Stapled haemorrhoidopexy vs. Milligan-Morgan haemorrhoidectomy for grade III haemorrhoids: a randomized clinical trial

The aim of this double blind randomized clinical trial was to compare the short-term and long-term outcomes of stapled haemorrhoidopexy (SH group) performed using a circular stapler with that of the Milligan-Morgan haemorrhoidectomy (MMH group). A total of 79 consecutive patients with grade III haemorrhoids were randomized into two groups treated with SH (n. 39) and MMH (n. 40). The outcomes of the procedures were evaluated postoperatively and over a follow-up period of minimum 2 years. Patients undergoing the SH procedure showed greater short term advantages than MMH group with reduced pain, shorter length of hospital stay, earlier return to work and high patient satisfaction. Long-term follow-up has indicated more favourable results in MMH group in terms of resumption of symptoms with absence of residual prolapse and risk of recurrence of prolapse. At two years follow-up recurrent prolapse was confirmed in six patients of SH group (13%) whereas in none of the MMH group. At six months follow-up there weren’t significant difference in the mean satisfaction score for the two groups. At two years the mean satisfaction score was higher in the MMH group vs SH group. Seven patients in the SH group needed a reoperation whereas none in MMH group. From January 2009, in our Surgery Unit the patients are always informed about a higher recurrence rate of SH and we perform this technique only when the patient choices to accept this risk to take advantage of the short-term benefits of this procedure.

Teaching down or learning up

Résumé : L'élément important que cette thèse sous-tend est que l'enseignement efficace n'est pas seulement constitué de techniques et de méthodologie, mais plutôt d'attitude et d'approche envers l'enseignement. Ceci ne veut pas nécessairement dire que plusieurs méthodes d'enseignement reçues dans un cours avec l'intention d'optimaliser les mécanismes de transmission et d'assimilation de la matière sont inappropriées. Cependant, l'absence de ce que nous pourrions définir comme un ton pédagogique est essentiel, c'est-à-dire, qu'une attitude positive à la productivité autant vis-à-vis de la matière à transmettre que vis-à-vis de l'individu impliqué dans "l'acte" de réception versus la découverte, aura davantage de succès. Toute autre méthode sera complètement inefficace, inaccessible, voire même inutile. D'emblée, dans l'hypothèse de départ, l'argument principal présente une attitude générale d'enseignement à divers échelons ; soit au niveau secondaire ou collégial qui est inappropriée, incomplète ou négative. En d'autres mots, cette approche thérapeutise l'éducation. Dans l'exercice de cette approche, l'enseignant ou l'enseignante adopte plutôt le rôle d'un thérapeute que celui d'un éducateur. De ce fait, le professeur en situation a une approche plutôt de thérapeute que celle de maître-précepteur et que la matière présentée est souvent diluée, et réduite à des niveaux d'apprentissage accompagnés de carences notoires et d'échecs académiques. Les attentes d'une performance dans le milieu académique sont souvent des plus modestes. Cette même tendance d'une éducation à la baisse est évidente aussi dans le processus d'évaluation. Il est certain que dans les disciplines non scientifiques, l'évaluation formative a grandement suivi l'évaluation normative conduisant le précepteur, tour à tour, dans une évaluation dormative dans laquelle l'effort et l'intention remplacent les aptitudes et les habilitées réelles. Si l'approche pédagogique est vraiment l'élément crucial de l'éducation, il Importe que l'approche générale influence le climat de l'éducation contemporaine, de fait, devienne un palliatif contre-productif souvent réhabilitant. De plus, cette pseudo-thérapie d'où d'écoule une attitude exigeante envers l'enseignant et l'apprenant dont le fondement est la reconnaissance des impératifs culturels qui en sont le reflet et le corps doit-être affirmé et transposé dans la réalité. Cette dernière comprend des attentes très poussées en ce qui concerne la performance en classe et aussi le respect de la matière qui contient la présentation routinière et fondamentale; renouveau intense du processus d'évaluation qui fournira des standards communs et des objectifs externes dans l'évaluation du travail de l'étudiant. Cette connaissance et domestication empirique que nous présente Vygotsky dans un climat contemporain qu'il a expliqué ces termes comme "des zones de développement proximales" basées sur la doctrine suivante que le bon apprentissage précède le développement et que conséquemment s'ensuit une pédagogie d'apprentissage plutôt qu'une pédagogie centrée sur l'apprenant. L'application significative de ces derniers principes ou de ces épistémologiques s'imbriquent dans une situation d'apprentissage ascentionnel dont la structure est détaillée et considérée par différentes perspectives de la recherche qui suit.||Abstract : The central tenet of this thesis is that effective teaching is not only and perhaps not primarily a matter of technique and methodology but of attitude and approach. This is not to say that diverse methods of classroom instruction intended to optimize the mechanics of transmission and the assimilation of data are inappropriate but that in the absence of what we might denominate as a certain pedagogical tone. that is, a productive attitude toward both the material to be conveyed and the individuel engaged in the 'act' of reception-and-discovery, even the most powerful methods will be differentially unavailing or, at best, inefficient. Given this initial assumption, the argument proceeds that the general attitude toward instruction currently in place at the secondary echelons, that is, on the high school and college levels, may be popularly represented as a 'teaching down' approach, in other words, as one which seeks to therapeuticize education. In practice this means that the teacher tends to manifest in situ more as a therapist than as a preceptor, that the material to be presented is frequently diluted or scaled down to perceived levels of cognitive (dis)ability (as is also the case with the rate of instruction), and that performance expectations in the current pedagogical milieu are commonly quite modest. The same downward trend is evident in assessment protocols as well. Certainly in the nonscientific disciplines, normative evaluation has been widely succeeded by formative evaluation, leading in turn to a peculiar kind of dormative evaluation in which intangibles such as effort and intention may deputize for realized ability. If pedagogical approach is indeed the crucial element in instruction, and if the general approach that pervades the contemporary climate of instruction is indeed counter-productively remedial or rehabilitory, that is, therapeutic, then it should follow that a more demanding attitude toward teaching and learning founded on the recognition of the culturel imperative which teaching both reflects and embodies needs to be re-affirmed and translated into practice. This latter would entail the maintenance of high expectations with regard to classroom performance, a respect for the material which precludes its routine mitigation or debasement, a renewed insistance on grading protocols that provide an external, 'objective' or communal standard against which the student's work can be measured, the empirical acknowledgment or domestication of what Vygotsky has termed "the zone of proximal development," based on the doctrine that good learning proceeds in advance of development, and conséquently, a learning-centered rather than learner-centered pedagogy. The meaningful application of this latter set of principles or epistemological gradients comprises the 'learning up' situation whose structure is excunined in some détail and considered from various perspectives in the ensuing.

