Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation

The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. Recovery of blood coagulability began 30-60 min after reperfusion of the graft liver, and coagulability had returned toward baseline values 2 hr after reperfusion. A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors

System for the integrated management of urban settlement and infrastructure development

The overall economic, physical and decision-making environment in South Africa’s urban areas has changed dramatically in recent years. This paper provides a brief overview of these changes and then proceeds to describe a new approach towards urban management, and the develop­ment of a modular decision support system which can contribute to the management of urban settlement and infrastrucutre development within the framework of an integrated approach. This system includes modules for the indentification of potential urban set­tlement sites (both for new develop­ment and re-development/densification of existing developed areas), exploring the likely development of these areas (given certain urban/infrastrucutre management scenarios), and analysing the resource consumption impacts (both in terms of physical resources and financial resources) associated with each scenario. The system pro­vides the ability to rapidly compare and evaluate the impacts of alternative approaches to accommodate the vari­ous development pressures within a scenario-based approach

Adapting to compromised routines: Parental perspectives on physical activity and health for children and adolescents with type 1 diabetes in the UK during COVID-19 lockdown

\ua9 2024 The Author(s)Purpose: To determine how COVID-19 lockdown impacted physical activity (PA) levels, wellbeing, and diabetes management in children (aged 0–17 years) with type 1 diabetes (T1D), from the perspectives of their parent/guardian. Design and methods: This qualitative descriptive study is part of a larger, parallel mixed-methods design study, which incorporated a cross-sectional survey and semi-structured one-to-one interviews. Interviewees were recruited from the survey, which was distributed to parents of children/adolescents with T1D in the UK. Interviews explored diabetes management, mental and physical wellbeing, changes in PA levels, sleep quality before/during lockdown, and the effects of lockdown on the individual and their family. The interviews were transcribed and the data were analysed thematically. Results: 14 interviews were conducted with parents. Thematic analysis generated a central theme of routine disruption, with four further themes on diabetes management routines, harnessing the opportunities of lockdown, weighing up risk, and variable impact on wellbeing. Conclusions: Maintaining or increasing PA during COVID-19 lockdown was associated with better diabetes management, sleep, and wellbeing for children/adolescents with T1D, despite significant disruption to established routines. Use of technology during the pandemic contributed positively to wellbeing. Practice implications: It is crucial to emphasize the significance of maintaining a well-structured routine when treating patients with type 1 diabetes. A consistent routine, incorporating regular physical exercise and good sleep hygiene, will help with managing overall diabetes control

