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The influence of family support and psychological capital (PsyCap) is a topical discourse in entrepreneurship studies due to the unsupportive and turbulent environments most entrepreneurs operate in. However, studies concluding on the nature and direction of family support and PsyCap effects on start-up formation appear scant. This study aims to empirically examine family support effects on start-up formation with psychological capital (PsyCap) as a mediation factor. Specific emphasis was given to extended family support. The study utilized the partial least square (PLS) method for hypotheses testing with cross-sectional data collected from 261 randomly sampled trainees in an entrepreneurship training program organized by the Delta State Ministry of Youth Development. The PLS analysis showed that family support (β = 0.317, p = 0.000) and PsyCap (β = 0.202, p = 0.000) have a significant positive effect on start-up formation. The results proved that family support and PsyCap are valuable antecedent factors for positioning entrepreneurs to engage and thrive productively in the start-up formation process. Furthermore, PsyCap did not mediate the significant positive effect of family support on start-up formation (β = 0.235, p = 0.000; β = 0.103, p = 0.052). This result demonstrates that family support may not be enough for PsyCap to transmit its significant positive effect on start-up formation. Hence, there is a need to procure other alternate support from formal or informal settings.

Oxidized organosulfur compounds and, in particular, sulfoxides are of interest as solvents in the semiconductor and pharmaceutical industry, environmental contaminants, and simulants in deactivation of chemical warfare agents. An experimental study is reported of the interaction of porphyrin aluminum metal–organic framework Al-MOF-TCPPH2 (Compound 2) with diethyl sulfoxide (DESO) in pure form and in aqueous solution. First, the suitability of Compound 2 as sorbent in aqueous solution was assessed; namely, its long-term stability (up to 15 days) in liquid water has been investigated at room temperature and under stirring. Here, a novel facile spectroscopic method has been used, a periodic micro-sampling of sorbent from suspension, followed by vacuum mini-filtration and an ex situ time-dependent attenuated total reflection Fourier transform infrared spectroscopy (ATR FT-IR) analysis. Next, the interaction of Compound 2 with pure liquid DESO under ambient conditions was investigated, which yields the stoichiometric adsorption complex (Al-MOF-TCPPH2)1(DESO)2 denoted Compound 3. In this adsorption complex, molecules of DESO interact with the OH group and carboxylate group of the sorbent. Then, the removal of DESO from Compound 3 was assessed, using facile treatment with warm water in the micro Soxhlet apparatus followed by the ATR FT-IR analysis. Finally, Compound 2 was tested in sorption of DESO from diluted aqueous solution. In the initial step, the sorption proceeds very quickly (in <1 min the concentration of DESO decreases by about 20%) followed by a much slower step. The maximum amount of adsorbed DESO corresponds to half of the amount adsorbed from pure DESO as found by the high-performance liquid chromatography–ultraviolet detection method. This adsorbed amount corresponds to 1 mol DESO adsorbate per mol of sorbent. Porphyrin aluminum metal–organic framework Compound 2 is promising for the removal of DESO from diluted aqueous solution, and it is of interest for the removal of similar oxidized organosulfur compounds. [ABSTRACT FROM AUTHOR]

Objective: This study seeks to determine the contribution of government policy and Financial Inclusion (FI) to the financial and non-financial performance of SMEs in South Eastern Nigeria. Research Design & Methods: The study adopts qualitative methodology. The interview guide was pre-tested for reliability and validity. The study data were generated from purposively selected one hundred and twenty respondents. The audio recorded interview was transcribed and subjected to thematic content analysis. Findings: SMEs that received support from the government recorded marginal financial performance and improved non-financial performance. Also, SMEs that adopted FI strategies and devices experienced improvement in both their financial and non-financial performance. However, SMEs that combined government, friends and family supports, and FI strategies and devices recorded better improvements in their financial and non-financial performance. Contribution & Value Added: The combination of government, friends/family supports and FI strategies and devices gives better improvement to the financial and non-financial performance of SMEs in South Eastern Nigeria. Thus, the government can reinvent its policies so as to strengthen its implementing agencies and the families of SME owners. SME owners can achieve better financial and non-financial performance by combining government entrepreneurship incentives, friends/family supports and FI strategies and devices.

