bluuebunny/crossref_metadata_2025 huggingface dataset:
INCURSÕES SOBRE OS TERMOS E CONCEITOS DA EDUCAÇÃO MUSEAL
Authors: Cazelli Sibele , Valente Maria Esther
Published: September 2019

A educação em museu pode ser definida como um conjunto de valores, conceitos, saberes e práticas cujo objetivo é o desenvolvimento do visitante. Para abordar o tema, a proposta deste artigo é fazer algumas incursões sobre o entendimento de termos e conceitos da área em questão. Não se pretende fazer uma análise exaustiva, mas revisitar referências que destacam controvérsias de linguagem nas suas definições em diferentes países. Este interesse é motivado por indagações, ainda recorrentes, associadas à compreensão de termos como educação formal, não formal, informal e museal, que podem ser tornar confusos em função de suas finalidades. Isto porque são compartilhados por diferentes instituições com as quais se interrelacionam. Este fato ocorre, essencialmente, uma vez que a maior parte da literatura de caráter museológico difundida sobre os estudos de público provém de países ocidentais desenvolvidos e está e divulgada principalmente em inglês ou francês. Cotejando a literatura nacional e estrangeira pode-se estabelecer o caminho percorrido para a construção dos termos e conceitos usados na consolidação do corpo teórico da educação em museu. Considerando as definições do sociólogo francês Bourdieu, é possível entender a educação museal como um campo de conhecimento, ainda em construção, com pouca autonomia e em processo de acúmulo de capital científico. Neste sentido, busca-se contribuir para o adensamento deste tipo de educação, valorizando-a e legitimando-a, tanto no que diz respeito às suas práticas quanto aos profissionais que as desenvolvem.
PASSA DEMAQUILANTE NO TEU PRECONCEITO: TUTORIAIS DE MAQUIAGEM COMO PERFORMANCE QUEER NO YOUTUBE
Authors: Bertolotti Elisângela , Medeiros Rosângela Fachel de
Published: September 2019

O Youtube é, atualmente, um espaço privilegiado de trocas e de interações no ambiente virtual, no qual reconhecemos uma crescente visibilidade e sucesso de performancesque apresentam estéticas e/ou sensibilidades Queer, as quais, de maneira geral, transcendem o limite de um nicho de público LGBTTTQIA[1] e, cada vez mais, são assistidas por um público heterogêneo. Neste artigo propomos uma leitura do “#TUTORIAL | Olho tudo + Boca tudo | Esfumado preto com glitter”, do famoso maquiador youtuber/influencer Antonio Campagna, enquanto performance Queer que subverter o discurso heteronormativo, que associa a maquiagem ao feminino e à mulher, e possibilita uma fruição lúdica da indeterminação que o Queer promove e celebra. [1] A sigla originalmente criada como LGBT – Lesbicas, Gays, Bissexuais e Trans, e em uso desde 1990, com o passar do tempo e a maior atenção a esses indivíduos e as suas questões, foi sofrendo adequações, sendo essa sua versão mais recente, que identifica: Lésbicas, Gays, Bissexuais, Travestis, Transexuais, Transgêneros, Queer, Intersexo e Assexual.
XICA MANICONGO: A TRANSGENERIDADE TOMA A PALAVRA
Authors: Jesus Jaqueline Gomes de
Published: September 2019

XICA MANICONGO: A TRANSGENERIDADE TOMA A PALAVRA
OS DOIS BRASIS: O RURAL E O URBANO NAS PUBLICAÇÕES E PESQUISAS DO CENTRO BRASILEIRO DE PESQUISAS EDUCACIONAIS (1956-1964)
Authors: Gouvea Fernando César Ferreira
Published: September 2019

O presente artigo tem como objeto de estudo as publicações e pesquisas desenvolvidas pelo Centro Brasileiro de Pesquisas Educacionais (CBPE) - no período de 1956 a 1964 - que tiveram como centralidade as relações entre Educação e Sociedade numa trama que conduziu ao cotejamento entre o “mundo rural” e o “mundo urbano”, entre o “regional” e o “nacional”. O período em tela se refere à gestão do intelectual Anísio Teixeira à frente do CBPE. Tal período histórico foi marcado pelo nacional-desenvolvimentismo num processo de tentativa de transformação acelerada das relações econômicas e sociais numa perspectiva de dimensionar o progresso representado pela evolução urbana brasileira em contraste com o propalado imobilismo do universo rural. Entretanto, este artigo revela que – na contramão de uma visão uniforme do mundo rural – as publicações se abriram para a pluralidade deste universo. As fontes utilizadas para a sustentação deste argumento são a Revista Educação e Ciências Sociais, o Boletim Mensal do CBPE e os livros publicados pela instituição.
ONDAS EM RESSONÂNCIA: LETRAMENTOS DIGITAIS DE ESTUDANTES NA UNIVERSIDADE ABERTA DE PORTUGAL
Authors: Souza Terezinha Fernandes
Published: September 2019

O estudo foi realizado na Universidade Aberta (UAb) de Portugal,  no Módulo Introdutório de Ambientação Online (MAO) com o objetivo de analisar o processo de formação de estudantes online (idealização, práticas e discursos) com o uso das mídias digitais (MD) identificando a relação entre as competências a desenvolver nos estudantes e possíveis dimensões e habilidades de Letramentos Digitais (LD) mobilizadas durante a formação, destacando contribuições para propostas de formação a outros contextos.
EDUCAÇÃO MUSEAL ONLINE: A EDUCAÇÃO MUSEAL NA/COM A CIBERCULTURA
Authors: Marti Frieda Maria , Santos Edméa Oliveira dos
Published: September 2019

