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Accessible Summary: What is known on the subject?: Seclusion is a harmful and traumatising intervention for people accessing mental health services.People who are subject to seclusion in inpatient mental health services often first experience this within the first 24 h following admission.There is limited research examining how recent contact with services impacts the likelihood of seclusion when people are admitted to inpatient services. What the paper adds to existing knowledge?: Males, Māori and Pasifika experience higher rates of seclusion within the first 24 h following inpatient admission.People perceived by clinicians as overactive, aggressive, disruptive or agitated are seven times more likely to be secluded within the first 24 h.People referred from police or justice services are three times more likely to be secluded within the first 24 h.People who had frequent contact with community mental health services prior to inpatient admission were less likely to be secluded. What are the implications for practice?: The first 24 h of inpatient admission is a critical focus for eliminating the use of seclusion. Initial interactions with people recently admitted should focus on nurturing relationships and reducing distress.Mental health staff should consider the person's cultural needs, referral pathway, recent service contact and baseline ratings on the Health of the Nation Outcomes Scales (HoNOS) when working proactively to prevent the use of seclusion in the first 24 h following admission.Strengthening the focus on nurturing relationships, cultural understanding and non‐coercive de‐escalation approaches requires leadership support and strategic workforce development. Introduction: People who experience seclusion in inpatient mental health services often do so within the first 24 h following admission. There is limited research examining the potential contributing factors, particularly recent contact with services. Aim/Question: To identify factors associated with seclusion within the first 24 h following admission into acute inpatient mental health services. Method: A retrospective analysis was undertaken using routinely collected data from Aotearoa New Zealand mental health services. Results: A higher likelihood of seclusion within the first 24 h following admission was associated with: males, Māori, Pasifika, referrals from police/justice services, inpatient transfers, recent contact with crisis assessment teams and clinician perceptions of aggression, problematic substance use, cognitive problems and hallucinations or delusions. Recent contact with community mental health services was associated with a lower likelihood. Discussion: People's cultural needs, referral pathway, recent service contact and HoNOS scores should be considered when working to prevent the use of seclusion in the first 24 h following admission. Implications for Practice: The first 24 h following inpatient admission is a critical period for preventing the use of seclusion. Nurturing relationships, cultural understanding and use of non‐coercive de‐escalation approaches can support better outcomes for people recently admitted. [ABSTRACT FROM AUTHOR]

The widespread move to online schooling during the COVID-19 crisis meant that parents played a significant role in educating their children. However, there is a paucity of research relating to parents' perceptions of online and remote learning designs. This study used multiple regression analyses and thematic analysis of parent survey responses during COVID-19 to examine which online tasks reduced parental stress and student difficulty, increased student autonomy and learning, and increased parental satisfaction. A key finding was that digital creativity tasks were related to lower levels of parental stress, lower student difficulty, greater student autonomy and greater parent satisfaction with school support. Parents also preferred more web-conferencing lessons and offline tactile activities, and less digital worksheets. These findings have implications for educator-parent collaboration and for remote learning broadly. [ABSTRACT FROM AUTHOR]

With substantial mental health needs, United Nations guidelines recommend prisoners should have access to healthcare of the same standard as non-prisoners. CBT-based self-help is recommended for anxiety and depression; one approach is Living Life To The Full (LLTTFTM). This study evaluated the feasibility of Prison Officers providing guided self-help support to adult male offenders experiencing distress in a Scottish prison. Prison Officers attended training in delivering LLTTF books and worksheets. Seven prisoners completed four one-to-one sessions of LLTTF. A large effect size was associated with improving depression self-ratings pre- to post-treatment. Pre-treatment anxiety and social function were associated with non-significant change. Feedback from Prison Officers and prisoners indicated LLTTF materials would benefit from adaptation for prison, which could be revised with Prison Officers and prisoners. Results suggest further research on guided self-help in prison is worth pursuing. Designated guided self-help workers may be better placed to deliver LLTTF in this or an educational setting. [ABSTRACT FROM AUTHOR]

Background: Screen‐sharing technologies enable applications such as screen mirroring, video streaming and instant messaging across multiple device screens. Despite their increasing use in many contemporary classrooms, there is a paucity of research directly examining pedagogical benefits and issues of these technologies. Objectives: This study investigated the influence of screen‐sharing technologies on teachers' practices, highlighting pedagogical benefits and issues encountered. Methods: The paper drew on a sample of 321 K‐12 teachers and utilised principal components analysis, descriptive statistics and inductive coding. Results and Conclusions: Teachers reported greater mobility, increased ease of content sharing and deeper learner cognition as attributes of improved learning and teaching with the technologies. However, a minority highlighted technical issues such as network and hardware problems affecting their confidence. Despite increased mobility as an affordance, teachers' perceptions about mobility largely appeared to be predicated on assumptions that the technologies were intended for didactic instruction. Takeaways: The study contributes to a more nuanced understanding of screen‐sharing affordances while underscoring learner‐led screensharing as a focus for future research and practice. Lay Description: What is already known about this topic: Screen‐sharing technologies are becoming commonplace in many contemporary educational settings.The technologies represent integrated systems that enable functions such as mirroring, video streaming, online polls, real‐time editing, screen‐capturing and learner analytics.Screen‐sharing is indirectly examined in several studies with findings indicating improvements in group awareness, emotional engagement, learner confidence to share ideas and teachers' visualization of concepts.Existing findings are largely anecdotal and there are very few studies that have focused directly on screen‐sharing affordances. What this paper adds: An empirical study directly examining teachers' first‐hand perspectives of using screen‐sharing technologies.Benefits relate to greater task focus, deeper thinking, improvements to teaching practice and ease of sharing content.A minority of teachers experienced issues such as technical problems, inappropriate sharing and distraction.Mobility was recognized as a key affordance though remained underutilized by many teachers. Implications for practice and/or policy: Professional learning accompanying the use of screen‐sharing technologies can support teachers to take advantage of all features of screen sharing such as enhanced teacher mobility.Institutions need to provide requisite technical and professional support for teachers to effectively and reliably leverage screen‐sharing in the classroom.There is a need to explore teacher's and learner's screen‐sharing uses in situ to more fully understand issues and possibilities. [ABSTRACT FROM AUTHOR]