Background We aimed to assess the probability and factors associated with the presence of hepatitis C virus (HCV) antibody among HCV seronegative kidney transplant recipients receiving HCV-infected (nucleic acid testing positive) donor kidneys. Methods This is a retrospective review examining HCV antibody seroconversion of all kidney transplant recipients receiving an organ from an HCV-infected donor between 1 March 2018 and 2 December 2019 at a high-volume kidney transplant center in the southeast United States. Results Of 97 patients receiving HCV-infected kidneys, the final cohort consisted of 85 recipients with 5 (5.9%) recipients noted to have HCV antibody seroconversion in the setting of HCV viremia. The HCV RNA level at closest time of antibody measurement was higher in the seroconverted patients versus the ones who never converted [median and (interquartile range): 1,091,500 (345,000–8,360,000) vs 71,500 (73–313,000), p = 0.02]. No other significant differences including type of immunosuppression were noted between the HCV antibody positive group and HCV antibody negative group. Donor donation after cardiac death status [Odds Ratio (OR) and 95% Confidence Interval (CI) was: 8.22 (1.14–59.14)], donor age [OR (95% CI) (+5 years) was: 3.19 (1.39–7.29)] and Kidney Donor Profile Index [OR (95% CI) (+1) was:1.07 (1.01–1.15)] showed a statistically significant association with HCV seroconversion. Conclusions HCV antibody should not be considered routine screening for presence of infection in previously HCV naïve kidney transplant recipients receiving kidneys from HCV-infected donors, as only a modest percentage have antibody despite active viremia. The assessment of HCV viral load should be routine in all transplant recipients receiving organs from public health service increased risk donors.

Introduction and objectives: Cirrhosis-related mortality is underestimated and is increasing; extrahepatic factors may contribute. We examined trends in cirrhosis mortality from 1999-2017 in the United States attributed to liver-related (varices, peritonitis, hepatorenal syndrome, hepatic encephalopathy, hepatocellular carcinoma, sepsis) or extrahepatic (cardiovascular disease, influenza and pneumonia, diabetes, malignancy) causes, and compared mortality trends with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) populations. Materials and methods: A national mortality database was used. Changes in age-standardized mortality over time were determined by joinpoint analysis. Average annual percentage change (AAPC) was estimated. Results: Cirrhosis cohort: From 1999-2017, both liver-related (AAPC 1.3%; 95% confidence interval [CI] 0.7-1.9) and extrahepatic mortality (AAPC 1.0%; 95% CI 0.7-1.2) increased. Cirrhosis vs other chronic disease cohorts: changes in all-cause mortality were higher in cirrhosis (AAPC 1.0%; 95% CI 0.7-1.4) than CHF (AAPC 0.1%; 95% CI -0.5- 0.8) or COPD (AAPC -0.4%; 95% CI -0.6- -0.2). Sepsis mortality was highest in cirrhosis (AAPC 3.6%, 95% 3.2- 4.1) compared to CHF (AAPC 0.6%, 95% CI -0.5- 1.7) or COPD (AAPC 0.8%, 95% CI 0.5- 1.2). Cardiovascular mortality increased in cirrhosis (AAPC 1.3%, 95% CI 1.1- 1.5), declined in CHF (AAPC -2.0%, 95% CI -5.3- 1.3) and remained unchanged in COPD (AAPC 0.1%, 95% CI -0.2- 0.4). Extrahepatic mortality was higher among women, rural populations, and individuals >65 years with cirrhosis. Conclusions: Extrahepatic causes of death are important drivers of mortality and differentially impact cirrhosis compared to other chronic diseases.

Objective: This study seeks to determine the contributory factors to successful succession and post-succession performance. And the role of these factors in the post-succession financial and non-financial performance of family-owned SMEs in South Eastern Nigeria. Research Design & Methods: The adopted quantitative methodology is interview. In each of the purposively selected 25 family-owned SMEs, the incumbent, a sibling of the incumbent and a top level manager were interviewed. In all, 75 respondents were interviewed. The transcribed interviews were subjected to thematic content analysis. Findings: The contributory factors to successful succession are the characteristics of succession planning, the incumbent, the potential successor, and the family-owned SME. The factors that contribute to the post-succession performance are the culture of making succession planning a continuous process, and the characteristics of the incumbent and the family-owned SME. These factors ensure that children of the incumbent in the SME become more active so as to be selected as potential successors. Contribution & Value Added: The study identified the contributory factors to successful succession and post-succession performance of the family-owned SMEs. To achieve successful succession and post-succession performance, the incumbents should inculcate the characteristics of these factors into their potential successors. Also, these characteristics should be made part of the culture of the family-owned SMEs.

