Definition of Clinical and Immunological Phenotypes of Graft Dysfunction in Heart Transplant Recipients: Prognostic Implications and Role of Antibody Mediated Rejection

Background Despite its clinical relevance, there is a lack of consensus regarding the definition of graft dysfunction (GD) in heart transplant (HT). Herein we aim to characterize clinical phenotypes of patients with GD, either acute or chronic, comparing their outcomes with stable patients. In addition, we explored the risk factors outcomes in GD patients. Methods The patients were divided in 3 groups: Group A - Patients who recently underwent HT ( 5 years). Primary Endpoints were: overall mortality, hospitalizations for cardiovascular events and hospitalization for all-causes. The Combined Endpoints was death or /and hospitalizations for cardiovascular events (CV hospitalization). Results We enrolled 134 consecutive HT patients. Patients with GD 32(24%) had significant higher prevalence of class NYHA >II, low EF, CAV, longer QRS and Qtc on the ECG (p<0.01) and donor specific antibodies (DSA) (all p<0.05), as compared with group A and C. Clinical presentation was highly heterogeneous: 6(19%) had acute presentation, 3 for acute rejection, and 3 for acute coronary syndromes; 21(66%) had chronic presentation: 17(53%) associated with CAV, and 4(13%) as chronic dysfunction after antibody-mediated rejection. During the 2y follow-up, GD patients showed higher mortality (P=0.01) and higher CVE hospitalization rate (54; P< 0.01) than patients in group A and C. Low EF, time from HT, and chronic clinical presentation (p<0.01) were risk factors for the combined endpoint Conclusions GD after HT is characterized by highly variable clinical presentation and is correlated with a particularly poor prognosis. CAV is the most frequent etiology, and DSA are more often found in patients with GD than in stable ones, but do not seem to influence outcome

Strategies for fitting nonlinear ecological models in R, AD Model Builder, and BUGS

Summary: 1. Ecologists often use nonlinear fitting techniques to estimate the parameters of complex ecological models, with attendant frustration. This paper compares three open-source model fitting tools and discusses general strategies for defining and fitting models. 2. R is convenient and (relatively) easy to learn, AD Model Builder is fast and robust but comes with a steep learning curve, while BUGS provides the greatest flexibility at the price of speed. 3. Our model-fitting suggestions range from general cultural advice (where possible, use the tools and models that are most common in your subfield) to specific suggestions about how to change the mathematical description of models to make them more amenable to parameter estimation. 4. A companion web site (https://groups.nceas.ucsb.edu/nonlinear-modeling/projects) presents detailed examples of application of the three tools to a variety of typical ecological estimation problems; each example links both to a detailed project report and to full source code and data

The use of interactive graphics in programs for the computer aided design of electric networks

Imperial Users onl

Dividing by Zero. Tautology and Paradox in the Self-Descriptions of Anonymous

This paper engages with the loosely bounded, ill-defined Anonymous movement, in order to develop a theoretical reflection on the process of self-reference within contemporary collectives. It is grounded on a socio-cybernetic framework and builds on a computationallly-assisted interpretative analysis of a huge dataset of Facebook posts related to Anonymous’ self-descriptions. As selected examples show, Anonymous results inherently contradictory. Its boundaries are radically contingent and performative, to the extent that it is impossible to distinguish the authentic from the inauthentic. The collective defines itself as ontologically multiple and radically anti-essentialist. Moreover, whereas Anonymous’ actions are systematically contradictory, Anonymous self-descriptions, relying on arguments mirroring poststructuralist theories, can only be tautologically or paradoxically expressed. Building on Luhmann’s claim that the reproduction of modern societies depends on concealing their self-referential foundations, the conclusion argues that Anonymous, by embracing its own constitutive paradox, pushes the process of autopoiesis to a new, radically recursive logic, departing in this even from recent theorizations on reflexivity

Developing a distributed electronic health-record store for India

The DIGHT project is addressing the problem of building a scalable and highly available information store for the Electronic Health Records (EHRs) of the over one billion citizens of India