The new Eurotransplant Kidney Allocation System: report one year after implementation. Eurotransplant International Foundation

BACKGROUND: Upon the availability of a cadaveric donor kidney, a delicate allocation process precedes every transplantation. A remodeled Eurotransplant Kidney Allocation System (ETKAS)-derived from simulation studies-was installed in March 1996. The purpose was to adjust long waiting times and international exchange balances, while aiming at an optimal HLA-mismatch distribution. The new ETKAS consisted of a point-score system that was 100% patient oriented. METHODS: The impact of the new ETKAS on the composition of the waiting list, and the outcome of the allocation procedures during its first year, were evaluated and compared with the results obtained in 1995. RESULTS: The percentage of long-waiting patients and of patients with poorly matchable HLA phenotype increased significantly, from 9% to 19% and from 19% to 29%, respectively. Zero HLA-A-, HLA-B-, HLA-DR-mismatched patients still comprised 23% of the kidney transplant activity. The kidney exchange of the different Eurotransplant countries became balanced within 4 months; this persisted during the rest of the year. Pediatric patients had a high transplantation rate due to an assignment of extra points. The composition of the waiting list showed, after 1 year, fewer long-waiting patients and fewer patients with rare HLA phenotypes. CONCLUSIONS: The new ETKAS was able in its first year to meet the goals set at its introduction. In comparison with the old ETKAS, there was a better trade-off between HLA matching and waiting time. The value of computer simulation studies has been demonstrated impressively in the context of organ allocation.     

Hybrid cam mechanisms

This paper investigates the problem of driving a machine with several reciprocating heavy inertias. The drive should also realize some programmable flexibility of the motion, so that the operation of the machine, e,g., synchronization between different motions and duration of standstills, can easily be modified. The use of a single servomotor for every motion is not the best solution, since it does not allow for energy recuperation. This means that the installed servomotor power will be much higher than the required net peak power for the machine as a whole. The presented solution, however, reduces the servomotor peak torque and power by one order of magnitude, and makes energy transfer between the motions possible. The hybrid cam mechanism consists of a hybrid drive, which is a combination of a servomotor, a constant velocity motor and a cam follower mechanism. The operation principle exploits the nonlinear characteristics of the cam to add flexibility at low cost of energy. The hybrid solution is particularly successful for motions involving high peak acceleration. In addition, the concept can be used to reject disturbances. Simulations show the performance of the hybrid cam mechanism.     

Accurate determination of the mean relative humidity in controlled climates at high humidities (new method)

The measurement of the relative humidity (RH) at high levels to the desired accuracy is still a problem, especially for levels above 90% RH. The reasons for this are:

• i The accuracy of the standard apparatus is lower at high RH than at moderate and low RH;
• ii The need for accurate measurement of the RH in moisture controlled rooms is greater at high RH than at lower RH, because for moisture sensitive products, such as fibreboard boxes and certain horticultural products, the influence of a minor deviation in RH on the properties of these products is considerably greater at high RH than at moderate and low RH.

     

Elongational viscosity of microbead suspensions

A ‘tubeless syphon’ was used as an elongational viscometer for the purpose of measuring elongational viscosities of glass bead suspensions in dilute polymer solutions. It was found that while the shear viscosities increased, the elongational viscosities decreased very sharply with increasing bead concentration. The conclusions from the present data are then compared with the observed changes in the elastic properties of two phase molten polymer systems. A double shift procedure has been successfully adopted to correlate the experimental data.     

Non-markovian diffusion processes in polymers and a stretched exponential relaxation constitutive equation

Non-Markovian diffusion transport in polymers was studied. Applying the results of various researchers, a stretched exponential relaxation function was obtained and a linear viscoelastic constitutive equation formulated. Frequency dependent material functions, obtained from this constitutive equation were studied and the results successfully compared with experimental data for polyethylene oxide solutions. Sorption kinetics in a polymeric film were also studied. © 1994 John Wiley & Sons, Inc.     

Acid cleaning and passivation of power plant condensers and desalination plants

Experiences of acid cleaning and passivation treatments of copper alloy tubes are described. The suitability of corrosion monitoring to follow each step of such operation is demonstrated.     

A modified expectation maximization algorithm for penalized likelihood estimation in emission tomography

The maximum likelihood (ML) expectation maximization (EM) approach in emission tomography has been very popular in medical imaging for several years. In spite of this, no satisfactory convergent modifications have been proposed for the regularized approach. Here, a modification of the EM algorithm is presented. The new method is a natural extension of the EM for maximizing likelihood with concave priors. Convergence proofs are given.     

The so-called congenital trigger digit: further experience

The authors reviewed 53 patients with 70 congenital trigger digits. Three of these were seen at an early age. Most "congenital" trigger digits present later than the neonatal period. A clear difference exists between trigger thumbs and trigger fingers. In our series, thumbs were more frequently affected, 30% were bilateral and none resolved spontaneously. The long fingers were less frequently affected, and two of them (28%) recovered without operation. All other children had an operative release of the A1 pulley of the flexor tendon sheath, with excellent results.