Researchers and practitioners are divided on the preferred measures of business performance, largely due to the quality of available financial data and the measurability of the non-financial indicators. However, owing to the embeddedness of social networking in families and in the business world, this study reviews the contribution of social networking to the financial and non-financial performance of family businesses. The study is based on a review of 55 peer-reviewed published journal articles. Consequently, the most frequently used social networking platforms, the measures of financial performance, the measures and proxies of non-financial performance and the differences between financial and non-financial performance were identified. The study proposes the use of both financial and non-financial measures in assessing the performance of family businesses due to their complementary roles.

Objective: Despite the various approaches that have been adopted to control the negative consequences of environmental and social challenges, these consequences have persisted. Studies that have critiqued these challenges and the proffered solutions with the intent of offering a more encompassing and result oriented solutions are rare in the literature. Thus, based on the unprecedented dimensions the challenges have assumed, this study seeks to propose a holistic and more encompassing approach for managing the challenges. Research Design & Methods: The study adopts a research methodology that is based on a critical review and analysis of 25 related papers. The keywords employed to select the papers that were published between 1980 and 2020 are environmental challenges, social challenges and strategic development goals. Findings: The approaches adopted so far to manage environmental and social challenges have not yielded the desired results. This is because: all the stakeholders are not involved in the formulation and implementation of the approaches; the approaches are formulated and implemented as though environmental and social challenges are not interrelated; the approaches vary among the different institutions, countries and regions; in some areas, the level of implementation is partial, while in others it is full. Contribution & Value Added: Environmental and social challenges are interrelated. As such the Environmental and Social Responsibility Network (ESRN) is proposed as a more encompassing approach since it will bring together all those who are directly and indirectly affected by the challenges.

BACKGROUND:The utility of ex vivo Magnetic resonance imaging proton density fat fraction (MRI-PDFF) in donor liver fat quantification is unknown. PURPOSE:To evaluate the diagnostic accuracy and utility in predicting early allograft dysfunction (EAD) of ex vivo MRI-PDFF measurement of fat in deceased donor livers using histology as the gold standard. METHODS:We performed Ex vivo, 1.5 Tesla MRI-PDFF on 33 human deceased donor livers before implantation, enroute to the operating room. After the exclusion of 4 images (technical errors), 29 MRI images were evaluable. Histology was evaluable in 27 of 29 patients. EAD was defined as a peak value of aminotransferase >2000 IU/mL during the first week or an INR of ≥1.6 or bilirubin ≥10 mg/dL at day 7. RESULTS:MRI-PDFF values showed a strong positive correlation (Pearson's correlation coefficient) when histology (macro-steatosis) was included (r = 0.78, 95% confidence interval 0.57-0.89, p

Background: With the introduction of direct‐acting antiviral therapies (DAAs), the non‐use rate of hepatitis C virus (HCV)‐positive donor organs (D+) has decreased significantly. We present the donor, recipient, and transplant allograft characteristics, along with recipient outcomes, in one of the largest cohorts of HCV‐D+ transplants into HCV‐naïve recipients (R−). Methods: Charts of HCV D+/R− kidney (KT), liver (LT), and simultaneous liver‐kidney (SLKT) transplant recipients between January 2019 and July 2022 were reviewed. Primary outcomes of interest included waitlist times and 1‐year graft failure. Secondary outcomes included hospital and intensive care unit length of stay, post‐transplant complications, effectiveness of DAA therapy, and characteristics of patients who relapsed from initial DAA therapy. Results: Fifty‐five HCV D+/R− transplants at our center [42 KT (26 nucleic acid testing positive [NAT+], 16 NAT−), 12 LT (eight NAT+, four NAT−), and one SLKT (NAT+)] had a median waitlist time of 69 days for KT, 87 days for LT, and 15 days for SLKT. There were no graft failures at 1 year. All viremic recipients were treated with a 12‐week course of DAAs, of which 100% achieved end of treatment response (EOTR)—85.7% (n = 30) achieved sustained virologic response (SVR) and 14.3% relapsed (n = 5; four KT, one LT). All relapsed recipients were retreated and achieved SVR. The most common post‐transplantation complications include BK virus infection (n = 9) for KT and non‐allograft infections (n = 4) for LT. Conclusions: Our study has demonstrated no graft failures or recipient deaths at 1 year, and despite a 14.3% relapse rate, we achieved 100% SVR. Complications rates of D+/R− appeared comparable to national D−/R− complication rates. Further studies comparing D+/R− to D−/R− outcomes are needed. [ABSTRACT FROM AUTHOR]

