Mobile shopping experience : The factors and emotions affecting the shopping experience on a smartphone

With respect to their usage, online stores’ conversion rates on smartphones are still lower than on computers or desktops. Even though smartphones have their device limitations, there is still a monetary gap which could be diminished by knowing how to properly design an online shopping experience for a smartphone. This study adopts the idea behind Stimulus-Organism-Response model. Based on this model, an online store contains stimuli, which affect the customer’s organism. The organism can be divided to cognition and affect. The customer’s conscious behaviour is due to their cognition and unconscious behaviour due to affect, in other words emotions. Different emotions cause different behavioural responses and by knowing which emotions are the most significant in customers’ online shopping experience, customers’ actions can be predicted. This study’s purpose is to find out which stimuli, or factors, are most significant in m-shopping context and what emotions these factors evoke. To find out what these significant factors and emotions are, an experiment including three shopping tests was conducted. The shopping tests were carried out in ethical fashion apparel online stores. The experiment was done by ten participants. From these results was formed a list of 43 factors, which hold significance in customer’s online shopping experience. These 43 factors were divided in six main categories, which are named as content, navigation, visual, product, smartphone, and environment and internal state categories. The significant emotions inside each category were determined with the help of an emotion assessment tool called Geneva Emotion Wheel. Based on this study’s results, the navigation category is the most significant category for shopping experience, and the product category for shopping outcome. The shopping experience is not only affected by the online store’s design, but also by the online store’s products, environment, customer’s internal state and customer’s smartphone, though smartphone’s significance is small. The navigation and content factors evoke similar emotions and are relevant for completing a shopping task. The visual and product categories for their part evoke similar emotions and are important for attracting the customer. The taxonomy of significant factors and emotions provided in this study can be used by both researchers and managers alike to further study and plan an online shopping experience.Vaikka älypuhelinten merkitys nyky-yhteiskunnassa on suuri, jää verkkokauppojen konversiot älypuhelimilla selatessa suhteessa tietokoneita pienemmiksi. Vaikka älypuhelimilla on omat rajoittavat tekijänsä, hyvän shoppailukokemuksen luomalla verkkokaupan konversiota älypuhelimella voitaisiin parantaa. Tämä tutkimus käyttää pohjanaan S-O-R mallia. Mallin mukaan verkkokauppa sisältää ärsykkeitä, mitkä vaikuttavat elimistöömme joko kognitiivisella- tai tunnetasolla. Asiakkaan tietoinen toiminta johtuu kognitiosta ja tiedostamaton toiminta puolestaan tunteista. Eri tunteet aiheuttavat erilaista käyttäytymistä, ja tietämällä mitkä tunteista ovat kaikkein merkittävimpiä asiakkaan shoppailukokemuksessa, yrityksen on mahdollista ennustaa asiakkaan käyttäytymistä. Tämän tutkimuksen tarkoitus on selvittää, mitkä ärsykkeet, toisin sanoen tekijät, ovat kaikkein merkittävimpiä mobiilikaupankäynnin kontekstissa ja mitä tunteita nämä tekijät herättävät. Tutkimusta varten luotiin koeasetelma, jossa toteutettiin shoppailutesti kolmessa eri eettisessä vaateverkkokaupassa. Koeasetelmaan osallistui kymmenen henkilöä. Tulosten perusteella muodostettiin 43 tekijän lista, jotka jaettiin kuuteen kategoriaan: sisältö-, navigointi-, visuaalisuus-, tuote-, älypuhelin- ja ympäristö ja sisäiset tekijät -kategorioihin. Merkittävät tunteet kategorioiden sisällä määritettiin tunnearviointityökalun, Geneva Emotion Wheel, avulla. Tulosten perusteella navigointitekijät ovat kaikkein merkittävimpiä shoppailukokemuksen kannalta ja tuotetekijät puolestaan shoppailun lopputuloksen kannalta. Shoppailukokemukseen ei vaikuta ainoastaan verkkokaupan design, vaan shoppailukokemuksen luonnissa on otettava huomioon ympäristö, jossa älypuhelinta selataan, kuluttajan sisäiset tekijät sekä kuluttajan älypuhelin, vaikkakin älypuhelimen merkitys tässä tutkimuksessa olikin pieni. Navigointi- ja sisältötekijät herättävät samanlaisia tunteita ja ovat tärkeitä shoppailun läpiviemisen kannalta. Visuaaliset- ja tuotetekijät puolestaan herättävät keskenään samanlaisia tunteita ja ovat tärkeitä kuluttajan kiinnostuksen herättämisessä. Tässä tutkimuksessa koottua listausta shoppailukokemukseen vaikuttavista tekijöistä ja tunteista voidaan käyttää tulevaisuudessa tutkijoiden ja yritysten toimesta tutkittaessa ja suunniteltaessa shoppailukokemusta

