The demand for liver transplantation (LT) exceeds supply, with rising waiting list mortality. Utilization of high‐risk organs is low and a substantial number of procured livers are discarded. We ...report the first series of five transplants with rejected livers following viability assessment by normothermic machine perfusion of the liver (NMP‐L). The evaluation protocol consisted of perfusate lactate, bile production, vascular flows, and liver appearance. All livers were exposed to a variable period of static cold storage prior to commencing NMP‐L. Four organs were recovered from donors after circulatory death and rejected due to prolonged donor warm ischemic times; one liver from a brain‐death donor was declined for high liver function tests (LFTs). The median (range) total graft preservation time was 798 (range 724–951) min. The transplant procedure was uneventful in every recipient, with immediate function in all grafts. The median in‐hospital stay was 10 (range 6–14) days. At present, all recipients are well, with normalized LFTs at median follow‐up of 7 (range 6–19) months. Viability assessment of high‐risk grafts using NMP‐L provides specific information on liver function and can permit their transplantation while minimizing the recipient risk of primary graft nonfunction. This novel approach may increase organ availability for LT.
This pilot study introduces a novel approach to increase availability of livers for transplantation using normothermic machine perfusion to test the function of declined organs, reporting feasibility of this approach in five patients receiving such livers that met predefined viability criteria. See the editorial from Barbas and Knechtle on page 3075.
ABSTRACT
The International Pulsar Timing Array 2nd data release is the combination of data sets from worldwide collaborations. In this study, we search for continuous waves: gravitational wave ...signals produced by individual supermassive black hole binaries in the local universe. We consider binaries on circular orbits and neglect the evolution of orbital frequency over the observational span. We find no evidence for such signals and set sky averaged 95 per cent upper limits on their amplitude h95. The most sensitive frequency is 10 nHz with h95 = 9.1 × 10−15. We achieved the best upper limit to date at low and high frequencies of the PTA band thanks to improved effective cadence of observations. In our analysis, we have taken into account the recently discovered common red noise process, which has an impact at low frequencies. We also find that the peculiar noise features present in some pulsars data must be taken into account to reduce the false alarm. We show that using custom noise models is essential in searching for continuous gravitational wave signals and setting the upper limit.
Retransplantation candidates are disadvantaged owing to lack of good-quality liver grafts. Strategies that can facilitate transplantation of suboptimal grafts into retransplant candidates require ...investigation. The aim was to determine whether late liver retransplantation can be performed safely with suboptimal grafts, following normothermic machine perfusion.
A prospectively enrolled group of patients who required liver retransplantation received a suboptimal graft preserved via normothermic machine perfusion. This group was compared with both historical and contemporaneous cohorts of patient who received grafts preserved by cold storage. The primary outcome was 6-month graft and patient survival.
The normothermic machine perfusion group comprised 26 patients. The historical (cold storage 1) and contemporaneous (cold storage 2) groups comprised 31 and 25 patients respectively. The 6-month graft survival rate did not differ between groups (cold storage 1, 27 of 31, cold storage 2, 22 of 25; normothermic machine perfusion, 22 of 26; P = 0.934). This was despite the normothermic machine perfusion group having significantly more steatotic grafts (8 of 31, 7 of 25, and 14 of 26 respectively; P = 0.006) and grafts previously declined by at least one other transplant centre (5 of 31, 9 of 25, and 21 of 26; P < 0.001).
In liver retransplantation, normothermic machine perfusion can safely expand graft options without compromising short-term outcomes.
We report the case of a 6-year-old boy presenting to the emergency department after a syncopal event during a flu-like illness. Intermittent ventricular tachycardia was noted during Emergency Medical ...Services transport, and a focused cardiac ultrasound (FOCUS) in the emergency department revealed a dilated left ventricle and left atrium as well as severe global systolic dysfunction. Point-of-care ultrasound findings prompted expedited evaluation and management of this critically ill patient.
Earthen materials have been used in civil engineering construction worldwide with different forms, such as mud, adobe, rammed earth and bricks. Compressed stabilized earth blocks (CSEB) can be ...considered as a new member of the earthen building material family. Also, it can overcome the problems associated with fired bricks and cement blocks. Cement is the most commonly used as stabilizers to enhance the properties of CSEB. The governing factor which controls the properties of CSEB is the amount of clay content in the soil. Researches have concluded that about 25% of clay and silt (finer) content contributes to high compressive strength. However, controlling of larger particles is not addressed much. This study focused on controlling the finer content as well as larger particles with the use of construction waste (mostly with crushed concrete) and river sand. Selected soil was modified to get the finer content as 5%, 10%, 15% and 20%. This modification was done by adding river sand and construction waste to the soil to optimize the particle packing based on particle packing theories. Cement was used as the stabilizer with 6%, 8%, and 10%. (150 × 150 × 150) mm3 cubes were cast and tested for dry density, water absorption, 28 days wet and dry compressive strength, accelerated erosion and compared with SLS 1382; part 2 requirements. Block properties were conformed with SLS 1382 requirement when finer contents are 10% and 5% with 10% and 8% cement. Further, Industrial-scale blocks of (350 × 100 × 175) mm3 made with 10% finer and 8% cement satisfied the Grade 1 block properties. CSEB made mixing with construction waste contributes to manage the environmental pollution due to construction waste while giving a fair solution to the problem with the shortage of building materials.