Background: There is a lack of critical or empirical work interrogating the nature and purpose of evaluating technology use in education. Objectives: In this study, we examine the values underpinning the evaluation of technology use in education through field specialist perceptions. The study also poses critical reflections about the rigour of evaluation instruments development in the educational technology field. Method: A total of 48 domain specialists were surveyed to investigate the face and content validity of 39 items under eight constructs, with both qualitative and quantitative data from the survey analysed. Results: There was an alignment between the constructs that the specialists felt were important and the constructs that have typically been the focus of empirical studies, with field specialists indicating high relevance scores for technology (M = 3.24/4), learning outcomes (M = 3.20/4), affective elements (M = 3.19/4), behaviour (M = 3.15/4), presence/community (M = 3.07/4), teaching/pedagogy (M = 3.01/4), design (M = 2.96/4), and institutional environment (M = 2.86/4). Only a minority of other studies were found to perform face and content validity checks and even then only with small samples of respondents (usually n ≤ 5). Implications: Specialists in educational technology research confirm that all eight dimensions are important to consider when evaluating the use of technology in education. Thorough face and content validity processes should be adopted when developing educational technology evaluation instruments. Further work has validated an eight factor 28 item instrument for evaluating the use of technology in education using a large sample of students from a global open learning online course. Lay Description: What is already known about this topic: Comprehensive evaluation of technology use is essential to make decisions on learning technology strategies.There is a lack of critical work interrogating how technology use is evaluated in education.There is a need for developing evaluation instruments in the educational technology field. What this paper adds: An examination of 48 field specialist perceptions of important constructs when evaluating technology use in education.Field specialists agreed that eight constructs identified in empirical studies were relevant to educational technology evaluation.Evidence of limited face and content validation processes based on previous empirical work.A comprehensive 39‐item instrument for evaluating technology use in education. Implications of study findings for practitioners: Adopt a broad range of constructs when evaluating the use of technology in education.Apply face and content validation processes involving a large sample of experts.Consider using the 39‐item instrument to evaluate educational technology use. [ABSTRACT FROM AUTHOR]

We found that cirrhosis patients were more likely to have most types of pain, suggesting that they may have higher rates of pain and/or opioid dependence than patients without cirrhosis, perhaps related to concurrent psychiatric comorbidities and substance use disorders. Cirrhosis patients have high rates of chronic pain, yet providers often struggle to manage pain in this population due to risks associated with multiple classes of analgesics.[1] Opioids, in particular, are thought to exacerbate hepatic encephalopathy, and experts typically recommend dose reduction or complete avoidance in this population.[2] Despite these recommendations, we found that cirrhosis inpatients were more likely to receive opioids than inpatients without cirrhosis.[3] In the present study, we analyzed detailed clinical data from a large contemporary cohort of Veterans on long-term opioid therapy (LTOT), with and without cirrhosis, in an effort to better understand patient characteristics and analgesic prescribing patterns among cirrhosis patients on LTOT. In the present study of Veterans on LTOT, however, we found the opposite to be true: cirrhosis patients were I more i likely to receive high-dose opioids than patients without cirrhosis. [Extracted from the article]

INTRODUCTION We developed the strength training intervention (STRIVE), a home-based exercise program targeting physical function in patients with cirrhosis. In this pilot study, we aimed to evaluate the safety and efficacy of STRIVE. METHODS Eligible were adult patients with cirrhosis at 3 sites. Patients were randomized 2:1-12 weeks of STRIVE, a 30-minute strength training video plus a health coach or standard of care (SOC). Physical function and quality of life were assessed using the Liver Frailty Index (LFI) and Chronic Liver Disease Questionnaire (CLDQ), respectively. RESULTS Fifty-eight and 25 were randomized to STRIVE and SOC arms, respectively: 43% women, median age was 61 years, MELDNa, Model for End-Stage Liver Disease Sodium was 14, and 54% were Child-Pugh B/C. Baseline characteristics were similar in the STRIVE vs SOC arms except for rates of hepatic encephalopathy (19 vs 36%). LFI @ 12 weeks was available in 43 STRIVE and 20 SOC participants. After 12 weeks, the median LFI improved from 3.8 to 3.6 (ΔLFI -0.1) in the STRIVE arm and 3.7 to 3.6 (ΔLFI -0.1) in the SOC arm (P = 0.65 for ΔLFI difference). CLDQ scores improved from 4.6 to 5.2 in STRIVE participants (ΔCLDQ 0.38) and did not change in SOC participants (4.2-4.2; ΔCLDQ -0.03) (P = 0.09 for ΔCLDQ difference). One patient died (SOC arm) of bleeding. Only 14% of STRIVE participants adhered to the strength training video for 10-12 weeks. No adverse events were reported by STRIVE participants. DISCUSSION STRIVE, a home-based structured exercise program for patients with cirrhosis, was safely administered at 3 sites, but adherence was low. Although all participants showed minimal improvement in the LFI, STRIVE was associated with a substantial improvement in quality of life. [ABSTRACT FROM AUTHOR]

Purpose Clinical controversy regarding the most appropriate antithrombotic regimen after transcatheter aortic valve replacement remains. Current evidence, guidelines, and recommendations are discussed. Summary Antithrombotic selection following transcatheter aortic valve replacement depends on a variety of patient-specific factors. For patients without a preexisting indication for anticoagulation, initial trials employed dual antiplatelet therapy as the postprocedural therapy of choice. Newer studies in this patient population, however, suggest single antiplatelet therapy reduces bleeding events without sacrificing ischemic protection. In patients with a preexisting indication for anticoagulation, warfarin plus single antiplatelet therapy, as opposed to triple antithrombotic therapy, offered similar ischemic protection while reducing clinically significant bleeding. Warfarin monotherapy was associated with a further reduction in bleeding events. One trial demonstrated the safety and efficacy of using apixaban in patients with concomitant atrial fibrillation; however, routine use of rivaroxaban increased adverse cardiac and bleeding events, leaving the utility of direct-acting oral anticoagulants in question. Conclusion Available evidence and current guidelines point to a lack of consensus regarding antithrombotic selection after transcatheter aortic valve replacement. Patient-specific factors and comorbidities must be considered when tailoring therapy, with an emphasis on balancing thrombotic and bleeding risks. [ABSTRACT FROM AUTHOR]

To date, studies evaluating the association between frailty and mortality in patients with cirrhosis have been limited to assessments of frailty at a single time point. We aimed to evaluate changes in frailty over time and their association with death/delisting in patients too sick for liver transplantation. Adults with cirrhosis, listed for liver transplantation at 8 US centers, underwent ambulatory longitudinal frailty testing using the liver frailty index (LFI). We used multilevel linear mixed-effects regression to model and predict changes in LFI (ΔLFI) per 3 months, based on age, gender, model for end-stage liver disease (MELD)-Na, ascites, and hepatic encephalopathy, categorizing patients by frailty trajectories. Competing risk regression evaluated the subhazard ratio (sHR) of baseline LFI and predicted ΔLFI on death/delisting, with transplantation as the competing risk. We analyzed 2,851 visits from 1,093 outpatients with cirrhosis. Patients with severe worsening of frailty had worse baseline LFI and were more likely to have non-alcoholic fatty liver disease, diabetes, or dialysis-dependence. After a median follow-up of 11 months, 223 (20%) of the overall cohort died/were delisted because of sickness. The cumulative incidence of death/delisting increased by worsening ΔLFI group. In competing risk regression adjusted for baseline LFI, age, height, MELD-Na, and albumin, a 0.1 unit change in ΔLFI per 3 months was associated with a 2.04-fold increased risk of death/delisting (95% CI 1.35–3.09). Worsening frailty was significantly associated with death/delisting independent of baseline frailty and MELD-Na. Notably, patients who experienced improvements in frailty had a lower risk of death/delisting. Our data support the longitudinal measurement of frailty, using the LFI, in patients with cirrhosis and lay the foundation for interventional work aimed at reversing frailty. Frailty, as measured at a single time point, is predictive of death in patients with cirrhosis, but whether changes in frailty over time are associated with death is unknown. In a study of over 1,000 patients with cirrhosis who underwent frailty testing, we demonstrate that worsening frailty is strongly linked with mortality, regardless of baseline frailty and liver disease severity. Notably, patients who experienced improvements in frailty over time had a lower risk of death/delisting. Our data support the longitudinal measurement of frailty in patients with cirrhosis and lay the foundation for interventional work aimed at reversing frailty. • In patients with cirrhosis, changes in frailty were significantly associated with death/delisting. • Patients with cirrhosis who experienced improvements in frailty over time had a lower risk of death/delisting. • Our data support the longitudinal measurement of frailty in patients with cirrhosis. • This study lays the foundation for interventional work aimed at reversing frailty. [ABSTRACT FROM AUTHOR]

