Sample records for activities recipient monitoring

  1. 24 CFR 1000.508 - If the recipient monitoring identifies programmatic concerns, what happens?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... concerns, what happens? If the recipient's monitoring activities identify areas of concerns, the recipient... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false If the recipient monitoring... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient...

  2. 24 CFR 1000.508 - If the recipient monitoring identifies programmatic concerns, what happens?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... concerns, what happens? If the recipient's monitoring activities identify areas of concerns, the recipient... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false If the recipient monitoring... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient...

  3. 24 CFR 1000.508 - If the recipient monitoring identifies programmatic concerns, what happens?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... concerns, what happens? If the recipient's monitoring activities identify areas of concerns, the recipient... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false If the recipient monitoring... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient...

  4. 24 CFR 1000.508 - If the recipient monitoring identifies programmatic concerns, what happens?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... concerns, what happens? If the recipient's monitoring activities identify areas of concerns, the recipient... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false If the recipient monitoring... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient...

  5. 24 CFR 1000.508 - If the recipient monitoring identifies programmatic concerns, what happens?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... concerns, what happens? If the recipient's monitoring activities identify areas of concerns, the recipient... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false If the recipient monitoring... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient...

  6. 24 CFR 1000.501 - Who is involved in monitoring activities under NAHASDA?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.501 Who is involved in monitoring activities under NAHASDA? The recipient, the grant beneficiary and HUD are involved in monitoring activities under NAHASDA. ...

  7. 24 CFR 1000.501 - Who is involved in monitoring activities under NAHASDA?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.501 Who is involved in monitoring activities under NAHASDA? The recipient, the grant beneficiary and HUD are involved in monitoring activities under NAHASDA. ...

  8. 24 CFR 1000.501 - Who is involved in monitoring activities under NAHASDA?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.501 Who is involved in monitoring activities under NAHASDA? The recipient, the grant beneficiary and HUD are involved in monitoring activities under NAHASDA. ...

  9. 24 CFR 1000.501 - Who is involved in monitoring activities under NAHASDA?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.501 Who is involved in monitoring activities under NAHASDA? The recipient, the grant beneficiary and HUD are involved in monitoring activities under NAHASDA. ...

  10. 24 CFR 1000.501 - Who is involved in monitoring activities under NAHASDA?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.501 Who is involved in monitoring activities under NAHASDA? The recipient, the grant beneficiary and HUD are involved in monitoring activities under NAHASDA. ...

  11. 7 CFR 3015.91 - Monitoring by recipients.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...-supported activities to assure that performance goals are being achieved. Recipient monitoring shall cover... 7 Agriculture 15 2013-01-01 2013-01-01 false Monitoring by recipients. 3015.91 Section 3015.91..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Monitoring and Reporting Program Performance...

  12. 7 CFR 3015.91 - Monitoring by recipients.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...-supported activities to assure that performance goals are being achieved. Recipient monitoring shall cover... 7 Agriculture 15 2014-01-01 2014-01-01 false Monitoring by recipients. 3015.91 Section 3015.91..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Monitoring and Reporting Program Performance...

  13. 7 CFR 3015.91 - Monitoring by recipients.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...-supported activities to assure that performance goals are being achieved. Recipient monitoring shall cover... 7 Agriculture 15 2012-01-01 2012-01-01 false Monitoring by recipients. 3015.91 Section 3015.91..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Monitoring and Reporting Program Performance...

  14. 7 CFR 3015.91 - Monitoring by recipients.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...-supported activities to assure that performance goals are being achieved. Recipient monitoring shall cover... 7 Agriculture 15 2011-01-01 2011-01-01 false Monitoring by recipients. 3015.91 Section 3015.91..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Monitoring and Reporting Program Performance...

  15. 24 CFR 1000.502 - What are the monitoring responsibilities of the recipient, the grant beneficiary and HUD under...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.502 What are the... is responsible for monitoring grant activities, ensuring compliance with applicable Federal... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false What are the monitoring...

  16. 24 CFR 1000.502 - What are the monitoring responsibilities of the recipient, the grant beneficiary and HUD under...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.502 What are the... is responsible for monitoring grant activities, ensuring compliance with applicable Federal... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false What are the monitoring...

  17. 24 CFR 1000.502 - What are the monitoring responsibilities of the recipient, the grant beneficiary and HUD under...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.502 What are the... is responsible for monitoring grant activities, ensuring compliance with applicable Federal... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false What are the monitoring...

  18. 24 CFR 1000.502 - What are the monitoring responsibilities of the recipient, the grant beneficiary and HUD under...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.502 What are the... is responsible for monitoring grant activities, ensuring compliance with applicable Federal... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false What are the monitoring...

  19. 24 CFR 1000.502 - What are the monitoring responsibilities of the recipient, the grant beneficiary and HUD under...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.502 What are the... is responsible for monitoring grant activities, ensuring compliance with applicable Federal... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What are the monitoring...

  20. 24 CFR 1000.506 - If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.506 If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe? Yes. The Indian... it submit its monitoring evaluation/results to the Indian tribe? 1000.506 Section 1000.506 Housing...

  1. 24 CFR 1000.506 - If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.506 If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe? Yes. The Indian... it submit its monitoring evaluation/results to the Indian tribe? 1000.506 Section 1000.506 Housing...

  2. 24 CFR 1000.506 - If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.506 If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe? Yes. The Indian... it submit its monitoring evaluation/results to the Indian tribe? 1000.506 Section 1000.506 Housing...

  3. 24 CFR 1000.506 - If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.506 If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe? Yes. The Indian... it submit its monitoring evaluation/results to the Indian tribe? 1000.506 Section 1000.506 Housing...

  4. 24 CFR 1000.506 - If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.506 If the TDHE is the recipient, must it submit its monitoring evaluation/results to the Indian tribe? Yes. The Indian... it submit its monitoring evaluation/results to the Indian tribe? 1000.506 Section 1000.506 Housing...

  5. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  6. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  7. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  8. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  9. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  10. 24 CFR 1000.524 - What are HUD's performance measures for the review?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring...) The recipient has met the IHP-planned activities in the one-year plan. (e) The recipient has...

  11. 24 CFR 1000.524 - What are HUD's performance measures for the review?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring...) The recipient has met the IHP-planned activities in the one-year plan. (e) The recipient has...

  12. 45 CFR 2543.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 2543.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

  13. 15 CFR 14.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 14.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

  14. 14 CFR 1260.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Records § 1260.151 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subcontract, function or activity supported by the award. Recipients shall monitor subcontracts to ensure subcontractors have met the audit requirements as delineated...

  15. 14 CFR 1260.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Records § 1260.151 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subcontract, function or activity supported by the award. Recipients shall monitor subcontracts to ensure subcontractors have met the audit requirements as delineated...

  16. 15 CFR 14.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 14.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

  17. 45 CFR 2543.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 2543.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

  18. 14 CFR 1260.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Records § 1260.151 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subcontract, function or activity supported by the award. Recipients shall monitor subcontracts to ensure subcontractors have met the audit requirements as delineated...

  19. 45 CFR 2543.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 2543.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

  20. 45 CFR 2543.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 2543.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

  1. 15 CFR 14.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 14.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

  2. 15 CFR 14.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 14.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

  3. 24 CFR 1000.532 - What are the adjustments HUD makes to a recipient's future year's grant amount under section 405...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.532 What are the... housing activities may not be recaptured or deducted from future assistance provided on behalf of an... the recipient's control, when a recipient is not complying significantly with a major activity of its...

  4. 24 CFR 1000.532 - What are the adjustments HUD makes to a recipient's future year's grant amount under section 405...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.532 What are the... housing activities may not be recaptured or deducted from future assistance provided on behalf of an... the recipient's control, when a recipient is not complying significantly with a major activity of its...

  5. 24 CFR 1000.532 - What are the adjustments HUD makes to a recipient's future year's grant amount under section 405...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.532 What are the... housing activities may not be recaptured or deducted from future assistance provided on behalf of an... the recipient's control, when a recipient is not complying significantly with a major activity of its...

  6. 28 CFR 70.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 70.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients must monitor subawards...

  7. 29 CFR 95.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-Award Requirements Reports and Records § 95.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have met the audit...

  8. 29 CFR 95.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-Award Requirements Reports and Records § 95.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have met the audit...

  9. 29 CFR 95.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-Award Requirements Reports and Records § 95.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have met the audit...

  10. 22 CFR 226.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor...

  11. 22 CFR 226.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor...

  12. 29 CFR 95.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-Award Requirements Reports and Records § 95.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have met the audit...

  13. 22 CFR 226.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor...

  14. 28 CFR 70.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 70.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients must monitor subawards...

  15. 28 CFR 70.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 70.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients must monitor subawards...

  16. 28 CFR 70.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 70.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients must monitor subawards...

  17. 14 CFR § 1260.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Records § 1260.151 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subcontract, function or activity supported by the award. Recipients shall monitor subcontracts to ensure subcontractors have met the audit requirements as delineated...

  18. 22 CFR 226.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor...

  19. 24 CFR 1000.530 - What corrective and remedial actions will HUD request or recommend to address performance...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... is repeated; (2) Request the recipient to submit progress schedules for completing activities or... incur costs for the affected activity; (4) Recommend that the recipient redirect funds from affected...

  20. 24 CFR 1000.530 - What corrective and remedial actions will HUD request or recommend to address performance...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... is repeated; (2) Request the recipient to submit progress schedules for completing activities or... incur costs for the affected activity; (4) Recommend that the recipient redirect funds from affected...

  1. 10 CFR 600.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., program, subaward, function or activity supported by the award. Recipients shall monitor subawards to... overruns or high unit costs. DOE may specify in the award that the recipient provide this information on... § 600.112 with regard to use of this form as part of the award application.) (e) Recipients shall not be...

  2. 10 CFR 600.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., program, subaward, function or activity supported by the award. Recipients shall monitor subawards to... overruns or high unit costs. DOE may specify in the award that the recipient provide this information on... § 600.112 with regard to use of this form as part of the award application.) (e) Recipients shall not be...

  3. 10 CFR 600.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., program, subaward, function or activity supported by the award. Recipients shall monitor subawards to... overruns or high unit costs. DOE may specify in the award that the recipient provide this information on... § 600.112 with regard to use of this form as part of the award application.) (e) Recipients shall not be...

  4. 10 CFR 600.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., program, subaward, function or activity supported by the award. Recipients shall monitor subawards to... overruns or high unit costs. DOE may specify in the award that the recipient provide this information on... § 600.112 with regard to use of this form as part of the award application.) (e) Recipients shall not be...

  5. 24 CFR 1000.526 - What information will HUD use for its review?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... monitoring of the recipient's performance, including on-site evaluation of the quality of the work performed...

  6. 24 CFR 1000.526 - What information will HUD use for its review?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... monitoring of the recipient's performance, including on-site evaluation of the quality of the work performed...

  7. 24 CFR 1000.526 - What information will HUD use for its review?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... monitoring of the recipient's performance, including on-site evaluation of the quality of the work performed...

  8. 24 CFR 1000.526 - What information will HUD use for its review?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... monitoring of the recipient's performance, including on-site evaluation of the quality of the work performed...

  9. 24 CFR 1000.526 - What information will HUD use for its review?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... monitoring of the recipient's performance, including on-site evaluation of the quality of the work performed...

  10. 22 CFR 518.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS Post-Award Requirements Reports and Records § 518.51 Monitoring and reporting program performance...

  11. 22 CFR 518.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS Post-Award Requirements Reports and Records § 518.51 Monitoring and reporting program performance...

  12. 49 CFR 19.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS Post-Award Requirements Reports and Records § 19.51 Monitoring and reporting program performance...

  13. 22 CFR 518.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS Post-Award Requirements Reports and Records § 518.51 Monitoring and reporting program performance...

  14. 49 CFR 19.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS Post-Award Requirements Reports and Records § 19.51 Monitoring and reporting program performance...

  15. 49 CFR 19.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS Post-Award Requirements Reports and Records § 19.51 Monitoring and reporting program performance...

  16. 49 CFR 19.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS Post-Award Requirements Reports and Records § 19.51 Monitoring and reporting program performance...

  17. 22 CFR 518.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS Post-Award Requirements Reports and Records § 518.51 Monitoring and reporting program performance...

  18. 2 CFR 215.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS (OMB CIRCULAR A-110) Post Award Requirements Reports and Records § 215.51 Monitoring and reporting...

  19. 20 CFR 435.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., program, subaward, function or activity supported by the award. Recipients must monitor subawards to...) Recipients must immediately notify SSA of developments that have a significant impact on the award-supported... ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 435.51 Monitoring and...

  20. 2 CFR 215.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS (OMB CIRCULAR A-110) Post Award Requirements Reports and Records § 215.51 Monitoring and reporting...

  1. 20 CFR 435.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., program, subaward, function or activity supported by the award. Recipients must monitor subawards to...) Recipients must immediately notify SSA of developments that have a significant impact on the award-supported... ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 435.51 Monitoring and...

  2. 20 CFR 435.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., program, subaward, function or activity supported by the award. Recipients must monitor subawards to...) Recipients must immediately notify SSA of developments that have a significant impact on the award-supported... ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 435.51 Monitoring and...

  3. 2 CFR 215.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... ORGANIZATIONS (OMB CIRCULAR A-110) Post Award Requirements Reports and Records § 215.51 Monitoring and reporting...

  4. Activity of Reticulitermes flavipes (Isoptera: Rhinotermitidae) Exposed to Nestmates Treated with Slow-Acting Nonrepellent Termiticides

    Treesearch

    J.E. Mulrooney; R. D. Hasse; T. L. Wagner; P. D. Gerard

    2007-01-01

    A 32-channel acoustical event detector was used to monitor termite activity in donor/recipient bioassays of slow-acting nonrepellent termiticides. Acoustical detection of termite activity illustrated termite mortality over time, attributed to termiticides moving from donors to recipients. In the first of two donor-recipient experiments, worker termites (donors) were...

  5. 24 CFR 1000.542 - When may HUD require replacement of a recipient?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... practice of activities that constitute substantial or willful noncompliance with the requirements of...

  6. 24 CFR 1000.542 - When may HUD require replacement of a recipient?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... practice of activities that constitute substantial or willful noncompliance with the requirements of...

  7. 24 CFR 1000.542 - When may HUD require replacement of a recipient?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... practice of activities that constitute substantial or willful noncompliance with the requirements of...

  8. 24 CFR 1000.542 - When may HUD require replacement of a recipient?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... practice of activities that constitute substantial or willful noncompliance with the requirements of...

  9. 24 CFR 1000.542 - When may HUD require replacement of a recipient?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... practice of activities that constitute substantial or willful noncompliance with the requirements of...

  10. 24 CFR 1000.548 - Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.548 Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA activities be... audit pursuant to the Single Audit Act relating to NAHASDA activities be submitted to HUD? 1000.548...

  11. 24 CFR 1000.548 - Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.548 Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA activities be... audit pursuant to the Single Audit Act relating to NAHASDA activities be submitted to HUD? 1000.548...

  12. 24 CFR 1000.548 - Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.548 Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA activities be... audit pursuant to the Single Audit Act relating to NAHASDA activities be submitted to HUD? 1000.548...

  13. 24 CFR 1000.548 - Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.548 Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA activities be... audit pursuant to the Single Audit Act relating to NAHASDA activities be submitted to HUD? 1000.548...

  14. 24 CFR 1000.548 - Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.548 Must a copy of the recipient's audit pursuant to the Single Audit Act relating to NAHASDA activities be... audit pursuant to the Single Audit Act relating to NAHASDA activities be submitted to HUD? 1000.548...

  15. 24 CFR 1000.546 - Are audit costs eligible program or administrative expenses?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... attributable to NAHASDA funded activities. For a recipient not covered by the Single Audit Act, but which...

  16. 24 CFR 1000.546 - Are audit costs eligible program or administrative expenses?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... attributable to NAHASDA funded activities. For a recipient not covered by the Single Audit Act, but which...

  17. 24 CFR 1000.546 - Are audit costs eligible program or administrative expenses?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... attributable to NAHASDA funded activities. For a recipient not covered by the Single Audit Act, but which...

  18. 24 CFR 1000.546 - Are audit costs eligible program or administrative expenses?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... attributable to NAHASDA funded activities. For a recipient not covered by the Single Audit Act, but which...

  19. 24 CFR 1000.546 - Are audit costs eligible program or administrative expenses?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... attributable to NAHASDA funded activities. For a recipient not covered by the Single Audit Act, but which...

  20. 24 CFR 1000.518 - When must a recipient obtain public comment on its annual performance report?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.518 When must a recipient obtain public comment on its annual...

  1. 24 CFR 1000.518 - When must a recipient obtain public comment on its annual performance report?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.518 When must a recipient obtain public comment on its annual...

  2. 24 CFR 1000.518 - When must a recipient obtain public comment on its annual performance report?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.518 When must a recipient obtain public comment on its annual...

  3. 24 CFR 1000.518 - When must a recipient obtain public comment on its annual performance report?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.518 When must a recipient obtain public comment on its annual...

  4. 24 CFR 1000.518 - When must a recipient obtain public comment on its annual performance report?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.518 When must a recipient obtain public comment on its annual...

  5. 24 CFR 1000.534 - What constitutes substantial noncompliance?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... noncompliance has a material effect on the recipient meeting its planned activities as described in its Indian Housing Plan; (b) The noncompliance represents a material pattern or practice of activities constituting...

  6. 24 CFR 1000.534 - What constitutes substantial noncompliance?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... noncompliance has a material effect on the recipient meeting its planned activities as described in its Indian Housing Plan; (b) The noncompliance represents a material pattern or practice of activities constituting...

  7. 24 CFR 1000.534 - What constitutes substantial noncompliance?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... Indian Housing Plan; (b) The noncompliance represents a material pattern or practice of activities... expenditure of a material amount of the NAHASDA funds budgeted by the recipient for a material activity; or (d...

  8. 24 CFR 1000.534 - What constitutes substantial noncompliance?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... Indian Housing Plan; (b) The noncompliance represents a material pattern or practice of activities... expenditure of a material amount of the NAHASDA funds budgeted by the recipient for a material activity; or (d...

  9. 24 CFR 1000.534 - What constitutes substantial noncompliance?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... Indian Housing Plan; (b) The noncompliance represents a material pattern or practice of activities... expenditure of a material amount of the NAHASDA funds budgeted by the recipient for a material activity; or (d...

  10. 24 CFR 1000.520 - What are the purposes of HUD review?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... performance to determine whether the recipient: (a) Has carried out its eligible activities in a timely manner, has carried out its eligible activities and certifications in accordance with the requirements and the...

  11. 24 CFR 1000.520 - What are the purposes of HUD review?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... performance to determine whether the recipient: (a) Has carried out its eligible activities in a timely manner, has carried out its eligible activities and certifications in accordance with the requirements and the...

  12. 24 CFR 1000.520 - What are the purposes of HUD review?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... performance to determine whether the recipient: (a) Has carried out its eligible activities in a timely manner, has carried out its eligible activities and certifications in accordance with the requirements and the...

  13. New Generation IGRA in Immunocompromised Individuals

    ClinicalTrials.gov

    2016-08-05

    Monitoring, Immunologic; Active Tuberculosis; Tuberculosis in Solid Organ Transplant Recipients; Tuberculosis in Marrow Transplant Recipients; Tuberculosis in Rheumatoid Arthritis; Tuberculosis in Chronic Renal Failure; Tuberculosis in HIV-infected Individuals

  14. 24 CFR 1000.530 - What corrective and remedial actions will HUD request or recommend to address performance...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... for completing activities or complying with the requirements of this part; (3) Recommend that the recipient suspend, discontinue, or not incur costs for the affected activity; (4) Recommend that the...

  15. 24 CFR 1000.530 - What corrective and remedial actions will HUD request or recommend to address performance...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... for completing activities or complying with the requirements of this part; (3) Recommend that the recipient suspend, discontinue, or not incur costs for the affected activity; (4) Recommend that the...

  16. 24 CFR 1000.530 - What corrective and remedial actions will HUD request or recommend to address performance...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... for completing activities or complying with the requirements of this part; (3) Recommend that the recipient suspend, discontinue, or not incur costs for the affected activity; (4) Recommend that the...

  17. 24 CFR 84.85 - Reports and records.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure... retention and access to records for awards to recipients. Federal awarding agencies shall not impose any... the records of recipients that are pertinent to an award, except when HUD can demonstrate that such...

  18. 24 CFR 84.85 - Reports and records.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure... retention and access to records for awards to recipients. Federal awarding agencies shall not impose any... the records of recipients that are pertinent to an award, except when HUD can demonstrate that such...

  19. 24 CFR 84.85 - Reports and records.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure... retention and access to records for awards to recipients. Federal awarding agencies shall not impose any... the records of recipients that are pertinent to an award, except when HUD can demonstrate that such...

  20. 24 CFR 84.85 - Reports and records.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure... retention and access to records for awards to recipients. Federal awarding agencies shall not impose any... the records of recipients that are pertinent to an award, except when HUD can demonstrate that such...

  1. 24 CFR 84.85 - Reports and records.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure... retention and access to records for awards to recipients. Federal awarding agencies shall not impose any... the records of recipients that are pertinent to an award, except when HUD can demonstrate that such...

  2. 24 CFR 1000.532 - What are the remedial actions that HUD may take in the event of recipient's substantial...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.532 What are the...) Limit the availability of payments under NAHASDA to programs, projects, or activities not affected by... of NAHASDA or these regulations is not a pattern or practice of activities constituting willful...

  3. 24 CFR 1000.532 - What are the remedial actions that HUD may take in the event of recipient's substantial...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.532 What are the...) Limit the availability of payments under NAHASDA to programs, projects, or activities not affected by... of NAHASDA or these regulations is not a pattern or practice of activities constituting willful...

  4. 24 CFR 1000.556 - Does the Freedom of Information Act (FOIA) apply to recipient records?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.556 Does the Freedom of Information Act (FOIA) apply to...

  5. 24 CFR 1000.556 - Does the Freedom of Information Act (FOIA) apply to recipient records?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.556 Does the Freedom of Information Act (FOIA) apply to...

  6. 24 CFR 1000.556 - Does the Freedom of Information Act (FOIA) apply to recipient records?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.556 Does the Freedom of Information Act (FOIA) apply to...

  7. 24 CFR 1000.556 - Does the Freedom of Information Act (FOIA) apply to recipient records?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.556 Does the Freedom of Information Act (FOIA) apply to...

  8. 24 CFR 1000.556 - Does the Freedom of Information Act (FOIA) apply to recipient records?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.556 Does the Freedom of Information Act (FOIA) apply to...

  9. Comparison of quantitative cytomegalovirus (CMV) PCR in plasma and CMV antigenemia assay: clinical utility of the prototype AMPLICOR CMV MONITOR test in transplant recipients.

    PubMed

    Caliendo, A M; St George, K; Kao, S Y; Allega, J; Tan, B H; LaFontaine, R; Bui, L; Rinaldo, C R

    2000-06-01

    The correlation between the prototype AMPLICOR CMV MONITOR test (Roche Molecular Systems), a quantitative PCR assay, and the cytomegalovirus (CMV) pp65 antigenemia assay was evaluated in transplant recipients. Sequential blood specimens were collected on 29 patients (491 specimens), the leukocyte fraction was tested by CMV antigenemia, and quantitative PCR was performed on plasma specimens. None of the 15 patients (242 specimens) who were antigenemia negative were positive for CMV DNA by PCR, and none of these patients developed active CMV disease. There were 14 antigenemia-positive patients, 8 of whom developed active CMV disease. In all patients, there was a good association between the antigenemia and PCR assays. Ganciclovir-resistant virus was isolated from three patients with active CMV disease. These three patients had persistently elevated levels of antigenemia and CMV DNA by PCR when resistance to ganciclovir developed. This standardized, quantitative CMV PCR assay on plasma has clinical utility for the diagnosis of active disease and in monitoring the response to antiviral therapy in transplant recipients.

  10. Comparison of Quantitative Cytomegalovirus (CMV) PCR in Plasma and CMV Antigenemia Assay: Clinical Utility of the Prototype AMPLICOR CMV MONITOR Test in Transplant Recipients

    PubMed Central

    Caliendo, Angela M.; St. George, Kirsten; Kao, Shaw-Yi; Allega, Jessica; Tan, Ban-Hock; LaFontaine, Robert; Bui, Larry; Rinaldo, Charles R.

    2000-01-01

    The correlation between the prototype AMPLICOR CMV MONITOR test (Roche Molecular Systems), a quantitative PCR assay, and the cytomegalovirus (CMV) pp65 antigenemia assay was evaluated in transplant recipients. Sequential blood specimens were collected on 29 patients (491 specimens), the leukocyte fraction was tested by CMV antigenemia, and quantitative PCR was performed on plasma specimens. None of the 15 patients (242 specimens) who were antigenemia negative were positive for CMV DNA by PCR, and none of these patients developed active CMV disease. There were 14 antigenemia-positive patients, 8 of whom developed active CMV disease. In all patients, there was a good association between the antigenemia and PCR assays. Ganciclovir-resistant virus was isolated from three patients with active CMV disease. These three patients had persistently elevated levels of antigenemia and CMV DNA by PCR when resistance to ganciclovir developed. This standardized, quantitative CMV PCR assay on plasma has clinical utility for the diagnosis of active disease and in monitoring the response to antiviral therapy in transplant recipients. PMID:10834964

  11. 24 CFR 1000.520 - What are the purposes of HUD's review of the Annual Performance Report?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.520 What are the purposes of HUD's review of the Annual... whether the recipient: (a) Has carried out its eligible activities in a timely manner, has carried out its...

  12. 24 CFR 1000.520 - What are the purposes of HUD's review of the Annual Performance Report?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.520 What are the purposes of HUD's review of the Annual... whether the recipient: (a) Has carried out its eligible activities in a timely manner, has carried out its...

  13. 24 CFR 1000.510 - What happens if tribal monitoring identifies compliance concerns?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false What happens if tribal monitoring... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.510 What happens if tribal monitoring identifies compliance...

  14. 24 CFR 1000.510 - What happens if tribal monitoring identifies compliance concerns?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What happens if tribal monitoring... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.510 What happens if tribal monitoring identifies compliance...

  15. 24 CFR 1000.510 - What happens if tribal monitoring identifies compliance concerns?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false What happens if tribal monitoring... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.510 What happens if tribal monitoring identifies compliance...

  16. 24 CFR 1000.503 - What is an appropriate extent of HUD monitoring?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.503 What is an appropriate extent of HUD monitoring? (a) Subject to any... HUD monitoring? 1000.503 Section 1000.503 Housing and Urban Development REGULATIONS RELATING TO...

  17. 24 CFR 1000.510 - What happens if tribal monitoring identifies compliance concerns?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false What happens if tribal monitoring... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.510 What happens if tribal monitoring identifies compliance...

  18. 24 CFR 1000.510 - What happens if tribal monitoring identifies compliance concerns?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false What happens if tribal monitoring... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.510 What happens if tribal monitoring identifies compliance...

  19. 24 CFR 1000.503 - What is an appropriate extent of HUD monitoring?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.503 What is an appropriate extent of HUD monitoring? (a) Subject to any... HUD monitoring? 1000.503 Section 1000.503 Housing and Urban Development REGULATIONS RELATING TO...

  20. 40 CFR 30.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 30.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  1. 40 CFR 30.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 30.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  2. 40 CFR 30.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 30.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  3. 40 CFR 30.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 30.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  4. 22 CFR 145.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 145.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  5. 22 CFR 145.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 145.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  6. 22 CFR 145.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 145.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  7. 22 CFR 145.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 145.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  8. 36 CFR 1210.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 1210.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  9. 36 CFR 1210.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 1210.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  10. 36 CFR 1210.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 1210.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award...

  11. Active CMV and EBV infections in renal transplant recipients with unexplained fever and elevated serum creatinine.

    PubMed

    Hasannia, Tahereh; Moosavi Movahed, Seyed Majid; Vakili, Rosita; Rafatpanah, Houshang; Hekmat, Reza; Valizadeh, Narges; Rezaee, Seyed Abdolrahim

    2016-10-01

    Proper identification of active cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are helpful for monitoring antiviral treatment in transplant recipients. Qualitative and quantitative CMV, EBV DNA PCR techniques in the context of serological tests are performed for early detection and differentiation of active and latent CMV and EBV infections in renal transplantation. Basically, 129 renal transplanted recipients monitored carefully and hospitalized for unexplained elevated creatinine levels or high fever and 21 of their donors were studied. CMV DNA was detected in 63.5% of the febrile episodes following transplantation and in 46.42% of readmitted patients using qualitative PCR method. In the first group, 15% of the patients and in the second group 42.85% of the patients had copy numbers more than cutoff point (900 copies/mL). Cutoff point had 100% sensitivity and 82.5% specificity for active and symptomatic CMV infection. Only 15.5% of the subjects were positive for EBV infection by qualitative PCR method. Among them 5% had >2000 copies/mL and were symptomatic. One subject with a history of three times hospitalization had higher EBV viral load and developed post-transplant lymphoproliferative disorder. CMV load was significantly correlated with elevated creatinine levels (OR = 3.1, p = 0.006), abnormal heart sounds (OR = 4.7; p = 0.02) and hypertension (OR = 3.6; p = 0.03). Only qRT-PCR could differentiate between latent and active infections and might be clinically useful for monitoring symptomatic CMV and EBV infections and initiation of the antiviral therapy. Elevated creatinine levels, hypertension, and abnormal heart sounds could be considered as main manifestations of HCMV infection in kidney recipients.

  12. 43 CFR 12.951 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Organizations Post-Award Requirements § 12.951 Monitoring and reporting program performance. (a) Recipients are... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant...

  13. 43 CFR 12.951 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Organizations Post-Award Requirements § 12.951 Monitoring and reporting program performance. (a) Recipients are... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant...

  14. 43 CFR 12.951 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Organizations Post-Award Requirements § 12.951 Monitoring and reporting program performance. (a) Recipients are... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant...

  15. 43 CFR 12.951 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Organizations Post-Award Requirements § 12.951 Monitoring and reporting program performance. (a) Recipients are... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant...

  16. 24 CFR 1000.512 - Are performance reports required?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... the following: (1) A comparison of actual accomplishments to the planned activities established for the period; (2) The reasons for slippage if established planned activities were not met; and (3...

  17. 24 CFR 1000.512 - Are performance reports required?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability... the following: (1) A comparison of actual accomplishments to the planned activities established for the period; (2) The reasons for slippage if established planned activities were not met; and (3...

  18. 24 CFR 1000.538 - What remedies are available for substantial noncompliance?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... to programs, projects, or activities not affected by the failure to comply; or (4) In the case of... expenditure of funds for activities affected by such failure to comply. (c) If HUD determines that the failure...

  19. 24 CFR 1000.538 - What remedies are available for substantial noncompliance?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... to programs, projects, or activities not affected by the failure to comply; or (4) In the case of... expenditure of funds for activities affected by such failure to comply. (c) If HUD determines that the failure...

  20. 24 CFR 1000.538 - What remedies are available for substantial noncompliance?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... to programs, projects, or activities not affected by the failure to comply; or (4) In the case of... expenditure of funds for activities affected by such failure to comply. (c) If HUD determines that the failure...

  1. 24 CFR 1000.516 - What reporting period is covered by the annual performance report?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.516 What reporting period is covered by the annual...

  2. 24 CFR 1000.516 - What reporting period is covered by the annual performance report?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.516 What reporting period is covered by the annual...

  3. 24 CFR 1000.516 - What reporting period is covered by the annual performance report?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.516 What reporting period is covered by the annual...

  4. 24 CFR 1000.516 - What reporting period is covered by the annual performance report?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.516 What reporting period is covered by the annual...

  5. 24 CFR 1000.516 - What reporting period is covered by the annual performance report?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.516 What reporting period is covered by the annual...

  6. 24 CFR 280.30 - Grant agreement.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Grant agreement. 280.30 Section 280... agreement. (a) General. The recipient's responsibilities under NHOP will be incorporated in a grant agreement excecuted by HUD and the recipient. (b) HUD Monitoring. HUD will monitor the recipient's...

  7. 24 CFR 280.30 - Grant agreement.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Grant agreement. 280.30 Section 280... agreement. (a) General. The recipient's responsibilities under NHOP will be incorporated in a grant agreement excecuted by HUD and the recipient. (b) HUD Monitoring. HUD will monitor the recipient's...

  8. 24 CFR 280.30 - Grant agreement.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Grant agreement. 280.30 Section 280... agreement. (a) General. The recipient's responsibilities under NHOP will be incorporated in a grant agreement excecuted by HUD and the recipient. (b) HUD Monitoring. HUD will monitor the recipient's...

  9. 24 CFR 280.30 - Grant agreement.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Grant agreement. 280.30 Section 280... agreement. (a) General. The recipient's responsibilities under NHOP will be incorporated in a grant agreement excecuted by HUD and the recipient. (b) HUD Monitoring. HUD will monitor the recipient's...

  10. Monitoring for HHV-6 infection after renal transplantation: evaluation of risk factors for sustained viral replication.

    PubMed

    Luiz, Claudia R; Machado, Clarisse M; Canto, Cynthia L M; Christ, Silvia C C; Pestana, Jose O M; Kotton, Camille N; Camargo, Luis F A

    2013-03-27

    Human herpesvirus-6 (HHV-6) is known to reactivate after renal transplantation and has been associated with several clinical manifestations. Risk factors for sustained viral replication, however, remain unclear. Thirty consecutive kidney transplant patients were prospectively followed for HHV-6 replication between February 2007 and February 2008. Plasma samples for DNA detection were collected from the donor and the recipient before transplantation and from the recipient weekly for the first 2 months after transplantation and then every 2 weeks for 2 additional months. HHV-6 active infection was defined as detection of viral DNA in plasma, by polymerase chain reaction, in at least two consecutive samples over an interval of at least 1 week. Active viral infection was detected in 25% of the recipients before transplantation and 27% (8 of 30) of the patients after transplantation. The mean time to onset of viral replication was 28.1 days after transplantation and 7 of 8 (87.5%) were asymptomatic. Risk factors associated with active HHV-6 infection were receiving an organ from a living donor (P=0.028), recipients with IgM antibodies detected before transplantation (P=0.005), and pretransplantation recipient HHV-6 viral load more than 10,000 copies/mL plasma (P=0.034). Active HHV-6 infection occurs early after renal transplantation and is mostly asymptomatic. Donor or recipient infection may occur at the time of transplantation and are related to higher rates of posttransplantation infections.

  11. 29 CFR 34.34 - Monitoring.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Monitoring. 34.34 Section 34.34 Labor Office of the... Nondiscrimination and Equal Opportunity Requirements of JTPA § 34.34 Monitoring. (a) The Director may periodically... monitoring directly any JTPA recipient or from investigating any matter necessary to determine a recipient's...

  12. 49 CFR 26.37 - What are a recipient's responsibilities for monitoring the performance of other program...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 1 2011-10-01 2011-10-01 false What are a recipient's responsibilities for... Contracting § 26.37 What are a recipient's responsibilities for monitoring the performance of other program participants? (a) You must implement appropriate mechanisms to ensure compliance with the part's requirements...

  13. 49 CFR 26.37 - What are a recipient's responsibilities for monitoring the performance of other program...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 1 2014-10-01 2014-10-01 false What are a recipient's responsibilities for... Contracting § 26.37 What are a recipient's responsibilities for monitoring the performance of other program participants? (a) You must implement appropriate mechanisms to ensure compliance with the part's requirements...

  14. 49 CFR 26.37 - What are a recipient's responsibilities for monitoring the performance of other program...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 1 2012-10-01 2012-10-01 false What are a recipient's responsibilities for... Contracting § 26.37 What are a recipient's responsibilities for monitoring the performance of other program participants? (a) You must implement appropriate mechanisms to ensure compliance with the part's requirements...

  15. 49 CFR 26.37 - What are a recipient's responsibilities for monitoring the performance of other program...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 1 2013-10-01 2013-10-01 false What are a recipient's responsibilities for... Contracting § 26.37 What are a recipient's responsibilities for monitoring the performance of other program participants? (a) You must implement appropriate mechanisms to ensure compliance with the part's requirements...

  16. Liver Afferents Contribute to Water Drinking-Induced Sympathetic Activation in Human Subjects: A Clinical Trial

    PubMed Central

    May, Marcus; Gueler, Faikah; Barg-Hock, Hannelore; Heiringhoff, Karl-Heinz; Engeli, Stefan; Heusser, Karsten; Diedrich, André; Brandt, André; Strassburg, Christian P.; Tank, Jens; Sweep, Fred C. G. J.; Jordan, Jens

    2011-01-01

    Water drinking acutely increases sympathetic activity in human subjects. In animals, the response appears to be mediated through transient receptor potential channel TRPV4 activation on osmosensitive hepatic spinal afferents, described as osmopressor response. We hypothesized that hepatic denervation attenuates water drinking-induced sympathetic activation. We studied 20 liver transplant recipients (44±2.6 years, 1.2±0.1 years post transplant) as model of hepatic denervation and 20 kidney transplant recipients (43±2.6 years, 0.8±0.1 years post transplant) as immunosuppressive drug matched control group. Before and after 500 ml water ingestion, we obtained venous blood samples for catecholamine analysis. We also monitored brachial and finger blood pressure, ECG, and thoracic bioimpedance. Plasma norepinephrine concentration had changed by 0.01±0.07 nmol/l in liver and by 0.21±0.07 nmol/l in kidney transplant recipients (p<0.05 between groups) after 30–40 minutes of water drinking. While blood pressure and systemic vascular resistance increased in both groups, the responses tended to be attenuated in liver transplant recipients. Our findings support the idea that osmosensitive hepatic afferents are involved in water drinking-induced sympathetic activation in human subjects. Trial Registration ClinicalTrials.gov NCT01237431 PMID:22016786

  17. 7 CFR 3015.91 - Monitoring by recipients.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Monitoring by recipients. 3015.91 Section 3015.91 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Monitoring and Reporting Program Performance...

  18. The effect of self-efficacy, depression and symptom distress on employment status and leisure activities of liver transplant recipients.

    PubMed

    Weng, Li-Chueh; Huang, Hsiu-Li; Wang, Yi-Wen; Lee, Wei-Chen; Chen, Kang-Hua; Yang, Tsui-Yun

    2014-07-01

    To examine the effect of self-efficacy, subjective work ability, depression and symptom distress on and to provide a description of, the employment and leisure activities of liver transplant recipients. Return to work and leisure activities have become an important aspect of life for liver transplant recipients worldwide. An investigation of the factors that influence the employment status and leisure activities has been recommended as a means to help transplant recipients restore their productivity. This was a cross-sectional, descriptive and correlational study in 2010. A convenience sampling method was used. Data were collected using a set of questionnaires that were administered retrospectively. A total of 106 liver transplant patients were included in this study. The post-transplantation employment rate was 45.2%. The positive predictors of employment were higher subjective work ability and higher symptom distress. Gender (female), monthly family income (

  19. Serial Monitoring of Immune Markers Being Represented Regulatory T Cell/T Helper 17 Cell Ratio: Indicating Tolerance for Tapering Immunosuppression after Liver Transplantation

    PubMed Central

    Jhun, JooYeon; Lee, Seung Hoon; Lee, Soon Kyu; Kim, Hee Yeon; Jung, Eun Sun; Kim, Dong Goo; Choi, JeongWon; Bae, Si Hyun; Yoon, Seung Kew; Chung, Byung Ha; Yang, Chul Woo; Cho, Mi-La; Choi, Jong Young

    2018-01-01

    Recipients of liver transplantation (LT) require long-term immunosuppressive drug treatment, but lifelong immunosuppressive treatment has severe side effects. It is known that some LT recipients develop immune tolerance, and although the development of such operational tolerance should allow a decrease in the burden of immunosuppressive drug treatment, the factors that indicate operational tolerance are not clear. This study aimed to monitor immunological markers over time in LT recipients to identify those markers indicating the development of operational tolerance. We performed a prospective pilot study measuring immune markers, including the ratio of regulatory T (Treg) and T helper (Th) 17 cells in peripheral blood in the 14 most immunologically stable patients among 70 clinically stable LT recipients. The doses of immunosuppressive drugs given to these 14 LT recipients were tapered over time and they were monitored for immunological markers related to the development of immune tolerance. As the doses of immunosuppressive drugs were reduced, the Treg/Th17, Th1/Th17, and CD8/Th17 ratio in tolerant recipients was significantly increased compared with that of nontolerant recipients. These results suggest that monitoring of changes in the immune makers, including Treg/Th17 ratio during tapering of immunosuppression may allow prediction of the development of tolerance. PMID:29545795

  20. 34 CFR 403.32 - What must the State plan contain?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... ADULT EDUCATION, DEPARTMENT OF EDUCATION STATE VOCATIONAL AND APPLIED TECHNOLOGY EDUCATION PROGRAM How... participate in the programs authorized under the State Vocational and Applied Technology Program, the State... monitoring of projects, services, and activities conducted by eligible recipients to ensure that the eligible...