Introduction: A successful living donor liver transplant (LDLT) is the culmination of a multifaceted process coordinated among key stakeholders. Methods: We conducted an electronic survey of US liver transplant (LT) centers (August 26, 2021–October 10, 2021) regarding attitudes, barriers, and facilitators of LDLT to learn how to expand LDLT safely and effectively in preparation for the American Society of Transplantation Living Donor Liver Transplant Consensus Conference. Results: Responses were received from staff at 58 programs (40.1% of US LT centers). There is interest in broadening LDLT (100% of LDLT centers, 66.7% of non‐LDLT centers) with high level of agreement that LDLT mitigates donor shortage (93.3% of respondents) and that it should be offered to all suitable candidates (87.5% of respondents), though LDLT was less often endorsed as the best first option (29.5% of respondents). Key barriers at non‐LDLT centers were institutional factors and surgical expertise, whereas those at LDLT centers focused on waitlist candidate and donor factors. Heterogeneity in candidate selection for LDLT, candidate reluctance to pursue LDLT, high donor exclusion rate, and disparities in access were important barriers. Conclusion: Findings from this study may help guide current and future expansion of LDLT more efficiently in the US. These efforts require clear and cohesive messaging regarding LDLT benefits, engagement of the public community, and dedicated resources to equitably increase LDLT access. [ABSTRACT FROM AUTHOR]

Even though combined anti-retroviral therapy (cART) dramatically improves patient survival, they remain at a higher risk of being afflicted with non-infectious complications such as cardiovascular disease (CVD). This increased risk is linked to persistent inflammation and chronic immune activation. In this study, we assessed whether this complication is related to HIV-derived ssRNAs inducing in macrophages increases in TNFα release through TLR8 activation leading to foam cell formation. HIV ssRNAs induced foam cell formation in monocyte-derived macrophages (MDMs) in a dose-dependent manner. This response was reduced when either endocytosis or endosomal acidification was inhibited by dynasore or chloroquine, respectively. Using a flow cytometry FRET assay, we demonstrated that ssRNAs bind to TLR8 in HEK cells. In MDMs, ssRNAs triggered a TLR8-mediated inflammatory response that ultimately lead to foam cell formation. Targeted silencing of the TLR8 and MYD88 genes reduced foam cell formation. Furthermore, foam cell formation induced by these ssRNAs was blocked by an anti-TNFα neutralizing antibody. Taken together in MDMs, HIV ssRNAs are internalized; bind TLR8 in the endosome followed by endosomal acidification. TLR8 signaling then triggers TNFα release and ultimately leads to foam cell formation. As this response was inhibited by a blocking anti-TNFα antibody, drug targeting HIV ssRNA-driven TLR8 activation may serve as a potential therapeutic target to reduce chronic immune activation and inflammation leading to CVD in HIV+ patients.

