Heart Transplantation in Patients Older than 65 Years: Worthwhile or Wastage of Organs?

BACKGROUND: Patients older than 65 years have traditionally not been considered candidates for heart transplantation. However, recent studies have shown similar survival. We evaluated immediate and medium-term results in patients older than 65 years compared with younger patients. METHODS: From November 2003 to December 2013, 258 patients underwent transplantation. Children and patients with other organ transplantations were excluded from this study. Recipients were divided into two groups: 45 patients (18%) aged 65 years and older (Group A) and 203 patients (81%) younger than 65 years (Group B). RESULTS: Patients differed in age (67.0 ± 2.2 vs. 51.5 ± 9.7 years), but gender (male 77.8 vs. 77.3%; p = 0.949) was similar. Patients in Group A had more cardiovascular risk factors and ischemic cardiomyopathy (60 vs. 33.5%; p < 0.001). Donors to Group A were older (38.5 ± 11.3 vs. 34.0 ± 11.0 years; p = 0.014). Hospital mortality was 0 vs. 5.9% (p = 0.095) and 1- and 5-year survival were 88.8 ± 4.7 versus 86.8 ± 2.4% and 81.5 ± 5.9 versus 77.2 ± 3.2%, respectively. Mean follow-up was 3.8 ± 2.7 versus 4.5 ± 3.1 years. Incidence of cellular/humoral rejection was similar, but incidence of cardiac allograft vasculopathy was higher (15.6 vs. 7.4%; p = 0.081). Incidence of diabetes de novo was similar (p = 0.632), but older patients had more serious infections in the 1st year (p = 0.018). CONCLUSION: Heart transplantation in selected older patients can be performed with survival similar to younger patients, hence should not be restricted arbitrarily. Incidence of infections, graft vascular disease, and malignancies can be reduced with a more personalized approach to immunosuppression. Allocation of donors to these patients does not appear to reduce the possibility of transplanting younger patients.

Heart Transplantation in Patients Older than 65 Years: Worthwhile or Wastage of Organs?

BACKGROUND: Patients older than 65 years have traditionally not been considered candidates for heart transplantation. However, recent studies have shown similar survival. We evaluated immediate and medium-term results in patients older than 65 years compared with younger patients. METHODS: From November 2003 to December 2013, 258 patients underwent transplantation. Children and patients with other organ transplantations were excluded from this study. Recipients were divided into two groups: 45 patients (18%) aged 65 years and older (Group A) and 203 patients (81%) younger than 65 years (Group B). RESULTS: Patients differed in age (67.0 ± 2.2 vs. 51.5 ± 9.7 years), but gender (male 77.8 vs. 77.3%; p = 0.949) was similar. Patients in Group A had more cardiovascular risk factors and ischemic cardiomyopathy (60 vs. 33.5%; p < 0.001). Donors to Group A were older (38.5 ± 11.3 vs. 34.0 ± 11.0 years; p = 0.014). Hospital mortality was 0 vs. 5.9% (p = 0.095) and 1- and 5-year survival were 88.8 ± 4.7 versus 86.8 ± 2.4% and 81.5 ± 5.9 versus 77.2 ± 3.2%, respectively. Mean follow-up was 3.8 ± 2.7 versus 4.5 ± 3.1 years. Incidence of cellular/humoral rejection was similar, but incidence of cardiac allograft vasculopathy was higher (15.6 vs. 7.4%; p = 0.081). Incidence of diabetes de novo was similar (p = 0.632), but older patients had more serious infections in the 1st year (p = 0.018). CONCLUSION: Heart transplantation in selected older patients can be performed with survival similar to younger patients, hence should not be restricted arbitrarily. Incidence of infections, graft vascular disease, and malignancies can be reduced with a more personalized approach to immunosuppression. Allocation of donors to these patients does not appear to reduce the possibility of transplanting younger patients.

Toxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in the developing male Wistar(Han) rat II: chronic dosing causes developmental delay

We have investigated whether fetal exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) causes defects in the male reproductive system of the rat, using chronically exposed rats to ensure continuous exposure of the fetus. 5-6 week old rats were exposed to control diet, or diet containing TCDD, to attain an average dose of 2.4, 8 and 46 ng TCDD kg-1 day-1 for twelve weeks, whereupon the rats were mated, and allowed to litter; rats were switched to control diet after parturition. Male offspring were allowed to develop until kills on PND70 (25 per group), or PND120 (all remaining animals). Offspring from the high dose group showed an increase in total litter loss, and the number of animals alive on post-natal day (PND) 4 in the high dose group was ~26% less than control. The high and medium dose offspring showed decreased weights at various ages. Balano-preputial separation was significantly delayed in all three dose groups, compared to control. There were no significant effects of maternal treatment when the offspring were subjected to a functional observational battery, or learning tests, with the exception that the high dose group showed a deficit in motor activity. 20 rats per group were mated to females, and there were no significant effects of maternal treatment on the fertility of these rats, nor on the F1 or F2 sex ratio. Sperm parameters at PND70 and 120 showed no significant effect of maternal treatment, with the exception that there was an increase in the proportion of abnormal sperm in the high dose group at PND70; this is associated with the developmental delay in puberty in this dose group. There were no remarkable findings of maternal treatment on organ weights, with the exception that testis weights were reduced by ~10% at PND70 (but not PND120), and although the experiment was sufficiently powered to detect small changes, ventral prostate weight was not reduced. There were no significant effects of maternal treatment upon histopathological comparison of high dose and control group organs. These data confirm that developmental exposure to TCDD shows no potent effect on adult sperm parameters or accessory sexual organs, but show that delay in BPS occurs after exposure to low doses of TCDD, and this is dependent upon whether TCDD is administered acutely or chronically.

Phytate-phosphorus and phytase contents on the relative weight of organs, intestinal morphometry and performance of broilers.

ABSTRACT: In order to evaluate the efficiency of phytase in diets with low and high phytate phosphorus (PP) content, as a consequence of wheat bran inclusion, on the relative weight of organs, intestinal morphometry and performance, three hundred and eighty-four male Cobb500 broilers were housed in metabolic cages. Animals were assigned into four treatments in a 2x2 factorial scheme in a randomized block design with eight replicates of 12 birds each. From 11 days of age birds received experimental diets, which consisted of: Diet low in PP; Diet low in PP with phytase (500FTU kg-1); Diet with a high PP and Diet with a high PP with phytase (500FTU kg-1). At 22 and 32 days of age two birds were slaughtered in order to collect gizzard, heart, liver, cecum, cloacal bursa, and at 32 days, a portion of the duodenum, jejunum and ileum was collected for morphometric evaluation. From 22 to 32 days of age average feed intake, average weight gain, average body weight and feed conversion ratio were also evaluated. Data were subjected to analysis of variance, fixed effects of diet and phytase and interaction between factors as well as the random block effects were tested. There was no significant interaction for the variables studied, concluding that phytase in diets with low or high phytate phosphorus content did not change the relative weight of organs, intestinal morphometrics and performance; only isolated effects were observed. RESUMO: Para avaliar a eficiência da fitase em dietas com baixo e alto teor de fósforo fítico (PP), em função da inclusão ou não do farelo de trigo, sobre o peso relativo de órgãos, morfometria intestinal e desempenho, foram alojados 384 frangos de corte, machos da linhagem Cobb500, em gaiolas metabólicas. Os animais foram distribuídos em quatro tratamentos em um arranjo fatorial 2x2 em delineamento de blocos casualizados com oito repetições e 12 aves por unidade experimental (UE). A partir de 11 dias de idade as aves receberam as dietas experimentais, que consistiram em: Dieta com baixo teor de PP; Dieta com baixo teor de PP com fitase (500FTU kg-1); Dieta com alto teor de PP e Dieta com alto teor de PP com fitase (500FTU kg-1). Aos 22 e 32 dias de idade foram abatidas duas aves por UE para coletar a moela, coração, fígado, ceco, bolsa cloacal, e aos 32 dias foi coletada uma porção do duodeno, jejuno e íleo para avaliação da morfometria. No período de 22 a 32 dias de idade foram avaliados o consumo médio de ração, ganho de peso médio, peso médio corporal e a conversão alimentar. Os dados foram submetidos à análise de variância, onde foram testados os efeitos fixos de dieta e fitase e a interação entre os fatores, bem como o efeito aleatório de bloco. Não foi observada interação significativa para nenhuma das variáveis estudadas, concluindo-se que a fitase em dietas com baixo ou alto de PP não altera o peso relativo dos órgãos, a morfometria intestinal e o desempenho, apenas efeitos isolados foram observados.

