Kelp forests are being degraded and/or lost in many regions, and as such, interest in active kelp restoration approaches to reinstate forests is growing. ‘Green gravel’ is a promising new kelp restoration technique that involves seeding small rocks with kelp zoospores, rearing the gametophyte and juvenile sporophyte stages in aquaria before outplanting them at restoration sites. However, to be considered a viable approach to kelp forest restoration, the efficacy of this technique needs to be assessed across a range of environmental contexts and kelp species. Here, we aimed to understand the utility of green gravel as a kelp restoration technique for wave-exposed intertidal shores. Two substrate types – gravel and cobbles – were seeded with Saccharina latissima, reared in the aquarium and outplanted at two sites along the northeast coast of England. Outplanted rocks were monitored for retention, and the density and length of S. latissima. Juvenile sporophytes persisted on both rock types, although declines in density and variations in length were observed over time. Substrate retention was low, with gravel more likely to be removed from restoration sites compared to cobbles, and all outplanted rocks were lost after eight months. While our initial testing of the green gravel restoration technique on wave-exposed shores was not successful, our results provide important insights for developing/refining the technique and a baseline for comparison for future efforts. However, prior to commencing large-scale kelp restoration in wave-exposed areas using green gravel, further testing of the technique and comparisons with other restoration approaches are needed.

One of the criteria used by many transplant centers in assessing psychosocial eligibility for solid organ transplantation is social support. Yet, social support is a highly controversial requirement that has generated ongoing debate between ethicists and clinicians who favor its consideration (i.e., utility maximizers) and those who object to its use on equity grounds (i.e., equity maximizers). The assumption underlying both of these approaches is that social support is not a commodity that can be purchased in the marketplace. This essay argues for the reconceptualization of social support as a product that can—and should—be purchased for transplant candidates to render them eligible for transplant.

Recent evidence suggests that vitamin D deficiency is associated with CVD, impaired kidney function and proteinuria. To date, no study has evaluated these associations in renal transplant recipients (RTR) adjusting for body adiposity assessed by a ‘gold standard’ method. This study aimed to evaluate the vitamin D status and its association with body adiposity, CVD risk factors, estimated glomerular filtration rate (eGFR) and proteinuria in RTR, living in Rio de Janeiro, Brazil (a low-latitude city (22°54'10"S)), taking into account body adiposity evaluated by dual-energy X-ray absorptiometry (DXA). This cross-sectional study included 195 RTR (114 men) aged 47·6 (sd 11·2) years. Nutritional evaluation included anthropometry and DXA. Risk factors for CVD were hypertension, diabetes mellitus, dyslipidaemia and the metabolic syndrome. eGFR was evaluated using the Chronic Kidney Disease Epidemiology Collaboration equation. Serum 25-hydroxyvitamin D (25(OH)D) concentration was used to define vitamin D status as follows: 10 % (n 19) had vitamin D deficiency (<16 ng/ml), 43 % (n 85) had insufficiency (16–30 ng/ml) and 47 % (n 91) had sufficiency (>30 ng/ml). Percentage of body fat (DXA) was significantly associated with vitamin D deficiency independently of age, sex and eGFR. Lower 25(OH)D was associated with higher odds of the metabolic syndrome and dyslipidaemia after adjustment for age, sex and eGFR, but not after additional adjustment for body fat. Hypertension and diabetes were not related to 25(OH)D. Lower serum 25(OH)D was associated with increasing proteinuria and decreasing eGFR even after adjustments for age, sex and percentage of body fat. This study suggests that in RTR of a low-latitude city hypovitaminosis D is common, and is associated with excessive body fat, decreased eGFR and increased proteinuria.

This article examines the legal transfer of restrictive race-based immigration laws across self-governing settler societies in the United States, Canada, Australia, New Zealand and South Africa in the late nineteenth and early twentieth century. These societies shared the common policy objective of limiting Chinese and other ‘non-white’ immigration. They each also faced informal and formal restrictions on implementing overtly racist immigration policies. This created fertile ground for legal transfers. When an innovation was found that could achieve the policy goal of race-based immigration restriction, without direct reference to race, it quickly spread across all jurisdictions operating in that paradigm. The legal transfer of three mechanisms is examined: (1) landing taxes; (2) passenger-per-ship restrictions; and (3) literacy tests. The article concludes by drawing parallels with contemporary transfers of restrictive border control policies targeting asylum seekers and irregular migrants more broadly.

