased the hazard of graft loss without an impact on patient survival., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift-to some degree-from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by "crisis standards of care," but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities.

Data on adult liver transplants performed in the US in 2018 are notable for (1) continued growth in numbers of new waitlist registrants (11,844) and transplants performed (8250); (2) continued increase in the transplant rate (54.5 per 100 waitlist-years); (3) a precipitous decline in waitlist registrations and transplants for hepatitis-C-related indications; (4) increases in waitlist registrants and recipients with alcoholic liver disease and with clinical profiles consistent with non-alcoholic fatty liver disease; (5) increased use of hepatitis C virus antibody-positive donor livers; and (6) continued improvement in graft survival despite changing recipient characteristics such as older age and higher rates of obesity and diabetes. Variability in transplant rates remained by candidate race, hepatocellular carcinoma status, urgency status, and geography. The volume of pediatric liver transplants was relatively unchanged. The highest rate of pre-transplant mortality persisted for children aged younger than 1 year. Children underwent transplant at higher acuity than in the past, as evidenced by higher model for end-stage liver disease/pediatric end-stage liver disease scores and listings at status 1A and 1B at transplant. Despite higher illness severity scores at transplant, pediatric graft and patient survival posttransplant have improved over time., (.)