O presente artigo tem como objetivo narrar as principais transformações comunicacionais e educacionais geradas pelo rápido e intenso desenvolvimento das tecnologias digitais em rede (TDR) na contemporaneidade e discutir sua relação com a educação museal. O termo e noção ‘Educação Museal Online’ (EMO) é apresentado e sugerido como um novo modo de fazerpensar[1] ações educativas museais na/com a cibercultura, a partir dos referenciais teórico-epistemológicos da multirreferencialidade (Ardoino, 1998) e das pesquisas dos/nos/com os cotidianos (Alves, 2008, 2010; Certeau, 2014), assim como das experiências de práticas educativas museais online levadas a cabo pela primeira autora com/na Seção de Assistência ao Ensino do Museu Nacional/UFRJ, como parte de sua participação como professora colaboradora do setor e de sua pesquisa de doutorado em desenvolvimento no Programa de Pós-Graduação (PROPED) da Faculdade de Educação da Universidade do Estado do Rio de Janeiro (UERJ).[1] Segundo OLIVEIRA e ALVES (2008, p. 11) a junção de termos e a sua inversão, em alguns casos, foi a forma das autoras mostrarem “os limites para as pesquisas nos/dos/com os cotidianos, do modo dicotomizado criado pela ciência moderna para analisar a sociedade”.
A Review of Passive Radio Frequency Identification Systems for Animal Monitoring in Livestock Facilities
Authors: Brown-Brandl T. M. , Adrion F. , Maselyne J. , Kapun A. , Hessel E. F. , Saeys W. , Van Nuffel A. , Gallmann E.
Published: September 2019

Abstract.

Animal facilities are increasing in size, while the availability of skilled workers is decreasing, thus, making it difficult for the farm laborers to ensure the health and well-being of all animals under their care. Passive Radio Frequency Identification (RFID) systems have been successfully used in animal facilities and research has identified potential applications in behavior monitoring for automated illness detection. While RFID signals range in frequency from 9 kHz to 5.8 GHz, the three most common frequencies are Low Frequency (LF, 125 kHz or 134.2 kHz), High Frequency (HF, 13.56 MHz), and Ultra-High Frequency (UHF, 865-868 MHz or 902-928 MHz). The objective of this article is to compare and evaluate the application of these three different RFID systems within large research facilities for livestock and poultry in terms of hardware characteristics, system design, and data processing and usage. Differences in tag construction, availability and cost are evident, but also basic differences in reader and antenna function, such as physics of communication, speed of detection, and anti-collision procedures exist. The systems have significant differences in reading ranges and are known to have varying influence of materials, especially water and metal, on the performance of the systems. However, the data streams, as well as methods of data processing and the creation of events (e.g., visits to a feeder), are similar for all systems. The characteristics mentioned do not necessarily identify an ideal RFID technology but reveal positive and negative aspects of each system. The three different RFID systems have been successfully applied in livestock and poultry facilities. Current research is focused on the utilization of the RFID data in prediction and decision models for illness, animal welfare, and management actions. Keywords: Behavior, Cattle, Frequency ranges, Health and welfare, Poultry, Swine, Transponder.
Construction of a Dataset of Stored-grain Insects Images for Intelligent Monitoring
Authors: Li Jiangtao , Zhou Huiling , Jayas Digvir S. , Jia Qingxuan
Published: September 2019

Abstract. We constructed an image dataset of adults of 10 common species of stored-grain insects. This dataset is very significant for the research on image recognition algorithms for stored-grain insects, in order to implement intelligent monitoring for insects in warehouses. Images were collected using two kinds of devices: a developed automatic insect image acquisition device that can be fitted with different traps in warehouses and the commonly used smart phones. The images in this dataset contained 10 species of insect instances with various sizes, poses, and orientations. Each image corresponded to an xml file to store the species names and bounding boxes of insect instances in images. In total, 3,757 images were collected, and 159,238 insect instances were marked. The fine-grained classification algorithm based on Bilinear CNN and the object detection algorithms based on Faster R-CNN were adopted as baseline algorithms for benchmark experiments. Experiment results indicated that this dataset could support the research of image recognition algorithms of stored-grain insects, but it is a challenging task to detect small, adhesive and overlapped insect instances in images of this dataset. Currently, this dataset can be accessed at rgbinsect.cn. Keywords: Bilinear CNN, Faster R-CNN, Image dataset, Image recognition, Monitoring, Stored-grain Insects.
Chilled Aeration to Control Pests and Maintain Grain Quality during Summer Storage of Wheat in the North Central Region of Kansas
Authors: Morales-Quiros Alejandro , Campabadal Carlos , Maier Dirk E. , Lazzari Sonia M.N. , Lazzari Flavio A. , Phillips Thomas W.
Published: September 2019

Abstract.

