Lungs from “nonideal,” but acceptable donors are underutilized; however, organ procurement organization (OPO) metrics do not reflect the extent to which OPO‐specific practices contribute to these trends. We developed a comprehensive system to evaluate nonideal lung donor avoidance, or risk aversion among OPOs. Adult donors in the UNOS registry who donated ≥1 organ for transplantation between 2007 and 2018 were included. Nonideal donors had any of age>50, smoking history ≥20 pack‐years, PaO2/FiO2 ratio ≤350, donation after circulatory death, or increased risk status. OPO‐level risk aversion in donor pursuit, consent attainment, lung recovery, and transplantation was assessed. Among 83916 donors, 70372 (83.9%) were nonideal. Unadjusted OPO‐level rates of nonideal donor pursuit ranged from 81 to 100%. In a three‐tier system of overall risk aversion, tier 3 OPOs (least risk‐averse) had the highest rates of nonideal donor pursuit, consent attainment, lung recovery, and transplantation. Tier 1 OPOs (most risk‐averse) had the lowest rates of donor pursuit, consent attainment, and lung recovery, but higher rates of transplantation compared to tier 2 OPOs (moderately risk‐averse). Risk aversion varies among OPOs and across the donation process. OPO evaluations should reflect early donation process stages to best differentiate over‐ and underperforming OPOs and encourage optimal OPO‐specific performance.

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Background: Writer's cramp (WC) dystonia presents with abnormal postures during the task of writing and is an ideal dystonia subtype to study disease mechanisms for all forms of focal dystonia. Development of novel therapies is contingent on identifying sensitive and specific measures that can relate to the clinical syndrome and achieve a realistic sample size to power clinical research study for a rare disease. Although there have been prior studies employing automated measures of writing kinematics, it remains unclear which measures can distinguish WC subjects with high sensitivity and specificity and how these measures relate to clinician rating scales and patient-reported disability. The goal of this study was to: 1-identify automated writing measures that distinguish WC from healthy subjects, 2-measure sensitivity and specificity of these automated measures as well as their association with established dystonia rating scales, and 3-determine the sample size needed for each automated measure to power a clinical research study. Methods: 21 WC dystonia and 22 healthy subjects performed a sentence-copying assessment on a digital tablet in a kinematic software and hand recognition software. The sensitivity and specificity of automated measures was calculated using a logistic regression model. Measures were then correlated with examiner and patient rating scales. Power analysis was performed for 2 clinical research designs using these automated measures. Results: Of the 23 automated writing measures analyzed, only 3 measures showed promise for use in a clinical research study. The automated measures of writing legibility, duration, and peak acceleration were able to distinguish WC from healthy controls with high sensitivity and specificity, correlated with examiner-rated dystonia sub-score measures and demonstrated relatively smaller sample sizes suitable for research studies in a rare disease population. Discussion: We identified novel automated writing outcome measures for use in clinical research studies of WC subjects which capture key aspects of the clinical disease and can serve as important readout of dystonia disease mechanism as well as future disease interventions.

Background: About 20% of patients with small vessel ischemic stroke (SVS) have cognitive impairment; however, the role of genetic factors in predicting cognitive outcomes following SVS has not been fully explored. APOE and ABCC9 have been associated with Alzheimer’s disease and hippocampal sclerosis respectively and play an important role in the neurovascular unit. We evaluated whether allelic variants in these genes influence cognitive outcomes following SVS. Methods: We conducted a retrospective analysis of a prospective cohort of patients enrolled in the ASA-Bugher Small Vessel Intracranial Disease Whole Genome Association Studies. Patients with SVS were categorized by APOE (presence or absence of ε4 allele) and ABCC9 SNP rs704180 (presence or absence of A allele) status. The primary outcomes were total score on the short form of the MoCA, which assesses global cognition, and time to complete Trails B, which is a measure of executive function that can be affected by stroke. Linear regression analyses were performed using the genetic exposures of interest, adjusting for age, education, sex, race/ethnicity, NIHSS score, burden of white matter disease (WMD; using the CHS validated score 0-9), and time between stroke and the cognitive assessment. Results: The sample included 145 patients who had SVS and available APOE and ABCC9 data. Among this cohort, 51.4% were men and 27.6% African American. The median age of the study participants was 63.4 years, the median years of education was 12, the median NIHSS was 2, and the median WMD burden score was 2. The mean time between stroke and the cognitive assessment was 75 days. The APOE ε4 allele was present in 35.0% and ABCC9 A allele in 74.8%. The presence of APOE ε4 allele was not associated with post-stroke MoCA scores (p=0.31) or Trails B (p=0.86). ABCC9 A allele was also not associated with post-stroke MoCA scores (p=0.34) or Trails B (p=0.31). Older age, higher NIHSS score, and greater burden of WMD were independently associated with longer times to complete Trails B (p<0.0001), but not with the MoCA score. Conclusion: Following SVS, several patient characteristics, including age, stroke severity, and WMD burden, rather than their APOE and ABCC9 allelic statuses, were associated with post-stroke measures of executive function.