Heterogeneous indications and the need for viability assessment:An international survey on the use of machine perfusion in liver transplantation

Although machine perfusion (MP) is being increasingly adopted in liver transplantation, indications, timing, and modality are debated. To investigate current indications for MP a web-based Google Forms survey was launched in January 2021 and addressed to 127 experts in the field, identified among first and corresponding Authors of MP literature in the last 10 years. The survey presented 10 real-life cases of donor–recipient matching, asking whether the liver would be accepted (Q1), whether MP would be used in that particular setting (Q2) and, if so, by which MP modality (Q3) and at what timing during preservation (Q4). Respondents could also comment on each case. The agreement was evaluated using Krippendorff's alpha coefficient. Answers from 39 (30.1%) participants disclosed significant heterogeneity in graft acceptance, MP indications, technique, and timing. Agreement between respondents was generally poor (Q1, α = 0.11; Q2, α = 0.14; Q3, α = 0.12, Q4, α = 0.11). Overall, respondents preferred hypothermic MP and an end-ischemic approach in 56.3% and 81.1% of cases, respectively. A total of 18 (46.2%) participants considered only one MP approach, whereas 17 (43.6%) and 3 (7.7%) considered using alternatively 2 or 3 different techniques. Of 38 comments, 17 (44.7%) were about the use of MP for graft viability assessment before implantation. This survey shows considerable variability in MP indications, emphasizing the need to identify scenarios of optimal utilization for each technique. Viability assessment emerges as a fundamental need of transplant professionals when considering the use of MP

Home and healthcare. The prospect of home adaptation through a computational design decision-support system

This paper presents an ongoing research to define the framework of a computational design approach based on the idea of spatial analysis and spatial synthesis to implement multicriteria evaluations and provide evidence of the performance of the design alternatives in the specific case of home adaptation for healthcare at home. The European health systems place among the priority objectives the strengthening of the provision of healthcare at home to guarantee the aging in place of elderly people and to limit, at the same time, the unnecessary use of resources. Therefore, existing homes must provide adequate safety, comfort, and accessibility features to ensure a high quality of life for the care receivers and facilitate the caregivers' tasks. To address the complexity of the requirements to be met, we propose a spatial decision support system (SDSS) to implement multi-criteria assessments to ergonomic design problems at a spatial scale of apartment homes. The system is intended to streamline and assist designers and homeowners in planning interventions for home adaptations for healthcare. Such design problems can be formulated as decision problems with costs and benefits modeled within constraints of validity and quality criteria/objectives. Concerning the specific field of study, the system evaluates the degree of compliance with the accessibility and visibility quality criteria of each design alternative. The reiteration of the evaluation mechanism allows for the classification and supports the selection of satisfactory technical solutions identified with an informed and well-balanced trade-off between the relevant quality criteria

Modularity and customisation for home care – Configuration and multicriteria analysis of furnishings

Given the ageing population and the growing interest in prior verification of the compatibility of existing housing to accommodate home care activities, this paper reports the results of a research aimed at implementing tools to support the design of housing adaptation in anticipation of flexibility to accompany the evolving needs of the elderly cared for. An evaluation system was structured starting with the definition of requirements connoting the home space for home care, which was useful for selecting and verifying, on a performance basis, the compliance of furniture available on the market, also in relation to modularity and readiness for customisation. The best-performing furniture solutions were entered into a database that will be made interoperable in future research developments in a BIM environment.   Article info Received: 10/09/2023; Revised: 08/10/2023; Accepted: 19/10/202

Heterogeneous Indications and the Need for Viability Assessment: An International Survey on the Use of Machine Perfusion in Liver Transplantation

Although machine perfusion (MP) is being increasingly adopted in liver transplantation, indications, timing, and modality are debated. To investigate current indications for MP a web-based Google Forms survey was launched in January 2021 and addressed to 127 experts in the field, identified among first and corresponding Authors of MP literature in the last 10 years. The survey presented 10 real-life cases of donor-recipient matching, asking whether the liver would be accepted (Q1), whether MP would be used in that particular setting (Q2) and, if so, by which MP modality (Q3) and at what timing during preservation (Q4). Respondents could also comment on each case. The agreement was evaluated using Krippendorff's alpha coefficient. Answers from 39 (30.1%) participants disclosed significant heterogeneity in graft acceptance, MP indications, technique, and timing. Agreement between respondents was generally poor (Q1, α = 0.11; Q2, α = 0.14; Q3, α = 0.12, Q4, α = 0.11). Overall, respondents preferred hypothermic MP and an end-ischemic approach in 56.3% and 81.1% of cases, respectively. A total of 18 (46.2%) participants considered only one MP approach, whereas 17 (43.6%) and 3 (7.7%) considered using alternatively 2 or 3 different techniques. Of 38 comments, 17 (44.7%) were about the use of MP for graft viability assessment before implantation. This survey shows considerable variability in MP indications, emphasizing the need to identify scenarios of optimal utilization for each technique. Viability assessment emerges as a fundamental need of transplant professionals when considering the use of MP. Keywords: ex situ organ perfusion; machine perfusion; normothermic regional perfusion; organ preservation; viability assessment