Chilled aeration allows grain to be cooled, independent of ambient conditions, to “safe” temperatures at which insects, fungi, and spoilage development are reduced to a minimum. The objective of this research was to evaluate the advantages of using grain chilling to preserve the quality of grain and reduce post-harvest losses caused by insects and fungi, compared to the conventional aeration and storage strategies used during summer storage in central Kansas. The research trials were developed at a farmer’s cooperative in central Kansas in 2015 and 2016 on low-moisture wheat harvested during the summer of 2015 and 2016, respectively, and stored in two 1,350 metric ton (t) steel silos in which one was chilled and the other was used as a control managed by the cooperative. Temperature of the grain inside each silo was monitored with temperature cables. Variables evaluated were: moisture content (MC), grain and flour quality, insect-pest development and reproduction rate, insect fragments per 500 g of grain, and fungi presence. In 2015, the chilling treatment reduced the grain temperature from 28°C to 17°C in approximately 175 h, while in 2016 it took 245 h to reach about the same temperature with an initial grain temperature of 39°C. Grain temperatures below 25°C were not achieved in the control silo during the summer using ambient aeration. Minimum variation of MC was observed in the Chilled silo while ambient aeration reduced the moisture content by 0.5%. Reproduction rates of the red flour beetle and lesser grain borer were significantly reduced by chilling temperatures lower than 17°C. Lower temperatures also reduced insect populations detected in probe traps and insect damaged kernels. Insect fragments and fungi presence had no significant increase throughout the trials in either of the silos. No clear evidence of flour quality being better preserved at lower temperatures was detected. The energy cost of running the grain chiller was between 0.26-0.32 $/t higher than ambient aeration. Keywords: Ambient aeration, Grain chilling, Grain quality, Stored-product fungi, Stored-product insects, Summer storage, Wheat.
Development of a Stochastic Storm Generator Using High-Resolution Precipitation Records
Authors: Revuelta-Acosta Josept D. , Flanagan Dennis C. , Engel Bernard A.
Published: September 2019

Abstract.

Sophisticated field and watershed scale environmental models for runoff, erosion control, environmental, and global-change investigations require detailed continuous temporal and spatial inputs of precipitation to drive the hydrologic processes. For accurate estimates of these processes, the resolution of the input data must allow the representation of the variability of precipitation as it represents a major source of variability in the model outputs. Currently, the use of stochastic weather generators is widespread to generate continuous series of meteorological data at gauged and ungauged locations. These weather simulators are designed to replicate the statistical properties of real weather data at monthly or daily time resolutions. However, daily values of precipitation do not represent the variability of storm parameters within a day, which is assumed to significantly influence the predictions of environmental or agricultural models where processes are sensitive to sub-daily values. This research proposes a parsimonious stochastic storm generator based on 5-min time resolution and correlated non-normal Monte Carlo-based numerical simulation. The model considers correlated non-normal random rainstorm characteristics such as time between storms, duration, and amount of precipitation, as well as the storm intensity structure. The accuracy of the model was verified by comparing the generated rainfall with rainfall data from a randomly selected 5-min weather station in North Carolina. Current results have shown that the proposed storm generator can capture the essential statistical features of rainstorms as well as their patterns followed by their intensities, preserving the first four moments of monthly storm events, good annual extreme event correspondence, and the correlation structure within each storm. Finally, as the proposed model depends on statistical properties at a site, this may allow the use of the synthetic storms in ungauged locations provided relevant information from a regional analysis is available. Keywords: Monte Carlo, Stochastic storm generator, Storm distribution.
Dynamic Heat Flux Measurements from Finishing Pigs
Authors: Cortus Erin L , Darrington Joseph , Thaler Robert C
Published: September 2019

Abstract. Animal heat production and transfer data needs updating as genetics evolve, and newer technology provides alternative settings for collecting heat flux measurements. The project objective was to use heat flux sensors to measure the postural (resting, standing) effects on heat flux from finishing pigs, and compare estimated tissue resistance and sensible heat production based on these measurements to literature values. We measured heat flux from 12 individually housed active barrows with average (±SD) weight ranges of 95.6±15.5 kg and 111±13.9 kg, for Trials 1 and 2, respectively. We affixed heat flux sensors to the shaved areas on the right and left sides and rumps of the pigs to collect heat flux measurements every minute over a 6-h period during each trial. An overhead video camera system recorded pig behavior and positioning within each pen throughout the trials. Heat flux measurements showed rapid heat loss between a pig and floor when the pig lies on a cooled surface, but the heat flux starts to decrease almost immediately to steady state levels. When standing, the average heat flux from the rear of the pigs (124±8 W m-2) was greater than the heat flux from the sides of the animal (117±8 W m-2) (p<0.05, n=24). A linear regression model (R2=0.2735, n=24) with an intercept of 143 W m-2, suggests the heat flux decreases 0.25 W m-2 for each 1 kg increase in pig mass. Tissue resistance estimates from these heat flux measurements are approximately 60% of tissue resistance model estimates from the 1990’s. The heat flux data translate to sensible heat production estimates of 1.8 W kg-1, within the range of calorimeter-based estimates from recent literature. Keywords: Heat transfer model, Pigs, Pig housing, Tissue resistance.
A Pilot Study on the Microclimate of a Multi-span Solar Energy Greenhouse
Authors: Ni Mengwei , Lan Dun , Shah Jahan Mohammad , Wang Jian , Guo Shirong
Published: September 2019

Abstract.