  1. 34 CFR 403.32 - What must the State plan contain?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ADULT EDUCATION, DEPARTMENT OF EDUCATION STATE VOCATIONAL AND APPLIED TECHNOLOGY EDUCATION PROGRAM How... participate in the programs authorized under the State Vocational and Applied Technology Program, the State... monitoring of projects, services, and activities conducted by eligible recipients to ensure that the eligible...

  2. 34 CFR 403.32 - What must the State plan contain?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... ADULT EDUCATION, DEPARTMENT OF EDUCATION STATE VOCATIONAL AND APPLIED TECHNOLOGY EDUCATION PROGRAM How... participate in the programs authorized under the State Vocational and Applied Technology Program, the State... monitoring of projects, services, and activities conducted by eligible recipients to ensure that the eligible...

  3. 34 CFR 403.32 - What must the State plan contain?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... ADULT EDUCATION, DEPARTMENT OF EDUCATION STATE VOCATIONAL AND APPLIED TECHNOLOGY EDUCATION PROGRAM How... participate in the programs authorized under the State Vocational and Applied Technology Program, the State... monitoring of projects, services, and activities conducted by eligible recipients to ensure that the eligible...

  4. 34 CFR 403.32 - What must the State plan contain?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... ADULT EDUCATION, DEPARTMENT OF EDUCATION STATE VOCATIONAL AND APPLIED TECHNOLOGY EDUCATION PROGRAM How... participate in the programs authorized under the State Vocational and Applied Technology Program, the State... monitoring of projects, services, and activities conducted by eligible recipients to ensure that the eligible...

  5. 38 CFR 49.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 49.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing...

  6. 38 CFR 49.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 49.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing...

  7. 7 CFR 3019.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  8. 7 CFR 3019.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  9. 38 CFR 49.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 49.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing...

  10. 7 CFR 3019.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  11. 7 CFR 3019.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  12. 38 CFR 49.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 49.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing...

  13. Successional Distance between the Source and Recipient Influence Seed Germination and Seedling Survival during Surface Soil Replacement in SW China

    PubMed Central

    Shen, You-xin; Gao, Lei; Xia, Xue; Li, Yuhui; Guan, Huilin

    2013-01-01

    Adding propagules (source) to a degraded site (recipient) is a common way of manipulating secondary succession to restore diversity and services formerly provided by forests. However, heretofore no study has considered the effect of “successional distance” between source and recipient site. Four sites in the Shilin karst area of SW China were treated as different states along a secondary successional sere: grass, shrub, young secondary forest, and primary forest. Ten 1 m ×1m soil quadrats in the grass, shrub and young forest sites were replaced with 10 cm deep soil sources from corresponding later successional stage(s) in January 2009. Woody plant seed germination was monitored in the first year and seedling survival was monitored until the end of the second year. At the end of 2010, 2097 seeds of woody plants belonging to 45 taxa had germinated, and 3.9% of the seedlings and 7.8% of the species survived. Germination of most species was sensitive to ambient light (red, far-red, R:FR ratios, photosynthetically active radiation). Soil source and recipient site had a significant effect on the total number of seeds and number of species that germinated, and on the percentage of seedlings that survived through the end of the second year. Closer successional stages between recipient site and soil source had higher seed germination and seedling-survival percentages. However, a transition threshold exists in the young forest state, where seeds can germinate but not survive the second year. Our results, although based on an unreplicated chronosequence, suggest that successional distance between soil sources and recipient sites affect forest recruitment and restoration in degraded karst of SW China. PMID:24223891

  14. 41 CFR 105-72.601 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS 72.60-Post-Award Requirements...

  15. 41 CFR 105-72.601 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS 72.60-Post-Award Requirements...

  16. 24 CFR 84.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Recipients shall immediately notify HUD of developments that have a significant impact on the award-supported... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 84.51 Monitoring and reporting program performance. (a) Recipients are responsible for...

  17. 41 CFR 105-72.601 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS 72.60-Post-Award Requirements...

  18. 34 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... the award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements...) Recipients shall immediately notify the Secretary of developments that have a significant impact on the award... AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  19. 24 CFR 84.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) Recipients shall immediately notify HUD of developments that have a significant impact on the award-supported... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 84.51 Monitoring and reporting program performance. (a) Recipients are responsible for...

  20. 34 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... the award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements...) Recipients shall immediately notify the Secretary of developments that have a significant impact on the award... AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  1. 36 CFR § 1210.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the NHPRC of developments that have a significant impact on the award... WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  2. 34 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... the award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements...) Recipients shall immediately notify the Secretary of developments that have a significant impact on the award... AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  3. 24 CFR 84.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) Recipients shall immediately notify HUD of developments that have a significant impact on the award-supported... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 84.51 Monitoring and reporting program performance. (a) Recipients are responsible for...

  4. 41 CFR 105-72.601 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements as...) Recipients shall immediately notify the Federal awarding agency of developments that have a significant... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS 72.60-Post-Award Requirements...

  5. 24 CFR 84.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) Recipients shall immediately notify HUD of developments that have a significant impact on the award-supported... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 84.51 Monitoring and reporting program performance. (a) Recipients are responsible for...

  6. 34 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... the award. Recipients shall monitor subawards to ensure subrecipients have met the audit requirements...) Recipients shall immediately notify the Secretary of developments that have a significant impact on the award... AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award...

  7. Patient attitudes toward mobile phone-based health monitoring: questionnaire study among kidney transplant recipients.

    PubMed

    McGillicuddy, John William; Weiland, Ana Katherine; Frenzel, Ronja Maximiliane; Mueller, Martina; Brunner-Jackson, Brenda Marie; Taber, David James; Baliga, Prabhakar Kalyanpur; Treiber, Frank Anton

    2013-01-08

    Mobile phone based remote monitoring of medication adherence and physiological parameters has the potential of improving long-term graft outcomes in the recipients of kidney transplants. This technology is promising as it is relatively inexpensive, can include intuitive software and may offer the ability to conduct close patient monitoring in a non-intrusive manner. This includes the optimal management of comorbidities such as hypertension and diabetes. There is, however, a lack of data assessing the attitudes of renal transplant recipients toward this technology, especially among ethnic minorities. To assess the attitudes of renal transplant recipients toward mobile phone based remote monitoring and management of their medical regimen; and to identify demographic or clinical characteristics that impact on this attitude. After a 10 minute demonstration of a prototype mobile phone based monitoring system, a 10 item questionnaire regarding attitude toward remote monitoring and the technology was administered to the participants, along with the 10 item Perceived Stress Scale and the 7 item Morisky Medication Adherence Scale. Between February and April 2012, a total of 99 renal transplant recipients were identified and agreed to participate in the survey. The results of the survey indicate that while 90% (87/97) of respondents own a mobile phone, only 7% (7/98) had any prior knowledge of mobile phone based remote monitoring. Despite this, the majority of respondents, 79% (78/99), reported a positive attitude toward the use of a prototype system if it came at no cost to themselves. Blacks were more likely than whites to own smartphones (43.1%, 28/65 vs 20.6%, 7/34; P=.03) and held a more positive attitude toward free use of the prototype system than whites (4.25±0.88 vs 3.76±1.07; P=.02). The data demonstrates that kidney transplant recipients have a positive overall attitude toward mobile phone based health technology (mHealth). Additionally, the data demonstrates that most kidney transplant recipients own and are comfortable using mobile phones and that many of these patients already own and use smart mobile phones. The respondents felt that mHealth offers an opportunity for improved self-efficacy and improved provider driven medical management. Respondents were comfortable with the idea of being monitored using mobile technology and are confident that their privacy can be protected. The small subset of kidney transplant recipients who are less interested in mHealth may be less technologically adept as reflected by their lower mobile phone ownership rates. As a whole, kidney transplant recipients are receptive to the technology and believe in its utility.

  8. 75 FR 63187 - Agency Information Collection Activities: Proposed Collection: Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-14

    .... Information is needed to match donor organs with recipients, to monitor compliance of member organizations... techniques or other forms of information technology. Proposed Project: Data System for Organ Procurement and Transplantation Network (42 CFR Part 121, OMB No. 0915-0184): Extension The operation of the Organ Procurement and...

  9. 78 FR 49532 - Request for Public Comment: 30-Day Proposed Information Collection: Application for Participation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-14

    ... Scholarship recipients; monitor the academic performance of recipients; and to place recipients at payback... Initial Program Progress Report 1200 1 1200 0.13 ( 8 min) 160 (IHS-856-8). Notification of Academic...

  10. Activated effector and memory T cells contribute to circulating sCD30: potential marker for islet allograft rejection.

    PubMed

    Saini, D; Ramachandran, S; Nataraju, A; Benshoff, N; Liu, W; Desai, N; Chapman, W; Mohanakumar, T

    2008-09-01

    T-cell activation up-regulates CD30 resulting in an increase in serum soluble CD30 (sCD30). CD4+ T cells, a major source for sCD30, play a significant role in the pathogenesis of rejection. In this study, sCD30 was measured pre- and posttransplant in mouse islet allograft models and human islet allograft recipients. sCD30 was measured by ELISA in diabetic C57BL/6, CD4Knockout (KO) and CD8KO islet allograft recipients. sCD30 increased significantly prior to rejection (1.8 +/- 1 days) in 80% of allograft recipients. Sensitization with donor splenocytes, or a second graft, further increased sCD30 (282.5 +/- 53.5 for the rejecting first graft vs. 374.6 +/- 129 for the rejecting second graft) prior to rejection suggesting memory CD4+ T cells contribute to sCD30. CD4KO failed to reject islet allograft and did not demonstrate sCD30 increase. CD8KO showed elevated (227 +/- 107) sCD30 (1 day) prior to rejection. High pretransplant sCD30 (>20 U/ml) correlated with poor outcome in human islet allograft recipients. Further, increase in sCD30 posttransplant preceded (3-4 months) loss of islet function. We conclude that sCD30 is released from activated CD4 T cells prior to islet allograft rejection and monitoring sCD30 can be a valuable adjunct in the follow-up of islet transplant recipients.

  11. Epstein-Barr DNA serology and positron-emission tomography imaging of the head and neck in pediatric transplant recipients.

    PubMed

    Sidell, Douglas; Venick, Robert S; Shapiro, Nina L

    2014-05-01

    Epstein-Barr virus (EBV) infection is a potential precursor of post-transplantation lymphoproliferative disorder (PTLD) in the pediatric transplant patient. Positron-emission tomography (PET) imaging is increasingly utilized in this population to monitor for neoplasia and PTLD. We assess the association between EBV serum titers and Waldeyer's ring and cervical lymph node PET positivity in the pediatric transplant recipient. Retrospective analysis of EBV serology and PET imaging results in pediatric orthotopic liver transplantation (OLT) recipients. Imaging results and laboratory data were reviewed for all pediatric OLT recipients from January 2005 to July 2011 at a single institution. Charts were evaluated for PET positivity at Waldeyer's ring or cervical lymphatics, and for EBV serology results. Demographic data extracted include patient sex and age at transplantation. A total of 122 pediatric OLT recipients were reviewed. Twelve patients (10%) underwent PET imaging. Overall, four patients (33%) had evidence of PET positivity at Waldeyer's ring or cervical lymphatics. Five patients (42%) had positive EBV serology. There was a significant association between PET imaging results and EBV DNA serology results (P = .01). PTLD surveillance in the pediatric transplant recipient is an important component of long-term care in this population. Although PET imaging is a new modality in monitoring pediatric transplant recipients for early signs of PTLD, an association between EBV serology and PET imaging results appears to exist. With increased implementation, PET imaging will likely prove valuable in its ability to monitor the transplant recipient at risk for PTLD. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Immune Monitoring for CMV in Transplantation.

    PubMed

    Yong, Michelle K; Lewin, Sharon R; Manuel, Oriol

    2018-03-14

    Immune monitoring to determine when and how the recovery of cytomegalovirus (CMV)-specific T-cells occurs post-transplantation may help clinicians to risk stratify individuals at risk of complications from CMV. We aimed to review all recent clinical studies using CMV immune monitoring in the pre- and post-transplant setting including the use of recently developed standardized assays (Quantiferon-CMV and the CMV ELISPOT) to better understand in whom, when, and how immune monitoring is best used. Pre-transplant assessment of CMV immunity in solid-organ transplant recipients where CMV seropositive recipients had undetectable cell-mediated responses despite past immunity has shown that they are at a much higher risk of developing CMV reactivation. Post-transplant CMV immune monitoring can guide (shorten or prolong) the duration of antiviral prophylaxis, identify recipients at risk of post-prophylaxis CMV disease, and predict recurrent CMV reactivation. Thus, CMV immune monitoring, in addition to current clinical and DNA-based monitoring for CMV, has the potential to be incorporated into routine clinical care to better improve CMV management in both the stem and solid-organ transplant population.

  13. Home blood pressure monitoring in heart transplant recipients: comparison with ambulatory blood pressure monitoring.

    PubMed

    Ambrosi, Pierre; Kreitmann, Bernard; Habib, Gilbert

    2014-02-15

    How reliable is home blood pressure monitoring (HBPM) in heart transplant recipients is not known. Possibly, it may underestimate hypertensive burden, because blood pressure (BP) nondipper profile is frequent among these patients. This prospective study has been designed to determine whether HBPM adequately identifies hypertension in heart transplant recipients. We compared HBPM with ambulatory blood pressure monitoring (ABPM) for the diagnosis of uncontrolled hypertension in 74 patients 13.5±6.7 years after heart transplantation. HBPM was measured with a validated semiautomatic device twice every morning and twice every evening on 7 consecutive days, within 15 days of ABPM. We also measured the relationship between HBPM, ABPM, and organ damage as measured by albuminuria and left ventricular mass. A nondipper profile was found in 53 (72%) patients. HBPM and ABPM were close according to Pearson bivariate correlations. There was no significant correlation between left ventricular mass and BP either at HBPM or ABPM. Proteinuria significantly correlated with systolic BP either at HBPM (R=0.42; P=0.0002) or ABPM (R=0.25; P=0.03). HBPM adequately classified 61 of 74 (82%) patients as hypertensives or as nonhypertensives or controlled hypertensives. Despite a high prevalence of nondipper profile, HBPM gives a reliable estimate of BP burden in most heart transplant recipients. Thus, our results strongly suggest that HBPM is useful for the long-term follow-up of heart transplant recipients.

  14. 40 CFR 35.713 - Eligible recipients.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Monitoring (section 28) § 35.713 Eligible recipients. (a) The Regional Administrator will treat a Tribe or... an existing government exercising substantial governmental duties and powers; (3) Has adequate...

  15. 20 CFR 667.410 - What are the oversight roles and responsibilities of recipients and subrecipients?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What are the oversight roles and... INVESTMENT ACT Oversight and Monitoring § 667.410 What are the oversight roles and responsibilities of recipients and subrecipients? (a) Roles and responsibilities for all recipients and subrecipients of funds...

  16. Increased confidence to engage in physical exertion: older ICD recipients' experiences of participating in an exercise training programme.

    PubMed

    Morken, Ingvild Margreta; Norekvål, Tone M; Isaksen, Kjetil; Munk, Peter S; Karlsen, Bjørg; Larsen, Alf I

    2013-06-01

    Research suggests that exercise training (ET) programmes may improve both physical and psychosocial functioning in implantable cardioverter defibrillator (ICD) recipients. Most of this research has been conducted by means of quantitative methods. However, knowledge of older ICD recipients' experiences of participating in such programmes is sparse. There is thus a need for more detailed qualitative data from the perspective of older patients. To describe older ICD recipients' experiences of participating in an ET programme. A qualitative design with semistructured interviews involving 12 older ICD recipients who had participated in a 3-month ET programme. Mini-disc recordings of the interviews were transcribed verbatim and analysed using content analysis. The analysis revealed two major themes: (1) 'increased confidence to engage in physical exertion'; and (2) 'increased satisfaction with life'. The first theme is illustrated by three subthemes: 'perceived support from physiotherapists', 'perceiving the heart rate monitor as a motivation to exercise', and 'perceiving peers as motivators for enjoyment and making the effort to exercise'. The second theme was illustrated by the following subthemes: 'perceived psychosocial benefits', 'perceived physical benefits', and 'exercise as a new health habit'. The findings indicate that exercising in a cardiac rehabilitation centre together with peers and supervised by skilled healthcare professionals may increase motivation to exert oneself, leading to emotional and physical benefits as well as a more social and active lifestyle for older ICD recipients.

  17. Lowered Immune Cell Function in Liver Recipients Recovered From Posttransplant Lymphoproliferative Disease Who Developed Graft Tolerance.

    PubMed

    Chung, Patrick Ho Yu; Chan, See Ching; Chan, Kwong Leung; Chan, Yuk Sing; Kwok, Janette Siu Yin; Lo, Chung Mau

    2016-03-01

    Tolerance after treatment and recovery from posttransplant lymphoproliferative disease (PTLD) have been described but little is known about the immunology. The objective of this study is to evaluate the immunity of pediatric recipients who recovered from PTLD. Pediatric recipients who recovered from PTLD after liver transplant and twice the number of recipients who never had PTLD were recruited. Their immune statuses were measured by ImmuKnow (measurement of adenosine 5-triphospate level produced CD4+ T helper cells), and the results were divided into 3 groups, "low" (≤225 ng/mL), "moderate" (226 to 524 ng/mL), and "high" (≥525 ng/mL). The results of both groups were compared and analyzed. Nine PTLD recipients and 20 non-PTLD recipients were recruited. There were no significant differences in terms of sex and age between the 2 groups. The majority of PTLD recipients (88.9%) had "low" immune status responses, and none of them had "high" responses. For non-PTLD recipients, more than half (55%) had "moderate" immune status responses. The median value of adenosine 5-triphospate levels was significantly lower in the PTLD group (119 ng/mL vs 380.5 ng/mL P = 0.014), and their trough immunosuppressant level was also lower (3.8 μg/L vs 7.7 μg/L; P = 0.004). None of the patients in either group had abnormal liver enzymes (aspartate aminotransferase/alanine aminotransferase) to suggest graft rejection. Patients who recovered from PTLD have a lower CD4 T-cell activity compared with those who have not suffered from PTLD. Under careful monitoring, their immunosuppressant levels can be kept at low levels to prevent recurrence of PTLD.

  18. Thoracic organ transplantation: laboratory methods.

    PubMed

    Patel, Jignesh K; Kobashigawa, Jon A

    2013-01-01

    Although great progress has been achieved in thoracic organ transplantation through the development of effective immunosuppression, there is still significant risk of rejection during the early post-transplant period, creating a need for routine monitoring for both acute antibody and cellular mediated rejection. The currently available multiplexed, microbead assays utilizing solubilized HLA antigens afford the capability of sensitive detection and identification of HLA and non-HLA specific antibodies. These assays are being used to assess the relative strength of donor specific antibodies; to permit performance of virtual crossmatches which can reduce the waiting time to transplantation; to monitor antibody levels during desensitization; and for heart transplants to monitor antibodies post-transplant. For cell mediated immune responses, the recent development of gene expression profiling has allowed noninvasive monitoring of heart transplant recipients yielding predictive values for acute cellular rejection. T cell immune monitoring in heart and lung transplant recipients has allowed individual tailoring of immunosuppression, particularly to minimize risk of infection. While the current antibody and cellular laboratory techniques have enhanced the ability to manage thoracic organ transplant recipients, future developments from improved understanding of microchimerism and graft tolerance may allow more refined allograft monitoring techniques.

  19. Safety of diphtheria, tetanus, acellular pertussis and inactivated poliovirus (DTaP-IPV) vaccine.

    PubMed

    Daley, Matthew F; Yih, W Katherine; Glanz, Jason M; Hambidge, Simon J; Narwaney, Komal J; Yin, Ruihua; Li, Lingling; Nelson, Jennifer C; Nordin, James D; Klein, Nicola P; Jacobsen, Steven J; Weintraub, Eric

    2014-05-23

    In 2008, a diphtheria, tetanus, acellular pertussis, and inactivated poliovirus combined vaccine (DTaP-IPV) was licensed for use in children 4 through 6 years of age. While pre-licensure studies did not demonstrate significant safety concerns, the number vaccinated in these studies was not sufficient to examine the risk of uncommon but serious adverse events. To assess the risk of serious adverse events following DTaP-IPV vaccination. The study was conducted from January 2009 through September 2012 in the Vaccine Safety Datalink (VSD) project. In the VSD, electronic vaccination and encounter data are updated and aggregated weekly as part of ongoing surveillance activities. Based on previous reports and biologic plausibility, eight potential adverse events were monitored: meningitis/encephalitis; seizures; stroke; Guillain-Barré syndrome; Stevens-Johnson syndrome; anaphylaxis; serious allergic reactions other than anaphylaxis; and serious local reactions. Adverse event rates in DTaP-IPV recipients were compared to historical incidence rates in the VSD population prior to 2009. Sequential probability ratio testing was used to analyze the data on a weekly basis. During the study period, 201,116 children received DTaP-IPV vaccine. Ninety-seven percent of DTaP-IPV recipients also received other vaccines on the same day, typically measles-mumps-rubella and varicella vaccines. There was no statistically significant increased risk of any of the eight pre-specified adverse events among DTaP-IPV recipients when compared to historical incidence rates. In this safety surveillance study of more than 200,000 DTaP-IPV vaccine recipients, there was no evidence of increased risk for any of the pre-specified adverse events monitored. Continued surveillance of DTaP-IPV vaccine safety may be warranted to monitor for rare adverse events, such as Guillain-Barré syndrome. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Parvovirus B19 Infection and Severe Anemia in Renal Transplant Recipients

    PubMed Central

    Carraturo, Antonio; Catalani, Valentina; Ottaviani, Donatella; Menichelli, Patrizia; Rossini, Maurizio; Terella, Delia; Biondi, Brunello

    2012-01-01

    Kidney transplant (KT) recipients can develop symptomatic Parvovirus (PV) B19 infections, frequently associated with persistent anemia. The aim of this study was to evaluate the prevalence and clinical significance of PV B19 infection in anemic and non-anemic KT patients. Overall, out of 64 patients monitored for the presence of PV B19 by real-time PCR, 2 (3.12%) had an active PV B19 infection, in absence of other viral coinfections. The 2 cases occurred in nonanemic kidney transplant patients group (2/50, 4%), while none of the anemic transplant patients (0/14) was found to suffer from this infection. Moreover, patients affected by active PV B19 infection showed viral loads not exceeding 1 × 105 genome copies/reaction. In conclusion, in this study, PV B19 infection was not common in renal transplant population and wasn't associated with severe anemia. PMID:22619569

  1. Monitoring Extracellular Vesicle Cargo Active Uptake by Imaging Flow Cytometry.

    PubMed

    Ofir-Birin, Yifat; Abou Karam, Paula; Rudik, Ariel; Giladi, Tal; Porat, Ziv; Regev-Rudzki, Neta

    2018-01-01

    Extracellular vesicles are essential for long distance cell-cell communication. They function as carriers of different compounds, including proteins, lipids and nucleic acids. Pathogens, like malaria parasites ( Plasmodium falciparum, Pf ), excel in employing vesicle release to mediate cell communication in diverse processes, particularly in manipulating the host response. Establishing research tools to study the interface between pathogen-derived vesicles and their host recipient cells will greatly benefit the scientific community. Here, we present an imaging flow cytometry (IFC) method for monitoring the uptake of malaria-derived vesicles by host immune cells. By staining different cargo components, we were able to directly track the cargo's internalization over time and measure the kinetics of its delivery. Impressively, we demonstrate that this method can be used to specifically monitor the translocation of a specific protein within the cellular milieu upon internalization of parasitic cargo; namely, we were able to visually observe how uptaken parasitic Pf -DNA cargo leads to translocation of transcription factor IRF3 from the cytosol to the nucleus within the recipient immune cell. Our findings demonstrate that our method can be used to study cellular dynamics upon vesicle uptake in different host-pathogen and pathogen-pathogen systems.

  2. Post-transplant monitoring of soluble CD30 level as predictor of graft outcome: a single center experience from China.

    PubMed

    Wang, Dong; Wu, Weizhen; Yang, Shunliang; Wang, Qinghua; Tan, Jianming

    2012-12-01

    There are no reliable parameters for post-transplantation immunological monitoring, which might enable recipient-tailored immunosuppressive therapy. 250 renal graft recipients were enrolled and detected for sCD30 level pre-transplantation, and on days 5 and 14, and on months 1, 3, 6, 12, 24, 36, 48 and 60 post-transplantation. Analysis was performed on correlation between sCD30 level and acute rejection, lung infection, or graft loss respectively. sCD30 levels descended to a nadir with a mean of 10.2 ± 3.8 U/mL on day 30 post-transplantation, then rose gradually, and approached 21.8 ± 10.1 U/mL on month 3, 34.2 ± 16.5 U/mL on month 6, and 42.9 ± 29.5 U/mL on month 12, then presented a stable level. Recipients with AR had significantly higher sCD30 levels than those without AR on days 5 and 14 post-transplantation. Recipients with pneumonia had significantly lower sCD30 levels within 3 months post-transplantation than those without pneumonia. Significantly higher sCD30 levels were recorded in recipients who suffered graft loss than those with normal graft function on days 5 and 14, and on months 6, 12, and 24. High sCD30 level (≥ 48.3 U/mL) at month 12 post-transplantation has an obvious detrimental effect on renal graft survival (p=0.000, HR=9.075). Serum sCD30 level might reflect immune state of renal graft recipients. Post-transplantation sequential monitoring of sCD30 level is necessary, which might not only identify recipients at the risk of acute rejection and graft loss, but also chosen as an independent predictor of pneumonia in renal transplant recipients. Copyright © 2012 Elsevier B.V. All rights reserved.

  3. 43 CFR 12.951 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... readily quantified, such quantitative data should be related to cost data for computation of unit costs... including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e) Recipients... performance data from recipients. ...

  4. 41 CFR 105-72.601 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... readily quantified, such quantitative data should be related to cost data for computation of unit costs... including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e) Recipients... performance data from recipients. ...

  5. 7 CFR 3019.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... readily quantified, such quantitative data should be related to cost data for computation of unit costs... including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e) Recipients... performance data from recipients. ...

  6. Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: An ESGICH survey.

    PubMed

    Navarro, David; San-Juan, Rafael; Manuel, Oriol; Giménez, Estela; Fernández-Ruiz, Mario; Hirsch, Hans H; Grossi, Paolo Antonio; Aguado, José María

    2017-12-01

    Scant information is available about how transplant centers are managing their use of quantitative molecular testing (QNAT) assays for active cytomegalovirus (CMV) infection monitoring in solid organ transplant (SOT) recipients. The current study was aimed at gathering information on current practices in the management of CMV infection across European centers in the era of molecular testing assays. A questionnaire-based cross-sectional survey study was conducted by the European Study Group of Infections in Immunocompromised Hosts (ESGICH) of the Society of Clinical Microbiology and Infectious Diseases (ESCMID). The invitation and a weekly reminder with a personal link to an Internet service provider (https://es.surveymonkey.com/) was sent to transplant physicians, transplant infectious diseases specialists, and clinical virologists working at 340 European transplant centers. Of the 1181 specialists surveyed, a total of 173 responded (14.8%): 73 transplant physicians, 57 transplant infectious diseases specialists, and 43 virologists from 173 institutions located at 23 different countries. The majority of centers used QNAT assays for active CMV infection monitoring. Most centers preferred commercially available real-time polymerase chain reaction (RT-PCR) assays over laboratory-developed procedures for quantifying CMV DNA load in whole blood or plasma. Use of a wide variety of DNA extraction platforms and RT-PCR assays was reported. All programs used antiviral prophylaxis, preemptive therapy, or both, according to current guidelines. However, the centers used different criteria for starting preemptive antiviral treatment, for monitoring systemic CMV DNA load, and for requesting genotypic assays to detect emerging CMV-resistant variants. Significant variation in CMV infection management in SOT recipients still remains across European centers in the era of molecular testing. International multicenter studies are required to achieve commutability of CMV testing and antiviral management procedures. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. 14 CFR 1260.151 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established..., analysis and explanation of cost overruns or high unit costs. (e) Recipients shall not be required to... performance data from recipients. ...

  8. Evaluation of COBAS AmpliPrep/COBAS TaqMan CMV Test for use in hematopoietic stem cell transplant recipients.

    PubMed

    Ramanan, Poornima; Razonable, Raymund R

    2017-07-01

    Cytomegalovirus (CMV) is a common opportunistic infection that contributes to poor outcomes in hematopoietic stem cell transplant (HSCT) recipients. Prevention of CMV end-organ disease in allogeneic HSCT recipients is commonly achieved by preemptive antiviral therapy of asymptomatic CMV reactivation that is detected by serial nucleic acid testing (NAT). However, there was no standardized CMV NAT until the development of the World Health Organization (WHO) International Standard. Areas covered: This article provides a comprehensive review on COBAS AmpliPrep/TaqMan (CAP/CTM) CMV assay (Roche) and emphasizes the limitations in the clinical use of CMV NAT in HSCT recipients. Expert commentary: The CAP/CTM CMV Test is the first US FDA approved commercial quantitative NAT for CMV viral load monitoring of plasma samples in solid organ transplant and HSCT recipients. The CAP/CTM assay has wide linear range of DNA quantification and demonstrates colinearity to the WHO International Standard. Studies of CAP/CTM CMV assay in HSCT recipients are still limited, but are now being reported to define viral thresholds for diagnosis, surveillance and monitoring. Results from these early studies in HSCT recipients suggest that, while the WHO IS has improved the inter-laboratory result variances, there are still important factors that continue to contribute to assay variability. This lack of harmony among NAT highlights the need for further standardization.

  9. Monitoring of Nonsteroidal Immunosuppressive Drugs in Patients With Lung Disease and Lung Transplant Recipients

    PubMed Central

    Meyer, Keith C; Nathanson, Ian; Angel, Luis; Bhorade, Sangeeta M; Chan, Kevin M; Culver, Daniel; Harrod, Christopher G; Hayney, Mary S; Highland, Kristen B; Limper, Andrew H; Patrick, Herbert; Strange, Charlie; Whelan, Timothy

    2012-01-01

    Objectives: Immunosuppressive pharmacologic agents prescribed to patients with diffuse interstitial and inflammatory lung disease and lung transplant recipients are associated with potential risks for adverse reactions. Strategies for minimizing such risks include administering these drugs according to established, safe protocols; monitoring to detect manifestations of toxicity; and patient education. Hence, an evidence-based guideline for physicians can improve safety and optimize the likelihood of a successful outcome. To maximize the likelihood that these agents will be used safely, the American College of Chest Physicians established a committee to examine the clinical evidence for the administration and monitoring of immunosuppressive drugs (with the exception of corticosteroids) to identify associated toxicities associated with each drug and appropriate protocols for monitoring these agents. Methods: Committee members developed and refined a series of questions about toxicities of immunosuppressives and current approaches to administration and monitoring. A systematic review was carried out by the American College of Chest Physicians. Committee members were supplied with this information and created this evidence-based guideline. Conclusions: It is hoped that these guidelines will improve patient safety when immunosuppressive drugs are given to lung transplant recipients and to patients with diffuse interstitial lung disease. PMID:23131960

  10. 36 CFR 1210.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established..., analysis and explanation of cost overruns or high unit costs. (e) Recipients shall not be required to... requesting performance data from recipients. ...

  11. Cooperative runtime monitoring

    NASA Astrophysics Data System (ADS)

    Hallé, Sylvain

    2013-11-01

    Requirements on message-based interactions can be formalised as an interface contract that specifies constraints on the sequence of possible messages that can be exchanged by multiple parties. At runtime, each peer can monitor incoming messages and check that the contract is correctly being followed by their respective senders. We introduce cooperative runtime monitoring, where a recipient 'delegates' its monitoring task to the sender, which is required to provide evidence that the message it sends complies with the contract. In turn, this evidence can be quickly checked by the recipient, which is then guaranteed of the sender's compliance to the contract without doing the monitoring computation by itself. A particular application of this concept is shown on web services, where service providers can monitor and enforce contract compliance of third-party clients at a small cost on the server side, while avoiding to certify or digitally sign them.

  12. 38 CFR 49.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... readily quantified, such quantitative data should be related to cost data for computation of unit costs... including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e) Recipients... performance data from recipients. (Authority: Pub. L. 104-156; 110 Stat. 1396) ...

  13. Hospital-based allogenic bone bank--10-year experience.

    PubMed

    Hou, C-H; Yang, R-S; Hou, S-M

    2005-01-01

    Bone banking in a hospital provides resources of allogenic bone grafts. However, they may transmit infection from donor to recipient. We found few reports discussing the infection rate and monitoring processes associated with bone banks. The discard rate using the screening test was 18.5% (309/1674) in this series. The leading cause was hepatitis B antigen (HBsAg) positive donor serum (67%), followed by Venereal Disease Research Laboratory (VDRL) positive donor serum (15%), and anti-hepatitis C virus (HCV) positive donor serum (12%). The overall infection rate in the recipients was 1.3% (17/1365). Among 1353 implanted allografts, 22 cases (1.6%) had a positive swab culture result after thawing. Only four out of these 22 cases (18.2%) developed infection. However, the wound cultures of the infected recipients were different from the swab culture of thawing allografts except in one case. Among the 1331 recipients with sterile allograft bones, 13 (1%) were found to have infection. In conclusion, our bone bank operates under a strict monitoring system which results in a low infection rate. The recipient's status, the aseptic technique and environment during operation is likely to be more critical in prevention of allograft-related infection.

  14. 15 CFR 14.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... readily quantified, such quantitative data should be related to cost data for computation of unit costs... including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e) Recipients... comply with clearance requirements of 5 CFR part 1320 when requesting performance data from recipients. ...

  15. Tissue-specific exosome biomarkers for noninvasively monitoring immunologic rejection of transplanted tissue

    PubMed Central

    Korutla, Laxminarayana; Habertheuer, Andreas; Yu, Ming; Rostami, Susan; Yuan, Chao-Xing; Reddy, Sanjana; Korutla, Varun; Koeberlein, Brigitte; Trofe-Clark, Jennifer; Rickels, Michael R.; Naji, Ali

    2017-01-01

    In transplantation, there is a critical need for noninvasive biomarker platforms for monitoring immunologic rejection. We hypothesized that transplanted tissues release donor-specific exosomes into recipient circulation and that the quantitation and profiling of donor intra-exosomal cargoes may constitute a biomarker platform for monitoring rejection. Here, we have tested this hypothesis in a human-into-mouse xenogeneic islet transplant model and validated the concept in clinical settings of islet and renal transplantation. In the xenogeneic model, we quantified islet transplant exosomes in recipient blood over long-term follow-up using anti-HLA antibody, which was detectable only in xenoislet recipients of human islets. Transplant islet exosomes were purified using anti-HLA antibody–conjugated beads, and their cargoes contained the islet endocrine hormone markers insulin, glucagon, and somatostatin. Rejection led to a marked decrease in transplant islet exosome signal along with distinct changes in exosomal microRNA and proteomic profiles prior to appearance of hyperglycemia. In the clinical settings of islet and renal transplantation, donor exosomes with respective tissue specificity for islet β cells and renal epithelial cells were reliably characterized in recipient plasma over follow-up periods of up to 5 years. Collectively, these findings demonstrate the biomarker potential of transplant exosome characterization for providing a noninvasive window into the conditional state of transplant tissue. PMID:28319051

  16. New Organ Allocation System for Combined Liver-Kidney Transplants and the Availability of Kidneys for Transplant to Patients with Stage 4-5 CKD.

    PubMed

    Asch, William S; Bia, Margaret J

    2017-05-08

    A new proposal has been created for establishing medical criteria for organ allocation in recipients receiving simultaneous liver-kidney transplants. In this article, we describe the new policy, elaborate on the points of greatest controversy, and offer a perspective on the policy going forward. Although we applaud the fact that simultaneous liver-kidney transplant activity will now be monitored and appreciate the creation of medical criteria for allocation in simultaneous liver-kidney transplants, we argue that some of the criteria proposed, especially those for allocating a kidney to a liver recipient with AKI, are too liberal. We call on the nephrology community to follow the consequences of this new policy and push for a re-examination of the longstanding policy of allocating kidneys to multiorgan transplant recipients before all other candidates. The charge to protect our system of equitable organ allocation is very challenging, but it is a challenge that we must embrace. Copyright © 2017 by the American Society of Nephrology.

  17. 29 CFR 95.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established..., analysis and explanation of cost overruns or high unit costs. (e) Recipients shall not be required to... performance data from recipients. (Approved by the Office of Management and Budget, Approval Number 1225-0017) ...

  18. 45 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established..., analysis and explanation of cost overruns or high unit costs. (e) Recipients shall submit the original and..., “Controlling Paperwork Burdens on the Public,” when requesting performance data from recipients. ...

  19. 2 CFR 215.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., such quantitative data should be related to cost data for computation of unit costs. (2) Reasons why..., analysis and explanation of cost overruns or high unit costs. (e) Recipients shall not be required to... clearance requirements of 5 CFR part 1320 when requesting performance data from recipients. ...

  20. Monitoring of early humoral immunity to identify lung recipients at risk for development of serious infections: A multicenter prospective study.

    PubMed

    Sarmiento, Elizabeth; Cifrian, Jose; Calahorra, Leticia; Bravo, Carles; Lopez, Sonia; Laporta, Rosalia; Ussetti, Piedad; Sole, Amparo; Morales, Carmen; de Pablos, Alicia; Jaramillo, Maria; Ezzahouri, Ikram; García, Sandra; Navarro, Joaquin; Lopez-Hoyos, Marcos; Carbone, Javier

    2018-04-06

    Infection is still a leading cause of death during the first year after lung transplantation. We performed a multicenter study among teaching hospitals to assess monitoring of early humoral immunity as a means of identifying lung recipients at risk of serious infections. We prospectively analyzed 82 adult lung recipients at 5 centers in Spain. Data were collected before transplantation and at 7 and 30 days after transplantation. Biomarkers included IgG, IgM, IgA, complement factors C3 and C4, titers of antibodies to pneumococcal polysaccharide antigens (IgG, IgA, IgM) and antibodies to cytomegalovirus (IgG), and serum B-cell activating factor (BAFF) levels. The clinical follow-up period lasted 6 months. Clinical outcomes were bacterial infections requiring intravenous anti-microbial agents, cytomegalovirus (CMV) disease, and fungal infections requiring therapy. We found that 33 patients (40.2%) developed at least 1 serious bacterial infection, 8 patients (9.8%) had CMV disease, and 10 patients (12.2%) had fungal infections. Lower IgM antibody levels against pneumococcal polysaccharide antigens at Day 7 (defined as <5 mg/dl) were a risk factor for serious bacterial infection (adjusted odds ratio [OR] 3.96; 95% confidence interval [CI] 1.39 to 11.26; p = 0.0099). At Day 7 after transplantation, IgG hypogammaglobulinemia (defined as IgG <600 mg/dl) was associated with a higher risk of CMV disease (after adjustment for CMV mismatch: OR 8.15; 95% CI 1.27 to 52.55; p = 0.028) and fungal infection (adjusted OR 8.03, 95% CI 1.51 to 42.72; p = 0.015). Higher BAFF levels before transplantation were associated with a higher rate of development of serious bacterial infection and acute cellular rejection. Early monitoring of specific humoral immunity parameters proved useful for the identification of lung recipients who are at risk of serious infections. Copyright © 2018 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  1. Separation of lymphocytes by electrophoresis under terrestrial conditions and at zero gravity

    NASA Technical Reports Server (NTRS)

    Rubin, A. L.

