Survival after liver transplantation in the United Kingdom and Ireland compared with the United States

<b>Background and Aim</b>: Surgical mortality in the US is widely perceived to be superior to that in the UK. However, previous comparisons of surgical outcome in the two countries have often failed to take sufficient account of case-mix or examine long-term outcome. The standardised nature of liver transplantation practice makes it uniquely placed for undertaking reliable international comparisons of surgical outcome. The objective of this study is to undertake a risk-adjusted disease-specific comparison of both short- and long-term survival of liver transplant recipients in the UK and Ireland with that in the US. <b>Design, setting and participants</b>: Multi-centre cohort study using two high quality national databases including all adults who underwent a first single organ liver transplant in the UK and Ireland (n=5,925) and the US (n=41,866) between March 1994 and March 2005. <b>Main outcome measures</b>: Post-transplant mortality during the first 90 days, 90 days-1 year and beyond the first year, adjusted for donor and recipient characteristics. <b>Results</b>: Risk-adjusted mortality in the UK and Ireland was generally higher than in the US during the first 90 days (hazard ratio 1.17 95%CI 1.07-1.29), both for patients transplanted for acute liver failure (hazard ratio 1.27 95%CI 1.01-1.60) as well as those transplanted for chronic liver disease (hazard ratio 1.18 95% CI 1.07- 1.31). Between 90 days and 1 year post-transplantation, no statistically significant differences in overall risk- adjusted mortality were noted between the two cohorts. Survivors of the first post-transplant year in the UK and Ireland had lower overall risk-adjusted mortality than those transplanted in the US (hazard ratio 0.88 95% CI 0.81- 0.96). This difference was observed among patients transplanted for chronic liver disease (hazard ratio 0.88 95%CI 0.81-0.96) but not those transplanted for acute liver failure (hazard ratio 1.02 95%CI 0.70- 1.50). <b>Conclusions</b>: Whilst risk adjusted mortality is higher in the UK and Ireland during the first 90 days following liver transplantation, it is higher in the US among those liver transplant recipients who survived the first post- transplant year. Our results are consistent with the notion that the US has superior acute peri-operative care whereas the UK appears to provide better quality chronic care following liver transplantation surgery

Support for midlife anxiety diagnosis as an independent risk factor for dementia: a systematic review

OBJECTIVES: Anxiety is an increasingly recognised predictor of cognitive deterioration in older adults and in those with mild cognitive impairment. Often believed to be a prodromal feature of neurodegenerative disease, anxiety may also be an independent risk factor for dementia, operationally defined here as preceding dementia diagnosis by ≥10 years. DESIGN: A systematic review of the literature on anxiety diagnosis and long-term risk for dementia was performed following published guidelines. SETTING AND PARTICIPANTS: Medline, PsycINFO and Embase were searched for peer-reviewed journals until 8 March 2017. Publications reporting HR/OR for all-cause dementia based on clinical criteria from prospective cohort or case-control studies were selected. Included studies measured clinically significant anxiety in isolation or after controlling for symptoms of depression, and reported a mean interval between anxiety assessment and dementia diagnosis of at least 10 years. Methodological quality assessments were performed using the Newcastle-Ottawa Scale. OUTCOME MEASURE: HR/OR for all-cause dementia. RESULTS: Searches yielded 3510 articles, of which 4 (0.02%) were eligible. The studies had a combined sample size of 29 819, and all studies found a positive association between clinically significant anxiety and future dementia. Due to the heterogeneity between studies, a meta-analysis was not conducted. CONCLUSIONS: Clinically significant anxiety in midlife was associated with an increased risk of dementia over an interval of at least 10 years. These findings indicate that anxiety may be a risk factor for late-life dementia, excluding anxiety that is related to prodromal cognitive decline. With increasing focus on identifying modifiable risk factors for dementia, more high-quality prospective studies are required to clarify whether clinical anxiety is a risk factor for dementia, separate from a prodromal symptom

How phonetic features project more talk

Investigations into the management of turn-taking have typically focussed on pitch and other prosodic phenomena, particularly pitch-accents. Here, non-pitch phonetic features and their role in turn-taking are described. Through sustained phonetic and interactional analysis of a naturally occurring, 12-minute long telephone call between two adult speakers of British English, sets of talk-projecting and turn-projecting features are identified. Talk-projecting features include the avoidance of durational lengthening, articulatory anticipation, continuation of voicing, the production of talk in maximally close proximity to a preceding point of possible turn-completion, and the reduction of consonants and vowels. Turn-projecting features include the converse of each of the talk-projecting features, and two other distinct features: release of plosives at the point of possible turn-completion, and the production of audible outbreaths. We show that features of articulatory and phonatory quality and duration are relevant factors in the design and treatment of talk as talk- or turn-projective

Changes in Received Pronunciation: Diachronic Case Studies

This paper sets out to investigate changes and individual irregularities in the Received Pronunciation of a number of individuals over time and to compare them with the changes noted in contemporary RP in the literature. The aim of the study is to ascertain whether accent change affects individuals during their lifetimes or is only brought about by new generations of speakers accepting different pronunciations as the norm and effectively speaking with a different accent to older generations within their social circle. The variations/changes looked for were: CLOTH transfer, CURE lowering, GOAT allophony, R-sandhi, and T-voicing. The procedure of the study was to identify the presence or absence of these features in the speech of certain individuals in recordings made over a period of at least 35 years. The individuals studied were: Her Majesty Queen Elizabeth II, Baroness Thatcher, Sir David Attenborough and David Dimbleby. The results of these comparisons suggest that individual speakers are not greatly affected by changes in pronunciation taking place around them and generally stay with the preferred pronunciation of their youth. There are, however, cases where a general uncertainty amongst speakers of the accent, here found in CURE lowering, does influence the speech of individuals over time

