Vascular Complications of Allograft Nephrectomy

AbstractObjectivesTo identify risk factors that predisposes patients to vascular complications from allograft nephrectomy and to determine the safe management of this group of patients.DesignThis is a retrospective review of 1543 renal transplants performed in our institution between January 1990 and January 2002.Patients and methodsDuring this period, 161 (10.4%) transplant nephrectomies were performed, of which we identified nine patients (5.6%) who sustained significant vascular complications.ResultsSeven patients required ligation of external iliac artery for control of haemorrhage. Immediate vascular reconstructions (femoral–femoral cross-over bypass in two cases and one vein patch to an external iliac artery defect) were performed in three patients. Two patients had endovascular stenting of their external iliac artery pseudoaneurysm. No patient suffered limb loss. However, three patients died—two died from overwhelming sepsis and one patient died of an intra-cerebral haemorrhage.ConclusionsWhile vascular complications associated with transplant nephrectomy are relatively rare, they are associated with a significantly poor outcome. Immediate attempts to reconstruct the vascular supply to the lower limb are associated with a high complication rate. We advocate that where possible, vascular reconstruction should be deferred and that external iliac artery ligation can be performed safely with surprisingly low limb ischaemia rate

Toward an integrated approach to perception and action: conference report and future directions

This article was motivated by the conference entitled “Perception & Action – An Interdisciplinary Approach to Cognitive Systems Theory,” which took place September 14–16, 2010 at the Santa Fe Institute, NM, USA. The goal of the conference was to bring together an interdisciplinary group of neuroscientists, roboticists, and theorists to discuss the extent and implications of action–perception integration in the brain. The motivation for the conference was the realization that it is a widespread approach in biological, theoretical, and computational neuroscience to investigate sensory and motor function of the brain in isolation from one another, while at the same time, it is generally appreciated that sensory and motor processing cannot be fully separated. Our article summarizes the key findings of the conference, provides a hypothetical model that integrates the major themes and concepts presented at the conference, and concludes with a perspective on future challenges in the field

Facial masculinity is related to perceived age, but not perceived health

Variation in women's preferences for male facial masculinity may reflect variation in attraction to immunocompetence or to maturity. This paper reports two studies on (a) the interrelationships between women's preferences for masculinity, apparent health, and age in male faces and (b) the extent to which manipulating each of these characteristics affects women's attributions of the remaining characteristics. Both studies were carried out with a large sample of the general public (Studies 1a and 2a) and independently in a laboratory environment with smaller undergraduate samples (Studies 1b and 2b). In both samples, masculinity and age preferences were positively related, and masculinity preferences were not associated with preferences for apparent health. There was also a positive relationship between perceived age and perceived masculinity in both samples, but evidence for a link between perceptions of masculinity and health was equivocal. Collectively, these findings suggest that variation in women's preferences for masculine proportions in male faces reflect variation in attraction to male age and do not support a strict immunocompetence explanation of preferences for facial masculinity

No ‘silver bullet’:Multiple factors control population dynamics of european purple sea urchins in Lough Hyne marine reserve, Ireland

Two-decade-long monitoring studies at Europe\u27s first statutory marine reserve—Lough Hyne in SW Ireland—indicate that benthic communities are rapidly changing. Populations of the ecologically important purple urchin (Paracentrotus lividus) have fluctuated widely, most recently with a population boom in the late 1990s, followed by a mass mortality that persists to the present day. Eight general hypotheses have been proposed to account for the urchin decline including cold temperature limiting reproduction, ephemeral algal exudates disrupting urchin fertilization, low larval availability (due to over-harvesting and/or episodic recruitment), high mortality of settlers and juveniles due to hypoxia, hyperoxia, or predation (a trophic cascade hypothesis), and increased mortality due to pathogens (stress hypothesis). The cold-temperature and the trophic cascade hypotheses appear unlikely. The remaining hypotheses, however, all seem to play a role, to some degree, in driving the urchin decline. Ulvoid exudates, for example, significantly reduced urchin fertilization and few larvae were found in plankton tows (2012–2015), indicating low larval availability in summer. Whilst settling urchins regularly recruited under shallow-subtidal rocks until 2011, no settlers were found in these habitats from 2011 to 2014 or in field experiments (2012–2018) using various settlement substrata. Seawater quality was poor in shallow areas of the lough with extreme oxygen fluctuations (diel-cycling hypoxia), and 1-day experimental exposures to DO values < 1 mg L−1 were lethal to most juvenile urchins. Multiple increases of the predatory spiny starfish (Marthasterias glacialis) population in recent decades may also have contributed to the demise of the coexisting juvenile urchins. Finally, urchins of all sizes were seen suffering from dropped spines, tissue necrosis, or white-coloured infection, suggestive of stress-related pathogen mortality. There was a paucity of broken tests, indicating limited predation by large crustaceans; the large number of adult urchins ‘missing’ and few P. lividus tests on the north shore points to possible urchin removal by poachers and/or starfish predation. While these ecological, environmental, and anthropogenic processes occur on open coast rocky shores, many are exacerbated by the semi-enclosed nature of this fully marine sea lough due to its limited flushing. Multiple factors, including low larval availability and rapidly expanding starfish populations, coupled with degraded habitat quality (ephemeral algal mats and extreme oxygen fluctuations), indicate that the purple urchin populations will not recover without an improvement in the water quality of Lough Hyne Marine Reserve, the restocking of urchins, and protection from poaching