    1977-01-01

    Electrophoretic mobility (EPM) of human peripheral lymphocytes were examined with the following objectives: To determine differences in EPM of lymphocytes under immuno-stimulated and immuno-suppressed states. To define the conditions necessary for the separation of lymphocyte sub-populations in normal and pathological conditions; To investigate immunological active, charged chemical groups on lymphocyte surfaces; and to investigate pathophysiological mechanisms of immune responsiveness, as reflected by alterations in EPM. To evaluate the potential of lymphocyte electrophoresis as: (1) a means of monitoring the immune status of kidney transplant recipients, (2) in predicting the outcome of kidney transplants, and (3) as a method for separation of lymphocyte sub-populations, the EPM was studied for unfractionated human peripheral lymphocytes and of populations enriched with T and "B" cells from normal adults, hemodialysis patients and kidney transplant recipients.

  2. 28 CFR 70.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... quantitative data should be related to cost data for computation of unit costs. (2) Reasons why established..., analysis and explanation of cost overruns or high unit costs. (d) Recipients are required to submit the... when requesting performance data from recipients. [Order No. 1980-95, 60 FR 38242, July 26, 1995; Order...

  3. Evaluation of Digital PCR as a Technique for Monitoring Acute Rejection in Kidney Transplantation.

    PubMed

    Lee, Hyeseon; Park, Young-Mi; We, Yu-Mee; Han, Duck Jong; Seo, Jung-Woo; Moon, Haena; Lee, Yu-Ho; Kim, Yang-Gyun; Moon, Ju-Young; Lee, Sang-Ho; Lee, Jong-Keuk

    2017-03-01

    Early detection and proper management of kidney rejection are crucial for the long-term health of a transplant recipient. Recipients are normally monitored by serum creatinine measurement and sometimes with graft biopsies. Donor-derived cell-free deoxyribonucleic acid (cfDNA) in the recipient's plasma and/or urine may be a better indicator of acute rejection. We evaluated digital PCR (dPCR) as a system for monitoring graft status using single nucleotide polymorphism (SNP)-based detection of donor DNA in plasma or urine. We compared the detection abilities of the QX200, RainDrop, and QuantStudio 3D dPCR systems. The QX200 was the most accurate and sensitive. Plasma and/or urine samples were isolated from 34 kidney recipients at multiple time points after transplantation, and analyzed by dPCR using the QX200. We found that donor DNA was almost undetectable in plasma DNA samples, whereas a high percentage of donor DNA was measured in urine DNA samples, indicating that urine is a good source of cfDNA for patient monitoring. We found that at least 24% of the highly polymorphic SNPs used to identify individuals could also identify donor cfDNA in transplant patient samples. Our results further showed that autosomal, sex-specific, and mitochondrial SNPs were suitable markers for identifying donor cfDNA. Finally, we found that donor-derived cfDNA measurement by dPCR was not sufficient to predict a patient's clinical condition. Our results indicate that donor-derived cfDNA is not an accurate predictor of kidney status in kidney transplant patients.

  4. 20 CFR 627.475 - Oversight and monitoring.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... monitoring. (a) The Secretary may monitor all recipients and subrecipients of financial assistance pursuant... program quality and outcomes meet the objectives of the Act and regulations promulgated thereunder; (2... Coordination and Special Services Plan (GCSSP). (e)(1) The PIC, pursuant to standards established by the...

  5. 49 CFR 23.29 - What monitoring and compliance procedures must recipients follow?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... OF DISADVANTAGED BUSINESS ENTERPRISE IN AIRPORT CONCESSIONS ACDBE Programs § 23.29 What monitoring... agreements and management contracts, the enforcement mechanisms, and other means you use to ensure compliance...

  6. A majority of mice show long-term expression of a human. beta. -globin gene after retrovirus transfer into hematopoietic stem cells

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bender, M.A.; Gelinas, R.E.; Miller

    1989-04-01

    Murine bone marrow was infected with a high-titer retrovirus vector containing the human {beta}-globin and neomycin phosphotransferase genes. Anemic W/W/sup v/ mice were transplanted with infected marrow which in some cases had been exposed to the selective agent G418. Human {beta}-globin expression was monitored in transplanted animals by using a monoclonal antibody specific for human {beta}-globin polypeptide, and hematopoietic reconstitution was monitored by using donor and recipient mice which differed in hemoglobin type. In some experiments all transplanted mice expressed the human {beta}-globin polypeptide for over 4 months, and up to 50% of peripheral erythrocytes contained detectable levels of polypeptide.more » DNA analysis of transplanted animals revealed that virtually every myeloid cell contained a provirus. Integration site analysis and reconstitution of secondary marrow recipients suggested that every mouse was reconstituted with at least one infected stem cell which had extensive repopulation capability. The ability to consistently transfer an active {beta}-globin gene into mouse hematopoietic cells improves the feasibility of using these techniques for somatic cell gene therapy in humans.« less

  7. Recommendations for the proper use of nonprescription cough suppressants and expectorants in solid-organ transplant recipients.

    PubMed

    Gabardi, Steven; Carter, Danielle; Martin, Spencer; Roberts, Keri

    2011-03-01

    To describe the pharmacology and safety of oral over-the-counter cough suppressants and expectorants and to present recommendations for the use of these agents in solid-organ transplant recipients based on the potential for adverse drug reactions or drug-disease interactions. Data from journal articles and other sources describing the pharmacology and safety of over-the-counter cough suppressants and expectorants, drug-drug interactions with immunosuppressive agents, and drug-disease state interactions are reviewed. Potential and documented drug-drug interactions between immunosuppressive agents and over-the-counter cough medications guaifenesin, dextromethorphan, diphenhydramine, and codeine were evaluated on the basis of pharmacokinetic and pharmacodynamic principles. Interactions between these cough medications and the physiological changes in the body following transplantation also were examined. Diphenhydramine requires additional monitoring when used to treat cough in transplant recipients owing to its anticholinergic properties and the potential for interactions with cyclosporine. Dextromethorphan can be used in most transplant recipients, although greater caution should be exercised if the patient has undergone liver transplant or has liver impairment. Guaifenesin can be used in transplant recipients but should be used with caution in patients receiving kidney or lung transplants and in patients with renal impairment. Codeine combined with guaifenesin is another option for cough and can be used in most transplant patients although those with reduced renal function should be monitored carefully for adverse events.

  8. The possible critical role of T-cell help in DSA-mediated graft loss.

    PubMed

    Süsal, Caner; Slavcev, Antonij; Pham, Lien; Zeier, Martin; Morath, Christian

    2018-06-01

    In this review, we discuss a possible central role of T-cell help in severe forms of graft damage mediated by donor-specific HLA antibodies (DSA). Some kidney transplant recipients with pretransplant DSA show a high graft failure rate, whereas in other patients DSA do not harm the transplanted kidney and in most cases, disappear shortly after transplantation. Analyzing 80 desensitized highly immunized kidney transplant recipients and another multicenter cohort of 385 patients with pretransplant HLA antibodies, we reported recently that an ongoing T-cell help from an activated immune system, as measured by an increased level of soluble CD30 in serum, might be necessary for the DSA to exert a deleterious effect. Patients positive for both pretransplant DSA and sCD30 appear to require special measures, such as the elimination of DSA from the circulation, potent immunosuppression, good HLA-matching, and intense post-transplant monitoring, whereas exclusion of DSA-positive patients from transplantation in the absence of high sCD30 may not be justified in all cases, even if the pretransplant DSA are strong and complement-activating. © 2018 Steunstichting ESOT.

  9. 78 FR 19333 - Agency Information Collection Activities: Renewal of Currently Approved Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-29

    ... to submit section 1512 data elements as set forth in the Recipient Reporting Data Dictionary... reported by prime recipients and sub-recipients are included in the Recipient Reporting Data Dictionary...

  10. Chagas disease in bone marrow transplantation: an approach to preemptive therapy.

    PubMed

    Altclas, J; Sinagra, A; Dictar, M; Luna, C; Verón, M T; De Rissio, A M; García, M M; Salgueira, C; Riarte, A

    2005-07-01

    The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.

  11. 20 CFR 645.245 - Who is responsible for oversight and monitoring of Welfare-to-Work grants?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... at the recipient level for competitive grants. (b) The Governor must monitor local boards (or other... compliance with applicable laws and regulations. The Governor must develop and make available for review a...

  12. 20 CFR 645.245 - Who is responsible for oversight and monitoring of Welfare-to-Work grants?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... at the recipient level for competitive grants. (b) The Governor must monitor local boards (or other... compliance with applicable laws and regulations. The Governor must develop and make available for review a...

  13. Primary Cytomegalovirus Infection Causing Guillain-Barré Syndrome in a Living Renal Allograft Recipient

    PubMed Central

    Israel, Ezra

    2017-01-01

    Guillain-Barré Syndrome (GBS) is a common acute autoimmune polyneuropathy in adults. There have been few reported cases of Guillain-Barré Syndrome associated with active cytomegalovirus (CMV) infection in renal transplant recipients. Here we present a case of active CMV viremia inducing Guillain-Barré Syndrome in a renal transplant recipient. We discuss the treatment regimen utilized. Furthermore, we performed a review of the literature and discuss the cases of CMV induced GBS in renal transplant recipients. PMID:29348962

  14. Long-term outcomes and management of lung transplant recipients.

    PubMed

    Costa, Joseph; Benvenuto, Luke J; Sonett, Joshua R

    2017-06-01

    Lung transplantation is an established treatment for patients with end-stage lung disease. Improvements in immunosuppression and therapeutic management of infections have resulted in improved long-term survival and a decline in allograft rejection. Allograft rejection continues to be a serious complication following lung transplantation, thereby leading to acute graft failure and, subsequently, chronic lung allograft dysfunction (CLAD). Bronchiolitis obliterans syndrome (BOS), the most common phenotype of CLAD, is the leading cause of late mortality and morbidity in lung recipients, with 50% having developed BOS within 5 years of lung transplantation. Infections in lung transplant recipients are also a significant complication and represent the most common cause of death within the first year. The success of lung transplantation depends on careful management of immunosuppressive regimens to reduce the rate of rejection, while monitoring recipients for infections and complications to help identify problems early. The long-term outcomes and management of lung transplant recipients are critically based on modulating natural immune response of the recipient to prevent acute and chronic rejection. Understanding the immune mechanisms and temporal correlation of acute and chronic rejection is thus critical in the long-term management of lung recipients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Continuous monitoring of kidney transplant perfusion with near-infrared spectroscopy.

    PubMed

    Malakasioti, Georgia; Marks, Stephen D; Watson, Tom; Williams, Fariba; Taylor-Allkins, Mariesa; Mamode, Nizam; Morgan, Justin; Hayes, Wesley N

    2018-05-11

    Current reliance on clinical, laboratory and Doppler ultrasound (DUS) parameters for monitoring kidney transplant perfusion in the immediate post-operative period in children risks late recognition of allograft hypoperfusion and vascular complications. Near-infrared spectroscopy (NIRS) is a real-time, non-invasive technique for monitoring tissue oxygenation percutaneously. NIRS monitoring of kidney transplant perfusion has not previously been validated to the gold standard of DUS. We examined whether NIRS tissue oxygenation indices can reliably assess blood flow in established paediatric kidney transplants. Paediatric kidney transplant recipients ages 1-18 years with stable allograft function were eligible. Participants underwent routine DUS assessment of kidney transplant perfusion, including resistive index (RI) and peak systolic velocity at the upper and lower poles. NIRS data [tissue oxygenation index (TOI%)] were recorded for a minimum of 2 min with NIRS sensors placed on the skin over upper and lower allograft poles. Twenty-nine subjects with a median age of 13.3 (range 4.8-17.8) years and a median transplant vintage of 26.5 months participated. Thirteen (45%) were female and 20 (69%) were living donor kidney recipients. NIRS monitoring was well tolerated by all, with 96-100% valid measurements. Significant negative correlations were observed between NIRS TOI% and DUS RI at both the upper and lower poles (r = -0.4 and -0.6, P = 0.04 and 0.001, respectively). Systolic blood pressure but not estimated glomerular filtration rate also correlated with NIRS TOI% (P = 0.01). NIRS indices correlate well with DUS perfusion and haemodynamic parameters in established paediatric kidney transplant recipients. Further studies are warranted to extend NIRS use for continuous real-time monitoring of early post-transplant perfusion status.

  16. Monitoring of circulating antibodies in a renal transplantation population: preliminary results.

    PubMed

    Rodríguez Ferrero, M L; Arroyo, D; Panizo, N; Vicario, J L; Balas, A; Anaya, F

    2012-11-01

    The presence of circulating antibodies (CA) against human leukocyte antigen (HLA) and major-histocompatibility-complex class I-related chain A (MICA) antigens has been associated with worse renal function and reduced kidney allograft survival. We sought to describe the presence of donor-specific anti-HLA antibodies, non-donor specific antibodies, and antibodies against MICA antigens among a cohort of renal transplant recipients with respect to their evolution effects on renal function and occurrence of an acute rejection episode (AR) after transplantation. This prospective study of 22 renal transplant recipients of deceased donor kidneys underwent studies of antibodies before and 3 months after grafting using Luminex technology. Ten patients (five men and five women) showed preexistent CA. Comparing patients with versus without preformed CA, we did not observe a significant difference in donor and recipient age or gender. Eight patients (80%) with CA had undergone induction treatment with anti-human-activated T-lymphocyte rabbit immunoglobulin and 2 (20%) with basiliximab. There were no differences between groups regarding the incidence of acute rejection episodes (ARE n = 3 each). There was one case of Banff grade IIB ARE in a patient without preexisting CA; the other episodes were low-grade cellular responses. There were no differences in other variables including cold ischemia time, HLA mismatches, panel-reactive antibody levels, number of transfusions, cytomegalovirus infection or renal function at discharge and 3 months later. Retransplantation was the only factor associated with preformed CA. Retransplantation and preformed CA were associated with CA at 3 months after transplantation. CA monitoring is important for highly sensitized renal transplants, although our experience failed to show a difference in graft survival or renal function in the first 3 months' follow-up. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Correlation of IMPDH1 gene polymorphisms with subclinical acute rejection and mycophenolic acid exposure parameters on day 28 after renal transplantation.

    PubMed

    Kagaya, Hideaki; Miura, Masatomo; Saito, Mitsuru; Habuchi, Tomonori; Satoh, Shigeru

    2010-08-01

    The risk of acute rejection in patients with higher exposure to mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil (MMF), might be due to inosine 5'-monophosphate dehydrogenase (IMPDH) polymorphisms. The correlations with subclinical acute rejection, IMPDH1 polymorphisms and MPA exposure on day 28 post-transplantation were investigated in 82 Japanese recipients. Renal transplant recipients were given combination immunosuppressive therapy consisting of tacrolimus and 1.0, 1.5 or 2.0 g/day of MMF in equally divided doses every 12 hr at designated times. There were no significant differences in the incidence of subclinical acute rejection between IMPDH1 rs2278293 or rs2278294 polymorphisms (p = 0.243 and 0.735, respectively). However, in the high MPA night-time exposure range (AUC > 60 microg x h/ml and C(0 )> or = 1.9 microg/ml), there was a significant difference in the incidence of subclinical acute rejection between IMPDH1 rs2278293 A/A, A/G and G/G genotypes (each p = 0.019), but not the IMPDH1 rs2278294 genotype. In the higher daytime MPA exposure range, patients with the IMPDH1 rs2278293 G/G genotype also tended to develop subclinical acute rejection. In patients with the IMPDH rs2278293 A/A genotype, the risk of subclinical acute rejection episode tends to be low and the administration of MMF was effective. The risk of subclinical acute rejection for recipients who cannot adapt in therapeutic drug monitoring (TDM) of MPA seems to be influenced by IMPDH1 rs2278293 polymorphism. The prospective analysis of IMPDH1 rs2278293 polymorphism as well as monitoring of MPA plasma concentration after transplantation might help to improve MMF therapy.

  18. 24 CFR 1000.120 - May a recipient use Indian preference or tribal preference in selecting families for housing...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false May a recipient use Indian preference or tribal preference in selecting families for housing assistance? 1000.120 Section 1000.120... AMERICAN HOUSING ACTIVITIES Affordable Housing Activities § 1000.120 May a recipient use Indian preference...

  19. Reducing Dangerous Nighttime Events in Persons with Dementia Using a Nighttime Monitoring System

    PubMed Central

    Rowe, Meredeth A.; Kelly, Annette; Horne, Claydell; Lane, Steve; Campbell, Judy; Lehman, Brandy; Phipps, Chad; Keller, Meredith; Benito, Andrea Pe

    2009-01-01

    Background Nighttime activity, a common occurrence in persons with dementia, increases the risk for injury and unattended home exits, and impairs the sleep patterns of caregivers. Technology is needed that will alert caregivers of nighttime activity in persons with dementia to help prevent injuries and unattended exits. Methods As part of a product development grant, a randomized pilot study was conducted to test the effectiveness of a new night monitoring system designed for informal caregivers to use in the home. Data from 53 subjects were collected at 9 points in time over a 12-month period regarding injuries and unattended home exits that occurred while the caregiver slept. Nighttime activity frequently resulted in nursing home placement. Results The night monitoring system proved a reliable adjunct to assist caregivers in managing nighttime activity. A total of 9 events (injuries or unattended home exits) occurred during the study with 6 events occurring in the control group. Using intent-to-treat analysis, there was no difference between the groups. However, in a secondary analysis based on use of the intervention, experimental subjects were 85% less likely to sustain an event than control subjects. Conclusion When nighttime activity occurred, it resulted in severe injuries sometimes associated with subsequent nursing home placement. The night monitoring system represents a new technology that caregivers can use to assist them in preventing nighttime injuries and unattended home exits in care recipients with dementia. PMID:19751921

  20. Intermediate-term graft loss after renal transplantation is associated with both donor-specific antibody and acute rejection.

    PubMed

    Devos, Jennifer M; Gaber, Ahmed Osama; Teeter, Larry D; Graviss, Edward A; Patel, Samir J; Land, Geoffrey A; Moore, Linda W; Knight, Richard J

    2014-03-15

    Renal transplant recipients with de novo DSA (dDSA) experience higher rates of rejection and worse graft survival than dDSA-free recipients. This study presents a single-center review of dDSA monitoring in a large, multi-ethnic cohort of renal transplant recipients. The authors performed a nested case-control study of adult kidney and kidney-pancreas recipients from July 2007 through July 2011. Cases were defined as dDSA-positive whereas controls were all DSA-negative transplant recipients. DSA were determined at 1, 3, 6, 9, and 12 months posttransplant, and every 6 months thereafter. Of 503 recipients in the analysis, 24% developed a dDSA, of whom 73% had dDSA against DQ antigen. Median time to dDSA was 6.1 months (range 0.2-44.6 months). After multivariate analysis, African American race, kidney-pancreas recipient, and increasing numbers of human leukocyte antigen mismatches were independent risk factors for dDSA. Recipients with dDSA were more likely to suffer an acute rejection (AR) (35% vs. 10%, P<0.001), an antibody-mediated AR (16% vs. 0.3%, P<0.001), an AR ascribed to noncompliance (8% vs. 2%, P=0.001), and a recurrent AR (6% vs. 1%, P=0.002) than dDSA-negative recipients. At a median follow-up of 31 months, the death-censored actuarial graft survival of dDSA recipients was worse than the DSA-free cohort (P=0.002). Yet, for AR-free recipients, there was no difference in graft survival between cohorts (P=0.66). Development of dDSA was associated with an increased incidence of graft loss, yet the detrimental effect of dDSA was limited in the intermediate term to recipients with AR.

  1. Safety of herpes zoster vaccine in the shingles prevention study: a randomized trial.

    PubMed

    Simberkoff, Michael S; Arbeit, Robert D; Johnson, Gary R; Oxman, Michael N; Boardman, Kathy D; Williams, Heather M; Levin, Myron J; Schmader, Kenneth E; Gelb, Lawrence D; Keay, Susan; Neuzil, Kathleen; Greenberg, Richard N; Griffin, Marie R; Davis, Larry E; Morrison, Vicki A; Annunziato, Paula W

    2010-05-04

    The herpes zoster vaccine is effective in preventing herpes zoster and postherpetic neuralgia in immunocompetent older adults. However, its safety has not been described in depth. To describe local adverse effects and short- and long-term safety profiles of herpes zoster vaccine in immunocompetent older adults. Randomized, placebo-controlled trial with enrollment from November 1998 to September 2001 and follow-up through April 2004 (mean, 3.4 years). A Veterans Affairs Coordinating Center generated the permutated block randomization scheme, which was stratified by site and age. Participants and follow-up study personnel were blinded to treatment assignments. (ClinicalTrials.gov registration number: NCT00007501) 22 U.S. academic centers. 38 546 immunocompetent adults 60 years or older, including 6616 who participated in an adverse events substudy. Single dose of herpes zoster vaccine or placebo. Serious adverse events and rashes in all participants and inoculation-site events in substudy participants during the first 42 days after inoculation. Thereafter, vaccination-related serious adverse events and deaths were monitored in all participants, and hospitalizations were monitored in substudy participants. After inoculation, 255 (1.4%) vaccine recipients and 254 (1.4%) placebo recipients reported serious adverse events. Local inoculation-site side effects were reported by 1604 (48%) vaccine recipients and 539 (16%) placebo recipients in the substudy. A total of 977 (56.6%) of the vaccine recipients reporting local side effects were aged 60 to 69 years, and 627 (39.2%) were older than 70 years. After inoculation, herpes zoster occurred in 7 vaccine recipients versus 24 placebo recipients. Long-term follow-up (mean, 3.39 years) showed that rates of hospitalization or death did not differ between vaccine and placebo recipients. Participants in the substudy were not randomly selected. Confirmation of reported serious adverse events with medical record data was not always obtained. Herpes zoster vaccine is well tolerated in older, immunocompetent adults. Cooperative Studies Program, Department of Veterans Affairs, Office of Research and Development; grants from Merck to the Veterans Affairs Cooperative Studies Program; and the James R. and Jesse V. Scott Fund for Shingles Research.

  2. 34 CFR 110.24 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false Recipient assessment of age distinctions. 110.24..., DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF AGE IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Duties of ED Recipients § 110.24 Recipient assessment of age distinctions. (a) As part...

  3. 34 CFR 110.24 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 1 2013-07-01 2013-07-01 false Recipient assessment of age distinctions. 110.24..., DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF AGE IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Duties of ED Recipients § 110.24 Recipient assessment of age distinctions. (a) As part...

  4. 34 CFR 110.24 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false Recipient assessment of age distinctions. 110.24..., DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF AGE IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Duties of ED Recipients § 110.24 Recipient assessment of age distinctions. (a) As part...

  5. 34 CFR 110.24 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 1 2012-07-01 2012-07-01 false Recipient assessment of age distinctions. 110.24..., DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF AGE IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Duties of ED Recipients § 110.24 Recipient assessment of age distinctions. (a) As part...

  6. 45 CFR 1610.8 - Program integrity of recipient.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... OF NON-LSC FUNDS, TRANSFERS OF LSC FUNDS, PROGRAM INTEGRITY § 1610.8 Program integrity of recipient. (a) A recipient must have objective integrity and independence from any organization that engages in restricted activities. A recipient will be found to have objective integrity and independence from such an...

  7. Prospective Epstein-Barr virus-related post-transplant lymphoproliferative disorder prevention program in pediatric allogeneic hematopoietic stem cell transplant: virological monitoring and first-line treatment.

    PubMed

    Chiereghin, A; Prete, A; Belotti, T; Gibertoni, D; Piccirilli, G; Gabrielli, L; Pession, A; Lazzarotto, T

    2016-02-01

    In 28 pediatric allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients, we aimed to evaluate: (i) the impact of routine Epstein-Barr virus (EBV) DNA monitoring on the development of EBV-related post-transplant lymphoproliferative disorder (EBV-PTLD); (ii) the incidence of EBV infection and the potential risk factors; and (iii) the suitability of whole blood (WB) as clinical specimen to monitor the risk of patients to develop EBV-PTLD. Quantitative real-time polymerase chain reaction assay was performed on WB samples for all patients. EBV DNA quantification also in peripheral blood mononuclear cells (PBMCs) samples was adopted for the patients at higher risk of developing EBV-PTLD (≥ 10,000 copies/mL WB). High EBV DNAemia levels were observed in 37.5% of the actively infected recipients (57.1%). Severe aplastic anemia, matched-unrelated donor transplant, the reduced-intensity conditioning regimen and, to a lesser extent, the in vivo T-cell depletion with anti-thymocyte immunoglobulin were associated with high viral load. A significant correlation between EBV DNA levels in WB and PBMC samples was obtained (r = 0.755, P < 0.001). A similar kinetics of EBV DNA in the 2 blood compartments was observed. Clinically, both specimen types appeared to be equally informative to assess the risk of patients to develop PTLD. On the basis of EBV DNAemia levels, in 3 patients (10.7%) immunosuppressive therapy was reduced and 1 patient (3.5%) received early treatment for probable EBV disease. No patients developed EBV-PTLD. WB proved to be a suitable clinical specimen to monitor EBV DNA load after allo-HSCT for the management of EBV infection and PTLD prevention. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. High prevalence of asymptomatic Leishmania spp. infection among liver transplant recipients and donors from an endemic area of Brazil.

    PubMed

    Clemente, W T; Rabello, A; Faria, L C; Peruhype-Magalhães, V; Gomes, L I; da Silva, T A M; Nunes, R V P; Iodith, J B; Protil, K Z; Fernandes, H R; Cortes, J R G; Lima, S S S; Lima, A S; Romanelli, R M C

    2014-01-01

    Visceral leishmaniasis is an uncommon disease in transplant recipients; however, if left untreated, the mortality can be high. If an organ donor or recipient is known to be an asymptomatic Leishmania spp. carrier,monitoring is advised. This study proposes to assess the prevalence of asymptomatic Leishmania spp.infection in liver transplant donors and recipients from an endemic area. A total of 50 liver recipients and 17 liver donors were evaluated by direct parasite search, indirect fluorescent antibody test (IFAT), anti-Leishmania rK39 rapid test and Leishmania spp.DNA detection by polymerase chain reaction (PCR).Leishmania spp. amastigotes were not observed in liver or spleen tissues. Of the 67 serum samples, IFAT was reactive in 1.5% and indeterminate for 17.9%, and the anti-Leishmania rK39 rapid test was negative for all samples. The PCR test was positive for 7.5%, 8.9%, and 5.9% of blood, liver and spleen samples, respectively(accounting for 23.5% of the donors and 8% of the recipients). Leishmania infantum-specific PCR confirmed all positive samples. In conclusion, a high prevalence of asymptomatic L. infantum was observed in donors and recipients from an endemic area, and PCR was the most sensitive method for screening these individuals.

  9. Caregiver Confidence: Does It Predict Changes in Disability among Elderly Home Care Recipients?

    ERIC Educational Resources Information Center

    Li, Lydia W.; McLaughlin, Sara J.

    2012-01-01

    Purpose of the study: The primary aim of this investigation was to determine whether caregiver confidence in their care recipients' functional capabilities predicts changes in the performance of activities of daily living (ADL) among elderly home care recipients. A secondary aim was to explore how caregiver confidence and care recipient functional…

  10. A patient self-collection method for longitudinal monitoring of respiratory virus infection in solid organ transplant recipients.

    PubMed

    Preiksaitis, Carl M; Kuypers, Jane M; Fisher, Cynthia E; Campbell, Angela P; Jerome, Keith R; Huang, Meei-Li; Boeckh, Michael; Limaye, Ajit P

    2015-01-01

    Methods for the longitudinal study of respiratory virus infections are cumbersome and limit our understanding of the natural history of these infections in solid organ transplant (SOT) recipients. To assess the feasibility and patient acceptability of self-collected foam nasal swabs for detection of respiratory viruses in SOT recipients and to define the virologic and clinical course. We prospectively monitored the course of symptomatic respiratory virus infection in 18 SOT patients (14 lung, 3 liver, and 1 kidney) using patient self-collected swabs. The initial study sample was positive in 15 patients with the following respiratory viruses: rhinovirus (6), metapneumovirus (1), coronavirus (2), respiratory syncytial virus (2), parainfluenza virus (2), and influenza A virus (2). One hundred four weekly self-collected nasal swabs were obtained, with a median of 4 samples per patient (range 1-17). Median duration of viral detection was 21 days (range 4-77 days). Additional new respiratory viruses detected during follow-up of these 15 patients included rhinovirus (3), metapneumovirus (2), coronavirus (1), respiratory syncytial virus (1), parainfluenza virus (1), and adenovirus (1). Specimen collection compliance was good; 16/18 (89%) patients collected all required specimens and 79/86 (92%) follow-up specimens were obtained within the 7 ± 3 day protocol-defined window. All participants agreed or strongly agreed that the procedure was comfortable, simple, and 13/14 (93%) were willing to participate in future studies using this procedure. Self-collected nasal swabs provide a convenient, feasible, and patient-acceptable methodology for longitudinal monitoring of upper respiratory virus infection in SOT recipients. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Anemia as a complication of parvovirus b19 infection in renal transplant recipients.

    PubMed

    Čapenko, Svetlana; Kozireva, Svetlana; Folkmane, Inese; Bernarde, Kristīna; Rozentāls, Rafails; Murovska, Modra

    2012-01-01

    The frequency of B19 infection in renal transplant donors and recipients was studied to determine the significance of active viral infection in the development of anemia. Serum, plasma, and peripheral blood leukocyte samples of 47 renal transplant donors, 38 recipients with anemia (Group 1), and 25 without anemia (Group 2) after renal transplantation were evaluated for the presence of anti-B19 specific antibodies (ELISA) and B19 DNA (nPCR). Active persistent B19 infection after renal transplantation was detected in 12 of the 38 in the Group 1 (10 had reactivation and 2 primary infection), and none of the recipients in the Group 2 had it. Of the 12 recipients in the Group 1, 10 were seropositive and 2 seronegative before renal transplantation; 10 received the transplants from the seropositive and 2 from seronegative donors. rHuEPO therapy-resistant severe anemia was detected only in the recipients with active B19 infection after renal transplantation in the Group 1 (7/12). The logistic regression analysis revealed a significant relationship between active B19 infection and severe anemia (OR, 0.039; 95% CI, 0.006-0.257; P=0.001). Active B19 infection was documented only in the anemic recipients and could be associated with the development of severe anemia after renal transplantation. This allows us to recommend concurrent screening for viral DNA in plasma and detection of anti-B19 IgM class antibodies. To find the association between B19 infection and the development of anemia, further investigations are necessary.

  12. Comparison of balance of tritium activity in waste water from nuclear power plants and at selected monitoring sites in the Vltava River, Elbe River and Jihlava (Dyje) River catchments in the Czech Republic.

    PubMed

    Hanslík, Eduard; Marešová, Diana; Juranová, Eva; Sedlářová, Barbora

    2017-12-01

    During the routine operation, nuclear power plants discharge waste water containing a certain amount of radioactivity, whose main component is the artificial radionuclide tritium. The amounts of tritium released into the environment are kept within the legal requirements, which minimize the noxious effects of radioactivity, but the activity concentration is well measurable in surface water of the recipient. This study compares amount of tritium activity in waste water from nuclear power plants and the tritium activity detected at selected relevant sites of surface water quality monitoring. The situation is assessed in the catchment of the Vltava and Elbe Rivers, affected by the Temelín Nuclear Power Plant as well as in the Jihlava River catchment (the Danube River catchment respectively), where the waste water of the Dukovany Nuclear Power Plant is discharged. The results show a good agreement of the amount of released tritium stated by the power plant operator and the tritium amount detected in the surface water and highlighted the importance of a robust independent monitoring of tritium discharged from a nuclear power plant which could be carried out by water management authorities. The outputs of independent monitoring allow validating the values reported by a polluter and expand opportunities of using tritium as e.g. tracer. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. 7 CFR 4274.314 - Loan purposes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... collection fees, management consultant fees, and other fees for services rendered by professionals..., and (B) Monitoring and control of the ultimate recipients' cash, inventory, and accounts receivable...

  14. 7 CFR 4274.314 - Loan purposes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... collection fees, management consultant fees, and other fees for services rendered by professionals..., and (B) Monitoring and control of the ultimate recipients' cash, inventory, and accounts receivable...

  15. 7 CFR 4274.314 - Loan purposes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... collection fees, management consultant fees, and other fees for services rendered by professionals..., and (B) Monitoring and control of the ultimate recipients' cash, inventory, and accounts receivable...

  16. 7 CFR 4274.314 - Loan purposes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... collection fees, management consultant fees, and other fees for services rendered by professionals..., and (B) Monitoring and control of the ultimate recipients' cash, inventory, and accounts receivable...

  17. 7 CFR 4274.314 - Loan purposes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... collection fees, management consultant fees, and other fees for services rendered by professionals..., and (B) Monitoring and control of the ultimate recipients' cash, inventory, and accounts receivable...

  18. Nonadherence to immunosuppressive therapy in kidney transplant recipients: can technology help?

    PubMed

    Nerini, Erika; Bruno, Fulvio; Citterio, Franco; Schena, Francesco P

    2016-10-01

    End-stage kidney disease is a life-threatening condition that compels patients to accept either dialysis or transplant. Kidney transplantation is the best choice for patients with end-stage kidney disease because it ensures higher quality of life and longer survival rates than other choices, with less cost for the healthcare system. However, in order for renal recipients to maintain the functioning graft they must take lifelong immunosuppressive medications, with possible side effects and low medication adherence. It is known that low medication adherence in kidney transplant recipients may cause poor outcomes, chronic graft rejection, and graft failure. In this review, the authors give an overview of nonadherence in the transplant setting. In addition, they analyze the role of different technologies as an aid to improve adherence, with a focus on mobile-phone based solutions to monitor and enhance kidney transplant recipient compliance.

  19. Clinical Usefulness of Monitoring Cytomegalovirus-Specific Immunity by Quantiferon-CMV in Pediatric Allogeneic Hematopoietic Stem Cell Transplantation Recipients.

    PubMed

    Lee, Sae Mi; Kim, Yae Jean; Yoo, Keon Hee; Sung, Ki Woong; Koo, Hong Hoe; Kang, Eun Suk

    2017-05-01

    Cytomegalovirus (CMV) is a well-established cause of morbidity and mortality in pediatric recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). CD8⁺ T-cells are important for controlling CMV infection. We conducted a prospective pilot study to investigate the clinical utility of measuring the CMV-specific T-cell immune response using the QuantiFERON-CMV assay (QF-CMV) in pediatric allo-HSCT recipients. Overall, 16 of 25 (64%) patients developed CMV infection. QF-CMV was evaluated in these 16 patients during the early and late phases of the first CMV infection post allo-HSCT. Whereas the initial QF-CMV results during the early phase of CMV infection did not correlate with the course of the corresponding infection, the QF-CMV results post resolution of the first CMV infection correlated with the recurrence of CMV infection until 12 months post allo-HSCT; no recurrent infections occurred in the four QF-CMV-positive patients, while recurrent infections manifested in five of eight QF-CMV-negative (62.5%) and all three QF-CMV-indeterminate patients (P=0.019). In spite of the small number of patients examined, this study supports the potential application of monitoring CMV-specific T-cell immunity using the QF-CMV assay to predict the recurrence of CMV infection in pediatric allo-HSCT recipients. © The Korean Society for Laboratory Medicine.

  20. Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients.

    PubMed

    Russell, Cynthia; Conn, Vicki; Ashbaugh, Catherine; Madsen, Richard; Wakefield, Mark; Webb, Andrew; Coffey, Deanna; Peace, Leanne

    2011-01-01

    Immunosuppressive medication non-adherence is one of the most prevalent but preventable causes of poor outcomes in adult renal transplant recipients, yet there is a paucity of studies testing interventions in this area. Using a randomized controlled trial design, 30 adult renal transplant recipients were screened for medication non-adherence using electronic monitoring. Fifteen non-adherent participants were randomized to receive either a continuous self-improvement intervention or attention control management. The six-month continuous self-improvement intervention involved the participant and clinical nurse specialist collaboratively identifying the person's life routines, important people, and possible solutions to enhance medication taking. The participant then received individual monthly medication taking feedback delivered via a graphic printout of daily medication taking generated from electronic monitoring. The mean medication adherence score for the continuous self-improvement intervention group (n = 8) was statistically significantly higher than the attention control group's (n = 5) mean medication adherence score (p = 0.03). The continuous self-improvement intervention effect size (Cohen's d) was large at 1.4. Participants' perceptions of the intervention were highly favorable. The continuous self-improvement intervention shows promise as an effective and feasible approach to improve medication adherence in adult renal transplant recipients. A fully-powered study with a diverse sample is needed to confirm these preliminary findings. © 2010 John Wiley & Sons A/S.

  1. Loss of Myeloid Related Protein-8/14 Exacerbates Cardiac Allograft Rejection

    PubMed Central

    Shimizu, Koichi; Libby, Peter; Rocha, Viviane Z.; Folco, Eduardo J.; Shubiki, Rica; Grabie, Nir; Jang, Sunyoung; Lichtman, Andrew H.; Shimizu, Ayako; Hogg, Nancy; Simon, Daniel I.; Mitchell, Richard N.; Croce, Kevin

    2011-01-01

    Background The calcium-binding proteins myeloid-related protein (MRP)-8 (S100A8) and MRP-14 (S100A9) form MRP-8/14 heterodimers (S100A8/A9, calprotectin) that regulate myeloid cell function and inflammatory responses, and serve as early serum markers for monitoring acute allograft rejection. Despite functioning as a pro-inflammatory mediator, the pathophysiological role of MRP-8/14 complexes in cardiovascular disease is incompletely defined. This study investigated the role of MRP-8/14 in cardiac allograft rejection using MRP-14-deficient mice (MRP14-/-) that lack MRP-8/14 complexes. Methods and Results We examined parenchymal rejection (PR) after major histocompatibility complex (MHC) class II allomismatched cardiac transplantation (bm12 donor heart and B6 recipients) in wild-type (WT) and MRP14-/- recipients. Allograft survival averaged 5.9 ± 2.9 weeks (n=10) in MRP14-/- recipients, compared to > 12 weeks (n = 15, p < 0.0001) in WT recipients. Two weeks after transplantation, allografts in MRP14-/- recipients had significantly higher PR scores (2.8 ± 0.8, n=8) than did WT recipients (0.8 ± 0.8, n=12, p<0.0001). Compared to WT recipients, allografts in MRP14-/- recipients had significantly increased T-cell and macrophage infiltration, as well as increased mRNA levels of IFN-γ and IFN-γ–associated chemokines (CXCL9, CXCL10, and CXCL11), IL-6, and IL-17, with significantly higher levels of Th17 cells. MRP14-/- recipients also had significantly more lymphocytes in the adjacent paraaortic lymph nodes than did WT recipients (cell number per lymph node: 23.7 ± 0.7 × 105 for MRP14-/- vs. 6.0 ± 0.2 × 105 for WT, p < 0.0001). The dendritic cells (DCs) of the MRP14-/- recipients of bm12 hearts expressed significantly higher levels of the co-stimulatory molecules CD80 and CD86 than did those of WT recipients 2 weeks after transplantation. Mixed leukocyte reactions using allo-EC-primed MRP14-/- DCs resulted in significantly higher antigen-presenting function than reactions using WT DCs. Ovalbumin-primed MRP14-/- DCs augmented proliferation of OT-II CD4+ T cells with increased IL-2 and IFN-γ production. Cardiac allografts of B6 MHC class II-/- hosts and of B6 WT hosts receiving MRP14-/- DCs had significantly augmented inflammatory cell infiltration and accelerated allograft rejection, compared to WT DCs from transferred recipient allografts. Bone marrow–derived MRP14-/- DCs infected with MRP-8 and MRP-14 retroviral vectors showed significantly decreased CD80 and CD86 expression compared to controls, indicating that MRP-8/14 regulates B7-costimulatory molecule expression. Conclusion Our results indicate that MRP-14 regulates B7 molecule expression and reduces antigen presentation by DCs, and subsequent T-cell priming. The absence of MRP-14 markedly increased T-cell activation and exacerbated allograft rejection, indicating a previously unrecognized role for MRP-14 in immune cell biology. PMID:22144572

  2. 24 CFR 1000.26 - What are the administrative requirements under NAHASDA?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... recipient of a cash escrow of not less than 20 percent of the total contract price, subject to reduction... monitoring of disbursements by the contractor. (12) Section 85.37, “Subgrants.” (13) Section 85.40, “Monitoring and reporting program performance,” except paragraphs (b) through (d) and paragraph (f). (14...