Because the educational technology research literature is so broad, it is difficult for researchers to acquire an accurate sense of the issues and trends across the entire field. There has not been any recent effort to synthesize or critically analyse the systematic reviews in the area of educational technology. This study analysed 73 systematic literature reviews, including meta‐analyses, focused on the evaluation of technology in educational contexts, in order to holistically understand the impact of learning technology use across different aspects of evaluation. Among these reviews, the most common theme examined was learning outcomes (89%), followed by affective elements (45%), behaviours (25%), technological elements (21%) and teaching/pedagogical aspects (19%). Most of the reviews found that the use of technology improved learning outcomes and affective perceptions. Approaches involving interaction, gamification, constructivism, student‐centred learning and feedback were most effective. The analysis highlighted the need for more reviews focusing on multiple aspects of learning technology evaluation, on school level education and on the use of technology in naturalistic (non‐interventional) settings. Critical reflections are also cast on the methods used to conduct systematic reviews in the educational technology field. Lay Description: What is already known about this topic Systematic literature reviews are often used to understand trends in specific areas of educational technology research and evaluation.There has not been any recent effort to synthesis or critically analyse the reviews in areas of educational technology research. What this paper adds A critical analysis of 73 systematic reviews to understand trends in learning technology evaluation.Technology use consistently improves outcomes across reviews of different learning domains, technologies, and levels.Approaches involving interaction, gamification, constructivism, student‐centred learning and feedback were most effective.The majority of systematic reviews did not evaluate the quality of the primary papers which they examined. Implications of study findings for practitioners Educators should preference approaches that are constructivist, social, gamified, student‐centred and involving feedback.Educators should strive to evaluate the quality of the papers they review as well as multiple aspects of learning.The more detailed findings of this paper will enable educators to adopt a more nuanced approach to their practice. [ABSTRACT FROM AUTHOR]

• K155M stabilizes V1V2 β-strand conformation relevant to broad antibody recognition. • β-strand stabilized V1V2 immunogens elicit antibody responses with greater cross-reactivity. • Fine-tuning immunogen conformation modulates immunogenicity. Antibodies against the HIV-1 V1V2 loops were the only correlate of reduced infection risk in the RV144 vaccine trial, highlighting the V1V2 loops as promising targets for vaccine design. The V1V2 loops are structurally plastic, exhibiting either an α-helix-coil or β-strand conformation. V1V2-specific antibodies may thus recognize distinct conformations, and an antibody's conformational specificity can be an important determinant of breadth and function. Restricting V1V2 conformational plasticity in an immunogen may thus provide control over the conformational specificity and quality of a vaccine-elicited antibody response. Previously, we identified a V1V2 sequence variant (K155M) that results in enhanced recognition by cross-reactive antibodies recognizing the β-strand conformation. Here, we relate V1V2 antigenicity to immunogenicity by comparing the immunogenicity profiles of wildtype and K155M immunogens in two mouse models. In one model, immunization with gp70 V1V2 K155M but not wildtype elicited antibody responses that were cross-reactive to a panel of heterologous gp120 and gp140 antigens. In a second model, we compared the effect of K155M on immunogenicity in the context of gp70 V1V2, gD V1V2 and gp120, examining the effects of scaffold, epitope-focusing and immunization regimen. K155M variants, especially in the context of a gp120 immunogen, resulted in more robust, durable and cross-reactive antibody responses than wildtype immunogens. Restriction of the β-stranded V1V2 conformation in K155M immunogens may thus be associated with the induction of cross-reactive antibody responses thought to be required of a protective HIV-1 vaccine. [ABSTRACT FROM AUTHOR]

Abstract There are a large variety of methodologies, contexts and perspectives that have been used to evaluate the use of technology in education. The vast array of literature involving learning technology evaluation makes it challenging to acquire an accurate sense of the different aspects of learning that are evaluated, and the possible approaches that can be used to evaluate them. This study conducted a systematic review of how technology use in education has been evaluated, based on 365 papers published in Computers and Education between 2015 and 2017. The papers analyzed encompassed a diverse range of education levels, disciplines and technologies, that were broadly commensurate with characterizations of the learning technology field from other studies. The analysis found that the evaluation of learning technology use tended to focus on eight themes: learning outcomes, affective elements, behaviors, design, technology elements, pedagogy, presence, and institutional environment. In the majority of studies (66.6%) at least one established instrument was used to evaluate the effectiveness of learning technology usage, however, a wide variety of instruments were observed within sub-themes of evaluation. The 22 instruments used to evaluate an aspect of learning technology usage in more than one study are identified. Evaluation trends for different disciplines, technologies and educational levels are also established. The findings provide an analytical framework that educators and researchers can utilize when evaluating the use of technology in education, and could potentially inform the development of new, more holistic and more robust evaluation methods. Highlights • Eight foci of learning technology evaluations emerged from a systematic review. • The main foci were learning outcomes, affective elements, behaviors and design. • Of the 365 papers analyzed, 66.6% used at least one instrument from a prior study. • The 22 instruments used in multiple studies to evaluate sub-categories are reported. • The results assist learning technology evaluation and characterize the field. [ABSTRACT FROM AUTHOR]

