Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation

The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. Recovery of blood coagulability began 30-60 min after reperfusion of the graft liver, and coagulability had returned toward baseline values 2 hr after reperfusion. A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors

Ambient Air Pollution and Pregnancy Outcomes: A Review of the Literature

Over the last decade or so, a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. We reviewed these studies, which were identified by a systematic search of the main scientific databases. Virtually all reviewed studies were population based, with information on exposure to air pollution derived from routine monitoring sources. Overall, there is evidence implicating air pollution in adverse effects on different birth outcomes, but the strength of the evidence differs between outcomes. The evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the postneonatal period. For air pollution and birth weight the evidence suggests causality, but further studies are needed to confirm an effect and its size and to clarify the most vulnerable period of pregnancy and the role of different pollutants. For preterm births and intrauterine growth retardation (IUGR) the evidence as yet is insufficient to infer causality, but the available evidence justifies further studies. Molecular epidemiologic studies suggest possible biologic mechanisms for the effect on birth weight, premature birth, and IUGR and support the view that the relation between pollution and these birth outcomes is genuine. For birth defects, the evidence base so far is insufficient to draw conclusions. In terms of exposure to specific pollutants, particulates seem the most important for infant deaths, and the effect on IUGR seems linked to polycyclic aromatic hydrocarbons, but the existing evidence does not allow precise identification of the different pollutants or the timing of exposure that can result in adverse pregnancy outcomes

Benchmarking of hospital information systems: Monitoring of discharge letters and scheduling can reveal heterogeneities and time trends

<p>Abstract</p> <p>Background</p> <p>Monitoring of hospital information system (HIS) usage can provide insights into best practices within a hospital and help to assess time trends. In terms of effort and cost of benchmarking, figures derived automatically from the routine HIS system are preferable to manual methods like surveys, in particular for repeated analysis.</p> <p>Methods</p> <p>Due to relevance for quality management and efficient resource utilization we focused on time-to-completion of discharge letters (assessed by CT-plots) and usage of patient scheduling. We analyzed these parameters monthly during one year at a major university hospital in Germany.</p> <p>Results</p> <p>We found several distinct patterns of discharge letter documentation indicating a large heterogeneity of HIS usage between different specialties (completeness 51 – 99%, delays 0 – 90 days). Overall usage of scheduling increased during the observation period by 62%, but again showed a considerable variation between departments.</p> <p>Conclusion</p> <p>Regular monitoring of HIS key figures can contribute to a continuous HIS improvement process.</p

Advantages of venous bypass during orthotopic transplantation of the liver.

Venous bypass restores normal hemodynamic physiology during the critical anhepatic phase of orthotopic transplantation of the liver. Its routine use in adults undergoing transplantation in Pittsburgh has resulted in lower operative blood losses, a lower frequency of postoperative renal failure, and a greater probability of survival for all but the highest risk patients. Because it allows for a longer anhepatic phase, the surgeon has the option of tailoring the native hepatectomy to the needs of the individual case, even to the point, in difficult cases, of obtaining most of the hemostasis after removal of the native liver, but before sewing in the donor organ. Selective use of bypass in children may offer similar advantages

Metric characterization of cluster dynamics on the Sierpinski gasket

We develop and implement an algorithm for the quantitative characterization of cluster dynamics occurring on cellular automata defined on an arbitrary structure. As a prototype for such systems we focus on the Ising model on a finite Sierpsinski Gasket, which is known to possess a complex thermodynamic behavior. Our algorithm requires the projection of evolving configurations into an appropriate partition space, where an information-based metrics (Rohlin distance) can be naturally defined and worked out in order to detect the changing and the stable components of clusters. The analysis highlights the existence of different temperature regimes according to the size and the rate of change of clusters. Such regimes are, in turn, related to the correlation length and the emerging "critical" fluctuations, in agreement with previous thermodynamic analysis, hence providing a non-trivial geometric description of the peculiar critical-like behavior exhibited by the system. Moreover, at high temperatures, we highlight the existence of different time scales controlling the evolution towards chaos.Comment: 20 pages, 8 figure

Mangarara Formation: exhumed remnants of a middle Miocene, temperate carbonate, submarine channel-fan system on the eastern margin of Taranaki Basin, New Zealand