The mutable defendant: from penitent to rights-bearing and beyond

This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this recordContemporary criminal justice is premised on a rights-bearing defendant safe-guarded from arbitrary state punishment by due process. The paucity of academic commentary on the role of the criminal defendant suggests that there is a common assumption that the role is static. However, the rights-bearing defendant is a relatively new concept. Through a legal history analysis, this article demonstrates that the defendant’s role can mutate in response to pressures placed on the criminal trial. Broadly, there have been three conceptualisations of the defendant; the penitent Anglo-Norman defendant, the advocate defendant of the jury trial, and the rights-bearing adversarial defendant. Importantly, the shift from one conceptualisation to another has occurred gradually and often without commentary or conscious effort to instigate change. There are many contemporary pressures that could be impacting on the rights-bearing defendant. The concept of a mutable defendant provides a new theory through which to analyse these pressures. This article considers the introduction of adverse inferences regarding the right to silence and disclosure, and the rise of ‘digilantism’. These new pressures, it is suggested, help to facilitate a rhetoric of deservingness that goes against the rights-bearing defendant and raises the risk its role could once again be mutating

A Moment in Ecuador

2012 essay contest winner Rosa Gimson\u27s A Moment in Ecuado

A case study of boundary layer ventilation by convection and coastal processes

It is often assumed that ventilation of the atmospheric boundary layer is weak in the absence of fronts, but is this always true? In this paper we investigate the processes responsible for ventilation of the atmospheric boundary layer during a nonfrontal day that occurred on 9 May 2005 using the UK Met Office Unified Model. Pollution sources are represented by the constant emission of a passive tracer everywhere over land. The ventilation processes observed include shallow convection, turbulent mixing followed by large-scale ascent, a sea breeze circulation and coastal outflow. Vertical distributions of tracer are validated qualitatively with AMPEP (Aircraft Measurement of chemical Processing Export fluxes of Pollutants over the UK) CO aircraft measurements and are shown to agree impressively well. Budget calculations of tracers are performed in order to determine the relative importance of these ventilation processes. Coastal outflow and the sea breeze circulation were found to ventilate 26% of the boundary layer tracer by sunset of which 2% was above 2 km. A combination of coastal outflow, the sea breeze circulation, turbulent mixing and large-scale ascent ventilated 46% of the boundary layer tracer, of which 10% was above 2 km. Finally, coastal outflow, the sea breeze circulation, turbulent mixing, large-scale ascent and shallow convection together ventilated 52% of the tracer into the free troposphere, of which 26% was above 2 km. Hence this study shows that significant ventilation of the boundary layer can occur in the absence of fronts (and thus during high-pressure events). Turbulent mixing and convection processes can double the amount of pollution ventilated from the boundary layer

Time spent in hospital after liver transplantation: Effects of primary liver disease and comorbidity.

AIM: To explore the effect of primary liver disease and comorbidities on transplant length of stay (TLOS) and LOS in later admissions in the first two years after liver transplantation (LLOS). METHODS: A linked United Kingdom Liver Transplant Audit - Hospital Episode Statistics database of patients who received a first adult liver transplant between 1997 and 2010 in England was analysed. Patients who died within the first two years were excluded from the primary analysis, but a sensitivity analysis was also performed including all patients. Multivariable linear regression was used to evaluate the impact of primary liver disease and comorbidities on TLOS and LLOS. RESULTS: In 3772 patients, the mean (95%CI) TLOS was 24.8 (24.2 to 25.5) d, and the mean LLOS was 24.2 (22.9 to 25.5) d. Compared to patients with cancer, we found that the largest difference in TLOS was seen for acute hepatic failure group (6.1 d; 2.8 to 9.4) and the largest increase in LLOS was seen for other liver disease group (14.8 d; 8.1 to 21.5). Patients with cardiovascular disease had 8.5 d (5.7 to 11.3) longer TLOS and 6.0 d (0.2 to 11.9) longer LLOS, compare to those without. Patients with congestive cardiac failure had 7.6 d longer TLOS than those without. Other comorbidities did not significantly increase TLOS nor LLOS. CONCLUSION: The time patients spent in hospital varied according to their primary liver disease and some comorbidities. Time spent in hospital of patients with cancer was relatively short compared to most other indications. Cardiovascular disease and congestive cardiac failure were the comorbidities with a strong impact on increased LOS

Immediate and Distracted Imitation in Second-Language Speech: Unreleased Plosives in English

The paper investigates immediate and distracted imitation in second-language speech using unreleased plosives. Unreleased plosives are fairly frequently found in English sequences of two stops. Polish, on the other hand, is characterised by a significant rate of releases in such sequences. This cross-linguistic difference served as material to look into how and to what extent non-native properties of sounds can be produced in immediate and distracted imitation. Thirteen native speakers of Polish first read and then imitated sequences of words with two stops straddling the word boundary. Stimuli for imitation had no release of the first stop. The results revealed that (1) a non-native feature such as the lack of the release burst can be imitated; (2) distracting imitation impedes imitative performance; (3) the type of a sequence interacts with the magnitude of an imitative effec