Incidence of football injuries sustained on artificial turf compared to grass and other playing surfaces : a systematic review and meta-analysis

Background: Prior reviews have not conducted statistical synthesis of injury incidence on artificial turf in football. To analyse and compare the incidence of injuries sustained playing football (soccer) on artificial turf compared to grass and other playing surfaces. Methods: This was a systematic review and meta-analysis. We searched PubMed, Scopus, SPORTDiscus, and Web of Science databases in October 2022 without filters. All observational studies (prospective or retrospective) that analysed injuries sustained playing football on artificial turf and which included a control group that played on grass or other surface were included. Studies were included if they reported the number of injuries and the exposure time for the playing surfaces. Risk of bias was assessed by Newcastle-Ottawa Scale. A random effects model was used to calculate the pooled incidence rate ratios (IRR) with 95% confidence intervals. Protocol was registered with PROSPERO on October 30th, 2022. Registration number: CRD42022371414. Findings: We screened 1447 studies, and evaluated 67 full reports, and finally included 22 studies. Risk of bias was a notable issue, as only 5 of the 22 studies adjusted their analysis for potential confounders. Men (11 studies: IRR 0.82, CI 0.72–0.94) and women (5 studies: IRR 0.83, CI 0.76–0.91) had lower injury incidence on artificial turf. Professional players had a lower incidence of injury (8 studies: IRR 0.79, CI 0.70–0.90) on artificial turf, whereas there was no evidence of differences in the incidence of injury in amateur players (8 studies: IRR 0.91, CI 0.77–1.09). The incidence of pelvis/thigh (10 studies: IRR 0.72, CI 0.57–0.90), and knee injuries (14 studies: IRR 0.77, CI 0.64–0.92) were lower on artificial turf. Interpretation: The overall incidence of football injuries is lower on artificial turf than on grass. Based on these findings, the risk of injury can't be used as an argument against artificial turf when considering the optimal playing surface for football. Funding: No specific funding was received for this study.publishedVersionPeer reviewe

Biokaasuteknologiaa maatiloilla II : biokaasulaitoksen käsittelyjäännöksen hyödyntäminen lannoitteena