Influence of climate variability and stocking strategies on greenhouse gas emissions (GHGE), production and profit of a northern Queensland beef cattle herd

Previous studies of greenhouse gas emissions (GHGE) from beef production systems in northern Australia have been based on models of ‘steady-state’ herd structures that do not take into account the considerable inter-annual variation in liveweight gain, reproduction and mortality rates that occurs due to seasonal conditions. Nor do they consider the implications of flexible stocking strategies designed to adapt these production systems to the highly variable climate. The aim of the present study was to quantify the variation in total GHGE (t CO2e) and GHGE intensity (t CO2e/t liveweight sold) for the beef industry in northern Australia when variability in these factors was considered. A combined GRASP–Enterprise modelling platform was used to simulate a breeding–finishing beef cattle property in the Burdekin River region of northern Queensland, using historical climate data from 1982–2011. GHGE was calculated using the method of Australian National Greenhouse Gas Inventory. Five different stocking-rate strategies were simulated with fixed stocking strategies at moderate and high rates, and three flexible stocking strategies where the stocking rate was adjusted annually by up to 5%, 10% or 20%, according to pasture available at the end of the growing season. Variation in total annual GHGE was lowest in the ‘fixed moderate’ (~9.5 ha/adult equivalent (AE)) stocking strategy, ranging from 3799 to 4471 t CO2e, and highest in the ‘fixed high’ strategy (~5.9 ha/AE), which ranged from 3771 to 7636 t CO2e. The ‘fixed moderate’ strategy had the least variation in GHGE intensity (15.7–19.4 t CO2e/t liveweight sold), while the ‘flexible 20’ strategy (up to 20% annual change in AE) had the largest range (10.5–40.8 t CO2e/t liveweight sold). Across the five stocking strategies, the ‘fixed moderate’ stocking-rate strategy had the highest simulated perennial grass percentage and pasture growth, highest average rate of liveweight gain (121 kg/steer), highest average branding percentage (74%) and lowest average breeding-cow mortality rate (3.9%), resulting in the lowest average GHGE intensity (16.9 t CO2e/t liveweight sold). The ‘fixed high’ stocking rate strategy (~5.9 ha/AE) performed the poorest in each of these measures, while the three flexible stocking strategies were intermediate. The ‘fixed moderate’ stocking strategy also yielded the highest average gross margin per AE carried and per hectare. These results highlight the importance of considering the influence of climate variability on stocking-rate management strategies and herd performance when estimating GHGE. The results also support a body of previous work that has recommended the adoption of moderate stocking strategies to enhance the profitability and ecological stability of beef production systems in northern Australia.