Extreme low and high temperature is the main obstacle to grow plants in an ambient environment. Due to climate change, these problems are getting worse day by day. To resolve this dilemma a new type of energy-saving greenhouse structure, a multi-span solar energy greenhouse (SEG), was designed and constructed in the Yangtze valley region of China. Using a multi-span plastic greenhouse as a control greenhouse (CG), the microclimate characteristics of the SEG were studied in winter and summer. The results showed that, because the SEG adopted the cooling way of the combination of external shading and natural ventilation in summer, on a sunny day and cloudy day, the average air temperature of the SEG were 3.9°C and 0.9°C lower than CG, respectively, the average solar transmittance were 40% and 18% lower than CG, respectively, indoor microclimate distribution was more uniform. In an acute temperature condition, the effect of natural ventilation on cooling inside the SEG was better than CG during the daytime. Additionally, during the winter season, on a sunny day and cloudy day, compared with CG, the average solar transmittances of the SEG were 24% and 12% lower than CG, respectively, at the same time, the average air temperature of the SEG were 2.1°C and 2.3°C higher than CG, respectively. During the nighttime, the soil surface as well as the film temperature of the SEG, was higher than CG, whether it was on a sunny or a cloudy day, the daily effective accumulated temperature in SEG was more than CG. A north wall was built inside the SEG could effectively improve indoor nighttime temperature, and per unit volume of the SEG could save 0.63 L of diesel per day in winter, thereby saving $0.53, and reducing carbon emissions by 1.74 kg. Taken together, considering all aspect we concluded that the indoor environment of the SEG was more suitable for plant growth and cost-effective for crop cultivation as well. Keywords: Energy-saving, Greenhouse, Microclimate characteristics, Solar energy, Thermal environment.
Comparison between the Nutritional Qualities of Oil Extracted from Gac Aril by Solvent Method with Ohmic Heating and Conventional Methods
Authors: Aamir Muhammad - , Jittanit Weerachet -
Published: September 2019

Abstract. Nutritional qualities of Gac aril oil extracted by three different methods including mechanical press and solvent extractions using ohmic and conventional heating treatments were compared. The main objective was to determine the extraction technique that provided high nutritional quality. For mechanical method, oil was extracted using a screw press whereas three extraction stages were applied for solvent methods with the ratios of Gac aril powder:hexane at 1:7, 1:6, 1:5 for 7, 6, and 5 h, respectively. It appeared that the solvent extraction with ohmic heating provided superior nutritional quality of Gac aril oil with the highest values of total antioxidant activities, total phenolic content, omega-3 and 6 fatty acids, ß-carotene and lycopene in comparison with its counterparts. The scanning electron micrographs showed that ohmic heating influenced oil quality by distraction of cell membrane structure. Key fatty acids in oil obtained from ohmic method were oleic, palmitic, stearic and linoleic acids. It also contained ß-carotene and lycopene at 58.22 and 15.68 mg/100 g, respectively. Keywords: Emerging technology, Gac aril oil, Gac fruit, Nutrition, Ohmic heating.
Children, parents and non-parents: to whom does ‘the future’ belong?
Authors: Rosen Rachel , Suissa Judith
Published: September 2019

Narratives of ‘the future’ shape action, and the idea that certain members of society have more of a claim to ‘the future’ than others has received explicit articulation from academics, political commentators and journalists. Children are often viewed as the embodiment of ‘the future’, with parents positioned as having unique stakes in ‘the future’, particularly in comparison to non-parents. Asserting one agent’s rights to ‘the future’ inevitably undercuts another’s, and marginalised groups may be held responsible for the state of ‘the future’ but rendered unable to speak about it. In contrast, we argue that ‘the future’ is not the private possession of exclusionary subject positions or reductive political imaginaries which reduce the possible to a continuation of capitalist ethno-nations. Instead, we propose to understand futures as a collective intergenerational endeavour involving critical reflection on the present in order to challenge injustices in the present and enact evaluable changes. Doing so requires nothing short of a radical reimagining and remaking of childhood, (non)parenthood and adult–child relations.
Macronutrient and calorie content in preterm and term human milk at first three week after delivery
Authors: Murty Dessy Shinta , Putra Hasriza Eka , Mulatsih Sri , Nurani Neti , Wibowo Tunjung
Published: September 2019

Background The macronutrients in human milk change dynamically and vary among mothers. Evaluation of macronutrient content in human milk is needed to improve nutritional management in preterm infants.

Objective To measure the macronutrient content in preterm and full term human milk during three lactation periods in the first three weeks after delivery.

Methods We conducted a prospective study among 80 mothers of infants who were hospitalized in the Department of Perinatology/NICU at Sardjito Hospital, Yogyakarta. Carbohydrate, fat, protein, and caloric content were measured using a MIRIS human milk analyzer, once per week for three consecutive weeks after delivery. A single, daytime human milk specimen was collected in the morning by directly expressing from the breast.

Results Median protein, fat, carbohydrate, and caloric contents of mature milk in the preterm group were 1.40 (IQR 0.38), 3.25 (IQR 1.00), 5.70 (IQR 0.80) g/dL, and 60 kcal/dL, respectively. Median protein, fat, carbohydrate, and caloric contents of mature milk in the full term group were 1.40 (IQR 0.35), 3.30 (IQR 0.77), 5.80 (IQR 0.75) g/dL, and 62 kcal/dL, respectively, at the third week after delivery. In both groups, protein content in the first week was significantly higher than in the third week (P<0.001) after delivery. In contrast, fat content in the first week was significantly lower than in the third week (P< 0.05) after delivery, in both groups.

Conclusions There are no significant differences in macronutrient and caloric content between preterm and full term human milk during the first three weeks after delivery. However, there are significant changes in fat and protein content in both preterm and full term human milk during early lactation, between the first and third weeks.
Case report discussion of management of pink tetralogy of Fallot in VACTERL association
Authors: Putra Bayushi Eka , Hendrarto Toto Wisnu
Published: September 2019

Tetralogy of Fallot (TOF) and VACTERL are considered rare entities requiring medical attention with regards to diagnosis and management. When TOF is associated with VACTERL association, case management might differ from a simple case of TOF.

