Effect of the clinical course of acute-on-chronic liver failure prior to liver transplantation on post-transplant survival

BACKGROUND & AIMS: Patients with acute-on-chronic liver failure (ACLF) can be listed for liver transplantation (LT) because LT is the only curative treatment option. We evaluated whether the clinical course of ACLF, particularly ACLF-3, between the time of listing and LT affects 1-year post-transplant survival. METHODS: We identified patients from the United Network for Organ Sharing database who were transplanted within 28 days of listing and categorized them by ACLF grade at waitlist registration and LT, according to the EASL-CLIF definition. RESULTS: A total of 3,636 patients listed with ACLF-3 underwent LT within 28 days. Among those transplanted, 892 (24.5%) recovered to no ACLF or ACLF grade 1 or 2 (ACLF 0–2) and 2,744 (75.5%) had ACLF-3 at transplantation. One-year survival was 82.0% among those transplanted with ACLF-3 vs. 88.2% among those improving to ACLF 0–2 (p 60 years of age, 1-year survival was significantly higher among those who improved from ACLF-3 to ACLF 0–2 than among those who did not. CONCLUSIONS: Improvement from ACLF-3 at listing to ACLF 0–2 at transplantation enhances post-LT survival, particularly in those who recovered from circulatory or brain failure, or were removed from the mechanical ventilator. The beneficial effect of improved ACLF on post-LT survival was also observed among patients >60 years of age. LAY SUMMARY: Liver transplantation (LT) for patients with acute-on-chronic liver failure grade 3 (ACLF-3) significantly improves survival, but 1-year survival probability after LT remains lower than the expected outcomes for transplant centers. Our study reveals that among patients transplanted within 28 days of waitlist registration, improvement of ACLF-3 at listing to a lower grade of ACLF at transplantation significantly enhances post-transplant survival, even among patients aged 60 years or older. Subgroup analysis further demonstrates that improvement in circulatory failure, brain failure, or removal from mechanical ventilation have the strongest impact on post-transplant survival

Information Policy Country Report: Singapore

http://deepblue.lib.umich.edu/bitstream/2027.42/64846/1/IPOL country report - Singapore (2009).pd

Assessment of the Al–Fe–Ti system

The Al–Fe–Ti system has been assessed and the limiting binary systems are shortly reviewed. Based on a thorough review of the literature, isotherms at 800, 900, and 1000 °C have been re-evaluated and a provisional isotherm at 1200 °C is presented for the first time. The effect of alloying the binary phases with the third component is reviewed with regard to the ternary homogeneity ranges, crystallography, order/disorder transformations, and site occupancies. Of the variously reported ternary compounds only the existence of “Al2FeTi” (τ2) and “Al8FeTi3” (τ3) is confirmed. The occurrence of the phases τ2*, τ′2, and of a new stacking variant of TiAl is still under discussion, while the existence of the phases Fe2AlTi (τ1) and Fe25Al69Ti6 (X) is ruled out. The presented reaction scheme corroborates the isothermal sections and also a representation of the liquidus surface is given. Magnetic, electrical, thermochemical, atomistic and diffusion data for Al–Fe–Ti alloys are summarised and an overview about studies on modelling of phase equilibria and phase transformations is given

Development of Performance Evaluation Indicators for Table Grape Packaging Units. 2. Global Indexes

The adoption of a global index (GI) for performance evaluation has been increasingly recognized as a useful strategy for decision-making as it simplifies the interpretation and monitoring of the results. Because the GI is often built by adopting a combination of different procedures for normalization, weighting, and aggregation of indicators, it is challenging to select the optimal combination of procedures, since the countless combinations lead to different results. This paper proposes a method for the development of a robust and original GI for the evaluation of table grape production units (TGPUs). Various combinations of procedures were used to develop eighteen GIs for each TGPU. These are located in the lower-middle San Francisco valley in the northeast of Brazil, where their robustness was assessed by identifying outlier GIs and via a graphical analysis. Plausible GIs were reliably identified and a cluster analysis was conducted to categorize the TGPUs into groups considering each performance objective. The identification of the outlier GIs and the use of the plausible GIs in cluster formation constitute a new scientific approach to the topic, which can be extended to other applications and contribute to the sustainable development of several industries

Development of Performance Evaluation Indicators for Table Grape Packaging Units

In order to improve the process management of table grape packaging, its performance should be evaluated. However, the literature on performance evaluation indicators is scarce. To address this research gap, we propose a method for the development of performance evaluation indicators for table grape packaging units, which are characterized by labor-intensive and highly seasonal production processes in the agro-economic sector. The stages include the following: contextualizing table grape packaging units, selecting the performance objectives, selecting techniques to be used in the development of the indicators, and applying the method to the packaging units of table grapes. The techniques adopted in the development of the indicators aimed at the cost, quality, flexibility, reliability, and speed performance objectives were data envelopment analysis, principal component analysis, quantification of the batch, compliance with the program within the established deadline, and measurement of the execution time of the batch, respectively. The results obtained in the case study demonstrate that the correlations between the performance indicators do not indicate the need to disregard any of them. Furthermore, the standard deviation values for each indicator are similar. Thus, both results of correlations and standard deviation confirm the importance of the indicators chosen for the performance evaluation of table grape packaging