The aim of the research is to semi-automate the process of generating formal specifications from legal contracts in natural language text form. Towards this end, the paper presents a tool, named ...ContrattoA, that semi-automatically conducts semantic annotation of legal contract text using an ontology for legal contracts. ContrattoA was developed through two iterations where lexical patterns were defined for legal concepts and their effectiveness was evaluated with experiments. The first iteration was based on a handful of sample contracts and resulted in defining lexical patterns for recognizing concepts in the ontology; these were evaluated with an empirical study where one group of subjects was asked to annotate legal text manually, while a second group edited the annotations generated by ContrattoA. The second iteration focused on the lexical patterns for the core contract concepts of obligation and power where results of the first iteration were mixed. On the basis of an extended set of sample contracts, new lexical patterns were derived and those were shown to substantially improve the performance of ContrattoA, nearing in quality the performance of experts. The experiments suggest that good quality annotations can be generated for a broad range of contracts with minor refinements to the lexical patterns.
Background & Aims
The impact of gender and donor/recipient gender mismatch on LT outcomes is controversial. The aim of this study was to compare outcomes of LT in Europe, using the ELTR database, ...between male and female recipients, including donor/recipient gender mismatch.
Methods
Recipient, donor and transplant characteristics were compared between male and female patients. Patient survival was compared between groups, and the impact of donor/recipient gender matching as well as donor and recipient anthropometric characteristics were evaluated as potential risk factors for post‐LT death/graft loss.
Results
A total of 46,334 LT patients were evaluated (70.5% men and 29.5% women). Ten‐year survival rate was significantly higher in female than in male recipients (66% vs 59%, P < .0001). At multivariate analysis, adjusted for indication to LT and type of graft, donor/recipient gender mismatch (HR 1.12, 95% CI 1.04‐1.2; P = .003), donor age > 60 years (HR 1.09, 95% CI 1.01‐1.18; P = .027) and recipient age (HR 1.02, 95% CI 1.1‐1.02; P < .0001) were significantly associated with post‐LT lower survival rate in men. Conversely in female recipients, donor BMI > 30 (HR 1.32, 95% CI 1.09‐1.6; P = .005), donor age > 60 years (HR 1.15, 95% CI 1.01‐1.32; P = .027) and recipient age (HR 1.02, 95% CI 1.01‐1.02; P < .0001) were significantly associated with lower post‐LT survival rate.
Conclusions
Donor/recipient gender mismatch in male recipients and the use of obese donor in female recipients are associated with reduced survival after LT. Therefore, the incorporation of donor and recipient anthropometric quantities in the allocation process should be a matter of further studies, as their matching can significantly influence long‐term outcomes.
Bacterial infections are frequent in patients with cirrhosis and increase the risk of death and drop-out from liver transplant (LT) waiting list. In patients with bacterial infections, LT is ...frequently delayed because of the fear of poor outcomes. We evaluated the impact of pre-LT infections on post-LT complications and survival.
From 2012 to 2018, consecutive patients transplanted at the Hospital of Padua were identified and classified in two groups: patients surviving an episode of bacterial infection within 3 months before LT (study group) and patients without infections before LT (control group). Post-LT outcomes (complications, new infections, survival) were collected.
A total of 466 LT recipients were identified (study group n = 108; control group n = 358). After LT, the study group had a higher incidence of new bacterial (57% vs. 20%, p <0.001) and fungal infections (14% vs. 5%, p = 0.001) and of septic shock (8% vs. 2%, p = 0.004) than the control group. Along with the model for end-stage liver disease (MELD) score and alcohol-related cirrhosis, bacterial infection pre-LT was an independent predictor of post-LT infections (odds ratio = 3.92; p <0.001). Nevertheless, no significant difference was found in 1-year (88% vs. 89%, p = 0.579) and 5-year survival rates (76% vs. 75%, p = 0.829) between the study group and control group. Within the study group, no association was found between the time elapsed from infection improvement/resolution to LT and post-LT outcomes.
Patients with pre-LT infections have a higher risk of new bacterial and fungal infections and of septic shock after LT. However, post-LT survival is excellent. Therefore, as soon as the bacterial infection is improving/resolving, transplant should not be delayed, but patients with pre-transplant bacterial infections require active surveillance for infections after LT.
Bacterial infections increase mortality and delay transplant in patients with cirrhosis awaiting liver transplantation (LT). Little is known about the impact of adequately treated infections before LT on post-transplant complications and outcomes. The study highlights that pre-LT infections increase the risk of post-LT infections, but post-LT survival rates are excellent despite the risk. These findings suggest that physicians should not delay LT because of concerns about pre-LT infections, but instead should actively monitor these patients for infections after surgery.
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•In patients with cirrhosis, the prognostic impact of pre-LT infections is not completely understood.•Pre-LT infections increase the risk of post-LT infections but do not affect patients’ survival.•Time from infection resolution to LT does not affect incidence of post-LT complication and survival rates.•As soon as infections are resolving, it is safe to proceed with LT without any delay.•Patients with pre-LT infection require active surveillance for infections after LT.
Liver transplantation (LT) is the most successful treatment for patients with decompensated cirrhosis. The availability of effective and safe etiological treatments has altered the natural history of ...decompensated cirrhosis. Recently, the concept of recompensation has been defined. Patients who achieve recompensation may be removed from the waiting list for LT. Therefore, achieving an etiological cure is the cornerstone in the treatment of patients with decompensated cirrhosis. However, most patients improve their liver function after an etiologic cure, and only a proportion of patients achieve true recompensation after an etiological cure. Some patients maintain a condition of “MELD purgatory,” that is, an improvement in the Model for End-Stage Liver Disease score without relevant clinical improvement that prevents delisting and may be even detrimental because lower Model for End-Stage Liver Disease score delays LT. Herein, we review the available evidence regarding recompensation and the management of recompensated patients on the waiting list for LT.
