Body mass index affects kidney transplant outcomes: a cohort study over 5 years using a steroid sparing protocol

Background: There is controversy regarding the suitability of high body mass index (BMI) candidates accessing the transplant waitlist. Patients and Methods: Observational study on consecutive kidney transplant recipients undergoing surgery between January 2014 and March 2016 at our centre. Patients were stratified according to BMI. Survival outcomes and graft function were analysed to In review investigate the effect of donor’s and recipient’s demographic characteristics. Results: 396 kidney transplant recipients: 260 males, mean age 51.8 ± 15.9 years, followed up for a mean time of 5.86 ± 2.29 years. Mean BMI 26.2 ± 5.1. BMI class 1 (20 ≤ BMI ≤ 24.9) n=133, class 2 (25 ≤ BMI ≤ 29.9) n= 155, class 3 (30 ≤ BMI ≤34.9) n=53, class 4 (BMI ≥ 35) n=21), class V (BMI ≤ 19.9) n=34. Patient survival was not significantly different according to the recipient’s BMI class (p=0.476); graft survival was affected (p=0.031), as well as graft function up to 2 years post-transplant and at 4 years follow up (p=0.016). At logistic regression the factors independently associated with graft loss were only donor’s age (p=0.05) and BMI class of the recipient (p=0.002). Conclusions: Obesity did not impact on patient’s survival but affected graft function and graft loss

The Friendly Health Issue Network to Support Computer-Assisted Education for Clinical Reasoning in Multimorbidity Patients

Clinical reasoning in multimorbidity conditions asks for the ability to anticipate the possible evolutions of the overall health state of a patient and to identify the interactions among the concurrent health issues and their treatments. The HIN (Health Issue Network) approach, as Petri Nets-based formal language, is introduced as capable of providing a novel perspective to facilitate the acquisition of such competencies, graphically representing the network among a set of health issues (HIs) that affect a person throughout their life, and describing how HIs evolve over time. The need to provide a more immediate user-oriented interface has led to the development of f-HIN (friendly HIN), a lighter version based on the same mathematical properties as HIN, from which stems in turn the f-HINe (friendly HIN extracted) model, used to represent networks related to either real patients’ clinical experiences extracted from electronic health records, or from teacher-designed realistic clinical histories. Such models have also been designed to be embedded in a software learning environment that allows drawing a f-HIN diagram, checking for its format correctness, as well as designing clinical exercises for the learners, including their computer-assisted assessment. The present paper aims at introducing and discussing the f-HIN/f-HINe models and their educational use. It also introduces the main features of the software learning environment it was built upon, pointing out its importance to: (i) help medical teachers in designing and representing the context of a learning outcome; and (ii) handle the complex history of a multimorbidity patient, to be conveyed in Case-Based Learning (CBL) exercises

Investigation via morphological analysis of aluminium foams produced by replication casting

Foams and porous materials with cellular structure have many interesting combinations of physical and mechanical properties coupled with low specific weight. By means of replication casting it is possible to manufacture foams from molten metal without direct foaming. A soluble salt is used as space holder, which is removed by leaching in water. This can be done successfully if the content of space holding fillers is so high that all the granules are interconnected. One of the main advantages of using the replication casting is a close control of pore sizes which is given by the distribution of particle sizes of the filler material. This contrasts with the pore size distribution of the materials foamed by other processes where a wider statistical distribution of pores is found. On the other hand, the maximum porosities that can be achieved using space holders are limited to values below 60%, whereas the other methods allow for porosities up to 98%. Temperature of the mould and infiltration pressure are critical process parameters: a typical problem encountered is the premature solidification of the melt, especially due to the high heat capacity of the salt. In this work foam properties such as cell shape, distribution and anisotropy and defect presence are investigated by using digital image processing technique. For this purpose replicated AlSi7Mg0.3 alloy foams are produced by infiltrating preforms of NaCl particles, varying the metal infiltration pressure and the mould preheating temperature. An original procedure based on image analysis has been set up to determine size, morphology and distribution of cells. The paper demonstrates that this methodology, coupled with microstructural analysis, is a useful tool for investigating the effects of process parameters on foam properties

