Public discourse and policy change: Absence of harm from increased oversight and transparency in OPO performance

The Centers for Medicare and Medicaid Services announced changes to the Final Rule for organ procurement organizations (OPOs) in November 2020, after a 23-month period of public debate. One concern among transplant stakeholders was that public focus on OPO underperformance would harm deceased donation. Using CDC-WONDER data, we studied whether donation performance dropped during the era of public debate about OPO reform (December 2018–February 2020). Overall OPO performance as measured relative to cause, age, and location-consistent deaths rose by 12.3% in 2019, compared to a median annual change of 2.5% 2009–2019. Organ recoveries exceeded seasonally adjusted forecasts by 4.2% in the first half of 2019, by 8.1% following the Executive Order issuing a mandate for OPO metric reform, and by 14.1% between the Notice of Public Rule Making and the onset of COVID-19-related systemic disruptions. We describe changes in donor phenotype in the period of increased performance; improvement was greatest for older and donation after cardiac death (DCD) donors, and among decedents who did not have a drug-related mechanism of death. In summary, performance during an era of intense public debate and proposed regulatory changes yielded 692 additional donors over expectations, and no detriment to organ donation was observed.     

The collection and analysis of human fallopian tubal fluid

A technique for the collection of Human Tubal Fluid (HTF) has been presented. It is a one-time procedure, coincident to other adominal surgery. The procedure has shown itself to be safe on 37 consecutive cases. The greatest quantity of HTF was obtained near the day of ovulation from patients with long fallopian tubes. A specimen with little or no turbidity usually could be withdrawn from the collection bag 24 hours after surgery. Electrophoresis of HTF in agarose resulted in patterns different from those found with the patient's serum. An altered albumin peak was noted in 2 cases, while in a third case, the HTF exhibited an increase in the ß globulin fraction. Immunoelectrophoresis demonstrated that many serum constituents are present in HTF. The immunoglobulin content presented a distribution similar to that which occurs in serum. Unlike other external secretions, _γG is the major immunoglobulin constituent present in HTF. The sodium, phosphorus and magnesium content of HTF was similar to that of serum. In comparison with patient's serum, the potassium and chlorides of HTF were augmented while there was a diminution of HTF calcium. Glucose in tubal fluid was usually a half to a third of the patient's serum level. Marked elevations of amylase and lactic dehydrogenase (LDH) were noted in HTF.     

Adolescent Weight Management and Perceptions: An Analysis of the National Longitudinal Study of Adolescent Health

Researchers investigated contemporary weight management activities and weight perceptions among adolescents and determined the effects of school health education on these perceptions and activities. This national, random sample of more than 6,500 adolescents (grades 7-12) measured perceived weight, weight change efforts, weight change activities, Body Mass Index, and health education for weight management. Results indicate that most adolescents: 1) take part in efforts to manage their weight, although many struggle with perceiving their weight; 2) engage in appropriate weight change efforts; and 3) report receiving school health education that positively effects some aspects of their weight management behavior. Thus, adolescents are concerned about weight and perceptions of weight and are engaging in a variety of weight change activities for weight maintenance and weight change. School health education appears to have some effect in improving adolescent health behavior, and discussion centers on this topic.     

Decline in lung function and mortality: the Busselton Health Study

BACKGROUND: There is a direct association between level of lung function, measured by forced expiratory volume in 1 second (FEV1) and mortality rates. A low FEV may result from an increased decline in FEV1 with age, which may be an independent predictor of mortality. OBJECTIVE: To examine the association between decline in FEV1 and mortality in a cohort from a community health study. SETTING AND METHODS: From five cross sectional studies in Busselton between 1969 and 1981 a cohort of 751 men and 940 women was identified who had three assessments of lung function over a six year period and had other health related data collected. Each subject's average FEV1 and decline in FEV1 (litre/year) were calculated from these three measurements. Mortality follow up to December 1995 was obtained. Cause of death was taken as the certified cause of death from the death certificate using ICD9 categories. RESULTS: The average decline in FEV1 was 0.04 litre per year (SD = 0.07) for men and 0.03 litre per year (SD = 0.06) for women. Average FEV1 was significantly associated with all cause and cardiovascular disease mortality in both sexes. In women there was a significant association between decline in FEV1 and death from all causes, after adjusting for average FEV1, age, smoking, coronary heart disease, and cardiovascular disease risk factors; a 0.05 litre per year increase in the rate of decline of FEV1 increased the risk of death for all causes by 1.23 (95% confidence interval 1.06, 1.44). In men the effect of decline in FEV1 on death rate was less; for all men the hazard ratio for a 0.05 litre/year greater decline in FEV1 was 1.19 (0.99, 1.21). CONCLUSION: Decline in lung function, measured by FEV1 is a predictor of death, independent of average FEV1 and risk factors for cardiovascular disease.     

Effect of pregnancy during TMI crisis on mothers' mental health and their child's development.

Five years after the Three Mile Island nuclear accident, the mental health of women who had been pregnant and living within 10 miles of Three Mile Island at the time of the accident was similar to that of women from the same area who became pregnant after the accident. Ratings of the development of the two groups of children when they were 5 years old were also similar. However, women who were pregnant during the crisis and had been "extremely disturbed" about their pregnancies rated their children's health as poorer than did the women who were pregnant later.     

Development of acute lymphoblastic leukemia following treatment for acute myeloid leukemia in children with Down syndrome: A case report and retrospective review of Children's Oncology Group acute myeloid leukemia trials

Children with Down syndrome have a 150‐fold increased risk of developing acute myeloid leukemia (AML) and 20‐fold increased risk of developing acute lymphoblastic leukemia (ALL). Although the risk of developing AML and ALL is significantly increased in children with Down syndrome, the development of both malignancies in the same patient is very rare. We describe a patient with Down syndrome who developed ALL 6 years after being diagnosed with AML. We performed a literature review and Children's Oncology Group query and discovered eight published cases and five cases of ALL following AML in pediatric patients with Down syndrome, as well as six cases of ALL following AML in non‐Down syndrome patients. There was a similar cumulative incidence of ALL after treatment for AML in the Down syndrome and non‐Down syndrome populations. Overall survival in patients with Down syndrome who developed ALL after treatment for AML was comparable to overall survival for patients with Down syndrome with de novo ALL with an average follow‐up of 7 years after ALL diagnosis. Clinical data collected were used to discuss whether this phenomenon represents a secondary leukemia, second primary cancer, or mixed‐lineage leukemia.     

Nursing Case Management Strategies for Adults with Serious Mental Illness Seeking Dental Services

A university-community partnership initiated a dental screening and nursing case management program for Medicaid-insured adults with serious mental illness (SMI). Forty-three adults with SMI participated in dental screening; 72% participated in case management. Per client, an average of six case management contacts was made. After 6 months, 87% (27/31) had attended at least one dental appointment, with a 13% no-show rate; 8 completed treatment, 4 had ongoing treatment, 12 had interrupted care, and 3 were lost to follow-up. Adults with SMI experienced high unmet dental needs; nursing case management strategies aided clients to initiate and complete dental care.