ABSTRACT
We searched for an isotropic stochastic gravitational wave background in the second data release of the International Pulsar Timing Array, a global collaboration synthesizing decadal-length ...pulsar-timing campaigns in North America, Europe, and Australia. In our reference search for a power-law strain spectrum of the form $h_c = A(f/1\, \mathrm{yr}^{-1})^{\alpha }$, we found strong evidence for a spectrally similar low-frequency stochastic process of amplitude $A = 3.8^{+6.3}_{-2.5}\times 10^{-15}$ and spectral index α = −0.5 ± 0.5, where the uncertainties represent 95 per cent credible regions, using information from the auto- and cross-correlation terms between the pulsars in the array. For a spectral index of α = −2/3, as expected from a population of inspiralling supermassive black hole binaries, the recovered amplitude is $A = 2.8^{+1.2}_{-0.8}\times 10^{-15}$. None the less, no significant evidence of the Hellings–Downs correlations that would indicate a gravitational-wave origin was found. We also analysed the constituent data from the individual pulsar timing arrays in a consistent way, and clearly demonstrate that the combined international data set is more sensitive. Furthermore, we demonstrate that this combined data set produces comparable constraints to recent single-array data sets which have more data than the constituent parts of the combination. Future international data releases will deliver increased sensitivity to gravitational wave radiation, and significantly increase the detection probability.
Abstract
The donor–acceptor (D-A) type of conjugated polymers has emerged as the paradigm of the third generation of electronically conducting polymers demonstrating improved infrared activity and ...intrinsic electronic conductivity. Judicious selection of donor (D) and acceptor (A) monomers for copolymerization can further fine-tune these properties. Notably, for such refinement, natural compounds provide many conjugated molecules with various functional groups. Berberine cation (Ber
+
) found in
Coscinium fenestratum
has extensive conjugation and contains both an electron deficient isoquinolium A moiety and electron-rich D-type methylenedioxy and methoxy groups. The incorporation of natural products in electronic materials is a novel area of research which opens a wide scope for future electronic and optoelectronic devices. Investigation of their fundamental properties via computer simulations is therefore important. In this study, quantum chemical calculations are performed using density functional theory (DFT) to investigate the electronic and optical properties of oligomers of Ber
+
and 3,4-ethylenedioxythiophene (EDOT) and to explore the possibilities for homo-polymerization of Ber
+
and its copolymerization with EDOT. It has been revealed that homo-polymerization is not favoured but copolymerization with EDOT is possible. As such, Ber
+
was copolymerized with EDOT and the copolymers formed by electro-polymerization are extensively characterised and the D-A behaviour of the copolymers verified. Furthermore, the theoretical predictions have been compared with the experimental data.
The impacts of crop rotation systems on the arbuscular mycorrhizal fungal (AMF) spore density, mycorrhizal colonization of rice roots, soil C fractions and C stocks in seasonally dry climatic zone of ...Sri Lanka were examined in Rice–Soybean (RS) and Rice–Onion (RO) crop rotation systems during the subsequent rice cultivation season and, compared these with a rice monoculture,
i.e
. Rice–Rice (RR). The study also examined the correlations between AMF occurrence and soil carbon stocks. Results revealed that RS crop rotation system significantly enhances the occurrence of AMF spores in soil with a higher fraction of large sized spores, the total organic C (TOC), microbial biomass C (MBC), water soluble C (WSC), labile C and a high AMF colonization in rice roots in the subsequent rice cultivation season. The diversity of AMF morphospecies were also the highest in RS. Reduction in AMF density in the soil in RR crop rotation system may be due to prolonged anaerobic conditions prevailed. The growth of onion has drastically reduced the AMF colonization in rice and soil C contents. Soil carbon stocks showed positive correlations with % root colonization and AMF spore number in soil. Thus, the study confirmed that C stocks in paddy soils can be improved by intercropping with AMF supporting plants like soya bean. This is the first report that shows positive correlations of AMF sporulation and % root colonization in lowland rice with soil carbon stocks.
Purpose of the study: The study aimed to develop and validate a holistically based follow-up pain assessment diary for patients with cancer pain in Sri Lanka. Design of the study: Mixed-method design ...adapted. Methods used: Developing a pain diary and testing its psychometric qualities were done in two phases. Comprehensive literature research and qualitative semistructured interviews with patients, clinical, and subject specialists created the pain diary items. Content, face, construct, criterion validity, and reliability were evaluated. Findings: The essential domains to be assessed were identified under six main categories; pain and related characteristics, physical, psychological, social, spiritual, and financial aspects. The average variance extracted from the subscales “Influence on daily life,” “Gastric disturbances,” and “Pain intensity” were 0.526, 0.562, and 0.696, respectively. The heterotrait–monotrait criterion values between subscales were from 0.691 to 0.44, which was lower than the threshold. Good to excellent correlation coefficients were demonstrated with the scores of reference tools. Cronbach's alpha was computed for each subscale and ranged from 0.75 to 0.92 and composite reliability from 0.921 to 0.826. Conclusions: Pain diary is a reliable and valid instrument for follow-up assessment of holistic pain experience enabling holistic nursing among patients with cancer pain in Sri Lanka.
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