Orthotopic liver transplantation in U.S. veterans under primary tacrolimus immunosupression.

The evolution and refinement of surgical techniques, per ioperative patient care, and immunosuppression hav~ estab~ished orthoto~ic li~er transplantation (OLTX) as a ~ighly successful therapeutic modality for patients wrth end-stage hver disease. In February 1989,Tacrohmus (Prograf®, formerly FK 506)was first used successfully at the University of Pittsburgh Medical Center to treat patients with rejection refractory to cyclosporine-based immunosuppression." Clinical trials utilizing Tacrolimus in solid organ transplantation followed, and in April of 1994 it was approved for use by the Food and Drug Administration

Mood Worlds: A Virtual Environment for Autonomous Emotional Expression

Immersive interactive technologies such as virtual reality (VR) have the potential to foster well-being. While VR applications have been successfully used to evoke positive emotions through the presetting of light, colour and scenery, the experiential potential of allowing users to independently create a virtual environment (VE) has not yet been sufficiently addressed. To that end, we explore how the autonomous design of a VE can affect emotional engagement and well-being. We present Mood Worlds - a VR application allowing users to visualise their emotions by self-creating a VE. In an exploratory evaluation (N=16), we found that Mood Worlds is an effective tool supporting emotional engagement. Additionally, we found that an autonomous creation process in VR increases positive emotions and well-being. Our work shows that VR can be an effective tool to visualise emotions, thereby increasing positive affect. We discuss opportunities and design requirements for VR as positive technology

Letting It Go: Four Design Concepts to Support Emotion Regulation in Virtual Reality

Depicting emotions, both in reality (e.g. art therapy) and in virtual reality (VR), is an established method for emotion regulation (ER), promoting reflection, behaviour change and mental well-being. However, the specific ways in which users engage with and process negative emotions in VR remains unclear. In this study, we conducted expert interviews with psychotherapists and collaboratively identified design requirements for VR interventions that support the processing of negative emotions. Our findings highlight the potential of VR to facilitate the transition from negative to positive experiences. Based on these findings, we propose specific design concepts for using VR as positive technology for emotion regulation

Experimental evidence of differences in the absorption spectra of clustered and isolated ions in erbium doped fibers

The absorption spectra of clustered and isolated ions in erbium-doped germanosilicate fibers have been experimentally studied. The ground state absorption spectra broaden as the degree of erbium-ion clustering increases, indicating that the absorption spectra of clustered ions is significantly different from that of the homogeneous ions. This is confirmed by comparing the broadened absorption spectra with the fibre unbleachable loss spectrum; a direct measurement of the clustered ions. This is the first experimental evidence indicating different absorption cross-sections for the two species of ions in germanosilicate glass, an assumption used in the theoretical description of self-pulsing in erbium doped fiber lasers, but in direct contradiction to the pair-induced quenching model widely used to characterise EDFAs

Hepatitis C virus genotypes in liver transplant recipients: Impact on posttransplant recurrence, infections, response to interferon-α therapy and outcome

Background. End-stage liver disease due to hepatitis C virus (HCV) is the most common indication for liver transplantation in U.S. veterans. We investigated the influence of HCV genotypes on the incidence and timing of recurrent HCV hepatitis, survival, infectious morbidity, and response to interferon-α therapy in this unique patient population. Methods. HCV genotype was determined by direct sequencing of the NS5 region of HCV with type-specific primers. Results. Genotype 1a (66%, 32/47) was the predominant genotype. Type 1b was found in 25% (12/47) of patients and type 2b was found in 9% (4/47). His topathologically recurrent HCV hepatitis developed in 53% (25/47) of the patients after transplantation. This group included 45% (14/31) of the patients with type 1a, 67% (8/12) of the patients with type 1b, and 25% (1/4) of the patients with type 2b (P>0.5). The time to recurrence and the severity of HCV recurrence as defined by aminotransferase levels or Knodell scores were not different among the three genotypes. There was a trend toward a higher incidence of major infections in patients with type 1b (75%) versus type 1a (48%) and type 2b (50%) (P=0.11). The response to interferon-α therapy did not differ significantly among the genotypes. Mortality at 5 years was 16% (5/31) in patients with genotype 1a, 42% (5/12) in patients with genotype 1b, and 50% (2/4) in patients with genotype 2b (P=0.06). Conclusions. The incidence, time to recurrence, and response to interferon-α therapy did not differ be tween the various genotypes in our liver transplant recipients. However, there was a trend toward higher infectious morbidity and overall mortality in patients with genotype 1b after transplantation

A high incidence of native portal vein thrombosis in veterans undergoing liver transplantation

The incidence of native portal vein thrombosis (PVT) in liver transplant recipients has been reported to range from 2.1 to 13.8%. We have identified an inordinately high incidence of PVT in a consecutive series of U.S. veterans receiving liver transplants. Between October 1989 and February 1994, 88 consecutive U.S. veterans received 99 orthotopic liver transplants under primary Tacrolimus (Prograf, formerly FK506) based immunosuppression. A number of clinical features were examined in an effort to identify risk factors for PVT and outcome was compared to patients without PVT. Native PVT was present in 23/88 (26%) patients. All of these patients were male U.S. veterans with a mean age of 47 years. When compared to the 65 patients without PVT, we found no significant difference with respect to underlying liver disease, age, Childs-Pugh score (mean = 12), UNOS status as defined prior to April 1995 (95% UNOS 3 or 4), previous abdominal surgery, or liver volume. Median blood loss for patients with PVT (21 units of packed red blood cells) was greater than for those without PVT (14 units, P = 0.04). Portal thrombectomy was performed in 11 patients, 11 patients required mesoportal jump grafts, and 1 patient had an interposition graft. Standard veno-venous bypass was used in 10 patients with single bypass utilized for the remainder. Actuarial patient survival for all patients at 1, 2, and 4 years was 88, 85, and 79%, respectively. There was no significant difference in patients with or without PVT. Patients with PVT had poorer graft survival than patients without PVT (86% vs 65%, 1 year; 81% vs 65%, 2 years; 81% vs 61%, 4 years; P = 0.03); however, this was not related to technical problems with the portal venous inflow. PVT occurred in 26% of U.S. veterans undergoing liver transplantation. These patients bad significantly higher operative blood loss and poorer graft survival. The high incidence of postnecrotic cirrhosis in a predominantly male group of patients with advanced disease, as is evident by the high mean Childs-Pugh score and UNOS status, perhaps accounts for our observations

The Role of Mobile and Virtual Reality Applications to Support Well-Being: An Expert View and Systematic App Review

Interactive technologies for autonomous mental health management are on the rise due to limited therapy access and stigma. However, most commercial mental health apps are neither theory-based nor clinically tested, and psychological theories are not easily accessible to app designers. Thus, it remains unclear if current mobile and VR mental health apps meet therapists’ expectations. To address this gap, we conducted interviews (N=11 ) to build an understanding about current therapeutic practices with a focus on emotion regulation and their applicability to mobile apps. We then conducted a systematic app review of 60 mental-health-related mobile and VR apps applying the themes identified in our interviews as an understanding lens. We draw upon the identified discrepancies to pinpoint design implications for better embedding lived therapeutic practice into mental health apps. We contribute by providing a common grounding between therapists and developers on the features and properties of well-being mobile and VR apps