Government regulations are increasingly affecting the security, privacy and governance of information systems in the United States, Europe and elsewhere. Consequently, companies and software ...developers are required to ensure that their software systems comply with relevant regulations, either through design or re-engineering. We previously proposed a methodology for extracting stakeholder requirements, called rights and obligations, from regulations. In this paper, we examine the challenges to developing tool support for this methodology using the Cerno framework for textual semantic annotation. We present the results from two empirical evaluations of a tool called “Gaius T.” that is implemented using the Cerno framework and that extracts a conceptual model from regulatory texts. The evaluation, carried out on the U.S. HIPAA Privacy Rule and the Italian accessibility law, measures the quality of the produced models and the tool’s effectiveness in reducing the human effort to derive requirements from regulations.
Acute kidney injury (AKI) commonly occurs in patients with decompensated cirrhosis. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) could help discriminate between different etiologies of ...AKI. The aim of this study was to investigate the use of uNGAL in (1) the differential diagnosis of AKI, (2) predicting the response to terlipressin and albumin in patients with hepatorenal syndrome-AKI (HRS-AKI), and (3) predicting in-hospital mortality in patients with AKI.
One hundred sixty-two consecutive patients with cirrhosis and AKI were included from 2015 to 2020 and followed until transplant, death, or 90 days. Standard urinary markers and uNGAL were measured. Data on treatment, type, and resolution of AKI were collected. Thirty-five patients (21.6%) had prerenal AKI, 64 (39.5%) HRS-AKI, 27 (16.7%) acute tubular necrosis-AKI (ATN-AKI), and 36 (22.2%) a mixed form of AKI. Mean values of uNGAL were significantly higher in ATN-AKI than in other types of AKI (1162 ng/ml 95% CI 423-2105 ng/ml vs. 109 ng/ml 95% CI 52-192 ng/ml; p < 0.001). uNGAL showed a high discrimination ability in predicting ATN-AKI (area under the receiver operating characteristic curve, 0.854; 95% CI 0.767-0.941; p < 0.001). The best-performing threshold was found to be 220 ng/ml (sensitivity, 89%; specificity, 78%). The same threshold was independently associated with a higher risk of nonresponse (adjusted OR aOR, 6.17; 95% CI 1.41-27.03; p = 0.016). In multivariable analysis (adjusted for age, Model for End-Stage Liver Disease, acute-on-chronic liver failure, leukocytes, and type of AKI), uNGAL was an independent predictor of in-hospital mortality (aOR, 1.74; 95% CI 1.26-2.38; p = 0.001).
uNGAL is an adequate biomarker for making a differential diagnosis of AKI in cirrhosis and predicting the response to terlipressin and albumin in patients with HRS-AKI. In addition, it is an independent predictor of in-hospital mortality.
The prognostic impact of acute decompensation (AD), i.e. the development of complications that require hospitalization, has recently been assessed. However, complications of cirrhosis do not ...necessarily require hospitalization and can develop progressively, as in the recently defined non-acute decompensation (NAD). Nevertheless, there is no data regarding the incidence and prognostic impact of NAD. The aim of the study was to evaluate the incidence and the prognostic impact of NAD and AD in outpatients with cirrhosis.
A total of 617 outpatients with cirrhosis from two Italian tertiary centers (Padua and Milan) were enrolled from January 2003 to June 2021 and followed prospectively until the end of the study, death or liver transplantation. The complications registered during follow-up were considered as AD if they required hospitalization, or NAD if managed at the outpatient clinic.
During follow-up, 154 patients (25.0% of total patients) developed complications, 69 patients (44.8%) developed NAD and 85 (55.2%) developed AD, while 29 patients with NAD (42.0%) developed a further episode of AD during follow-up. Sixty-month survival was significantly higher in patients with no decompensation than in patients with NAD or AD. On multivariable analysis, AD (hazard ratio HR 21.07, p <0.001), NAD (HR 7.13, p <0.001), the etiological cure of cirrhosis (HR 0.38, p <0.001) and model for end-stage liver disease score (HR 1.12, p = 0.003) were found to be independent predictors of mortality.
The first decompensation is non-acute in almost 50% of outpatients, though such events are still associated with decreased survival compared to no decompensation. Patients who develop NAD must be treated with extreme care and monitored closely to prevent the development of AD.
This multicenter study is the first to investigate the role of non-acute decompensation (NAD) in patients with cirrhosis. In fact, while the unfavorable impact of acute decompensation is well known, there is currently a dearth of evidence on NAD, despite it being a common occurrence in clinical practice. Our data show that almost half of decompensations in patients with cirrhosis can be considered NAD and that such events are associated with a higher risk of mortality than no decompensation. This study has important clinical implications because it highlights the need to carefully consider patients who develop NAD, in order to prevent further decompensation and reduce mortality.
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•In clinical practice, patients can develop complications progressively (NAD) rather than acutely (AD).•The unfavorable impact of AD in patients with cirrhosis is well known, while the role of NAD is still to be proven.•NAD accounted for 45% of decompensations and 42% of patients with NAD developed AD during follow-up.•Mortality in patients with NAD is higher than in compensated patients.•Patients with NAD should be monitored closely to prevent the development of AD.
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