Biokaasuprosessin vaikutukset naudan lietelannan ominaisuuksiin: • Käsittelyjäännöksen typen käyttökelpoisuus nousi raakalantaan verrattuna ohranviljelyssä, vaikka lieteanalyysissä liukoisen typen pitoisuus ei noussut ja liukoisen typen osuuden nousua ei voitu osoittaa. Käsittelyjäännöksen liukoinen typpi oli ohran lannoitteena täysin väkilannoitetypen veroista, kun raakalannan typpi vastasi 85-prosenttisesti väkilannoitetyppeä. Nurmenviljelyssä raakalannan ja käsittelyjäännöksen typen käyttökelpoisuus oli samaa tasoa. • Käsittelyjäännöksen fosforin käyttökelpoisuus oli korkeampi kuin raakalannan sekä ohran että nurmenviljelyssä. • Biokaasukäsittelyn edullinen vaikutus typen ja fosforin hyväksikäyttöön näkyi käsittelyjäännöksen raakalantaa pienempänä typen ja fosforin ylijäämänä. • Käsittelyjäännös oli tasalaatuisempaa ja juoksevampaa kuin raakalanta ja sen ravinnepitoisuuden vaihtelu oli pienempää kuin raakalannan. • Käsittelyjäännös koettiin teknisesti raakalantaa helpompikäyttöiseksi ja sen hajuhaitat vähäisemmiksi. • Käsittelyjäännöksen pH oli korkeampi kuin raakalannan, mutta tällä ei ollut vaikutusta maan pH-arvoon. • Riippumatta siitä, rajoittaako lannan levitystä kokonaistyppi (nitraattiasetus) vai pellon fosforiluokka, pystyy käsittelyjäännöstä käyttämällä levittämään kerta-annoksena hieman (7 %) enemmän liukoista typpeä hehtaarille. Kotieläintalouden tuotantoyksikkökoon kasvu ja tilojen keskittyminen tietyille alueille ovat johtaneet tilalla syntyvän lantamäärän kasvuun sekä lannan alueelliseen ja paikalliseen keskittymiseen. Nautakarjatiloilla tilan hallinnassa olevat pellot riittävät yleensä vastaanottamaan tuotetun lannan, mutta suurissa eläinyksiköissä lannan kuljetus kauaksi tilakeskuksesta aiheuttaa lisätyötä ja -kustannuksia. Joissain tapauksissa tilan omat pellot eivät riitä vastaanottamaan syntyvää lantamäärää. Lisämaan hankkiminen tai vastaanottosopimukset naapuritilojen kanssa mahdollistavat lannan levittämisen suuremmalle peltopinta-alalle, mutta lisää usein samalla kuljetustarvetta. Lannan tehokkaampi hyödyntäminen prosessoinnin avulla voi nostaa lopputuotteiden lannoitearvoa ja tuottaa myös uusiutuvaa energiaa. Esimerkiksi mekaaninen ja kemiallinen separointi sekä lannan anaerobinen hajotus biokaasulaitoksissa voivat tehdä lannan kuljettamisesta kauemmaksi taloudellisesti kannattavaa ja siten lisätä lannan käytettävyyttä peltolannoituksessa. Lannan sisältämien ravinteiden ja energian tehokas hyväksikäyttö on edellytyksenä niin kestävälle elintarviketuotannolle kuin maatalouden ravinnekuormituksen vähentämiselle. Tämän tutkimuksen tavoitteena oli selvittää naudan lietelannan, tilakohtaisen biokaasulaitoksen käsittelyjäännöksen ja käsittelyjäännöksestä separoitujen neste- ja kuivajakeiden käyttöarvoa nurmen ja ohran tuotannossa verrattuna väkilannoitetyppeen. Laajemmin tavoite oli saada lisää tutkittua tietoa orgaanisten, lantapohjaisten lannoitteiden mahdollisuuksista ravinteiden kierron tehostamisessa ja väkilannoitteiden korvaajana tilakohtaisissa ratkaisuissa. Tutkimus oli osa laajempaa ’Biokaasuteknologian käyttöönoton edistäminen Pohjois-Savossa’ -hanketta, jonka ensimmäinen osaraportti julkaistiin MTT Raporttina 113. Nurmen ja ohran kenttäkokeet toteutettiin kahtena erillisenä lohkoittain satunnaistettuna kokeena Luonnonvarakeskus (Luke) Maaningalla (silloinen MTT Maaninka) vuosina 2009–2012. Molemmissa kokeissa tutkittiin raakalannan, biokaasulaitoksen käsittelyjäännöksen ja jäännöksestä separoitujen neste- ja kuivajakeiden lannoitusvaikutusta. Jakeet annettiin koeruuduille eri tavoin riippuen kasvilajista. Nurmikoe oli nelivuotinen sisältäen perustamisvuoden suojaviljan (ohra), kun taas ohrakokeen tulokset ovat kolmelta vuodelta. Raakalanta ja käsittelyjäännös sijoitettiin 5–7 cm syvyyteen. Jäännöksestä separoidut kuiva- ja nestejakeet levitettiin käsin pintaan ja kuivajae mullattiin äestämällä. Orgaaniset lannoitteet annettiin ohralle keväällä ja nurmelle toiselle sadolle. Nurmi niitettiin aina kahdesti kesässä. Lisäksi kokeessa oli kuusi erilaista väkilannoitteena annettua typpitasoa. Niiden avulla muodostettiin typen satovastefunktiot, joihin orgaanisten lannoitteiden typen hyväksikäyttöä verrattiin. Syksyisin otettiin maanäytteet kolmesta eri syvyydestä. Ohrakokeessa käsittelyjäännöksellä saatiin yhtä suuret sadot kuin vastaavalla