Efektifitas Implementasi Smm Iso 9001:2008 Pada Smk Negeri Di Kota Singaraja

Penelitian ini bertujuan untuk memberikan gambaran tentang : 1) efektivitas penerapan Sistem Manajemen Mutu (SMM) ISO 9001:2008 pada SMK Negeri di kota Singaraja dilihat dari konteks, masukan, proses, dan hasil penerapan; 2) kendala-kendala yang dihadapai dalam melaksanakan SMM ISO 9001:2008 pada SMK Negeri dikota Singaraja serta alternatif pemecahannya. Penelitian ini dilaksanakan pada SMK Negeri dikota Singaraja pada tahun pelajaran 2013/2014, dengan menggunakan model evaluasi CIPP dari Stufflebeam yang melibatkan 354 responden. Variabel konteks yang terdiri dari sub variabel SMM sekolah dan keterlibatan komite sekolah. Variabel masukan terdiri dari sub variabel manajemen sekolah dan keterlibatan dunia USAha/dunia industri (DU/DI). Variabel proses yang terdiri dari sub variabel pemeliharaan dan pengadaan sarana pendidikan, kegiatan belajar mengajar oleh guru, dan kegiatan belajar mengajar siswa. Variabel produk dengan sub variabel nilai ujian tahun pemelajaran 2013/2014 (UN, US dan UK). Metode kuesioner digunakan untuk menjaring data SMM sekolah, manajemen sekolah dengan responden semua staff manajemen, keterlibatan dunia USAha/dunia industri (DU/DI), dan proses pembelajaran siswa. Metode wawancara untuk menjaring data keterlibatan komite sekolah. Metode observasi untuk menjaring data kegiatan belajar mengajar oleh guru. Metode studi dokumen untuk menjaring data SMM sekolah, pengadaan dan pemeliharaan sarana pendidikan, dan nilai ujian. Hasil penelitian menunjukkan bahwa : 1) efektif dilihat dari variabel konteks dengan frekuensi kategori positif 54.286% untuk SMM dan frekuensi kategori positif 75% untuk keterlibatan komite; 2) efektif dilihat dari variabel masukan dengan frekuensi kategori positif 57.6271% untuk manajmen sekolah dan frekuensi kategori positif 52.041% untuk keterlibatan DU/DI; 3) kurang efektif dilihat dari variabel proses dengan frekuensi kategori negatif 63.1578% untuk pemeliharaan dan pengadaan saran pendidikan, dan frekuensi kategori positif 57.4713% untuk kegiatan belajar mengajar oleh guru, dan frekuensi kategori positif 52.308% untuk kegiatan belajar mengajar siswa; 4) efektif dilihat dari variabel produk dengan frekuensi kategori positif 52.055.00% untuk nilai ujian. Bertolak dari hasil penelitian tersebut dapat direkomendasikan: 1) meningkatkan koordinasi setiap kebijakan baru; 2) penerapan SMM perlu disosialisasikan secara terus menerus pada setiap kesempatan; 3) meningkatkan komitmen warga sekolah untuk menerapakan SMM; 4) meningkatkan koordinasi dengan industri menuju Manajemen Partisipatif; 5) memberikan tugas dan tanggungjawab yang jelas kepada kepala program

A review of standard pharmacological therapy for adult asthma - Steps 1 to 5

The aim of pharmacological therapy for asthma is to improve symptoms and lung function and minimise the risk of asthma attacks. The intensity of treatment is based on the level of asthma control and the potential risk of future deterioration. In the British asthma guidelines, treatments are divided into Step One to Five, with each Step signifying a need for an increase in therapy in response to symptoms or to prevent exacerbations. Treatments comprise of inhaled or systemic medications. Inhaled therapy includes short-acting and long-acting medication to improve symptoms and inhaled corticosteroids which reduce airway inflammation. Systemic treatments include medications which act on specific biological pathways, such as the leukotriene or IgE pathways, or systemic corticosteroids. In choosing a particular therapy, treatment benefits are balanced by the potential risks of medication-related adverse effects. This review will provide a practical guide to the key pharmacological therapies for adult asthma at Steps One to Five based on British guidelines and consider future options for new treatments

Breakfast omission reduces subsequent resistance exercise performance

Although much research has examined the influence of morning carbohydrate intake (i.e., breakfast) on endurance performance, little is known about its effects on performance in resistance-type exercise. Sixteen resistance-trained men (age 23 ± 4 years, body mass 77.56 ± 7.13 kg, and height 1.75 ± 0.04 m) who regularly (≥3 day/wk) consumed breakfast completed this study. After assessment of 10 repetition maximum (10RM) and familiarization process, subjects completed 2 randomized trials. After an overnight fast, subjects consumed either a typical breakfast meal (containing 1.5 g of carbohydrate/kg; breakfast consumption [BC]) or a water-only breakfast (breakfast omission [BO]). Two hours later, subjects performed 4 sets to failure of back squat and bench press at 90% of their 10RM. Sensations of hunger, fullness, desire to eat, and prospective food consumption were collected before, as well as immediately, 1 hour and 2 hours after BC/BO using 100-mm visual analogue scales. Total repetitions completed were lower during BO for both back squat (BO: 58 ± 11 repetitions; BC: 68 ± 14 repetitions; effect size [ES] = 0.98; p < 0.001) and bench press (BO: 38 ± 5 repetitions; BC: 40 ± 5 repetitions; ES = 1.06; p < 0.001). Fullness was greater, whereas hunger, desire to eat, and prospective food consumption were lower after a meal for BC compared with BO (p < 0.001). The results of this study demonstrate that omission of a pre-exercise breakfast might impair resistance exercise performance in habitual breakfast consumers. Therefore, consumption of a high-carbohydrate meal before resistance exercise might be a prudent strategy to help maximize performanc