The middle Miocene Mangarara Formation is a thin (1–60 m), laterally discontinuous unit of moderately to highly calcareous (40–90%) facies of sandy to pure limestone, bioclastic sandstone, and conglomerate that crops out in a few valleys in North Taranaki across the transition from King Country Basin into offshore Taranaki Basin. The unit occurs within hemipelagic (slope) mudstone of Manganui Formation, is stratigraphically associated with redeposited sandstone of Moki Formation, and is overlain by redeposited volcaniclastic sandstone of Mohakatino Formation. The calcareous facies of the Mangarara Formation are interpreted to be mainly mass-emplaced deposits having channelised and sheet-like geometries, sedimentary structures supportive of redeposition, mixed environment fossil associations, and stratigraphic enclosure within bathyal mudrocks and flysch. The carbonate component of the deposits consists mainly of bivalves, larger benthic foraminifers (especially Amphistegina), coralline red algae including rhodoliths (Lithothamnion and Mesophyllum), and bryozoans, a warm-temperate, shallow marine skeletal association. While sediment derivation was partly from an eastern contemporary shelf, the bulk of the skeletal carbonate is inferred to have been sourced from shoal carbonate factories around and upon isolated basement highs (Patea-Tongaporutu High) to the south. The Mangarara sediments were redeposited within slope gullies and broad open submarine channels and lobes in the vicinity of the channel-lobe transition zone of a submarine fan system. Different phases of sediment transport and deposition (lateral-accretion and aggradation stages) are identified in the channel infilling. Dual fan systems likely co-existed, one dominating and predominantly siliciclastic in nature (Moki Formation), and the other infrequent and involving the temperate calcareous deposits of Mangarara Formation. The Mangarara Formation is an outcrop analogue for middle Miocene-age carbonate slope-fan deposits elsewhere in subsurface Taranaki Basin, New Zealand

Application of the PISA design model to monopiles embedded in layered soils

The PISA design model is a procedure for the analysis of monopile foundations for offshore wind turbine applications. This design model has been previously calibrated for homogeneous soils; this paper extends the modelling approach to the analysis of monopiles installed at sites where the soil profile is layered. The paper describes a computational study on monopiles embedded in layered soil configurations comprising selected combinations of soft and stiff clay and sand at a range of relative densities. The study comprises (a) analyses of monopile behaviour using detailed three-dimensional (3D) finite-element analysis, and (b) calculations employing the PISA design model. Results from the 3D analyses are used to explore the various influences that soil layering has on the performance of the monopile. The fidelity of the PISA design model is assessed by comparisons with data obtained from equivalent 3D finite-element analyses, demonstrating a good agreement in most cases. This comparative study demonstrates that the PISA design model can be applied successfully to layered soil configurations, except in certain cases involving combinations of very soft clay and very dense sand. </jats:p

PISA design methods for offshore wind turbine monopiles

Abstract This paper provides an overview of the PISA design model recently developed for laterally loaded offshore wind turbine monopiles through a major European joint-industry academic research project, the PISA Project. The focus was on large diameter, relatively rigid piles, with low length to diameter (L/D) ratios, embedded in clay soils of different strength characteristics, sand soils of different densities and in layered soils combining clays and sands. The resulting design model introduces new procedures for site specific calibration of soil reaction curves that can be applied within a one-dimensional (1D), Winkler-type, computational model. This paper summarises the results and key conclusions from PISA, including design methods for (a) stiff glacial clay till (Cowden till), (b) brittle stiff plastic clay (London clay), (c) soft clay (Bothkennar clay), (d) sand of varying densities (Dunkirk), and, (e) layered profiles (combining soils from (a) to (d)). The results indicate that the homogeneous soil reaction curves applied appropriately for layered profiles in the 1D PISA design model provide a very good fit to the three-dimensional finite element (3D FE) calculations, particularly for profiles relevant to current European offshore wind farm sites. Only a small number of cases, involving soft clay, very dense sand and L/D = 2 monopiles, would appear to require more detailed and bespoke analysis.</jats:p

PISA design model for monopiles for offshore wind turbines: Application to a marine sand

This paper describes a one-dimensional (1D) computational model for the analysis and design of laterally loaded monopile foundations for offshore wind turbine applications. The model represents the monopile as an embedded beam and specially formulated functions, referred to as soil reaction curves, are employed to represent the various components of soil reaction that are assumed to act on the pile. This design model was an outcome of a recently completed joint industry research project – known as PISA – on the development of new procedures for the design of monopile foundations for offshore wind applications. The overall framework of the model, and an application to a stiff glacial clay till soil, is described in a companion paper by Byrne and co-workers; the current paper describes an alternative formulation that has been developed for soil reaction curves that are applicable to monopiles installed at offshore homogeneous sand sites, for drained loading. The 1D model is calibrated using data from a set of three-dimensional finite-element analyses, conducted over a calibration space comprising pile geometries, loading configurations and soil relative densities that span typical design values. The performance of the model is demonstrated by the analysis of example design cases. The current form of the model is applicable to homogeneous soil and monotonic loading, although extensions to soil layering and cyclic loading are possible. </jats:p

Retrospective model-based inference guides model-free credit assignment

An extensive reinforcement learning literature shows that organisms assign credit efficiently, even under conditions of state uncertainty. However, little is known about credit-assignment when state uncertainty is subsequently resolved. Here, we address this problem within the framework of an interaction between model-free (MF) and model-based (MB) control systems. We present and support experimentally a theory of MB retrospective-inference. Within this framework, a MB system resolves uncertainty that prevailed when actions were taken thus guiding an MF credit-assignment. Using a task in which there was initial uncertainty about the lotteries that were chosen, we found that when participants’ momentary uncertainty about which lottery had generated an outcome was resolved by provision of subsequent information, participants preferentially assigned credit within a MF system to the lottery they retrospectively inferred was responsible for this outcome. These findings extend our knowledge about the range of MB functions and the scope of system interactions