liukoisen typen määrällä väkilannoitteessa, paitsi kuivana vuonna 2010, jolloin sato oli 10 % alhaisempi. Raakalannalla sadon määrä oli vain 85 % väkilannoitteeseen verrattuna. Separoinnista ja jakeiden käytöstä ei näyttänyt olevan ohralle erityistä hyötyä. Nurmikokeessa kuivuus aiheutti suuremman eron typen hyväksikäytössä kuin biokaasuprosessi tai separointi: kuivana vuonna raakalanta ja käsittelyjäännös tuottivat selkeästi väkilannoitetta heikomman tuloksen, mutta nestejakeella vastaavaa eroa ei havaittu. Raakalannalla ja käsittelyjäännöksellä ei ollut eroa lannoitusvaikutuksessa. Ohralla typen taseet olivat pääasiassa positiivisia, ja käsittelyjäännöksen tase oli raakalantaa alhaisempi kahtena vuonna. Ohra ei siis käyttänyt kaikkea sille annettua typpeä, mutta käsittelyjäännöksen typpi oli paremmin hyödynnettävissä kuin raakalannan. Nurmella ensimmäisen sadon taseet olivat tyypillisesti negatiivisia, eli nurmi otti typpeä enemmän kuin sille väkilannoitteena annettiin. Tämä vaikutti myös kokonaissadon taseisiin. Nurmi hyödynsi käsittelyjäännöksen typen raakalannan typpeä tehokkaammin ainoastaan vuonna 2012, jolloin käsittelyjäännöksen liukoisen typen osuus kokonaistypestä oli suurempi kuin raakalannalla. Nestejakeella lannoitetut ruudut saivat enemmän kokonaistyppeä kuin muut koejäsenet, mikä näkyi positiivisina taseina joka vuosi. Myös fosforitaseet poikkesivat selvästi kasvilajien välillä. Ohralla fosforitase oli lähes aina positiivinen, myös väkilannoiteruuduilla, kun nurmella fosforin vuositase oli lähes poikkeuksetta negatiivinen. Biokaasuprosessi paransi fosforin näennäistä hyväksikäyttöä sekä ohra- että nurmikokeessa. Sekä raakalannan että käsittelyjäännöksen käytön vaikutus maan viljavuusfosforin pitoisuuteen oli pienehkö, mutta käsittelyjäännöksen käyttö nosti maan viljavuusfosforin pitoisuutta suhteessa raakalannan käyttöön. Todennäköinen syy tähän on biokaasuprosessin aiheuttamat muutokset lietelannan orgaanisen aineksen koostumuksessa, mikä vaikuttaa kilpailuun maan fosforinpidätyspaikoista. Orgaanisten lannoitteiden lannoitusvaikutus, ravinnetaseet sekä maaperän typpikierto ovat selvästi erilaisia nurmenviljelyssä kuin viljanviljelyssä. Tämä selittyy pääosin viljelytekniikan eroilla (mm. lannoitus- ja korjuukertojen määrät, jyvien tai koko kasvuston korjuu) sekä kasvien erilaisella ravinteidenottokyvyllä. Näiden kokeiden perusteella käsittelyjäännöksen edut, etenkin typen ja fosforin käyttökelpoisuuden parantuminen suhteessa karjanlantaan tulevat selvemmin esiin ohran- kuin nurmenviljelyssä.----------------------------------------------------------------------------------------------- • Plant-availability of nitrogen was higher in digestate than in raw manure when cultivating oat, even though no increase in soluble nitrogen was detected in manure analysis. The soluble nitrogen in digestate was as effective in oat cultivation as mineral fertilizer, while that of raw manure was 85% of mineral fertilizer. In grass cultivation nitrogen plant-availability of digestate and raw manure were similar. • Plant-availability of phosphorus was higher in digestate than in raw manure with both oat and grass cultivation. • The improved nitrogen and phosphorus uptake when using digestate was also shown as less excess of nitrogen and phosphorus than when using raw manure. • Digestate was more homogeneous and fluid compared to raw manure and its nutrient con-tent more stable. • Digestate was technically easier to handle and the research group found its odour less foul than that of raw manure. • Digestate pH was higher than with raw manure but this had no effect on soil pH. • Regardless of the limiting factor in manure fertilization (manure/digestate total nitrogen or soil phosphorus), digestate allowed for a slightly higher dose of soluble nitrogen (7%) per hectare. Increasing unit size of animal husbandry and its concentration into certain regions have led to in-creasing amount of manure per farm and regional concentration of manure. On dairy and beef farms the field area per se is not typically restricting manure use because forage area is in proportion to number of animals. On large units, however, the distances to fields increase and thus transportation of slurry to distant paddocks severely increases transportation costs. In addition, in some cases the field area of one