  3. Registered nurse intent to promote physical activity for hospitalised liver transplant recipients.

    PubMed

    Pearson, Jocelyn A; Mangold, Kara; Kosiorek, Heidi E; Montez, Morgan; Smith, Diane M; Tyler, Brenda J

    2017-12-26

    To describe how registered nurse work motivation, attitudes, subjective norm and perceived behavioural control influence intention to promote physical activity in hospitalised adult liver transplant recipients. Descriptive study of clinical registered nurses caring for recipients of liver transplant at a tertiary medical centre. Intent to Mobilise Liver Transplant Recipient Scale, Work Extrinsic and Intrinsic Motivation Scale, and demographics were used to explore registered nurses' work motivation, attitudes, subjective norms, perceived behavioural control and intention to promote physical activity of hospitalised adult liver transplant recipients during the acute postoperative phase. Data analysis included demographics, comparison between scale items and analysis of factors predicting intent to mobilise. Factors predictive of intention to promote physical activity after liver transplant included appropriate knowledge to mobilise patients (R 2  = .40) and identification of physical activity as nursing staff priority (R 2  = .15) and responsibility (R 2  = .03). When implementing an early mobilisation protocol after the liver transplant, education on effects of physical activity in the immediate postoperative period are essential to promote implementation in practice. Nursing care environment and leadership must be supportive to ensure mobility is a registered nurse priority and responsibility. Nursing managers can leverage results to implement a mobility protocol. © 2017 John Wiley & Sons Ltd.

  4. 7 CFR 15b.18 - Existing facilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Accessibility § 15b.18 Existing facilities. (a) Accessibility. A recipient shall operate each assisted program or activity so that when each part is viewed in... results in making its program or activity accessible to qualified handicapped persons. A recipient is not...

  5. Relative reductions in soluble CD30 levels post-transplant predict acute graft function in islet allograft recipients receiving three different immunosuppression protocols.

    PubMed

    Hire, Kelly; Hering, Bernhard; Bansal-Pakala, Pratima

    2010-08-01

    Despite advances in islet transplantation, challenges remain in monitoring for anti-islet immune responses. Soluble CD30 (sCD30) has been investigated as a predictor of acute rejection in kidney, lung, and heart transplantation as well as in a single study in human islet cell recipients. In this study, sCD30 levels were retrospectively assessed in 19 allograft recipients treated with three different immunosuppression induction therapies. Soluble CD30 levels were assessed at pre-transplant; early post-transplant (day 4-day 7); one-month post-transplant; and late post-transplant (day 90-day 120) and then correlated with eventual graft outcomes at 1-year follow-up. Results showed no correlation between mean serum sCD30 levels at any point in time pre- or post-transplant and graft function at 1-year follow-up. However, analysis demonstrated that mean sCD30 levels at day 28 or day 90-day 120 decreased from pre-transplant levels in recipients with long-term islet allograft function compared to recipients with partial or non-graft function (a decrease of 43.6+/-25.6% compared to 16.7+/-35.2%, p<0.05). In another finding, immunosuppression with the ATG protocol led to a greater reduction in sCD30 levels post-transplant overall. A larger reduction post-transplant correlated with full graft function. The results demonstrate that a relative reduction in sCD30 levels post-transplant may be applicable as a biomarker to monitor graft function in islet allograft recipients. Additionally, knowledge of the impact of various immunosuppression protocols on the timing and extent of changes in post-transplant sCD30 levels could aid in patient-specific tailoring of immunosuppression. Copyright © 2010 Elsevier B.V. All rights reserved.

  6. Effects of a Structured Physical Activity Program on Habitual Physical Activity and Body Composition in Patients With Chronic Kidney Disease and in Kidney Transplant Recipients.

    PubMed

    Masajtis-Zagajewska, Anna; Muras, Katarzyna; Nowicki, Michał

    2018-05-16

    In this study, we compared the effects of an individualized physical activity program on lifestyle, metabolic profile, body composition, and quality of life in kidney transplant recipients and patients with chronic kidney disease. Our study included 24 kidney transplant recipients and 15 patients with chronic kidney disease at stage 3/4. Body composition (impedance spectroscopy) and habitual physical activity (accelerometry) assessed at baseline were used to prepare the individualized physical activity program. Participants received repeated training, which was supervised during the first 2 weeks, followed by short message service reminders. Measurements were repeated after 1 and 3 months. Time spent daily on physical activity and total energy expenditure increased in kidney transplant recipients (from 126 ± 87 to 200 ± 132 min/day [P = .001] and from 1.73 ± 0.37 to 2.24 ± 0.59 cal/min [P < .001]) and in patients with chronic kidney disease (from 79 ± 78 to 109 ± 114 min/day [P < .001] and from 1.5 ± 0.5 to 1.92 ± 0.47 cal/min [P < .001]). Adipose mass (40.8 ± 11.5 vs 38.5 ± 10.3 kg; P = .01), total body water (38.1 ± 9.1 vs 37.3 ± 9.7 L; P = .01), and fat tissue index (14.3 ± 3.7 vs 13.5 ± 3.1 kg/m2; P = .009) decreased significantly only in kidney transplant recipients. Body cell mass decreased in patients with chronic kidney disease. Significant changes of estimated glomerular filtration rates were observed in kidney transplant recipients. Increased physical activity achieved through structured exercise programs induced beneficial effects on metabolic profile and body composition in patients with chronic kidney disease, with even greater benefits in kidney transplant recipients.

  7. Dissociating response conflict and error likelihood in anterior cingulate cortex.

    PubMed

    Yeung, Nick; Nieuwenhuis, Sander

    2009-11-18

    Neuroimaging studies consistently report activity in anterior cingulate cortex (ACC) in conditions of high cognitive demand, leading to the view that ACC plays a crucial role in the control of cognitive processes. According to one prominent theory, the sensitivity of ACC to task difficulty reflects its role in monitoring for the occurrence of competition, or "conflict," between responses to signal the need for increased cognitive control. However, a contrasting theory proposes that ACC is the recipient rather than source of monitoring signals, and that ACC activity observed in relation to task demand reflects the role of this region in learning about the likelihood of errors. Response conflict and error likelihood are typically confounded, making the theories difficult to distinguish empirically. The present research therefore used detailed computational simulations to derive contrasting predictions regarding ACC activity and error rate as a function of response speed. The simulations demonstrated a clear dissociation between conflict and error likelihood: fast response trials are associated with low conflict but high error likelihood, whereas slow response trials show the opposite pattern. Using the N2 component as an index of ACC activity, an EEG study demonstrated that when conflict and error likelihood are dissociated in this way, ACC activity tracks conflict and is negatively correlated with error likelihood. These findings support the conflict-monitoring theory and suggest that, in speeded decision tasks, ACC activity reflects current task demands rather than the retrospective coding of past performance.

  8. 7 CFR 15a.11 - Application.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... of the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM... 15a applies to every recipient and to each education program or activity operated by such recipient which receives or benefits from Federal financial assistance. ...

  9. Rituximab-Related Late-Onset Neutropenia in Kidney Transplant Recipients Treated for Antibody-Mediated Acute Rejection.

    PubMed

    Ahmadi, Fatemeh; Dashti-Khavidaki, Simin; Khatami, Mohammad-Reza; Lessan-Pezeshki, Mahboob; Khalili, Hossein; Khosravi, Malihe

    2017-08-01

    Kidney transplant is a new area for use of rituximab, which is being used to treat acute antibody-mediated rejection or as an induction agent in ABO- or HLA-incompatible grafts. We report on late-onset neutropenia in rituximab-treated kidney transplant recipients with antibody-mediated rejection. This observational prospective study was performed on kidney transplant recipients with clinically suspicious or biopsy-proven antibody-mediated rejection treated with plasmapheresis plus intravenous immunoglobulin with (cases) or without (controls) rituximab. Compared with none of the controls, 4 of 6 patients (66.7%) in the rituximab-treated group experienced late-onset neutropenia 35 to 93 days after the last dose of rituximab. The course of neutropenia was complicated by endocarditis in 1 patient, resulting in his death just because of a lack of valvular surgery. Increased use of rituximab to treat antibody-mediated rejection among kidney transplant recipients requires attention to its late-onset adverse event, neutropenia. Although asymptomatic in some patients, kidney transplant recipients treated concomitantly with plasmapheresis and mycophenolate mofetil are predisposed to hypogammaglobulinemia, and monitoring of patients for infections is required.

  10. Securing recipiency in workplace meetings: Multimodal practices

    PubMed Central

    Ford, Cecilia E.; Stickle, Trini

    2013-01-01

    As multiparty interactions with single courses of coordinated action, workplace meetings place particular interactional demands on participants who are not primary speakers (e.g. not chairs) as they work to initiate turns and to interactively coordinate with displays of recipiency from co-participants. Drawing from a corpus of 26 hours of videotaped workplace meetings in a midsized US city, this article reports on multimodal practices – phonetic, prosodic, and bodily-visual – used for coordinating turn transition and for consolidating recipiency in these specialized speech exchange systems. Practices used by self-selecting non-primary speakers as they secure turns in meetings include displays of close monitoring of current speakers’ emerging turn structure, displays of heightened interest as current turns approach possible completion, and turn initiation practices designed to pursue and, in a fine-tuned manner, coordinate with displays of recipiency on the parts of other participants as well as from reflexively constructed ‘target’ recipients. By attending to bodily-visual action, as well as phonetics and prosody, this study contributes to expanding accounts for turn taking beyond traditional word-based grammar (i.e. lexicon and syntax). PMID:24976789

  11. 45 CFR 617.14 - Remedial action by recipients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....14 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION NONDISCRIMINATION ON THE BASIS OF AGE IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE FROM NSF... the effects of the discrimination. If another recipient exercises control over the recipient that has...

  12. 45 CFR 617.14 - Remedial action by recipients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....14 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION NONDISCRIMINATION ON THE BASIS OF AGE IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE FROM NSF... the effects of the discrimination. If another recipient exercises control over the recipient that has...

  13. Tolerance assays: measuring the unknown.

    PubMed

    Newell, Kenneth A; Larsen, Christian P

    2006-06-15

    Distinguishing transplant recipients who will benefit from a reduction in, or even the withdrawal of, immunosuppression from those who require intensive, lifelong immunosuppression will be dependent on developing strategies for immune monitoring. Currently, no assays have been shown to accurately predict the development or presence of donor-specific tolerance in humans after transplantation. In this overview we describe and discuss those assays that we believe may be useful for identifying tolerant transplant recipients. Validation of "tolerance" assays will be critical for the safe development of tolerance regimens in humans.

  14. 43 CFR 17.302 - To what programs or activities do these regulations apply?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... regulations apply to each DOI recipient and to each program or activity operated by the recipient which receives Federal financial assistance provided by DOI. (b) The Act and these regulations do not apply to...

  15. 45 CFR 605.37 - Nonacademic services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... activities. (2) Nonacademic and extracurricular services and activities may include counseling services... groups or clubs sponsored by the recipients, referrals to agencies which provide assistance to... making available outside employment. (b) Counseling services. A recipient to which this subpart applies...

  16. 43 CFR 17.302 - To what programs or activities do these regulations apply?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... regulations apply to each DOI recipient and to each program or activity operated by the recipient which receives Federal financial assistance provided by DOI. (b) The Act and these regulations do not apply to...

  17. 28 CFR 42.722 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Recipient assessment of age distinctions. 42.722 Section 42.722 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL... Programs or Activities; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.722...

  18. 75 FR 32508 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-08

    ... teaching. Noyce recipients may be undergraduates majoring in a science, technology, engineering, or... which Noyce recipients teach, and recipients' plans to teach in high-need schools and to pursue... teacher effectiveness. The methods of data collection will include both primary and secondary data...

  19. 45 CFR 617.4 - General duties of recipients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... subrecipients, and the instrument under which the Federal financial assistance is passed to the subrecipient... NONDISCRIMINATION ON THE BASIS OF AGE IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE FROM NSF § 617.4 General duties of recipients. Each recipient of Federal financial assistance from NSF shall...

  20. Immune monitoring with a lymphocyte adenosine triphosphate assay in kidney transplant recipients treated with a calcineurin inhibitor.

    PubMed

    Sugiyama, Kentaro; Tsukaguchi, Mahoto; Toyama, Akira; Satoh, Hiroshi; Saito, Kazuhide; Nakagawa, Yuki; Takahashi, Kota; Tanaka, Sachiko; Onda, Kenji; Hirano, Toshihiko

    2014-06-01

    The adenosine triphosphate assay using peripheral lymphocytes may be useful to evaluate the risks of acute rejection and infection in kidney transplant patients. We used the adenosine triphosphate assay to evaluate differences between recipients who were treated with cyclosporine- or tacrolimus-based immunosuppressive therapy. Adenosine triphosphate levels were measured in peripheral CD4+ cells before and after transplant and were correlated with clinical outcomes in 45 kidney transplant recipients. These recipients received immunosuppressive therapy with either cyclosporine (23 patients) or tacrolimus (22 patients). Adenosine triphosphate levels were significantly lower in the cyclosporine- than tacrolimus-based therapy groups from 2 to 6 weeks after transplant. Adenosine triphosphate levels were similar between these groups before and 1 week after transplant. The frequency of cytomegalovirus infection was greater in the recipients who received cyclosporine (17 patients [74%]) than tacrolimus (6 patients [27%]; P ≦ .003). The frequency of acute rejection episodes was similar between the cyclosporine and tacrolimus groups. These observations suggest that cyclosporine-based immunosuppressive therapy causes excessive immunosuppression compared with tacrolimus-based therapy, evidenced by the lymphocyte adenosine triphosphate levels. The adenosine triphosphate assay using peripheral CD4+ cells may be a useful method for predicting the occurrence of cytomegalovirus infections in kidney transplant recipients.

  1. Physical activity reduces fatigue in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis of randomized trials.

    PubMed

    Oberoi, Sapna; Robinson, Paula D; Cataudella, Danielle; Culos-Reed, S Nicole; Davis, Hailey; Duong, Nathan; Gibson, Faith; Götte, Miriam; Hinds, Pamela; Nijhof, Sanne L; Tomlinson, Deborah; van der Torre, Patrick; Cabral, Sandra; Dupuis, L Lee; Sung, Lillian

    2018-02-01

    Objective was to determine whether physical activity reduces the severity of fatigue in patients with cancer or hematopoietic stem cell transplant (HSCT) recipients. We conducted a meta-analysis of randomized trials comparing physical activity with control interventions for the management of fatigue in patients with cancer or HSCT recipients. There were 170 trials included. Physical activity reduced the severity of fatigue when compared to all control groups (standardized mean difference -0.49, 95% confidence interval -0.60 to -0.37; P < 0.00001). Aerobic, neuromotor, resistance and combination exercises were all effective in reducing fatigue although smaller effects were observed with resistance exercises (P interaction = 0.01). Other intervention and patient characteristics did not influence the effect of physical activity on the severity of fatigue. Physical activity was effective at reducing fatigue in patients with cancer and HSCT recipients across patient sub-groups. Determining the best approaches for safe implementation should be a priority. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Incidence of Ganciclovir Resistance in CMV-positive Renal Transplant Recipients and its Association with UL97 Gene Mutations.

    PubMed

    Aslani, Hamid Reza; Ziaie, Shadi; Salamzadeh, Jamshid; Zaheri, Sara; Samadian, Fariba; Mastoor-Tehrani, Shayan

    2017-01-01

    Human cytomegalovirus (CMV) remains the most common infection affecting organ transplant recipients. Despite advances in the prophylaxis and acute treatment of CMV, it remains an important pathogen affecting the short- and long-term clinical outcome of solid organ transplant recipient. The emergence of CMV resistance in a patient reduces the clinical efficacy of antiviral therapy, complicates therapeutic and clinical management decisions, and in some cases results in loss of the allograft and/or death of the patient. Common mechanisms of CMV resistance to ganciclovir have been described chiefly with the UL97 mutations. Here we evaluate Incidence of ganciclovir resistance in 144 CMV-positive renal transplant recipients and its association with UL97 gene mutations. Active CMV infection was monitored by viral DNA quantification in whole blood, and CMV resistance was assessed by UL97 gene sequencing. Six mutations in six patients were detected. Three patients (2.6%) of 112 patients with history of ganciclovir (GCV) treatment had clinical resistance with single UL97 mutations at loci known to be related to resistance (including mutations at codon 594, codon 460, and codon 520). three patients who were anti-CMV drug naïve had single UL97 mutations (D605E) without clinical resistance. Our results confirm and extend our earlier findings on the specific mutations in the UL97 phosphotransferase gene in loci that have established role in ganciclovir resistance and also indicate that clinical ganciclovir resistance due to UL97 gene mutations is an issue in subjects with history of with ganciclovir treatment. D605E mutations remains a controversial issue that needs further investigations.

  3. Regular monitoring of cytomegalovirus (CMV)-specific cell-mediated immunity in intermediate-risk kidney transplant recipients: predictive value of the immediate post-transplant assessment.

    PubMed

    Fernández-Ruiz, Mario; Giménez, Estela; Vinuesa, Víctor; Ruiz-Merlo, Tamara; Parra, Patricia; Amat, Paula; Montejo, Miguel; Paez-Vega, Aurora; Cantisán, Sara; Torre-Cisneros, Julián; Fortún, Jesús; Andrés, Amado; San Juan, Rafael; López-Medrano, Francisco; Navarro, David; María Aguado, José

    2018-05-24

    Previous studies on monitoring of post-transplant cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) are limited by single-center designs and disparate risk categories. We aimed to assess the clinical value of a regular monitoring strategy in a large multicenter cohort of intermediate-risk kidney transplant (KT) recipients. We recruited 124 CMV-seropositive KT recipients with no T-cell-depleting induction preemptively managed at four Spanish institutions. CMV-specific interferon-γ-producing CD4 + and CD8 + T-cells were enumerated through the first post-transplant year by intracellular cytokine staining after stimulation with pp65 and IE-1 peptides (mean of 6 measurements per patient). The primary outcome was the occurrence of any CMV event (asymptomatic infection and/or disease). Optimal cut-off values for CMV-specific T-cells were calculated at baseline and day 15. Twelve-month cumulative incidence of CMV infection and/or disease was 47.6%. Patients with pre-transplant CMV-specific CD8 + T-cell count <1.0 cells/μL had higher risk of CMV events (adjusted hazard ratio [aHR]: 2.84; P-value = 0.054). When the CMI assessment was performed at the immediate post-transplant period (day 15), the presence of <2.0 CD8 + T-cells/μL (aHR: 2.18; P-value = 0.034) or <1.0 CD4 + T-cells/μL (aHR: 2.43; P-value = 0.016) also predicted the subsequent development of CMV event. In addition, lower counts of CMV-specific CD4 + (but not CD8 + ) T-cells at days 60 and 180 were associated with a higher incidence of late-onset events. Monitoring for CMV-specific CMI in intermediate-risk KT recipients must be regular to reflect dynamic changes in overall immunosuppression and individual susceptibility. The early assessment at post-transplant day 15 remains particularly informative. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  4. Immunological monitoring after organ transplantation: potential role of soluble CD30 blood level measurement.

    PubMed

    Truong, Dinh Quang; Darwish, Ahmed A; Gras, Jérémie; Wieërs, Grégoire; Cornet, Anne; Robert, Annie; Mourad, Michel; Malaise, Jacques; de Ville de Goyet, Jean; Reding, Raymond; Latinne, Dominique

    2007-06-01

    Analysing the relevance of soluble CD30 (sCD30) in the bloodstream before and after transplantation may be important for the monitoring of transplant recipients. In this study, 27 patients (15 pediatric liver and 12 adult kidney graft recipients) were investigated. In the liver graft group, the patients who developed acute rejection during the first month (n=9) had a slightly higher sCD30 value on pre-transplantation baseline (day 0) and post-transplantation day 7, when compared to patients with normal graft function (n=6) (day 0: 102(1.6) U/ml versus 118(1.5) U/ml, p=0.52) and (day 7: 69(1.5) U/ml versus 83(1.6) U/ml, p=0.47). Increased serum sCD30 was shown to correlate with increased interleukin-10 circulating levels between day 0 and day 7 (r=0.53; p=0.04), whereas, no correlation could be evidenced between interferon-gamma (IFN-gamma) and sCD30 (r=0.02; p=0.47). Similarly, in the kidney transplantation group, no significant difference was found in sCD30 levels at day 0 in both groups with graft rejection or normal graft function (n=6) (85(1.3) U/ml versus 77(1.6) U/ml, p=0.66), but sCD30 decreased significantly at day 7 post-transplantation from baseline value in the rejection group (n=6) (77(1.6) versus 35(1.4); p=0.02). We conclude that increased serum sCD30 was correlated with increased IL-10 (interleukin-10) circulating levels, but not with IFN-gamma levels in the post-transplantation period. Neither pre-transplantation sCD30 nor sCD30 at day 7 post-transplantation could be correlated with acute rejection in liver graft recipient. The monitoring of sCD30 might constitute a tool to assess the risk of acute rejection in renal transplant but did not appear as a valuable mean for early immunological monitoring in the small group of liver allograft recipients patients analysed in this study.

  5. 28 CFR 42.722 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Recipient assessment of age distinctions... EMPLOYMENT OPPORTUNITY; POLICIES AND PROCEDURES Nondiscrimination on the Basis of Age in Federally Assisted Programs or Activities; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.722...

  6. 28 CFR 42.722 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Recipient assessment of age distinctions... EMPLOYMENT OPPORTUNITY; POLICIES AND PROCEDURES Nondiscrimination on the Basis of Age in Federally Assisted Programs or Activities; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.722...

  7. 28 CFR 42.722 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Recipient assessment of age distinctions... EMPLOYMENT OPPORTUNITY; POLICIES AND PROCEDURES Nondiscrimination on the Basis of Age in Federally Assisted Programs or Activities; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.722...

  8. 28 CFR 42.722 - Recipient assessment of age distinctions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Recipient assessment of age distinctions... EMPLOYMENT OPPORTUNITY; POLICIES AND PROCEDURES Nondiscrimination on the Basis of Age in Federally Assisted Programs or Activities; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.722...

  9. Association Between Spousal Caregiver Well-Being and Care Recipient Healthcare Expenditures.

    PubMed

    Ankuda, Claire K; Maust, Donovan T; Kabeto, Mohammed U; McCammon, Ryan J; Langa, Kenneth M; Levine, Deborah A

    2017-10-01

    To measure the association between spousal depression, general health, fatigue and sleep, and future care recipient healthcare expenditures and emergency department (ED) use. Prospective cohort study. Health and Retirement Study. Home-dwelling spousal dyads in which one individual (care recipient) was aged 65 and older and had one or more activity of daily living or instrumental activity of daily living disabilities and was enrolled in Medicare Part B (N = 3,101). Caregiver sleep (Jenkins Sleep Scale), depressive symptoms (Center for Epidemiologic Studies Depression-8 Scale), and self-reported general health measures. Primary outcome was care recipient Medicare expenditures. Secondary outcome was care recipient ED use. Follow-up was 6 months. Caregiver depressive symptoms score and six of 17 caregiver well-being measures were prospectively associated with higher care recipient expenditures after minimal adjustment (P < .05). Higher care recipient expenditures remained significantly associated with caregiver fatigue (cost increase, $1,937, 95% confidence interval (CI) = $770-3,105) and caregiver sadness (cost increase, $1,323, 95% CI = $228-2,419) after full adjustment. Four of 17 caregiver well-being measures, including severe fatigue, were significantly associated with care recipient ED use after minimal adjustment (P < .05). Greater odds of care recipient ED use remained significantly associated with caregiver fatigue (odds ratio (OR) = 1.24, 95% CI = 1.01-1.52) and caregiver fair to poor health (OR = 1.23, 95% CI = 1.04-1.45) after full adjustment. Caregiver total sleep score was not associated with care recipient outcomes. Poor caregiver well-being, particularly severe fatigue, is independently and prospectively associated with higher care recipient Medicare expenditures and ED use. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  10. Best single time point correlations with AUC for cyclosporine and tacrolimus in HIV-infected kidney and liver transplant recipients.

    PubMed

    Frassetto, Lynda A; Tan-Tam, Clara C; Barin, Burc; Browne, Matt; Wolfe, Alan R; Stock, Peter G; Roland, Michelle; Benet, Leslie Z

    2014-03-27

    Interactions between antiretrovirals (ARVs) and transplant immunosuppressant agents (IS) among HIV-infected transplant recipients may lead to lack of efficacy or toxicity. In transplant recipients not infected with HIV, tacrolimus (TAC) trough levels (C0) or cyclosporine (CsA) drawn at C0 or 2 hours after dosing (C2) correlate with drug exposure (area under the curve [AUC]/dose) and outcomes. Because of ARV-IS interactions in HIV-infected individuals, and the high rate of rejection in these subjects, this study investigated the correlations between IS concentrations and exposure to determine the best method to monitor immunosuppressant levels. This study prospectively studied 50 HIV-infected transplant recipients undergoing kidney or liver transplantation evaluating the pharmacokinetics of the IS in 150 studies over time after transplantation (weeks 2 to 4, 12, 28, 52, and 104). IS levels were measured with liquid chromatography-tandem mass spectrometry and AUC calculated using WinNonlin 9.0. Correlation analyses were run on SAS 9.2. CsA concentration at C4 correlated better with AUC than C0 or C2, and over time TAC concentration correlated better at C0 or C2. It is suggested that C0 is acceptable for TAC monitoring, but poor predictability will occur at C0 with CsA. The low correlation of C0 with CsA AUC could be responsible for the higher rejection rates on CsA that has been reported in these subjects.

  11. Alloantibody and Autoantibody Monitoring Predicts Islet Transplantation Outcome in Human Type 1 Diabetes

    PubMed Central

    Piemonti, Lorenzo; Everly, Matthew J.; Maffi, Paola; Scavini, Marina; Poli, Francesca; Nano, Rita; Cardillo, Massimo; Melzi, Raffaella; Mercalli, Alessia; Sordi, Valeria; Lampasona, Vito; Espadas de Arias, Alejandro; Scalamogna, Mario; Bosi, Emanuele; Bonifacio, Ezio; Secchi, Antonio; Terasaki, Paul I.

    2013-01-01

    Long-term clinical outcome of islet transplantation is hampered by the rejection and recurrence of autoimmunity. Accurate monitoring may allow for early detection and treatment of these potentially compromising immune events. Islet transplant outcome was analyzed in 59 consecutive pancreatic islet recipients in whom baseline and de novo posttransplant autoantibodies (GAD antibody, insulinoma-associated protein 2 antigen, zinc transporter type 8 antigen) and donor-specific alloantibodies (DSA) were quantified. Thirty-nine recipients (66%) showed DSA or autoantibody increases (de novo expression or titer increase) after islet transplantation. Recipients who had a posttransplant antibody increase showed similar initial performance but significantly lower graft survival than patients without an increase (islet autoantibodies P < 0.001, DSA P < 0.001). Posttransplant DSA or autoantibody increases were associated with HLA-DR mismatches (P = 0.008), induction with antithymocyte globulin (P = 0.0001), and pretransplant panel reactive alloantibody >15% in either class I or class II (P = 0.024) as independent risk factors and with rapamycin as protective (P = 0.006) against antibody increases. DSA or autoantibody increases after islet transplantation are important prognostic markers, and their identification could potentially lead to improved islet cell transplant outcomes. PMID:23274902

  12. Pancreas allograft biopsies in the management of pancreas transplant recipients: histopathologic review and clinical correlations.

    PubMed

    Gaber, Lillian W

    2007-08-01

    Pancreas transplantation has become a therapeutic option for patients with type 1 diabetes mellitus who are in end-stage renal failure. It also is indicated for a subset of nonuremic, insulin-dependent diabetics who experience extreme difficulties in maintaining proper glucose homeostasis by insulin therapy that compromises their productivity and safety. To provide a review of the literature and expert experiences for understanding the histologic findings in pancreas transplantation. The published literature between 1990 and 2005 was reviewed for this report. Additionally, personal files of the author were used, along with biopsy slides that were used for figures. Pancreas transplantation reestablishes the physiologic state of insulin secretion, and pancreas transplant recipients are able to maintain a state of long-term euglycemia and are less likely to be exposed to hyperglycemia and its systemic complications. Key to the success of transplantation is the scrupulous management and close monitoring of the pancreas transplant recipients. To that end, histologic evaluation of pancreas allografts assumed a pivotal role in management of pancreas allograft dysfunction episodes, and in some centers surveillance biopsies are used to monitor immunologically high-risk situations.

  13. 7 CFR 15b.13 - Reasonable accommodation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) A recipient shall make reasonable accommodation to the known physical or mental limitations of an... accommodation would impose an undue hardship on the operation of its program or activity. (b) Reasonable... undue hardship on the operation of a recipient's programs or activities, factors to be considered...

  14. 24 CFR 761.21 - Plan requirement.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... funding source for each activity, identifying in particular all activities to be funded under this part... requirement. (a) General requirement. To receive funding under this part, each PHDEP qualified recipient or... the application for PHDEP funding, and an otherwise qualified recipient that does not submit a PHDEP...

  15. Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?

    PubMed Central

    Michaud, Laurent; Ludwig, Gundula; Berney, Sylvie; Rodrigues, Stéphanie; Niquille, Anne; Santschi, Valérie; Favre, Anne-Sophie; Lange, Anne-Catherine; Michels, Annemieke A.; Vrijens, Bernard; Bugnon, Olivier; Pilon, Nathalie; Pascual, Manuel; Venetz, Jean-Pierre; Stiefel, Friedrich; Schneider, Marie-Paule

    2016-01-01

    Background: Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. Objective: This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Methods: Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). Results: Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Conclusion: Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics. PMID:28042353

  16. [Early detection, prevention and management of renal failure in liver transplantation].

    PubMed

    Castells, Lluís; Baliellas, Carme; Bilbao, Itxarone; Cantarell, Carme; Cruzado, Josep Maria; Esforzado, Núria; García-Valdecasas, Juan Carlos; Lladó, Laura; Rimola, Antoni; Serón, Daniel; Oppenheimer, Federico

    2014-10-01

    Renal failure is a frequent complication in liver transplant recipients and is associated with increased morbidity and mortality. A variety of risk factors for the development of renal failure in the pre- and post-transplantation periods have been described, as well as at the time of surgery. To reduce the negative impact of renal failure in this population, an active approach is required for the identification of those patients with risk factors, the implementation of preventive strategies, and the early detection of progressive deterioration of renal function. Based on published evidence and on clinical experience, this document presents a series of recommendations on monitoring RF in LT recipients, as well as on the prevention and management of acute and chronic renal failure after LT and referral of these patients to the nephrologist. In addition, this document also provides an update of the various immunosuppressive regimens tested in this population for the prevention and control of post-transplantation deterioration of renal function. Copyright © 2013 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

  17. Paraoxonase 1 Phenotype and Mass in South Asian versus Caucasian Renal Transplant Recipients.

    PubMed

    Connelly, Philip W; Maguire, Graham F; Nash, Michelle M; Rapi, Lindita; Yan, Andrew T; Prasad, G V Ramesh

    2012-01-01

    South Asian renal transplant recipients have a higher incidence of cardiovascular disease compared with Caucasian renal transplant recipients. We carried out a study to determine whether paraoxonase 1, a novel biomarker for cardiovascular risk, was decreased in South Asian compared with Caucasian renal transplant recipients. Subjects were matched two to one on the basis of age and sex for a total of 129 subjects. Paraoxonase 1 was measured by mass, arylesterase activity, and two-substrate phenotype assay. Comparisons were made by using a matched design. The frequency of PON1 QQ, QR and RR phenotype was 56%, 37%, and 7% for Caucasian subjects versus 35%, 44%, and 21% for South Asian subjects (χ(2) = 7.72, P = 0.02). PON1 mass and arylesterase activity were not significantly different between South Asian and Caucasian subjects. PON1 mass was significantly associated with PON1 phenotype (P = 0.0001), HDL cholesterol (P = 0.009), LDL cholesterol (P = 0.02), and diabetes status (P < 0.05). Arylesterase activity was only associated with HDL cholesterol (P = 0.003). Thus the frequency of the PON1 RR phenotype was higher and that of the QQ phenotype was lower in South Asian versus Caucasian renal transplant recipients. However, ethnicity was not a significant factor as a determinant of PON1 mass or arylesterase activity, with or without analysis including PON1 phenotype. The two-substrate method for determining PON1 phenotype may be of value for future studies of cardiovascular complications in renal transplant recipients.

  18. 42 CFR 403.904 - Reports of payments or other transfers of value to covered recipients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... research payment, including all research-related costs for activities outlined in a written agreement... reporting food and beverage. (1) When allocating the cost of food and beverage among covered recipients in a group setting where the cost of each individual covered recipient's meal is not separately identifiable...

  19. 42 CFR 403.904 - Reports of payments or other transfers of value to covered recipients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... research payment, including all research-related costs for activities outlined in a written agreement... reporting food and beverage. (1) When allocating the cost of food and beverage among covered recipients in a group setting where the cost of each individual covered recipient's meal is not separately identifiable...

  20. 77 FR 57178 - Agency Information Collection Activities: Proposed Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-17

    ...) maintain a written record of the request; (2) establish the relationship of the requester to the deceased... Maintain Home-- 20 CFR 416.212(b)(1)--0960-0516. When SSI recipients (1) enter a public institution or (2... from the recipient, the recipient's family, or friends confirming SSI payments are needed to maintain...

  1. 45 CFR 1610.4 - Authorized use of non-LSC funds.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... activity prohibited by or inconsistent with Section 504. (c) A recipient may receive private funds and use.... (a) A recipient may receive tribal funds and expend them in accordance with the specific purposes for which the tribal funds were provided. (b) A recipient may receive public or IOLTA funds and use them in...

  2. 20 CFR 641.881 - What are the SCSEP recipient's responsibilities relating to awards to subrecipients?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... awards to subrecipients? (a) The SCSEP recipient is responsible for all grant activities, including the... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What are the SCSEP recipient's responsibilities relating to awards to subrecipients? 641.881 Section 641.881 Employees' Benefits EMPLOYMENT AND...

  3. Database Comparison of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) and the SRTR U.S. Transplant Registry1,2,3

    PubMed Central

    Gillespie, BW; Merion, RM; Ortiz-Rios, E; Tong, L; Shaked, A; Brown, RS; Ojo, AO; Hayashi, PH; Berg, CL; Abecassis, MM; Ashworth, AS; Friese, CE; Hong, JC; Trotter, JF; Everhart, JE

    2010-01-01

    Data submitted by transplant programs to the Organ Procurement and Transplantation Network (OPTN) are used by the Scientific Registry of Transplant Recipients (SRTR) for policy development, performance evaluation, and research. This study compared OPTN/SRTR data with data extracted from medical records by research coordinators from the nine-center A2ALL study. A2ALL data were collected independently of OPTN data submission (48 data elements among 785 liver transplant candidates/recipients; 12 data elements among 386 donors). At least 90% agreement occurred between OPTN/SRTR and A2ALL for 11/29 baseline recipient elements, 4/19 recipient transplant or follow-up elements, and 6/12 donor elements. For the remaining recipient and donor elements, >10% of values were missing in OPTN/SRTR but present in A2ALL, confirming that missing data were largely avoidable. Other than variables required for allocation, the percentage missing varied widely by center. These findings support an expanded focus on data quality control by OPTN/SRTR for a broader variable set than those used for allocation. Center-specific monitoring of missing values could substantially improve the data. PMID:20199501

  4. [Patient with B-CLL with a history of unrelated hematopoietic cells donation--retrospective analysis of CLL development and implication for the recipient].

    PubMed

    Jindra, P; Žejšková, L; Peková, S; Navrátilová, J; Schutzová, M; Vokurka, S; Koza, V

    2012-01-01

    Donor cell leukemia (DCL) is a relatively rare but well documented complication of hematopoietic stem cell transplantation. So far, publications described only DCL arising de novo in the recipient. In this study, we describe a case of chronic lymphocytic leukemia (B-CLL) developing in a volunteer unrelated donor from the Czech National Marrow Donors Registry (CNMDR) several years after donation. From archival DNA sample, we have retrospectively found that subclinical CLL clone was already present at the time of donation but early death of recipient prevented eventual development of DCL. This case documents well the long period between detection of B-CLL clone and full development of clinical-laboratory symptomatology. The medical and ethical questions posed by an isolated case of detection of hematological malignancy present either only in the donor or only in the recipient are discussed. The case demonstrates the increasing risk of development of various forms of DCL and thus highlights the need for long-term monitoring of stem cell donor, not only in terms of health of donor but also in terms of potential risks for the recipient.

  5. 43 CFR 17.211 - Reasonable accommodation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Reasonable accommodation. (a) A recipient shall make reasonable accommodation to the known physical or mental... that the accommodation would impose an undue hardship on the operation of its program or activity. (b... accommodation would impose an undue hardship on the operation of a recipient's program or activity, factors to...

  6. 22 CFR 217.12 - Reasonable accommodation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... accommodation. (a) A recipient shall make reasonable accommodation to the known physical or mental limitations... the accommodation would impose an undue hardship on the operation of its program or activity. (b... would impose an undue hardship on the operation of a recipient's program or activity, factors to be...

  7. Validity and reliability of a novel immunosuppressive adverse effects scoring system in renal transplant recipients.

    PubMed

    Meaney, Calvin J; Arabi, Ziad; Venuto, Rocco C; Consiglio, Joseph D; Wilding, Gregory E; Tornatore, Kathleen M

    2014-06-12

    After renal transplantation, many patients experience adverse effects from maintenance immunosuppressive drugs. When these adverse effects occur, patient adherence with immunosuppression may be reduced and impact allograft survival. If these adverse effects could be prospectively monitored in an objective manner and possibly prevented, adherence to immunosuppressive regimens could be optimized and allograft survival improved. Prospective, standardized clinical approaches to assess immunosuppressive adverse effects by health care providers are limited. Therefore, we developed and evaluated the application, reliability and validity of a novel adverse effects scoring system in renal transplant recipients receiving calcineurin inhibitor (cyclosporine or tacrolimus) and mycophenolic acid based immunosuppressive therapy. The scoring system included 18 non-renal adverse effects organized into gastrointestinal, central nervous system and aesthetic domains developed by a multidisciplinary physician group. Nephrologists employed this standardized adverse effect evaluation in stable renal transplant patients using physical exam, review of systems, recent laboratory results, and medication adherence assessment during a clinic visit. Stable renal transplant recipients in two clinical studies were evaluated and received immunosuppressive regimens comprised of either cyclosporine or tacrolimus with mycophenolic acid. Face, content, and construct validity were assessed to document these adverse effect evaluations. Inter-rater reliability was determined using the Kappa statistic and intra-class correlation. A total of 58 renal transplant recipients were assessed using the adverse effects scoring system confirming face validity. Nephrologists (subject matter experts) rated the 18 adverse effects as: 3.1 ± 0.75 out of 4 (maximum) regarding clinical importance to verify content validity. The adverse effects scoring system distinguished 1.75-fold increased gastrointestinal adverse effects (p=0.008) in renal transplant recipients receiving tacrolimus and mycophenolic acid compared to the cyclosporine regimen. This finding demonstrated construct validity. Intra-class correlation was 0.81 (95% confidence interval: 0.65-0.90) and Kappa statistic of 0.68 ± 0.25 for all 18 adverse effects and verified substantial inter-rater reliability. This immunosuppressive adverse effects scoring system in stable renal transplant recipients was evaluated and substantiated face, content and construct validity with inter-rater reliability. The scoring system may facilitate prospective, standardized clinical monitoring of immunosuppressive adverse drug effects in stable renal transplant recipients and improve medication adherence.

  8. Liver transplantation for HBsAg-positive recipients using grafts from HBsAg-positive deceased donors.

    PubMed

    Choi, YoungRok; Choi, Jong Young; Yi, Nam-Joon; Lee, Kyoungbun; Mori, Shozo; Hong, Geun; Kim, Hyeyoung; Park, Min-Su; Yoo, Tae; Suh, Suk-Won; Lee, Hae Won; Lee, Kwang-Woong; Suh, Kyung-Suk

    2013-12-01

    This study reports our experience using deceased donor liver grafts from HBsAg-positive donors. We performed eight cases of liver transplantation (LT) using grafts from deceased HBsAg-positive donors between November 2005 and October 2010. The median age of donors was 48 years (range: 26-64). HBV DNA in the serum of donors ranged from 44 to 395 IU/ml, but HBeAg in all donors was negative. Preoperative laboratory and liver biopsy samples revealed the absence of definitive cirrhotic features and hepatitis. All recipients showed HBsAg positive preoperatively except one patient with HBsAg(-) status post previous LT for HBV related liver cirrhosis. The median age was 60 years (range: 46-76) at LT. Post-LT antiviral management consisted of hepatitis B immunoglobulin and antiviral nucleos(t)ide analogues. The median follow-up period was 25.5 months (range: 14-82). Of eight recipients, two recipients experienced serum HBsAg and HBV DNA disappearance postoperatively. Three recipients died of HBV-unrelated causes. The remaining five recipients were stable with normal liver function and no marked pathologic changes on follow-up biopsies. This experience shows that LT using grafts from deceased HBsAg-positive donors is feasible, and may represent a valuable expansion of the pool of organ donors with appropriate antiviral management and monitoring. © 2013 Steunstichting ESOT. Published by John Wiley & Sons Ltd.

