bluuebunny/crossref_metadata_2025 huggingface dataset:
Line Operational Evaluation (LOE) Air Carrier Scenario Based Evaluation
Authors: Hamman William R. , Holt Robert W.
Published: July 2017

This paper presents a methodology for developing Line Operational Evaluations (LOEs) which assess crew and individual pilot proficiency in the FAA's Advanced Qualification Program (AQP). Under AQP, Crew Resource Management (CRM) skills are trained and assessed along with technical maneuvers in the issuing of an Airmen type certification. The environment for assessing this technical and CRM proficiency is the LOE which must be designed and implemented under strict adherence to the requirements of AQP. The paper will discuss the five major steps in the design process, discuss the issues associated with scenario based measurement of pilot proficiency, and the application of statistical analysis to improve evaluator standardization and the reliability and validity of data.
Rapidly Reconfigurable Event-Set Based Line Operational Evaluation Scenarios
Authors: Bowers Clint , Jentsch Florian , Baker David , Prince Carolyn , Salas Eduardo
Published: July 2017

An important cornerstone of the Advanced Qualification Program is the use of realistic flight simulations to train flight crews and evaluate their proficiency. This is achieved through the use of Line Operational Simulations (LOSs) which contain a number of realistic event sets that require flight crews to use the knowledge, skills, and abilities they gained in training in both technical and crew resource management areas. In the past, the development of LOS scenarios was complex, expensive, and time-consuming. As a result, the number of LOS scenarios used by any particular training organization was limited. This may have led, in some cases, to the LOS scenarios being compromised among flight crews, thus reducing the validity and reliability of the assessment process. In response to this problem, it has been suggested to create a methodology for quickly reconfiguring the content of flight simulator LOS scenarios. This paper provides a background for this new development and describes a research project that was begun in response to this need. A number of specific research questions are discussed which need to be answered before the methodology can be adopted by participants in the AQP program.
Application of Psychometrics to the Calibration of Air Carrier Evaluators
Authors: Holt Robert W. , Johnson Peder J. , Goldsmith Timothy E.
Published: July 2017

The FAA's Advanced Qualification Program (AQP) encourages airlines to implement proficiency-based training programs and requires collection of reliable and valid performance assessment data. We present applications of traditional and innovative psychometric methods to this domain.
The Time Cost of Head-Up Displays for Older Drivers: Critical Event Onset, Task Location, and Display Type
Authors: Caird J.K. , Chugh J.
Published: July 2017

The principle advantage of a head-up display (HUD) is that a driver does not have to take their eyes off the road. However, the advantage afforded by a HUD may be lost when surprising or unexpected events occur in the traffic environment. This study sought to determine the time-costs for elderly drivers associated with responses to the appearance of a pedestrian (critical event) while engaged in a HUD task. Sixteen older drivers (65 to 81, Mean = 73) interacted with a number of tasks presented in a low-cost driving simulator. Critical event onset after engaging in a HUD task (+100, +250, +1000 ms), display location (head-up, head-down), tracking difficulty (easy, hard), and display type (visual search, verbal memory) were the within-subjects variables. Analyses of perception-response time (PRT) and missed events (error) indicate that braking to a critical event, while performing a display task, is affected by the interaction between the temporal and spatial limitations of visual attention. HUD design and safety issues are briefly considered.
Visual, Perceptual, and Cognitive Measures as Predictors of Collision Detection in Older Drivers
Authors: James Christina L. , Wochinger Kathryn , James W. Spencer , Boehm-Davis Deborah
Published: July 2017

This experiment examined whether visual, perceptual, or cognitive measures predicted the ability to detect vehicle collisions in intersections. Sixty subjects, comprised of three age groups balanced by gender, were presented dynamic intersection approaches in a part-task driving simulator. The subjects were asked to project the forward progress of crossing traffic and to indicate whether any of the crossing vehicles would conflict with their vehicle. Independent variables included visual, perceptual, and cognitive test batteries. Dependent variables included accuracy in collision detection and error type. Results showed that all three batteries predicted accuracy, but that the perceptual battery was the most predictive for each age group.
Assessing the Value of Human Performance Modeling in Exploring Pilot-System Dynamics
Authors: Bautsch Holly S. , McNeese Michael D. , Narayanan S.
Published: July 2017

All too often human-systems integration is not addressed until the final stages of systems development. Because of constraints in the time-cost-schedule, it is typically too late in the acquisition process to make adaptations that address cognitive engineering and user-centered performance. Traditionally, designers have not had methods/tools that comprehensively integrate them in the concept exploration stage of design decision-making. Human-systems integration may currently include cognitive engineering or human performance modeling but rarely combines these methods to comprehensively establish human design requirements. This paper assesses the value of both cognitive engineering and human performance modeling by evaluating pilot-system dynamics in an advanced mission. One model is informed through traditional task analysis, while the other model utilizes cognitive task analysis. An experiment is reported which analyzes model outcomes in contrast to a “benchmark” (pilot-in-the-loop data). The results assess model similarities and differences. The discussion evaluates how human performance models can enhance cognitive engineering in design decision-making.
Assessing the Effect of Incompatible Light on Night Vision Goggle Performance
Authors: Gibb Randall W. , Reising Jack D.
Published: July 2017

