Kalophrynus palmatissimus (commonly known as Lowland Grainy Frog) at Ayer Hitam Forest Reserve (AHFR), Selangor and Pasoh Forest Reserve (PFR), Negeri Sembilan was carried out from 12 November 2016 to 13 September 2017. The study was to examine data on the morphometric traits of K. palmatissimus at the two forest reserves. 15 morphometric traits of K. palmatissimus that were taken by using vernier calipers. Frog surveys were done by using 15 and 18 nocturnal 400 m transect lines with an interval distance of 20 m at AHFR and PFR, respectively. The GPS coordinates for all frog samples were recorded to ensure the precise geographic location. In addition, five climatic data were recorded. The results showed that most morphometric traits in AHFR (n = 34) and PFR (n = 31) were positively correlated with each other. On the other hand, climatic factor, which was soil pH, had a significant positive influence on most of the morphometric traits (p < .01), except for tympanum diameter and upper eyelid width (p ≥ .05). Meanwhile, the temperature had a significantly negative influence on all morphometric traits (p < .01). General linear model (GLM) analysis showed that snout‐vent length (SVL) influenced most morphometric traits , except for hand length . Later, it was found that the snout‐vent length of K. palmatissimus at AHFR was slightly larger than at PFR . It showed that there were variations in morphometric traits of K. palmatissimus at AHFR and PFR. From PCA analysis, morphometric traits are grouped into two components for AHFR and PFR, respectively. In AHFR, head length, eye diameter, head width, internarial distance, interorbital distance, forearm length, tibia length, foot length, and thigh length were strongly correlated, while snout length and eye‐nostril distance were strongly correlated. In PFR, eye diameter, head width, internarial distance, interorbital distance, foot length, and thigh length were strongly correlated, though snout length and eye‐nostril distance were strongly correlated, hence, suggested that all morphometric traits grow simultaneously in K. palmatissimus with eye‐nostril distance (EN), and snout length (SL) growing almost simultaneously at AHFR (r = .91) and PFR (r = .97). There is still a lack of available information regarding the distribution and morphometric studies of K. palmatissimus in Malaysia, especially at AHFR and PFR. This study showed 15 different morphometric traits of K. palmatisssimus between AHFR and PFR, with K. palmatissimus at AHFR were found to be slightly larger than at PFR.A research study on morphometrics of  Kalophrynus palmatissimus (commonly known as Lowland Grainy Frog) at Ayer Hitam Forest Reserve (AHFR), Selangor and Pasoh Forest Reserve (PFR), Negeri Sembilan was carried out from 12 November 2016 to 13 September 2017. The study was conducted to examine data on the morphometric traits of K. palmatissimus at the two forest reserves. The data collections showed the 15 different morphometric traits of K. palmatissimus between AHFR and PFR with K. palmatissimus at AHFR were slightly larger than at PFR.A research study on morphometrics of  According to Matsui , since there is a lack of study on the detailed information concerning the morphometric traits differentiation of these species in Peninsular Malaysia especially at AHFR and PFR. Though several studies conducted, the studies only measured 13 morphometric traits . Furthermore, previous studies only focused on morphometric traits of K. palmatissimus with different populations separately  and the potential correlations among morphometric traits and climatic factors.In this study, o Matsui , there wts Kiew,  and two ts Kiew,  for specly Kiew, . In the 22.12, covered with lowland dipterocarp forest and hill dipterocarp forest at its north‐eastern boundary. The three studied PFR compartments were Compartment 21, Compartment 22, and Compartment 32 , Selangor and Pasoh Forest Reserve (PFR), Negeri Sembilan from 12 November 2016 to 13 September 2017. The Ayer Hitam Forest Reserve (AHFR) is 15 to 233 m above sea level with its highest peak at Bukit Permatang Kumbang. The Rasau River at the south and Bohol River at the north are the primary sources of irrigation in this forest  was utilized as the sampling method. VES helps to maximize the observation of frogs in each survey so that the optimum number of frog species per survey can be achieved  to ensure precise geographic location records. Prior to the survey, climatic factors, such as macroclimates and microclimates data  were recorded by using meteorological apparatus  and pH soil device (pH soil and moisture tester Takemura DM‐15 for soil pH).The coordinates of captured Captured frogs were stored in plastic containers (12 cm × 7 cm) and brought back to the on‐site laboratories. The captured frogs were weighed by using a weighing