  9. The Academic Scholar Award of the American Association of Plastic Surgeons: the first 20 years.

    PubMed

    Sweeney, Walter M; Cederna, Paul S; Losee, Joseph E; Lee, W P Andrew; Katz, Adam J; Rubin, J Peter; Gosain, Arun K

    2015-02-01

    This study evaluated the 20-year history of the American Association of Plastic Surgeons Academic Scholar Award from 1992 through 2012, to assess the program's value and justify future investment. The curricula vitae of 18 Academic Scholars who completed their award by 2012 were analyzed. Data were compiled into 5-year blocks and reviewed. Award recipients has 589 grants, an average of 33 per recipient. Sixty-nine grants were active, and the recipient was the principal investigator in 61 of these grants. Active funding is $68 million. Recipients average 3.7 active grants per person, with a value of $3.8 million per grant. The average number of grants peaks at 5 to 10 years after award completion and then declines slightly to 42 at 10 to 15 years. During this time, total grant money increased from $956,667 to $8.1 million, suggesting that senior surgeons produce more money with fewer grants. Recipients produced 2378 peer-reviewed articles, and productivity was the highest 5 to 10 years after award completion. Three hundred forty-one individuals were mentored, and each recipient mentored an average of 18 individuals. Forty-two mentees entered academics, and 32 generated extramural funding. Scholars increased mentorship activity, as demonstrated by (1) increased grants as any role, (2) increased grant funding as any role, (3) increased median number of senior author publications, and (4) mentorship activities and accomplishments of mentees. The Academic Scholar program met its goals based on (1) Scholars' careers, (2) increased mentorship, and (3) cost-benefit ratio of the American Association of Plastic Surgeons investment. Every $1 invested produces $70, with a return that exceeds 1000 percent.

  10. Frequent occurrence of cytomegalovirus retinitis during immune reconstitution warrants regular ophthalmic screening in high-risk pediatric allogeneic hematopoietic stem cell transplant recipients.

    PubMed

    Hiwarkar, Prashant; Gajdosova, Eva; Qasim, Waseem; Worth, Austen; Breuer, Judith; Chiesa, Robert; Ridout, Deborah; Edelsten, Clive; Moore, Anthony; Amrolia, Persis; Veys, Paul; Rao, Kanchan

    2014-06-01

    Although cytomegalovirus (CMV) retinitis (CMVR) is a well-recognized complication after allogeneic hematopoietic stem cell transplantation (HSCT), standard operating procedures for ophthalmic monitoring are variable. In particular, authors perceived a greater risk of CMVR after pediatric HSCT for inherited immunodeficiencies, in patients who often have pretransplantation viremia. This study was therefore performed to identify high-risk pediatric HSCT recipients who would benefit from regular ophthalmic monitoring. During a 5-year study period, we retrospectively analyzed findings in 56 of 304 consecutive HSCT recipients (age range, 0.5-197 months) in whom significant CMV viremia developed (CMV level at PCR, ≥4000 copies/mL). All HSCT recipients with significant CMV viremia underwent retinal examination weekly (inpatients) or every other week (outpatients), with examinations performed by a skilled ophthalmologist. CMVR developed in 13 (4%) of 304 HSCT recipients, 23% (13 of 56) of those with significant CMV viremia. Pretransplant viremia (odds ratio, 11.3; P < .01), acute (grade ≥2) graft-vs-host disease (odds ratio, 8.2; P < .02) and mismatched graft (odds ratio, 8; P < .02) were identified as independent risk factors. Compared with other invasive CMV diseases, CMVR was more often a late-onset disease, occurring at a median of 199 days after HSCT. At diagnosis, a significantly higher CD4 T-cell count (≥200/µL; P < .03) and a lower CMV load (P < .004) was observed in children with CMVR, compared with those in whom lung, gut, or liver CMV disease developed. We report an increased risk of CMVR in high-risk pediatric HSCT recipients. This form of CMV disease differs from other invasive CMV disease in its relationship to immune reconstitution and viral dynamics. We have studied the relationship between these variables and suggested a risk-stratified ophthalmic screening strategy. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  11. Use of Lung Allografts From Donation After Cardiac Death Donors: A Single-Center Experience.

    PubMed

    Costa, Joseph; Shah, Lori; Robbins, Hilary; Raza, Kashif; Sreekandth, Sowmya; Arcasoy, Selim; Sonett, Joshua R; D'Ovidio, Frank

    2018-01-01

    Lung transplantation remains the only treatment for end-stage lung disease. Availability of suitable lungs does not parallel this growing trend. Centers using donation after cardiac death (DCD) donor lungs report comparable outcomes with those from brain-dead donors. Donor assessment protocols and consistent surgical teams have been advocated when considering using the use of DCD donors. We present our experience using lungs from Maastricht category III DCD donors. Starting 2007 to July 2016, 73 DCD donors were assessed, 44 provided suitable lungs that resulted in 46 transplants. A 2012 to October 2016 comparative cohort of 379 brain-dead donors were assessed. Recipient and donor characteristics and primary graft dysfunction (PGD) and survival were monitored. Seventy-three DCD (40% dry run rate) donors assessed yielded 46 transplants (23 double, 6 right, and 17 left). Comparative cohort of 379 brain-dead donors yielded 237 transplants (112 double, 43 right, and 82 left). One- and 3-year recipient survival was 91% and 78% for recipients of DCD lungs and 91% and 75% for recipients of lungs from brain-dead donors, respectively. PGD 2 and 3 in DCD recipients at 72 hours was 4 of 46 (9%) and 6 of 46 (13%), respectively. Comparatively, brain-dead donor recipient cohort at 72 hours with PGD 2 and 3 was 23 of 237 (10%) and 41 of 237 (17%), respectively. Our experience reaffirms the use of lungs from DCD donors as a viable source with favorable outcomes. Recipients from DCD donors showed equivalent PGD rate at 72 hours and survival compared with recipients from brain-dead donors. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. 76 FR 6597 - Agency Information Collection Activities: Proposed Collection; Comment Request-Healthy Incentives...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-07

    ...: The total estimated number of respondents is 2,945. This includes: 2,638 SNAP recipients who will...-hour dietary recall in rounds 2 and 3); an additional sample of 66 SNAP recipients who will participate... the SNAP recipients will complete a second 24-hour dietary recall on a nonconsecutive day. Stakeholder...

  13. 29 CFR 37.16 - What is this part's effect on a recipient's obligations under other laws, and what limitations...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 1 2012-07-01 2012-07-01 false What is this part's effect on a recipient's obligations... individual's participation in, any program or activity based on the recipient's belief or concern that the..., sex, national origin, age, disability, political affiliation or belief, or citizenship. ...

  14. 29 CFR 37.16 - What is this part's effect on a recipient's obligations under other laws, and what limitations...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 1 2011-07-01 2011-07-01 false What is this part's effect on a recipient's obligations... individual's participation in, any program or activity based on the recipient's belief or concern that the..., sex, national origin, age, disability, political affiliation or belief, or citizenship. ...

  15. 29 CFR 37.16 - What is this part's effect on a recipient's obligations under other laws, and what limitations...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 1 2013-07-01 2013-07-01 false What is this part's effect on a recipient's obligations... individual's participation in, any program or activity based on the recipient's belief or concern that the..., sex, national origin, age, disability, political affiliation or belief, or citizenship. ...

  16. 24 CFR 1000.108 - How is HUD approval obtained by a recipient for housing for non low-income Indian families and...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... recipient for housing for non low-income Indian families and model activities? 1000.108 Section 1000.108... AMERICAN HOUSING ACTIVITIES Affordable Housing Activities § 1000.108 How is HUD approval obtained by a.... Assistance to non low-income Indian families must be in accordance with § 1000.110. Proposals may be...

  17. Effects of recipient oocyte age and interval from fusion to activation on development of buffalo (Bubalus bubalis) nuclear transfer embryos derived from fetal fibroblasts.

    PubMed

    Lu, F; Jiang, J; Li, N; Zhang, S; Sun, H; Luo, C; Wei, Y; Shi, D

    2011-09-15

    The objective was to investigate the effect of recipient oocyte age and the interval from activation to fusion on developmental competence of buffalo nuclear transfer (NT) embryos. Buffalo oocytes matured in vitro for 22 h were enucleated by micromanipulation under the spindle view system, and a fetal fibroblast (pretreated with 0.1 μg/mL aphidicolin for 24 h, followed by culture for 48 h in 0.5% fetal bovine serum) was introduced into the enucleated oocyte, followed by electrofusion. Both oocytes and NT embryos were activated by exposure to 5 μM ionomycin for 5 min, followed by culture in 2 mM 6-dimethyl-aminopurine for 3 h. When oocytes matured in vitro for 28, 29, 30, 31, or 32 h were activated, more oocytes matured in vitro for 30 h developed into blastocysts in comparison with oocytes matured in vitro for 32 h (31.3 vs 19.9%, P < 0.05). When electrofusion was induced 27 h after the onset of oocyte maturation, the cleavage rate (78.0%) was higher than that of electrofusion induced at 28 h (67.2%, P < 0.05), and the blastocyst yield (18.1%) was higher (P < 0.05) than that of electrofusion induced at 25 or 26 h (7.4 and 8.5%, respectively). A higher proportion of NT embryos activated at 3 h after electrofusion developed to the blastocyst stage (18.6%) in comparison with NT embryos activated at 1 h (6.0%), 2 h (8.3%), or 4 h (10.6%) after fusion (P < 0.05). No recipient was pregnant 60 d after transfer of blastocysts developed from NT embryos activated at 1 h (0/8), 2 h (0/10), or 4 h (0/9) after fusion. However, 3 of 16 recipients were pregnant following transfer of blastocysts developed from the NT embryos activated at 3 h after fusion, and two of these recipients maintained pregnancy to term. We concluded that the developmental potential of buffalo NT embryos was related to recipient oocyte age and the interval from fusion to activation. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Held in contempt: the psychological, interpersonal, and performance consequences of contempt in a work context.

    PubMed

    Melwani, Shimul; Barsade, Sigal G

    2011-09-01

    Guided by a social function of emotions perspective, the authors examined a model of the psychological, interpersonal, and performance consequences of contempt in a series of 3 experiments that tested the outcomes of being a recipient of contempt in the work domain. In these experiments, participants engaged in a business strategy simulation with a virtual partner-a computer programmed to give contemptuous and other types of feedback. In Study 1, which examined the task performance and interpersonal outcomes of contempt, recipients of contempt had significantly better task performance but also significantly more interpersonal aggressiveness toward their virtual partners compared with recipients of failure, angry, or neutral feedback. Study 2 examined 3 psychological outcomes mediating the contempt-task performance/aggression relationship: self-esteem, returned feelings of contempt, and activation levels. Lowered levels of implicit self-esteem and greater levels of activation significantly mediated the relationship between receiving contempt and task performance, whereas the contempt-aggression relationship was mediated by lowered implicit self-esteem and increased feelings of returned contempt. Study 3 examined status as a moderator of these relationships. Low-status recipients had significantly better task performance than did equal-status recipients, who performed significantly better than did the high-status recipients of contempt. In addition, low-status recipients displayed significantly lower levels of aggression in response to contempt than did equal-status and high-status recipients. PsycINFO Database Record (c) 2011 APA, all rights reserved.

  19. Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation.

    PubMed

    Hoy, Sheridan M; Keating, Gillian M

    2011-07-30

    Dexmedetomidine (Precedex®), a pharmacologically active dextroisomer of medetomidine, is a selective α(2)-adrenergic receptor agonist. It is indicated in the US for the sedation of mechanically ventilated adult patients in an intensive care setting and in non-intubated adult patients prior to and/or during surgical and other procedures. This article reviews the pharmacological properties, therapeutic efficacy and tolerability of dexmedetomidine in randomized, double-blind, placebo-controlled, multicentre studies in these indications. Post-surgical patients in an intensive care setting receiving dexmedetomidine required less rescue sedation with intravenous propofol or intravenous midazolam to achieve and/or maintain optimal sedation during the assisted ventilation period than placebo recipients, according to two randomized, double-blind, multinational studies. Moreover, significantly more dexmedetomidine than placebo recipients acquired and/or maintained optimal sedation without rescue sedation. Sedation with dexmedetomidine was also effective in terms of the total dose of morphine administered, with dexmedetomidine recipients requiring less morphine than placebo recipients; with regard to patient management, dexmedetomidine recipients were calmer and easier to arouse and manage than placebo recipients. Intravenous dexmedetomidine was effective as a primary sedative in two randomized, double-blind, placebo-controlled, multicentre studies in adult patients undergoing awake fibre-optic intubation or a variety of diagnostic or surgical procedures requiring monitored anaesthesia care. In one study, significantly fewer dexmedetomidine than placebo recipients required rescue sedation with intravenous midazolam to achieve and/or maintain optimal sedation; conversely, in another study, rescue sedation with intravenous midazolam was not required by significantly more dexmedetomidine than placebo recipients. Primary sedation with intravenous dexmedetomidine was also effective in terms of the secondary efficacy endpoints, including the mean total dose of midazolam and fentanyl administered and the percentage of patients requiring further sedation (in addition to dexmedetomidine or placebo and midazolam), with, for the most part, significant between-group differences observed in favour of dexmedetomidine over placebo. In general, no significant differences were observed between the dexmedetomidine and placebo treatment groups in the anaesthesiologists' assessment of ease of intubation, haemodynamic stability, patient cooperation and/or respiratory stability. Intravenous dexmedetomidine is generally well tolerated when utilized in mechanically ventilated patients in an intensive care setting and for procedural sedation in non-intubated patients. Dexmedetomidine is associated with a lower rate of postoperative delirium than midazolam or propofol; it is not associated with respiratory depression. While dexmedetomidine is associated with hypotension and bradycardia, both usually resolve without intervention. Thus, intravenous dexmedetomidine provides a further option as a short-term (<24 hours) primary sedative in mechanically ventilated adult patients in an intensive care setting and in non-intubated adult patients prior to and/or during surgical and other procedures.

  20. 49 CFR 19.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... projects can be readily quantified, such quantitative data should be related to cost data for computation... information including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e... performance data from recipients. ...

  1. 22 CFR 518.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... projects can be readily quantified, such quantitative data should be related to cost data for computation... information including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e... performance data from recipients. ...

  2. Impacting Mediators of Change for Physical Activity among Elderly Food Stamp Recipients

    ERIC Educational Resources Information Center

    Dye, Cheryl J.; Williams, Joel E.; Kemper, Karen A.; McGuire, Francis A.; Aybar-Damali, Begum

    2012-01-01

    A multidisciplinary team developed and pilot-tested a curriculum, delivered by trained lay educators, to increase self-efficacy for physical activity among elderly food stamp recipients. Curriculum development was guided by a comprehensive literature review. Process evaluation was used to revise the curriculum and to assess lay educator training…

  3. Fecal Microbiota Transplantation for Refractory Clostridium difficile Colitis in Solid Organ Transplant Recipients

    PubMed Central

    Friedman-Moraco, R. J.; Mehta, A. K.; Lyon, G. M.; Kraft, C. S.

    2015-01-01

    Fecal microbiota transplantation (FMT) has been shown to be safe and efficacious in individuals with refractory Clostridium difficile . It has not been widely studied in individuals with immunosuppression due to concerns about infectious complications. We describe two solid organ transplant recipients, one lung and one renal, in this case report that both had resolution of their diarrhea caused by C. difficile after FMT. Both recipients required two FMTs to achieve resolution of their symptoms and neither had infectious complications. Immunosuppressed individuals are at high risk for acquisition of C. difficile and close monitoring for infectious complications after FMT is necessary, but should not preclude its use in patients with refractory disease due to C. difficile . Sequential FMT may be used to achieve cure in these patients with damaged microbiota from antibiotic use and immunosuppression. PMID:24433460

  4. Assistance Received by Employed Caregivers and Their Care Recipients: Who Helps Care Recipients when Caregivers Work Full Time?

    ERIC Educational Resources Information Center

    Scharlach, Andrew E.; Gustavson, Kristen; Dal Santo, Teresa S.

    2007-01-01

    Purpose: This study examined the association among caregiver labor force participation, employees' caregiving activities, and the amount and quality of care received by care recipients. Design and Methods: Telephone interviews were conducted with 478 adults who were employed full time and 705 nonemployed adults who provided care to a family member…

  5. 24 CFR 1000.36 - How long must a recipient retain records regarding exceptions made to the conflict of interest...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false How long must a recipient retain records regarding exceptions made to the conflict of interest provisions? 1000.36 Section 1000.36 Housing... AMERICAN HOUSING ACTIVITIES General § 1000.36 How long must a recipient retain records regarding exceptions...

  6. Serial perioperative cell-free DNA levels in donors and recipients undergoing living donor liver transplantation.

    PubMed

    Prakash, K; Aggarwal, S; Bhardwaj, S; Ramakrishna, G; Pandey, C K

    2017-10-01

    Effect of anaesthesia and surgery on cell-free DNA (cfDNA) is not known. Given that surgical stress augments inflammation and injury, we hypothesized that levels of cfDNA will fluctuate during perioperative period. Therefore, in this study serial perioperative cfDNA concentration was measured in donors and recipients undergoing living donor liver transplantation (LDLT). Baseline, post-induction, intraoperative and post-operative plasma cfDNA levels were evaluated in 21 donors and recipients each, by Sytox green method. In addition, qPCR was performed in a subset of samples. Baseline cfDNA levels were higher in recipients (37.62 ng/ml) than in donors (25.49 ng/ml). A decrease in cfDNA was observed following anaesthesia induction in both recipients (11.90 ng/ml) and donors (10.75 ng/ml). When the kinetics of the cfDNA was monitored further, an increase was noted intraoperatively in donors (46.18 ng/ml) and recipients (anhepatic phase: 56.25 ng/ml, reperfusion phase: 54.36 ng/ml). cfDNA levels remained high post-operatively. One recipient who developed post-operative sepsis had the highest cfDNA level (94.72 ng/ml). Plasma cfDNA levels are high in recipients indicative of liver injury. Lower cfDNA levels following induction may be attributed to the subduing effect of anaesthetic agents on cell death. High cfDNA levels seen in intra- and post-operative phases reflect cellular trauma and inflammation. This similar pattern of fluctuation of cfDNA level in donors and recipients is suggestive of its possible utility as a surgical stress marker. In addition, comparable cfDNA levels in anhepatic and reperfusion phase reflect less ischemia reperfusion injury during LDLT. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  7. Immunology Update: Long-Term Care of Solid Organ Transplant Recipients.

    PubMed

    Starr, S Paul

    2016-11-01

    Nearly 31,000 US patients received solid organ transplants in 2015 and the number is increasing. Care of transplant recipients includes management of a variety of common posttransplantation issues. Skin cancers are common because of immunosuppression and require skin examinations at intervals. Patients should be educated about the need to report new skin lesions. The rates of other cancers also are increased, including cancers of the head and neck, lung, esophagus, cervix, and urinary tract. Osteoporosis is common in transplant recipients; monitoring and early therapy are important. Patients should not smoke, and vaccinations should be current except for live-virus vaccines, which are contraindicated in patients with immunosuppression. Family physicians should be familiar with the posttransplantation immunosuppression drugs their patients are taking and know their adverse effects and drug interactions. For example, calcineurin inhibitors (eg, cyclosporine, tacrolimus) can impair renal function and increase rates of hypertension and myocardial ischemia. They also interact with statins, macrolide antibiotics, diltiazem, and other drugs. Interval laboratory testing is required to monitor the health of the transplanted organ (eg, renal function tests for kidney transplants, transaminases for liver transplants). Finally, clinicians should remain alert for development of opportunistic infection. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  8. Ambulatory blood pressure monitoring in solid organ transplantation.

    PubMed

    Ramesh Prasad, G V

    2012-01-01

    Solid organ transplant recipients are at an increased risk for hypertension and cardiovascular disease. To assist in their management, 24-h ambulatory blood pressure monitoring (ABPM) has become increasingly used in both clinical research settings and practice. ABPM has been used to better define post-transplant hypertension incidence and prevalence in different solid organ transplantation populations. ABPM provides additional information on cardiovascular risk beyond that obtained by clinic-based readings, based on its ability to assess 24-h blood pressure (BP) load, detect nocturnal non-dipping, and predict target organ damage. It has provided some assurance about the safety of living kidney donation. Information from ABPM can be used to guide living kidney donor selection, and because ABPM-related data has been correlated with clinically important kidney and heart transplant recipient outcomes, it may be a valuable adjunct in their management. Despite these advantages, barriers to wider use of ABPM include expense, clinical inertia in hypertension management, lack of prospective clinical trial data, and clinical problems that compete with hypertension for attention such as acute or chronic allograft dysfunction. The increasing amount of research and clinical use for ABPM may allow for closer assessment and intervention to help address the increased cardiovascular risk faced by many solid organ transplant recipients. © 2011 John Wiley & Sons A/S.

  9. Variation in active and passive resource inputs to experimental pools: mechanisms and possible consequences for food webs

    USGS Publications Warehouse

    Kraus, Johanna M.; Pletcher, Leanna T.; Vonesh, James R.

    2010-01-01

    1. Cross-ecosystem movements of resources, including detritus, nutrients and living prey, can strongly influence food web dynamics in recipient habitats. Variation in resource inputs is thought to be driven by factors external to the recipient habitat (e.g. donor habitat productivity and boundary conditions). However, inputs of or by ‘active’ living resources may be strongly influenced by recipient habitat quality when organisms exhibit behavioural habitat selection when crossing ecosystem boundaries. 2. To examine whether behavioural responses to recipient habitat quality alter the relative inputs of ‘active’ living and ‘passive’ detrital resources to recipient food webs, we manipulated the presence of caged predatory fish and measured biomass, energy and organic content of inputs to outdoor experimental pools of adult aquatic insects, frog eggs, terrestrial plant matter and terrestrial arthropods. 3. Caged fish reduced the biomass, energy and organic matter donated to pools by tree frog eggs by ∼70%, but did not alter insect colonisation or passive allochthonous inputs of terrestrial arthropods and plant material. Terrestrial plant matter and adult aquatic insects provided the most energy and organic matter inputs to the pools (40–50%), while terrestrial arthropods provided the least (7%). Inputs of frog egg were relatively small but varied considerably among pools and over time (3%, range = 0–20%). Absolute and proportional amounts varied by input type. 4. Aquatic predators can strongly affect the magnitude of active, but not passive, inputs and that the effect of recipient habitat quality on active inputs is variable. Furthermore, some active inputs (i.e. aquatic insect colonists) can provide similar amounts of energy and organic matter as passive inputs of terrestrial plant matter, which are well known to be important. Because inputs differ in quality and the trophic level they subsidise, proportional changes in input type could have strong effects on recipient food webs. 5. Cross-ecosystem resource inputs have previously been characterised as donor-controlled. However, control by the recipient food web could lead to greater feedback between resource flow and consumer dynamics than has been appreciated so far.

  10. Neurocultural evidence that ideal affect match promotes giving

    PubMed Central

    Park, BoKyung; Blevins, Elizabeth; Knutson, Brian

    2017-01-01

    Abstract Why do people give to strangers? We propose that people trust and give more to those whose emotional expressions match how they ideally want to feel (“ideal affect match”). European Americans and Koreans played multiple trials of the Dictator Game with recipients who varied in emotional expression (excited, calm), race (White, Asian) and sex (male, female). Consistent with their culture’s valued affect, European Americans trusted and gave more to excited than calm recipients, whereas Koreans trusted and gave more to calm than excited recipients. These findings held regardless of recipient race and sex. We then used fMRI to probe potential affective and mentalizing mechanisms. Increased activity in the nucleus accumbens (associated with reward anticipation) predicted giving, as did decreased activity in the right temporo-parietal junction (rTPJ; associated with reduced belief prediction error). Ideal affect match decreased rTPJ activity, suggesting that people may trust and give more to strangers whom they perceive to share their affective values. PMID:28379542

  11. Neurocultural evidence that ideal affect match promotes giving.

    PubMed

    Park, BoKyung; Blevins, Elizabeth; Knutson, Brian; Tsai, Jeanne L

    2017-07-01

    Why do people give to strangers? We propose that people trust and give more to those whose emotional expressions match how they ideally want to feel ("ideal affect match"). European Americans and Koreans played multiple trials of the Dictator Game with recipients who varied in emotional expression (excited, calm), race (White, Asian) and sex (male, female). Consistent with their culture's valued affect, European Americans trusted and gave more to excited than calm recipients, whereas Koreans trusted and gave more to calm than excited recipients. These findings held regardless of recipient race and sex. We then used fMRI to probe potential affective and mentalizing mechanisms. Increased activity in the nucleus accumbens (associated with reward anticipation) predicted giving, as did decreased activity in the right temporo-parietal junction (rTPJ; associated with reduced belief prediction error). Ideal affect match decreased rTPJ activity, suggesting that people may trust and give more to strangers whom they perceive to share their affective values. © The Author (2017). Published by Oxford University Press.

  12. [Retrospective study of the implementation of the qualitative PCR technique in biological samples for monitoring toxoplasmosis in pediatric patients receiving hematopoietic stem cell transplantation].

    PubMed

    Nigro, Mónica G; Figueroa, Carlos; Ledesma, Bibiana A

    2014-01-01

    Toxoplasmosis is an opportunistic infection caused by the parasite Toxoplasma gondii. The infection is severe and difficult to diagnose in patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Twelve patients receiving HSCT were monitored post-transplant, by qualitative PCR at the Children's Hospital S.A.M.I.C. "Prof. Dr. Juan P. Garrahan". The monitoring of these patients was defined by a history of positive serology for toxoplasmosis in the donor or recipient and because their hematologic condition did not allow the use of trimethoprim-sulfamethoxazole for prophylaxis. During the patients' monitoring, two of them with positive PCR results showed signs of illness by T. gondii and were treated with pyrimethamine-clindamycin. In two other patients, toxoplasmosis was the cause of death and an autopsy finding, showing negative PCR results. Four patients without clinical manifestations received treatment for toxoplasmosis because of positive PCR detection. In four patients there were no signs of toxoplasmosis disease and negative PCR results during follow-up. The qualitative PCR technique proved useful for the detection of toxoplasmosis reactivation in HSCT recipients, but has limitations in monitoring and making clinical decisions due to the persistence of positive PCR over time and manifestations of toxicity caused by the treatment. Copyright © 2014 Asociación Argentina de Microbiología. Publicado por Elsevier España. All rights reserved.

  13. Use of video-based education and tele-health home monitoring after liver transplantation: Results of a novel pilot study.

    PubMed

    Ertel, Audrey E; Kaiser, Tiffany E; Abbott, Daniel E; Shah, Shimul A

    2016-10-01

    In this observational study, we analyzed the feasibility and early results of a perioperative, video-based educational program and tele-health home monitoring model on postoperative care management and readmissions for patients undergoing liver transplantation. Twenty consecutive liver transplantation recipients were provided with tele-health home monitoring and an educational video program during the perioperative period. Vital statistics were tracked and monitored daily with emphasis placed on readings outside of the normal range (threshold violations). Additionally, responses to effectiveness questionnaires were collected retrospectively for analysis. In the study, 19 of the 20 patients responded to the effectiveness questionnaire, with 95% reporting having watched all 10 videos, 68% watching some more than once, and 100% finding them effective in improving their preparedness for understanding their postoperative care. Among these 20 patients, there was an observed 19% threshold violation rate for systolic blood pressure, 6% threshold violation rate for mean blood glucose concentrations, and 8% threshold violation rate for mean weights. This subset of patients had a 90-day readmission rate of 30%. This observational study demonstrates that tele-health home monitoring and video-based educational programs are feasible in liver transplantation recipients and seem to be effective in enhancing the monitoring of vital statistics postoperatively. These data suggest that smart technology is effective in creating a greater awareness and understanding of how to manage postoperative care after liver transplantation. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Electrical Integration of Human Embryonic Stem Cell-Derived Cardiomyocytes in a Guinea Pig Chronic Infarct Model

    PubMed Central

    Shiba, Yuji; Filice, Dominic; Fernandes, Sarah; Minami, Elina; Dupras, Sarah K.; Van Biber, Benjamin; Trinh, Peter; Hirota, Yusuke; Gold, Joseph D.; Viswanathan, Mohan; Laflamme, Michael A.

    2014-01-01

    Background Human embryonic stem cell-derived cardiomyocytes (hESC-CMs) were recently shown to be capable of electromechanical integration following their direct injection into intact or recently injured guinea pig hearts, and hESC-CM transplantation in recently injured hearts correlated with improvements in contractile function and a reduction in the incidence of arrhythmias. The present study was aimed at determining the ability of hESC-CMs to integrate and modulate electrical stability following transplantation in a chronic model of cardiac injury. Methods & Results At 28 days following cardiac cryoinjury, guinea pigs underwent intra-cardiac injection of hESC-CMs, non-cardiac hESC-derivatives (non-CMs) or vehicle. Histology confirmed partial remuscularization of the infarct zone in hESC-CM recipients, while non-CM recipients showed heterogeneous xenografts. The three experimental groups showed no significant difference in the left ventricular dimensions or fractional shortening by echocardiography or in the incidence of spontaneous arrhythmias by telemetric monitoring. While recipients of hESC-CMs and vehicle showed a similar incidence of arrhythmias induced by programmed electrical stimulation at 4-weeks post-transplantation, non-CM recipients proved to be highly inducible, with a ~3-fold greater incidence of induced arrhythmias. In parallel studies, we investigated the ability of hESC-CMs to couple with host myocardium in chronically injured hearts by the intravital imaging of hESC-CM grafts that stably expressed a fluorescent reporter of graft activation, the genetically-encoded calcium sensor GCaMP3. In this work, we found that only ~38% (5 of 13) of recipients of GCaMP3+ hESC-CMs showed fluorescent transients that were coupled to the host electrocardiogram. Conclusions hESC-CMs engraft in chronically injured hearts without increasing the incidence of arrhythmias, but their electromechanical integration is more limited than was previously reported following their transplantation in a subacute injury model. Moreover, non-CM grafts may promote arrhythmias under certain conditions, a finding that underscores the need for input preparations of high cardiac purity. PMID:24516260

  15. Inflammation and Atherosclerosis Are Associated With Hypertension in Kidney Transplant Recipients.

    PubMed

    Azancot, Maria A; Ramos, Natalia; Torres, Irina B; García-Carro, Clara; Romero, Katheryne; Espinel, Eugenia; Moreso, Francesc; Seron, Daniel

    2015-12-01

    The aim of the current study was to evaluate risk factors associated with hypertension in kidney transplant recipients. The authors recruited 92 consecutive kidney transplant recipients and 30 age-matched patients with chronic kidney disease without history of cardiovascular events. Twenty-four-hour ambulatory blood pressure monitoring, pulse wave velocity, and carotid ultrasound were performed. Serum levels of log-transformed interleukin 6 (Log IL-6), soluble tumor necrosis factor receptor 2, and intercellular adhesion molecule 1 were determined. Twenty-four-hour systolic blood pressure (SBP) (P=.0001), Log IL-6 (P=.011), and total number of carotid plaques (P=.013) were higher, while the percentage decline of SBP from day to night was lower in kidney transplant recipients (P=.003). Independent predictors of 24-hour SBP were urinary protein/creatinine ratio and circulating monocytes (P=.001), while Log IL-6, serum creatinine, and total number of carotid plaques (P=.0001) were independent predictors of percentage decline of SBP from day to night. These results suggest that subclinical atherosclerosis and systemic inflammation are associated with hypertension after transplantation. © 2015 Wiley Periodicals, Inc.

  16. Clinical impact of culture-positive preservation fluid on solid organ transplantation: A systematic review and meta-analysis.

    PubMed

    Oriol, Isabel; Sabé, N; Tebé, C; Veroux, M; Boin, I F S F; Carratalà, J

    2018-04-01

    Contamination of the preservation fluid (PF) used for donated organs is a potential source of post-transplant infection. However, the information on this issue is scarce. We therefore conducted a systematic review and meta-analysis to assess the incidence of culture-positive PF and its impact on solid organ transplant (SOT) recipients. Seventeen studies were identified and included. The overall incidence of culture-positive PF was 37% (95% CI: 27% to 49%), and the incidence of PF-related infections among SOT recipients with PF cultures that grew pathogenic microorganisms was 10% (95% CI: 7% to 15%). There were differences in the rates of infections due to pathogenic microorganisms between SOT recipients who received pre-emptive treatment and those who did not, but without statistical significance. The mortality rate among SOT recipients with PF-related infection was 35% (95% CI: 21% to 53%). In conclusion, although contamination of the PF of donated organs is frequent, the incidence of PF-related infection is relatively low. A closely clinical and microbiologic monitoring of the SOT recipient in case of culture-positive PF, regardless of the type of microorganism isolated might be do in order to establish a prompt diagnosis of PF-related infection. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Pregnancy outcomes among solid organ transplant recipients in British Columbia.

    PubMed

    Humphreys, Robert A; Wong, Helen H L; Milner, Ruth; Matsuda-Abedini, Mina

    2012-05-01

    Since 1954, over 14 000 women have given birth after having had an organ transplantation. Unfortunately, some women and physicians remain misinformed about the feasibility and outcomes of pregnancy post transplantation. Our primary objective was to assess their perceptions and difficulties with regard to becoming pregnant. Our secondary objectives were to determine the incidence of pregnancies among transplant recipients in British Columbia and any maternal, graft, or fetal complications. From 1997 to 2007 in British Columbia, there were over 500 female recipients of solid organ transplants. We surveyed recipients in this group who were of child-bearing age. One hundred forty of 295 (47%) eligible recipients responded: 44 of these women had attempted pregnancy after transplant, and 31 women gave birth to 47 children. One half of the respondents planned to have children post transplant; 108 of 140 (77%) had no children before transplant. One quarter of the respondents were advised against pregnancy by their physician, and 33% of these women found a new physician to support their pregnancy. Rates of miscarriage (27%), rejection (21%), and prematurity (65%) were higher than expected. Infections were rare, and no birth defects or noteworthy health problems in the offspring were reported. Overall, pregnancy appears to be safe following solid organ transplantation, but careful monitoring and counselling are recommended.

  18. 24 CFR 84.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... programs or projects can be readily quantified, such quantitative data should be related to cost data for... information including, when appropriate, analysis and explanation of cost overruns or high unit costs. (e... when requesting performance data from recipients. ...

  19. Longitudinal analysis of physical activity, fluid intake, and graft function among kidney transplant recipients

    PubMed Central

    Gordon, Elisa J.; Prohaska, Thomas R.; Gallant, Mary P.; Sehgal, Ashwini R.; Strogatz, David; Yucel, Recai; Conti, David; Siminoff, Laura A.

    2010-01-01

    Summary Self-care is recommended to kidney transplant recipients as a vital component to maintain long-term graft function. However, little is known about the effects of physical activity, fluid intake, and smoking history on graft function. This longitudinal study examined the relationship between self-care practices on graft function among 88 new kidney transplant recipients in Chicago, IL and Albany, NY between 2005 and 2008. Participants were interviewed, completed surveys, and medical charts were abstracted. Physical activity, fluid intake, and smoking history at baseline were compared with changes in estimated glomerular filtration rate (eGFR) (every 6 months up to 1 year) using bivariate and multivariate regression analysis, while controlling for sociodemographic and clinical transplant variables. Multivariate analyses revealed that greater physical activity was significantly (P < 0.05) associated with improvement in GFR at 6 months; while greater physical activity, absence of smoking history, and nonwhite ethnicity were significant (P < 0.05) predictors of improvement in GFR at 12 months. These results suggest that increasing physical activity levels in kidney recipients may be an effective behavioral measure to help ensure graft functioning. Our findings suggest the need for a randomized controlled trial of exercise, fluid intake, and smoking history on GFR beyond 12 months. PMID:19619168

  20. Longitudinal analysis of physical activity, fluid intake, and graft function among kidney transplant recipients.

    PubMed

    Gordon, Elisa J; Prohaska, Thomas R; Gallant, Mary P; Sehgal, Ashwini R; Strogatz, David; Yucel, Recai; Conti, David; Siminoff, Laura A

    2009-10-01

    Self-care is recommended to kidney transplant recipients as a vital component to maintain long-term graft function. However, little is known about the effects of physical activity, fluid intake, and smoking history on graft function. This longitudinal study examined the relationship between self-care practices on graft function among 88 new kidney transplant recipients in Chicago, IL and Albany, NY between 2005 and 2008. Participants were interviewed, completed surveys, and medical charts were abstracted. Physical activity, fluid intake, and smoking history at baseline were compared with changes in estimated glomerular filtration rate (eGFR) (every 6 months up to 1 year) using bivariate and multivariate regression analysis, while controlling for sociodemographic and clinical transplant variables. Multivariate analyses revealed that greater physical activity was significantly (P < 0.05) associated with improvement in GFR at 6 months; while greater physical activity, absence of smoking history, and nonwhite ethnicity were significant (P < 0.05) predictors of improvement in GFR at 12 months. These results suggest that increasing physical activity levels in kidney recipients may be an effective behavioral measure to help ensure graft functioning. Our findings suggest the need for a randomized controlled trial of exercise, fluid intake, and smoking history on GFR beyond 12 months.

  1. Newly acquired kiwi fruit allergy after bone marrow transplantation from a kiwi-allergic donor.

    PubMed

    Garzorz, N; Thomas, J; Eberlein, B; Haferlach, C; Ring, J; Biedermann, T; Schmidt-Weber, C; Eyerich, K; Seifert, F; Eyerich, S

    2016-07-01

    The phenomenon of allergy transfer from an allergic donor to a non-allergic recipient via hematopoietic cell transplantation has been described by several reports. However, it could not yet been conclusively shown that allergic reaction of the recipient is elicited by the donor's cells. In the case of a 46-year-old male patient who - for the first time in his life - had two episodes of oral allergic syndrome upon kiwi consumption after having received myeloablative hematopoietic stem cell transplantation (HCT) from his kiwi-allergic sister, we aimed to clarify the origin of allergen reactive cells in the donor. We not only intended to demonstrate if allergy was transferred by HCT but also to present an experimental workup for the analysis of allergy transfer by HCT. Allergic sensitization to kiwi in recipient and donor was proven by ImmunoCAP. Furthermore, origin of peripheral blood mononuclear cells (PBMCs) was analyzed by chromosomal fluorescence in situ hybridization (FISH). To confirm allergic reaction and activation of hematopoietic cells by customized kiwi extract, we performed basophil activation test from whole blood as well as T cell proliferation assays from purified PBMCs of both recipient and donor. Basophil activation upon kiwi extract was demonstrated in both recipient and donor. Besides, we showed proliferation of CD4(+) T cells after incubation with kiwi extract. FISH analysis proved that hematopoietic cells of the male recipient completely originated from the female donor. Exemplified in this patient, we show for the first time that allergy transfer is mediated by the donor's cells. Moreover, our experimental approach using customized kiwi extract to prove contribution of kiwi-specific T and B cells in both kiwi-allergic recipient and donor could serve as a model approach for future studies. © 2016 European Academy of Dermatology and Venereology.

  2. Solid organ transplantation: referral, management, and outcomes in HIV-infected patients.

    PubMed

    Roland, Michelle E; Carlson, Laurie L; Frassetto, Lynda A; Stock, Peter G

    2006-12-01

    Advances in HIV management make it difficult to deny solid organ transplantation to HIV-infected patients based on futility arguments. Preliminary studies suggest that both patient and graft survival are similar in HIV-negative and HIV-positive transplant recipients. While there has been no significant HIV disease progression, substantial interactions between immunosuppressants and antiretroviral drugs necessitate careful monitoring. The evaluation and management of HIV-infected transplant candidates and recipients require excellent communication among a multidisciplinary team, the primary HIV care provider, and the patient. Timely referral for transplant evaluation will prevent unnecessary mortality during the pre-transplant evaluation process.