The metabolome as a diagnostic for maximal aerobic capacity during exercise in type 1 diabetes

\ua9 The Author(s) 2024.Aims/hypothesis: Our aim was to characterise the in-depth metabolic response to aerobic exercise and the impact of residual pancreatic beta cell function in type 1 diabetes. We also aimed to use the metabolome to distinguish individuals with type 1 diabetes with reduced maximal aerobic capacity in exercise defined by V˙O2peak. Methods: Thirty participants with type 1 diabetes (≥3 years duration) and 30 control participants were recruited. Groups did not differ in age or sex. After quantification of peak stimulated C-peptide, participants were categorised into those with undetectable (&lt;3 pmol/l), low (3–200 pmol/l) or high (&gt;200 pmol/l) residual beta cell function. Maximal aerobic capacity was assessed by V˙O2peak test and did not differ between control and type 1 diabetes groups. All participants completed 45 min of incline treadmill walking (60% V˙O2peak) with venous blood taken prior to exercise, immediately post exercise and after 60 min recovery. Serum was analysed using targeted metabolomics. Metabolomic data were analysed by multivariate statistics to define the metabolic phenotype of exercise in type 1 diabetes. Receiver operating characteristic (ROC) curves were used to identify circulating metabolomic markers of maximal aerobic capacity (V˙O2peak) during exercise in health and type 1 diabetes. Results: Maximal aerobic capacity (V˙O2peak) inversely correlated with HbA1c in the type 1 diabetes group (r2=0.17, p=0.024). Higher resting serum tricarboxylic acid cycle metabolites malic acid (fold change 1.4, p=0.001) and lactate (fold change 1.22, p=1.23 710−5) differentiated people with type 1 diabetes. Higher serum acylcarnitines (AC) (AC C14:1, F value=12.25, p=0.001345; AC C12, F value=11.055, p=0.0018) were unique to the metabolic response to exercise in people with type 1 diabetes. C-peptide status differentially affected metabolic responses in serum ACs during exercise (AC C18:1, leverage 0.066; squared prediction error 3.07). The malic acid/pyruvate ratio in rested serum was diagnostic for maximal aerobic capacity (V˙O2peak) in people with type 1 diabetes (ROC curve AUC 0.867 [95% CI 0.716, 0.956]). Conclusions/interpretation: The serum metabolome distinguishes high and low maximal aerobic capacity and has diagnostic potential for facilitating personalised medicine approaches to manage aerobic exercise and fitness in type 1 diabetes. Graphical Abstract: (Figure presented.)

Multitask Learning on Graph Neural Networks: Learning Multiple Graph Centrality Measures with a Unified Network

The application of deep learning to symbolic domains remains an active research endeavour. Graph neural networks (GNN), consisting of trained neural modules which can be arranged in different topologies at run time, are sound alternatives to tackle relational problems which lend themselves to graph representations. In this paper, we show that GNNs are capable of multitask learning, which can be naturally enforced by training the model to refine a single set of multidimensional embeddings $\in \mathbb{R}^d$ and decode them into multiple outputs by connecting MLPs at the end of the pipeline. We demonstrate the multitask learning capability of the model in the relevant relational problem of estimating network centrality measures, focusing primarily on producing rankings based on these measures, i.e. is vertex $v_1$ more central than vertex $v_2$ given centrality $c$?. We then show that a GNN can be trained to develop a \emph{lingua franca} of vertex embeddings from which all relevant information about any of the trained centrality measures can be decoded. The proposed model achieves $89\%$ accuracy on a test dataset of random instances with up to 128 vertices and is shown to generalise to larger problem sizes. The model is also shown to obtain reasonable accuracy on a dataset of real world instances with up to 4k vertices, vastly surpassing the sizes of the largest instances with which the model was trained ($n=128$). Finally, we believe that our contributions attest to the potential of GNNs in symbolic domains in general and in relational learning in particular.Comment: Published at ICANN2019. 10 pages, 3 Figure

