Previous studies that have assessed the association of pre‐transplant antiphospholipase A2 receptor autoantibody (PLA2R‐Ab) concentration with a recurrence of membranous nephropathy (rMN) post‐kidney ...transplant have yielded variable results. We tested 16 consecutive transplant patients with a history of iMN for pre‐transplant PLA2R‐Ab. Enzyme‐linked immunosorbent assay titers (Euroimmun, NJ, USA) >14 RU/mL were considered positive. A receiver operating characteristic (ROC) analysis was performed after combining data from Quintana et al. (n = 21; Transplantation February 2015) to determine a PLA2R‐Ab concentration which could predict rMN. Six of 16 (37%) patients had biopsy‐proven rMN at a median of 3.2 yr post‐transplant. Of these, five of six (83%) had a positive PLA2R‐Ab pre‐transplant with a median of 82 RU/mL (range = 31–1500). The only patient who had rMN with negative PLA2R‐Ab was later diagnosed with B‐cell lymphoma. One hundred percent (n = 10) of patients with no evidence of rMN (median follow‐up = five yr) had negative pre‐transplant PLA2R‐Ab. In a combined ROC analysis (n = 37), a pre‐transplant PLA2R‐Ab > 29 RU/mL predicted rMN with a sensitivity of 85% and a specificity of 92%. Pre‐transplant PLA2R‐Ab could be a useful tool for the prediction of rMN. Patients with rMN in the absence of PLA2R‐Ab should be screened for occult malignancy and/or alternate antigens.
The objective was to identify individuals with undiagnosed prediabetes from administrative data using adaptive techniques. The data source was a national Medicare Advantage Prescription Drug (MAPD) ...plan administrative data set. A retrospective, cross-sectional study developed and evaluated data adaptive logistic regression, decision tree, neural network, and ensemble predictive models for metabolic syndrome and prediabetes using 3 mutually exclusive cohorts (N = 279,903). The misclassification rate (MCR), average squared error (ASE), c-statistics, sensitivity (SN), and false positive (FP) rates were compared to select the final predictive models. MAPD individuals with continuous enrollment from 2013 to 2014 were included. Metabolic syndrome and prediabetes were defined using clinical guidelines, diagnosis, and laboratory data. A total of 512 variables identified through subject matter expertise in addition to utilizing all data available were evaluated for the modeling. The ensemble model demonstrated better discrimination (c-statistics, MCR, and ASE of 0.83, 0.24, and 0.16, respectively), high SN, and low FP rate in predicting metabolic syndrome than the individual data adaptive modeling techniques. Logistic regression demonstrated better discrimination (c-statistics, MCR, and ASE of 0.67, 0.13, and 0.11 respectively), high SN, and low FP rate in predicting prediabetes than the other adaptive modeling techniques or ensemble methods. The scored data predicted prediabetes in 44% of the MAPD population, which is comparable to 2005–2006 National Health and Nutrition Examination Survey prediabetes rates of 41%. The logistic regression model demonstrated good performance in predicting undiagnosed prediabetes in MAPD individuals.
Moisture induced degradation is a challenge facing flexible CIGS modules designs as the polymeric barriers usually have higher water vapor transmittance rate (WVTR) than rigid glass barriers. In the ...process of module design, the expected lifetime is a key point in selecting the most appropriate barriers. However, the correlation between common acceleration tests and module lifetime is still not well known. This work introduces a method of monitoring flexible CIGS module degradation in-situ by recording sheet resistance when a module is exposed to humidity and temperature. An empirical Hallberg-Peck model was employed to estimate the module lifetime.
Abstract
Background
Correct personal protective equipment (PPE) use is key to prevent infection. Observations on a single unit at the Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) ...prior to COVID-19 (October 2019-February 2020) showed low rates of correct PPE use among healthcare workers (HCWs) (Figure 1). In response to the COVID-19 epidemic, the VA implemented new PPE protocols. Based on our initial observations, we were concerned that incorrect use of PPE may increase the risk of COVID-19 exposure among HCWs. Resident physicians, who work at many sites, may be at high-risk for incorrect PPE use due to rapid turnover and limited site-specific PPE training. We aimed to assess and improve COVID-19 PPE use among internal medicine residents rotating at the VA TVHS.
Figure 1: Pre-COVID-19 Observations of Adherence to Contact Precaution Protocols at the Veterans Affairs Tennessee Valley Healthcare System
Methods
We used the plan, do, study, act (PDSA) model. Prior to starting VA rotations, residents were emailed PPE education to review. We implemented a 1-hour video conference PPE protocol review at rotation start followed by in-person PPE use evaluations for residents performed by infectious diseases fellows on day 2 and day 5-6 post-review to provide just-in-time educational intervention. Errors at each PPE don/doff step were tracked. Correct PPE use data from both observations were compared using McNemar’s test. Baseline and post-implementation resident surveys assessed PPE use knowledge and comfort.