Patient Active Approaches in Osteopathic Practice: A Scoping Review

Background: In the field of manual therapies there is a growing interest in moving from passive hands-on approaches to patient active approaches. In the osteopathic field there are both active and passive methods described as integrated in the process of care. However, this prospective linkage has not been formally explored and is not well shared in the community of practice. The present review aims to appraise the relevant literature on the functioning and principles of Patient active osteopathic approaches (PAOAs) and explore a prospective model for selecting the different types of PAOA, highlighting their integration into patient management strategies. Methods: A scoping review was conducted to analyze the relevant literature on the functioning and the different principles of PAOA and to obtain a comprehensive perspective on the phenomenon. Results: The eligible articles provide insights into the mechanisms of functioning and principles of application of active approaches to be integrated with hands-on approaches. These results provide new insights into the relevance of PAOA to clinical practice. Conclusions: The proposal, emerging from the review, may promote discussions in the community of practice and provide a road map for research towards achieving an evidence-based structure for PAOA

Selective hydrogenation of 1,3-butadiene by transition metal compounds immobilized in 1-butyl-3-methyl imidazolium room temperature ionic liquids

The compounds [Co(acac)2], [Co(acac)3], [Fe(acac)3] and [Ni(acac)2] (acac = acetylacetonate) dissolved in 1-butyl-3-methyl imidazolium tetrafluoroborate (1), trifluoromethanesulphonate (2) or hexafluorophosphate (3) catalyze the reduction of 1,3-butadiene into butenes in a typical two-phase catalytic reaction. The 1,3-butadiene conversion, the selectivity and turnover frequencies (TOF) are strongly dependent on the nature of the transition metal catalyst precursor and the ionic liquid. For [Co(acac)2] dissolved in 1, kinetic studies strongly suggest that the reaction takes place in the ionic solution bulk, having an apparent activation energy for the overall process of 33.8 kJ mol-1. The recovered ionic catalyst solution can be reused several times without any significant changes on activity and selectivity.Os complexos [Co(acac)2], [Co(acac)3], [Fe(acac)3] e [Ni(acac)2] (acac = acetilacetonato) dissolvidos em tetrafluoroborato de 1-butil-3-metilimidazônio (1), trifluorometanosulfonato de 1-butil-3-metilimidazólio (2) ou hexafluorofosfato de 1-butil-3-metilimidazólio (3), catalisam a hidrogenação de 1,3-butadieno em butenos em sistema catalítico tipicamente bifásico. A conversão do 1,3-butadieno, a seletividade e a freqüência de rotação (TOF) são fortemente dependentes do metal de transição e do líquido iônico. Para [Co(acac)2] dissolvido em 1, estudos cinéticos sugerem que a reação ocorre no meio líquido iônico, com uma energia aparente de ativação de of 33.8 kJ mol-1. A solução iônica do catalisador pode ser recuperada e reutilizada várias vezes sem mudanças perceptíveis na atividade e seletividade da reação

Search for squarks and gluinos in events with isolated leptons, jets and missing transverse momentum at s√=8 TeV with the ATLAS detector

The results of a search for supersymmetry in final states containing at least one isolated lepton (electron or muon), jets and large missing transverse momentum with the ATLAS detector at the Large Hadron Collider are reported. The search is based on proton-proton collision data at a centre-of-mass energy s√=8 TeV collected in 2012, corresponding to an integrated luminosity of 20 fb−1. No significant excess above the Standard Model expectation is observed. Limits are set on supersymmetric particle masses for various supersymmetric models. Depending on the model, the search excludes gluino masses up to 1.32 TeV and squark masses up to 840 GeV. Limits are also set on the parameters of a minimal universal extra dimension model, excluding a compactification radius of 1/R c = 950 GeV for a cut-off scale times radius (ΛR c) of approximately 30

Evidence for the Higgs-boson Yukawa coupling to tau leptons with the ATLAS detector

Results of a search for H → τ τ decays are presented, based on the full set of proton-proton collision data recorded by the ATLAS experiment at the LHC during 2011 and 2012. The data correspond to integrated luminosities of 4.5 fb−1 and 20.3 fb−1 at centre-of-mass energies of √s = 7 TeV and √s = 8 TeV respectively. All combinations of leptonic (τ → `νν¯ with ` = e, µ) and hadronic (τ → hadrons ν) tau decays are considered. An excess of events over the expected background from other Standard Model processes is found with an observed (expected) significance of 4.5 (3.4) standard deviations. This excess provides evidence for the direct coupling of the recently discovered Higgs boson to fermions. The measured signal strength, normalised to the Standard Model expectation, of µ = 1.43 +0.43 −0.37 is consistent with the predicted Yukawa coupling strength in the Standard Model