farm may no longer be large enough for manure utilization. To ensure sufficient area for spreading, the farms have had to either increase its field area or hand out manure to neighboring farms. Manure processing, such as mechanical and chemical separation and anaerobic digestion in biogas plants may provide profitable solutions for transporting manure to further distances and thus improve manure utilization in fertilization. Efficient use of manure energy and nutrient content is a prerequisite for sustainable food production and decreasing agricultural nutrient load to the environment. The aim of this study was to find out the fertilizing value of cattle slurry, digestate from a farm-scale biogas plant and the separated solid and liquid fraction of the digestate in barley and grass production. The use of these organic fertilizers was also compared to that of mineral fertilizers. The aim was also to increase empirical data on the possibilities of organic fertilizers for enhancing manure utilization and replacing mineral fertilizers in farm-scale solutions. The field experiments with barley and grass were performed as two separate and randomized complete block design experiments in Luke Maaninka research station during 2009−2012. Both experiments studied the fertilizing effect of raw slurry, digestate and separated solid and liquid fractions of digestate. The different organic fertilizers were spread to the field plots dependent on the plant species. The experiment of grass silage took four years including the whole crop (barley) in the establishment year, while the results of the barley experiment are from three years. Both slurry and digestate were injected into the depth of 5−7 cm with a plot-sized slurry spread-er. Fractions were spread to the surface of soil by hand and solid fraction was mixed in to the soil by harrowing. Organic fertilizers were spread for the barley in the spring and for the grass after the first harvest. During the production years, the grass was harvested twice at silage stage. In addition, the experiments included six levels of mineral N application to calculate N fertilizer replacement value for soluble N fraction of the organic fertilizers. Soil samples (depths of 0–2 cm, 2–10 cm and 10–25 cm) were taken in each autumn. In the barley experiment, digestate gave similar yields as comparable dose of mineral soluble nitrogen (N), except in the dry year of 2010, when the yield was 10% lower. Raw slurry yielded only 85% of the yield from digestate. Separation and use of the fractions did not show particular benefits for barley. In the grass experiment, drought caused a larger difference in N uptake than the use of digestate or separated digestate: in the dry year, raw manure and digestate gave significantly lower yields that mineral fertilizer. However, when using the liquid fraction of digestate no such effect was noticed. Raw manure and digestate did not differ in fertilizing effect. With barley, N balance was mostly positive i.e. the N removal in harvested crop was lower than input N as slurry and fertilizers. The N balance of digestate was lower than that of raw slurry in two of the studied years. With grass, the N balances of the first cut were usually negative, which lead negative annual balances. On the grass plots, digestate produced a lower N balance than raw slurry only in 2012, when its proportion of soluble nitrogen of total nitrogen content was higher than that of raw slurry. The plots fertilized with liquid fraction of digestate received a higher dose of total N than the other plots, which was also seen as positive balances each year. Also the P balances differed significantly between the plant species. With barley, the P balance was almost always positive, as with mineral fertilizers, while with grass, it was nearly without exception negative. The fertilizing effect, nutrient balances and soil nitrogen cycle of organic fertilizers are clearly different in grass production than in cereal cultivation. This is mostly explained by differences in cultivation methods (e.g. amount of fertilizing and harvesting times, harvesting the grains or the entire bi-omass) and by different nutrient uptake ability of the plants. According to this study, the benefits of using digestate are clearer for barley cultivation than for grass production.201