This experiment was conducted at the Teaching and Research Farm of Faculty of Agriculture and Veterinary Medicine, Imo State University, Owerri, Nigeria, between May-August, 2018. It investigated the efficacy of Ocimum gratissimum against cowpea pod borer, Maruca vitrata. Four rates of liquid extracts were used, 0, 50, 100, and 150 mls as treatments using randomized complete block design. Proximate analysis on Ocimum gratissimum revealed percentage nutritional contents of ash 14.58%, moisture 82.22%, fibre 9.37% and protein 3.16%. Phytochemical analysis revealed phytate, 12.45g, tannin, 15.43g, sapogenin 11.64g, anthocyanidines 0.27g, and quinine 11.09g. Mineral compositions were Sodium 0.321mg/100g, potassium 0.355mg/100g, calcium 0.0144mg/100g, Magnesium 1.85mg/100g and cadmium 0.187/100g. Heavy metals include zinc, 0.250mg/100g, cadmium 0.00mg/100g, chromium 0.00mg/100g, Fe 0.381mg/100g, Nickel 0.291mg/100g and manganese 0.492mg/100g. Infrared compounds were alcohol 3344.5, aldehyde 2719, carboxylic acid 2995.5, alkenes 2804.4, isocyanate 2804.4. Data were collected on number of insects observed after application, number of plants infested, number of leaves damaged, and number of pods per plot and yield weight. Further results showed that treatments reduced number of insects, number of plants infested, number of leaves damaged, 2, 3, 4 WAP and these were significantlydifferent P≤0.05. Number of pods and yield weight were significantly P≤0.05 different over the control. In this study, Ocimum gratissimum reduced the number of insect pest attack (Maruca vitrata) on cowpea and these actions were due to the anti-nutritional constituents contained in the extract. This experiment was conducted at the Teaching and Research Farm of Faculty of Agriculture and Veterinary Medicine, Imo State University, Owerri, Nigeria, between May-August, 2018. It investigated the efficacy of Ocimum gratissimum against cowpea pod borer, Maruca vitrata. Four rates of liquid extracts were used, 0, 50, 100, and 150 mls as treatments using randomized complete block design. Proximate analysis on Ocimum gratissimum revealed percentage nutritional contents of ash 14.58%, moisture 82.22%, fibre 9.37% and protein 3.16%. Phytochemical analysis revealed phytate, 12.45g, tannin, 15.43g, sapogenin 11.64g, anthocyanidines 0.27g, and quinine 11.09g. Mineral compositions were Sodium 0.321mg/100g, potassium 0.355mg/100g, calcium 0.0144mg/100g, Magnesium 1.85mg/100g and cadmium 0.187/100g. Heavy metals include zinc, 0.250mg/100g, cadmium 0.00mg/100g, chromium 0.00mg/100g, Fe 0.381mg/100g, Nickel 0.291mg/100g and manganese 0.492mg/100g. Infrared compounds were alcohol 3344.5, aldehyde 2719, carboxylic acid 2995.5, alkenes 2804.4, isocyanate 2804.4. Data were collected on number of insects observed after application, number of plants infested, number of leaves damaged, and number of pods per plot and yield weight. Further results showed that treatments reduced number of insects, number of plants infested, number of leaves damaged, 2, 3, 4 WAP and these were significantlydifferent P≤0.05. Number of pods and yield weight were significantly P≤0.05 different over the control. In this study, Ocimum gratissimum reduced the number of insect pest attack (Maruca vitrata) on cowpea and these actions were due to the anti-nutritional constituents contained in the extract. [ABSTRACT FROM AUTHOR]

16 cowpea varieties were screened for resistance to the legume pod borer, Maruca vitrata F. under natural infestation in the field. Plants were planted in a randomized complete block design in three replicates; each plot consisted of four rows, 3m long. Spacing was 1.5m between plots and 0.75m between rows. Intra- row spacing was 0.2m.Two weeks prior to planting experimental materials, a susceptible cultivar was planted perpendicular to every range of rows within a plot to serve as a reservoir of the test insect, M.vitrata. Plants were sprayed with Monocrotophos at 200g a.i /ha once at the vegetative stage and at the onset of flower bud initiation and later during podding to control other pests apart from Maruca. Larval density, flower damage, pod damage, seed damage, pod load (a measure of the degree of successful pod production) and Index of pod evaluation (Ipe), calculated as [PL X (9-PD)], (a measure of the varietal performance of the cowpea genotypes) were used to assess resistance in cowpea varieties. Significant variations were observed in the level of resistance among the cowpea genotypes in the field. The findings show that Tvu 4578 is resistant while Tvu 1544, IT97K-499-35, IT93K452-1 and IT90K-76 show promising level of resistance. The probable factor contributing to resistance may be non- preference or host plant resistant factors. [ABSTRACT FROM AUTHOR]

Background: There are known racial and socioeconomic disparities in the use of epinephrine autoinjectors (EAI) for anaphylaxis. Objective: To measure the rates of EAI prescription filling and identify patient demographic factors associated with filling rates among patients discharged from the pediatric emergency department. Methods: This was a retrospective observational cohort study of all patients discharged from a pediatric emergency department who received an outpatient prescription for an EAI between January 1, 2018, and October 31, 2019. The rates of prescription filling were calculated, and multivariable logistic regression was performed to identify sociodemographic factors associated with prescription filling. Results: Of 717 patients included in the analysis, 54.8% (95% confidence interval {CI}, 51.1%-58.5%) filled their prescription. There were no significant associations between EAI fill rates and patient age or sex. In bivariable analysis, non-Hispanic white patients were more likely to fill EAI prescriptions compared with non-Hispanic Black patients (odds ratio [OR] 1.89 [95% CI, 1.11-3.20]), and patients with in-state Medicaid were significantly less likely to fill EAI prescriptions compared with those patients with private insurance (OR 0.69 [95% CI, 0.48-0.98]). However, after multivariable adjustment, there was no significant difference in filling by age, insurance status, or race or ethnicity. Conclusions: Only approximately half the patients had their EAI prescriptions filled after discharge. Filling rates did not vary by sociodemographic characteristics. [ABSTRACT FROM AUTHOR]