Chronic low back pain among French healthcare workers and prognostic factors of return to work (RTW): a non-randomized controlled trial

International audience

Exclusive breastfeeding practices in the Coast region, Tanzania.

Background: Although breastfeeding in general is common and culturally accepted in many sub-Saharan countries, recommended exclusive breastfeeding infants to 6 months is rare. In rural Tanzania, data on infant feeding practices is rare. Objective: To examine and describe exclusive breastfeeding practices in rural settings (Coast Region) of Tanzania. Methods: A cross-sectional study was conducted in Coast Region of Tanzania involving 342 mothers. Only mothers with children aged between 6 and 23 months were interviewed in their residences. Data analyses included descriptive and logistic regression analyses. Results: The majority, 66%, of mothers reported to have breastfed their new born within the first hour of life. About 30% reported to have breastfed exclusively for up to at least six months. Those who did not practice complete exclusive breastfeeding mentioned insufficient milk as the main reason. Correlates of exclusive breastfeeding included maternal education and attitudes towards exclusive breastfeeding. Conclusion: The rate of exclusive breastfeeding in rural areas like the Coast Region of Tanzania is still very low. Programs aimed to promote exclusive breastfeeding must take multi-factorial considerations.

Effective Approaches to Enhancing the Social Dimension of Higher Education

Despite all intentions in the course of the Bologna Process and decades of investment into improving the social dimension, results in many national and international studies show that inequity remains stubbornly persistent, and that inequity based on socio-economic status, parental education, gender, country-of-origin, rural background and more continues to prevail in our Higher Education systems and at the labour market. While improvement has been shown, extrapolation of the gains of the last 40 years in the field show that it could take over 100 years for disadvantaged groups to catch up with their more advantaged peers, should the current rate of improvement be maintained. Many of the traditional approaches to improving equity have also necessitated large-scale public investments, in the form of direct support to underrepresented groups. In an age of austerity, many countries in Europe are finding it necessary to revisit and scale down these policies, so as to accommodate other priorities, such as balanced budgets or dealing with an aging population. An analysis of the current situation indicates that the time is ripe for disruptive innovations to mobilise the cause forward by leaps and bounds, instead of through incrementalist approaches. Despite the list of programmes in this analysis there is very little evidence as to the causal link between programmes, methodologies for their use and increases/improvements in equity in institutions. This creates a significant information gap for institutions and public authorities seeking for indicators to allocate limited resources to equity improving initiatives, without adequate evidence of effectiveness. The IDEAS project and this publication aims at addressing and improving this information gap. (DIPF/Orig.)

Biostratigraphy and average linear sedimentation rate and accumulation rate of ODP Site 159-959 (Table 1)