Tetralogy of Fallot (TOF) is defined as a complex congenital cardiac abnormality characterized by ventricular septal defect, right outflow tract obstruction, right ventricular hypertrophy, and overriding aorta.1 The term was coined in 1888 by Fallot of Marseilles, even though the defect had been described in 1673 by Steno of Denmark. The entity was then studied extensively to deliver better care management through medical and surgical approaches.2
P: 1 Genetic Fingerprint of Hepatic Encephalopathy Risk in Liver Cirrhosis
Authors: Gil-Gómez Antonio , Ampuero Javier , Rojas Ángela , Gallego-Durán Rocío , Millán Raquel , Muñoz-Hernández Rocío , Francés Rubén , Soriano Germán , Romero-Gómez Manuel
Published: September 2019

BACKGROUND:

To determine the impact of genetic factors on the development of hepatic encephalopathy (HE) in patients with liver cirrhosis.

METHODS:

Patients suffering from compensated liver cirrhosis [n = 434; estimation cohort (n = 294) and validation cohort (n = 140)] were included. Patients were followed up for five years until HE bouts, liver transplant, or death. Methods: Patients were genotyped for 62 candidate SNPs (genes involved in the pathophysiology of HE: inflammation, ammonia and glutamine metabolism, intestinal barrier integrity and oxidative stress) by using OpenArray custom plates. Likewise, a haplotype formed by four SNPs within GLS plus the length of a microsatellite in the promoter region of GLS were determined (Romero-Gómez et al. Ann Intern Med 2010). Statistical analysis was performed by Cox regression and Kaplan-Meier for continuous and categorical data. Significant variables, and those known as weighted prognostic indicators, were entered into multivariable models by competing risks, according to Fine and Gray's method.

RESULTS:

In the estimation cohort, competing risks analysis showed GLS mutations, FUT2-(rs601338), TLR9-(rs5743836), SLC1A3-(rs2562582) and SLC1A5-(rs313853), together with MELD, albumin, sodium and previous episodes of HE as variables independently associated to HE development. Those genes encode for proteins involved in maintenance of intestinal barrier integrity by host-microbial interactions (FUT2), pro-inflammatory response triggered by pathogens (TLR-9) and glutamine transport (SLC1A3 and SLC1A5). Combining these genetic factors according to number of alleles at risk, three levels of risk patients were defined: low, mid or high risk [sHR: 1; 6.5 (1.8–22.9) P = 0.004; 27.1 (7.5–96.8) P < 0.001, respectively] (C-index = 0.82). This regression model performed in a similar manner in the validation cohort [sHR: 1; 4.2 (1.2–14.3) P = 0.024; 10.0 (2.7–36.7) P < 0.001] (C-index = 0.78). Cumulative survival free of HE after 5 years was also influenced by this genetic fingerprint: 95.3%, 77.0% and 42.5% for the low, mid and high-risk groups (log-Rank 53.1; P < 0.001) in the estimation, and 85.2%, 56.0% and 40.0% (log-Rank 14.1; P < 0.001) in the validation cohort, respectively (Figure 1).

CONCLUSIONS:

Combination of unfavorable variants could predict HE. This genetic fingerprint could be implemented in clinical practice for decision making in the management of cirrhotic patients. Besides, this work emphasizes the role of these pathways in the pathophysiology of HE and brings out novel genes as potential therapeutic targets.
P: 8 Assessment of Cirrhotic Patients With Covert Hepatic Encephalopathy (HE) Through the EncephalApp (Stroop-Test) Based on Critical Flicker Frequency and PHES-Test
Authors: Neye R.M. , Kircheis G. , Hilger N. , Lüth S.
Published: September 2019

BACKGROUND:

In daily clinical practice, the detection of HE is still less represented but strongly required. Therefore, we assessed the EncephalApp (Stroop-Test) in a German population by standard diagnostic procedures such as the Critical Flicker Frequency (CFF) and the PHES-Test (Psychometric Hepatic Encephalopathy Score). One of the purposes of the trial was finding a Cut-Off value for the EncephalApp in the German population.

METHODS:

81 patients with liver cirrhosis underwent the testing of the CFF, the PHES-Test and the EncephalApp. A control group of 25 healthy subjects were examined in the same manner. The CFF was considered pathological with <39 Hz and the PHES-Test with < - 4 value points. The On-plus-Off Time of the EncephalApp was compared to the results of the CFF and the PHES-Test. Different Cut-Offs of the On-plus-Off Time were analyzed. Within these HE groups, the mean values of the PHES-Test, the CFF and the On-plus-Off Time of the EncephalApp were compared and the ROC Analysis (receiver operating characteristic) was conducted. Laboratory parameters, clinical data, and further imaging techniques were also included and compared.

RESULTS:

The study group (n = 81) included 52 men and 29 women (62.8 years ± 12.5). For the evaluation of the EncephalApp, different Cut-Off values were determined and their specificity and sensitivity were calculated. The comparative parameter was the result of the PHES-Test. Through the creation of a ROC curve, the AUC (area under the curve) showed that the Cut-Off time of >224 sec with 0.803 is the most efficient with better sensitivity (79%) and specificity (82%). Other Cut-Off values showed lower sensitivities and higher false negative values.