Efficient achievement of enteral autonomy facilitates resolution of liver injury in necrotizing enterocolitis induced short bowel syndrome

Peer reviewe

Surgery versus non-operative treatment for ER-stress unstable Weber-B unimalleolar fractures : A study protocol for a prospective randomized non-inferiority (Super-Fin) trial

Publisher Copyright: ©Roughly two-thirds of ankle fractures are unimalleolar injuries, the Weber B-type fibula fracture being by far the most common type. Depending on the trauma and the accompanying soft-tissue injury, these fractures are either stable or unstable. Current clinical practice guidelines recommend surgical treatment for unstable Weber B-type fibula fractures. An ongoing randomized, parallel group, non-inferiority trial comparing surgery and non-operative treatment for unstable Weber B-type ankle fractures with allocation ratio 1:1. The rationale for non-inferiority design is as follows: By being able to prove non-inferiority of non-operative treatment, we would be able to avoid complications related to surgery. However, the primary concern related to non-operative treatment is increased risks of ankle mortise incongruency, leading to secondary surgery, early post-traumatic osteoarthritis and poor function. After providing informed consent, 126 patients aged 16 years or older with an unimalleolar Weber B-type unstable fibula fracture were randomly assigned to surgery (open reduction and internal fixation) or non-operative treatment (6-week cast immobilization). We have completed the patient enrolment and are currently in the final stages of the 2-year follow-up. The primary, non-inferiority outcome is the Olerud-Molander Ankle Score (OMAS) at 2 years (primary time point). The predefined non-inferiority margin is set at 8 OMAS points. Secondary outcomes include the Foot and Ankle Score, a 100 mm Visual Analogue Scale for function and pain, the RAND-36-Item Health Survey for health-related quality-of-life, the range-of-motion of the injured ankle, malunion (ankle joint incongruity) and fracture union. Treatment-related complications and harms; symptomatic non-unions, loss of congruity of the ankle joint, reoperations and wound infections will also be recorded. We hypothesize that non-operative treatment yields non-inferior functional outcome to surgery, the current standard treatment, with no increased risk of harms.Peer reviewe

The advantages and limitations of digital games in children’s health promotion

Childhood is an important period for forming the foundation for future health and well-being, and there is need for new methods for these health promotion purposes. Digital games are promising methods that could cover the challenges current health promotion efforts are facing. Ethical acceptability is an essential aspect of health promotion methods and special attention needs to be paid when promoting the health of children. This and increased interest in digital games as health promotion methods highlight the need for discussing the limitations, in addition to reasoning the advantages of digital games in children’s health promotion, to advance ethically sustainable development and use of health games. The aim of this overview review is to summarize and discuss the advantages and limitations of digital games in children’s health promotion based on the previous literature.We conducted a systematic literature search from scientific databases, and supplemented the search with a manual search. In total 42 articles and other forms of literature were included to the content analysis. We found several advantages and limitations of digital games in children’s health promotion. The findings considered: 1) issues related to the implementation of health promotion using digital games (perspectives of the provider and the player), and 2) possible outcomes of digital games in children (perspectives of physical, psychological, cognitive, social and health behavior related outcomes).The found advantages give good reasons for the use of digital games in children’s health promotion. However, the developers, publishers and professionals should consider carefully also the limitations of digital games in children’s health promotion to support ethically sustainable development and use of health games in children. As the interest in health games and thereby the utilization of them increases, there is a need for guidelines for developers, publishers and professional who develop and recommend health games especially for children

