A Proof of Concept Study on Real-Pime LiMAx CYP1A2 Liver Function Assessment of Donor Grafts During Normothermic Machine Perfusion

No single reliable parameter exists to assess liver graft function of extended criteria donors during ex-vivo normothermic machine perfusion (NMP). The liver maximum capacity (LiMAx) test is a clinically validated cytochromal breath test, measuring liver function based on 13CO2 production. As an innovative concept, we aimed to integrate the LiMAx breath test with NMP to assess organ function. Eleven human livers were perfused using NMP. After one hour of stabilization, LiMAx testing was performed. Injury markers (ALT, AST, miR-122, FMN, and Suzuki-score) and lactate clearance were measured and related to LiMAx values. LiMAx values ranged between 111 and 1838 µg/kg/h, and performing consecutive LiMAx tests during longer NMP was feasible. No correlation was found between LiMAx value and miR-122 and FMN levels in the perfusate. However, a significant inverse correlation was found between LiMAx value and histological injury (Suzuki-score, R = − 0.874, P < 0.001), AST (R = − 0.812, P = 0.004) and ALT (R = − 0.687, P = 0.028). Furthermore, a significant correlation was found with lactate clearance (R = 0.683, P = 0.043). We demonstrate, as proof of principle, that liver function during NMP can be quantified using the LiMAx test, illustrating a positive correlation with traditional injury markers. This new breath-test application separates livers with adequate cytochromal liver function from inadequate ones and may support decision-making in the safe utilization of extended criteria donor grafts

Design decisions for a real time, alcohol craving study using physio- and psychological measures

The current study was a pilot for an alcohol craving monitoring study with a biosensor (E4 wristband) and ecological momentary assessment (EMA) smartphone app. The E4 wristband was evaluated on compliance rates, usability, comfort and stigmatization. Two EMA methodologies (signal- and interval-contingent design) were compared on data variability, compliance and perceived burden. Results show that both EMA methodologies captured variability of craving and compliance rates were between medium to low. The perceived burden of the designs was high, in particular for the signal-contingent design. Participants wore the wristband ranging from occasionally to often and the usability was rated good. Many participants reported frequent questioning about the bracelet, which they indicated as positive. However, addicted individuals are expected not to appreciate this attention, we therefore propose to provide them with coping strategies. Efforts should be made to increase compliance, we therefore propose the interval contingent design with micro incentives

First principles investigation of exchange interactions in quasi-one-dimensional antiferromagnet CaV2O4

The effect of orbital degrees of freedom on the exchange interactions in the spin-1 quasi-one-dimensional antiferromagnet CaV2O4 is systematically studied. For this purpose a realistic low-energy model with the parameters derived from the first-principles calculations is constructed. The exchange interactions are calculated using both the theory of infinitesimal spin rotations near the mean-field ground state and the superexchange model, which provide a consistent description. The obtained behaviour of exchange interactions substantially differs from the previously proposed phenomenological picture based on the magnetic measurements and structural considerations, namely: (i) Despite quasi-one-dimensional character of the crystal structure, consisting of the zigzag chains of edge-sharing VO6 octahedra, the electronic structure is essentially three-dimensional, that leads to finite interactions between the chains; (ii) The exchange interactions along the legs of the chains appear to dominate; and (iii) There is a substantial difference of exchange interactions in two crystallographically inequivalent chains. The combination of these three factors successfully reproduces the behaviour of experimental magnetic susceptibility.Comment: 15 pages, 6 figures, supplementary materia

Decision making in interhospital transport of critically ill patients: national questionnaire survey among critical care physicians

Objective: This study assessed the relative importance of clinical and transport-related factors in physicians' decision-making regarding the interhospital transport of critically ill patients. Methods: The medical heads of all 95 ICUs in The Netherlands were surveyed with a questionnaire using 16 case vignettes to evaluate preferences for transportability; 78 physicians (82%) participated. The vignettes varied in eight factors with regard to severity of illness and transport conditions. Their relative weights were calculated for each level of the factors by conjoint analysis and expressed in beta. The reference value (beta = 0) was defined as the optimal conditions for critical care transport; a negative beta indicated preference against transportability. Results: The type of escorting personnel (paramedic only: beta = 3.1) and transport facilities (standard ambulance beta = 1.21) had the greatest negative effect on preference for transportability. Determinants reflecting severity of illness were of relative minor importance (dose of noradrenaline beta = 0.6, arterial oxygenation beta = 0.8, level of peep beta = 0.6). Age, cardiac arrhythmia, and the indication for transport had no significant effect. Conclusions: Escorting personnel and transport facilities in interhospital transport were considered as most important by intensive care physicians in determining transportability. When these factors are optimal, even severely critically ill patients are considered able to undergo transport. Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trip

Elimination of Identity?based Discrimination in Food and Nutrition Programmes in India

India's growth story in recent years is being criticised for its inability to reduce the ever?increasing income inequality and higher incidence of malnutrition among its children, particularly those belonging to marginalised groups such as Scheduled Castes (SCs). This article examines the prevalence of identity?based discrimination in health and nutritional programmes and finds it to be one of the important reasons for the higher incidence of malnutrition among SC children. While examining the guidelines of two major nutritional support programmes – the Integrated Child Development Services (ICDS) and the Mid Day Meal (MDM) Scheme – the article argues for making these more caste? and gender?sensitive in order to eliminate discrimination. It offers policy recommendations to address and monitor the discrimination in nutrition programmes. These include greater participation by marginalised groups like SCs in service planning and delivery, ensuring quality and promoting accountability; training and sensitisation of service providers; and the revision of administrative guidelines