SIGNET: protocol for a multicentre, single-blind prospective, group sequential, randomised controlled trial to evaluate the benefits of a single dose of simvastatin given to potential organ donors declared dead by neurological criteria on outcomes in organ recipients.

Introduction: Successful organ transplantation in patients with end-stage organ failure improves long-term survival, improves quality of life and reduces costs to the NHS. Despite an increase in the number of deceased organ donors over the last decade, there remains a considerable shortfall of suitable organs available for transplantation. Over half of UK donors are certified dead by neurological criteria following brain stem compression, which leads to severe physiological stress in the donor, combined with a hyperinflammatory state.

Taphonomic impact of vertebrate scavengers on degradation and dispersal of remains, southeastern British Columbia.

Vertebrate scavengers represent important taphonomic agents that can act on a body, particularly when in an outdoor environment. Understanding the effects of these agents will direct how and where to search for human remains and influence the likelihood of discovery in a particular region. The current study aimed to identify the taphonomic impact of scavenger guilds in the peri-urban and rural regions of southeastern British Columbia.

The taphonomic impact of scavenger guilds in peri-urban and rural regions of central and southern Alberta. Part I - Identification of forensically relevant vertebrate scavengers.

As a body decomposes in an outdoor environment, numerous taphonomic agents can act on the process of human decomposition. It is important to understand the impact of these agents as they can vary the rate of soft and hard tissue loss which may alter postmortem interval estimations. One taphonomic factor which has not been extensively investigated in many regions of the world, including Canada, are vertebrate scavengers.

The dominance-diversity dilemma in animal conservation biology.

The alteration of environmental conditions has two major outcomes on the demographics of living organisms: population decline of the common species and extinction of the rarest ones. Halting the decline of abundant species as well as the erosion of biodiversity require solutions that may be mismatched, despite being rooted in similar causes. In this study, we demonstrate how rank abundance distribution (RAD) models are mathematical representations of a dominance-diversity dilemma.

Seasonal impact of scavenger guilds as taphonomic agents in central and northern Ontario, Canada.

The process of human decomposition is driven by biological decomposers, mainly bacteria, vertebrates, and invertebrate scavengers. When vertebrate scavengers have access to a body, they can considerably accelerate decomposition through consumption of soft tissue and dispersal of skeletal elements. Presently, there are limited data available on vertebrate scavenging activity in Canada, particularly in densely populated provinces such as Ontario.

The taphonomic impact of scavenger guilds in southern Quebec during summer and fall in two distinct habitats.

Decomposition of human remains is a complex process impacted by many intrinsic and extrinsic factors. A less-studied extrinsic factor in forensic taphonomy are the scavengers that consume soft and hard tissue. Scavengers physically degrade and remove soft tissue, disperse, and destroy skeletal elements, which can make locating remains challenging.

Detecting grave sites from surface anomalies: A longitudinal study in an Australian woodland.

Forensic investigations of single and mass graves often use surface anomalies, including changes to soil and vegetation conditions, to identify potential grave locations. Though numerous resources describe surface anomalies in grave detection, few studies formally investigate the rate at which the surface anomalies return to a natural state; hence, the period the grave is detectable to observers. Understanding these processes can provide guidance as to when ground searches will be an effective strategy for locating graves.

Modeling biodiversity benchmarks in variable environments.

Effective environmental assessment and management requires quantifiable biodiversity targets. Biodiversity benchmarks define these targets by focusing on specific biodiversity metrics, such as species richness. However, setting fixed targets can be challenging because many biodiversity metrics are highly variable, both spatially and temporally.

Differential Role of Prefrontal and Parietal Cortices in Controlling Level of Consciousness.

Consciousness is determined both by level (e.g., being awake versus being anesthetized) and content (i.

Reduced intraepidermal nerve fiber density after a sustained increase in insular glutamate: a proof-of-concept study examining the pathogenesis of small fiber pathology in fibromyalgia.

Introduction: Neuroimaging reveals increased glutamate within the insula of patients with fibromyalgia (FM), suggesting a link between FM symptoms and increased central excitatory neurotransmission. Many patients with FM also present with decreased intraepidermal nerve fiber density (IENFD), consistent with small fiber pathology. It remains unknown, however, whether either of these mechanistic findings represent a cause or a consequence of the other.

Outcome after heart transplantation from donation after circulatory-determined death donors.

Background: The requirement for heart transplantation is increasing, vastly outgrowing the supply of hearts available from donation after brain death (DBD) donors. Transplanting hearts after donation after circulatory-determined death (DCD) may be a viable additive alternative to DBD donors. This study compared outcomes from the largest single-center experience of DCD heart transplantation against matched DBD heart transplants.