A generative design system based on evolutionary and mathematical functions

Previous work by Professor John Frazer on Evolutionary Architecture provides a basis for the development of a system evolving architectural envelopes in a generic and abstract manner. Recent research by the authors has focused on the implementation of a virtual environment for the automatic generation and exploration of complex forms and architectural envelopes based on solid modelling techniques and the integration of evolutionary algorithms, enhanced computational and mathematical models. Abstract data types are introduced for genotypes in a genetic algorithm order to develop complex models using generative and evolutionary computing techniques. Multi-objective optimisation techniques are employed for defining the fitness function in the evaluation process.

Creative design and the generative evolutionary paradigm

Design as seen from the designer's perspective is a series of amazing imaginative jumps or creative leaps. But design as seen by the design historian is a smooth progression or evolution of ideas that they seem self-evident and inevitable after the event. But the next step is anything but obvious for the artist/creator/inventor/designer stuck at that point just before the creative leap. They know where they have come from and have a general sense of where they are going, but often do not have a precise target or goal. This is why it is misleading to talk of design as a problem-solving activity - it is better defined as a problem-finding activity. This has been very frustrating for those trying to assist the design process with computer-based, problem-solving techniques. By the time the problem has been defined, it has been solved. Indeed the solution is often the very definition of the problem. Design must be creative-or it is mere imitation. But since this crucial creative leap seem inevitable after the event, the question must arise, can we find some way of searching the space ahead? Of course there are serious problems of knowing what we are looking for and the vastness of the search space. It may be better to discard altogether the term "searching" in the context of the design process: Conceptual analogies such as search, search spaces and fitness landscapes aim to elucidate the design process. However, the vastness of the multidimensional spaces involved make these analogies misguided and they thereby actually result in further confounding the issue. The term search becomes a misnomer since it has connotations that imply that it is possible to find what you are looking for. In such vast spaces the term search must be discarded. Thus, any attempt at searching for the highest peak in the fitness landscape as an optimal solution is also meaningless. Futhermore, even the very existence of a fitness landscape is fallacious. Although alternatives in the same region of the vast space can be compared to one another, distant alternatives will stem from radically different roots and will therefore not be comparable in any straightforward manner (Janssen 2000). Nevertheless we still have this tantalizing possibility that if a creative idea seems inevitable after the event, then somehow might the process be rserved? This may be as improbable as attempting to reverse time. A more helpful analogy is from nature, where it is generally assumed that the process of evolution is not long-term goal directed or teleological. Dennett points out a common minsunderstanding of Darwinism: the idea that evolution by natural selection is a procedure for producing human beings. Evolution can have produced humankind by an algorithmic process, without its being true that evolution is an algorithm for producing us. If we were to wind the tape of life back and run this algorithm again, the likelihood of "us" being created again is infinitesimally small (Gould 1989; Dennett 1995). But nevertheless Mother Nature has proved a remarkably successful, resourceful, and imaginative inventor generating a constant flow of incredible new design ideas to fire our imagination. Hence the current interest in the potential of the evolutionary paradigm in design. These evolutionary methods are frequently based on techniques such as the application of evolutionary algorithms that are usually thought of as search algorithms. It is necessary to abandon such connections with searching and see the evolutionary algorithm as a direct analogy with the evolutionary processes of nature. The process of natural selection can generate a wealth of alternative experiements, and the better ones survive. There is no one solution, there is no optimal solution, but there is continuous experiment. Nature is profligate with her prototyping and ruthless in her elimination of less successful experiments. Most importantly, nature has all the time in the world. As designers we cannot afford prototyping and ruthless experiment, nor can we operate on the time scale of the natural design process. Instead we can use the computer to compress space and time and to perform virtual prototyping and evaluation before committing ourselves to actual prototypes. This is the hypothesis underlying the evolutionary paradigm in design (1992, 1995).