Rates of seclusion vary across New Zealand's publicly funded district health board (DHB) adult mental health inpatient services as indicated by national data. Anecdotally, this variation has been attributed to a range of factors directly relating to the people admitted to acute inpatient services. This study examined the extent to which variation in seclusion rates could be explained by the sociodemographic and clinical differences between populations admitted into adult mental health inpatient services. Retrospective data were obtained from the Programme for the Integration of Mental Health Data (PRIMHD). A logistic regression model was fitted to these data, with seclusion (yes/no) as the dependent variable and DHB groups as the independent variable. The DHBs were classified into four groups based on their seclusion rates. The model adjusted for ethnicity, age, number of bed nights, total Health of the Nation Outcome Scales (HoNOS) scores, and compulsory treatment status. Odds ratios remained virtually unchanged after adjustment for sociodemographic and clinical factors. People admitted to DHB Group 4 (highest secluding DHBs) were 11 times more likely to be secluded than people in Group 1 (lowest secluding DHBs), adjusted OR = 11.1, 95% CI [7.5,16.4], P < 0.001. Results indicate DHB variation in seclusion rates cannot be attributed to the sociodemographic and clinical factors of people admitted into DHB adult mental health inpatient services. Instead, this variation may be explained by differences in service delivery models and practice approaches. A model of system improvements aimed at reducing seclusion is discussed. [ABSTRACT FROM AUTHOR]

The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug‐taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self‐injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de‐escalation techniques, reduction tools, trauma‐informed care, and consulting with consumers and whānau. [ABSTRACT FROM AUTHOR]

Summary: Cirrhosis is associated with hormonal dysregulation, as evidenced by secondary amenorrhoea in reproductive‐aged women, and feminization of cirrhotic men. Whether hormone levels vary by severity of cirrhosis in women is not known. If identified, such changes may have important clinical relevance, particularly, as low sex hormone binding globulin (SHBG) and follicle stimulating hormone (FSH) are known to promote metabolic and cardiovascular disease in women. In a cohort of post‐menopausal women with chronic hepatitis C virus (HCV) infection, we compared comprehensive sex hormone levels by presence of cirrhosis, as well as across Child‐Turcotte‐Pugh (CTP) class. Results: There were n = 18 cirrhotic and n = 21 noncirrhotic women with a median age of 57 years (interquartile range [IQR] 53‐62). Compared to noncirrhotics, cirrhotic women had higher oestradiol (11.0 vs 6.0 pg/mL, P = 0.05) and oestrone levels (32.0 vs 8.0 ng/mL, P < 0.001), and lower sex hormone binding globulin (SHBG) (69.2 vs 155.6 nmol/L, P = 0.001), and FSH levels (4.9 vs 89.6 mIU/mL, P < 0.001). Among cirrhotic women, there was a progressive decline in FSH and SHBG and concurrent rise in oestrone levels from CTP class A to C (test of trend, P values ≤0.02). Cirrhosis is associated with lower FSH and SHBG levels in cirrhotic compared to noncirrhotic women with HCV infection. In cirrhotic women, these levels demonstrate steady decline by disease severity. Given known associations of low SHBG and FSH with cardio‐metabolic disease, the clinical implications of hormonal changes by cirrhosis severity in HCV‐infected women warrants investigation. [ABSTRACT FROM AUTHOR]

Background: Impaired physical capacity increases peri-liver transplant complications. Patient perceptions regarding exercise prior to transplantation are not known.Aims: This study aimed to assess patient and caregiver activity levels, perceptions of willingness to exercise, and of provider advice.Methods: Consecutive patients listed for liver transplant and caregivers presenting for routine outpatient visits were evaluated over a 3-month interval. Anonymous surveys adapted to patients and caregivers addressed the importance and safety of exercise, type and duration of exercise performed, barriers, willingness to wear a monitoring device, and perceived provider recommendations. Responses were logged on a Likert scale from 1 to 5.Results: Three hundred and sixty-eight responses were received. Most participants perceived exercise as important. Patients exercised three times per week for 30 min. Eighty percent endorsed walking (median response: 2-agree; IQR 1-2). Most did not jog, swim, cycle, or strength train. Fatigue, reported by 70%, was the major barrier (2, IQR 1-3). Over 90% of caregivers endorsed exercise as important (1-strongly agree, IQR 1-2) and encouraged exercise (median response 2, IQR 1-2). Over 60% of patients (median response 2, IQR 1-3) and caregivers (median response 2, IQR 2-3) felt providers encouraged exercise.Conclusions: Patients and caregivers are willing to exercise to optimize physical fitness prior to liver transplantation. [ABSTRACT FROM AUTHOR]

Structure-based approaches to antigen design utilize insights from antibody (Ab):antigen interactions and a refined understanding of protective Ab responses to engineer novel antigens presenting epitopes with conformations relevant to eliciting or discovering protective humoral responses. For human immunodeficiency virus-1 (HIV-1), one model of protection is provided by broadly neutralizing Abs (bnAbs) against epitopes present in the closed prefusion trimeric conformation of HIV-1 envelope glycoprotein, such as the variable loops 1-2 (V1V2) apex. Here, computational design and directed evolution yielded a novel V1V2 sequence variant with potential utility for inclusion in an immunogen for eliciting bnAbs, or as an epitope probe for their detection. The computational design goal was to engineer a minimal single-chain antigen with three copies of the V1V2 loops to support maintenance of closed prefusion V1V2 trimeric conformation and presentation of bnAb epitopes. Via directed evolution of this computationally designed single-chain antigen, we isolated a V1V2 sequence variant that in monomeric form exhibited preferential recognition by quaternary-preferring and conformation-dependent mAbs. Structural context and transferability of this phenotype to V1V2 sequences from all strains of HIV-1 tested suggest a conformation-stabilizing effect. This example demonstrates the potential utility of computational design and directed evolution-based protein engineering strategies to develop minimal, conformation-stabilized epitope-specific antigens. [ABSTRACT FROM AUTHOR]

This national survey sought to determine the practices and policies pertaining to opioid and opioid substitution therapy (OST) use in the selection of liver transplant (LT) candidates. Of 114 centers, 61 (53.5%) responded to the survey, representing 49.2% of the LT volume in 2016. Only two programs considered chronic opioid (1 [1.6%]) or OST use (1 [1.6%]) absolute contraindications to transplant, while 63.9% and 37.7% considered either one a relative contraindication, respectively. The majority of programs did not have a written policy regarding chronic opioid use (73.8%) or OST use (78.7%) in LT candidates. Nearly half (45.9%) of centers agreed that there should be a national consensus policy addressing opioid and OST use. The majority of responding LT centers did not consider opioid or OST use in LT candidates to be absolute contraindications to LT, but there was significant variability in center practices. These surveys also demonstrated a lack of written policies in the assessment of the candidacy of such patients. The results of our survey identify an opportunity to develop a national consensus statement regarding opioid and OST use in LT candidates to bring greater uniformity and equity into the selection of LT candidates. [ABSTRACT FROM AUTHOR]