How to improve smallholder market access: Evaluation of Mercados Campesinos in Colombia

This paper presents an analysis of the results obtained in the project called "Mercados Campesinos" carried out in the central region of Colombia between 2004 and 2015. This analysis was performed to evaluate the impacts of this short food value chain experience and its influence on economic, social and political dimensions of smallholders' market access.The analysis included two complementary research methods: quantitative and qualitative approaches. These methods were stated to identify the benefits accrued to participants usingthree different methodologies: i) t-test analysis; ii) an impact evaluation known as difference-in-difference and iii) multilevel regressions. On the other hand, qualitative analysis was based on semi-structured interviews and informal dialogues to investigate the perceptions of a selected group of beneficiaries regarding how project goals have been achieved. The results showed that one of the most influential elements in smallholders'market access has been the role of peasant organizations, associations and local farmer committees. These administrative structures greatly affected the economic efficiency, political participation and, to a lesser extent, commercial improvements. Project outcomes have been extremely influenced by participants' expectations of improvements in wellbeing, life quality, production rates, and income. The project was not able to reach a good level of financial sustainability; however, it provided peasants with well-designed tools to self-coordinate their actions. Proof of that is that farmers started to organize themselves autonomously to exert pressure at municipal and local levels

Aurea diagnosis of pneumomediastinum. A case report

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process

Model studies on the synthesis of madangamine alkaloids. Assembly of the macrocyclic rings

Using simplified model derivatives, the assembly of the macrocyclic rings of madangamines, including the 13- and 14-membered D rings of madangamines C-E, the all-cis-triunsaturated 15-membered D ring of madangamine A, and the (Z,Z)-unsaturated 11-membered E ring common to madangamines A-E, has been studied

Discontinuously supervised aerobic training vs. physical activity promotion in the self-management of type 2 diabetes in older Italian patients: design and methods of the 'TRIPL-A' randomized controlled trial

Physical activity (PA) has health benefits for people with type 2 diabetes (T2D). Indeed, regular PA is considered an important part of any T2D management plan, yet most patients adopt a sedentary lifestyle. Exercise referral schemes (ERS) have the potential to effectively promote physical activity among T2D patients, and their effectiveness may be enhanced when they are supported by computer-based technologies. The 'TRIPL-A' study (i.e., a TRIal to promote PhysicaL Activity among patients in the young-old age affected by T2D) aims to assess if realizing an innovative ERS, based on a strong partnership among general practitioners, specialist physicians, exercise specialists, and patients, and supported by a web-based application (WBA), can effectively lead sedentary older T2D patients to adopt an active lifestyle

The biomedical piglet: establishing reference intervals for haematology and clinical chemistry parameters of two age groups with and without iron supplementation

Background: The similarities between swine and humans in physiological and genomic patterns, and the great correlation in size and anatomy, make pigs extremely useful in preclinical studies. New-born piglets can represent a model for congenital and genetic diseases in new-born children. It is known that piglets may have significant differences in clinicopathological results compared to adult pigs. Therefore, adult laboratory reference intervals cannot be applied to piglets. The aim of this study was to compare haematological and chemical variables in piglets of two ages and determinate age-related reference intervals for commercial hybrid young pigs. Blood samples were collected under general anaesthesia from 130 animals divided into five- (P5) and 30- (P30) day-old piglets. Only P30 animals were treated with parenteral iron after birth. Samples were analysed using automated haematology (ADVIA 2120) and chemistry analysers, and age-related reference intervals were calculated. Results: Significant higher values of RBC, Hb and HCT were observed in P30 animals when compared to P5, with an opposite trend for MCV. These results were associated with a reduction of the RBC regeneration process and the thrombopoietic response. The TSAT and TIBC were significantly higher in P30 compared to P5; however, piglets remained iron deficient compared to adult reference intervals reported previously. Conclusions: In conclusion, this paper emphasises the high variability occurring in clinicopathological variables between new-born and 30-day-old pigs, and between piglets and adult pigs. This study provides valuable reference data for piglets at precise ages and could be used in the future as historical control improving the Reduction in animal experiments, as suggested by the 3Rs principle