Intelligent Liver Function Testing (iLFT):An Intelligent Laboratory Approach to Identifying Chronic Liver Disease

The intelligent Liver Function Testing (iLFT) pathway is a novel, algorithm-based system which provides automated laboratory investigations and clinical feedback on abnormal liver function test (LFT) results from primary care. iLFT was introduced to NHS Tayside, Scotland, in August 2018 in response to vast numbers of abnormal LFTs, many of which were not appropriately investigated, coupled with rising mortality from chronic liver disease. Here, we outline the development and implementation of the iLFT pathway, considering the implications for the diagnostic laboratories, primary care services and specialist hepatology clinics. Additionally, we describe the utility, outcomes and evolution of iLFT, which was used over 11,000 times in its first three years alone. Finally, we will consider the future of iLFT and propose areas where similar ‘intelligent’ approaches could be used to add value to laboratory investigations.</p

Intelligent Liver Function Testing (iLFT):An Intelligent Laboratory Approach to Identifying Chronic Liver Disease

The intelligent Liver Function Testing (iLFT) pathway is a novel, algorithm-based system which provides automated laboratory investigations and clinical feedback on abnormal liver function test (LFT) results from primary care. iLFT was introduced to NHS Tayside, Scotland, in August 2018 in response to vast numbers of abnormal LFTs, many of which were not appropriately investigated, coupled with rising mortality from chronic liver disease. Here, we outline the development and implementation of the iLFT pathway, considering the implications for the diagnostic laboratories, primary care services and specialist hepatology clinics. Additionally, we describe the utility, outcomes and evolution of iLFT, which was used over 11,000 times in its first three years alone. Finally, we will consider the future of iLFT and propose areas where similar ‘intelligent’ approaches could be used to add value to laboratory investigations.</p

Performance analysis of grid-connected wind turbines

The development of wind turbines (WT) and the capacities of wind power plants have increased significantly in the last years. Wind power plants (WPP) must provide the power quality required by new regulations and the reliability of the power system that is interconnected to. It is very important to analyze and understand the sources of disturbances that affect the power quality. In this paper is analyzed the performance of three different popular wind generators that are connected to the power system. Based on this analysis was made a comparison for the three wind turbines studied that are: The squirrel-cage induction generator (SCIG), the doubly-fed induction generator (DFIG), and the permanent-magnet synchronous generator (PMSG). The fixed speed system is more simple and reliable, but severely limits the energy production of a wind turbine and power quality. In case of variable speed systems, comparisons shows that generator of similar rating can significantly enhance energy capture as well as power quality. Moreover, performance of their output power leveling is validated by a new method numerically as maximum energy function and leveling function. The performances of these wind turbines and their characteristics are analysed in steady-state. Wind turbines systems are modeled in Matlab/Simulink environment. Simulation results matched well with the theoretical turbines operation

Low skilled take their qualifications &quot;one step up&quot;

Adult learning is recognized as a key component of lifelong learning and Member States are required to remove barriers to participation, to increase overall quality and efficiency in adult learning, to speed up the process of validation and recognition and to ensure sufficient investment in and monitoring of the field (European Commission, 2006, 2007; European Parliament, 2008; European Council, 2008). It is unanimously recognized that adult learning can play a pivotal role in meeting the goals of the Lisbon Strategy, by fostering social cohesion, providing citizens with the skills required to find new jobs and helping Europe to better respond to the challenges of globalisation. Such needs are taken into consideration in this Volume where the main issues faced are related to what 33 European countries have been doing in order to raise the skills levels of low-skilled workers, address the problem of the high number of early school leavers, combat social exclusion, ensure the efficiency, effectiveness, quality of adult learning

Management of facial paralysis following treatment of neurosurgical tumours

The purpose of this study is to present our experience on improving the quality of life of patients with facial paralysis due to an operated intracranial tumour, by performing minimally invasive static reanimation procedures. We reviewed the clinical information pertaining to neurosurgical patients with facial paralysis that underwent static reanimation. The study included 11 patients with complete facial nerve paralysis of all nerve branches, that reported different primary complaints upon presentation. The performed procedures consisted of gold plate insertion into the superior eyelid, inferior eyelid ectropion correction or suture suspension. The functional results were favourable in all cases and the resulting appearance was acceptable. The choice of the different techniques used is discussed. Good outcomes are possible using static reanimation with an adequate adaptation of the techniques to the main patient complaint

catena-Poly[zinc-tris­(μ-dimethyl­carbamato-κ2 O:O′)-zinc-μ-(2-phenyl­benzimidazolido-κ2 N:N′]