Current specifications indicate that cockpit lighting designed for night vision goggle (NVG) operations is compatible with NVGs if it does not degrade NVG-aided visual acuity (VA). This study compared two measures of VA; USAF Tri-Bar Chart and NVG Chart. NVG-aided contrast sensitivity (CS) also was assessed; three CS charts having spatial frequencies (SF) of 3, 6, and 12 cycles/degree (cpd) were developed. VA and CS were measured with either low or high levels of incompatible light present. Results revealed that performance did not differ between the two VA measures. Under low incompatible light, CS was degraded only for the high SF. Under high incompatible light, CS was degraded for all SFs. These results suggest that the choice of VA measure should depend upon evaluation factors (e.g., available time, sample size). CS can be used as an alternative to VA and may provide a more complete index of cockpit lighting compatibility.
The Use of Executable Cognitive Models in Simulation-Based Intelligent Embedded Training
Authors: Zachary Wayne , Ryder Joan , Hicinbothom James , Bracken Kevin
Published: July 2017

This paper defines a new role for expert models in intelligent embedded training — guiding practice. The integration of problem-based practice with focused, automated instruction has long proven elusive in training systems for complex real-world domains. The training strategy of ‘guided practice’ offers a way to merge the approaches of traditional simulation-based practice and intelligent tutoring's knowledge tracing. The performance of the trainee is dynamically assessed against scenario-specific expectations and performance standards, which are generated during the simulation by embedded models of expert operators. This research developed an executable cognitive model capable of solving realistic simulation scenarios in an expert-level manner, identified and implemented modifications and extensions to this baseline model needed to generate dynamic and adaptive expectations of future trainee actions, and developed means of providing cognitive state information for use in (separate) diagnostic processes, without resorting to full-scale knowledge tracing methods.
What We Have Learned from the Accrediting Program
Authors: English Earl
Published: July 2017

In a report given to the joint AATJ-AASDJ-ASJSA assembly at the Minneapolis convention, the retiring executive secretary of the Accrediting Committee offers some significant observations based on his observations at 46 schools. Dr. English is associate dean of the School of Journalism at Missouri.
Free Flow of Information: UNESCO's World-Wide Program
Authors: Behrstock Julian
Published: July 2017

Projects launched by the United Nations Educational, Scientific and Cultural Organization to overcome barriers which now prevent the unhampered exchange of words and images are outlined by the Acting Head, Division of Free Flow of Information, Mass Communications Department.
Research, Argumentation and Action in the Media Field
Authors: Lazarsfeld Paul F.
Published: July 2017

Founder and first director of Columbia University's Bureau of Applied Social Research, and a pioneer in the application of the methods of social science to the problems of mass communications, Dr. Lazarsfeld is especially well qualified to discuss a subject of fundamental importance in journalism research.
Brownfields National Partnership: The Federal Role in Brownfields Redevelopment
Authors: Kaiser Sven-Erik
Published: July 2017

Brownfields, properties with actual or perceived contamination and active potential for reuse, have risen rapidly to the top of the national economic development policy agenda. Bringing together economic, environmental, and community interests, one sees vigorous public and private brownfields efforts in progress across the country. Based on the principle that one can assess, clean up, and sustainably reuse contaminated properties, the federal Brownfields Initiative empowers states, communities, and other stakeholders to work together to solve the brownfields challenge. This article provides public works officials with the information they need about the Brownfields National Partnership Action Agenda and the multiagency federal activities underway to support local brownfields projects. Any opinions expressed in this article are the views of the author and do not necessarily represent the views of the U.S. Environmental Protection Agency.
The Impact of Strategy And Structure On The Organizational Performance of Restaurant Firms
Authors: Tse Eliza Ching-Yick , Olsen Michael D.
Published: July 2017

There is an increased emphasis in the management literature on the use of strategic management as the primary means of adapting organizations to their changing environments. for firms in the maturing hospitality industry to survive and succeed, they will have to depend upon their ability to strategically align themselves with the turbulent environment and select appropriate strategies to create defendable competitive positions. Success in strategy implementation depends partly on a proper match between strategy and organizational structure and this match is expected to have a positive impact on financial performance. This study was conducted to explore the relationships among strategies of restaurant firms, their organizational structure and financial performance. The top management team in 296 American multi-unit restaurant firms were surveyed. Results regarding relationships posited among strategy, structure and performance are presented.
New Concepts To Old Topics: Employee Recruitment, Selection And Retention
Authors: VanDyke Thomas , Strick Sandra
Published: July 2017