CONCLUSIONS:

After evaluating the specificity, sensitivity and AUC the most efficient Cut-Off value for the On-plus-Off Time in the EncephalApp is >224 sec. In comparison with the CFF and the PHES testing, most of the patient withdrawals (especially in higher grade HE) within the study were registered by the EncephalApp. The EncephalApp is a valid and quick method to diagnose minimal HE but has its limitations in the grading between HE grade 1 and 2.
P: 13 The Role of Monocarboxylate Transporter-1 and Lactate Metabolism on the Development of Cognitive Deficits During NAFLD
Authors: Hadjihambi Anna , Hosford Patrick S , Jalan Rajiv , Pellerin Luc
Published: September 2019

BACKGROUND:

Non-alcoholic fatty liver disease (NAFLD) is a major complication of obesity. Certain observations regarding NAFLD induced neuropsychiatric and neurochemical alterations have been reported but mechanisms are unknown (Seo, 2016). In this context, monocarboxylate transporter-1 (MCT1) haploinsufficient mice, which resist high fat diet (HFD) induced hepatic steatosis represent an interesting model (Carneiro, 2017). Using a mouse model of NAFLD (HFD+high fructose/high glucose in water [HF/HG]) we investigated the development of cognitive deficits and state of cerebral oxygenation and cerebrovascular reactivity.

METHODS:

Behavioural tests (open field/novel object recognition/forced swimming test [FST]) were performed in mice fed control diet (NC; WT + NC, MCT1 ± +NC) or HFD HF/HG (WT + HFD HF/HG, MCT1 ± +HFD HF/HG) for 16 weeks. Baseline PO2 (in somatosensory cortex) and in response to systemic hypercapnia (10% CO2) was monitored under anaesthesia by a fluorescence method (Oxylite™). Microelectrode biosensors were used for measurements of lactate release by cortical slices. EchoMRI was performed to assess lean/fat mass.

RESULTS:

Increased fat mass (not lean mass) was observed in WT and MCT1± mice (50% less) on HFD HF/HG compared to NC controls. Liver mass was only significantly higher in WT + HFD HF/HG mice compared to NC controls. Behavioural tests did not reveal any significant differences between groups except for FST, which indicated a depression-related behaviour in the WT + HFD HF/HG group compared to their controls. This was not observed with MCT1 ±+HFD HF/HG mice. WT+HFD HF/HG mice had a lower cerebral PO2 baseline and PO2 response induced by systemic hypercapnia compared to NC controls (although significance was not reached), while the MCT1± groups remained unchanged. Tonic lactate release was unaltered between all groups although the MCT1 ± +HFD HF/HG group indicated a trend of decreased lactate tone.

CONCLUSIONS:

Our results suggest that NAFLD is associated with a depression-related behaviour and a trend of decreased cerebral PO2 baseline. MCT1 haploinsufficient mice were resistant to the reported phenotypes, suggesting a link between liver metabolism and neuropathophysiological alterations in NAFLD.
P: 17 The Two-year Outcome in Patients With MHE and Sarcopenia on Mortality and the Development of OHE
Authors: Gupta Rohit , Thomas James , Anderson Greg , Rahman Tony
Published: September 2019

BACKGROUND:

Hepatic encephalopathy is a significant complication of liver cirrhosis that is associated with a worse prognosis but also a poorer quality of life. The combination of sarcopenia and hepatic encephalopathy has a cascading and deleterious effect on both conditions. The aim of this study was to evaluate the long-term outcomes in patients who have minimal hepatic encephalopathy (MHE) and sarcopenia on mortality and the development of overt hepatic encephalopathy (OHE).

METHODS:

In this prospective trial, patients with liver cirrhosis at The Prince Charles Hospital were enrolled and followed for an average two years. An extensive exclusion criterion was used to reduce confounding factors; this included: active psychiatric condition, IVDU/drug use, neurological conditions, current significant alcohol intake, stroke, dementia, ongoing infection, language barrier, active malignancy, vision impairment, uncontrolled sleep apnoea, electrolyte disturbance and grade 1–4 encephalopathy. The diagnosis of MHE was Encephalapp Stroop test (Stroop) >190, Psychometric hepatic encephalopathy score (PHES) < −4 and Critical Flicker Frequency (CFF) <39. The diagnosis of sarcopenia was completed using hand grip strength comparing to standard deviation data based on sex and age. A subset of participants underwent a DEXA scan to assess for lean body mass. Participant's clinical and electronic notes were assessed to evaluate mortality and the development of OHE.

RESULTS:

A total of 187 patients with a diagnosis of cirrhosis were approached for recruitment in the trial. 98 patients were excluded, whilst 17 patients declined. A total of 72 participants were enrolled in the trial. 37 participants had MHE whilst 35 participants did not have MHE. 16 participants had sarcopenia and MHE, whilst 14 participants had sarcopenia with no MHE. Over the average two year follow up, participants who did not have MHE and were not sarcopenic did not develop overt hepatic encephalopathy. Whilst participants with MHE and Sarcopenia had a significantly higher risk of developing OHE and mortality as can be seen in Figure 1
P value <0.05. The Stroop test had the highest sensitivity 70% [CI 47%–86%] whilst the CFF had the highest specificity 78 % [CI 66%–87%] P value 0.005. In the subset analysis of patients who underwent a DEXA scan to assess lean body mass, this was not able to predict the risk of developing OHE.

CONCLUSIONS:

MHE and Sarcopenia assessment can be easily completed as a bedside clinical test to predict the long-term risk of mortality and the development of overt hepatic encephalopathy.
P: 21 Changes in Cerebral Hemodynamic Parameters in Patients With Acute Liver Failure
Authors: Pérez Juanita , López Viridiana , Cantú Carlos , Flores Fernando , Torre Aldo
Published: September 2019

BACKGROUND:

Acute liver failure (ALF) is a clinical syndrome that results from severe and sudden loss of liver function in a patient without preexisting liver disease.1 High intracranial pressure (ICP) leads to loss of cerebral perfusion, brain herniation and irreversible brain damage in patients with acute liver failure (AHF).2 Transcranial Doppler ultrasound (TCD) is a non-invasive device that can continuously measure the speed of cerebral blood flow, producing a velocity-time waveform that indirectly monitors changes in cerebral hemodynamics, making it very useful in patients with ALF.3,4 Objetives Compare the cerebral hemodynamic parameters in patients with ALF using TCD before and after liver transplantation.