Teacher professional learning workshops have been frequently used to prepare in-service and pre-service teachers for effective use of technology in education. Evaluation of these workshops is crucial to identify the effectiveness of these programmes in terms of improving teaching skills, increasing knowledge, changing attitudes, and developing capabilities which support the achievement of student learning outcomes. Multiple approaches for evaluating professional development programmes have been developed, though each with different emphases and theoretical positioning. In this systematic review, 41 research-oriented teacher professional development workshops on technology use were critically analysed to understand how such workshops are evaluated. This study examines content evaluation, instrument types, and common professional development frameworks in teacher professional development workshops and reports on their usage and alignment. Based on the findings, the majority of papers in the systematic review did not deploy comprehensive professional development evaluation models to assess teacher professional development workshops. The majority of studies did not report on the use of established instruments for the purposes of data collection. It was further observed that the majority of these studies did not attempt to evaluate different dimensions of teacher change or different dimensions related to evaluation. [ABSTRACT FROM AUTHOR]

The fact that patients with IDD are systematically excluded from transplant waitlists again reveals a concerning opacity in listing decisions and the policies governing transplant candidacy evaluations. This is just one example of how the transplant evaluation process leads to the systematic exclusion of certain groups of people from receiving a potentially lifesaving transplant. Comment & Response B In Reply b We read with great interest the Letter to the Editor by Mr Kumar in response to our Viewpoint,[1] which highlighted that the financial evaluation conducted as part of transplant candidacy evaluation is unjust and perpetuates racial and socioeconomic disparities in health outcomes. [Extracted from the article]

Background: Second-generation direct-acting antiviral agents are integral to treatment of hepatitis C (HCV) infection. Eight-week courses of ledipasvir/sofosbuvir (LDV/SOF) have been supported in some studies, but data are limited on efficacy in real-world use. Controversy exists regarding applicability of clinical trials to real-world effectiveness. We report virologic responses of patients with HCV genotype 1 infection receiving LDV/SOF for 8 or 12 weeks in a large integrated healthcare system. Methods: All patients receiving LDV/SOF, without ribavirin, were identified from pharmacy records, and outcomes are reported. Only treatment-naïve patients without evidence of cirrhosis and hepatitis C viral load less than 6 million IU/ml were candidates for 8-week therapy. Treatment was at clinician discretion, but delivered by a multidisciplinary team and reviewed for appropriateness and adherence to these criteria by one of the authors, all experienced in hepatitis C treatment. Sustained viral response at 12 weeks (SVR 12) was contrasted between those receiving 8 and those receiving 12 weeks of treatment. Results: Completed prescriptions for LDV/SOF, without ribavirin, as of 30 September 2015 were identified in 1021 patients. Five patients discontinued therapy due to medical reasons and 35 had incomplete follow-up viral load data, thus there were 981 evaluable patients: 377 treated for 8 weeks and 604 treated for 12 weeks. SVR 12 was virtually identical at 93.6 and 93.5%, respectively. Baseline characteristics differed between the two groups, as only treatment-naïve, non-cirrhotic, non-HIV-infected patients were eligible for an 8-week course of therapy. Conclusions: Eight-week courses of LDV/SOF are comparable to 12-week courses in real-world use among selected patients supported by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

This Viewpoint demonstrates that the financial measures used to place patients on the transplant waiting list is an example of structural racism and offers 3 policy shifts to address those inequities. [ABSTRACT FROM AUTHOR]

Background & Aims Current clinical assays for total 25-hydroxy ( OH) vitamin D measure vitamin D bound to vitamin D-binding protein ( DBP) and albumin plus unbound ('free') D. We investigated the relationship between total and free 25( OH)D with bone metabolism markers in normal (>3.5 g/dl) vs. low (≤3.5 g/dl) albumin cirrhotics. Methods Eighty-two cirrhotics underwent measurement of free and total 25( OH)D by immunoassay, DBP and markers of bone metabolism [intact parathyroid hormone ( iPTH), C-telopeptide ( CTX), bone-specific alkaline phosphatase ( BSAP), osteocalcin, amino-terminal pro-peptide of type 1-collagen (P1 NP)]. Pearson's coefficients assessed relevant associations. Results Cirrhotics with low ( n = 54) vs. normal ( n = 28) albumin had lower total 25( OH)D (12.1 vs. 21.7 ng/ml), free 25( OH)D (6.2vs.8.6 pg/ml) and DBP(91.4 vs. 140.3 μg/ml) [ P < 0.01 for each]. iPTH was similar in low and normal albumin groups (33 vs. 28 pg/ml; P = 0.38), although serum CTX(0.46vs.0.28 ng/ml) and BSAP(31.7 vs. 24.8 μg/L) were increased ( P < 0.01). An inverse relationship was observed between total 25( OH)D and iPTH in normal ( r = −0.47, P = 0.01) but not low albumin cirrhotics ( r = 0.07, P = 0.62). Similar associations were seen between free 25( OH)D and iPTH(Normal: r = −0.46, P = 0.01; Low: r = −0.03, P = 0.84). BSAP, osteocalcin and P1 NP were elevated above the normal range in all cirrhotics but not consistently associated with total or free 25(OH)D. Conclusions Cirrhotics with low vs. normal albumin have lower levels of DBP, total and free 25( OH)D. The expected relationship between total or free 25( OH)D with iPTH was observed in normal but not in low albumin cirrhotics, demonstrating that total 25( OH)D is not an accurate marker of bioactive vitamin D status in cirrhotics with synthetic dysfunction. Additional investigation into the role of vitamin D supplementation and its impact on bone mineral homoeostasis in this population is needed. [ABSTRACT FROM AUTHOR]

Background & Aims The US liver allocation system effectively prioritizes most liver transplant candidates by disease severity as assessed by the Model for End-Stage Liver Disease ( MELD) score. Yet, one in five dies on the wait-list. We aimed to determine whether clinician assessments of health status could identify this subgroup of patients at higher risk for wait-list mortality. Methods From 2012-2013, clinicians of all adult liver transplant candidates with laboratory MELD≥12 were asked at the clinic visit: 'How would you rate your patient's overall health today (0 = excellent, 5 = very poor)?' The odds of death/delisting for being too sick for the transplant by clinician-assessment score ≥3 vs. <3 were assessed by logistic regression. Results Three hundred and forty-seven liver transplant candidates (36% female) had a mean follow-up of 13 months. Men differed from women by disease aetiology (<0.01) but were similar in age and markers of liver disease severity ( P > 0.05). Mean clinician assessment differed between men and women (2.3 vs. 2.6; P = 0.02). The association between clinician-assessment and MELD was ρ = 0.28 ( P < 0.01). 53/347 (15%) died/were delisted. In univariable analysis, a clinician-assessment score ≥ 3 was associated with increased odds of death/delisting (2.57; 95% CI 1.42-4.66). After adjustment for MELD and age, a clinician-assessment score ≥ 3 was associated with 2.25 (95% CI 1.22-4.15) times the odds of death/delisting compared to a clinician-assessment score < 3. Conclusions A standardized clinician assessment of health status can identify liver transplant candidates at high risk for wait-list mortality independent of MELD score. Objectifying this 'eyeball test' may inform interventions targeted at this vulnerable subgroup to optimize wait-list outcomes. [ABSTRACT FROM AUTHOR]