Global trends and challenges in deceased donor kidney allocation.

Worldwide, the number of patients able to benefit from kidney transplantation is greatly restricted by the severe shortage of deceased donor organs. Allocation of this scarce resource is increasingly challenging and complex. Striking an acceptable balance between efficient use of (utility) and fair access to (equity) the limited supply of donated kidneys raises controversial but important debates at ethical, medical, and social levels.

Patient preferences, knowledge and beliefs about kidney allocation: qualitative findings from the UK-wide ATTOM programme.

Objective: To explore how patients who are wait-listed for or who have received a kidney transplant understand the current UK kidney allocation system, and their views on ways to allocate kidneys in the future.

Design: Qualitative study using semistructured interviews and thematic analysis based on a pragmatic approach.

Participants: 10 deceased-donor kidney transplant recipients, 10 live-donor kidney transplant recipients, 12 participants currently wait-listed for a kidney transplant and 4 participants whose kidney transplant failed.

A single-centre experience of Roux-en-Y enteric drainage for pancreas transplantation.

Exocrine drainage following pancreas transplantation can be achieved by drainage into the bladder or bowel, the latter typically by direct duodeno-jejunostomy; the use of Roux-en-Y enteric drainage is uncommon. We report a retrospective analysis of a single-centre experience of Roux-en-Y enteric drainage following pancreas transplantation. Over a 14-year period (2001-2015), 204 consecutive adult pancreas transplants were performed (96.

Functional assessment and transplantation of the donor heart after circulatory death.

Background: After a severe shortage of brain-dead donors, the demand for heart transplantation has never been greater. In an attempt to increase organ supply, abdominal and lung transplant programs have turned to the donation after circulatory-determined death (DCD) donor. However, because heart function cannot be assessed after circulatory death, DCD heart transplantation was deemed high risk and never adopted routinely.

Factors Associated With Short- and Long-term Liver Graft Survival in the United Kingdom: Development of a UK Donor Liver Index.

Background: A measure of donor liver quality, the donor liver index, was developed and validated for the UK population of transplant recipients. Unlike previously proposed measures, this index is only based on variables that are available at the point of retrieval, and so does not include cold ischemic time.

Methods: Indices of liver quality were based on data from the UK Transplant Registry on all 7929 liver transplants between January 2000 and December 2014.

A Re-evaluation of Discarded Deceased Donor Kidneys in the UK: Are Usable Organs Still Being Discarded?

Background: A significant proportion of procured deceased donor kidneys are subsequently discarded. The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012, enabling kidneys at risk of discard to be simultaneously offered to participating centers. We undertook an analysis of discarded kidneys to determine if unnecessary organ discard was still occurring since the KFTS was introduced.

Transplantation of organs from deceased donors with meningitis and encephalitis: a UK registry analysis.

Background: Deceased organ donors, where the cause of death is meningitis or encephalitis, are a potential concern because of the risks of transmission of a potentially fatal infection to recipients.

Methods: Using the UK Transplant Registry, a retrospective cohort analysis of deceased organ donors in the UK was undertaken to better understand the extent to which organs from deceased donors with meningitis and/or encephalitis (M/E) (of both known and unknown cause) have been used for transplantation, and to determine the associated recipient outcomes.

Results: Between 2003 and 2015, 258 deceased donors with M/E were identified and the causative agent was known in 188 (72.

Predicting patient survival after deceased donor kidney transplantation using flexible parametric modelling.

Background: The influence of donor and recipient factors on outcomes following kidney transplantation is commonly analysed using Cox regression models, but this approach is not useful for predicting long-term survival beyond observed data. We demonstrate the application of a flexible parametric approach to fit a model that can be extrapolated for the purpose of predicting mean patient survival. The primary motivation for this analysis is to develop a predictive model to estimate post-transplant survival based on individual patient characteristics to inform the design of alternative approaches to allocating deceased donor kidneys to those on the transplant waiting list in the United Kingdom.

Insular balance of glutamatergic and GABAergic signaling modulates pain processing.

Neuroimaging studies of patients with chronic pain have shown that neurotransmitter abnormalities, including increases in glutamate and decreases in GABA, could be responsible for the cortical hyperactivity and hyperalgesia/allodynia observed in some pain conditions. These finding are particularly evident in the insula, a brain region known to play a role in both the sensory-discriminative and the affective-motivational aspects of pain processing. However, clinical studies are not entirely able to determine the directionality of these findings, nor whether they are causal or epiphenomenon.