Early death or retransplantation in adults after orthotopic liver transplantation: Can outcome be predicted?

Early, reliable outcome prediction after a liver transplant would help improve organ use by minimizing unnecessary retransplantations. At the same time, early intervention in those cases destined to fail may ameliorate the high morbidity and mortality associated with retransplantation. The purpose of this study was to analyze several parameters that have been identified in the past as being associated with patient and graft outcome, and to try to develop a model that would allow us to make predictions based on data available in the early postoperative period. A total of 148 patients were followed in a prospective, observational study. Graft failure was defined as patient death or retransplantation within 3 months of surgery. Preoperative variables studied included patient demographics, need for life support, presence of ascites, serum bilirubin, serum albumin, prothrombin time, serum creatinine, and the results of the cytotoxic crossmatch. During the first 5 postoperative days, standard measurements included serum transaminases, serum bilirubin, ketone body ratio, prothrombin time, factor V, and serum lactate. Oxygen consumption was measured shortly after surgery, once the patients had rewarmed to 36°C. There were 131 successful transplants (88.5%) and 17 failures (11.5%). Most of the variables studied were found to be associated with outcome (by univariate analysis) at different points in the early postoperative period. However, receiver operating characteristic curve analysis showed that the predictive ability of even the best parameter was not adequate to make decisions on individual patients. Multivariate analysis, using stepwise logistic regression, yielded a model with an overall accuracy of 92.7%. Again, receiver operating characteristic curve analysis suggested that this model did not achieve the discriminating power needed for routine clinical use. We are still not able to accurately predict outcome in the early posttransplant period. We must be very careful when evaluating parameters, or scoring systems, that are said to accomplish this. It is especially important in this era of cost containment, with its renewed pressures to guide therapy based on our perceived understanding of a patient’s future clinical course. © 1994 by Williams & Wilkins

Clinical features of a novel TIMP-3 mutation causing Sorsby's fundus dystrophy: implications for disease mechanism

AIMS: To describe the phenotype in three family members affected by a novel mutation in the gene coding for the enzyme tissue inhibitor of metalloproteinase-3 (TIMP-3). METHODS: Three members of the same family were seen with a history of nyctalopia and visual loss due to maculopathy. Clinical features were consistent with Sorsby's fundus dystrophy. Exon 5 of the gene coding for TIMP-3 was amplified by the polymerase chain reaction, single strand conformation polymorphism analysis undertaken and exon 5 amplicons were directly sequenced. RESULTS: Onset of symptoms was in the third to fourth decade. Five of six eyes had geographic macular atrophy rather than neovascularisation as a cause for central visual loss. Peripheral retinal pigmentary disturbances were present. Scotopic ERGs were abnormal in all three. Mutation analysis showed a GT transversion in all three resulting in a premature termination codon, E139X, deleting most of the carboxy terminal domain of TIMP-3. CONCLUSIONS: The patients described had a form of Sorsby's fundus dystrophy which fell at the severe end of the spectrum of this disease. Postulated disease mechanisms include deposition of dimerised TIMP-3 protein

Winds and tides of the Extended Unified Model in the mesosphere and lower thermosphere validated with meteor radar observations

The mesosphere and lower thermosphere (MLT) is a critical region that must be accurately reproduced in general circulation models (GCMs) that aim to include the coupling between the lower and middle atmosphere and the thermosphere. An accurate representation of the MLT is thus important for improved climate modelling and the development of a whole atmosphere model. This is because the atmospheric waves at these heights are particularly large, and so the energy and momentum they carry is an important driver of climatological phenomena through the whole atmosphere, affecting terrestrial and space weather. The Extended Unified Model (ExUM) is the recently developed version of the Met Office's Unified Model which has been extended to model the MLT. The capability of the ExUM to model atmospheric winds and tides in the MLT is currently unknown. Here, we present the first study of winds and tides from the ExUM. We make a comparison against meteor radar observations of winds and tides from 2006 between 80 and 100 km over two radar stations – Rothera (68∘ S, 68∘ W) and Ascension Island (8∘ S, 14∘ W). These locations are chosen to study tides in two very different tidal regimes – the equatorial regime, where the diurnal (24 h) tide dominates, and the polar regime, where the semi-diurnal (12 h) tide dominates. The results of this study illustrate that the ExUM is capable of reproducing atmospheric winds and tides that capture many of the key characteristics seen in meteor radar observations, such as zonal and meridional wind maxima and minima, the increase in tidal amplitude with increasing height, and the decrease in tidal phase with increasing height. In particular, in the equatorial regime some essential characteristics of the background winds, tidal amplitudes and tidal phases are well captured but with significant differences in detail. In the polar regime, the difference is more pronounced. The ExUM zonal background winds in austral winter are primarily westward rather than eastward, and in austral summer they are larger than observed above 90 km. The ExUM tidal amplitudes here are in general consistent with observed values, but they are also larger than observed values above 90 km in austral summer. The tidal phases are generally well replicated in this regime. We propose that the bias in background winds in the polar regime is a consequence of the lack of in situ gravity wave generation to generate eastward fluxes in the MLT. The results of this study indicate that the ExUM has a good natural capability for modelling atmospheric winds and tides in the MLT but that there is room for improvement in the model physics in this region. This highlights the need for modifications to the physical parameterization schemes used in the model in this region – such as the non-orographic spectral gravity wave scheme – to improve aspects such as polar circulation. To this end, we make specific recommendations of changes that can be implemented to improve the accuracy of the ExUM in the MLT.</p

Regulating Highly Automated Robot Ecologies: Insights from Three User Studies

Highly automated robot ecologies (HARE), or societies of independent autonomous robots or agents, are rapidly becoming an important part of much of the world's critical infrastructure. As with human societies, regulation, wherein a governing body designs rules and processes for the society, plays an important role in ensuring that HARE meet societal objectives. However, to date, a careful study of interactions between a regulator and HARE is lacking. In this paper, we report on three user studies which give insights into how to design systems that allow people, acting as the regulatory authority, to effectively interact with HARE. As in the study of political systems in which governments regulate human societies, our studies analyze how interactions between HARE and regulators are impacted by regulatory power and individual (robot or agent) autonomy. Our results show that regulator power, decision support, and adaptive autonomy can each diminish the social welfare of HARE, and hint at how these seemingly desirable mechanisms can be designed so that they become part of successful HARE.Comment: 10 pages, 7 figures, to appear in the 5th International Conference on Human Agent Interaction (HAI-2017), Bielefeld, German

A three-dimensional time-dependent algorithm for ionospheric imaging using GPS

Global Positioning System (GPS) satellite receivers provide a world-wide network of phase and group delay measurements. The combination of two-frequency measurements can be used to derive the integral of the electron concentration along each satellite-to-receiver path, a parameter known as the Total Electron Content (TEC). At this stage these slant TEC data are diffi cult to interpret as they originate from a combination of a temporally changing ionosphere and spatially changing observation geometry. In this paper TEC data are inverted to evaluate the underlying distribution and time evolution of electron concentration. Accordingly, a new three-dimensional, time-dependent algorithm is presented here for imaging ionospheric electron concentration using GPS signals. The inversion results in a three-dimensional movie rather than a static image of the electron-concentration distribution. The technique is demonstrated using simulated ground-based GPS data from actual measurement geometry over Europe