Background: Whether chronic HCV, a disease characterized by systemic inflammation, impacts bone mineral density (BMD) independent of cirrhosis is unknown. Aim: We aimed to evaluate the association between BMD, systemic inflammation, and markers of bone turnover in chronic HCV without cirrhosis. Methods: Non-cirrhotics, 40-60 years old, with chronic HCV underwent measurement of: (1) BMD by dual-energy X-ray absorptiometry scan and (2) serum markers of systemic inflammation and bone turnover. By Chi-squared or t test, we compared those with normal versus low BMD. Results: Of the 60 non-cirrhotics, 53 % were female and 53 % Caucasian. Mean (SD) age was 53.3 years (5.7), total bilirubin 0.7 mg/dL (0.3), creatinine 0.8 mg/dL (0.2), and body mass index 28.4 kg/m (6.5). Low BMD was observed in 42 %: 30 % had osteopenia, 12 % had osteoporosis. Elevated tumor necrosis factor α, interleukin-6, and C-reactive protein levels were found in 26, 32, and 5 %, respectively, but did not differ by BMD group ( p > 0.05). Patients with low BMD had higher serum phosphorus (4.1 vs. 3.5 mg/dL) and pro-peptide of type 1 collagen (P1NP; 73.1 vs. 47.5 ng/mL) [ p < 0.05], but similar bone-specific alkaline phosphatase, serum C-telopeptide, and parathyroid hormone levels. Conclusions: Low BMD is prevalent in 40- to 60-year-old non-cirrhotics with chronic HCV, but not associated with systemic inflammatory markers. Elevated P1NP levels may help to identify those at increased risk of bone complications in this population. Chronic HCV should be considered a risk factor for bone loss, prompting earlier BMD assessments in both men and women. [ABSTRACT FROM AUTHOR]

Background Attacks of neuropathic pain, usually abdominal, are characteristic of the acute porphyrias and accompanied by overproduction of heme-precursor molecules, specifically delta-aminolevulinic acid and porphobilinogen. The basis for the acute symptoms in these diseases has been speculative. Methods We review genetic acute porphyria, hereditary tyrosinemia, and an acquired condition, lead poisoning. All perturb heme synthesis and present with a similar pain syndrome. Results Although each of these conditions has characteristic urine biochemistry, all exhibit excess delta-aminolevulinic acid. Moreover, in all, treatment with hemin reduces delta-aminolevulinic acid and relieves symptoms. In contrast, use of recombinant porphobilinogen deaminase to knock down porphobilinogen in acute porphyria was ineffective. Conclusions There is now convincing evidence that delta-aminolevulinic acid is the cause of pain in the acute porphyrias. The efficacy of hemin infusion is due mainly, if not entirely, to its inhibition of hepatic delta-aminolevulinic acid synthase-1, the enzyme that catalyzes delta-aminolevulinic acid formation. Delta-aminolevulinic acid synthase-1 is a rational target for additional therapies to control symptoms in acute porphyria. [ABSTRACT FROM AUTHOR]

Soy is the major source of dietary exposure to isoflavonoids (IFLs). Accumulating evidence supports a role for soy and IFLs in the protection against many chronic diseases including cancer. After soy intake we found a biphasic IFL appearance pattern in plasma as well as in urine that we suggest to be due to IFL absorption in the small intestine (ca. 10%) during the first 2 h after intake and IFL absorption in the large intestine (ca. 90%) 4–6 h after intake. While each IFL disappears from the circulation at different times excellent correlations between urinary and circulating IFL values were discovered and algorithms to convert urinary excretion values into circulating levels were established. We suggest the term ‘apparent bioavailability’ when using urinary data to describe IFL exposure. The IFL bioavailability was found to be influenced by gut bacteria, oral antibiotic treatment (OABX), and an individual’s age and health status. While daidzein (DE) and genistein start to be absorbed minutes after intake, equol (EQ) appears in plasma only after a minimum of 8 h following soy intake owing to the required transit time of DE to the colon where the conversion of DE to EQ takes place by intestinal microbiota. We have also shown that the apparent IFL bioavailability is higher in children than adults, higher in healthy versus non-healthy individuals, and decreased in children but increased in adults during OABX. Finally, we propose to use a urinary EQ/DE ratio of 0.018 with a DE threshold to identify EQ producers. With this cutoff definition we observed that EQ production is inconsistent over time in 5–30% of both premenopausal and postmenopausal women. [ABSTRACT FROM AUTHOR]

Highlights: [•] Low dose X-irradiation from computer tomography alters plasma antioxidants in vivo. [•] Strongest predictors for post-CT plasma micronutrient changes were baseline levels. [•] Plasma antioxidants may protect against damage from X-rays during clinical CT scans. [ABSTRACT FROM AUTHOR]

Understanding the coordination between humoral and cellular immune responses may be the key to developing protective vaccines, and because genetic studies of long-term HIV-1 nonprogressors have associated specific HLA-B alleles with spontaneous control of viral replication, this subject group presents an opportunity to investigate relationships between arms of the adaptive immune system. Given evidence suggesting that cellular immunity may play a role in viral suppression, we sought to determine whether and how the humoral immune response might vary among controllers. Significantly, Fc-mediated antibody effector functions have likewise been associated with durable viral control. In this study, we compared the effector function and biophysical features of HIV-specific antibodies in a cohort of controllers with and without protective HLA-B alleles in order to investigate whether there was evidence for multiple paths to HIV-1 control, or whether cellular and humoral arms of immunity might exhibit coordinated profiles. However, with the exception of IgG2 antibodies to gp41, HLA status was not associated with divergent humoral responses. This finding did not result from uniform antibody responses across subjects, as controllers could be regrouped according to strong differences in their HIV-specific antibody subclass specificity profiles. These divergent antibody profiles were further associated with significant differences in nonneutralizing antibody effector function, with levels of HIVspecific IgG1 acting as the major distinguishing factor. Thus, while HLA background among controllers was associated with minimal differences in humoral function, antibody subclass and specificity profiles were associated with divergent effector function, suggesting that these features could be used to make functional predictions. Because these nonneutralizing antibody activities have been associated with spontaneous viral control, reduced viral load, and nonprogression in infected subjects and protection in vaccinated subjects, understanding the specific features of IgGs with potentiated effector function may be critical to vaccine and therapeutic antibody development. IMPORTANCE In this study, we investigated whether the humoral and cellular arms of adaptive immunity exhibit coordinated or compensatory activity by studying the antibody response among HIV-1 controllers with different genetic backgrounds. [ABSTRACT FROM AUTHOR]

Highlights: [•] Interest in lipid-phase antioxidants has resulted in the growth of new analytical techniques. [•] New developments in HPLC-based assays for multiple analyte determinations using serum or plasma. [•] Blood levels for selected analytes from the last 15years of healthy cord blood, children and adults. [Copyright &y& Elsevier]