METHODS:

Retrospective and descriptive study. We searched patients with ALF during the period 2014–2018, who underwent TDC. For the descriptive analysis, medians of the quantitative variables and percentages of the qualitative variables were used. The comparison of medians was made using t student. Values were expressed as median and interquartile range, analyzed with Mann-Whitney U test. A value of P < 0.05 was considered statistically significant.

RESULTS:

We studied 10 patients (9 women, 1 man), with a median age of 29 years. The etiology of the liver failure was the following: 50% for autoimmune hepatitis, 20% undetermined, 10% hepatitis A and 10% pharmacological. We identified 4 deaths, 1 of which was during the post-transplant period. The following parameters were measured: systolic peak velocity (SPV), final diastolic velocity (FDV), médium veloctiy of the middle brain artery (VM), resistance index (RI) and pulsatility index (PI). There was changes in RI and PI, before transplant TDC: RI 0.69 (0.58–0.71) PI 1.29 (0.96–1.37) and after transplant TDC RI 0.51 (0.0–0.58), PI 0.78 (0.55–0.95) P value = 0.005 and 0.005 respectively.

CONCLUSIONS:

There was a significant decrease in the rates of pulsatility and resistance after liver transplantation.
P: 26 The Modification of Quantity and Quality of Muscle Mass Improves the Cognitive Impairment After TIPS
Authors: Gioia Stefania , Merli Manuela , Nardelli Silvia , Lattanzi Barbara , Ridola Lorenzo , Riggio Oliviero
Published: September 2019

BACKGROUND:

Hepatic encephalopathy (HE) is the major complication of transjugular intrahepatic portosystemic shunt (TIPS). In cirrhotic patients, a correlation between sarcopenia and hepatic encephalopathy has been suggested.

AIM:

to evaluate the evolution of the skeletal muscle quantity and quality at CT scan and of the patients' cognitive impairment (both overt and minimal HE) before and after TIPS.

PATIENTS AND METHODS:

27 cirrhotic patients submitted to TIPS were studied. The modification of Skeletal Muscle Index (SMI), muscle attenuation, HE and plasma ammonia were evaluated before and after a mean follow-up of 9.8 ± 4 months after TIPS.

RESULTS:

During the follow-up, the mean SMI and muscle attenuation increased significantly, although not uniformly in all patients. PHES (Psychometric Hepatic Encephalopathy Score) and ammonia improved significantly in the patients with amelioration in SMI >10% (n = 16) and not in those without (n = 11) (PHES: −1.6 ± 2 vs −4.8 ± 2.1; P = 0.0005; ammonia: 48.5 ± 28.7 vs 96 ± 31.5 μg/dl; P = 0.0004). Moreover, the prevalence of minimal HE (12.5% vs 73%, P = 0.001) as well as the number of episodes of overt HE during the follow-up were significantly reduced in the patients with improved SMI. MELD remained stable or worsened after TIPS and was not significantly different between the groups with or without SMI improvement.

CONCLUSION:

The amelioration of muscle wasting and HE independent of liver function observed after TIPS supports the causal relationship between muscle wasting and HE.
P: 27 Evaluation of Neurocognitive Function in Patients With Compensated and Decompensed Cirrhosis
Authors: Mayorga Marín Tania , Delgadillo Aldo Torre
Published: September 2019

BACKGROUND:

Cirrhosis is the end result of chronic liver damage caused by multiple entities. Up to 20%–60% of patients with cirrhosis are affected by a peculiar type of mild cognitive impairment related to selective attention and executive functions, visuomotor capacity, psychomotor speed, inhibition of response and selection of response that can only be detected by psychometry.

METHODS:

An observational, cross-sectional, analytical study was carried out. A total sample of 126 patients was established, 64 patients for each group. The NeuroPsi instrument was applied to determine the domains (Orientation, Attention, Visual Episodic Memory, Verbal Episodic Memory, Language, Reading Writing, Executive Conceptual Functions and Executive Motor Functions); With the transcranial Doppler, the hemodynamic parameters such as velocity, pulsatility index, resistance index, as well as the apnea index to assess cerebral vasoreactivity were evaluated.

RESULTS:

Up to now, 55 patients were studied, two groups were established: compensated cirrhotic 18 and decompensated, the gender ratio was 38% men and 62% women, with a median of 60 years. Compensated cirrhotics showed a higher percentage of patients without hepatic encephalopathy (HE) 65% vs 27.1%. The mean Child Pugh score was 7.47 ± 1.82. MELD Na mean for total patients was 12.98 ± 5.04. Of the masters, Reading Writing with 4.50 ± 0.89 for compensated and 4.85 ± 0.50 in decompensated (P = 0.07); in the domain of Executive Motor Functions with 5.69 ± 1.8 for compensated and 6.24 ± 0.89 decompensated (P = 0.16).

