A longitudinal analysis of the impact of fatigue on return to activities of daily living during the first year after liver transplantation

poster abstractLiver transplantation is often thought of as organ recovery and lifesaving surgery. The reality is a prolonged and stressful time for the patient and their family (Scott & Brown, 2011). The persistence of fatigue after liver transplantation is well documented in the research literature (Aadahl, Hansen, Kirkegaard, & Groenvold, 2002; van den Berg-Emons et al., 2006; Van Ginneken et al., 2010). However, there is no evidence as to the timing of how this fatigue dissipates during the early transplanted period and its impact on quality of life. Furthermore, studies on changes in fatigue do not start until 6 months after transplant, leaving a gap in knowledge of the patient’s experience post-surgery up to this point. This ongoing longitudinal study is aimed at better understanding the recovery process. Patients from a Midwest medical center (N=21) were followed post-discharge, at weeks 1-8 and at months 3, 6, 9, and 12. The FACIT-Fatigue Scale (Cella, 1997) indicates a decrease in fatigue scores (less fatigue) in those subjects without adverse events. Adverse events including re-hospitalization, surgical complications and organ rejection were associated with higher FACIT scores (higher level of fatigue) and less resolution over this first year. Through this research Dr. Scott and her team hope to translate their findings into educational resources for patients and their families to understand what to anticipate during the post-transplant recovery period

Microembossing of ultrafine grained Al: microstructural analysis and finite element modelling

Ultra fine grained (UFG) Al-1050 processed by equal channel angular pressing (ECAP) and UFG Al-Mg-Cu-Mn processed by high pressure torsion (HPT) were embossed at both room temperature and 300 °C, with the aim of producing micro-channels. The behaviour of Al alloys during the embossing process was analysed using finite element (FE) modelling. The cold embossing of both Al alloys is characterised by a partial pattern transfer, a large embossing force, channels with oblique sidewalls and a large failure rate of the mould. The hot embossing is characterised by straight channel sidewalls, fully transferred patterns and reduced loads which decrease the failure rate of the mould. Hot embossing of UFG Al-Mg-Cu-Mn produced by HPT shows a potential of fabrication of microelectromechanical system (MEMS) components with micro channels

Impact of medical, health related, social and occupational factors on post-liver transplant recovery: a longitudinal study

poster abstractPurpose: Organ transplantation is a serious surgery with nearly 10% of patients failing to survive the first three months. Studies of quality of life reflect an increase post-transplant, as compared to pre-transplant, then reports vary including a trend towards decreasing QOL scores by the end of the first transplanted year. In this first year, patients have an increased risk of re-hospitalization due to infection, failure of the body to accept the graft, problems with anti-rejection medications or post- surgical complications. Methods: A longitudinal study of liver transplant recipients (n=23) followed medical, social, and occupational factors, along with SF-36 measures. Results: Variability in QOL scores at 1, 2, 3, 6, 9, and 12 months were directly related to identifiable factors. In those subjects where health returned in an uncomplicated manner, QOL scores consistently improved with the greatest change occurring over the first six months and then tapering off through the end of the first year. Conclusions: These subjects almost uniformly expressed frustration at the length of time it took to return to a healthy state. In circumstances where recovery was delayed due to medical reasons, QOL scores declined significantly until the problems were resolved. In several cases, QOL scores stayed low as these individuals were unprepared for the potential complications associated with this difficult surgery

Herbal medicine use during breastfeeding: A cross-sectional study among mothers visiting public health facilities in the Western area of Sierra Leone

© 2019 The Author(s). Background: The use of medications, including herbal medicines during breastfeeding is always a concern among women. Currently, there is no published evidence on whether Sierra Leonean women use herbal medicine during breastfeeding. This study investigates the prevalence, correlates and pattern of herbal medicine use during breastfeeding. Methodology: We conducted a cross-sectional study among 378 current breastfeeding mothers visiting public healthcare facilities within the Western area of Sierra Leone. Descriptive statistics and logistic regression analysis were used for data analysis. Results: Over a third of mothers (n = 140, 37.0%) used herbal medicine during breastfeeding. However, very few herbal medicine users (2.1%, n = 3) used herbal medicine to augment breastfeeding. Dietary changes were the most common method used to increase breast milk supply (93.9%, n = 355) with cassava leaves sauce and tubers being the most common dietary addition. Mothers with children more than six months old were more likely to use herbal medicine than mothers with younger children (OR:1.8; CI:1.13-2.85,p = 0.013). Among herbal medicine users, only 11.4% (n = 16) disclosed their herbal medicine use to their conventional healthcare providers. Conclusion: The use of herbal medicine among breastfeeding mothers attending public health facilities in the Western area of Sierra Leone is common. Whilst this use is not usually specific to increasing breast milk supply, our study indicates that herbal medicines may be used to 'cleanse' initial breast milk