Abstract: Equol (EQ) is produced by intestinal bacteria from the soy isoflavone daidzein (DE) in 30%–60% of the population and is believed to provide benefits from soy intake. A robust EQ status definition is lacking, and it is uncertain whether EQ is formed consistently within an individual and ceases upon oral antibiotic treatment. In a randomized, double-blind, placebo-controlled soy intervention trial with 350 postmenopausal women, DE and EQ were analyzed by liquid chromatography/tandem mass spectrometry at baseline and every 6 months over 2.5 years in overnight urine, spot urine and plasma. Equol production changes and status (remaining an EQ producer or nonproducer or changing towards an EQ producer or nonproducer) were assessed. Equol status was determined most dependably by overnight urine applying as cutoff a ratio of EQ/DE≥0.018 with a DE threshold ≥2 nmol/mg creatinine: the soy and placebo groups had approximately 30% consistent EQ producers during the study, but 14% and 35%, respectively, changed EQ status (mean 1.4–1.7 times), while 27% and 17%, respectively, had antibiotic treatment (P<.01 for inverse association). No significant trend in change of EQ production or status was observed when overnight urine was limited to collections closest to before and after antibiotic treatment. Similarly, antibiotic type or class, duration, dose or time between antibiotic treatment and overnight urine collection showed no consistent influence on EQ production. Equol production can markedly change intraindividually over 2.5 years, and antibiotic treatment impacts it inconsistently. Factors other than antibiotic treatment must be considered as causes for EQ production changes. [Copyright &y& Elsevier]

Objectives To test whether lower serum uric acid ( UA) levels are associated with longevity independent of renal function. Design Cross-sectional cohort study. Setting Ashkenazi Jewish individuals with exceptional longevity (Longevity Genes Project at Albert Einstein College of Medicine). Participants Long-lived individuals ( LLI) of Ashkenazi Jewish ethnicity (mean age ± standard deviation 97.7 ± 2.9, n = 365), their offspring (mean age ± standard deviation 68.2 ± 8.2, n = 593) and controls (without family history of longevity, mean age ± standard deviation 72.5 ± 9.9, n = 356). Measurements Association between UA levels and estimated glomerular filtration rate ( eGFR) as well as chronic kidney disease ( CKD) stage, and correlation of UA levels of LLI and offspring were determined. Because LLI lack an appropriate control group, UA levels, eGFR, and prevalence of hyperuricemia and CKD stages were compared between offspring and controls. Results Offspring were less likely to have hyperuricemia and had lower UA levels than controls. Despite negative correlation between UA levels and eGFR and positive correlation between UA levels and CKD stages, eGFR and the prevalence of CKD stage III to V were not found to be different between offspring and controls. Furthermore, significant association between UA levels in LLI and their offspring (β estimate 0.1544, 95% confidence interval = 0.08-0.23, P < .001) has been observed. Conclusion Offspring had lower UA levels than controls despite similar renal function, suggesting that other factors such as UA metabolism or renal tubular transport determine UA levels. The association between UA levels and longevity is particularly intriguing because UA levels are potentially modifiable with diet and drugs. [ABSTRACT FROM AUTHOR]

Abstract: Clams are listed on prominent healthcare websites as an excellent source of iron (Fe). However, the amount, type and bioavailability of iron in clam products are poorly understood, as is their content of environmental metals such as aluminum (Al). In this study, live Manila and processed clams were assayed for Fe, Al, and heme-iron content. Results were compared to beef. Relative iron bioavailability was assessed by an in vitro digestion/Caco-2 cell method using FeSO4 as a reference iron source. Inhibitory effects of Al and tea flavonoids on iron bioavailability were also evaluated. Mean iron content expressed as mg/reference amount (RA, 56g edible portion) ranged from 0.57 in minced clams to 17.2mg/RA in whole baby clams; Al ranged from 0.29 to 26.4mg/RA, probably reflecting grit content. Beef contained 3.0mg Fe and 0.07mg Al per RA of 85g. Heme iron was very low in clams (<0.4mg/RA) relative to beef (2.3±0.2mg/RA). One serving (56g) of live or minced clams provided less than one-third as much bioavailable iron as 9.8mg FeSO4; whereas one serving of whole baby clams provided the same amount of bioavailable iron as 9.8mg of FeSO4. Flavonoids reduced iron solubility and bioavailability; Al reduced only iron bioavailability. We conclude that live and minced clams should not be considered good sources of bioavailable iron, and the high Al content of whole baby clams raises concerns about recommending these clams as an iron source. [Copyright &y& Elsevier]

Non-immune human antibody fragment libraries have generated antigen-binding proteins useful as prospective research, imaging, diagnostic and therapeutic agents. However, because the generation of such libraries relies on cloning antibody sequences from the circulating immune repertoire rather than truly naïve, germline sequences, their composition may reflect the deletion of autoreactive sequences, making them less suited for isolating binding clones to human antigens, but perhaps useful in applications where an in vitro handle on representative circulating antibody diversity is desired. Here we demonstrate that a large non-immune human scFv library is relatively depleted of sequences capable of recognizing human antigens as compared with orthologs antigens. Additionally, because this non-naïve, non-immune library may capture a representative section of antibody diversity, we explore its possible utility in conducting early pre-screens to predict the antigenicity of prospective therapeutics and find a correlation between the clinical immunogenicity of a small panel of protein therapeutics with their propensity for interacting with the library. [ABSTRACT FROM PUBLISHER]

This article reports on an experiment that critically tests user preference for an input modality (speech vs. Dual Tone Multiple Frequency[DTMF])in a phone-based message retrieval system. Unlike previous studies that compared these two modalities, the speech system used in this study was a fully functioning natural language system, and participants in this study were working professionals, rather than college students. Results indicate that (a) DTMF was more effective and efficient for linear tasks, whereas speech was better for nonlinear tasks; (b) speech was preferred to DTMF by a majority of users; (c) speech was judged as being more satisfying, more entertaining, and easier to use than DTMF; and (d) user preference for a particular modality was better predicted by user performance in nonlinear tasks rather than linear ones. Possible reasons for users' continuing preference for the speech modality even after experiencing fairly high recognition errors are discussed. Finally, the importance of examining speech user interfaces from other perspectives, in addition to efficiency maximization, is emphasized. The results of this study have theoretical, as well as practical, implications for the design of speech user interfaces and interactive voice response applications. [ABSTRACT FROM AUTHOR]

Although electronic communication plays an important role in the modern workplace, the interruptions created by poorly-timed attempts to communicate are disruptive. Prior work suggests that sharing an indication that a person is currently busy might help to prevent such interruptions, because people could wait for a person to become available before attempting to initiate communication. We present a context-aware communication client that uses the built-in microphones of laptop computers to sense nearby speech. Combining this speech detection sensor data with location, computer, and calendar information, our system models availability for communication, a concept that is distinct from the notion of presence found in widely-used systems. In a 4 week study of the system with 26 people, we examined the use of this additional context. To our knowledge, this is the first-field study to quantitatively examine how people use automatically sensed context and availability information to make decisions about when and how to communicate with colleagues. Participants appear to have used the provided context to as an indication of presence, rather than considering availability. Our results raise the interesting question of whether sharing an indication that a person is currently unavailable will actually reduce inappropriate interruptions. [Copyright &y& Elsevier]