Overcoming tumor resistance by heterologous adeno-poxvirus combination therapy

Successful cancer control relies on overcoming resistance to cell death and on activation of host antitumor immunity. Oncolytic viruses are particularly attractive in this regard, as they lyse infected tumor cells and trigger robust immune responses during the infection. However, repeated injections of the same virus promote antiviral rather than antitumor immunity and tumors may mount innate antiviral defenses to restrict oncolytic virus replication. In this article, we have explored if alternating the therapy virus could circumvent these problems. We demonstrate in two virus-resistant animal models a substantial delay in antiviral immune- and innate cellular response induction by alternating injections of two immunologically distinct oncolytic viruses, adenovirus, and vaccinia virus. Our results are in support of clinical development of heterologous adeno-/vaccinia virus therapy of cancer.Peer reviewe

Variability of Care and Access to Transplantation for Children with Biliary Atresia Who Need a Liver Replacement

Background & Aims: Biliary atresia (BA) is the commonest single etiology indication for liver replacement in children. As timely access to liver transplantation (LT) remains challenging for small BA children (with prolonged waiting time being associated with clinical deterioration leading to both preventable pre- and post-transplant morbidity and mortality), the care pathway of BA children in need of LT was analyzed—from diagnosis to LT—with particular attention to referral patterns, timing of referral, waiting list dynamics and need for medical assistance before LT. Methods: International multicentric retrospective study. Intent-to-transplant study analyzing BA children who had indication for LT early in life (aged < 3 years at the time of assessment), over the last 5 years (2016–2020). Clinical and laboratory data of 219 BA children were collected from 8 transplant centers (6 in Europe and 2 in USA). Results: 39 patients underwent primary transplants. Children who underwent Kasai in a specialist -but not transplant- center were older at time of referral and at transplant. At assessment for LT, the vast majority of children already were experiencing complication of cirrhosis, and the majority of children needed medical assistance (nutritional support, hospitalization, transfusion of albumin or blood) while waiting for transplantation. Severe worsening of the clinical condition led to the need for requesting a priority status (i.e., Peld Score exception or similar) for timely graft allocation for 76 children, overall (35%). Conclusions: As LT currently results in BA patient survival exceeding 95% in many expert LT centers, the paradigm for BA management optimization and survival have currently shifted to the pre-LT management. The creation of networks dedicated to the timely referral to a pediatric transplant center and possibly centralization of care should be considered, in combination with implementing all different graft type surgeries in specialist centers (including split and living donor LTs) to achieve timely LT in this vulnerable population

Variability of Care and Access to Transplantation for Children with Biliary Atresia Who Need a Liver Replacement

Background & Aims: Biliary atresia (BA) is the commonest single etiology indication for liver replacement in children. As timely access to liver transplantation (LT) remains challenging for small BA children (with prolonged waiting time being associated with clinical deterioration leading to both preventable pre- and post-transplant morbidity and mortality), the care pathway of BA children in need of LT was analyzed—from diagnosis to LT—with particular attention to referral patterns, timing of referral, waiting list dynamics and need for medical assistance before LT. Methods: International multicentric retrospective study. Intent-to-transplant study analyzing BA children who had indication for LT early in life (aged < 3 years at the time of assessment), over the last 5 years (2016–2020). Clinical and laboratory data of 219 BA children were collected from 8 transplant centers (6 in Europe and 2 in USA). Results: 39 patients underwent primary transplants. Children who underwent Kasai in a specialist -but not transplant- center were older at time of referral and at transplant. At assessment for LT, the vast majority of children already were experiencing complication of cirrhosis, and the majority of children needed medical assistance (nutritional support, hospitalization, transfusion of albumin or blood) while waiting for transplantation. Severe worsening of the clinical condition led to the need for requesting a priority status (i.e., Peld Score exception or similar) for timely graft allocation for 76 children, overall (35%). Conclusions: As LT currently results in BA patient survival exceeding 95% in many expert LT centers, the paradigm for BA management optimization and survival have currently shifted to the pre-LT management. The creation of networks dedicated to the timely referral to a pediatric transplant center and possibly centralization of care should be considered, in combination with implementing all different graft type surgeries in specialist centers (including split and living donor LTs) to achieve timely LT in this vulnerable population