We recently reported our experience with exercise stress echocardiography in children with prior history of Kawasaki disease and coronary arterial involvement. Dobutamine stress echocardiography has been used in adults (doses up to 50 μg/kg/min) for diagnosis and risk stratification of coronary arterial disease. To date, no studies have assessed the safety and utility of high-dose dobutamine for the detection of abnormalities of wall motion in children, although low dose dobutamine (5 μg/kg/min) has been used to assess left ventricular function after use of anthracycline in children. Our study group consisted of 10 children known to have Kawasaki disease, and 16 children who had undergone heart transplantation. After baseline transthoracic echocardiographic imaging, dobutamine was infused in an incremental fashion, 10–40 μg/kg/min intravenously, to attain peak heart rate. Heart rate and blood pressure were monitored continuously, and 4 standard echocardiographic images were acquired at each stage of dobutamine infusion and at recovery. Images were digitized, and the left ventricular segments were reviewed to assess wall motion. No patients suffered serious side effects such as arrhythmias or hypotension. Studies were complete in all 26 patients. One study proved positive, with a new abnormality of wall motion identified corresponding to a critical right coronary arterial stenosis. Peak heart rate and blood pressure were similar for the 2 groups. High dose dobutamine stress echocardiography, therefore, is feasible and safe in children, and may detect flow-limiting coronary arterial stenoses noninvasively. The technique may safely be applied to other subsets of children where assessment of ischemia and contractile reserve is warranted.

Objectives: The aim of this study was to estimate thresholds for production volume, durability, and cost of care for the cost-effective adoption of liver organ replacement technologies (ORTs).

Methods: We constructed a discrete-event simulation model of the liver allocation system in the United States. The model was calibrated against UNOS data (1994–2000). Into this model, we introduced ORTs with varying durability (time to failure), cost of care, and production volume. Primary outputs of interest were time to 5 percent reduction in the waiting list and time to 5 percent increase in expected transplant volume.

Results: Model output for both calibration and validation phases closely matched published data: waiting list length (±2 percent), number of transplants (±2 percent), deaths while waiting (±5 percent), and time to transplant (±11 percent). Reducing the waiting list was dependent on both ORT durability and production volume. The longer the durability, the less production volume needed to reduce the waiting list and vice versa. However, below 250 ORT/year, durability needed to be >2 years for any significant change to be seen in the waiting list. For base-case costs, all ORT production volume and durability scenarios result in more transplants per year at less total cost of care/patient than the current system. ORTs remain cost saving until manufacturing costs are >5 times base-case costs, production is less 500 ORT/year, and durability <6 months.

Conclusions: Although there remain many technical challenges to overcome, as long as ORTs can meet these threshold criteria, they have the potential of transforming the world of end-stage liver disease.

Objective: The study was conducted to understand the emotional impact of multiple myeloma, as well as the impact of its principle treatment, peripheral blood stem cell transplant (PBSCT). The absence of psycho-oncology research literature on this population prompted the need for a hypothesis-generating investigation. Thus, a qualitative design was used to construct a theoretical model of the trauma relating to diagnosis and treatment of myeloma. The study also incorporates the important period of reflection and growth following treatment.

Methods: The sample consisted of 3 women and 3 men treated for myeloma at a New York City-based cancer treatment center. Data from individual interviews were audiotaped and transcribed. After extensive review, the data were categorized into groups of repeating ideas, themes and broad theoretical constructs.

Results: A five-construct model emerged from the data analysis that integrated a model of trauma and growth presented in earlier work (Auerbach et al., 2006). These constructs roughly correspond with stages of illness, but do not necessarily imply a linear process, as suggested by stage models. The first construct is diagnosis. Patients receive the news that they have multiple myeloma. Initial reactions are discussed and a treatment plan takes form. In the second construct, treatment, patients highlight the physical and emotional hurdles confronted throughout treatment. The third construct, network of safety, presents social factors that play a role in comforting patients throughout illness. Patients recognize the importance of a strong support system during their experiences. In the fourth construct, recuperation, physical energy is regained after an arduous recovery period. This contributes to higher spirits and a motivation to reengage with life. The fifth construct is reflection and new existence. Patients strive to balance a new reality that relapse and death are inevitable, along with their need to live a meaningful life. Many do not yet appreciate how their disease has impacted them, but describe how their interpersonal lives and perceptions have changed, both positively and negatively.

Significance of results: Limitations of the study, future directions for research and clinical implications are discussed.

During the past 30 years, organ transplantation has developed from a highly experimental procedure into an important part of routine clinical practice. This is reflected by the fact that graft survival times, which were once considered in terms of days or weeks, are now measured in terms of years or decades, with enormous corresponding benefits for the patient. Much of this improvement is due to the development of sophisticated immunosuppressive drugs that inhibit the rejection response mediated by the immune system of the recipient. However, almost without exception, all of the grafts that are transplanted from one genetically disparate individual to another are eventually rejected. The Holy Grail in transplantation is the development of protocols that lead to transplantation tolerance and provide stable graft function without long-term drug therapy. In this article, we have discussed the need for alternatives to current immunosuppression and reviewed the results of animal models, which suggest that long-term stable tolerance is an achievable goal.