The major purpose of this study was to determine what actions hospitality companies are taking to combat the current labor shortage. The study identified the most productive sources of employees, and which techniques were most effective in selecting employees, and traditional and nontraditional reward systems used.
The Role of Guest Relations In State Tourism Marketing Programs
Authors: Toepper Lorin K.
Published: July 2017

A questionnaire returned from state travel and tourism offices was used in order to examine the role of guest relations within states' tourism marketing programs, to determine its importance relative to other components, and to describe guest relations programs currently being implemented.
Students' Conceptions of Learning and Good Teaching in Dutch Higher Hotel Education
Authors: Van Rossum E.J.
Published: July 2017

The concepts of learning and teaching are central at all levels of our educational systeem. The question however is, to what extent the people involved (teachers and students) attach the same meaning to these concepts. Even more important perhaps is the subsequent question, what the consequences 109634808801200243 this are for the realization of everyday teaching. In this article we shall elaborate a few aspects of the two above mentioned questions.
Teenage Employment In Hospitality: Attitudes, Outcomes And Analysis
Authors: Divine H. A. , Bartlett A. L.
Published: July 2017

The benefits of career education have been questioned by recent research on the academic and social development of students who work while 109634808801200244in high school. The current study investigates attitudes about short and long term advantages and disadvantages of high school employment among a sample of workers and non-workers who have gone on to college. Findings are generally positive, and recommendations are made for providing an employment experience which is beneficial to the employer and the high school students.
Putting Artificial Intelligence And Expert Systems To Work for The Hospitality Industry
Authors: Farsad Behshld
Published: July 2017

Artificial intelligence (AI) has existed formally as a field of science and technology for over thirty years. 109634808801200264Nevertheless, it has no precise definition due to it's diversity. Over the years Al has developed into three principal branches: expert systems, natural language communication, and robotics. Expert systems (ES) among the three branches is currently attracting much attention and is of most interest to many professionals as well as organizations. However, the development of expert systems—the computer programs that emulate the thinking processes of human brain in solving problems—is very complex and extremely costly.

Although the current applications of ES are mainly is space exploration, it should be noted that some of the greatest opportunities for expert systems in the hospitality industry lie in small, routine, everyday tasks like departmental budget analysis, shift scheduling, credit verification, and room assignment.
Social care research
Authors: Glanville Julie , Golder Su , Glanville Julie , Mather Lisa , Wright Kath
Published: July 2017

Unlike health care research, with its relatively well-developed research registers and major indexed databases, finding out about social care research is more of a challenge. However, the following selected key resources form part of a growing range of excellent information services.

As a user of the Internet, you are the best judge of the value and usefulness of relevant websites. If you would like to alert readers to useful web pages or suggest topics for this column please send details to:
The Role of Daclizumab in Balancing Resources for Inpatient and Outpatient Transplant Services
Authors: Korsun Angelina , Vincenti Flavio , Ruck Dorothy , Whitelaw Nevin , Ladoulis Charles , Whitelaw George
Published: July 2017

Transplant professionals have the dual responsibility of achieving acceptable clinical outcomes and controlling costs. One approach transplant centers have used to control transplant-related costs has been to decrease patients' length of stay, and thus it has decreased significantly in the last 6 years. This reduction in resource consumption has been accomplished by increased efficiency in providing transplantation services, expanding the number of outpatient services available, and integrating new technologies. Future cost containment measures by payers, especially Medicare, will continue to require that transplant centers manage resources and meet financial objectives while achieving acceptable clinical outcomes.

Daclizumab, a new immunosuppressive drug, is used as an example in this article, which assesses its value in helping meet resource management and financial goals.
Organ Donation and Transplantation as Health Programs in Italy
Authors: Venturoli Nicola , Venturi Sergio , Taddei Stefania , Ridolfi Lorenza , Pugliese Maria Rosa , Petrini Flavia , Monti Marzia , Costa Alessandro Nanni , Martinelli Gerardo
Published: July 2017

Organ and tissue donation and transplantation have a role in public health programs as organizational projects designed by public health departments to increase the quality and number of donations and transplantations. These programs serve as communication projects to inform public opinion on cerebral death, organ and tissue shortages, procurement and allocation rules, and the quality of life of transplanted patients. The health department of Emilia-Romagna created a regional law and a multimedia communication program for these purposes, resulting in a 95% increase of cadaver donor in 4 years. In 1995, regional activity reached the European mean level and afterwards surpassed it. In 1997, the bone bank was activated, followed in 1998 by the heart valve and vascular segment bank. The regional health department now considers transplant activities a primary goal; human and professional relations between intensive care units and the transplant reference center are considered crucial; cooperation among health departments, medical teams involved in organ procurement and transplant activities has been fostered, and the local coordination network has been active and efficient. The public information campaign has proven important in providing information both to professionals and citizens.
Teaching Patients about Kidney Transplantation: Documentation
Authors: Messina Catherine J. , Russell Cynthia L. , Ewigman Mary Ann , Ward Ceresa , Mefrakis Lisa
Published: July 2017

