Early transplantation maximizes survival in severe acute-on-chronic liver failure: results of a Markov decision process model

BACKGROUND: Uncertainties exist surrounding the timing of liver transplantation (LT) among patients with acute-on-chronic liver failure grade 3 (ACLF-3), regarding whether to accept a marginal quality donor organ to allow for earlier LT or wait for either an optimal organ offer or improvement in the number of organ failures, in order to increase post-LT survival. METHODS: We created a Markov decision process model to determine the timing of LT among patients with ACLF-3 within 7 days of listing, to maximize overall one-year survival probability. RESULTS: We analyzed six groups of candidates with ACLF-3: patients age ≤60 or >60 years, patients with 3 organ failures alone or 4-6 organ failures, and hepatic or extrahepatic ACLF-3. Among all groups, LT yielded significantly greater overall survival probability versus remaining on the waiting list for even 1 additional day (p 60 years or with 4-6 organ failures. Probability of improvement from ACLF-3 to ACLF-2 does not influence these recommendations, as the likelihood of organ recovery was less than 10%. CONCLUSION: During the first week after listing for patients with ACLF-3, earlier LT in general is favored over waiting for an optimal quality donor organ or for recovery of organ failures, with the understanding that the analysis is limited to consideration of only these three variables. LAY SUMMARY: In the setting of grade three acute-on-chronic liver failure (ACLF-3), questions remain regarding the timing of transplantation in terms of whether to proceed with liver transplantation with a marginal donor organ versus waiting for an optimal liver, and whether to transplant a patient with ACLF-3 or wait until improvement to ACLF-2. In this study, we used a Markov decision process model to demonstrate that earlier transplantation of patients listed with ACLF-3 maximizes overall survival, as opposed to waiting for an optimal donor organ or for improvement in the number of organ failures

Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA

Spatially valid proprioceptive cues improve the detection of a visual stimulus

Vision and proprioception are the main sensory modalities that convey hand location and direction of movement. Fusion of these sensory signals into a single robust percept is now well documented. However, it is not known whether these modalities also interact in the spatial allocation of attention, which has been demonstrated for other modality pairings. The aim of this study was to test whether proprioceptive signals can spatially cue a visual target to improve its detection. Participants were instructed to use a planar manipulandum in a forward reaching action and determine during this movement whether a near-threshold visual target appeared at either of two lateral positions. The target presentation was followed by a masking stimulus, which made its possible location unambiguous, but not its presence. Proprioceptive cues were given by applying a brief lateral force to the participant’s arm, either in the same direction (validly cued) or in the opposite direction (invalidly cued) to the on-screen location of the mask. The d′ detection rate of the target increased when the direction of proprioceptive stimulus was compatible with the location of the visual target compared to when it was incompatible. These results suggest that proprioception influences the allocation of attention in visual spac

Expression stability of putative reference genes in equine endometrial, testicular, and conceptus tissues

<p>Abstract</p> <p>Background</p> <p>Quantitative RT-PCR data are commonly normalized using a reference gene. A reference gene is a transcript which expression does not differ in the tissue of interest independent of the experimental condition. The objective of this study was to evaluate the stability of mRNA expression levels of putative reference genes in three different types of equine tissue, endometrial, testicular, and conceptus tissue.</p> <p>Findings</p> <p>The expression stability of four (uterine tissue) and six (testicular and conceptus tissue) was assessed using descriptive data analysis and the software programs Normfinder and geNorm. In uterine samples, <it>18S </it>showed the largest degree of variation in expression while <it>GAPDH</it>, <it>B2M</it>, and <it>ACTB </it>were stably expressed. <it>B2M </it>and <it>GAPDH </it>were identified as the most stably expressed genes in testicular samples, while <it>18S </it>showed some extent of regulation between samples. Conceptus tissue overall was characterized by very low variability of the transcripts analyzed with <it>GAPDH</it>, <it>YWHZ</it>, and 18S being the most stably expressed genes.</p> <p>Conclusions</p> <p>In equine endometrium, <it>GAPDH</it>, <it>B2M</it>, and <it>ACTB </it>transcript levels are equally stable, while <it>18S </it>is less stably expressed. In testes and associated structures, <it>B2M </it>and <it>GAPDH </it>are the transcripts showing the least amount of variation, while in conceptus tissue <it>GAPDH</it>, <it>YWHZ</it>, and <it>18S </it>were identified as the most suitable reference genes. Overall, transcripts analyzed in conceptus tissue were characterized by less variation than transcripts analyzed in uterine and testicular tissue.</p