Generative and evolutionary models for design

The paper describes three design models that make use of generative and evolutionary systems. The models describe overall design methods and processes. Each model defines a set of tasks to be performed by the design team, and in each case one of the tasks requires a generative or evolutionary design system. The architectures of these systems are also broadly described.

Is the Marlboro man the only alternative? The role of gender identity and self-construal salience in evaluations of male models

This research examines how men react to male models in print advertisements. In two experiments, we show that the gender identity of men influences their responses to advertisements featuring a masculine, feminine, or androgynous male model. In addition, we explore the extent to which men feel they will be classified by others as similar to the model as a mechanism for these effects. Specifically, masculine men respond most favorably to masculine models and are negative toward feminine models. In contrast, feminine men prefer feminine models when their private self is salient. Yet in a collective context, they prefer masculine models.These experiments shed light on how gender identity and self-construal influence male evaluations and illustrate the social pressure on men to endorse traditional masculine portrayals. We also present implications for advertising practice.

Generative systems as relational bridges

Generative media systems present an opportunity for users to leverage computational systems to make sense of complex media forms through interactive and collaborative experiences. Generative music and art are a relatively new phenomenon that use procedural invention as a creative technique to produce music and visual media. These kinds of systems present a range of affordances that can facilitate new kinds of relationships with music and media performance and production. Early systems have demonstrated the potential to provide access to collaborative ensemble experiences to users with little formal musical or artistic expertise. This paper examines the relational affordances of these systems evidenced by selected field data drawn from the Network Jamming Project. These generative performance systems enable access to unique ensemble with very little musical knowledge or skill and they further offer the possibility of unique interactive relationships with artists and musical knowledge through collaborative performance. In this presentation I will focus on demonstrating how these simulated experiences might lead to understandings that may be of educational and social benefit. Conference participants will be invited to jam in real time using virtual interfaces and to view video artifacts that demonstrate an interactive relationship with artists.

Similarity not favourability : the role of donor prototypes in predicting willingness to donate organs while living

Using an extended Prototype/Willingness Model, we examined the predictors of willingness to donate an organ to a partner/family member and a stranger while living. A questionnaire assessed university students’ (N = 284) attitudes, subjective norm, prototype favourability, prototype similarity, moral norm, and willingness to donate organs in each recipient scenario. All variables, except prototype favourability, predicted willingness to donate organs in both situations. Future strategies should emphasise perceived approval from important others for living donation, the consistency of living donation with one’s own morals, and encourage perceptions of similarity between oneself and living donors to increase acceptance of living donation.

Daddies, assistants and foolsbdifferentiation of male representations in present-day advertising.

This paper explores the way men are represented in present-day advertising. Most gender related studies have concentrated in studying women in advertising and claim that men are still represented as the dominant gender and in more active, independent and functional roles than women. This paper asks whether this still holds for advertising in the beginning of 21st century. Many cultural changes may have broken the earlier stereotypes, for example changes in the family life, attitudes toward various sexual identities, concepts of masculinity and femininity, and changes in cultural style.

Wrapped fragments : Drapery, the eighteenth century portrait bust and the male subject

The depiction of drapery (generalised cloth as opposed to clothing) is a well-established convention of Neo-Classical sculpture and is often downplayed by art historians as of purely rhetorical value. It can be argued however that sculpted drapery has served a spectrum of expressive ends, the variety and complexity of which are well illustrated by a study of its use in portrait sculpture. For the Neo-Classical portrait bust, drapery had substantial iconographic and political meaning, signifying the new Enlightenment notions of masculine authority. Within the portrait bust, drapery also served highly strategic aesthetic purposes, alleviating the abruptness of the truncated format and the compromising visual consequences of the “cropped” body. With reference to Joseph Nollekens’ portraits of English statesman Charles James Fox and the author’s own sculptural practice, this paper analyses the Neo-Classical use of drapery to propose that rendered fabric, far from mere stylistic flourish, is a highly charged visual signifier with much scope for exploration in contemporary sculptural practice.