Increasing demands are being placed on transplant nurse coordinators for more precise documentation of their teaching of kidney transplant patients, but the amount of time nurses have for this added documentation remains unchanged or has diminished. After a thorough review of the literature, our transplant team found no patient teaching documentation format that assisted us in overcoming the problem of increased demands. Consequently, following the Joint Commission on Accreditation of Healthcare Organization standards, we developed a Renal Transplant Patient Teaching Record that has assisted our team in documenting the pre- and post-transplant patient teaching that we complete.
Reliability of Ultrasound Screening of Liver and Kidney Donors: A Retrospective Study
Authors: Venturoli Nicola , Costa Alessandro Nanni , Ridolfi Lorenza , Pugliese Maria Rosa , Taddei Stefania , Petrini Flavia , Bolondi Luigi , Martinelli Gerardo
Published: July 2017

The reliability of abdominal ultrasound in screening liver and kidney donors was assessed by correlating ultrasound findings with the suitability of organs for transplantation as determined by direct examination of the organs. We evaluated 100 multiorgan donors (100 livers, 200 kidneys) during a 15-month period. Abdominal ultrasound showed the following results for liver and kidney, respectively: specificity, 95.6% and 98.9%; sensitivity, 62.5% and 66.6%; and accuracy, 93% and 97%. These results show that abdominal ultrasound is a valuable tool for determining suitability of organs for transplantation when the ultrasound findings are normal. When ultrasound findings are abnormal, further studies are necessary to determine the suitability of the organs for transplantation.
Liver Transplantation in a Patient at Psychosocial Risk
Authors: Carlson Jeff , Potter Linn , Pennington Shane , Nour Bakr , Sebastian Anthony , Paris Wayne
Published: July 2017

Psychosocial assessment of transplant candidates is a challenging task. Securing adequate information is made more difficult when patients present with fulminant hepatic failure. When the patient cannot be interviewed and the family is reluctant to provide vital information, a comprehensive pretransplant psychosocial evaluation is virtually impossible. However, even the most difficult cases have the potential for a positive result when a good psychosocial profile of the patient is obtained after transplantation, a team treatment plan is developed and carried out which addresses current and anticipated problems, and the patient obtains mental health treatment.
Adaptation of a Weight Management Program for a Potential Lung Transplant Candidate
Authors: Forsythe Janet , Cooley Kim , Greaver Betty
Published: July 2017

Obesity is a relative contraindication for heart and lung transplantation at most transplant centers. Surgical risks are higher for obese patients, and 1 study suggests that obesity is significantly correlated with higher posttransplant death rates in cardiac transplantation. Obesity is a restrictive disease that contributes to exercise intolerance in patients with lung disease. A weight management group was formed at a transplant center to help obese patients with heart and/or lung disease lose weight and maintain their goal weight, with the hope of decreasing their waiting time to be listed for transplantation and their incidence of weight-related complications. Some patients experienced symptomatic improvment, which delayed their need for heart or lung transplantation.
Psychosocial Assessments and Outcomes in Organ Transplantation
Authors: Dew Mary Amanda , Switzer Galen E. , DiMartini Andrea F. , Matukaitis Jennifer , Fitzgerald Mary Grace , Kormos Robert L.
Published: July 2017

A qualitative review was conducted to define the term psychosocial as applied to transplant patients and to summarize evidence regarding the role and impact of psychosocial assessments and outcomes across the transplant process. English-language case series and empirical studies from January 1970 through April 1990 that were abstracted in Medline and Psychological Abstracts or listed in publications' bibliographies were used as data sources. A qualitative analysis was performed to determine the depth of the case reports and whether the empirical reports obtained statistically reliable, clinically significant findings. The authors conclude that psychosocial assessments differ in content and application to candidate selection depending on the transplant program. Psychosocial status before transplant does not consistently affect medical outcomes after transplant. Psychosocial status generally improves with transplant, although difficulties are prevalent in psychological adjustment and in compliance with medical regimens. Psychiatric history can predict psychological outcomes after transplant but does not consistently predict compliance. Social supports and coping strategies strengthen psychosocial outcomes. Posttransplant psychosocial outcomes may predict physical morbidity and mortality.
Introduction of the Certificate in Transplant Coordination in the United Kingdom
Authors: Mandefield Helen , Wellington Fiona , Morgan Vanessa
Published: July 2017

Training for transplant coordinators is not mandatory in the United Kingdom, although the United Kingdom Transplant Coordinators Association has provided informal courses since 1988. The authors of this article were responsible for the development of an accredited training program for transplant coordinators in the United Kingdom. Accredited by the University of Central England, the course modules have been run and managed by the Association since 1996. The course consists of 3 modules: Introduction to Transplant Coordination, Interpersonal and Professional Skills for Transplant Coordinators, and Introduction to Research Methods for Transplant Coordinators. Between 1996 and 1999, 64 transplant coordinators (60% of transplant coordinators currently in post) in the United Kingdom have undertaken at least 1 module. The Association feels that the accredited training program means one step further on the road to professional recognition of transplant coordinators in the United Kingdom.
Alternative Technique to Cannulate the Descending Aorta for Abdominal Organ Procurement in a Hemodynamically Unstable Patient
Authors: Kollar Andras , Stratta Robert J. , Grandas Oscar H. , Kizilisik Tarik
Published: July 2017