This paper reports on research in workplace issues encountered by knowledge workers in cubicle environments, and on BlueSpace, a prototype workspace with the goal of addressing workers'' critical needs for privacy, concentration and personalization. To inform the design process, more than 50 on-site interviews with knowledge workers were conducted at six companies ranging from dot.com startups to Fortune 100 corporations. Several common requirements emerged including the need for a sense of control of one''s workspace, the ability to create privacy on-demand to improve concentration and minimize unwanted interruptions, as well as in-place support for dyadic interactions. Many other common workplace complaints (e.g. too hot, too cold, too noisy) were found to be derivative of the major requirements for individual control and privacy. [Copyright &y& Elsevier]

The advent of mobile devices and the wireless Internet is having a profound impact on the way people communicate, as well as on the user interaction paradigms used to access information that was traditionally accessible only through visual interfaces. Applications for mobile devices entail the integration of various data sources optimized for delivery to limited hardware resources and intermittently connected devices through wireless networks. Although telephone interfaces arise as one of the most prominent pervasive applications, they present interaction challenges such as the augmentation of speech recognition through natural language (NL) understanding and high-quality text-to-speech conversion. This article presents an experience in building an automated assistant that is natural to use and could become an alternative to a human assistant. The Mobile Assistant (MA) can read e-mail messages, book appointments, take phone messages, and provide access to personal-organizer information. Key components are a conversational interface, enterprise integration, and notifications tailored to user preferences. The focus of the research has been on supporting the pressing communication needs of mobile workers and overcoming technological hurdles such as achieving high accuracy speech recognition in noisy environments, NL understanding, and optimal message presentation on a variety of devices and modalities. The article outlines findings from the 2 broad field trials and lessons learned regarding the support of mobile workers with pervasive computing devices and emerging technologies. [ABSTRACT FROM AUTHOR]

This article explores the application of generative artificial intelligence (GAI) and large language models (LLMs) in the field of gastroenterology and hepatology. It introduces the concept of prompt engineering, which involves optimizing user inputs to guide LLMs in generating desired outputs. The article discusses the goals of prompt engineering, such as task completion and in-context learning, and explains the core elements of a prompt. It also examines different approaches to prompting and the roles of system, user, and assistant in the interaction with LLMs. The article concludes by emphasizing the importance of prompt engineering in improving the performance of LLMs in extracting data from research articles, while acknowledging the limitations of this approach. [Extracted from the article]

Simple Summary: Liver transplantation (LT) is one of the primary treatments for hepatocellular carcinoma (HCC) and significantly improves patient survival. However, the application of LT for HCC faces challenges owing to advancements in cancer-specific treatments and increased patient comorbidities. This review explores the current controversies and advancements in LT for HCC, focusing on managing comorbidities, the impact of frailty, selection criteria, the role of radiology, and the potential use of immunotherapy. We emphasize the importance of immunosuppression management and surveillance for HCC recurrence. A multidisciplinary approach is crucial to optimize the outcomes of patients with HCC undergoing LT, ensuring comprehensive care and improved survival rates. Liver transplantation (LT) remains one of the most effective treatments for hepatocellular carcinoma (HCC) and significantly enhances patient survival. However, the application of LT for HCC faces challenges owing to advancements in cancer-specific treatment modalities and the increased burden of patients' comorbidities. This narrative review explores current controversies and advancements in LT for HCC. Key areas of focus include the management of comorbidities and patient education by advanced practice nurses, impacts of frailty on waitlists and post-LT outcomes, selection criteria for LT in the era of new downstaging tools, role of radiology in patient selection, and implications of potential immunotherapy use both before and after LT. Additionally, the importance of immunosuppression management with strategies aimed at minimizing rejection while considering the risk of HCC recurrence and the role of surveillance for HCC recurrence is highlighted. This review also underscores the importance of a multidisciplinary approach for optimizing outcomes in patients with HCC undergoing LT. [ABSTRACT FROM AUTHOR]

In this review article, we discuss the model for end-stage liver disease (MELD) score and its dual purpose in general and transplant hepatology. As the landscape of liver disease and transplantation has evolved considerably since the advent of the MELD score, we summarise emerging concepts, methodologies, and technologies that may improve mortality prognostication in the future. Finally, we explore how these novel concepts and technologies may be incorporated into clinical practice. [ABSTRACT FROM AUTHOR]

In patients with cirrhosis and chronic liver disease, acute-on-chronic liver failure is emerging as a major cause of mortality. These guidelines indicate the preferred approach to the management of patients with acute-on-chronic liver failure and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation process. In instances where the evidence was not appropriate for Grading of Recommendations, Assessment, Development, and Evaluation, but there was consensus of significant clinical merit, key concept statements were developed using expert consensus. These guidelines are meant to be broadly applicable and should be viewed as the preferred, but not only, approach to clinical scenarios. [ABSTRACT FROM AUTHOR]

Background: Low medication adherence is known to contribute to worse health outcomes in the general population.Aim: We aimed to evaluate the medication regimen and determine the adherence levels among patients with end-stage liver disease.Methods: We measured adherence in patients awaiting liver transplantation at a single center using the 8-item Morisky Medication Adherence Scale (MMAS-8), with a score <8 classified as low adherence. Medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI) tool. Factors associated with low adherence were identified by logistic regression.Results: Of 181 patients, 33% were female, median age was 62, and model for end-stage liver disease (MELD) score was 13. The median (IQR) number of medications was 10 (7-13), and the MRCI was 19 (13-27). In total, 54 (30%) were high adherers, and 127 (70%) were low adherers. In total, 42% reported sometimes forgetting to take their medication and 22% reported intermittent adherence within the past 2 weeks. The most common reasons for low adherence were: forgetfulness (27%) and side effects (14%). Compared to high adherence, low adherence was associated with higher number of medications, medication complexity, and diabetes, but lower rates of hepatocellular carcinoma and self-perceived health. In univariable logistic regression, total medication number (OR 1.08), MRCI (OR 1.04), diabetes (OR 2.38), HCC (OR 0.38), and lower self-perceived health (OR 1.37), were statistically significant factors associated with non-adherence. In multivariate analysis, only medication number without supplements (OR 1.14) remained significantly associated with medication non-adherence.Conclusion: A majority of patients awaiting liver transplantation demonstrated low medication adherence. Total number of medications and regimen complexity were strong correlates of low adherence. Our data underscores the need for chronic liver disease management programs to improve medication adherence in this vulnerable population. [ABSTRACT FROM AUTHOR]