Results
Pre-implementation survey response rate was 72% (21/29); 19/21(91%) reported knowing which PPE to use and 16/21(76%) reported knowing how to safely don/doff PPE. Twenty of 29 (69%) residents completed both observations. Errors decreased by 55% (p=0.0045) from 17/20 (85%) to 6/20 (30%) between initial and follow up observations. Errors in hand hygiene, inclusion of all donning/doffing steps, and PPE reuse decreased, but PPE don/doff order errors increased (Figure 2). Post-project survey response rate was 16/29 (55%). All 16 reported knowing which PPE to use and how to safely don/doff PPE, and 11/16 (69%) residents felt both online and in-person interventions were helpful.
Figure 2: COVID-19 PPE Errors and Correction Types by Observation
Conclusion
Correct COVID-19 PPE use is essential to protect HCWs and patients. Just-in-time education intervention for PPE training may yield higher correct use compared to pre-recorded or online training.
Disclosures
All Authors: No reported disclosures
The Soil Moisture Active Passive (SMAP) mission Level-4 Surface and Root-Zone Soil Moisture (L4_SM) data product is generated by assimilating SMAP L-band brightness temperature observations into the ...NASA Catchment land surface model. The L4_SM product is available from 31 March 2015 to present (within 3 days from real time) and provides 3-hourly, global, 9-km resolution estimates of surface (0-5 cm) and root-zone (0-100 cm) soil moisture and land surface conditions. This study presents an overview of the L4_SM algorithm, validation approach, and product assessment versus in situ measurements. Core validation sites provide spatially averaged surface (root zone) soil moisture measurements for 43 (17) “reference pixels” at 9- and 36-km gridcell scales located in 17 (7) distinct watersheds. Sparse networks provide point-scale measurements of surface (root zone) soil moisture at 406 (311) locations. Core validation site results indicate that the L4_SM product meets its soil moisture accuracy requirement, specified as an unbiased RMSE (ubRMSE, or standard deviation of the error) of 0.04 m3 m−3 or better. The ubRMSE for L4_SM surface (root zone) soil moisture is 0.038 m3 m−3 (0.030 m3 m−3) at the 9-km scale and 0.035 m3 m−3 (0.026 m3 m−3) at the 36-km scale. The L4_SM estimates improve (significantly at the 5% level for surface soil moisture) over model-only estimates, which do not benefit from the assimilation of SMAP brightness temperature observations and have a 9-km surface (root zone) ubRMSE of 0.042 m3 m−3 (0.032 m3 m−3). Time series correlations exhibit similar relative performance. The sparse network results corroborate these findings over a greater variety of climate and land cover conditions.
The authors describe the internal cranial expansion (ICE) procedure, a surgical technique that was used to treat two chronically shunt-treated children who presented with medically and surgically ...refractory intracranial hypertension despite the presence of functioning cerebrospinal fluid shunt systems. The ICE procedure was used as a means to increase intracranial volume without sacrificing calvarial rigidity. Intracranial volume was increased by 5% in one case and 10% in the other. Both patients have returned to their neurological and functional baselines, and they are free of symptoms related to intracranial hypertension.
All ministry leaders concern themselves with the intersection of Jesus-centered ministry and contemporary culture. They ask themselves questions such as, "What do we need to change in order to keep ...up with a wired world?" "What should never change?" "What are the nonnegotiables of faith in Jesus?" Many have attempted to answer these questions. However, most of these leaders offer solutions that the everyday ministry leader simply cannot replicate. Signs of the Times is a unique offering to those who wrestle with the mash-up of ministry and culture. All of the contributors have found success within their ministries, and yet most do not minister to thousands on a weekly basis. Additionally, all of them have had the privilege of studying directly with Dr. Leonard I. Sweet. Despite having authored more than fifty books, Sweet can still be a bit of an enigma. Many of his readers have been deeply influenced by him, and yet they may still struggle to understand what his insights might mean for their ministry. Each of the contributors to this work thoughtfully engages with a key idea that they personally learned from Sweet and they translate it for ministry in the early twenty-first century.
We present a case of functional and histopathologic tolerance, chimerism, and spontaneous clearance of HBV in a patient four years after living donor liver transplant (LDLT). A 19‐year‐old male ...patient underwent a LDLT for HBV cirrhosis. He voluntarily ceased immunosuppression and antiviral therapy after 6 months. He is now four years status post transplant without any episodes of rejection or clinical manifestation of liver disease. PCR and VNTR were used to show donor‐recipient chimerism and a large degree of genetic similarity between the pair. MLC and cytokine elaboration were used to show recipient hyporeactivity towards donor antigen. He also has clinical evidence of clearing his HBV without continued use of HBIG. (Liver Transpl 2004;10:1432–1435.)
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