During organ procurement, maintaining adequate organ perfusion is crucial. Hemodynamic instability may compromise organ viability and demand quick intervention, sometimes rapid, early cannulation of vessels, so that organs may be salvaged. In this case report of an unstable donor with large retroperitoneal hematoma, a surgical approach is presented that has previously not been described. The technique facilitated hemodynamic stability while allowing rapid cannulation of the retrocardiac descending aorta.
Economic Evaluation of Kidney Transplantation versus Hemodialysis in Patients with End-Stage Renal Disease in Hungary
Authors: Kaló Zoltán , Járay Jeno , Nagy Júlia
Published: July 2017

Background—

Kidney transplantation is generally acknowledged as the more clinically effective and more cost-effective option in managing patients with end-stage renal disease, compared with dialysis. This study looked for confirmatory evidence in a Hungarian population.

Methods—

Patients (n = 242) with end-stage renal disease who received cadaveric kidney transplantation during 1994 were followed up for 3 years. They were compared with patients (n = 840) receiving hemodialysis who were on a waiting list for transplantation. Data were collected retrospectively. Treatments were compared for clinical efficacy and for cost-effectiveness.

Results—

At month 36, the standard mortality hazard function was 3.5 times higher in the group receiving hemodialysis ( P<.0001) than in the transplant recipients. Average treatment costs per patient over the 3 years were also significantly higher ( P<.0001) in the hemodialysis group than in the group that received transplants. The cost of 1 year gained by transplantation was significantly less ( P<.0001) than the cost associated with hemodialysis.

Conclusions—

Compared with hemodialysis, kidney transplantation provides greater survival benefits to patients with end-stage renal disease, at less cost.
Challenges in Donor Care
Authors: Powner David J.
Published: July 2017

This article is provided as a self-study feature on care of organ donors. Questions and possible responses are provided. Review all the responses for each question.
The Economics of Kidney Transplantation versus Hemodialysis
Authors: Loubeau Patricia R. , Loubeau Jean-Michel , Jantzen Robert
Published: July 2017

Using 1998 data for 8 transplantation centers located in New York City, this study found that kidney transplantation was a more cost-effective treatment than hemodialysis for the Medicare program. The initially higher costs of transplantation were fully recouped by Medicare 2 years and 10 months after surgery. For persons who are eligible for Medicare solely due to their end-stage renal disease status, transplantation would generate average monthly savings of $3800 over dialysis for the 2 years following the break-even point. For those eligible for reasons other than end-stage renal disease, for example, the aged, the average savings would be $2400. The savings difference arises because Medicare coverage for immunosuppressants for the former group ends 36 months after transplantation.
Evaluation Guidelines for Adult and Pediatric Kidney Transplant Programs: The Missouri Experience
Authors: Hillerman Wanda L. , Russell Cynthia L. , Barry Dana , Brewer Brenda , Bianchi Lyn , Cundiff Wendy , Friedman Barry , Hoff Judy , Hood Annette , Mahon Mitch , Olesky Jan , White Monique
Published: July 2017

Context

Rigorous candidate evaluation is paramount for estimating risk and long-term success with transplantation. In addition, because of increasing waiting times, patients are seeking listing at multiple centers or transferring waiting time from one center to another. Variations in center evaluation criteria are becoming increasingly important to patients.

Objective

To describe the similarities and differences among the evaluation guidelines for adult and pediatric kidney transplant programs in Missouri.

Design

A descriptive design was used.

Setting and Participants

Kidney transplant nurse coordinators from 7 adult and 4 pediatric kidney transplant programs from 10 centers in Missouri were invited to submit the kidney transplant candidate evaluation guidelines from their programs.

Results

Guidelines were submitted by nurse coordinators from all programs. Consults with the kidney transplant team members, including surgeon, nephrologist, social worker, and nurse coordinator, were included in all of the programs. For the adult programs, 67% (20/30) of the tests and laboratory values were agreed on by at least 70% of the program transplant team members. Similarly, for the pediatric programs, 62% (16/26) of the age-appropriate tests and laboratory values were agreed on by at least 75% of the program transplant team members.

