Introduction: Infectious complications can be a major cause of morbidity and mortality in solid organ transplant recipients. Preservation fluid is necessary to maintain organ viability but may serve as a vector or infection. The utility of screening preservation fluid routinely for microbial growth and the impact of culture-positive preservation fluid is controversial. Research Question: What is the clinical impact of a culture positive preservation fluid in a kidney transplant recipient? Design: This retrospective study was performed to define the incidence of post-operative infection related to PF and examine the negative sequelae of culture-positive PF. One hundred and fifty-two deceased donor renal transplant recipients from January 2015 to December 2017 were included for analysis. Results: Overall, 67% of patients (102/152) received an allograft from a culture-positive PF. Nearly 80% of microbial growth was consistent with skin flora, and coagulase-negative staphylococci was the most frequently isolated organism (56%). Sixty-seven percent of patients (68/102) with culture-positive PF received antimicrobial treatment for an average duration of 5 days. There was no difference in the incidence of infection between patients with culture positive PF compared to culture-negative PF. Furthermore, there were no cases of infection related to PF regardless of whether culture-positive PF was treated or untreated. The incidence of subsequent C. difficile infection and multidrug-resistant organisms was similar. Discussion: This study suggests antimicrobial treatment for culture positive PF may not be necessary with pathogens that are common contaminants and of low virulence. Interventional studies are needed to validate this strategy.

The study of communication in a network setting has gained increasing popularity in recent years. While audience effects on aggressive interactions have been studied extensively, male–female interactions have often been overlooked. In addition, little is known about how reproductive status affects the nature of audience effects. Siamese fighting fish, Betta splendens, are a popular subject for communication network studies, but male–female interactions have not been explored in this setting. In this study, pairs of male and female Betta were presented with a male, female or no audience to determine whether the presence of an audience alters the behaviour of the interactants. Within these three audience types, there were four reproductive status conditions with receptivity indicated by nest presence for males and reproductive barring for females. It was predicted that male–female interactions would be affected by the presence of an audience, especially when both interactants are receptive as has been found in male–male interactions in this species. The results suggest that presence of an audience and reproductive status act in combination to influence male–female interactions, but only in interactant‐directed behaviours. Not all behaviours were equally affected by these factors. For example, while tail beats to the other interact were greatest when a female audience was present and both the interactants were receptive, this was not true for gill flaring. This study is among the first investigations into audience effects on male–female interactions including the first in Betta and suggests that courtship as well as aggression should be explored in a network setting.

No abstract

The protocol-driven aspect of the mnemonic refers to ALEEN, a method developed by Peter Pronovost, MD, to respectfully communicate with upset patients. It stands for Anticipate their anger and do not take it personally, Listen without interrupting, Empathize with what they are saying, Explain what happened and why, and Negotiate a way forward. We use this same protocol to communicate respectfully with distressed residents. If a resident is upset about a program director's decision, being heard and receiving an empathetic response can help even if the decision does not change. Individualized refers to one-on-one check-ins between residency leadership and residents at least once a month to ensure they are feeling well and supported, and to hear concerns they want to share. The last piece of the mnemonic is Defend. When a resident concern is brought to residency leadership, we avoid reactionary judgments. We ask the resident for his or her perspective and see ourselves as an advocate, willing to defend the resident if needed. If we determine resident wrongdoing, we approach our intervention from the framework of being an advocate for their greater goals-to help them build a reputation for the success they want to have.