Indications for liver transplantation in the cyclosporine era

One hundred seventy orthotopic liver transplants were performed under conventional immunosuppression with azathioprine and steroids with 1- and 5-year survivals of 32.9% and 20.0%, respectively. Since the introduction of cyclosporine-prednisone therapy in March 1980, 313 primary orthotopic liver transplants have been performed. Actuarial survivals at 1 and 5 years have improved to 69.7% and 62.8%, respectively. Biliary atresia is now the most common indication for liver replacement. In adults, primary biliary cirrhosis and sclerosing cholangitis have become more common indications for transplantation, and alcoholic cirrhosis and primary liver malignancy as indications have declined. Early enthusiasm for liver transplantation in patients with hepatic cancer has been tempered by the finding that recurrence is both common and rapid. An increasing number of patients with inborn errors of metabolism originating in the liver are receiving transplants, including patients with Wilson's disease, tyrosinemia, alpha-1-antitrypsin deficiency, glycogen storage disease, familial hypercholesterolemia, and hemochromatosis. Survival in this group of patients has been excellent (74.4% at 1 and 5 years). A hemophiliac who received a transplant for postnecrotic cirrhosis has survived and may have been cured of his hemophilia. About 20% of patients require retransplantation for rejection, technical failure, or primary graft failure. Only 4 of the patients receiving retransplants under conventional immunosuppression survived beyond 6 months, and all died within 14 months of retransplantation. Sixty-eight patients have received retransplants under cyclosporine-prednisone. Thirty-one patients are surviving, all for at least 1 year. Six of the 12 patients requiring a third transplant are alive 2 to 3 years after the primary operation. An aggressive approach to retransplantation in the patient with a failed graft is justified

Comparing families of dynamic causal models

Mathematical models of scientific data can be formally compared using Bayesian model evidence. Previous applications in the biological sciences have mainly focussed on model selection in which one first selects the model with the highest evidence and then makes inferences based on the parameters of that model. This “best model” approach is very useful but can become brittle if there are a large number of models to compare, and if different subjects use different models. To overcome this shortcoming we propose the combination of two further approaches: (i) family level inference and (ii) Bayesian model averaging within families. Family level inference removes uncertainty about aspects of model structure other than the characteristic of interest. For example: What are the inputs to the system? Is processing serial or parallel? Is it linear or nonlinear? Is it mediated by a single, crucial connection? We apply Bayesian model averaging within families to provide inferences about parameters that are independent of further assumptions about model structure. We illustrate the methods using Dynamic Causal Models of brain imaging data

Harmonic Vibrational Excitations in Disordered Solids and the "Boson Peak"

We consider a system of coupled classical harmonic oscillators with spatially fluctuating nearest-neighbor force constants on a simple cubic lattice. The model is solved both by numerically diagonalizing the Hamiltonian and by applying the single-bond coherent potential approximation. The results for the density of states $g(\omega)$ are in excellent agreement with each other. As the degree of disorder is increased the system becomes unstable due to the presence of negative force constants. If the system is near the borderline of stability a low-frequency peak appears in the reduced density of states $g(\omega)/\omega^2$ as a precursor of the instability. We argue that this peak is the analogon of the "boson peak", observed in structural glasses. By means of the level distance statistics we show that the peak is not associated with localized states

Transgressing the moral economy: Wheelerism and management of the nationalised coal industry in Scotland

This article illuminates the links between managerial style and political economy in post-1945 Britain, and explores the origins of the 1984–1985 miners' strike, by examining in longer historical context the abrasive attitudes and policies of Albert Wheeler, Scottish Area Director of the National Coal Board (NCB). Wheeler built on an earlier emphasis on production and economic criteria, and his micro-management reflected pre-existing centralising tendencies in the industries. But he was innovative in one crucial aspect, transgressing the moral economy of the Scottish coalfield, which emphasised the value of economic security and changes by joint industrial agreement

Effective one-dimensionality of AC hopping conduction in the extreme disorder limit

It is argued that in the limit of extreme disorder AC hopping is dominated by "percolation paths". Modelling a percolation path as a one-dimensional path with a sharp jump rate cut-off leads to an expression for the universal AC conductivity, that fits computer simulations in two and three dimensions better than the effective medium approximation.Comment: 6 postscript figure

Real-Time Contrast Enhancement to Improve Speech Recognition

An algorithm that operates in real-time to enhance the salient features of speech is described and its efficacy is evaluated. The Contrast Enhancement (CE) algorithm implements dynamic compressive gain and lateral inhibitory sidebands across channels in a modified winner-take-all circuit, which together produce a form of suppression that sharpens the dynamic spectrum. Normal-hearing listeners identified spectrally smeared consonants (VCVs) and vowels (hVds) in quiet and in noise. Consonant and vowel identification, especially in noise, were improved by the processing. The amount of improvement did not depend on the degree of spectral smearing or talker characteristics. For consonants, when results were analyzed according to phonetic feature, the most consistent improvement was for place of articulation. This is encouraging for hearing aid applications because confusions between consonants differing in place are a persistent problem for listeners with sensorineural hearing loss

Heat treatment significantly increases the sharpness of silcrete stone tools

Humans were regularly heat-treating stone tool raw materials as early as 130,000 years ago. The late Middle Stone Age (MSA) and Late Stone Age (LSA) of South Africa's Western Cape region provides some of the earliest and most pervasive archaeological evidence for this behaviour. While archaeologists are beginning to understand the flaking implications of raw material heat treatment, its potential functional benefits remain unanswered. Using silcrete from the Western Cape region, we investigate the impact of heat treatment on stone tool cutting performance. We quantify the sharpness of silcrete in its natural, unheated form, before comparing it with silcrete heated in three different conditions. Results show that heat-treated silcrete can be significantly sharper than unheated alternatives, with cutting forces halving and energy requirements reducing by approximately two-thirds. The data suggest that silcrete may have been heat treated during the South African MSA and LSA to increase the sharpness and performance of stone cutting edges. This early example of material engineering has implications for understanding Stone Age populations’ technological capabilities, inventiveness and raw material choices. We predict that heat-treatment behaviours in other prehistoric and ethnographic contexts may also be linked to increases in edge sharpness and concerns about functional performance

Auditory-inspired morphological processing of speech spectrograms: applications in automatic speech recognition and speech enhancement

New auditory-inspired speech processing methods are presented in this paper, combining spectral subtraction and two-dimensional non-linear filtering techniques originally conceived for image processing purposes. In particular, mathematical morphology operations, like erosion and dilation, are applied to noisy speech spectrograms using specifically designed structuring elements inspired in the masking properties of the human auditory system. This is effectively complemented with a pre-processing stage including the conventional spectral subtraction procedure and auditory filterbanks. These methods were tested in both speech enhancement and automatic speech recognition tasks. For the first, time-frequency anisotropic structuring elements over grey-scale spectrograms were found to provide a better perceptual quality than isotropic ones, revealing themselves as more appropriate—under a number of perceptual quality estimation measures and several signal-to-noise ratios on the Aurora database—for retaining the structure of speech while removing background noise. For the second, the combination of Spectral Subtraction and auditory-inspired Morphological Filtering was found to improve recognition rates in a noise-contaminated version of the Isolet database.This work has been partially supported by the Spanish Ministry of Science and Innovation CICYT Project No. TEC2008-06382/TEC.Publicad