Conclusions

Within the Missouri programs, testing is consistent whether the center is large or small, adult or pediatric. Transplant teams should periodically review their kidney transplant recipient evaluation criteria for similarities to and differences from the current state-of-the-science and surrounding programs.
Pediatric Recipients of Living Donor Lobar Lung Transplants: Postoperative Care
Authors: Horn Monica V. , Schenkel Felicia A. , Woo Marlyn S. , Starnes Vaughn A.
Published: July 2017

Bilateral living donor lobar lung transplantation is a treatment option for selected children and adults with end-stage lung disease. Careful donor evaluation, skilled intraoperative management and surgical technique, and diligent immediate postoperative care and follow-up all contribute to better outcomes. Although medical management of whole lung transplant recipients in the immediate postoperative period is similar to that of lobar lung transplant recipients, there are specific differences. Anatomical distinctions, such as the entire cardiac output flowing to 2 lobes instead of 5, and thoracic space issues with simultaneous mechanical ventilation and chest tube suction, contribute to these differences. Early postoperative care, including initial postoperative stabilization, ventilation, fluid management, rejection/infection surveillance and prophylaxis, and beginning rehabilitation, can be adapted to ensure successful outcomes in these patients.
Posttransplant Viral Syndromes in Pediatric Patients: A Review
Authors: Pearlman Lisa S.
Published: July 2017

The success of pediatric solid organ transplantation has been largely due to advancements in surgical techniques, technology, and preoperative and postoperative care. Potent immunosuppression continues to reduce the incidence and severity of rejection, and improve long-term survival. However, there is growing awareness of the role immunosuppression plays in contributing to the incidence of cytomegalovirus, Epstein-Barr virus, and Epstein-Barr virus–associated posttransplant lymphoproliferative disease. Herpes viruses such as these present as primary or recurrent disease and continue to be a significant source of morbidity and mortality in transplant recipients. This paper reviews the predictors of disease, clinical features, diagnosis, and methods of treatment of these major posttransplant viral syndromes. As part of the human herpes virus family, varicella-zoster virus will also be discussed. A case study shows the delicate balance of treating concomitant varicella infection at the time of transplantation.
Improving Oxygenation When Conventional Ventilation Fails: A Case Study
Authors: Recicar John , Niles Patricia
Published: July 2017

Long periods of significant hypoxia do not disqualify a patient from becoming an organ donor. As the management of organ donor patients becomes more complex, recovery coordinators often have to change their thinking and resort to nonconventional means of management. This case study presents a hypoxic donor and how using pressure-control inverse ratio ventilation improved oxygenation in this donor. Before changing ventilator modes, the transplant surgeons were concerned about the long periods of hypoxia the patient had experienced during her hospitalization. After making the change, improving oxygenation, and demonstrating an improved oxygen state, 4 organs were recovered and subsequently transplanted. All the recovered organs functioned immediately after transplantation without any signs of poor performance. Although this treatment modality is not available at every institution, it can be used to improve oxygenation problems in organ donors.
Education Related to Organ Donation and Transplantation in Undergraduate Nursing Schools: 1993 versus 2000
Authors: Chabalewski Franki L. , Ellis James M. , McGaw Lin Johnson
Published: July 2017

Purpose

To evaluate the change in the amount and type of content related to organ donation and transplantation in US nursing schools from 1993 to 2000.

Methods

A survey of 700 nursing schools was conducted in 2000, and its results were compared with results of a similar survey conducted in 1993. Three hundred fifty schools (53.3%) completed the 2000 survey, and 426 (61%) completed the 1993 survey.

Results

Although the amount of time dedicated to donation ( P=.82) and transplantation ( P=.26) issues did not change significantly, the number and types of topics presented, such as minority concerns and cultural issues, increased significantly. There was also a significant increase ( P=.002) in faculty ratings of whether it is important to expose new graduates to this content. A significant increase was also observed in the number of schools that reported that organ procurement professionals presented such content to students (31% to 42%, P=.006).

Conclusion

Although the amount of time spent on these issues has not increased, the number of topics that are now included in the nursing curriculum has increased. In 2000, nursing faculty perceived such content as more important to include in the school's curriculum than in 1993. This change in perception may be a first step in creating a nursing workforce that is knowledgeable about organ donation and transplantation.
Attitudes of Potential Candidates for Heart and Heart-Lung Transplantation to Xenotransplantation
Authors: Long Tracy , Wray Jo , Myers Lynn , Banner Nicholas
Published: July 2017

Context and Objectives

Whether the fact that a transplanted organ is non-human would affect acceptance levels among potential recipients of heart and heart-lung xenografts has not been determined. Studies in renal patients have produced contradictory results. Furthermore, no previous studies have examined the attitudes toward xenotransplantation among the chief caregivers of potential transplant recipients.

Participants and Measures

Fifty-nine patients and 54 caregivers responded to a questionnaire that requested their views on xenotransplantation, the source and level of their knowledge about xenotransplantation, and the perceived costs and benefits of this intervention. Patients' and caregivers' attitudes to animal experimentation and killing animals for human benefit were also assessed by using a specifically designed attitude questionnaire.