We aimed to assess the probability and factors associated with the presence of hepatitis C virus (HCV) antibody among HCV seronegative kidney transplant recipients receiving HCV-infected (nucleic acid testing positive) donor kidneys. This is a retrospective review examining HCV antibody seroconversion of all kidney transplant recipients receiving an organ from an HCV-infected donor between 1 March 2018 and 2 December 2019 at a high-volume kidney transplant center in the southeast United States. Of 97 patients receiving HCV-infected kidneys, the final cohort consisted of 85 recipients with 5 (5.9%) recipients noted to have HCV antibody seroconversion in the setting of HCV viremia. The HCV RNA level at closest time of antibody measurement was higher in the seroconverted patients versus the ones who never converted [median and (interquartile range): 1,091,500 (345,000–8,360,000) vs 71,500 (73–313,000), p = 0.02]. No other significant differences including type of immunosuppression were noted between the HCV antibody positive group and HCV antibody negative group. Donor donation after cardiac death status [Odds Ratio (OR) and 95% Confidence Interval (CI) was: 8.22 (1.14–59.14)], donor age [OR (95% CI) (+5 years) was: 3.19 (1.39–7.29)] and Kidney Donor Profile Index [OR (95% CI) (+1) was:1.07 (1.01–1.15)] showed a statistically significant association with HCV seroconversion. HCV antibody should not be considered routine screening for presence of infection in previously HCV naïve kidney transplant recipients receiving kidneys from HCV-infected donors, as only a modest percentage have antibody despite active viremia. The assessment of HCV viral load should be routine in all transplant recipients receiving organs from public health service increased risk donors. [ABSTRACT FROM AUTHOR]

This review details the challenges with the canonical polymer swelling theory in its ability to accurately estimate realistic polymer swelling behavior. It is important to quantify this behavior since the development of new and hybrid materials with dynamic environmental response is expected to drive rapid growth and innovation in markets including biomedicine, electronics, pharmaceuticals, building and infrastructure, and aerospace. As many of these markets require high precision and controlled dynamic response, hydrogels are being investigated to help address some of the heat transfer and fluid flow challenges found in these applications. Stimuli-responsive materials usually respond to one stimulus (e.g., light, temperature, etc.) However, hybrid polymer materials that respond to multiple stimuli can be developed through the mixing of monomer chains with differing behaviors. For these materials, the synthesis conditions influence the polymer behavior in changing environmental conditions, and it is imperative to develop a deeper understanding of how the preparation of the polymer networks impacts the viscoelastic nature of the polymer. The work also discusses the influence that synthesis conditions have on the behavior of thermo-responsive Poly(N-isopropylacrylamide) (PNIPAAm). Lastly, the paper describes an inferential, nested regression model developed to highlight the dependence the swelling has on the synthesis technique used. [ABSTRACT FROM AUTHOR]

Background: Opioid medications are frequently used to address pain among patients with cirrhosis, including those on the liver transplant (LT) waitlist and after transplantation. However, opioid use has been associated with poor allograft outcomes and reduced transplant survival. We examined the impact of opioid use across the spectrum of advanced liver disease, from the initial hepatology consultation for cirrhosis through transplant referral, listing, and the post‐LT process. Methods: The study includes all patients referred for cirrhosis management in a single healthcare system in the United States. Data were extracted retrospectively through medical chart review. Results: Of 414 patients included in the study, 104 (25%) were treated with opioid. Patients on opioids were more likely to be White, have body mass indices (BMI) >30, have HCV, suffer from hepatic encephalopathy, cigarette smokers, and use benzodiazepines concurrently. Higher doses of opioids were associated with multiple emergency department (ED). Eighty‐nine underwent LT, including 20 opioid‐treated patients. There was no difference found between the opioid and non‐opioid groups with regard to allograft loss, ED visits, and hospital readmissions at 2 years post‐LT follow‐up. Conclusions: Opioid treatment was common among patients with cirrhosis. We did not find increased negative outcomes among opioid users across the spectrum of cirrhosis. However, the sample for LT patients was small. [ABSTRACT FROM AUTHOR]

