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

Destilador solar multietapa subatmosférico

Se presenta el diseño y los primeros resultados experimentales de un destilador multietapa operado a baja presión. El destilador está formado por varias etapas que se superponen verticalmente. El agua salada se entrega en la etapa superior y va pasando sucesivamente de etapa en etapa. La fuente térmica calienta la etapa inferior y por evaporaciones sucesivas calienta las superiores. El área de base es de 0.5 x 0.8 m2. El perímetro de cada etapa se construyó con caños cuadrados reforzados para poder bajar la presión intema evaluando un posible aumento de la producción. Se muestran detalles constructivos del equipo y resultados experimentales preliminares.This paper presents the design and first experimental results of a multistage distiller to be operated at low pressure. The distiller consists of several stages which overlap vertically. The salt water is delivered at the upper stage and passes successively from stage to stage. The thermal source heats the lower stage, and the others are heated by successive evaporations-condensation. Base area is 0.5 x 0.8 m2. The perimeter of each stage was constructed with reinforced square pipes to allow internal pressure lowering so the production can increase. It is shown the constructive details and preliminary experimental results.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Evaluación cuantitativa de F/OSS para la reutilización

El software Libre o de Código Abierto (F/OSS, por sus siglas en inglés) ha alcanzado amplia difusión, a partir de la calidad de algunos de sus productos. Este constituye una fuente abundante y accesible de software a bajo costo, no obstante, potencialmente podrían servir de base para nuevos desarrollos. A través de este proyecto proponemos fundamentalmente recopilar y desarrollar métricas que ayuden a evaluar proyectos F/OSS con miras a la reutilización, integrándolos en un marco de evaluación. El marco a desarrollar estará orientado principalmente a la información que puede extraerse del código fuente y de la evolución de los proyectos de software en cuestión.Eje: Ingeniería de SoftwareRed de Universidades con Carreras en Informática (RedUNCI

Native Speaker Perceptions of Accented Speech: The English Pronunciation of Macedonian EFL Learners

The paper reports on the results of a study that aimed to describe the vocalic and consonantal features of the English pronunciation of Macedonian EFL learners as perceived by native speakers of English and to find out whether native speakers who speak different standard variants of English perceive the same segments as non-native. A specially designed computer web application was employed to gather two types of data: a) quantitative (frequency of segment variables and global foreign accent ratings on a 5-point scale), and b) qualitative (open-ended questions). The result analysis points out to three most frequent markers of foreign accent in the English speech of Macedonian EFL learners: final obstruent devoicing, vowel shortening and substitution of English dental fricatives with Macedonian dental plosives. It also reflects additional phonetic aspects poorly explained in the available reference literature such as allophonic distributional differences between the two languages and intonational mismatch

F2 slope as a perceptual cue for the front-back contrast in Standard Southern British English

Acoustic studies of several languages indicate that second-formant (F2) slopes in high vowels have opposing directions (independent of consonantal context): front [iː]-like vowels are produced with a rising F2 slope while back [uː]-like vowels are produced with a falling F2 slope. The present study first reports acoustic measurements that confirm this pattern for the English variety of Standard Southern British English (SSBE), where /uː/ has shifted from the back to the front area of the vowel space and is now realized with higher midpoint F2 values than several decades ago. Subsequently, we test whether the direction of F2 slope also serves as a reliable cue to the /iː/-/uː/ contrast in perception. The findings show that F2 slope direction is used as a cue (additional to midpoint formant values) to distinguish /iː/ from /uː/ by both young and older SSBE listeners: an otherwise ambiguous token is identified as /iː/ if it has a rising F2 slope and as /uː/ if it has a falling F2 slope. Furthermore, our results indicate that listeners generalize their reliance on F2 slope to other contrasts, namely /ɛ/-/ɒ/ and /æ/-/ɒ/, even though F2 slope is not employed to differentiate these vowels in production. This suggests that in SSBE, a rising F2 seems to be perceptually associated with an abstract feature such as [+front] while a falling F2 with an abstract feature such as [-front]

Short- and long-term mortality after liver transplantation in patients with and without hepatocellular carcinoma in the UK.

BACKGROUND: The increasing demand for liver transplantation has led to considerable changes in characteristics of donors and recipients. This study evaluated the short- and long-term mortality of recipients with and without hepatocellular carcinoma (HCC) in the UK between 1997 and 2016. METHODS: First-time elective adult liver transplant recipients in the UK were identified and four successive eras of transplantation were compared. Hazard ratios (HRs) comparing the impact of era on short-term (first 90 days) and longer-term (from 90 days to 5 years) mortality were estimated, with adjustment for recipient and donor characteristics. RESULTS: Some 1879 recipients with and 7661 without HCC were included. There was an increase in use of organs donated after circulatory death (DCD), from 0 per cent in era 1 to 35·2 per cent in era 4 for recipients with HCC, and from 0·2 to 24·1 per cent for non-HCC recipients. The 3-year mortality rate decreased from 28·3 per cent in era 1 to 16·9 per cent in era 4 (adjusted HR 0·47, 95 per cent c.i. 0·35 to 0·63) for recipients with HCC, and from 20·4 to 9·3 per cent (adjusted HR 0·44, 0·36 to 0·53) for those without HCC. Comparing era 4 with era 1, improvements were more marked in short-term than in long-term mortality, both for recipients with HCC (0-90 days: adjusted HR 0·20, 0·10 to 0·39; 90 days to 5 years: adjusted HR 0·52, 0·35 to 0·75; P = 0·043) and for non-HCC recipients (0-90 days: adjusted HR 0·32, 0·24 to 0·42; 90 days to 5 years: adjusted HR 0·52, 0·40 to 0·67; P = 0·024). CONCLUSION: In the past 20 years, the mortality rate after liver transplantation has more than halved, despite increasing use of DCD donors. Improvements in overall survival can be explained by decreases in short-term and longer-term mortality

Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma.

BACKGROUND: Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study. METHODS: Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics. RESULTS: In total, 385 of 968 patients (39·8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235). CONCLUSION: TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation

Aplastic Anemia Complicating Orthotopic Liver Transplantation for Non-A, Non-B Hepatitis

Aplastic anemia developed in 9 of 32 patients (28 percent) undergoing orthotopic liver transplantation for acute non-A, non-B hepatitis, at one to seven weeks after the procedure. No patient previously had evidence of hematologic dysfunction or conditions known to be associated with aplastic anemia. No other cases of aplastic anemia were identified among 1463 patients undergoing liver transplantation for all other indications at the four centers participating in the study (chi-square = 415, P<0.001; 95 percent confidence interval for the incidence of aplastic anemia after transplantation for non-A, non-B hepatitis, 13 to 44 percent, vs. 0.00 to 0.13 percent for all other indications). The operative and postoperative treatment of these patients was not otherwise different, indicating that the aplastic anemia was a complication of the hepatitis, not of the transplantation procedure. Four of the nine patients died of complications due to infections. Three of the surviving patients have been followed for less than six months, one for one year, and one for two years. The two patients followed the longest have recovered marrow function to an appreciable degree, and two of the others have evidence of early recovery. We conclude that patients undergoing orthotopic liver transplantation for non-A, non-B hepatitis are at a high risk for the development of aplastic anemia. (N Engl J Med 1988; 319:393–6.) © 1988, Massachusetts Medical Society. All rights reserved