Analysis of patients' needs after liver transplantation in Tuscany: a prevalence study.

BACKGROUND: The reorganization of the healthcare system in Tuscany aims at characterizing the hospitals as a place for the treatment of acute patients. This event, together with the improvement of long-term survival after orthotopic liver transplantation (OLT), calls for a management network able to ensure effective continuity of care for patient needs in the posttransplantation period. MATERIALS AND METHODS: An observational study of prevalence has been carried out with the primary objective to evaluate patients' needs and criticalities both in routine daily life and in urgency in the posttransplantation period and the capacity of the regional health system to support them. A survey, using a semi-structured questionnaire consisting of 27 questions, was administered to all patients resident in Tuscany who underwent transplantation from 2000 to 2010. The survey tool assessed the following: socio-demographic data, personal, family and social difficulties, problems emerged in the clinical routine and urgency, resolution modality, relationships with the general practitioner and the referral specialist, and services the patients would appreciate receiving in their province of residence. RESULTS: In the study, 346 patients matched the inclusion criteria of the study, 324 gave telephone consent to participate in the survey, and 225 responded (69.4%). The most frequent difficulties were as follows: depression (39.5%), difficulty in returning to work (29.3%), low income (22.6%), lack of self-sufficiency (22.6%), addictions (19.1%) (cigarette smoking 16.4%), 12.4% eating disorders, and 18.9% other difficulties (social isolation, absence of a family network, and so on). The main reasons for dissatisfaction were as follows: difficulty to obtain the required laboratory tests and lack of a reference structure at the local health facility. Few patients have a referral specialists in their area and most of them primarily refer to the Transplant Center even late after the procedure. DISCUSSION: Early diagnosis of specific conditions (depression, addiction, and eating disorders) should be implemented in the follow-up period and services such as counselling, dietary support, rehabilitation, and social services should be provided locally. An integrated management system between the transplantation center and the local facilities (hospitals, general practitioners, primary care, and laboratories) should be implemented and referral specialized centers should be identified locally

Electrochemical characterization of thin passive films on Nb electrodes in H3PO4 solutions

The electrical and semiconducting properties of thin anodic passive films potentiostatically formed (1 V £ Ef £ 5 V vs. sce) on polycrystalline niobium electrodes in aqueous 0.5 mol/L H3PO4 solutions (pH 1.3) were studied, at room temperature, using electrochemical impedance spectroscopy. The data were analysed with a transfer function using a non-linear fitting routine, assuming that the resistance of the film is coupled in series with the faradaic impedance of the Nb(0) Nb(V) reaction, and these in parallel with the capacitance of the passive film/electrolyte interface. The relative permittivity of the films was estimated as about 44. The number concentration of donors (N D) in the films was found to decrease with Ef (i.e., with increasing film thickness). A flat band potential value of -0.72 V was also obtained from Mott-Schottky plots

Real-time optical manipulation of cardiac conduction in intact hearts

Optogenetics has provided new insights in cardiovascular research, leading to new methods for cardiac pacing, resynchronization therapy and cardioversion. Although these interventions have clearly demonstrated the feasibility of cardiac manipulation, current optical stimulation strategies do not take into account cardiac wave dynamics in real time. Here, we developed an all‐optical platform complemented by integrated, newly developed software to monitor and control electrical activity in intact mouse hearts. The system combined a wide‐field mesoscope with a digital projector for optogenetic activation. Cardiac functionality could be manipulated either in free‐run mode with submillisecond temporal resolution or in a closed‐loop fashion: a tailored hardware and software platform allowed real‐time intervention capable of reacting within 2 ms. The methodology was applied to restore normal electrical activity after atrioventricular block, by triggering the ventricle in response to optically mapped atrial activity with appropriate timing. Real‐time intraventricular manipulation of the propagating electrical wavefront was also demonstrated, opening the prospect for real‐time resynchronization therapy and cardiac defibrillation. Furthermore, the closed‐loop approach was applied to simulate a re‐entrant circuit across the ventricle demonstrating the capability of our system to manipulate heart conduction with high versatility even in arrhythmogenic conditions. The development of this innovative optical methodology provides the first proof‐of‐concept that a real‐time optically based stimulation can control cardiac rhythm in normal and abnormal conditions, promising a new approach for the investigation of the (patho)physiology of the heart

Clinical determinants of the PR interval duration in Swiss middle-aged adults: The CoLaus/PsyCoLaus study.