Background: The utility of ex vivo Magnetic resonance imaging proton density fat fraction (MRI-PDFF) in donor liver fat quantification is unknown. Purpose: To evaluate the diagnostic accuracy and utility in predicting early allograft dysfunction (EAD) of ex vivo MRI-PDFF measurement of fat in deceased donor livers using histology as the gold standard. Methods: We performed Ex vivo, 1.5 Tesla MRI-PDFF on 33 human deceased donor livers before implantation, enroute to the operating room. After the exclusion of 4 images (technical errors), 29 MRI images were evaluable. Histology was evaluable in 27 of 29 patients. EAD was defined as a peak value of aminotransferase >2000 IU/mL during the first week or an INR of ≥1.6 or bilirubin ≥10 mg/dL at day 7. Results: MRI-PDFF values showed a strong positive correlation (Pearson's correlation coefficient) when histology (macro-steatosis) was included (r = 0.78, 95% confidence interval 0.57‐0.89, p<0.0001). The correlation appeared much stronger when macro plus micro-steatosis were included (r = 0.87, 95% confidence interval 0.72‐0.94, p<0.0001). EAD was noted in 7(25%) subjects. AUC (Area Under the Curve) for macro steatosis (histology) predicted EAD in 73% (95% CI: 48–99), micro plus macro steatosis in 76% (95% CI: 49–100). AUC for PDFF values predicted EAD in 67(35–98). Comparison of the ROC curves in a multivariate model revealed, adding MRI PDFF values to macro steatosis increased the ability of the model in predicting EAD (AUC: 79%, 95% CI: 59–99), and addition of macro plus micro steatosis based on histology predicted EAD even better (AUC: 90%: 79–100, P = 0.054). Conclusion: In this pilot study, MRI-PDFF imaging showed potential utility in quantifying hepatic steatosis ex-vivo donor liver evaluation and the ability to predict EAD related to severe allograft steatosis in the recipient. [ABSTRACT FROM AUTHOR]

Summary: There is a dearth of published data regarding the presence of post‐transplant donor‐specific antibodies (DSA), especially C1q‐binding DSA (C1q+DSA), and patient and kidney allograft outcomes in simultaneous liver–kidney transplant (SLKT) recipients. We conducted a retrospective cohort study consisted of 85 consecutive SLKT patients between 2009 and 2018 in our center. Associations between presence of post‐transplant DSA, including persistent and/or newly developed DSA and C1q+DSA, and all‐cause mortality and the composite outcome of mortality, allograft kidney loss, and antibody‐mediated rejection were examined using unadjusted and age and sex‐adjusted Cox proportional hazards and time‐dependent regression models. The mean age at SLKT was 56 years and 60% of the patients were male. Twelve patients (14%) had post‐transplant DSA and seven patients (8%) had C1q+DSA. The presence of post‐transplant DSA was significantly associated with increased risk of mortality (unadjusted model: Hazard Ratio (HR) = 2.72, 95% confidence interval (CI): 1.06–6.98 and adjusted model: HR = 3.20, 95% CI: 1.11–9.22) and the composite outcome (unadjusted model: HR = 3.18, 95% CI: 1.31–7.68 and adjusted model: HR = 3.93, 95% CI: 1.39–11.10). There was also higher risk for outcomes in recipients with C1q+DSA compared the ones without C1q+DSA. Post‐transplant DSA is significantly associated with worse patient and kidney allograft outcomes in SLKT. Further prospective and large cohort studies are warranted to better assess these associations. [ABSTRACT FROM AUTHOR]

Purpose of review: Malnutrition is a common finding in patients with chronic advanced liver disease (CLD) and is an important prognostic predictor for morbidity and mortality. This review aims to summarize the latest evidence-based guidelines and expert opinion regarding diagnosing malnutrition in patients with CLD and providing optimal solutions. Recent findings: In addition to diet, evidence demonstrates sarcopenia and frailty are emerging concepts critical to outcomes in those with CLD. Thus, adequate assessment of nutritional status incorporates the interplay of nutrient intake, sarcopenia, and frailty. Summary: Addressing malnutrition in patients with CLD requires understanding the multifactorial mechanisms contributing to nutritional deficiencies, but also careful assessment of functional capacity. Interventions mitigating or reversing sarcopenia and frailty are equally important to nutritional supplementation. While the latency period between compensated and decompensated cirrhosis provides a good window for fruitful interventions, we believe providers need to be vigilant early on the course of CLD to maximize nutritional gains and halt muscle loss. [ABSTRACT FROM AUTHOR]