  3. 34 CFR 359.11 - What activities must each recipient carry out under this program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false What activities must each recipient carry out under this program? 359.11 Section 359.11 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION DISABILITY AND REHABILITATION RESEARCH: SPECIAL PROJECT...

  4. A fast and simple method for detecting and quantifying donor-derived cell-free DNA in sera of solid organ transplant recipients as a biomarker for graft function.

    PubMed

    Adamek, Martina; Opelz, Gerhard; Klein, Katrin; Morath, Christian; Tran, Thuong Hien

    2016-07-01

    Timely detection of graft rejection is an important issue in the follow-up care after solid organ transplantation. Until now, biopsy has been considered the "gold standard" in the diagnosis of graft rejection. However, non-invasive tests such as monitoring the levels of cell-free DNA (cfDNA) as a sensitive biomarker for graft integrity have attracted increasing interest. The rationale of this approach is that a rejected organ will lead to a significant release of donor-derived cfDNA, which can be detected in the serum of the transplant recipient. We have developed a novel quantitative real-time PCR (qPCR) approach for detecting an increase of donor-derived cfDNA in the recipient's serum. Common insertion/deletion (InDel) genetic polymorphisms, which differ between donor and recipient, are targeted in our qPCR assay. In contrast to some other strategies, no specific donor/recipient constellations such as certain gender combinations or human leukocyte antigen (HLA) discrepancies are required for the application of our test. The method was first validated with serial dilutions of serum mixtures obtained from healthy blood donors and then used to determine donor-derived cfDNA levels in patients' sera within the first 3 days after their kidney transplantation had been performed. Our method represents a universally applicable, simple and cost-effective tool which can potentially be used to detect graft dysfunction in transplant recipients.

  5. Predicting renal graft failure by sCD30 levels and de novo HLA antibodies at 1year post-transplantation.

    PubMed

    Wang, Dong; Wu, Guojun; Chen, Jinhua; Yu, Ziqiang; Wu, Weizhen; Yang, Shunliang; Tan, Jianming

    2012-06-01

    HLA antibodies and sCD30 levels were detected in the serum sampled from 620 renal graft recipients at 1 year post-transplantation, which were followed up for 5 years. Six-year graft and patient survivals were 81.6% and 91.0%. HLA antibodies were detected in 45 recipients (7.3%), of whom there were 14 cases with class I antibodies, 26 cases with class II, and 5 cases with both class I and II. Much more graft loss was record in recipients with HLA antibodies than those without antibodies (60% vs. 15.1%, p<0.001). Significantly higher sCD30 levels were recorded in recipients suffering graft loss than the others (73.9±48.8 U/mL vs. 37.3±14.6 U/mL, p<0.001). Compared with those with high sCD30 levels, recipients with low sCD30 levels (<50 U/mL) had much better 6-year graft survival (92.4% vs. 46.6%, p<0.001). Further statistical analysis showed that detrimental effect of de novo HLA antibodies and high sCD30 on graft survival was not only independent but also additive. Therefore, post-transplantation monitoring of HLA antibodies and sCD30 levels is necessary and recipients with elevated sCD30 level and/or de novo HLA antibody should be paid more attention in order to achieve better graft survival. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Temporal Coupling with Cortex Distinguishes Spontaneous Neuronal Activities in Identified Basal Ganglia-Recipient and Cerebellar-Recipient Zones of the Motor Thalamus

    PubMed Central

    Nakamura, Kouichi C.; Sharott, Andrew; Magill, Peter J.

    2014-01-01

    Neurons of the motor thalamus mediate basal ganglia and cerebellar influences on cortical activity. To elucidate the net result of γ-aminobutyric acid-releasing or glutamatergic bombardment of the motor thalamus by basal ganglia or cerebellar afferents, respectively, we recorded the spontaneous activities of thalamocortical neurons in distinct identified “input zones” in anesthetized rats during defined cortical activity states. Unexpectedly, the mean rates and brain state dependencies of the firing of neurons in basal ganglia-recipient zone (BZ) and cerebellar-recipient zone (CZ) were matched during slow-wave activity (SWA) and cortical activation. However, neurons were distinguished during SWA by their firing regularities, low-threshold spike bursts and, more strikingly, by the temporal coupling of their activities to ongoing cortical oscillations. The firing of neurons across the BZ was stronger and more precisely phase-locked to cortical slow (∼1 Hz) oscillations, although both neuron groups preferentially fired at the same phase. In contrast, neurons in BZ and CZ fired at different phases of cortical spindles (7–12 Hz), but with similar strengths of coupled firing. Thus, firing rates do not reflect the predicted inhibitory–excitatory imbalance across the motor thalamus, and input zone-specific temporal coding through oscillatory synchronization with the cortex could partly mediate the different roles of basal ganglia and cerebellum in behavior. PMID:23042738

  7. 38 CFR 18.437 - Nonacademic services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... include counseling services, physical recreational athletics, transportation, health services, recreational activities, special interest groups or clubs sponsored by the recipient, referrals to agencies... by the recipient and assistance in making available outside employment. (b) Counseling services...

  8. 34 CFR 104.37 - Nonacademic services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... include counseling services, physical recreational athletics, transportation, health services, recreational activities, special interest groups or clubs sponsored by the recipients, referrals to agencies... by the recipient and assistance in making available outside employment. (b) Counseling services. A...

  9. 24 CFR 58.72 - HUD or State actions on RROFs and certifications.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... responsible entity or other participants in the development process have not complied with the items in § 58... certification and RROF but subsequently learns (e.g., through monitoring) that the recipient violated § 58.22 or...

  10. 45 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... two copies of performance reports. (f) Recipients shall immediately notify the HHS awarding agency of... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR AWARDS AND SUBAWARDS TO INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NONPROFIT ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and...

  11. 45 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... two copies of performance reports. (f) Recipients shall immediately notify the HHS awarding agency of... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR AWARDS AND SUBAWARDS TO INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NONPROFIT ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and...

  12. 45 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... two copies of performance reports. (f) Recipients shall immediately notify the HHS awarding agency of... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR AWARDS AND SUBAWARDS TO INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NONPROFIT ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and...

  13. 45 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... two copies of performance reports. (f) Recipients shall immediately notify the HHS awarding agency of... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR AWARDS AND SUBAWARDS TO INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NONPROFIT ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and...

  14. FY2014 National Clean Diesel Funding Assistance (Diesel Emissions Reduction Act) Programmatic Terms and Conditions

    EPA Pesticide Factsheets

    Substantial federal involvement will take the form of monitoring the project by EPA, participation and collaboration between EPA and the recipient in program content, review of project progress, and quantification and reporting ofresults.

  15. Pharmacokinetics of prolonged-release tacrolimus and implications for use in solid organ transplant recipients.

    PubMed

    Tanzi, Maria G; Undre, Nasrullah; Keirns, James; Fitzsimmons, William E; Brown, Malcolm; First, M Roy

    2016-08-01

    Prolonged-release tacrolimus was developed as a once-daily formulation with ethylcellulose as the excipient, resulting in slower release and reduction in peak concentration (Cmax ) for a given dose compared with immediate-release tacrolimus, which is administered twice daily. This manuscript reviews pharmacokinetic information on prolonged-release tacrolimus in healthy subjects, in transplant recipients converted from immediate-release tacrolimus, and in de novo kidney and liver transplant recipients. As with the immediate-release formulation, prolonged-release tacrolimus shows a strong correlation between trough concentration (Cmin ) and area under the 24-hour time-concentration curve (AUC24 ), indicating that trough whole blood concentrations provide an accurate measure of drug exposure. We present the pharmacokinetic similarities and differences between the two formulations, so that prescribing physicians will have a better understanding of therapeutic drug monitoring in patients receiving prolonged-release tacrolimus. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Risk factors and long-term outcomes of pediatric liver transplant recipients with chronic high Epstein-Barr virus loads.

    PubMed

    Kamei, Hideya; Ito, Yoshinori; Kawada, Junichi; Ogiso, Satoshi; Onishi, Yasuharu; Komagome, Masahiko; Kurata, Nobuhiko; Ogura, Yasuhiro

    2018-04-20

    Serial monitoring of Epstein-Barr virus (EBV) reveals that certain pediatric liver transplant (LT) recipients exhibit high EBV loads for long periods. We investigated the incidence and risk factors of chronic high EBV (CHEBV) loads (continuous EBV DNA >10 000 IU/mL of whole blood for ≥6 months) and long-term outcomes. This single center, retrospective observational study investigated pediatric LT recipients who survived ≥6 months. We quantitated EBV DNA weekly during hospitalization and subsequently every 4 or 6 weeks at the outpatient clinic. Tacrolimus was maintained at a low trough level (<3 ng/mL, EBV DNA load >5000 IU/mL). Thirty-one of 77 LT recipients developed CHEBV. Univariate analysis revealed that age <2 years and body weight <10 kg upon LT, operation time <700 minutes, warm ischemia time (WIT) >35 minutes, graft-to-recipient weight ratio (GRWR) >2.7%, and preoperative EBV seronegativity were significantly associated with the development of CHEBV loads. Multivariate analysis identified significant associations of CHEBV with WIT >35 minutes, GRWR >2.7%, and preoperative seronegative. None of the recipients developed post-transplantation lymphoproliferative disorder. Survival rates of patients with and without CHEBV loads were not significantly different. A significant number of pediatric LT recipients developed CHEBV loads. Long WIT, high GRWR, and preoperative EBV seronegativity were significantly associated with the development of CHEBV loads. Although the long-term outcomes of patients with or without CHEBV loads were not significantly different, further studies of more subjects are warranted. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Cytomegalovirus (CMV) immune monitoring with ELISPOT and QuantiFERON-CMV assay in seropositive kidney transplant recipients

    PubMed Central

    Ryu, Ji Hyeong; Choi, Ae-Ran; Yu, Ji Hyun; Lim, Jihyang; Han, Kyungja; Kim, Sang Il; Yang, Chul Woo; Chung, Byung Ha

    2017-01-01

    Although cytomegalovirus (CMV) specific cell-mediated immunity (CMI) has been suggested as a predictive marker for CMV infection, proper CMI monitoring strategy in CMV-seropositive recipients and optimal method are not defined. The aim of this study was to evaluate two interferon gamma release assays during early post-transplant period as a predictor of the development of CMV infection in CMV-seropositive patients. A total of 124 CMV-seropositive recipients who received kidney transplantation from CMV-seropositive donor were prospectively examined. At pre-transplant and post-transplant 1 and 3 months, CMV-CMIs were tested using QuantiFERON-CMV assay (QF-CMV) and CMV specific T cell ELISPOT against CMV pp65 and IE-1 antigens (pp65-ELISPOT, IE-1-ELISPOT). CMV DNAemia occurred in 16 (12.9%) patients within 3 months after transplant. Post-transplant pp65 or IE-1 ELISPOT response, but not QF-CMV, was significantly associated with CMV DNAemia. The pp65 ELISPOT (cut-off; 30 spots/200,000 cells) and IE-1 ELISPOT (10 spots/200,000 cells) at post-transplant 1 month predicted the risk of post-transplant CMV DNAemia (P = 0.019). Negative predictive values (NPV) for protection from CMV DNAemia in case of positive ELISPOT results were 94.5% (95% CI: 86.9–97.8%) and 97.6% (95% CI: 86.3–99.6%) in pp65-ELISPOT and IE-1-ELISPOT assays, respectively. These results suggest that the variability may exist between CMV ELISPOT assays and QF-CMV, and CMV ELISPOT at post-transplant 1 month can identify the risk of CMV DNAemia in seropositive kidney transplant recipients. PMID:29232714

  18. Cytomegalovirus (CMV) immune monitoring with ELISPOT and QuantiFERON-CMV assay in seropositive kidney transplant recipients.

    PubMed

    Lee, Hyeyoung; Park, Ki Hyun; Ryu, Ji Hyeong; Choi, Ae-Ran; Yu, Ji Hyun; Lim, Jihyang; Han, Kyungja; Kim, Sang Il; Yang, Chul Woo; Chung, Byung Ha; Oh, Eun-Jee

    2017-01-01

    Although cytomegalovirus (CMV) specific cell-mediated immunity (CMI) has been suggested as a predictive marker for CMV infection, proper CMI monitoring strategy in CMV-seropositive recipients and optimal method are not defined. The aim of this study was to evaluate two interferon gamma release assays during early post-transplant period as a predictor of the development of CMV infection in CMV-seropositive patients. A total of 124 CMV-seropositive recipients who received kidney transplantation from CMV-seropositive donor were prospectively examined. At pre-transplant and post-transplant 1 and 3 months, CMV-CMIs were tested using QuantiFERON-CMV assay (QF-CMV) and CMV specific T cell ELISPOT against CMV pp65 and IE-1 antigens (pp65-ELISPOT, IE-1-ELISPOT). CMV DNAemia occurred in 16 (12.9%) patients within 3 months after transplant. Post-transplant pp65 or IE-1 ELISPOT response, but not QF-CMV, was significantly associated with CMV DNAemia. The pp65 ELISPOT (cut-off; 30 spots/200,000 cells) and IE-1 ELISPOT (10 spots/200,000 cells) at post-transplant 1 month predicted the risk of post-transplant CMV DNAemia (P = 0.019). Negative predictive values (NPV) for protection from CMV DNAemia in case of positive ELISPOT results were 94.5% (95% CI: 86.9-97.8%) and 97.6% (95% CI: 86.3-99.6%) in pp65-ELISPOT and IE-1-ELISPOT assays, respectively. These results suggest that the variability may exist between CMV ELISPOT assays and QF-CMV, and CMV ELISPOT at post-transplant 1 month can identify the risk of CMV DNAemia in seropositive kidney transplant recipients.

  19. Unaltered repopulation properties of mouse hematopoietic stem cells transduced with lentiviral vectors

    PubMed Central

    Gonzalez-Murillo, Africa; Lozano, M. Luz; Montini, Eugenio; Bueren, Juan A.

    2008-01-01

    Recent studies of retroviral-mediated gene transfer have shown that retroviral integrations themselves may trigger nonmalignant clonal expansion of hematopoietic stem cells (HSCs) in transplant recipients. These observations suggested that previous conclusions of HSC dynamics based on gamma-retroviral gene marking should be confirmed with improved vectors having a more limited capacity to transactivate endogenous genes. Because of the low trans-activation activity of self-inactivating lentiviral vectors (LVs), we have investigated whether the LV marking of mouse HSCs induces a competitive repopulation advantage in recipients of serially transplants. As deduced from analyses conducted in primary and secondary recipients, we concluded that lentivirally transduced HSCs have no competitive repopulation advantages over untransduced HSCs. By linear amplification-mediated polymerase chain reaction (LAM-PCR) analysis, we characterized LV-targeted genes in HSC clones that engrafted up to quaternary recipients. Although 9 clones harbored integrations close to defined retroviral insertion sites, none was characterized as a common integration site, and none was present in HSC clones repopulating quaternary recipients. Taken together, our results show unaltered repopulation properties of HSCs transduced with LVs, and confirm early studies suggesting the natural capacity of a few HSC clones to generate a monoclonal or oligoclonal hematopoiesis in transplant recipients. PMID:18684860

  20. Terms and conditions for Diesel Emissions Reduction Act Smartway financing projects where an eligible nonprofit grantee is implementing a loan program and loan Recipients will use the loan funds for activities that trigger Davis Bacon

    EPA Pesticide Factsheets

    Use this T&C for DERA Smartway financing projects where an eligible nonprofit grantee is implementing a loan program and loan Recipients will use the loan funds for activities that trigger Davis Bacon.

  1. The Global Fund's paradigm of oversight, monitoring, and results in Mozambique.

    PubMed

    Warren, Ashley; Cordon, Roberto; Told, Michaela; de Savigny, Don; Kickbusch, Ilona; Tanner, Marcel

    2017-12-12

    The Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients' misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of discussions with key stakeholders on the Global Fund, its paradigm of oversight, monitoring, and results in Mozambique. We conducted 38 semi-structured in-depth interviews in Maputo, Mozambique and members of the Global Fund Board and Secretariat in Switzerland. In-country stakeholders were representatives from Global Fund country structures (eg. Principle Recipient), the Ministry of Health, health or development attachés bilateral and multilateral agencies, consultants, and the NGO coordinating body. Thematic coding revealed concerns about the combination of weak country oversight with stringent and cumbersome requirements for monitoring and evaluation linked to performance-based financing. Analysis revealed that despite the changes associated with the New Funding Model, respondents in both Maputo and Geneva firmly believe challenges remain in Global Fund's structure and paradigm. The lack of a country office has many negative downstream effects including reliance on in-country partners and ineffective coordination. Due to weak managerial and absorptive capacity, more oversight is required than is afforded by country team visits. In-country partners provide much needed support for Global Fund recipients, but roles, responsibilities, and accountability must be clearly defined for a successful long-term partnership. Furthermore, decision-makers in Geneva recognize in-country coordination as vital to successful implementation, and partners welcome increased Global Fund engagement. To date, there are no institutional requirements for formalized coordination, and the Global Fund has no consistent representation in Mozambique's in-country coordination groups. The Global Fund should adapt grant implementation and monitoring procedures to the specific local realities that would be illuminated by more formalized coordination.

  2. Effects of interval between fusion and activation, cytochalasin B treatment, and number of transferred embryos, on cloning efficiency in goats.

    PubMed

    Liu, J; Li, L L; Du, S; Bai, X Y; Zhang, H D; Tang, S; Zhao, M T; Ma, B H; Quan, F S; Zhao, X E; Zhang, Y

    2011-10-01

    To improve the efficiency of somatic cell nuclear transfer (SCNT) in goats, we evaluated the effects of the interval between fusion and activation (1 to 5 h), cytochalasin B (CB) treatment after electrofusion, and the number of transferred embryos on the in vivo and in vitro development of cloned caprine embryos. The majority of the reconstructed embryos had condensed chromosomes and metaphase-like chromosomes at 2 and 3 h after fusion; cleavage and blastocyst rates from those two groups were higher (P < 0.05) than those of embryos activated 1, 4, or 5 h after fusion. Treatment with CB between fusion and activation improved in vitro and in vivo development of nuclear transfer (NT) goat embryos by reducing the fragmentation rate (P < 0.05). Although there were no significant differences in NT efficiency, pregnancy rate and kids born per recipient were increased by transfer of 20 or 30 embryos per recipient compared with 10 embryos. We concluded that CB treatment for 2 to 3 h between fusion and activation was an efficient method for generating cloned goats by somatic cell NT. In addition, increasing the number of embryos transferred to each recipient resulted in more live offspring from fewer recipients. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. A cortical motor nucleus drives the basal ganglia-recipient thalamus in singing birds

    PubMed Central

    Goldberg, Jesse H.

    2012-01-01

    The pallido-recipient thalamus transmits information from the basal ganglia (BG) to the cortex and plays a critical role motor initiation and learning. Thalamic activity is strongly inhibited by pallidal inputs from the BG, but the role of non-pallidal inputs, such as excitatory inputs from cortex, is unclear. We have recorded simultaneously from presynaptic pallidal axon terminals and postsynaptic thalamocortical neurons in a BG-recipient thalamic nucleus necessary for vocal variability and learning in zebra finches. We found that song-locked rate modulations in the thalamus could not be explained by pallidal inputs alone, and persisted following pallidal lesion. Instead, thalamic activity was likely driven by inputs from a motor ‘cortical’ nucleus also necessary for singing. These findings suggest a role for cortical inputs to the pallido-recipient thalamus in driving premotor signals important for exploratory behavior and learning. PMID:22327474

  4. Evaluation of humoral immunity profiles to identify heart recipients at risk for development of severe infections: A multicenter prospective study.

    PubMed

    Sarmiento, Elizabeth; Jaramillo, Maria; Calahorra, Leticia; Fernandez-Yañez, Juan; Gomez-Sanchez, Miguel; Crespo-Leiro, Maria G; Paniagua, Maria; Almenar, Luis; Cebrian, Monica; Rabago, Gregorio; Levy, Beltran; Segovia, Javier; Gomez-Bueno, Manuel; Lopez, Javier; Mirabet, Sonia; Navarro, Joaquin; Rodriguez-Molina, Juan Jose; Fernandez-Cruz, Eduardo; Carbone, Javier

    2017-05-01

    New biomarkers are necessary to improve detection of the risk of infection in heart transplantation. We performed a multicenter study to evaluate humoral immunity profiles that could better enable us to identify heart recipients at risk of severe infections. We prospectively analyzed 170 adult heart recipients at 8 centers in Spain. Study points were before transplantation and 7 and 30 days after transplantation. Immune parameters included IgG, IgM, IgA and complement factors C3 and C4, and titers of specific antibody to pneumococcal polysaccharide antigens (anti-PPS) and to cytomegalovirus (CMV). To evaluate potential immunologic mechanisms leading to IgG hypogammaglobulinemia, before heart transplantation we assessed serum B-cell activating factor (BAFF) levels using enzyme-linked immunoassay. The clinical follow-up period lasted 6 months. Clinical outcome was need for intravenous anti-microbials for therapy of infection. During follow-up, 53 patients (31.2%) developed at least 1 severe infection. We confirmed that IgG hypogammaglobulinemia at Day 7 (defined as IgG <600 mg/dl) is a risk factor for infection in general, bacterial infections in particular, and CMV disease. At Day 7 after transplantation, the combination of IgG <600 mg/dl + C3 <80 mg/dl was more strongly associated with the outcome (adjusted odds ratio 7.40; 95% confidence interval 1.48 to 37.03; p = 0.014). We found that quantification of anti-CMV antibody titers and lower anti-PPS antibody concentrations were independent predictors of CMV disease and bacterial infections, respectively. Higher pre-transplant BAFF levels were a risk factor of acute cellular rejection. Early immunologic monitoring of humoral immunity profiles proved useful for the identification of heart recipients who are at risk of severe infection. Copyright © 2017 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  5. Longitudinal Assessment of Renal Perfusion and Oxygenation in Transplant Donor-Recipient Pairs Using Arterial Spin Labeling and Blood Oxygen Level-Dependent Magnetic Resonance Imaging.

    PubMed

    Niles, David J; Artz, Nathan S; Djamali, Arjang; Sadowski, Elizabeth A; Grist, Thomas M; Fain, Sean B

    2016-02-01

    The aims of this study were to assess renal function in kidney transplant recipients and their respective donors over 2 years using arterial spin labeling (ASL) and blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) and to prospectively evaluate the effect of losartan on functional MRI measures in recipients. The study included 15 matched pairs of renal transplant donors and recipients. Arterial spin labeling and BOLD MRI of the kidneys were performed on donors before transplant surgery (baseline) and on both donors and recipients at 3 months, 1 year, and 2 years after transplant. After 3 months, 7 of the 15 recipients were prescribed 25 to 50 mg/d losartan for the remainder of the study. A linear mixed-effects model was used to evaluate perfusion, R2*, estimated glomerular filtration rate, and fractional excretion of sodium for changes across time or associated with losartan treatment. In donors, cortical perfusion in the remaining kidney decreased by 50 ± 19 mL/min per 100 g (11.8%) between baseline and 2 years (P < 0.05), while cortical R2* declined modestly by 0.7 ± 0.3 s-1 (5.6%; P < 0.05). In transplanted kidneys, cortical perfusion decreased markedly by 141 ± 21 mL/min per 100 g (34.2%) between baseline and 2 years (P < 0.001), while medullary R2* declined by 1.5 ± 0.8 s-1 (8.3%; P = 0.06). Single-kidney estimated glomerular filtration rate increased between baseline and 2 years by 17.7 ± 2.7 mL/min per 1.73 m (40.3%; P < 0.0001) in donors and to 14.6 ± 4.3 mL/min per 1.73 m (33.3%; P < 0.01) in recipients. Cortical perfusion at 1 and 2 years in recipients receiving 25 to 50 mg/d losartan was 62 ± 24 mL/min per 100 g higher than recipients not receiving the drug (P < 0.05). No significant effects of losartan were observed for any other markers of renal function. The results suggest an important role for noninvasive functional monitoring with ASL and BOLD MRI in kidney transplant recipients and donors, and they indicate a potentially beneficial effect of losartan in recipients.

  6. Caregiving-related needs of family caregivers of older Singaporeans.

    PubMed

    Ajay, Shweta; Østbye, Truls; Malhotra, Rahul

    2017-03-01

    To describe the extent and correlates of caregiving-related needs among family caregivers of Singaporeans aged 75+ with ≥1 activity of daily living limitations (care-recipients). National survey data of 1181 care-recipient/caregiver dyads were used. Caregiver's report (yes/no) of 16 needs was assessed. Care-recipient and caregiver correlates of each need were determined through logistic regression analysis. Caregiving-related needs were expressed by 42.3% caregivers. The most commonly reported need was keeping care-recipient safe at home (24.5%). Needs concerned with caring for care-recipients were more frequent than those concerned with the caregiver's own needs. The most frequent correlate was care-recipient's extent of mood impairment (associated with 13 needs). Caregivers should not neglect themselves when engaging in care provision. Families and service providers should explore whether reported lack of needs reflects limited awareness and/or under-reporting. © 2017 AJA Inc.

  7. Rotorcraft Health and Usage Monitoring Systems - A Literature Survey

    DTIC Science & Technology

    1991-05-01

    34"... ". , :’ " "Diot Lic lal Technical Report Documentaton Page 1. Report No. 2. Government Accession No. 3 . Recipient’s Catalog No. DOT/FAANRD-91/6 4...2 1.2.4 Data Sources ................................. 3 1.2.5 Industry Survey Products ..................... 3 2 .0 Overview...work being accomplished is being provided to the FAA. 3 2.0 OVERVIEW This report covers the results of the health and usage monitoring literature search

  8. Belatacept: a novel biologic for maintenance immunosuppression after renal transplantation.

    PubMed

    Martin, Spencer T; Tichy, Eric M; Gabardi, Steven

    2011-04-01

    In the past decade, the availability of new immunosuppressive maintenance therapies for use in solid organ transplantation has remained limited. Patients and clinicians have relied on immunosuppressive drugs that require a significant amount of therapeutic monitoring and are associated with a variety of adverse effects that affect both quality of life and allograft function. Belatacept is an investigational intravenous biologic agent for long-term use in renal transplant recipients. The costimulatory pathway (signal 2) of T-cell activation and proliferation is produced by stimulation of the T-cell surface marker, CD28, and is essential to the immune system's cellular response and ability to recognize an allograft as foreign. Belatacept is a potent antagonist of B7-1 (CD80) and B7-2 (CD86) ligands present on antigen-presenting cells that are responsible for activation of CD28. Recent phase III trials describe various dosing strategies of belatacept versus a standard cyclosporine protocol in recipients of both living- and deceased-donor renal transplants, as well as in patients receiving kidneys transplanted from extended-criteria donors. Compared with cyclosporine, belatacept has been shown to be noninferior in both patient and allograft survival rates. However, the rate of biopsy-proven acute cellular rejection occurred more frequently in the belatacept groups. Also, compared with standard calcineurin-based regimens, the risk of posttransplant lymphoproliferative disorder is increased in patients receiving belatacept, with the greatest risk in transplant recipients who are Epstein-Barr virus seronegative before transplantation. However, this investigational immunosuppressive agent may avert common adverse effects experienced with standard immunosuppressive protocols including renal dysfunction, metabolic disorders, neurotoxicities, glucose abnormalities, and cosmetic effects. More data on the long-term risks of belatacept are needed to better define its role as immunosuppressive maintenance therapy. Aside from an increased risk of malignancy, belatacept's limited adverse-effect profile and convenient dosing strategy may make it an attractive option for immuno-suppressive maintenance for both the patient and clinician.

  9. Immunisation Information Systems – useful tools for monitoring vaccination programmes in EU/EEA countries, 2016

    PubMed Central

    Derrough, Tarik; Olsson, Kate; Gianfredi, Vincenza; Simondon, Francois; Heijbel, Harald; Danielsson, Niklas; Kramarz, Piotr; Pastore-Celentano, Lucia

    2017-01-01

    Immunisation Information Systems (IIS) are computerised confidential population based-systems containing individual-level information on vaccines received in a given area. They benefit individuals directly by ensuring vaccination according to the schedule and they provide information to vaccine providers and public health authorities responsible for the delivery and monitoring of an immunisation programme. In 2016, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on the level of implementation and functionalities of IIS in 30 European Union/European Economic Area (EU/EEA) countries. It explored the governance and financial support for the systems, IIS software, system characteristics in terms of population, identification of immunisation recipients, vaccinations received, and integration with other health record systems, the use of the systems for surveillance and programme management as well as the challenges involved with implementation. The survey was answered by 27 of the 30 EU/EEA countries having either a system in production at national or subnational levels (n = 16), or being piloted (n = 5) or with plans for setting up a system in the future (n = 6). The results demonstrate the added-value of IIS in a number of areas of vaccination programme monitoring such as monitoring vaccine coverage at local geographical levels, linking individual immunisation history with health outcome data for safety investigations, monitoring vaccine effectiveness and failures and as an educational tool for both vaccine providers and vaccine recipients. IIS represent a significant way forward for life-long vaccination programme monitoring. PMID:28488999

  10. Immunisation Information Systems - useful tools for monitoring vaccination programmes in EU/EEA countries, 2016.

    PubMed

    Derrough, Tarik; Olsson, Kate; Gianfredi, Vincenza; Simondon, Francois; Heijbel, Harald; Danielsson, Niklas; Kramarz, Piotr; Pastore-Celentano, Lucia

    2017-04-27

    Immunisation Information Systems (IIS) are computerised confidential population based-systems containing individual-level information on vaccines received in a given area. They benefit individuals directly by ensuring vaccination according to the schedule and they provide information to vaccine providers and public health authorities responsible for the delivery and monitoring of an immunisation programme. In 2016, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on the level of implementation and functionalities of IIS in 30 European Union/European Economic Area (EU/EEA) countries. It explored the governance and financial support for the systems, IIS software, system characteristics in terms of population, identification of immunisation recipients, vaccinations received, and integration with other health record systems, the use of the systems for surveillance and programme management as well as the challenges involved with implementation. The survey was answered by 27 of the 30 EU/EEA countries having either a system in production at national or subnational levels (n = 16), or being piloted (n = 5) or with plans for setting up a system in the future (n = 6). The results demonstrate the added-value of IIS in a number of areas of vaccination programme monitoring such as monitoring vaccine coverage at local geographical levels, linking individual immunisation history with health outcome data for safety investigations, monitoring vaccine effectiveness and failures and as an educational tool for both vaccine providers and vaccine recipients. IIS represent a significant way forward for life-long vaccination programme monitoring. This article is copyright of The Authors, 2017.

  11. Welfare Reform: Moving the Hard-to-Employ Recipients into the Workforce. Report to the Chairman, Subcommittee on Human Resources, Committee on Ways and Means, House of Representatives.

    ERIC Educational Resources Information Center

    Fagnoni, Cynthia M.

    A study collected information on the participation of Temporary Assistance for Needy Families (TANF) recipients in work and work activities and their characteristics and how they have changed over time. Data were gathered on strategies states use to help hard-to-employ (HTE) TANF recipients get and keep jobs and on challenges states face in…

  12. Calreticulin mutants in mice induce an MPL-dependent thrombocytosis with frequent progression to myelofibrosis.

    PubMed

    Marty, Caroline; Pecquet, Christian; Nivarthi, Harini; El-Khoury, Mira; Chachoua, Ilyas; Tulliez, Micheline; Villeval, Jean-Luc; Raslova, Hana; Kralovics, Robert; Constantinescu, Stefan N; Plo, Isabelle; Vainchenker, William

    2016-03-10

    Frameshift mutations in the calreticulin (CALR) gene are seen in about 30% of essential thrombocythemia and myelofibrosis patients. To address the contribution of the CALR mutants to the pathogenesis of myeloproliferative neoplasms, we engrafted lethally irradiated recipient mice with bone marrow cells transduced with retroviruses expressing these mutants. In contrast to wild-type CALR, CALRdel52 (type I) and, to a lesser extent, CALRins5 (type II) induced thrombocytosis due to a megakaryocyte (MK) hyperplasia. Disease was transplantable into secondary recipients. After 6 months, CALRdel52-, in contrast to rare CALRins5-, transduced mice developed a myelofibrosis associated with a splenomegaly and a marked osteosclerosis. Monitoring of virus-transduced populations indicated that CALRdel52 leads to expansion at earlier stages of hematopoiesis than CALRins5. However, both mutants still specifically amplified the MK lineage and platelet production. Moreover, a mutant deleted of the entire exon 9 (CALRdelex9) did not induce a disease, suggesting that the oncogenic property of CALR mutants was related to the new C-terminus peptide. To understand how the CALR mutants target the MK lineage, we used a cell-line model and demonstrated that the CALR mutants, but not CALRdelex9, specifically activate the thrombopoietin (TPO) receptor (MPL) to induce constitutive activation of Janus kinase 2 and signal transducer and activator of transcription 5/3/1. We confirmed in c-mpl- and tpo-deficient mice that expression of Mpl, but not of Tpo, was essential for the CALR mutants to induce thrombocytosis in vivo, although Tpo contributes to disease penetrance. Thus, CALR mutants are sufficient to induce thrombocytosis through MPL activation. © 2016 by The American Society of Hematology.

  13. High frequency of central memory regulatory T cells allows detection of liver recipients at risk of early acute rejection within the first month after transplantation

    PubMed Central

    Boix-Giner, Francisco; Millan, Olga; San Segundo, David; Muñoz-Cacho, Pedro; Mancebo, Esther; Llorente, Santiago; Rafael-Valdivia, Lourdes; Rimola, Antoni; Fábrega, Emilio; Mrowiec, Anna; Allende, Luis; Minguela, Alfredo; Bolarín, Jose M.; Paz-Artal, Estela; López-Hoyos, Marcos; Brunet, Mercé

    2016-01-01

    Several studies have analyzed the potential of T regulatory cells (Treg cells) as biomarkers of acute rejection (AR). The aim of the present multicenter study was to correlate the percentage of peripheral Treg cells in liver graft recipients drawn at baseline up to 12 months after transplantation with the presence of AR. The percentage of central memory (cm) Treg cells (CD4+CD25highCD45RO+CD62L+) was monitored at pre-transplant and at 1 and 2 weeks, and 1, 2, 3 and 6 months and 1 year post-transplantation. The same validation standard operating procedures were used in all participating centers. Fifteen patients developed AR (23.4%). Hepatitis C virus recurrence was observed in 16 recipients, who displayed low peripheral blood cmTreg levels compared with patients who did not. A steady increase of cmTregs was observed during the first month after transplantation with statistically significant differences between AR and non-AR patients. The high frequency of memory Treg cells allowed us to monitor rejection episodes during the first month post-transplantation. On the basis of these data, we developed a prediction model for assessing risk of AR that can provide clinicians with useful information for managing patients individually and customizing immunosuppressive therapies. PMID:26270267

  14. Assessing the immunization status of pediatric cochlear implant recipients using a state-maintained immunization registry.

    PubMed

    Ou, Henry; Cleary, Patricia; Sie, Kathleen

    2010-10-01

    To demonstrate the use of a state-maintained database (CHILD Profile) to monitor immunization status of pediatric cochlear implant recipients, and to assess compliance with current vaccination recommendations for cochlear implant users managed at Seattle Children's Hospital. Cross-sectional study. Tertiary academic pediatric hospital. Subjects were 260 patients with cochlear implants managed at Seattle Children's Hospital between July 1, 1995, and May 1, 2008. Patients were stratified by age groups (0-2 years, 2-5 years, 5-10 years, > 10 years). Using a statewide children's immunization registry (CHILD Profile), subjects were assessed with regard to their immunization status for Haemophilus influenzae type B vaccination (HiB), 7-valent pneumococcal conjugate vaccination (PCV-7), and 23-valent pneumococcal polysaccharide vaccine (PPV-23). Two hundred twenty-five of 260 subjects (87%) were registered in CHILD Profile; 126 of 225 (56%) were up to date with CDC recommendations for patients with cochlear implants. PPV-23 was the vaccination most likely to be incomplete. Age was predictive of immunization status only with HiB vaccination. A statewide immunization registry can be used to monitor the immunization status of cochlear implant recipients. Subjects were significantly more likely to be incomplete for PPV-23 than for either PCV-7 or HiB vaccinations. Copyright © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

  15. Immune function monitoring in lung transplantation using adenosine triphosphate production: time trends and relationship to postoperative infection.

    PubMed

    Takahashi, Mamoru; Ohsumi, Akihiro; Ohata, Keiji; Kondo, Takeshi; Motoyama, Hideki; Hijiya, Kyoko; Aoyama, Akihiro; Date, Hiroshi; Chen-Yoshikawa, Toyofumi F

    2017-06-01

    The ImmuKnow (IK) assay is a comprehensive immune function test that involves measuring adenosine triphosphate produced by the cluster of differentiation 4+ T lymphocytes in peripheral blood. The aim of this study was to analyze the time trends of IK values and assess the relationship between IK values and infections in lung transplants. We prospectively collected 178 blood samples from 22 deceased-donor lung transplant (DDLT) recipients and 17 living-donor lobar lung transplant (LDLLT) recipients. A surveillance IK assay was performed postoperatively, then after 1 week and 1, 3, 6, and 12 months. Time trends of IK values in stable recipients peaked 1 week after DDLT (477 ± 247 ATP ng/ml), and 1 month after LDLLT (433 ± 134 ng/ml), followed by a gradual decline over 1 year. The mean IK values in infections were significantly lower than those in the stable state (119 vs 312 ATP ng/ml, p = 0.0002). IK values increased sharply after lung transplantation and then decreased gradually over time in the first year, suggesting a natural history of immune function. IK values were also significantly reduced during infections. These results may provide new insights into the utility of immune monitoring after lung transplantation.

  16. Early molecular diagnosis of acute Chagas disease after transplantation with organs from Trypanosoma cruzi-infected donors.

    PubMed

    Cura, C I; Lattes, R; Nagel, C; Gimenez, M J; Blanes, M; Calabuig, E; Iranzo, A; Barcan, L A; Anders, M; Schijman, A G

    2013-12-01

    Organ transplantation (TX) is a novel transmission modality of Chagas disease. The results of molecular diagnosis and characterization of Trypanosoma cruzi acute infection in naïve TX recipients transplanted with organs from infected deceased donors are reported. Peripheral blood and cerebrospinal fluid samples from the TX recipients of organs from infected donors were prospectively and sequentially studied for detection of T. cruzi by means of kinetoplastid DNA polymerase chain reaction (kDNA-PCR). In positive blood samples, a PCR algorithm for identification of T. cruzi Discrete Typing Units (DTUs) and quantitative real-time PCR (qPCR) to quantify parasitic loads were performed. Minicircle signatures of T. cruzi infecting populations were also analyzed using restriction fragment length polymorphism (RFLP)-PCR. Eight seronegative TX recipients from four infected donors were studied. In five, the infection was detected at 68.4 days post-TX (36-98 days). In one case, it was transmitted to two of three TX recipients. The comparison of the minicircle signatures revealed nearly identical RFLP-PCR profiles, confirming a common source of infection. The five cases were infected by DTU TcV. This report reveals the relevance of systematic monitoring of TX recipients using PCR strategies in order to provide an early diagnosis allowing timely anti-trypanosomal treatment. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

  17. Development of a cross-platform biomarker signature to detect renal transplant tolerance in humans

    PubMed Central

    Sagoo, Pervinder; Perucha, Esperanza; Sawitzki, Birgit; Tomiuk, Stefan; Stephens, David A.; Miqueu, Patrick; Chapman, Stephanie; Craciun, Ligia; Sergeant, Ruhena; Brouard, Sophie; Rovis, Flavia; Jimenez, Elvira; Ballow, Amany; Giral, Magali; Rebollo-Mesa, Irene; Le Moine, Alain; Braudeau, Cecile; Hilton, Rachel; Gerstmayer, Bernhard; Bourcier, Katarzyna; Sharif, Adnan; Krajewska, Magdalena; Lord, Graham M.; Roberts, Ian; Goldman, Michel; Wood, Kathryn J.; Newell, Kenneth; Seyfert-Margolis, Vicki; Warrens, Anthony N.; Janssen, Uwe; Volk, Hans-Dieter; Soulillou, Jean-Paul; Hernandez-Fuentes, Maria P.; Lechler, Robert I.