Subsurface chlorophyll maximum and hydrodynamics of the water column

The vertical distributions of chlorophyll a (in vivo fluorescence) and hydrodynamic properties were monitored in the Gulf of St. Lawrence (Canada) from 6 to 10 August 1983, using an automatic yo-yo profiling system and a chain of 4 current meters. Spectral analyses of temperature and in vivo fluorescence series showed that dominant frequencies were associated with internal waves (∼16 h inertial frequency). A subsurface chlorophyll maximum was continuously observed in the lower part of the 20 m thick photic layer, at a depth corresponding with maximum vertical stability of the water column, just above the nutricline.The depth of maximum phytoplankton production, at least on sunny days, corresponded to that of the subsurface chlorophyll maximum and of the maximum in vertical stability. This close association persisted despite strong horizontal advection and vertical movements caused by internal waves. Photosynthetic adjustment did occur in the water column: higher vertical stability at depth favored shade adaptation of the phytoplankton in the layer of maximum stability, as compared to the more light-adapted cells of the upper well-mixed layer. At our sampling station, vertical turbulent diffusion seemed to be high enough to replenish nutrients in the photic layer, so that they never became completely exhausted, even in surface waters. Therefore, the observed subsurface chlorophyll maximum not only resulted from environmental conditions more favorable for phytoplankton accumulation and growth, but it also involved active photosynthetic responses of phytoplankton

Cancer in The Gambia: 1988–97

We describe the incidence of cancer in The Gambia over a 10-year period using data collected through the Gambian National Cancer Registry. Major problems involved with cancer registration in a developing country, specifically in Africa are discussed. The data accumulated show a low overall rate of cancer incidence compared to more developed parts of the world. The overall age standardized incidence rates (ASR) were 61.0 and 55.7 per 100 000 for males and females, respectively. In males, liver cancer was most frequent, comprising 58% of cases (ASR 35.7) followed by non-Hodgkin lymphoma, 5.4% (ASR 2.4), lung 4.0%, (ASR 2.8) and prostate 3.3% (ASR 2.5) cancers. The most frequent cancers in females were cervix uteri 34.0% (ASR 18.9), liver 19.4% (ASR 11.2), breast 9.2% (ASR 5.5) and ovary 3.2% (ASR 1.6). The data indicate that cancers of the liver and cervix are the most prevalent cancers, and are likely to be due to infectious agents. It is hoped that immunization of children under 1 year against hepatitis B will drastically reduce the incidence of liver cancer in The Gambia. © 2001 Cancer Research Campaign http://www.bjcancer.co

The gravity duals of SO/USp superconformal quivers

We study the gravity duals of SO/USp superconformal quiver gauge theories realized by M5-branes wrapping on a Riemann surface ("G-curve") together with a Z_2-quotient. When the G-curve has no punctures, the gravity solutions are classified by the genus g of the G-curve and the torsion part of the four-form flux G_4. We also find that there is an interesting relation between anomaly contributions from two mysterious theories: T_{SO(2N)} theory with SO(2N)^3 flavor symmetry and \tilde{T}_{SO(2N)} theory with SO(2N) x USp(2N-2)^2 flavor symmetry. The dual gravity solutions for various SO/USp-type tails are also studied.Comment: 27 pages, 13 figures; v2 minor corrections, typos corrected, Figure 13 replaced, references adde

Involving community health workers in disease-specific interventions: perspectives from The Gambia on the impact of this approach

Background The Community Health Worker (CHW) programme is recognised as key for providing healthcare to communities, particularly in remote locations. CHWs are usually volunteers, nominated by their communities and trained to provide basic care and prevention for common illnesses. However, differences in disease-specific programmes aimed at meeting national agenda and perceived health needs of the community raises questions about the best approach to maximise the potential of this workforce. Methods This was an explorative qualitative study, ancillary to a larger trial on a malaria control intervention. In July 2017, 40 semi-structured interviews were conducted with 17 village health workers (VHWs), four community health nurses who supervise VHWs, and 19 key informants from the community. Analysis was concurrent to data collection and carried out using a deductive process for thematic analysis, with the aid of NVivo 11 Qualitative Analysis Software. Results There were three key aspects of the VHW role identified in this setting; (1) to give health advice; (2) to treat and refer patients; and (3) to support environmental cleaning. The VHWs’ involvement in the clinical trial impacted their role in several ways. Overall, this was perceived very positively by the community and the VHWs since it improved access to medication and training on how to treat malaria. However, involvement was also perceived to increase VHWs’ workload, and placed more emphasis on malaria over other common illnesses, creating a shift in the balance of their role between disease prevention and treatment. Conclusions VHWs are essential for the successful delivery of disease-specific activities at the community level. However, involving them in these activities has important implications for their everyday role. If carefully managed, it has the potential to improve their capacity to screen and treat specific diseases such as malaria