The crystal structure of the title compound, [Zn2(C13H9N2)(C3H6NO2)3]n, displays a long chiral chain. This is composed of zinc-dimer clusters capped by dimethyl­carbamate ligands, which lie on crystallographic twofold rotation axes and are polymerically linked in one dimension by 2-phenyl­benzimidadole (2–PBImi) organic ligands. The two Zn2+ ions defining the dimetal cluster are crystallographically independent, but display very similar coordination modes and tetra­hedral geometry. As such, each Zn2+ ion is coordinated on one side by the N-donor imidazole linker, while the other three available coordination sites are fully occupied by the O atoms from the capping dimethyl­carbamates. The chirality of the chain extends along the c axis, generating a rather long 52.470 (11) Å cell axis. Inter­estingly, the chiral material crystallizes from completely achiral precursors. A twofold axis and 31 screw axis serve to generate the long asymmetric unit

Inhibition of endothelial cell functions and of angiogenesis by the metastasis inhibitor NAMI-A

NAMI-A is a ruthenium-based compound with selective anti-metastasis activity in experimental models of solid tumours. We studied whether this activity was dependent on anti-angiogenic ability of NAMI-A. We thus investigated its in vitro effects on endothelial cell functions necessary for angiogenesis to develop, as well as its in vivo effects in the chick embryo chorioallantoic membrane model. Endothelial cell proliferation, chemotaxis, and secretion of the matrix-degrading enzyme metalloproteinase-2 were inhibited by NAMI-A in a dose-dependent manner, and without morphologic signs of cell apoptosis or necrosis. Lastly, NAMI-A displayed a dose-dependent in vivo anti-angiogenic activity in the chorioallantoic membrane model. These data suggest that the anti-angiogenic activity of NAMI-A can contribute to its anti-metastatic efficacy in mice bearing malignant solid tumours

Increased risk of chronic kidney disease and mortality in a cohort of people diagnosed with metabolic dysfunction associated steatotic liver disease with hepatic fibrosis

Background and aims: Metabolic dysfunction associated steatotic liver disease (MASLD) increases the risk of incident chronic kidney disease (CKD). However, the relative risk of CKD associated with increasing hepatic fibrosis, and consequent mortality risk, remains underexplored in real-world cohorts. In this study, we sought to establish whether hepatic fibrosis is associated with increased CKD risk and explore differences in mortality risk in a cohort of people living with MASLD, contingent on liver fibrosis and CKD status.Methods: This was an observational study of people who underwent routine liver function testing in Tayside, Scotland. MASLD was defined as: elevated ALT (&gt;30 U/L) or GGT (&gt;73 U/L); presence of diabetes, and/or hypertension, and/or obesity; weekly alcohol consumption &lt;14 units (112g (+/-8g) alcohol); and negative screen for other aetiologies. Data was collected from digital health records. We used log-binomial models to quantify the risk of CKD among those with and without fibrosis, and Cox regression models to estimate differences in mortality risk dependent on fibrosis and CKD.Results: In our cohort (n = 2,046), 1,448 (70.8%) people had MASLD without fibrosis and 598 (29.2%) with fibrosis; 161 (11.1%) and 117 (19.6%) respectively also had CKD. After excluding individuals with structural, autoimmune, or malignant CKD (n = 22), liver fibrosis (n = 593; 18.9% with CKD) was associated with increased CKD risk (aRR = 1.31, 1.04–1.64, p = 0.021). Increased mortality risk was observed for those with liver fibrosis (aHR = 2.30, 1.49–3.56, p = &lt;0.001) and was higher again among people with both fibrosis and CKD (aHR = 5.07, 3.07–8.39, p = &lt;0.014).Conclusions: Liver fibrosis was an independent risk factor for CKD in this cohort of people living with MASLD. Furthermore, those with MASLD with liver fibrosis had higher risk for mortality and this risk was further elevated among those with co-morbid CKD. Given the increased risk of CKD, and consequent mortality risk, among people living with MASLD fibrosis, renal function screening should be considered within liver health surveillance programmes and guidelines