Insulin therapy and dietary adjustments to normalize glycaemia and prevent nocturnal hypoglycaemia after evening exercise in type 1 diabetes: a randomized controlled trial

Introduction Evening-time exercise is a frequent cause of severe hypoglycemia in type 1 diabetes, fear of which deters participation in regular exercise. Recommendations for normalizing glycemia around exercise consist of prandial adjustments to bolus insulin therapy and food composition, but this carries only short-lasting protection from hypoglycemia. Therefore, this study aimed to examine the impact of a combined basal-bolus insulin dose reduction and carbohydrate feeding strategy on glycemia and metabolic parameters following evening exercise in type 1 diabetes. Methods Ten male participants (glycated hemoglobin: 52.4±2.2 mmol/mol), treated with multiple daily injections, completed two randomized study-days, whereby administration of total daily basal insulin dose was unchanged (100%), or reduced by 20% (80%). Participants attended the laboratory at ∼08:00 h for a fasted blood sample, before returning in the evening. On arrival (∼17:00 h), participants consumed a carbohydrate meal and administered a 75% reduced rapid-acting insulin dose and 60 min later performed 45 min of treadmill running. At 60 min postexercise, participants consumed a low glycemic index (LGI) meal and administered a 50% reduced rapid-acting insulin dose, before returning home. At ∼23:00 h, participants consumed a LGI bedtime snack and returned to the laboratory the following morning (∼08:00 h) for a fasted blood sample. Venous blood samples were analyzed for glucose, glucoregulatory hormones, non-esterified fatty acids, β-hydroxybutyrate, interleukin 6, and tumor necrosis factor α. Interstitial glucose was monitored for 24 h pre-exercise and postexercise. Results Glycemia was similar until 6 h postexercise, with no hypoglycemic episodes. Beyond 6 h glucose levels fell during 100%, and nine participants experienced nocturnal hypoglycemia. Conversely, all participants during 80% were protected from nocturnal hypoglycemia, and remained protected for 24 h postexercise. All metabolic parameters were similar. Conclusions Reducing basal insulin dose with reduced prandial bolus insulin and LGI carbohydrate feeding provides protection from hypoglycemia during and for 24 h following evening exercise. This strategy is not associated with hyperglycemia, or adverse metabolic disturbances

Gut microbiota of Type 1 diabetes patients with good glycaemic control and high physical fitness is similar to people without diabetes: an observational study

Type 1 diabetes is the product of a complex interplay between genetic susceptibility and exposure to environmental factors. Existing bacterial profiling studies focus on people who are most at risk at the time of diagnosis; there are limited data on the gut microbiota of people with long-standing Type 1 diabetes. This study compared the gut microbiota of patients with Type 1 diabetes and good glycaemic control and high levels of physical-fitness with that of matched controls without diabetes.Ten males with Type 1 diabetes and ten matched controls without diabetes were recruited; groups were matched for gender, age, BMI, peak oxygen uptake (VO2max ), and exercise habits. Stool samples were analysed using next-generation sequencing of the 16S rRNA gene to obtain bacterial profiles from each individual. Phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) was implemented to predict the functional content of the bacterial operational taxonomic units.Faecalibacterium sp., Roseburia sp. and Bacteroides sp. were typically the most abundant members of the community in both patients with Type 1 diabetes and controls, and were present in every sample in the cohort. Each bacterial profile was relatively individual and no significant difference was reported between the bacterial profiles or the Shannon diversity indices of Type 1 diabetes compared with controls. The functional profiles were more conserved and the Type 1 diabetes group were comparable with the control group.We show that both gut microbiota and resulting functional bacterial profiles from patients with long-standing Type 1 diabetes in good glycaemic control and high physical fitness levels are comparable with those of matched people without diabetes. This article is protected by copyright. All rights reserved