    2010-01-01

    Identifying transplant recipients in whom immunological tolerance is established or is developing would allow an individually tailored approach to their posttransplantation management. In this study, we aimed to develop reliable and reproducible in vitro assays capable of detecting tolerance in renal transplant recipients. Several biomarkers and bioassays were screened on a training set that included 11 operationally tolerant renal transplant recipients, recipient groups following different immunosuppressive regimes, recipients undergoing chronic rejection, and healthy controls. Highly predictive assays were repeated on an independent test set that included 24 tolerant renal transplant recipients. Tolerant patients displayed an expansion of peripheral blood B and NK lymphocytes, fewer activated CD4+ T cells, a lack of donor-specific antibodies, donor-specific hyporesponsiveness of CD4+ T cells, and a high ratio of forkhead box P3 to α-1,2-mannosidase gene expression. Microarray analysis further revealed in tolerant recipients a bias toward differential expression of B cell–related genes and their associated molecular pathways. By combining these indices of tolerance as a cross-platform biomarker signature, we were able to identify tolerant recipients in both the training set and the test set. This study provides an immunological profile of the tolerant state that, with further validation, should inform and shape drug-weaning protocols in renal transplant recipients. PMID:20501943

  18. The International Health Partnership Plus: rhetoric or real change? Results of a self-reported survey in the context of the 4th high level forum on aid effectiveness in Busan

    PubMed Central

    2012-01-01

    Background The Paris Declaration on Aid Effectiveness, which provides an international agreement on how to deliver aid, has recently been reviewed by the Organization for Economic Co-operation and Development (OECD). Health sector aid effectiveness is important, given the volume of financial aid and the number of mechanisms through which health assistance is provided. Recognizing this, the international community created the International Health Partnership (IHP+), to apply the Paris Declaration to the health sector. This paper, which presents findings from an independent monitoring process (IHP+Results), makes a valuable contribution to the literature in the context of the recent 4th High Level Forum on Aid Effectiveness in Busan, Korea. Methods IHP+Results monitored commitments made under the IHP + using an agreed framework with twelve measures for IHP + Development Partners and ten for IHP + recipient country governments. Data were collected through self-administered survey tools. IHP+Results analyzed these data, using transparent criteria, to produce Scorecards as a means to highlight progress against commitments and thereby strengthen mutual accountability amongst IHP + signatories. Results There have been incremental improvements in the strengthening of national planning processes and principles around mutual accountability. There has also been progress in Development Partners aligning their support with national budgets. But there is a lack of progress in the use of countries’ financial management and procurement systems, and in the integration of duplicative performance reporting frameworks and information systems. Discussion and Conclusions External, independent monitoring is potentially useful for strengthening accountability in health sector aid. While progress in strengthening country ownership, harmonisation and alignment seems evident, there are ongoing challenges. In spite of some useful findings, there are limitations with IHP + monitoring that need to be addressed. This is not surprising given the challenge of rigorously monitoring Development Partners across multiple recipient countries within complex global systems. The findings presented here suggest that the health sector is ahead of the game – in terms of having an established mechanism to promote alignment and harmonisation, and a relatively advanced monitoring framework and methods. But to capitalise on this, IHP + signatories should: a) reaffirm their commitments to the IHP+; b) actively embrace and participate in monitoring and evaluation processes; and c) strengthen in-country capacity notably amongst civil society organizations. PMID:22650766

  19. Increased long term mortality associated with rash after early measles vaccination in rural Senegal.

    PubMed

    Seng, R; Samb, B; Simondon, F; Cissé, B; Soumaré, M; Jensen, H; Bennett, J; Whittle, H; Aaby, P

    1999-01-01

    To examine whether clinical symptoms, including rash, were more common after measles immunization compared with placebo and to study the association between postvaccination symptoms and later mortality. Examination of side effects in the 3 weeks after immunization in a trial of high titer and standard titer measles vaccines. Two hundred twenty-four children randomly selected to be included in the surveillance for diarrhea, fever and rash. There was no difference in fever and diarrhea between recipients of high titer vaccines and recipients of placebo. However, high titer recipients tended to have more measles-like rashes than placebo recipients [relative risk, 2.12 (range, 0.90 to 5.03)]. Among recipients of high titer vaccines, children who presented a rash had higher mortality in the following 5 to 7 years than those who did not develop rash [mortality rate ratio, 3.85 (range, 1.52 to 9.79)]. High titer recipients without a rash had the same mortality as children in the placebo group who were given standard doses of measles vaccine at 10 months of age [mortality rate, 0.76 (range, 0.35 to 1.62)]. These observations suggest that in this particular study, rash after high titer measles vaccine may identify children who received a particularly high dose of vaccine or children with more severe and persistent postvaccination immunosuppression. Whether high titer vaccine is more likely than standard titer measles vaccine to provoke such reaction is not known, given that we did not compare side effects after different titers of measles vaccine. Future trials of live measles vaccine should monitor the development of rash.

  20. The observational study of selected sexual behaviour issues in female organ transplant recipients.

    PubMed

    Szpotanska-Sikorska, Monika; Mazanowska, Natalia; Staruch, Monika; Wielgos, Miroslaw; Pietrzak, Bronislawa

    2017-06-01

    To investigate sexual behaviour in women following solid organ transplantation. A cross-sectional single-centre survey study of 230 female organ transplant recipients, aged 18-45years. Sexual behaviour, contraceptive awareness and methods of birth control. 205 females declared to be post their sexual initiation. The mean age at sexual initiation in our study population was 20.3±3.3years (range: 14-32). Fifty-three percent (122/230) of the patients declared that they had only one sexual partner at enrolment. After transplantation female organ recipients became more sexually active (71% vs. 83%; p=0.018). The frequency of sexual intercourse decreased significantly in the post-transplant period (p=0.004). In the group of sexually active females before transplantation the frequency of sexual intercourses decreased significantly in the post-transplant period (mean Δ -0.16±0.79; p=0.004). An increase or lack of change in the frequency of sexual intercourse was noted amongst younger transplant-recipients (OR: 0.91; 95%CI 0.86-0.97) and women with effective birth control methods post-transplantation (OR: 3.68; 95%CI 1.60-8.49). Sexual education of organ transplant recipients is necessary, mainly in younger patients, who present to be more sexually active, thus they need to be taught about effective family planning. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. PCR diagnostics and monitoring of adenoviral infections in hematopoietic stem cell transplantation recipients

    PubMed Central

    Ussowicz, Marek; Rybka, Blanka; Wendycz-Domalewska, Danuta; Ryczan, Renata; Gorczyńska, Ewa; Kałwak, Krzysztof; Woźniak, Mieczysław

    2010-01-01

    After stem cell transplantation, human patients are prone to life-threatening opportunistic infections with a plethora of microorganisms. We report a retrospective study on 116 patients (98 children, 18 adults) who were transplanted in a pediatric bone marrow transplantation unit. Blood, urine and stool samples were collected and monitored for adenovirus (AdV) DNA using polymerase chain reaction (PCR) and real-time PCR (RT-PCR) on a regular basis. AdV DNA was detected in 52 (44.8%) patients, with mortality reaching 19% in this subgroup. Variables associated with adenovirus infection were transplantations from matched unrelated donors and older age of the recipient. An increased seasonal occurrence of adenoviral infections was observed in autumn and winter. Analysis of immune reconstitution showed a higher incidence of AdV infections during periods of low T-lymphocyte count. This study also showed a strong interaction between co-infections of AdV and BK polyomavirus in patients undergoing hematopoietic stem cell transplantations. PMID:20848295

  2. Effects of rivastigmine on actigraphically monitored motor activity in severe agitation related to Alzheimer's disease: a placebo-controlled pilot study.

    PubMed

    Mahlberg, Richard; Walther, Sebastian; Eichmann, Uta; Tracik, Ferenc; Kunz, Dieter

    2007-01-01

    Acetylcholinesterase inhibitors (AChEIs) are effective in the treatment of cognitive symptoms in Alzheimer's disease (AD). Because the behavioral and psychological symptoms of dementia (BPSD) have also been attributed to central cholinergic deficits, we examined whether the AChEI rivastigmine can reduce motor activity as measured in a rater-independent manner by wrist actigraphy in agitated AD patients. A total of 20 consecutive AD inpatients (13 females, 7 males, 80.4+/-9.1 years, S.D.) were included from our geriatric psychiatry unit, all of whom were exhibiting agitated behavior not attributable to delirium. Patients were assigned randomly and in a single-blinded fashion to rivastigmine 3mg or placebo for 14 days. Motor activity levels were monitored using an actigraph worn continuously on the wrist of the non-dominant hand. At the beginning and end of the study, patients were assessed using the Neuropsychiatric Inventory (NPI) and Nurses' Observation Scale for Geriatric Patients (NOSGER). Patients in the rivastigmine group exhibited less agitation than placebo recipients on the NPI-agitation subscale, but not on NOSGER. Actigraphic measurements showed a tendency towards reduced motor activity in the rivastigmine group. Because rivastigmine usually exerts its main effects after a longer period of time, the short-term effects seen in our study justify further controlled clinical trials examining the use of rivastigmine in BPSD by means of actigraphy.

  3. Evaluating a food bank recipe-tasting program.

    PubMed

    Keller-Olaman, Susan J; Edwards, Vicki; Elliott, Susan J

    2005-01-01

    Food banks mitigate immediate food insecurity, but their ability to promote healthy nutrition is constrained by how often recipients may visit and the range of foods available. In a descriptive study, a formative evaluation was completed of a combined heart-healthy recipe-tasting and education program that aims to promote healthy eating knowledge and skills in a group of food bank recipients in Hamilton, Ontario. Fifty-five adults were surveyed about food bank attendance, program awareness, perceived enhancement of knowledge and skills, and suggestions for program improvement. Most participants (73%) were positive about the program, and 91% wanted the program to continue. In addition, 78% would prepare the recipes sampled. In contrast, program awareness and planning food bank visits to coincide with the program were generally low. Food banks are potential sites for effective nutrition promotion programs. To reach more recipients, more frequent implementation and seeking the use of a designated room are suggested for the current program. The findings also suggest that the sampling approach to promoting healthy eating to food bank recipients deserves further study. For example, monitoring the selection of featured recipe ingredients would be a useful indicator of behaviour.

  4. Persistence, immune specificity, and functional ability of murine mutant ras epitope-specific CD4(+) and CD8(+) T lymphocytes following in vivo adoptive transfer.

    PubMed

    Bristol, J A; Schlom, J; Abrams, S I

    1999-05-25

    Adoptive T-cell transfer has been shown to be a potentially effective strategy for cellular immunotherapy in some murine models of disease. However, several issues remain unresolved regarding some of the basic features involved in effective adoptive transfer, such as the influence of specific peptide antigen (Ag) boost after T-cell transfer, the addition of IL-2 post-T-cell transfer, the trafficking of transferred T cells to lymphoid and nonlymphoid tissues, and the functional stability of recoverable CD4(+) and CD8(+) T cells. We investigated several of these parameters, particularly as they relate to the persistence and maintenance of effector functions of murine CD4(+) and/or CD8(+) T lymphocytes after adoptive cellular transfer into partially gamma-irradiated syngeneic hosts. Our laboratory previously identified murine (H-2(d)) immunogenic CD4(+) and CD8(+) T-cell peptide epitopes reflecting codon 12 ras mutations as tumor-specific Ag. Therefore, the model system chosen here employed epitope-specific MHC class II-restricted CD4(+) T cells and MHC class I-restricted CD8(+) T cells produced from previously immunized BALB/c mice. Between 2 and 7 days after T-cell transfer, recipient mice received various combinations of peptide boosts and/or IL-2 treatments. At different times after the T-cell transfer, spleen and lung tissues were analyzed phenotypically to monitor the persistence of the immune T cells and functionally (via proliferation or cytotoxicity assays) to assess the maintenance of peptide specificity. The results showed that immune donor T lymphocytes (uncultured immune T cells or cloned T cells) were recoverable from the spleens and lungs of recipient mice after transfer. The recovery of Ag-specific T-cell responses was greatest from recipient mice that received peptide boosts and IL-2 treatment. However, mice that received a peptide boost without IL-2 treatment responded nearly as well, which suggested that including a peptide boost after T-cell transfer was more obligatory than exogenous IL-2 treatment to sustain adoptively transferred T cells in vivo. Ag-specific T-cell responses were weak in mice that either received IL-2 alone or did not receive the cognate peptide boost after T-cell transfer. The T-cell clones were also monitored by flow cytometry or RT-PCR based on expression of the T-cell receptor Vbeta-chain, which was previously characterized. Ag-specific T cells were recovered from both spleens and lungs of recipient mice, demonstrating that the T-cell clones could localize to both lymphoid and nonlymphoid tissues. This study demonstrates that both uncultured and in vitro-cloned T lymphocytes can migrate to lymphoid tissues and nonlymphoid (e.g., lung) tissues in recipient hosts and that their functional activities can be maintained at these sites after transfer, if they are exposed to peptide Ag in vivo. Copyright 1999 Academic Press.

  5. Types, frequencies, and burden of nonspecific adverse events of drugs: analysis of randomized placebo-controlled clinical trials.

    PubMed

    Mahr, Alfred; Golmard, Clara; Pham, Emilie; Iordache, Laura; Deville, Laure; Faure, Pierre

    2017-07-01

    Scarce studies analyzing adverse event (AE) data from randomized placebo-controlled clinical trials (RPCCTs) of selected illnesses suggested that a substantial proportion of collected AEs are unrelated to the drug taken. This study analyzed the nonspecific AEs occurring with active-drug exposure in RPCCTs for a large range of medical conditions. Randomized placebo-controlled clinical trials published in five prominent medical journals during 2006-2012 were searched. Only trials that evaluated orally or parenterally administered active drugs versus placebo in a head-to-head setting were selected. For AEs reported from ≥10 RPCCTs, Pearson's correlation coefficients (r) were calculated to determine the relationship between AE rates in placebo and active-drug recipients. Random-effects meta-analyses were used to compute proportions of nonspecific AEs, which were truncated at a maximum of 100%, in active-drug recipients. We included 231 trials addressing various medical domains or healthy participants. For the 88 analyzed AE variables, AE rates for placebo and active-drug recipients were in general strongly correlated (r > 0.50) or very strongly correlated (r > 0.80). The pooled proportions of nonspecific AEs for the active-drug recipients were 96.8% (95%CI: 95.5-98.1) for any AEs, 100% (97.9-100) for serious AEs, and 77.7% (72.7-83.2) for drug-related AEs. Results were similar for individual medical domains and healthy participants. The pooled proportion of nonspecificity of 82 system organ class and individual AE types ranged from 38% to 100%. The large proportion of nonspecific AEs reported in active-drug recipients of RPCCTs, including serious and drug-related AEs, highlights the limitations of clinical trial data to determine the tolerability of drugs. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Substantial changes in mastery perceptions of dementia caregivers with the placement of a care recipient.

    PubMed

    Infurna, Frank J; Gerstorf, Denis; Zarit, Steven H

    2013-03-01

    The current study examined how a key component of caregiving stress processes, global mastery perceptions, changes with placing the care recipient in a nursing home or institution. We also explored the role of primary stressors in accounting for mastery changes with placement and whether characteristics of the caregiver and care recipient moderate reactions to placement. We applied multiphase growth curve models to prospective longitudinal data from 271 caregivers in the Caregiver Stress and Coping Study who experienced placement of their care recipient. Using a time-to/from-placement metric, we found that caregivers typically experienced declines in mastery preceding placement, followed by a significant increase within 1 year after placement and further increases thereafter. Corresponding changes in primary stressors (role overload) mediated the placement-related increase in mastery. Caregivers who reported more depressive symptoms and activities of daily living/instrumental activities of daily living dependencies of the care recipient were more likely to experience larger placement-related increases in mastery perceptions. Our findings suggest that placement alters psychological resources of caregivers and this effect is driven by corresponding changes in primary stressors. Findings also underscore the importance of examining change processes across salient life events and transitions.

  7. 28 CFR 54.400 - Education programs or activities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Section 54.400 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) NONDISCRIMINATION ON THE BASIS OF..., privilege, advantage, or opportunity. (c) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient educational institution may administer or assist in the...

  8. 29 CFR 37.42 - What are a recipient's responsibilities under this part to provide universal access to WIA Title...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... individuals in differing age groups. Such efforts may include, but are not limited to: (a) Advertising the recipient's programs and/or activities in media, such as newspapers or radio programs, that specifically...

  9. 49 CFR 602.13 - Eligible activities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Emergency repairs; (4) Permanent repairs; (5) Actual engineering and construction costs on approved projects... maintenance; (2) Project costs for which the recipient has received funding from another Federal agency; (3) Project costs for which the recipient has received funding through payments from insurance policies; (4...

  10. 7 CFR 3015.190 - Scope.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... costs. These cost principles shall apply to transactions and activities conducted under grants... AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Cost Principles § 3015.190 Scope. This subpart makes the allowable costs incurred by the recipient the maximum amount of money a recipient is entitled to receive...

  11. 40 CFR 7.65 - Accessibility.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... RECEIVING FEDERAL ASSISTANCE FROM THE ENVIRONMENTAL PROTECTION AGENCY Discrimination Prohibited on the Basis of Handicap § 7.65 Accessibility. (a) General. A recipient shall operate each program or activity... usable by handicapped persons. This paragraph does not: (1) Necessarily require a recipient to make each...

  12. 40 CFR 7.65 - Accessibility.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... RECEIVING FEDERAL ASSISTANCE FROM THE ENVIRONMENTAL PROTECTION AGENCY Discrimination Prohibited on the Basis of Handicap § 7.65 Accessibility. (a) General. A recipient shall operate each program or activity... usable by handicapped persons. This paragraph does not: (1) Necessarily require a recipient to make each...

  13. 40 CFR 7.65 - Accessibility.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... RECEIVING FEDERAL ASSISTANCE FROM THE ENVIRONMENTAL PROTECTION AGENCY Discrimination Prohibited on the Basis of Handicap § 7.65 Accessibility. (a) General. A recipient shall operate each program or activity... usable by handicapped persons. This paragraph does not: (1) Necessarily require a recipient to make each...

  14. 40 CFR 7.65 - Accessibility.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... RECEIVING FEDERAL ASSISTANCE FROM THE ENVIRONMENTAL PROTECTION AGENCY Discrimination Prohibited on the Basis of Handicap § 7.65 Accessibility. (a) General. A recipient shall operate each program or activity... usable by handicapped persons. This paragraph does not: (1) Necessarily require a recipient to make each...

  15. 40 CFR 7.65 - Accessibility.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... RECEIVING FEDERAL ASSISTANCE FROM THE ENVIRONMENTAL PROTECTION AGENCY Discrimination Prohibited on the Basis of Handicap § 7.65 Accessibility. (a) General. A recipient shall operate each program or activity... usable by handicapped persons. This paragraph does not: (1) Necessarily require a recipient to make each...

  16. 78 FR 19071 - Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-28

    ... Report and Certification for Section 1603: Payments for Specified Renewable Energy Property in Lieu of... monitor compliance with program requirements. Applicants for Section 1603 payments commit in the Terms and... recipients remain eligible, (2) determine that the amount of the 1603 payment remains allowable under...

  17. 28 CFR 70.52 - Financial reporting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... accounting system does not meet the standards in § 70.21, additional pertinent information to further monitor.... (ii) Reports must be on an accrual basis. Recipients are not required to convert their accounting system, but must develop such accrual information through best estimates based on an analysis of the...

  18. Longitudinal microbiome analysis of single donor fecal microbiota transplantation in patients with recurrent Clostridium difficile infection and/or ulcerative colitis

    PubMed Central

    Grewal, Suman; LaComb, Joseph F.; Park, Jiyhe; Channer, Breana; Rajapakse, Ramona; Bucobo, Juan Carlos; Buscaglia, Jonathan M.; Monzur, Farah; Chawla, Anupama; Yang, Jie; Robertson, Charlie E.; Frank, Daniel N.; Li, Ellen

    2018-01-01

    Background Studies of colonoscopic fecal microbiota transplant (FMT) in patients with recurrent CDI, indicate that this is a very effective treatment for preventing further relapses. In order to provide this service at Stony Brook University Hospital, we initiated an open-label prospective study of single colonoscopic FMT among patients with ≥ 2 recurrences of CDI, with the intention of monitoring microbial composition in the recipient before and after FMT, as compared with their respective donor. We also initiated a concurrent open label prospective trial of single colonoscopic FMT of patients with ulcerative colitis (UC) not responsive to therapy, after obtaining an IND permit (IND 15642). To characterize how FMT alters the fecal microbiota in patients with recurrent Clostridia difficile infections (CDI) and/or UC, we report the results of a pilot microbiome analysis of 11 recipients with a history of 2 or more recurrences of C. difficile infections without inflammatory bowel disease (CDI-only), 3 UC recipients with recurrent C. difficile infections (CDI + UC), and 5 UC recipients without a history of C. difficile infections (UC-only). Method V3V4 Illumina 16S ribosomal RNA (rRNA) gene sequencing was performed on the pre-FMT, 1-week post-FMT, and 3-months post-FMT recipient fecal samples along with those collected from the healthy donors. Fitted linear mixed models were used to examine the effects of Group (CDI-only, CDI + UC, UC-only), timing of FMT (Donor, pre-FMT, 1-week post-FMT, 3-months post-FMT) and first order Group*FMT interactions on the diversity and composition of fecal microbiota. Pairwise comparisons were then carried out on the recipient vs. donor and between the pre-FMT, 1-week post-FMT, and 3-months post-FMT recipient samples within each group. Results Significant effects of FMT on overall microbiota composition (e.g., beta diversity) were observed for the CDI-only and CDI + UC groups. Marked decreases in the relative abundances of the strictly anaerobic Bacteroidetes phylum, and two Firmicutes sub-phyla associated with butyrate production (Ruminococcaceae and Lachnospiraceae) were observed between the CDI-only and CDI + UC recipient groups. There were corresponding increases in the microaerophilic Proteobacteria phylum and the Firmicutes/Bacilli group in the CDI-only and CDI + UC recipient groups. At a more granular level, significant effects of FMT were observed for 81 genus-level operational taxonomic units (OTUs) in at least one of the three recipient groups (p<0.00016 with Bonferroni correction). Pairwise comparisons of the estimated pre-FMT recipient/donor relative abundance ratios identified 6 Gammaproteobacteria OTUs, including the Escherichia-Shigella genus, and 2 Fusobacteria OTUs with significantly increased relative abundance in the pre-FMT samples of all three recipient groups (FDR < 0.05), however the magnitude of the fold change was much larger in the CDI-only and CDI + UC recipients than in the UC-only recipients. Depletion of butyrate producing OTUs, such as Faecalibacterium, in the CDI-only and CDI + UC recipients, were restored after FMT. Conclusion The results from this pilot study suggest that the microbial imbalances in the CDI + UC recipients more closely resemble those of the CDI-only recipients than the UC-only recipients. PMID:29385143

  19. Longitudinal microbiome analysis of single donor fecal microbiota transplantation in patients with recurrent Clostridium difficile infection and/or ulcerative colitis.

    PubMed

    Mintz, Michael; Khair, Shanawaj; Grewal, Suman; LaComb, Joseph F; Park, Jiyhe; Channer, Breana; Rajapakse, Ramona; Bucobo, Juan Carlos; Buscaglia, Jonathan M; Monzur, Farah; Chawla, Anupama; Yang, Jie; Robertson, Charlie E; Frank, Daniel N; Li, Ellen

    2018-01-01

    Studies of colonoscopic fecal microbiota transplant (FMT) in patients with recurrent CDI, indicate that this is a very effective treatment for preventing further relapses. In order to provide this service at Stony Brook University Hospital, we initiated an open-label prospective study of single colonoscopic FMT among patients with ≥ 2 recurrences of CDI, with the intention of monitoring microbial composition in the recipient before and after FMT, as compared with their respective donor. We also initiated a concurrent open label prospective trial of single colonoscopic FMT of patients with ulcerative colitis (UC) not responsive to therapy, after obtaining an IND permit (IND 15642). To characterize how FMT alters the fecal microbiota in patients with recurrent Clostridia difficile infections (CDI) and/or UC, we report the results of a pilot microbiome analysis of 11 recipients with a history of 2 or more recurrences of C. difficile infections without inflammatory bowel disease (CDI-only), 3 UC recipients with recurrent C. difficile infections (CDI + UC), and 5 UC recipients without a history of C. difficile infections (UC-only). V3V4 Illumina 16S ribosomal RNA (rRNA) gene sequencing was performed on the pre-FMT, 1-week post-FMT, and 3-months post-FMT recipient fecal samples along with those collected from the healthy donors. Fitted linear mixed models were used to examine the effects of Group (CDI-only, CDI + UC, UC-only), timing of FMT (Donor, pre-FMT, 1-week post-FMT, 3-months post-FMT) and first order Group*FMT interactions on the diversity and composition of fecal microbiota. Pairwise comparisons were then carried out on the recipient vs. donor and between the pre-FMT, 1-week post-FMT, and 3-months post-FMT recipient samples within each group. Significant effects of FMT on overall microbiota composition (e.g., beta diversity) were observed for the CDI-only and CDI + UC groups. Marked decreases in the relative abundances of the strictly anaerobic Bacteroidetes phylum, and two Firmicutes sub-phyla associated with butyrate production (Ruminococcaceae and Lachnospiraceae) were observed between the CDI-only and CDI + UC recipient groups. There were corresponding increases in the microaerophilic Proteobacteria phylum and the Firmicutes/Bacilli group in the CDI-only and CDI + UC recipient groups. At a more granular level, significant effects of FMT were observed for 81 genus-level operational taxonomic units (OTUs) in at least one of the three recipient groups (p<0.00016 with Bonferroni correction). Pairwise comparisons of the estimated pre-FMT recipient/donor relative abundance ratios identified 6 Gammaproteobacteria OTUs, including the Escherichia-Shigella genus, and 2 Fusobacteria OTUs with significantly increased relative abundance in the pre-FMT samples of all three recipient groups (FDR < 0.05), however the magnitude of the fold change was much larger in the CDI-only and CDI + UC recipients than in the UC-only recipients. Depletion of butyrate producing OTUs, such as Faecalibacterium, in the CDI-only and CDI + UC recipients, were restored after FMT. The results from this pilot study suggest that the microbial imbalances in the CDI + UC recipients more closely resemble those of the CDI-only recipients than the UC-only recipients.

  20. Donor-specific hypo-responsiveness occurs in simultaneous liver-kidney transplant recipients after the first year.

    PubMed

    Taner, Timucin; Gustafson, Michael P; Hansen, Michael J; Park, Walter D; Bornschlegl, Svetlana; Dietz, Allan B; Stegall, Mark D

    2018-06-01

    Kidney allografts of patients who undergo simultaneous liver-kidney transplantation incur less immune-mediated injury, and retain better function compared to other kidney allografts. To characterize the host alloimmune responses in 28 of these patients, we measured the donor-specific alloresponsiveness and phenotypes of peripheral blood cells after the first year. These values were then compared to those of 61 similarly immunosuppressed recipients of a solitary kidney or 31 recipients of liver allografts. Four multicolor, non-overlapping flow cytometry protocols were used to assess the immunophenotypes. Mixed cell cultures with donor or third party cells were used to measure cell proliferation and interferon gamma production. Despite a significant overlap, simultaneous liver-kidney transplant recipients had a lower overall frequency of circulating CD8 + , activated CD4 + and effector memory T cells, compared to solitary kidney transplant recipients. Simultaneous liver-kidney transplant recipient T cells had a significantly lower proliferative response to the donor cells compared to solitary kidney recipients (11.9 vs. 42.9%), although their response to third party cells was unaltered. The frequency of interferon gamma producing alloreactive T cells in simultaneous liver-kidney transplant recipients was significantly lower than that of solitary kidney transplant recipients. Flow cytometric analysis of the mixed cultures demonstrated that both alloreactive CD4 + and CD8 + compartments of the simultaneous liver-kidney transplant recipient circulating blood cells were smaller. Thus, the phenotypic and functional characteristics of the circulating blood cells of the simultaneous liver-kidney transplant recipients resembled those of solitary liver transplant recipients, and appear to be associated with donor-specific hypo-alloresponsiveness. Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  1. 28 CFR 42.724 - Remedial and affirmative action.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Section 42.724 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT... Activities; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.724 Remedial and... discriminated on the basis of age, the recipient shall take remedial action that the Department considers...

  2. 22 CFR 142.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Administrative requirements for small recipients. 142.9 Section 142.9 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General Provisions...

  3. 34 CFR 104.47 - Nonacademic services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE... recipient to which this subpart applies may not discriminate on the basis of handicap. A recipient that...

  4. 22 CFR 142.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Administrative requirements for small recipients. 142.9 Section 142.9 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General Provisions...

  5. 22 CFR 142.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Administrative requirements for small recipients. 142.9 Section 142.9 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General Provisions...

  6. 34 CFR 104.47 - Nonacademic services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE... recipient to which this subpart applies may not discriminate on the basis of handicap. A recipient that...

  7. 22 CFR 142.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Administrative requirements for small recipients. 142.9 Section 142.9 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General Provisions...

  8. 34 CFR 104.47 - Nonacademic services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE... recipient to which this subpart applies may not discriminate on the basis of handicap. A recipient that...

  9. 34 CFR 104.47 - Nonacademic services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE... recipient to which this subpart applies may not discriminate on the basis of handicap. A recipient that...

  10. 22 CFR 142.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Administrative requirements for small recipients. 142.9 Section 142.9 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General Provisions...

  11. 22 CFR 218.24 - Information requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Information requirements. 218.24 Section 218.24... OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Duties of Agency Recipients § 218.24 Information requirements. Each recipient shall: (a) Make available upon request to the agency information necessary to...

  12. 22 CFR 143.24 - Information requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Information requirements. 143.24 Section 143.24... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Duties of Agency Recipients § 143.24 Information requirements. Each recipient shall: (a) Make available upon request to the agency information necessary to...

  13. 10 CFR 1040.67 - Reasonable accommodation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... known physical or mental limitations of an otherwise qualified handicapped applicant or employee unless the recipient can demonstrate that the accommodation would impose an undue hardship on the operation... accommodation would impose an undue hardship on the operation of a recipient's program or activity, factors to...

  14. 45 CFR 84.12 - Reasonable accommodation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... physical or mental limitations of an otherwise qualified handicapped applicant or employee unless the recipient can demonstrate that the accommodation would impose an undue hardship on the operation of its... an accommodation would impose an undue hardship on the operation of a recipient's program or activity...

  15. 45 CFR 1614.3 - Range of activities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... legal research systems or other resources. (c) The specific methods to be undertaken by a recipient to... bono basis through the provision of community legal education, training, technical assistance, research..., computer-assisted legal research systems or other resources; and (2) Support provided by the recipient in...

  16. 10 CFR 5.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  17. 10 CFR 5.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  18. 24 CFR 3.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  19. 10 CFR 5.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  20. 24 CFR 3.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  1. 24 CFR 3.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  2. In vivo imaging of endogenous enzyme activities using luminescent 1,2-dioxetane compounds.

    PubMed

    Tseng, Jen-Chieh; Kung, Andrew L

    2015-06-24

    Here we present a non-invasive imaging method for visualizing endogenous enzyme activities in living animals. This optical imaging method is based on an energy transfer principle termed chemically initiated electron exchange luminescence (CIEEL). The light energy is provided by enzymatic activation of metastable 1,2-dioxetane substrates, whose protective groups are removed by hydrolytic enzymes such as β-galactosidase and alkaline phosphatase. In the presence of a nearby fluorescent recipient, the chemical energy within the activated substrate is then transferred via formation of a charge-transfer complex with the fluorophore, a mechanism closely related to glow stick chemistry. Efficient CIEEL energy transfer requires close proximity between the trigger enzyme and the fluorescent recipient. Using cells stained with fluorescent dialkylcarbocyanines as the energy recipients, we demonstrated CIEEL imaging of cellular β-galactosidase or alkaline phosphatase activity. In living animals, we used a similar approach to non-invasively image alkaline phosphatase activity in the peritoneal cavity. In this report, we provide proof-of-concept for CIEEL imaging of in vivo enzymatic activity. In addition, we demonstrate the use of CIEEL energy transfer for visualizing elevated alkaline phosphatase activity associated with tissue inflammation in living animals.

  3. Tuberculosis in recipients of solid-organ transplants during 1995-2015 in Cali, Colombia.

    PubMed

    García-Goez, J F; Munera, G A; Rojas, V; Pacheco, R; Caylá, J A; Miro, J M

    2017-11-01

    Tuberculosis (TB) in solid-organ transplants (SOTs) is an important opportunistic infection associated with mortality and graft loss. SOT recipients carry a higher risk of contracting active TB than the general population. Clinical and radiographic presentations are non-specific, and sputum smear and culture have low yields. TB patients with SOTs require standard anti-tuberculosis treatment. However, rifampicin (RMP) use is associated with a 30% rate of acute graft rejection (AGR) and a 20% rate of transplant loss. To determine treatment outcomes in SOT recipients with active TB. A retrospective study of clinical and microbiological data and TB treatment outcomes. Among the 2349 transplants assessed, active TB was detected in 31 recipients; 55% had pulmonary TB and 40% were sputum smear-positive. In 32% of the patients, TB was diagnosed 30 days after symptom onset, 77% of the patients were cured and 10% died. AGR occurred in 13%. TB was diagnosed in <30 days. Anti-tuberculosis treatment without RMP (80% vs. 67%; P = 0.48, OR 0.5, 95%CI 0.07-3.55) and with moxifloxacin yielded higher treatment success rates and a lower risk of AGR.

  4. Special considerations in pediatric lung transplantation.

    PubMed

    Wells, Audrey; Faro, Albert

    2006-10-01

    More than 1300 lung or heart-lung transplants have been performed in children to date, resulting in many years of improved quality of life. Increasing experience has demonstrated that this therapy is unique and differs from adult lung transplantation in terms of indications, complications, pharmacokinetics, and monitoring. Unlike adult lung transplant recipients, cystic fibrosis and pulmonary vascular disease are very common indications. Complications such as graft dysfunction and bronchiolitis obliterans occur similarly in children as in adults, but others such as posttransplant lymphoproliferative disorders, growth retardation, respiratory tract infections, and medical nonadherence appear to be more common in pediatric lung transplant recipients. In addition, infants and adolescents are two very distinct populations that require special attention. Although the new lung allocation system grants some preference to children, donor shortage remains a limiting factor. Living donor lobar transplantation is an alternative for select candidates. Survival rates are similar between adult and pediatric transplant recipients. Support for collaborative studies is critical if we are to improve long-term outcomes for our young patients.

  5. Expanding access to transplantation with hepatitis C-positive donors: A new perspective on an old issue.

    PubMed

    Kling, Catherine E; Limaye, Ajit P; Landis, Charles S; Sibulesky, Lena

    2017-02-01

    With the need for organs far exceeding supply, donors previously exposed to hepatitis B (HBV) and hepatitis C (HCV) viral infections should be considered for transplantation. Although many centers have protocols for transplanting organs from HBV core antibody-positive (HBcAb+) donors into select recipients, in the era of direct-acting antivirals (DAAs), a new focus should be placed on HCV-positive donors. The transmission rate from HCV antibody-positive (HCVAb+) nucleic acid testing negative (HCV NAT-) donors is expected to be very low, and we encourage use of such organs in HCV recipients provided a normal biopsy, appropriate counseling, and careful post-transplant monitoring. While transmission of HCV from HCV NAT+ donors is universal, the success of DAA in obtaining a sustained viral response in post-transplant recipients should make the use of these organs more appealing. We herein provide information to help guide the use of organs from HCV donors. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Utilization of Collaborative Practice Agreements between Physicians and Pharmacists as a Mechanism to Increase Capacity to Care for Hematopoietic Stem Cell Transplant Recipients

    PubMed Central

    Merten, Julianna A.; Shapiro, Jamie F.; Gulbis, Alison M.; Rao, Kamakshi V.; Bubalo, Joseph; Lanum, Scott; Engemann, Ashley Morris; Shayani, Sepideh; Williams, Casey; Leather, Helen; Walsh-Chocolaad, Tracey

    2013-01-01

    Survival following hematopoietic stem cell transplantation (HSCT) has improved and the number of allogeneic HSCTs performed annually in the United States is expected to reach 10,000 by 2015. The National Marrow Donor Program created the System Capacity Initiative to formulate mechanisms to care for the growing number of HSCT recipients. One proposed method to increase capacity is utilization of pharmacists to manage drug therapy via collaborative practice agreements (CPAs). Pharmacists have managed drug therapy in oncology patients with CPAs for decades; however, there are limited HSCT centers that employ this practice. Engaging in collaborative practice and billing agreements with credentialed pharmacists to manage therapeutic drug monitoring, chronic medical conditions and supportive care in HSCT recipients may be cost-effective and enable physicians to spend more time on new or more complex patients. The goal of this paper is to provide a framework for implementation of a CPA and address how it may improve HSCT program capacity. PMID:23419976

  7. Assistance received by employed caregivers and their care recipients: who helps care recipients when caregivers work full time?

    PubMed

    Scharlach, Andrew E; Gustavson, Kristen; Dal Santo, Teresa S

    2007-12-01

    This study examined the association among caregiver labor force participation, employees' caregiving activities, and the amount and quality of care received by care recipients. Telephone interviews were conducted with 478 adults who were employed full time and 705 nonemployed adults who provided care to a family member or friend aged 50 or older, identified through random sampling of California households. We assessed care recipient impairment and service problems; the amounts and types of assistance received from caregivers, family and friends, and paid providers; and caregiver utilization of support services. Care recipients of caregivers employed full time were less likely to receive large amounts of care from their caregivers, more likely to receive personal care from paid care providers, more likely to use community services, and more likely to experience service problems than were care recipients of nonemployed caregivers. Employed caregivers were more likely to use caregiver support services than were nonemployed caregivers. Accommodation to caregiver full-time employment involves selective supplementation by caregivers and their care recipients, reflecting increased reliance on formal support services as well as increased vulnerability to service problems and unmet care recipient needs. These findings suggest the need for greater attention to the well-being of disabled elders whose caregivers are employed full time.

  8. 34 CFR 75.118 - Requirements for a continuation award.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... wants to receive a continuation award shall submit a performance report that provides the most current performance and financial expenditure information, as directed by the Secretary, that is sufficient to meet... Evaluation by the recipient, § 75.720 Financial and performance reports, § 74.51 Monitoring and reporting...

  9. 76 FR 40874 - Information Collection; Equal Opportunity Compliance Review Record

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-12

    ... of the Education Amendments Act of 1972. The Age Discrimination Act of 1975, as amended. Section 504... monitoring will take place to ensure the public is being served without any barriers or discrimination... receives services without discrimination or barriers to access, and that recipients' employees understand...

  10. 34 CFR 74.51 - Monitoring and reporting program performance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... programs or projects can be readily quantified, this quantitative data should be related to cost data for... information including, when appropriate, analysis, and explanation of cost overruns or high unit costs. (e... requirements of 5 CFR part 1320 when requesting performance data from recipients. (Approved by the Office of...

  11. ONF trainee awards contribute to capacity building in neurotrauma.

    PubMed

    Turner, Jane; Turner, Dan; Riopelle, Richard J; Bassett-Spiers, Kent; Kagan, Corinne

    2008-03-01

    Injury to the brain and spinal cord is one of the most catastrophic and costly occurrences in the Ontario health system. The objective of the present study was to evaluate the impact of past Ontario Neurotrauma Foundation (ONF) studentships and fellowships in terms of capacity building in the neurotrauma field in Ontario. An online, cross sectional survey amongst past recipients of studentships and fellowships that terminated prior to July 2005. Explicit data were collected on various aspects of career development including current activity, awards and publications. Thirty-six out of 42 (86%) eligible past trainees responded; 12 (33%) were Masters students, 12 (33%) were PhD students and 12 (33%) were Post-Doctoral students. A majority of the recipients (61%) are currently involved in neurotrauma-related activities (clinical, research and teaching) in more than 20% of their time, with no substantial differences between the degree groups. Half the recipients are currently involved in neurotrauma-related research in more than 20% of their time. The awardees published 1.5 peer-review manuscripts/person-year and received multiple awards. A high majority of our recipients (86%) feel that the ONF award had a substantial impact on their career. A high proportion of past award recipients remain involved in neurotrauma activities, especially in research. These results may lead to a cautious conclusion of the positive impact of the ONF studentships and fellowships on neurotrauma capacity building. These results should be considered in strategic planning of funding agencies similar to ONF.