Reconstructing the long-term evolution of organic sedimentation in the eastern Equatorial Atlantic (ODP Leg 159) provides information about the history of the climate/ocean system, sediment accumulation, and deposition of hydrocarbon-prone rocks. The recovery of a continuous, 1200 m long sequence at ODP Site 959 covering sediments from Albian (?) to the present day (about 120 Ma) makes this position a key location to study these aspects in a tropical oceanic setting. New high resolution carbon and pyrolysis records identify three main periods of enhanced organic carbon accumulation in the eastern tropical Atlantic, i.e. the late Cretaceous, the Eocene-Oligocene, and the Pliocene-Pleistocene. Formation of Upper Cretaceous black shales off West Africa was closely related to the tectonosedimentary evolution of the semi-isolated Deep Ivorian Basin north of the Côte d'Ivoire-Ghana Transform Margin. Their deposition was confined to certain intervals of the last two Cretaceous anoxic events, the early Turonian OAE2 and the Coniacian-Santonian OAE3. Organic geochemical characteristics of laminated Coniacian-Santonian shales reveal peak organic carbon concentrations of up to 17% and kerogen type I/II organic matter, which qualify them as excellent hydrocarbon source rocks, similar to those reported from other marginal and deep sea basins. A middle to late Eocene high productivity period occurred off equatorial West Africa. Porcellanites deposited during that interval show enhanced total organic carbon (TOC) accumulation and a good hydrocarbon potential associated with oil-prone kerogen. Deposition of these TOC-rich beds was likely related to a reversal in the deep-water circulation in the adjacent Sierra Leone Basin. Accordingly, outflow of old deep waters of Southern Ocean origin from the Sierra Leone Basin into the northern Gulf of Guinea favored upwelling of nutrient-enriched waters and simultaneously enhanced the preservation potential of sedimentary organic matter along the West African continental margin. A pronounced cyclicity in the carbon record of Oligocene-lower Miocene diatomite-chalk interbeds indicates orbital forcing of paleoceanographic conditions in the eastern Equatorial Atlantic since the Oligocene-Miocene transition. A similar control may date back to the early Oligocene but has to be confirmed by further studies. Latest Miocene-early Pliocene organic carbon deposition was closely linked to the evolution of the African trade winds, continental upwelling in the eastern Equatorial Atlantic, ocean chemistry and eustatic sea level fluctuations. Reduction in carbonate carbon preservation associated with enhanced carbon dissolution is recorded in the uppermost Miocene (5.82-5.2 Ma) section and suggests that the latest Miocene carbon record of Site 959 documents the influence of corrosive deep waters which formed in response to the Messinian Salinity Crisis. Furthermore, sea level-related displacement of higher productive areas towards the West African shelf edge is indicated at 5.65, 5.6, 5.55, 5.2, 4.8 Ma. In view of humid conditions in tropical Africa and a strong West African monsoonal system around the Miocene-Pliocene transition, the onset of pronounced TOC cycles at about 5.6 Ma marks the first establishment of upwelling cycles in the northern Gulf of Guinea. An amplification in organic carbon deposition at 3.3 Ma and 2.45 Ma links organic sedimentation in the tropical eastern Equatorial Atlantic to the main steps of northern hemisphere glaciation and testifies to the late Pliocene transition from humid to arid conditions in central and western African climate. Aridification of central Africa around 2.8 Ma is not clearly recorded at Site 959. However, decreased and highly fluctuating carbonate carbon concentrations are observed from 2.85 Ma on that may relate to enhanced terrigenous (eolian) dilution from Africa.

Home and group-based implementation of the "Growing Up Happily in the Family" program in at-risk psychosocial contexts

"Growing Up Happily in the Family" is a program to prevent child maltreatment targeted at parents of children aged 0-5 years old in at-risk psychosocial contexts. The program is delivered via either a group-based or a home-visit format. The objective of this study was to evaluate the impact of various implementation components in the home and group versions on changes in parental attitudes about child development and education. At-risk and non at-risk parents participated in the group-based (196 participants in 26 groups) and home-visit (95 participants) versions of the program delivered through local social services. We analyzed program adherence, adaptations, participant responsiveness, quality of delivery, and implementation barriers as predictors of changes in parental attitudes. The results showed that greater program adherence, better quality of delivery and participant responsiveness, and positive climate predicted changes in parental attitudes in both formats. Therefore, it is important to take into account the quality of the implementation process when testing the effectiveness of early group-based and home-visit interventions in at-risk families.

Domestic Rhodnius ecuadoriensis (Hemiptera, Reduviidae) infestation in Northern Peru: a comparative trial of detection methods during a six-month follow-up

Two passive methods in the assessment of intradomiciliary infestation by Rhodnius ecuadoriensis were tested: (i) the Gomes Nuñez sensor box (GN), (ii) sheets of white typing paper and (iii) one active timed manual method. The study was carried out in the Alto Chicama River Valley, Province of Gran Chimú, Department of La Libertad. The study design consisted of an initial searching of triatomines inside of the domestic environment by the manual capture active procedure (man/hour) covering all the studied houses. Then, matched pairs of GN boxes and paper sheets were simultaneously installed in the bedrooms of 207 households distributed in 19 localities. A comparative prospective trial of these passive detection devices were monitored at 2, 4 and, finally 6 months follow-up. Parasitological Trypanosoma rangeli and/or T. cruzi infections were investigated in two houses with high level of infestation by R. ecuadoriensis.16.9% of the 207 households investigated by an initial active manual method were infested with R. ecuadoriensis. The proportion of infested houses fluctuated from 6.2 to 55.5% amongst the 19 localities investigated. T. rangeli natural infection was detected in R.ecuadoriensis specimens collected in two households. Parasite rates in the bugs ranged from 16.6 to 21.7% respectively. The most striking fact was an average rate of salivary gland infection ranging from 7.4 to 8.3%. At the end of the sixth month period, a cumulative incidence of 31.4% of positive GN boxes against 15.9% for paper sheets was recorded. All three methods combined detected domestic infestation in 129 (62.3%) of the 207 houses studied in the 19 localities. The range of houses infested varies from 6.7% to 92.9%. In areas with low bug density infestation rates, the methodology experienced in our studies, seems to be the best choice for investigations on domestic R. ecuadoriensis populations.

Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

Background: Complex chronic diseases are a challenge for the current configuration of Health services. Case management is a service frequently provided for people with chronic conditions and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures, and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers, and services used. Methods and design: The study was divided into three phases, covering the detection of information needs, the design and its implementation in the healthcare system, using literature review and expert consensus methods to select variables that would be included in the registry. Objective: To describe the essential characteristics of the provision of ca re lo people who receive case management (structure, process and outcomes), with special emphasis on those with complex chronic diseases. Study population: Patients from any District of Primary Care, who initiate the utilization of case management services, to avoid information bias that may occur when including subjects who have already been received the service, and whose outcomes and characteristics could not be properly collected. Results: A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. Total sample was composed of 427 patients, of which 211 (49.4%) were women and 216 (50.6%) were men. The average functional level (Barthel lndex) was 36.18 (SD 29.02), cognitive function (Pfeiffer) showed an average of 4.37 {SD 6.57), Chat1son Comorbidity lndex, obtained a mean of 3.03 (SD 2.7) and Social Support (Duke lndex) was 34.2 % (SD 17.57). More than half of patients include in the Registry, correspond lo immobilized or transitional care for patients discharged from hospital (66.5 %). The patient's educational level was low or very low (50.4%). Caregivers overstrain (Caregiver stress index), obtained an average value of 6.09% (SD 3.53). Only 1.2 % of patients had declared their advanced directives, 58.6 had not defined the tutelage and the vast majority lived at home 98.8 %. Regarding the major events recorded at RANGE Registry, 25.8 % of the selected patients died in the first three months, 8.2 % suffered a hospital admission at least once time, 2.3%, two times, and 1.2% three times, 7.5% suffered a fall, 8.7% had pressure ulcer, 4.7% had problems with medication, and 3.3 % were institutionalized. Stroke is the more prevalent health problem recorded (25.1%), followed by hypertension (11.1%) and COPD (11.1%). Patients registered by NCMs had as main processes diabetes (16.8%) and dementia (11.3 %). The most frequent nursing diagnoses referred to the self-care deficit in various activities of daily living. Regarding to nursing interventions, described by the Nursing Intervention Classification (NIC), dementia management is the most used intervention, followed by mutual goal setting, caregiver and emotional support. Conclusions: The patient profile who receive case management services is a chronic complex patient with severe dependence, cognitive impairment, normal social support, low educational level, health problems such as stroke, hypertension or COPD, diabetes or dementia, and has an informal caregiver. At the first follow up, mortality was 19.2%, and a discrete rate of readmissions and falls.

(Appendix A) Sedimentation rate, geochemical and environmental magnetic proxies of the samples of the Metochia section, on the island of Gavdos, south of Crete

The upper Tortonian Metochia marls on the island of Gavdos provide an ideal geological archive to trace variations in Aegean sediment supply as well as changes in the North African monsoon system. A fuzzy-cluster analysis on the multiproxy geochemical and rock magnetic dataset of the astronomically tuned sedimentary succession shows a dramatic shift in the dominance of 'Aegean tectonic' clusters to 'North African climate' clusters. The tectonic signature, traced by the starvation of the Cretan sediment, now enables to date the late Tortonian basin foundering on Crete, related to the tectonic break-up of the Aegean landmass, at c. 8.2 Ma. The synchronous decrease in the North African climate proxies is interpreted to indicate a change in the depositional conditions of the sink rather than a climatic change in the African source. This illustrates that interpretations of climate proxies require a multiproxy approach which also assesses possible contributions of regional tectonism.