Results

Fifty-six percent of patients and 48% of caregivers were unsure about xenotransplantation. Seventy-nine percent of patients and 85% of caregivers indicated that they had received little or no information about xenotransplantation, and what information they had received was from nonmedical sources. Availability of organs was the main perceived benefit (36% of patients and 40% of caregivers) and ethical and moral issues were the main perceived cost (20% of patients and 25% of caregivers). Overall patients and caregivers were in agreement with animal experimentation and killing animals for human benefit.

Conclusions

Potential heart and heart-lung recipients and their caregivers have limited information about xenotransplantation and are currently unsure about the acceptability of this procedure. Although this uncertainty may be due to their lack of information about this intervention, it may also reflect concerns about the morality of breeding animals solely to provide organs for transplantation.
Effects of Gene Induction and Cytokine Production in Donor Care
Authors: Powner David J.
Published: July 2017

Gene induction, cytokine production, and programmed neuronal and myocardial cell death are concerns that have entered the areas of donor evaluation and care over the past several years. Following ischemic or traumatic brain injury and the evolution of brain death, a large number of proteins (cytokines) are produced as part of a regional inflammatory response. These cytokines and related compounds appear to contribute to programmed death (apoptosis) of individual cells and the severe cardiac and hemodynamic changes often encountered during donor care. In addition, these cytokines and related compounds may sensitize donor organs so that a faster and more severe form of rejection occurs in the recipient. Although no directed therapy for these cytokine effects is presently available, the organ procurement coordinator should be aware of these issues and concerns as new treatment options evolve in the near future.
Team Approach in Cross-Cultural Ethical Decision Making: A Case Study
Authors: Wong Frankie W. H. , Anderson Sandra M.
Published: July 2017

The increasing cultural diversity in modern society creates difficulties in cross-cultural ethical decision making for healthcare workers. Nurses need to be sensitive and knowledgeable about the cultural background of individual patients. Acknowledging an individual's cultural background and considering the characteristics of different cultures when planning the patient's care may facilitate the process of ethical decision making.
Extracorporeal Photopheresis in the Treatment of Persistent Rejection in a Pediatric Lung Transplant Recipient
Authors: Wise Barbara V. , King Karen E. , Rook Alain H. , Mogayzel Peter J.
Published: July 2017

Lung transplantation is an accepted therapy for children with end-stage lung disease. One-year lung transplant survival rates of 86% have been reported by the United Network for Organ Sharing. Allograft rejection is a common cause of death following transplantation. Extracorporeal photopheresis is a novel therapy used to treat solid-organ rejection; this therapy involves separating the leukocyte-rich fraction from whole blood, treating with psoralen and ultraviolet light A exposure. The objective of therapy is to reverse progressive and persistent rejection. Working collaboratively with an institution that offers extracorporeal photopheresis may provide an alternative or additional therapy in the management of ongoing rejection following solid-organ transplantation.
Evaluation of Living Liver Donors
Authors: Rudow Dianne LaPointe , Robert S. Brown
Published: July 2017

As a result of the cadaveric organ shortage, the number of centers performing living donor liver transplantation has increased. Living donor liver transplantation provides immediate organ availability and avoids the risk of life-threatening complications that occur with long waiting times for cadaveric organs; however, it puts a healthy person at risk for little personal gain. A standardized approach to donor evaluation ensures safety to potential donors. Careful medical (physical examination as well as laboratory and radiological evaluation) and psychological evaluation is imperative to reduce donor complications and ensure good outcomes in recipients. A social worker and psychiatrist assess for mental competency, provide emotional support, and can serve as independent donor advocates. Informed understanding and consent are crucial aspects of the evaluation and include ensuring that the donor understands all potential complications and is free of coercion. Safety of the donor must be the highest priority.
Avoidant Coping with Health Problems is Related to Poorer Quality of Life among Lung Transplant Candidates
Authors: Myaskovsky Larissa , Dew Mary Amanda , Switzer Galen E. , Hall Martica , Kormos Robert L. , Goycoolea Jean M. , DiMartini Andrea F. , Manzetti Jan D. , McCurry Kenneth R.
Published: July 2017

Context

Lung transplant candidates face numerous health-related stressors. Although previous work has described the range of coping strategies candidates may use, whether those strategies are related to quality of life in physical functioning, emotional, and social domains has rarely been examined.

Methods

Adult lung transplant candidates (N=128) participated in semistructured interviews that included questions regarding global and domain-specific quality of life and a multidimensional assessment of coping with health-related problems. Demographic characteristics, health status, and other psychosocial variables were also assessed, and their effects were examined and controlled in multivariate analyses of the coping–quality-of-life relationship.

Results

Respondents were most likely to use active, acceptance, and support-seeking strategies to cope with health problems. Self-blame or avoidance were rarely used. Although used least often, avoidant coping was the most strongly and consistently related to quality of life. With demographic and psychosocial variables controlled, higher avoidant coping remained associated with significantly poorer global quality of life, bodily pain, difficulty with daily work or activities as a function of emotional problems, and depressive symptomatology. Avoidant coping accentuated the association of poor health status and lower quality of life. Among respondents with lower health status, using more avoidant coping was associated with greater difficulty functioning in daily activities as a result of emotional problems. Those with higher health status had less difficulty functioning in daily activities as a result of emotional problems.