Star Formation in Galaxies Along the Hubble Sequence

Observations of star formation rates (SFRs) in galaxies provide vital clues to the physical nature of the Hubble sequence, and are key probes of the evolutionary properties of galaxies. The focus of this review is on the broad patterns in the star formation properties of galaxies along the Hubble sequence, and their implications for understanding galaxy evolution and the physical processes that drive the evolution. Star formation in the disks and nuclear regions of galaxies are reviewed separately, then discussed within a common interpretive framework. The diagnostic methods used to measure SFRs are also reviewed, and a self-consistent set of SFR calibrations is presented as an aid to workers in the field.Comment: 41 pages, with 9 figures. To appear in Volume 36 of the Annual Review of Astronomy and Astrophysic

Evo-devo of human adolescence: beyond disease models of early puberty

Despite substantial heritability in pubertal development, much variation remains to be explained, leaving room for the influence of environmental factors to adjust its phenotypic trajectory in the service of fitness goals. Utilizing evolutionary development biology (evo-devo), we examine adolescence as an evolutionary life-history stage in its developmental context. We show that the transition from the preceding stage of juvenility entails adaptive plasticity in response to energy resources, other environmental cues, social needs of adolescence and maturation toward youth and adulthood. Using the evolutionary theory of socialization, we show that familial psychosocial stress fosters a fast life history and reproductive strategy rather than early maturation being just a risk factor for aggression and delinquency. Here we explore implications of an evolutionary-developmental-endocrinological-anthropological framework for theory building, while illuminating new directions for research

Evolving the theory and praxis of knowledge translation through social interaction: a social phenomenological study

Background: As an inherently human process fraught with subjectivity, dynamic interaction, and change, social interaction knowledge translation (KT) invites implementation scientists to explore what might be learned from adopting the academic tradition of social constructivism and an interpretive research approach. This paper presents phenomenological investigation of the second cycle of a participatory action KT intervention in the home care sector to answer the question: What is the nature of the process of implementing KT through social interaction? Methods: Social phenomenology was selected to capture how the social processes of the KT intervention were experienced, with the aim of representing these as typical socially-constituted patterns. Participants (n = 203), including service providers, case managers, administrators, and researchers organized into nine geographically-determined multi-disciplinary action groups, purposefully selected and audiotaped three meetings per group to capture their enactment of the KT process at early, middle, and end-of-cycle timeframes. Data, comprised of 36 hours of transcribed audiotapes augmented by researchers\u27 field notes, were analyzed using social phenomenology strategies and authenticated through member checking and peer review. Results: Four patterns of social interaction representing organization, team, and individual interests were identified: overcoming barriers and optimizing facilitators; integrating \u27science push\u27 and \u27demand pull\u27 approaches within the social interaction process; synthesizing the research evidence with tacit professional craft and experiential knowledge; and integrating knowledge creation, transfer, and uptake throughout everyday work. Achieved through relational transformative leadership constituted simultaneously by both structure and agency, in keeping with social phenomenology analysis approaches, these four patterns are represented holistically in a typical construction, specifically, a participatory action KT (PAKT) model. Conclusion: Study findings suggest the relevance of principles and foci from the field of process evaluation related to intervention implementation, further illuminating KT as a structuration process facilitated by evolving transformative leadership in an active and integrated context. The model provides guidance for proactively constructing a \u27fit\u27 between content, context, and facilitation in the translation of evidence informing professional craft knowledge

Exploring the (missed) connections between digital scholarship and faculty development: a conceptual analysis

Abstract The aim of this paper is to explore the relationship between two research topics: digital scholarship and faculty development. The former topic drives attention on academics' new practices in digital, open and networked contexts; the second is focused on the requirements and strategies to promote academics' professional learning and career advancement. The research question addressing this study is: are faculty development strategies hindered by the lack of a cohesive view in the research on digital scholarship? The main assumption guiding this research question is that clear conceptual frameworks and models of professional practice lead to effective faculty development strategies. Through a wide overview of the evolution of both digital scholarship and faculty development, followed by a conceptual analysis of the intersections between fields, the paper attempts to show the extent on which the situation in one area (digital scholarship) might encompass criticalities for the other (faculty development) in terms of research and practices. Furthermore, three scenarios based on the several perspectives of digital scholarship are built in order to explore the research question in depth. We conclude that at the current state of art the relationship between these two topics is weak. Moreover, the dialogue between digital scholarship and faculty development could put the basis to forge effective professional learning contexts and instruments, with the ultimate goal of supporting academics to become digital scholars towards a more open and democratic vision of scholarship