RATE OF CONVERGENCE OF MAXIMUM LIKELIHOOD ESTIMATORS UNDER RELAXED SMOOTHNESS CONDITIONS ON THE LIKELIHOOD FUNCTION

This report reviews literature on the rate of convergence of maximum likelihood estimators and establishes a Central Limit Theorem, which yields an O(1/sqrt(n)) rate of convergence of the maximum likelihood estimator under somewhat relaxed smoothness conditions. These conditions include the existence of a one-sided derivative in θ of the pdf, compared to up to three that are classically required. A verification through simulation is included in the end of the report.

The impact of bariatric surgery on estimated glomerular filtration rate in patients with type 2 diabetes:a retrospective cohort study

Background: Diabetes mellitus is the most common cause of end-stage renal disease, which is associated with increased morbidity and mortality. The impact of bariatric surgery on chronic kidney disease is unclear. Objectives: Our primary aim was to assess the impact of bariatric surgery on estimated glomerular filtration rate (eGFR) in type 2 diabetes (T2D) patients. Our secondary aim was to compare the impact of bariatric surgery versus routine care on eGFR in patients with T2D. Setting: University Hospital, United Kingdom. Methods: A retrospective cohort analysis of adults with T2D who underwent bariatric surgery at a single center between January 2005 and December 2012. Data regarding eGFR were obtained from electronic patients records. eGFR was calculated using the Modification of Diet in Renal Disease formula. Data regarding patients with T2D who did not undergo bariatric surgery ("routine care") were obtained from patients attending the diabetes clinic at the same center from 2009 to 2011. Results: One hundred sixty-three patients were included (mean age 48.5±8.8 yr; baseline body mass index 50.8±9.1 kg/m2) and were followed for 3.0±2.3 years. Bariatric surgery resulted in an improvement in eGFR (median [interquartile range] 86.0 [73.0-100.0] versus 92.0 [77.0-101.0] mL/min/1.73 m2 for baseline versus follow-up, respectively; P = .003), particularly in patients with baseline eGFR≤60 mL/min/1.73 m2 (48.0 [42.0-57.0] versus 61.0 [55.0-63.0] mL/min/1.73 m2; P = .004). After adjusting for baseline eGFR, glycated hemoglobin (HbA1C), body mass index, age, and gender, bariatric surgery was associated with higher study-end eGFR compared with routine care (B = 7.787; P< .001). Conclusion: Bariatric surgery results in significant improvements in eGFR in T2D patients, particularly those with an eGFR≤60 mL/min/1.73 m2, while routine care was associated with a decline in eGFR.

Cavity ring‑up spectroscopy for dissipative and dispersive sensing in a whispering gallery mode resonator

In whispering gallery mode resonator sensing applications, the conventional way to detect a change in the parameter to be measured is by observing the steady-state transmission spectrum through the coupling waveguide. Alternatively, sensing based on cavity ring-up spectroscopy, i.e. CRUS, can be achieved transiently. In this work, we investigate CRUS using coupled mode equations and find analytical solutions with a large spectral broadening approximation of the input pulse. The relationships between the frequency detuning, coupling gap and ring-up peak height are determined and experimentally verified using an ultrahigh Q-factor silica microsphere. This work shows that distinctive dispersive and dissipative transient sensing can be realised by simply measuring the peak height of the CRUS signal, which may improve the data collection rate.

Outpatient follow-up during the first year after heart transplantation, is it feasible?

First year follow-up after heart transplantation requires invasive tests. Although patients used to be hospitalized for this purpose, ambulatory invasive procedures now offer the possibility of outpatient follow-up. The feasibility and security of this strategy is unknown. From 2007 we transitioned to outpatient follow-up. We have retrospectively reviewed the clinical course of the outpatient group (2007 to 2014) and an inpatient group (2000–2006). Basal characteristics, hospital stay, infections, rejection episodes and vascular complications were evaluated. 87 patients had Inpatient Follow-up (IF) and 98 Outpatient Follow-up (OF). Basal characteristics were similar, with significant differences in immunosuppression (tacrolimus IF 44.8% vs. OF 90.8%, and mycophenolate IF 86.2% vs OF 100%, both p values < 0.001) and age (IF 52 ± 11.5 years vs. OF 56.1 ± 11 years, p = 0.016). In the OF group more clinical visits were performed (IF 10 vs. OF 13, p < 0.001) while hospital stay was lower (IF 23 days vs. OF 3 days, p < 0.001). The rate of infection, rejection, and vascular complications was similar. No difference was found in 1-year mortality (IF 2.3% vs. 1.0%, p = 0.60). First year post-cardiac transplantation outpatient follow-up seems to be feasible and safe in terms of infection, rejection, vascular complications and mortality.