  12. 45 CFR 84.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Administrative requirements for small recipients. 84.9 Section 84.9 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General...

  13. 45 CFR 1170.42 - Admissions and recruitment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... recipient, has been validated as a predictor of success in the education program or activity in question and... inquiry exception. When a recipient is taking remedial action to correct the effects of past... first year grades, but shall conduct periodic validity studies against the criterion of overall success...

  14. 24 CFR 1000.124 - What maximum and minimum rent or homebuyer payment can a recipient charge a low-income rental...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... assisted with NAHASDA grant amounts? 1000.124 Section 1000.124 Housing and Urban Development Regulations... Activities § 1000.124 What maximum and minimum rent or homebuyer payment can a recipient charge a low-income...

  15. 32 CFR 196.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  16. 38 CFR 23.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  17. 18 CFR 1317.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  18. 32 CFR 196.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  19. 13 CFR 113.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  20. 18 CFR 1317.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  1. 14 CFR 1253.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  2. 45 CFR 86.31 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... restricted to members of one sex, which are designed to provide opportunities to study abroad, and which are... recipient educational institution to study at a foreign institution. A recipient educational institution may... makes available reasonable opportunities for similar studies for members of the other sex. Such...

  3. 38 CFR 23.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  4. 13 CFR 113.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  5. 13 CFR 113.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  6. 18 CFR 1317.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  7. 29 CFR 36.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  8. 44 CFR 19.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  9. 44 CFR 19.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  10. 38 CFR 23.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  11. 29 CFR 36.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  12. 32 CFR 196.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  13. 44 CFR 19.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  14. 14 CFR 1253.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... study abroad, and that are awarded to students who are already matriculating at or who are graduates of...) Assistance administered by a recipient educational institution to study at a foreign institution. A recipient... members of one sex provides, or otherwise makes available, reasonable opportunities for similar studies...

  15. Arterial blood pressure oscillation after active standing up in kidney transplant recipients.

    PubMed

    Gerhardt, U; Schäfer, M; Hohage, H

    2000-04-12

    Dynamic arterial blood pressure (FINAPRES) response to active standing up, normally consisting of initial rise, fall and recovery above the baseline (overshoot), was compared with the early steady-state arterial blood pressure level to measure sympathetic vasomotor function in healthy subjects [group 1: n=50, 10 female subjects, age 51+/-2.5 years; weight 78+/-2.3 kg; height 174+/-1.4 cm (mean+/-standard error of the mean)] and in kidney transplant recipients under basal (group 2a: n=50, age 51.7+/-1.7 years; weight 77+/-2.1 kg; height 174+/-1.5 cm) and under high (group 2b: same subjects as in group 2a) cyclosporine A whole blood levels. Furthermore, baroreflex sensitivity and the activity of the generating compounds of the sympathetic nervous systems (Mayer waves) were measured. Systolic and diastolic overshoot values did not differ statistically significant in the present study. In the control subjects, a systolic overshoot of 15.4+/-2.7 mmHg and a diastolic overshoot of 15.2+/-2 mmHg was detected. The systolic overshoot disappeared in 57% of group 2a (-7.1+/-2.7 mmHg; P<0.001) and in 50% of group 2b recipients (-8.0+/-2.7 mmHg; P<0.001). Systolic early steady-state level was not lower in kidney transplant recipients before cyclosporine (baseline+2 mmHg) intake, but after cyclosporine administration (baseline-3 mmHg; controls: baseline+3 mmHg; P<0.05). There was a strong association between the overshoot and steady-state levels (P for chi(2)<0.001, n=150). Overshoot of group 1 levels (r=0.428; P<0.01) and group 2 levels (r=0.714; P<0. 001) correlated to their respective steady-state blood pressure. Furthermore, recipients had reduced baroreceptor sensitivities estimated by sequence analysis as compared to controls (10+/-1 ms/mmHg vs. 7.5+/-1.4 ms/mmHg; P<0.05). Mayer waves amplitudes of the heart rate spectrum were elevated statistically significant in renal transplant recipients (44.4+/-0.2 vs. 43.8+/-2.2 A.U.). In conclusion, baroreceptor reflex-dependent overshoot of the arterial blood pressure after active standing up is diminished in kidney transplant recipients, whereas no association to the cyclosporine A whole blood level has been detected. The reduced overshoot may be due to the diminished baroreceptor sensitivity which could be shown in renal transplant recipients.

  16. Assessment of the T-SPOT.CMV interferon-γ release assay in renal transplant recipients: A single center cohort study.

    PubMed

    Chanouzas, Dimitrios; Small, Alexander; Borrows, Richard; Ball, Simon

    2018-01-01

    The measurement of CMV specific cellular immunity in organ transplant recipients could contribute additional acuity to serology based, CMV infection risk stratification, facilitating optimisation of immunosuppression and anti-viral prophylaxis. A pilot study of renal transplant recipient (RTR's) responses in the T-SPOT.CMV ELISPOT based assay. 108 RTR's were recruited 3 months post-transplantation, immediately prior to the cessation of stratified anti-viral prophylaxis, used in recipients from seropositive donors. RTR's were monitored for CMV viremia and disease. Cellular responses to peptides derived from CMV IE1 and pp65 were measured, using the T-SPOT.CMV assay. At recruitment, no CMV specific cellular immunity was detected by T-SPOT.CMV in CMV seronegative recipients (IE1 ≤ 1spot / 2.5x105 PBMC's; pp65 ≤ 3 spots / 2.5x105 PBMC's). At recruitment, CMV sero-positive recipients who made a robust response to both IE1 (>25 spots / 2.5x105 PBMC's) and pp65 (>50 spots / 2.5x105 PBMC's), were less likely to develop high level viremia than those who responded to one or neither antigen (0/28 vs 5/25; p<0.02). In CMV seronegative RTR's, CMV specific cellular immunity measured by T-SPOT.CMV was not detected prior to cessation of anti-viral prophylaxis. This differs from recent reports of CMV specific cellular immunity in a proportion of CMV seronegative RTR's, associated with protection from CMV infection. In seropositive RTR's, a dual response to IE1 and pp65 at recruitment, was associated with protection from subsequent viremia. This suggests that assessing the diversity of response to CMV antigens, may enhance risk stratification in this group.

  17. Clinical Characteristics and Outcomes of Late-Onset BK Virus Nephropathy in Kidney and Kidney-Pancreas Transplant Recipients.

    PubMed

    Imlay, Hannah; Whitaker, Kathryn; Fisher, Cynthia E; Limaye, Ajit P

    2018-05-29

    BK virus nephropathy (BKPyVAN) is a major complication in kidney transplant recipients (KTR) and typically occurs within 1 year of transplant. Guidelines vary in recommendations for BKPyV screening beyond 1 year. A systematic characterization of risk factors and outcomes of late-onset (>1 year) BKPyVAN has not previously been reported. We retrospectively compared characteristics and outcomes of early- (<1 year) and late-onset BKPyVAN (definitive [biopsy-confirmed] or presumptive [plasma BKPyV >10,000 copies/mL]) in a cohort of 671 KTR and simultaneous kidney-pancreas transplant (SPK) recipients between 2008 and 2013 at a single US transplant center. Proportions were compared using Chi square or Fisher's exact test with p < 0.05 considered significant. BKPyVAN was diagnosed in 96 (14.3%) patients (proven 16.7%, presumptive 83.3%): 79 (82.3%) early- and 17 (17.7%) late-onset. The proportion with late-onset BKPyVAN was significantly higher among SPK than KTR (4 of 7 [57.1%] vs 13 of 89 [14.6%], p=0.017). Late-onset represented "de novo" infection (no BKPyV detection within the first year) in 14 (82.4%) and progression of earlier lower-grade BKPyV reactivation in 3 (17.6%). Clinical outcomes were similar for early- and late-onset BKPyVAN (p>0.05 all comparisons). In a pooled analysis of prior studies of BKPyVAN in SPK recipients, 62.9% (17 of 27) were late-onset. A significant proportion of BKPyVAN is late-onset, especially among SPK recipients, and supports a longer duration of BKPyV monitoring for SPK recipients than recommended in some guidelines. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  18. Factors associated with medication hassles experienced by family caregivers of older adults.

    PubMed

    Travis, Shirley S; McAuley, William J; Dmochowski, Jacek; Bernard, Marie A; Kao, Hsueh-Fen S; Greene, Ruth

    2007-04-01

    We wished to identify potential factors associated with medication administration hassles, daily irritants, among informal caregivers who provide long-term medication assistance to persons aged 55 or older. A sample of 156 informal caregivers were recruited from seven states and several types of settings. The dependent variable was scores on the Family Caregiver Medication Administration Hassles Scale (FCMAHS). Independent variables included in the analyses were medication complexity; caregiver's gender, ethnicity, relationship to recipient, length of time in caregiving, education, and employment outside the home; care recipient's physical capacity and mental capacity; and whether the caregiver and care recipient live together. After preliminary analysis to reduce the number of independent variables, the remaining variables were included in a linear model (GLM procedure). Possible interactions and residuals were considered. Whites and Hispanics experience greater medication administration hassles than other groups, and perceived hassle intensity increases with medication complexity. Medication administration hassle scores increase with increasing education levels up to a high school degree, after which they remain consistently high. Caregivers whose care recipients have moderate levels of cognitive functioning have higher medication administration hassles scores than those whose care recipients have very high or very low cognitive functioning. The preliminary set of significant variables can be used to identify caregivers who may be at risk of experiencing medication administration hassles, increased stress, and potentially harmful events for their care recipients. Family caregivers are accepting complex caregiving responsibility for family members while receiving little or no support or assistance with caregiving hassles associated with this duty. The FCMAHS offers the means to monitor how caregivers are handling the daily irritants involved with medication administration so that educational interventions can be provided before hassles lead to more serious stress and strain.

  19. Sirolimus and everolimus clearance in maintenance kidney and liver transplant recipients: Diagnostic efficiency of the concentration/dose ratio for the prediction of trough steady-state concentrations

    PubMed Central

    Bouzas, Lorena; Hermida, Jesús

    2010-01-01

    Objectives Therapeutic monitoring of sirolimus and everolimus is necessary in order to minimize adverse side-effects and to ensure effective immunosuppression. A sirolimus-dosing model using the concentration/dose ratio has been previously proposed for kidney transplant patients, and the aim of our study was the evaluation of this single model for the prediction of trough sirolimus and everolimus concentrations. Methods Trough steady-state sirolimus concentrations were determined in several blood samples from each of 7 kidney and 9 liver maintenance transplant recipients, and everolimus concentrations from 20 kidney, 17 liver, and 3 kidney/liver maintenance transplant recipients. Predicted sirolimus and everolimus concentrations (Css), corresponding to the doses (D), were calculated using the measured concentrations (Css0) and corresponding doses (D0) on starting the study: Css = (Css0)(D)/D0. Results The diagnostic efficiency of the predicting model for the correct classification as subtherapeutic, therapeutic, and supratherapeutic values with respect to the experimentally obtained concentrations was 91.3% for sirolimus and 81.4% for everolimus in the kidney transplant patients. In the liver transplant patients the efficiency was 69.2% for sirolimus and 72.6% for everolimus, and in the kidney/liver transplant recipients the efficiency for everolimus was 67.9%. Conclusions The model has an acceptable diagnostic efficiency (>80%) for the prediction of sirolimus and everolimus concentrations in kidney transplant recipients, but not in liver transplant recipients. However, considering the wide ranges found for the prediction error of sirolimus and everolimus concentrations, the clinical relevance of this dosing model is weak. PMID:19943816

  20. Factors associated with the development of cytomegalovirus infection following solid organ transplantation.

    PubMed

    da Cunha-Bang, Caspar; Sørensen, Søren S; Iversen, Martin; Sengeløv, Henrik; Hillingsø, Jens G; Rasmussen, Allan; Mortensen, Svend A; Fox, Zoe V; Kirkby, Nikolai S; Christiansen, Claus B; Lundgren, Jens D

    2011-05-01

    Infection with cytomegalovirus (CMV) remains a potentially serious complication in transplant patients. In this study we explored the risk factors for CMV infection in the 12 months following a solid organ transplantation (n = 242) in patients monitored for CMV infection from 2004 to 2007. CMV infection was defined as 2 consecutive quantifiable CMV-polymerase chain reaction (PCR) values or 1 measurement of >3000 copies/ml. Data describing pre- and post-transplantation variables were extracted from electronic health records. Time to CMV infection was investigated using Cox proportional hazards analysis. Overall, 31% (75/242) of solid organ transplant patients developed CMV infection: 4/8 (50.0%) heart, 15/43 (34.9%) liver, 30/89 (33.7%) lung and 26/102 (25.5%) kidney transplant patients. The risk of CMV infection according to donor (D)/recipient (R) CMV serostatus (positive + or negative-) was highest for D+/R-(adjusted hazard ratio 2.6, 95% confidence interval 1.6-4.2) vs D+/R+, and was reduced for D-/R+(adjusted hazard ratio 0.2, 95% confidence interval 0.2-0.8) vs D+/R+. Positive donor CMV-serostatus is a major risk factor for CMV-infection in CMV-na ve recipients, but also in recipients with positive CMV-serostatus. Conversely, if donor is CMV serostatus is negative, the risk of CMV infection is low, irrespective of recipients CMV-serostatus. These findings suggest poorer immune function towards donor-induced strains of CMV versus recipient own latent strains.

  1. Harnessing the Foreign Body Reaction in Marginal Mass Device-less Subcutaneous Islet Transplantation in Mice.

    PubMed

    Pepper, Andrew R; Pawlick, Rena; Bruni, Antonio; Gala-Lopez, Boris; Wink, John; Rafiei, Yasmin; Bral, Mariusz; Abualhassan, Nasser; Shapiro, A M James

    2016-07-01

    Islet transplantation is a successful β-cell replacement therapy for selected patients with type 1 diabetes mellitus. However, despite early insulin independence, long-term graft attrition gradually reverts recipients to exogenous insulin dependency. Undoubtedly, as insulin producing stem cell therapies progress, a transplant site that is retrievable is desirable. This prerequisite is currently incompatible with intrahepatic islet transplantation. Herein, we evaluate the functional capacity of a prevascularized subcutaneous site to accommodate marginal islet mass transplantation in mice. Syngeneic mouse islets (150) were transplanted either under the kidney capsule (KC), into a prevascularized subcutaneous device-less (DL) site, or into the unmodified subcutaneous (SC) tissue. The DL site was created 4 weeks before diabetes induction and islet transplantation through the transient placement of a 5-Fr vascular catheter. Recipient mice were monitored for glycemic control and intraperitoneal glucose tolerance. A marginal islet mass transplanted into the DL site routinely reversed diabetes (n = 13 of 18) whereas all SC islet recipients failed to restore glycemic control (n = 0 of 10, P < 0.01, log-rank). As anticipated, nearly all islet-KC mice (n = 15 of 16) became euglycemic posttransplant. The DL recipients' glucose profiles were comparable to KC islet grafts, postintrapertioneal glucose tolerance testing, whereas SC recipients remained hyperglycemic postglucose challenge. All normoglycemic mice maintained graft function for 100 days until graft retrieval. DL and KC islet grafts stained positively for insulin, microvessels, and a collagen scaffold. The device-less prevascularized approach supports marginal mass islet engraftment in mice.

  2. Rapid single nucleotide polymorphism based method for hematopoietic chimerism analysis and monitoring using high-speed droplet allele-specific PCR and allele-specific quantitative PCR.

    PubMed

    Taira, Chiaki; Matsuda, Kazuyuki; Yamaguchi, Akemi; Uehara, Masayuki; Sugano, Mitsutoshi; Okumura, Nobuo; Honda, Takayuki

    2015-05-20

    Chimerism analysis is important for the evaluation of engraftment and predicting relapse following hematopoietic stem cell transplantation (HSCT). We developed a chimerism analysis for single nucleotide polymorphisms (SNPs), including rapid screening of the discriminable donor/recipient alleles using droplet allele-specific PCR (droplet-AS-PCR) pre-HSCT and quantitation of recipient DNA using AS-quantitative PCR (AS-qPCR) following HSCT. SNP genotyping of 20 donor/recipient pairs via droplet-AS-PCR and the evaluation of the informativity of 5 SNP markers for chimerism analysis were performed. Samples from six follow-up patients were analyzed to assess the chimerism via AS-qPCR. These results were compared with that determined by short tandem repeat PCR (STR-PCR). Droplet-AS-PCR could determine genotypes within 8min. The total informativity using all 5 loci was 95% (19/20). AS-qPCR provided the percentage of recipient DNA in all 6 follow-up patients without influence of the stutter peak or the amplification efficacy, which affected the STR-PCR results. The droplet-AS-PCR had an advantage over STR-PCR in terms of rapidity and simplicity for screening before HSCT. Furthermore, AS-qPCR had better accuracy than STR-PCR for quantification of recipient DNA following HSCT. The present chimerism assay compensates for the disadvantages of STR-PCR and is readily performable in clinical laboratories. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Fas/Fas Ligand pathways gene polymorphisms in pediatric renal allograft rejection.

    PubMed

    Fadel, Fatina I; Elshamaa, Manal F; Salah, Ahmed; Nabhan, Marwa; Rasheed, Maha; Kamel, Solaf; Kandil, Dina; Thabet, Eman H

    2016-07-01

    An essential milestone in pediatric transplantation is to find noninvasive biomarkers to monitor acute rejection (AR). In this retrospective (Case-control) study, we examined the role of Fas -670A/G and Fas Ligand (FasL) -843C/T gene polymorphisms in allograft nephropathy in pediatric renal transplant recipients. In 47 pediatric kidney transplant recipients and 20 healthy controls, Fas -670A/G and FasL -843C/T gene polymorphisms as well as serum soluble Fas Ligand level (sFasL) were measured. Serum sFasL levels were significantly higher in transplant recipients children than that in controls (548.25±298.64pg/ml vs 143.17±44.55pg/ml, p=0.0001). There was no significant difference between patients with AR and those without AR in regards to serum sFasL levels (567.70±279.87pg/ml vs 507.85±342.80pg/ml, p=0.56). Fas -670A/G genotypes or alleles were not significantly different between controls and transplant recipients and among transplant recipients with and without AR. (P>0.05 for all). FasL -843C/T genotypes were not different between transplant recipients and controls and among transplant recipients with and without AR (P>0.05 for all). However, Frequency of C allele in transplant patients was significantly higher than that in the control group (44.68% vs 25%, P=0.03). FasL -843C/T alleles were significantly different between patients with and without AR (P=0.03). The percentages of C allele were higher in children with AR (58.82% vs 36.67%). We found that serum FasL and serum creatinine were variables that were independently associated with AR. This study suggests that FasL gene polymorphisms in peripheral blood might be accurate in detecting cellular AR. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Cardiorespiratory functional assessment after pediatric heart transplantation.

    PubMed

    Pastore, E; Turchetta, A; Attias, L; Calzolari, A; Giordano, U; Squitieri, C; Parisi, F

    2001-12-01

    Limited data are available on the exercise capacity of young heart transplant recipients. The aim of this study was therefore to assess cardiorespiratory responses to exercise in this group of patients. Fourteen consecutive heart transplant recipients (six girls and eight boys, age-range 5-15 yr) and 14 healthy matched controls underwent a Bruce treadmill test to determine: duration of test; resting and maximum heart rates; maximum systolic blood pressure; peak oxygen consumption (VO2 peak); and cardiac output. Duration of test and heart rate increase were then compared with: time since transplantation, rejections per year, and immunosuppressive drugs received. The recipients also underwent the following lung function tests: forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). When compared with healthy controls, transplant recipients had tachycardia at rest (126 +/- 3.7 beats/min; p < 0.001); significantly reduced tolerance (9.3 +/- 0.4 min; p < 0.001), a maximum heart rate of 169 +/- 5.4 beats/min (p < 0.05); a cardiac output of 5.65 +/- 0.6 L/min (p < 0.05); and a lower heart-rate increase from rest to peak exercise (p < 0.001) but a similar VO2 peak. The heart-rate increase correlated significantly with time post-transplant (r = 0.55; p < 0.05), number of rejection episodes per year (r = - 0.63; p < 0.05), and number of immunosuppressive drugs (r = - 0.60; p < 0.05). The recipients had normal FVC and FEV1 values. After surgery, few heart transplant recipients undertake physical activity, possibly owing to over-protective parents and teachers and to a lack of suitable supervised facilities. The authors stress the importance of a cardiorespiratory functional evaluation for assessment of health status and to encourage recipients, if possible, to undertake regular physical activity.

  5. Plasma markers of B-cell activation and clonality in pediatric liver and hematopoietic stem cell transplant recipients

    PubMed Central

    Engels, Eric A.; Savoldo, Barbara; Pfeiffer, Ruth M.; Costello, Rene; Zingone, Adriana; Heslop, Helen E.; Landgren, Ola

    2012-01-01

    Introduction Transplant recipients are at risk of post-transplant lymphoproliferative disease (PTLD). Methods: Thirty-six pediatric transplant recipients were evaluated (18 hematopoietic stem cell and 18 liver recipients; 12 had PTLD). We studied 207 longitudinal plasma samples from these recipients for three markers of B-cell activation or clonality: immunoglobulin free light chains (FLCs), soluble CD30 (sCD30), and monoclonal immunoglobulins (M-proteins). Results Kappa FLCs, lambda FLCs, and sCD30 were elevated in 20.8%, 28.0%, and 94.2% of plasma specimens, respectively. FLC and sCD30 levels increased significantly 1.18–1.82 fold per log10 Epstein Barr virus (EBV) load in peripheral blood. Five PTLD cases manifested elevated FLCs with an abnormal kappa/lambda ratio, suggesting monoclonal FLC production. M-proteins were present in 91% of PTLD cases, vs. 50–67% of other recipients with high or low EBV loads (p=0.13). Concordance of FLCs, M-proteins, and PTLD tumor light chain restriction was imperfect. For example, one PTLD case with an IgG lambda M-protein had a tumor that was kappa restricted, and another case with an M-protein had a T-cell PTLD. In an additional case, an IgM kappa M-protein and excess kappa FLCs were both detected in plasma at PTLD diagnosis; while the tumor was not restricted at diagnosis, kappa restriction was present 5 years later when the PTLD relapsed. Discussion Plasma markers of B-cell dysfunction are frequent following transplantation and associated with poor EBV control. These abnormal markers may be produced by oligoclonal B-cell populations or PTLD tumor cells, and could potentially help identify recipients at high risk of PTLD. PMID:23222884

  6. Music appreciation and music listening in prelingual and postlingually deaf adult cochlear implant recipients.

    PubMed

    Moran, Michelle; Rousset, Alexandra; Looi, Valerie

    2016-01-01

    To explore the music appreciation of prelingually deaf adults using cochlear implants (CIs). Cohort study. Adult CI recipients were recruited based on hearing history and asked to complete the University of Canterbury Music Listening Questionnaire (UCMLQ) to assess each individual's music listening and appreciation. Results were compared to previous responses to the UCMLQ from a large cohort of postlingually deaf CI recipients. Fifteen prelingually deaf and 15 postlingually deaf adult cochlear implant recipients. No significant differences were found between the prelingual and postlingual participants for amount of music listening or music listening enjoyment with their CI. Sound quality of common instruments was favourable for both groups, with no significant difference in the pleasantness/naturalness of instrument sounds between the groups. Prelingually deaf CI recipients rated themselves as significantly less able to follow a melody line and identify instrument styles compared to their postlingual peers. The results suggest that the pre- and postlingually deaf CI recipients demonstrate equivalent levels of music appreciation. This finding is of clinical importance, as CI clinicians should be actively encouraging all of their recipients to explore music listening as a part of their rehabilitation.

  7. Intestinal transplantation: The anesthesia perspective.

    PubMed

    Dalal, Aparna

    2016-04-01

    Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation. Intestinal transplant grafts can be isolated or combined with the liver/duodenum/pancreas. Organ Procurement and Transplantation Network (OPTN) has defined intestinal donor criteria. Living donor intestinal transplant (LDIT) has the advantages of optimal timing, short ischemia time and good human leukocyte antigen matching contributing to lower postoperative complications in the recipient. Thoracic epidurals provide excellent analgesia for the donors, as well as recipients. Recipient management can be challenging. Thrombosis and obstruction of venous access maybe common due to prolonged parenteral nutrition and/or hypercoaguability. Thromboelastography (TEG) is helpful for managing intraoperative product therapy or thrombosis. Large fluid shifts and electrolyte disturbances may occur due to massive blood loss, dehydration, third spacing etc. Intestinal grafts are susceptible to warm and cold ischemia and ischemia-reperfusion injury (IRI). Post-reperfusion syndrome is common. Cardiac or pulmonary clots can be monitored with transesophageal echocardiography (TEE) and treated with recombinant tissue plasminogen activator. Vasopressors maybe used to ensure stable hemodynamics. Post-intestinal transplant patients may need anesthesia for procedures such as biopsies for surveillance of rejection, bronchoscopy, endoscopy, postoperative hemorrhage, anastomotic leaks, thrombosis of grafts etc. Asepsis, drug interactions between anesthetic and immunosuppressive agents and venous access are some of the anesthetic considerations for this group. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. DEL phenotype.

    PubMed

    Kwon, Dong H; Sandler, S G; Flegel, Willy A

    2017-09-01

    DEL red blood cells (RBCs) type as D- by routine serologic methods and are transfused routinely, without being identified as expressing a very weak D antigen, to D- recipients. DEL RBCs are detected only by adsorption and elution of anti-D or by molecular methods. Most DEL phenotypes have been reported in population studies conducted in East Asia, although DEL phenotypes have been detected also among Caucasian individuals. Approximately 98 percent of DEL phenotypes in East Asians are associated with the RHD*DEL1 or RHD*01EL.01 allele. The prevalence of DEL phenotypes has been reported among D- Han Chinese (30%), Japanese (28%), and Korean (17%) populations. The prevalence of DEL phenotypes is significantly lower among D- Caucasian populations (0.1%). Among the 3-5 percent of African individuals who are D-, there are no reports of the DEL phenotype. Case reports from East Asia indicate that transfusion of DEL RBCs to D- recipients has been associated with D alloimmunization. East Asian immigrants constitute 2.1 percent of the 318.9 million persons residing in the United States, and an estimated 2.8 percent are blood donors. Using these statistics, we estimate that 68-683 units of DEL RBCs from donors of East Asian ancestry are transfused as D- annually in the United States. Given the reports from East Asia of D alloimmunization attributed to transfusion of DEL RBCs, one would expect an occasional report of D alloimmunization in the United States following transfusion of DEL RBCs to a D- recipient. If such cases do occur, the most likely reason that they are not detected is the absence of active post-transfusion monitoring for formation of anti-D.

  9. Soluble CD30 and ELISA-detected human leukocyte antigen antibodies for the prediction of acute rejection in pediatric renal transplant recipients.

    PubMed

    Billing, Heiko; Sander, Anja; Süsal, Caner; Ovens, Jörg; Feneberg, Reinhard; Höcker, Britta; Vondrak, Karel; Grenda, Ryszard; Friman, Stybjorn; Milford, David V; Lucan, Mihai; Opelz, Gerhard; Tönshoff, Burkhard

    2013-03-01

    Biomarker-based post-transplant immune monitoring for the prediction of impending graft rejection requires validation in specific patient populations. Serum of 28 pediatric renal transplant recipients within the framework of a well-controlled prospective randomized trial was analyzed pre- and post-transplant for soluble CD30 (sCD30), a biomarker reflecting mainly T-cell reactivity, and anti-human leukocyte antigen (anti-HLA) antibody reactivity, a biomarker for B-cell activation. A sCD30 concentration ≥40.3 U/ml on day 14 was able to discriminate between patients with or without biopsy-proven acute rejection (BPAR) with a sensitivity of 100% and a specificity of 76%. Six of seven patients (86%) with BPAR showed a sCD30 above this cut-off, whereas only 3/21 patients (14%) without BPAR had a sCD30 above this cut-off (P = 0.004). For pre- and post-transplant anti-HLA class II reactivities by enzyme-linked immunosorbent assay, a cut-off value of 140 optical density was able to discriminate rejecters from nonrejecters with a sensitivity of 86% or 71% and a specificity of 81% or 90%, respectively. Withdrawal of steroids was associated with a approximately twofold higher serum sCD30 compared to controls, but did not affect anti-HLA reactivities. An increased post-transplant sCD30 serum concentration and positive pre- and post-transplant anti-HLA class II reactivities are informative biomarkers for impending BPAR in pediatric renal transplant recipients. (TWIST, Clinical Trial No: FG-506-02-43). © 2012 The Authors Transplant International © 2012 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.

  10. Correlation of BK Virus Neutralizing Serostatus With the Incidence of BK Viremia in Kidney Transplant Recipients.

    PubMed

    Abend, Johanna R; Changala, Marguerite; Sathe, Atul; Casey, Fergal; Kistler, Amy; Chandran, Sindhu; Howard, Abigail; Wojciechowski, David

    2017-06-01

    BK virus (BKV)-associated nephropathy is the second leading cause of graft loss in kidney transplant recipients. Due to the high prevalence of persistent infection with BKV in the general population, it is possible that either the transplant recipient or donor may act as the source of virus resulting in viruria and viremia. Although several studies suggest a correlation between donor-recipient serostatus and the development of BK viremia, specific risk factors for BKV-related complications in the transplant setting remain to be established. We retrospectively determined the pretransplant BKV neutralizing serostatus of 116 donors (D)-recipient (R) pairs using infectious BKV neutralization assays with representatives from the 4 major viral serotypes. The neutralizing serostatus of donors and recipients was then correlated with the incidence of BK viremia during the first year posttransplantation. There were no significant differences in baseline demographics or transplant data among the 4 neutralizing serostatus groups, with the exception of calculated panel-reactive antibody which was lowest in the D+/R- group. Recipients of kidneys from donors with significant serum neutralizing activity (D+) had elevated risk for BK viremia, regardless of recipient serostatus (D+ versus D-: odd ratio, 5.0; 95% confidence interval, 1.9-12.7]; P = 0.0008). Furthermore, donor-recipient pairs with D+/R- neutralizing serostatus had the greatest risk for BK viremia (odds ratio, 4.9; 95% confidence interval, 1.7-14.6; P = 0.004). Donor neutralizing serostatus correlates significantly with incidence of posttransplant BK viremia. Determination of donor-recipient neutralizing serostatus may be useful in assessing the risk of BKV infection in kidney transplant recipients.

  11. Lung transplantation in the United States, 1998-2007.

    PubMed

    McCurry, K R; Shearon, T H; Edwards, L B; Chan, K M; Sweet, S C; Valapour, M; Yusen, R; Murray, S

    2009-04-01

    This article highlights trends and changes in lung and heart-lung transplantation in the United States from 1998 to 2007. The most significant change over the last decade was implementation of the Lung Allocation Score (LAS) allocation system in May 2005. Subsequently, the number of active wait-listed lung candidates declined 54% from pre-LAS (2004) levels to the end of 2007; there was also a reduction in median waiting time, from 792 days in 2004 to 141 days in 2007. The number of lung transplants performed yearly increased through the decade to a peak of 1 465 in 2007; the greatest single year increase occurred in 2005. Despite candidates with increasingly higher LAS scores being transplanted in the LAS era, recipient death rates have remained relatively stable since 2003 and better than in previous years. Idiopathic pulmonary fibrosis became the most common diagnosis group to receive a lung transplant in 2007 while emphysema was the most common diagnosis in previous years. The number of retransplants and transplants in those aged > or =65 performed yearly have increased significantly since 1998, up 295% and 643%, respectively. A decreasing percentage of lung transplant recipients are children (3.5% in 2007, n = 51). With LAS refinement ongoing, monitoring of future impact is warranted.

  12. Monitoring Progress in Vocal Development in Young Cochlear Implant Recipients: Relationships between Speech Samples and Scores from the Conditioned Assessment of Speech Production (CASP)

    PubMed Central

    Ertmer, David J.; Jung, Jongmin

    2012-01-01

    Background Evidence of auditory-guided speech development can be heard as the prelinguistic vocalizations of young cochlear implant recipients become increasingly complex, phonetically diverse, and speech-like. In research settings, these changes are most often documented by collecting and analyzing speech samples. Sampling, however, may be too time-consuming and impractical for widespread use in clinical settings. The Conditioned Assessment of Speech Production (CASP; Ertmer & Stoel-Gammon, 2008) is an easily administered and time-efficient alternative to speech sample analysis. The current investigation examined the concurrent validity of the CASP and data obtained from speech samples recorded at the same intervals. Methods Nineteen deaf children who received CIs before their third birthdays participated in the study. Speech samples and CASP scores were gathered at 6, 12, 18, and 24 months post-activation. Correlation analyses were conducted to assess the concurrent validity of CASP scores and data from samples. Results CASP scores showed strong concurrent validity with scores from speech samples gathered across all recording sessions (6 – 24 months). Conclusions The CASP was found to be a valid, reliable, and time-efficient tool for assessing progress in vocal development during young CI recipient’s first 2 years of device experience. PMID:22628109

  13. Tobacco smoke exposure in either the donor or recipient before transplantation accelerates cardiac allograft rejection, vascular inflammation, and graft loss.

    PubMed

    Khanna, Ashwani K; Xu, Jianping; Uber, Patricia A; Burke, Allen P; Baquet, Claudia; Mehra, Mandeep R

    2009-11-03

    Tobacco exposure in cardiac transplant recipients, before and after transplantation, may increase the risk of cardiac allograft vasculopathy and allograft loss, but no direct evidence for this phenomenon is forthcoming. In this experimental study, we investigated early consequences of tobacco smoke exposure in cardiac transplant donors and recipients with an emphasis on alloinflammatory mediators of graft outcome. Using heterotopic rat cardiac transplantation, we tested the effects of donor or recipient tobacco smoke exposure in 6 groups of animals (rat heterotopic cardiac transplantation) as follows: tobacco-naïve allogeneic rejecting controls (n=6), tobacco-naïve nonrejecting controls (n=3; killed on day 5 to simulate survival times of tobacco-treated animals), isografts (n=3), both donor and recipient rats exposed to tobacco smoke (n=4), only donor rats exposed to tobacco smoke (n=7), and only recipient rats exposed to tobacco smoke (n=6). Polymerase chain reaction studies of tissue and peripheral (systemic) protein expression were performed to evaluate inflammatory (tumor necrosis factor-alpha, interferon-gamma, interleukin-6) and alloimmune (interleukin-1 receptor 2, programmed cell death-1, and stromal cell-derived factor-1) pathways, as was histological analysis of the cardiac allografts. Our experiments reveal that pretransplantation tobacco exposure in donors and/or recipients results in heightened systemic inflammation and increased oxidative stress, reduces posttransplantation cardiac allograft survival by 33% to 57%, and increases intragraft inflammation (tumor necrosis factor-alpha, interferon-gamma, interleukin-6) and alloimmune activation (CD3, interleukin-1 receptor 2, programmed cell death-1, and stromal cell-derived factor-1) with consequent myocardial and vascular destruction. These sentinel findings confirm that tobacco smoke exposure in either donors or recipients leads to accelerated allograft rejection, vascular inflammation, and graft loss. Molecular pathways that intersect as arbiters in this phenomenon include instigation of alloimmune activation associated with tobacco smoke-induced inflammation.

  14. The efficacy and stability of an information and communication technology-based centralized monitoring system of adherence to immunosuppressive medication in kidney transplant recipients: study protocol for a randomized controlled trial.

    PubMed

    Jung, Hee-Yeon; Seong, Sook Jin; Choi, Ji-Young; Cho, Jang-Hee; Park, Sun-Hee; Kim, Chan-Duck; Yoon, Young-Ran; Kim, Hyung-Kee; Huh, Seung; Yoon, Se-Hee; Lee, Jong Soo; Kim, Yong-Lim

    2017-10-16

    Immunosuppression non-adherence in kidney transplant recipients (KTRs) not only increases the risk of medical intervention due to acute rejection and graft loss but burdens the socioeconomic system in the form of increased healthcare costs. An aggressive preemptive effort by healthcare professionals, geared to ensure adherence to immunosuppressants in KTRs, is significant and imperative. This study was designed as a prospective, open-label, multicenter, randomized controlled study aimed at evaluating the efficacy and stability of an information and communication technology (ICT)-based centralized monitoring system in boosting medication adherence in KTRs. One hundred fourteen KTRs registered throughout the year 2017 to 2018 are randomized into either the ICT-based centralized home monitoring system or to ambulatory follow-up. The planned follow-up duration is 6 months. The ICT-based centralized home monitoring system described consists of a smart pill box equipped with personal identification system, a home monitoring system, an electronic Case Report Form (eCRF) system, and a comprehensive clinical trial management system (CTMS). It alerts both patients and medical staff with texts and pill box alarms if there is a dosage/dosing time error or a missed dose. Medication adherence and transplant outcomes for the follow-up period are compared between the two groups, while patient satisfaction as well as the stability and cost-effectiveness of the ICT-based monitoring system are to be evaluated. This on-going study is expected to determine if consistent use of the ICT-based centralized monitoring system described could maximize mediation adherence and subsequently enhance transplant outcomes in KTRs. Further, it would lay the foundation for successful implementation of this ICT-based monitoring system for effective management of medication adherence in KTRs. ClinicalTrials.gov, Identifier: NCT03136588 . Registered on 20 April 2017.

  15. Availability of anesthetic effect monitoring: utilization, intraoperative management and time to extubation in liver transplantation.

    PubMed

    Schumann, R; Hudcova, J; Bonney, I; Cepeda, M S

    2010-12-01

    Titration of volatile anesthetics to anesthetic effect monitoring using the bispectral index (BIS) has been shown to decrease anesthetic requirements and facilitate recovery from anesthesia unrelated to liver transplantation (OLT). To determine whether availability of such monitoring influences its utilization pattern and affect anesthetic care and outcomes in OLT, we conducted a retrospective analysis in recipients with and without such monitoring. We evaluated annual BIS utilization over a period of 7 years, and compared 41 BIS-monitored patients to 42 controls. All received an isoflurane/air/oxygen and opioid-based anesthetic with planned postoperative ventilation. Data collection included age, body mass index (BMI), gender, Model for End-stage Liver Disease (MELD) score, and time to extubation (TtE). Mean preanhepatic, anhepatic, and postanhepatic end-tidal isoflurane concentrations were compared, as well as BIS values for each phase of OLT using the Kruskal-Wallis and Wilcoxon signed-rank tests, respectively. The use of anesthetic effect monitoring when available increased steadily from 15% of cases in the first year to almost 93% by year 7. There was no significant difference in age, gender, BMI, MELD, or TtE between groups. The BIS group received less inhalational anesthetic during each phase of OLT compared to the control group. However, this difference was statistically significant only during the anhepatic phase (P = .026), and was clinically not impressive. Within the BIS group, the mean BIS value was 38.74 ± 5.25 (mean ± standard deviation), and there was no difference for the BIS value between different transplant phases. Availability of anesthetic effect monitoring as an optional monitoring tool during OLT results in its increasing utilization by anesthesia care teams over time. However, unless integrated into an intraoperative algorithm and an early extubation protocol for fast tracking of OLT recipients, this utilization does not appear to provide a clinical benefit but instead drives cost. Copyright © 2010 Elsevier Inc. All rights reserved.

  16. 42 CFR 121.7 - Identification of organ recipient.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....8. (3) When a donor or donor organ does not meet a transplant program's donor acceptance criteria... documentation of activities conducted to determine the suitability of the organ donor and shall maintain this... for another potential recipient in accordance with paragraph (b)(2) of this section. (e) Blood vessels...

  17. 45 CFR 1614.2 - General policy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the joint venture plan must meet the following conditions: (1) The recipients involved in the joint... § 1614.6; (2) Each recipient in the joint venture must be a bona fide participant in the activities undertaken by the joint venture; and (3) The joint PAI venture must provide an opportunity for involving...

  18. 34 CFR 104.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false Administrative requirements for small recipients. 104.9 Section 104.9 Education Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING...

  19. 34 CFR 104.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false Administrative requirements for small recipients. 104.9 Section 104.9 Education Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING...

  20. 34 CFR 104.9 - Administrative requirements for small recipients.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Administrative requirements for small recipients. 104.9 Section 104.9 Education Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING...

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