CONCLUSIONS:

This study could not find significant differences in the averages obtained in the 8 cognitive domains explored, between the compensated and decompensated cirrhotic patients, nor correlation between the Child Pugh score and the performance in the cognitive tests; It is considered relevant to increase the sample of this study to have more solid evidence. In the cerebral hemodynamic parameters assessed by transcranial Doppler, there were no significant differences between compensated and decompensated patients.
P: 30 Relation Between Mortality and Psychometric Test Results in Patients Awaiting Liver Transplantation
Authors: Wirries Ann-Katrin , Pflugrad Henning , Tryc Anita Blanka , Barg-Hock Hannelore , Klempnauer Jürgen , Goldbecker Annemarie , Strassburg Christian , Weissenborn Karin
Published: September 2019

BACKGROUND:

Hepatic encephalopathy is a common severe complication of liver cirrhosis that, however, so far is not considered as an indication for organ allocation to patients on the transplant waiting list. Multiple psychometric tests have been developed to detect hepatic encephalopathy. However, there is only rare data about the predictive value of psychometric test results regarding mortality in patients with liver cirrhosis. This retrospective analysis of prospective data determined the predictive value of the Inhibitory Control Test (ICT), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Portosystemic Encephalopathy Syndrome-Test and the Critical Flicker Frequency (CFF) assessment in regard to mortality in patients on the waiting list for liver transplantation.

METHODS:

143 patients awaiting liver transplantation were included. They underwent a test battery including the Inhibitory Control Test, the Repeatable Battery for the Assessment of Neuropsychological Status, the Portosystemic Encephalopathy Syndrome-Test which provides the psychometric hepatic encephalopathy score (PHES) and the Critical Flicker Frequency assessment at study inclusion. The PHES was available for all patients (n = 143), the RBANS scores for n = 115, the ICT results for n = 99, and the CFF results for n = 136 patients. Basic characteristics (age, gender, underlying liver disease, accompanying diseases) and Model for End-stage Liver Disease (MELD) -Score at the time of study inclusion were documented. Follow-up was done for 5 years. Patients who either received a liver transplantation or dropped out of the study during the observation period were censored. The five-year survival rate was analyzed with the Kaplan-Meier curve.

RESULTS:

Patients with abnormal PHES had a significantly higher mortality risk than patients with a normal PHES (P < 0.0001). Also patients with an abnormal RBANS result had a significantly higher risk to die than patients with a normal RBANS result (P = 0.018), but the difference was less significant compared to the PHES. Mortality risk did not significantly differ between patients with normal or abnormal CFF or ICT results. (CFF: P = 0.412; ICT: P = 0.202). In a binary logistic regression analysis the MELD-Score and diabetes were independent prognostic factors for mortality risk (MELD: P = 0.003; diabetes: P = 0.008). The MELD-Score turned out to have significant impact on the test results regarding the PHES (P < 0.0001), but not concerning the other tests (CFF: P = 0.903; RBANS: P = 0.065; ICT: P = 0.139).

CONCLUSIONS:

An abnormal PHES result is an indicator for an increased mortality risk, though less predictive than the MELD-Score.
P: 31 The Natural History of Cirrhosis After the Development of Hepatic Encephalopathy
Authors: Louissaint Jeremy , Tapper Elliot B.
Published: September 2019

BACKGROUND:

Hepatic encephalopathy (HE) is a watershed moment in the natural history of cirrhosis portending decreased quality of life and worsening prognosis. Recent strides in the management of HE have been made to decrease symptom burden and readmissions. The impact of these interventions requires a contemporary re-examination of the natural history of HE and its clinical implications.

METHODS:

We examined data from a 20% random sample of US Medicare enrollees with cirrhosis and continuous Part D prescription coverage from 2008–2014. Those with a diagnosis of HE prior to or within 3 months after the diagnosis of cirrhosis was made were excluded. Incident HE was defined by ICD-9 code 572.2 and/or the initiation of a prescription for an HE-specific treatment (Neomycin, Lactulose, or Rifaximin). Outcomes included transplant-free survival and hospital-days or 30-day readmissions per person-year. Multivariate analysis was performed for survival (hazard ratios, HR, Cox regression) and hospital utilization (incidence rate ratios, IRR, negative binomial regression).

RESULTS:

Among 186,160 Medicare-enrollees (median age 65 years) with cirrhosis, 49,164 experienced HE (26.4%). The median survival following cohort entry of those who did and did not develop HE was 5.78 and 3.4 years, respectively (P < 0.001). Multivariate analysis identified decreased survival with older age (HR 1.02, CI: 1.02–1.03), male sex (HR 1.21, CI: 1.19–1.24), ESRD (HR 1.08, CI: 1.01–1.14), and increasing Charlson Comorbidity Index (HR 1.2–1.42, CI: 1.17–1.48). Cirrhosis etiologies of HCV and alcohol were associated with improved survival (HR 0.87 CI: 0.85–0.90 and HR 0.82 CI: 0.79–0.85, respectively) while NAFLD was linked to increased mortality after HE (HR 1.07, CI: 1.02–1.12). Hospital-days per person year were 11.8 in patients with HE compared to 2.9 in those without (P < 0.001). Factors that were inversely associated with hospital utilization were Rifaximin use (HR 0.40, CI: 0.39–0.42) and gastroenterology consultation (HR 0.73, CI: 0.67–0.80). Rifaximin use was associated with decreased hospital-days (IRR 0.35, CI: 0.33–0.37) and fewer 30-day readmissions (HR 0.18, CI: 0.08–0.40), while gastroenterology consultation was associated only with a decreased risk of 30-day readmissions (HR 0.71: CI: 0.57–0.88) but not overall hospitalizations.

DISCUSSION:

The outcomes after HE in this contemporary Medicare-insured population are poor. The development of HE increases hospitalization utilization and worsens survival with few, potentially modifiable, targets for prospective study intervention.