Introduction: Non-invasive assessment of fibrosis is increasingly utilized in clinical practice to diagnose hepatic fibrosis. Non-invasive assessment of liver fibrosis relies on biologic and/or physical properties to assess tissue fibrosis. Serum markers estimate fibrosis by incorporating markers reflecting hepatic function (indirect markers) and/or markers measuring extracellular matrix degradation/fibrogenesis (direct markers). Radiology based techniques relay the mechanical properties and stiffness of a tissue, with increased stiffness associated with more advanced fibrosis. Areas covered: In this comprehensive review, the recent literature discussing serum markers and elastography-based techniques will be covered. These modalities are also explored in the setting of various liver diseases. Expert opinion: The etiology of liver disease and clinical context should be taken into consideration when non-invasive markers are incorporated in clinical practice. Non-invasive assessment of fibrosis has been most extensively utilized in hepatitis C, followed by hepatitis B and nonalcoholic fatty liver disease, but its role remains less developed in other etiologies of liver disease such as alcohol-associated liver disease and autoimmune liver disease. The role of non-invasive markers in predicting progression or regression of fibrosis, development of liver-related events and survival needs to be further explored. [ABSTRACT FROM AUTHOR]

The ability of packaging solutions to meet the high heat flux dissipation of power electronics relies heavily on effective thermal management strategies. During operation, power electronic devices generate high temperatures that can cause device degradation. To remove this heat from the devices, heat spreaders and cold plates are often used. However, the multiple layers that compose the module often lead to high thermal resistances that hinder heat dissipation and can give rise to interfacial failures. To address these challenges, this paper has investigated the direct integration of single-phase jet impingement cooling at the power electronic substrate level for improved thermal management. This method was evaluated using computational models, experiments, and analytical models. An optimization analysis was performed to determine the influence of various design parameters on the cooling system. Through the directly integrated cooling concept, a reduction of up to 25% in the total package thermal resistance compared to a conventional device package was achieved. In addition, the overall device temperature was reduced, and the thermal resistance was found to be between 0.21 °C/W and 0.47 °C/W for a heat dissipation of 100 W/cm2. [ABSTRACT FROM AUTHOR]

Researchers and practitioners are divided on the preferred measures of business performance, largely due to the quality of available financial data and the measurability of the non-financial indicators. However, owing to the embeddedness of social networking in families and in the business world, this study reviews the contribution of social networking to the financial and non-financial performance of family businesses. The study is based on a review of 55 peer-reviewed published journal articles. Consequently, the most frequently used social networking platforms, the measures of financial performance, the measures and proxies of non-financial performance and the differences between financial and non-financial performance were identified. The study proposes the use of both financial and non-financial measures in assessing the performance of family businesses due to their complementary roles. [ABSTRACT FROM AUTHOR]

• The Pediatric Assessment Triangle uses appearance, work of breathing, and circulation to quickly gauge the severity of illness and identify the underlying physiologic disturbance. • Inspiratory stridor generally is a sign of obstruction above the vocal cords, while expiratory stridor is an indication of obstruction in the trachea. Biphasic stridor is an indication of subglottic narrowing, whereas signs of lower airway obstruction include grunting, wheezing, and crackles. • Heated humidified high-flow nasal cannula is studied most commonly as an alternative form of respiratory support where continuous positive airway pressure (CPAP) is indicated. Outside of its role in infants with bronchiolitis, there is relatively limited evidence for heated humidified high-flow nasal cannula therapy in children. • The CPAP apparatus is available as a nasal plug, a nasal mask that covers the nares, a face mask that covers both the nares and the mouth, or a complete face mask that covers the entire face. When CPAP is used, the recommendation is to start low pressures (5 cmH2O) and increase in increments of 1 cmH2O as tolerated by the patient for goals of an exhaled tidal volume > 7 mL/kg, a respiratory rate normal for given age, and oxygen saturation > 90%. • Traditionally, bi-level positive airway pressure (BiPAP) has been used for pediatric patients with neuromuscular disorders, chronic lung disease, and obstructive airways. In the pediatric population, it has been limited to children weighing more than 20 kg because of the concern that small children are incapable of initiating supported breaths while on BiPAP; however, recent studies have shown BiPAP as a beneficial treatment modality for acute severe asthma exacerbations in children of all weights. • New American Academy of Pediatrics guidelines for bronchiolitis do not recommend routine chest radiographs or trials of albuterol or epinephrine aerosols. [ABSTRACT FROM AUTHOR]