The Interplay Between Anxiety and Social Functioning in Williams Syndrome

The developmental disorder Williams syndrome (WS) has been associated with an atypical social profile of hyper-sociability and heightened social sensitivity across the developmental spectrum. In addition, previous research suggests that both children and adults with WS have a predisposition towards anxiety. The current research aimed to explore the profiles of social behaviour and anxiety across a broad age range of individuals with the disorder (n = 59, ages 6–36 years). We used insights from parental reports on two frequently used measures, the Spence Children’s Anxiety Scale (SCAS-P) and the Social Responsiveness Scale (SRS). Severity of anxiety was correlated with a greater degree of social dysfunction as measured by the SRS in this group. We split the group according to high or low anxiety as measured by the SCAS-P and explored the profile of social skills for the two groups. Individuals high and low in anxiety differed in their social abilities. The results emphasise the need to address anxiety issues in this disorder and to consider how components of anxiety might relate to other features of the disorder

Localization by disorder in the infrared conductivity of (Y,Pr)Ba2Cu3O7 films

The ab-plane reflectivity of (Y{1-x}Prx)Ba2Cu3O7 thin films was measured in the 30-30000 cm-1 range for samples with x = 0 (Tc = 90 K), x = 0.4 (Tc = 35 K) and x = 0.5 (Tc = 19 K) as a function of temperature in the normal state. The effective charge density obtained from the integrated spectral weight decreases with increasing x. The variation is consistent with the higher dc resistivity for x = 0.4, but is one order of magnitude smaller than what would be expected for x = 0.5. In the latter sample, the conductivity is dominated at all temperatures by a large localization peak. Its magnitude increases as the temperature decreases. We relate this peak to the dc resistivity enhancement. A simple localization-by-disorder model accounts for the optical conductivity of the x = 0.5 sample.Comment: 7 pages with (4) figures include

Missing values: sparse inverse covariance estimation and an extension to sparse regression

We propose an l1-regularized likelihood method for estimating the inverse covariance matrix in the high-dimensional multivariate normal model in presence of missing data. Our method is based on the assumption that the data are missing at random (MAR) which entails also the completely missing at random case. The implementation of the method is non-trivial as the observed negative log-likelihood generally is a complicated and non-convex function. We propose an efficient EM algorithm for optimization with provable numerical convergence properties. Furthermore, we extend the methodology to handle missing values in a sparse regression context. We demonstrate both methods on simulated and real data.Comment: The final publication is available at http://www.springerlink.co

Race-Specific Patterns of Treatment Intensification Among Hypertensive Patients Using Home Blood Pressure Monitoring: Analysis Using Defined Daily Doses in the Heart Healthy Lenoir Study

Background: Racial disparities in blood pressure (BP) control persist, but whether differences by race in antihypertensive medication intensification (AMI) contribute is unknown. Objective: To compare AMI by race for patients with elevated home BP readings. Methods: This prospective cohort study followed adult patients from 6 rural primary care practices who used home BP monitoring (HBPM) and recorded/reported values. For providers, AMI was encouraged when mean HBPM systolic blood pressure (SBP) values were ⩾135 mm Hg; patients received phone-based coaching on HBPM technique and sharing HBPM findings. AMI was assessed between baseline and 12 months using defined daily dose (DDD) and summed to create a total antihypertensive DDD value. Results: A total of 217 patients (mean age = 61.4 ± 10.2 years; 66% female; 57% black) provided usable HBPM data. Among 90 (41%) intensification-eligible hypertensive patients (ie, mean HBPM SBP values for 6-months ⩾135 mm Hg), mean total antihypertensive DDD was increased in 61% at 12 months. Blacks had significantly higher mean DDD at baseline and 12 months, but intensification (+0.72 vs +0.65; P = 0.83) was similar by race. However, intensification was greater in males than females (+1.1 vs +0.39; P = 0.031). Reduction in mean SBP following intensification was greater in white versus black patients (−8.2 vs −3.9 mm Hg; P = 0.14). Conclusion/Relevance: Treatment intensification in HBPM users was similar by race, differed significantly by gender, and may produce a greater response in white patients. Differential AMI in HBPM users does not appear to contribute to persistent racial disparities in BP control

Motivators of online vulnerability: the impact of social network site use and FOMO

Continued and frequent use of social network sites (SNS) has been linked to a fear of missing out (FOMO) and online self-promotion in the form of friending and information disclosure. The present paper reports findings from 506 UK based Facebook users (53% male) who responded to an extensive online survey about their SNS behaviours and online vulnerability. Structural equation modelling (SEM) suggests that FOMO mediates the relationship between increased SNS use and decreased self-esteem. Self-promoting SNS behaviours provide more complex mediated associations. Longitudinal support (N = 175) is provided for the notion that decreased self-esteem might motivate a potentially detrimental cycle of FOMO-inspired online SNS use. The research considers the implications of social networking on an individual’s online vulnerability