Prolonged PR interval (PRi) is associated with adverse outcomes. However, PRi determinants are poorly known. We aimed to identify the clinical determinants of the PRi duration in the general population. Some clinical data are associated with prolonged PRi. Cross-sectional study conducted between 2014 and 2017. Electrocardiogram-derived PRi duration was categorized into normal or prolonged (>200 ms). Determinants were identified using stepwise logistic regression, and results were expressed as multivariable-adjusted odds ratio (OR) (95% confidence interval). A further analysis was performed adjusting for antiarrhythmic drugs, P-wave contribution to PRi duration, electrolytes (kalemia, calcemia, and magnesemia), and history of cardiovascular disease. Overall, 3655 participants with measurable PRi duration were included (55.6% females; mean age 62 ± 10 years), and 330 (9.0%) had prolonged PRi. Stepwise logistic regression identified male sex (OR 1.41 [1.02-1.97]); aging (65-74 years: OR 2.29 [1.61-3.24], and ≥ 75 years: OR 4.21 [2.81-6.31]); increased height (per 5 cm, OR 1.15 [1.06-1.25]); hypertension (OR 1.37 [1.06-1.77]); and hs troponin T (OR 1.67 [1.15-2.43]) as significantly and positively associated, and high resting heart rate (≥70 beats/min, OR 0.43 [0.29-0.62]) as negatively associated with prolonged PRi. After further adjustment, male sex, aging and increased height remained positively, and high resting heart rate negatively associated with prolonged PRi. Hypertension and hs troponin T were no longer associated. In a sample of the Swiss middle-aged population, male sex, aging and increased height significantly increased the likelihood of a prolonged PRi duration, whereas a high resting heart rate decreased it

Persistent nonbilious vomiting in a child: Possible duodenal webbing

An association between malrotation and congenital duodenal webbing is rare. We present our experience with four patients at two centers, and a review of published reports. There are currently 94 reported cases of duodenal pathology associated with malrotation. However, only 15 of the 94 cases (15.9%) include patients with malrotation and a duodenal web. We suggest that nonbilious vomiting in a child must prompt the surgeon to consider duodenal pathology even in the presence of malrotation

Canopy Changes of Brachiaria Managed Under Continuous Stocking in the Dry-Water Transition

Pasture supplementation is an alternative to take advantage of the forage mass deferred in the rainy season and maintain or provide weight gain in periods of rain absence. The objective was to compare the structural characteristics, mass production, density and population dynamics of tillers of Urochloa brizantha cv. ‘Paiaguas’ and U. spp. cv. ‘Convert’ under fixed and continuous stocking with steers supplemented in the trough or on the ground in the water/dry transition period. The experiment was carried out at Jatai Federal University, from March to June, in a completely randomized design and a 2x2 factorial scheme, using six paddocks/treatment. The completely randomized design was adopted and variance analysis was performed with software SAS following the GLM procedure, were compared using repeated-measures. There was a significant interaction between Brachiaria and the method of supplementation for basal, aerial, and total tiller density. Convert had an average of 551 basal and 577 total tiller/m2. Paiaguas grass presented higher tiller density (1,03 vs. 582 tiller/m2) and higher tiller birth rate (12.92 vs. 9.14%) than Convert. No significant difference was observed between brachiarias. The average height of Paiaguas was 62.34 and 50.70 cm for Convert. The average height was 57.83 and on the ground it was 54.90 cm. Supplementation offer method changed Paiaguas canopy. The Convert showed higher leaf and dead mass production but lower weeds despite its smaller tillering

Canopy Changes of Brachiaria Managed Under Continuous Stocking in the Dry-Water Transition

Pasture supplementation is an alternative to take advantage of the forage mass deferred in the rainy season and maintain or provide weight gain in periods of rain absence. The objective was to compare the structural characteristics, mass production, density and population demography of tillers of Urochloa brizantha cv. Paiaguás and Urochloa spp. cv. Convert under fixed and continuous stocking with steers supplemented with pelleted concentrate supplied in the trough or on the ground in the water/dry transition period. The experiment was carried out in the Jatai Federal University, from March to June 2020, in a completely randomized design and a 2 x 2 factorial scheme, using six paddocks/treatment. SAS was used considering repeated measures (RM) at 5% to do variance analysis. There was a significant interaction between Brachiaria and the method of supplementation for basal tiller, aerial and total tiller density. Convert-grass had an average of 551 basal and 577 total tiller/m2. Paiaguas grass presented higher tiller density (1,028 vs. 582 tiller/m2) and higher tiller birth rate (12.92 vs. 9.14%) than Convert. No significant difference was observed between the brachiarias. The average height of Paiaguas-grass was 62.34 cm and 50.70 cm for Convert-grass. The average height was 57.83 cm and on the ground it was 54.90 cm. Supplementation offer method changed Paiaguas canopy. The Convert showed higher leaf and dead mass production but lower weeds despite its smaller tillering

A structured approach to VO reconfigurations through Policies

One of the strength of Virtual Organisations is their ability to dynamically and rapidly adapt in response to changing environmental conditions. Dynamic adaptability has been studied in other system areas as well and system management through policies has crystallized itself as a very prominent solution in system and network administration. However, these areas are often concerned with very low-level technical aspects. Previous work on the APPEL policy language has been aimed at dynamically adapting system behaviour to satisfy end-user demands and - as part of STPOWLA - APPEL was used to adapt workflow instances at runtime. In this paper we explore how the ideas of APPEL and STPOWLA can be extended from workflows to the wider scope of Virtual Organisations. We will use a Travel Booking VO as example.Comment: In Proceedings FAVO 2011, arXiv:1204.579