Conclusions

Transplant team members are encouraged to be aware of and help patients refrain from using avoidant coping strategies.
Mortality from Time of Listing for Transplantation as an Indicator of Candidate Outcomes
Authors: Nathan Steven D. , Barnett Scott D. , Ahmad Shahzad , Harrison Jane , Shorr Andrew F. , Lefrak Edward A. , Burton Nelson A.
Published: July 2017

Context

Survival after transplantation has traditionally been the statistic most closely scrutinized as to the efficacy of the procedure and a program's performance. We propose that mortality from the time of listing is a more significant outcome measure for potential transplant candidates. We present our lung transplant program's outcomes using this measure.

Methods

An analysis was performed on all patients listed for lung transplantation at our institution between 1997 and 2002. Kaplan-Meier analyses of survival at 1, 2, and 3 years after listing were assessed.

Results

One hundred forty-eight patients qualified for the analysis; of these, 96 received transplants. The median time to transplantation was 142 days. Twenty-five of the patients died while waiting for a transplant. The median time to death for these patients was 311 days. Of the 27 transplant recipients who died, the median time from listing to death was 547 days. The 1-, 2-, and 3-year mortality rates after being listed were 20.0%, 32.4%, and 39.7%, respectively, for all patients.

Conclusions

Mortality after listing is a more relevant statistic for prospective transplant candidates. Intraprogram comparisons of listed nontransplant survival to listed transplant survival may facilitate the acceptance of sicker patients for transplant consideration. It may also help foster the development of an “alternate” list for transplantation and prove useful in helping determine organ prioritization.
Family Conversations about Organ Donation
Authors: Thompson Teresa L. , Robinson James D. , Kenny R. Wade
Published: July 2017

Objective

To describe family conversations about organ donation and to examine interrelationships among the content and outcomes of these conversations, and attitudes toward organ donation.

Design

Closed and open-ended survey questions.

Participants

353 men and 488 women.

Main Outcome Measures

Content analysis of reports of conversations and of reactions of family members to the conversations, as well as closed items assessing both those issues and attitudes toward donation.

Results

Most respondents who were willing to donate their organs had not talked with their families about their donation wishes. Conversations that did occur were typically about the patient's donation wishes and moral and altruistic reasons for donation, or included a story about donation. These approaches, as well as talking about the reasons for wishing to donate, were associated with positive responses from family members, whereas discussing fears about being declared dead prematurely or about the medical establishment were associated with negative responses.
Are Organ Donation Attitudes and Beliefs, Empathy, and Life Orientation Related to Donor Registration Status?
Authors: Rodrigue James R. , Cornell Danielle L. , Jackson Shannon I. , Kanasky William , Marhefka Stephanie , Reed Alan I.
Published: July 2017

Context

The severe organ donor shortage necessitates additional research on variables that may distinguish those who register to be organ donors and those who do not. Such research has important implications for the development of educational interventions.

Objective

To examine whether registered organ donors differ significantly from nondonors on measures of organ donation beliefs and attitudes, empathy, and life orientation.

Design and Setting

Prospective participants were approached about the study while visiting a local branch of the Department of Motor Vehicles. Once consent was obtained, participants completed several questionnaires.

Participants

Two hundred fifty community dwellers who visited the Department of Motor Vehicles office in Alachua County, Fla.

Main Outcome Measures

Organ donor registration status, beliefs about organ donation, attitudes toward organ donation, empathy, and life orientation (ie, optimism).

Results

Registered organ donors reported more positive beliefs toward organ donation than did nonregistered participants or participants who were undecided about their registration status. Registered organ donors also reported more positive organ donation attitudes and more optimism than did nonregistered participants.
Chronic Allograft Nephropathy: Pathogenesis and Management of an Important Posttransplant Complication
Authors: Aull Meredith J.
Published: July 2017

Chronic allograft nephropathy is a devastating complication of kidney transplantation that is responsible for a significant proportion of graft loss. This complication is characterized by a progressive decline in kidney function, which is not attributable to a specific cause. Many risk factors exist for the development of chronic allograft nephropathy, including donor-, recipient-, and transplant-related factors (eg, use of calcineurin inhibitors and acute rejection episodes), as well as comorbid conditions such as hypertension and hyperlipidemia. There is no definitive treatment for this complication; management has focused on minimization or withdrawal of calcineurin inhibitors in conjunction with addition of sirolimus or mycophenolate mofetil. Alterations in the immunosuppressive regimen must be done cautiously, as precipitating acute rejection will cause further damage to the allograft. Optimal control of blood pressure, particularly with the use of agents such as angiotensin II receptor blockers, in conjunction with management of dyslipidemia may be effective concurrent therapies in patients with chronic allograft nephropathy.