scale , and photographs of the frogs at every viewpoint were taken for species identification. Species identification was made by referring to the online database, namely “Amphibia.my: Amphibians & Reptiles of Peninsular Malaysia,” and reference books entitled “Amphibians and Reptiles of the Seribuat Archipelago of Peninsular Malaysia” by Grismer  and “The2.3K. palmatissimus were taken in millimeter (mm) units of the length, according to Matsui .Fifteen morphometric traits of o Matsui  by using2.4K. palmatissimus between two forest reserves, individuals of this species were assessed based on the presence or absence at the study areas . All statistical analyses were done separately for individuals from AHFR and PFR. The independent samples t test was performed to evaluate sexual dimorphism since it is known that K. palmatissimus is a sexually dimorphic animal  was conducted to further understand the growth pattern of all morphometric traits. All statistical analyses performed by using IBM SPSS Statistics version 22.0   from Ayer Hitam Forest Reserve, Selangor  and Pasoh Forest Reserve (PFR) samples also showed size dimorphism with females as the larger sex. At AHFR, the females had a lengthier head length (HL), eye diameter (ED), and head width (HW) than males  with each other , except for tympanum diameter and upper eyelid width (p ≥ .05). Meanwhile, temperature had a significant negative influence on all morphometric traits (p < .01). The SVL of K. palmatissimus found to be significantly associated with all morphometric traits, except for the species hand length  were bigger as compared to the K. palmatissimus in Pasoh Forest Reserve, Negeri Sembilan (PFR).This variation may be due to differences in climatic factors and the physical environment of the two forest reserves. AHFR's mean humidity and rainfall were higher than at PFR. Meanwhile, AHFR's mean temperature was lower than at PFR. The AHFR is surrounded by a construction area infrastructure, while PFR is surrounded by an oil palm plantation. Wang et al.  suggesteK. palmatissimus, except for hand length. When the snout‐vent length of K. palmatissimus grows, the other morphometric traits, which are head length, snout length, eye‐nostril distance, eye diameter, tympanum diameter, head width, internarial distance, interorbital distance, upper eyelid width, forearm length, tibia length, foot length, and thigh length, will simultaneously grow together. This supported the correlation results and suggested that all morphometric traits grow simultaneously in K. palmatissimus. This phenomenon was noted previously by Vega‐Trejo et al.  had significantly influenced other morphometric traits of o et al. , who indo et al.  mentioneK. palmatissimus into two components. Component 1 of AHFR, the increasing size of head width influenced the size of all morphometric traits of K. palmatissimus. This result seemed to be similar in Component 2 as increasing size of snout length influenced the size of eye‐nostril distance. In Component 1 of PFR, the increasing size of eye diameter influenced the size of other morphometric traits of K. palmatissimus, while the increasing size of snout length influenced the size of eye‐nostril distance in Component 2. The results identified that head width and eye diameter as the traits that influenced most other morphometric traits of K. palmatissimus at both forest reserves. Zug and Duellman  with all 15 morphometric traits. Meanwhile, soil pH had positive associations (p < .05) with a few morphometric traits of K. palmatissimus. Recent evidence suggested that for ectotherms, such as frogs, the low temperatures result in larger cells, which may increase their body size , eye diameter (ED), and head width (HW). The statistical results were the same for PFR, except for snout‐vent length (SVL), internarial distance (IND) and thigh length (THL) also showed a significant difference. The study proposed that there was sexual dimorphism between males and females K. palmatissimus at AHFR and PFR. Sexual dimorphism in anuran is where the male and female differ in body size and this difference is attributed to sexual selection , with K. palmatissimus at AHFR were slightly larger than at PFR. Furthermore, the females and males of K. palmatissimus were found to be sexually dimorphic. Still, all morphometric traits had simultaneous growth, and the temperature had a negative influence on all morphometric traits, whereas soil pH had a positive effect on a few morphometric traits. It suggested that the information from this study could contribute to a better understanding of K. palmatissimus morphologies characteristics and the influence of climatic factors (soil pH and temperature) on morphological characteristics of K. palmatissimus at the two forest reserves. This could help future conservation programs and management to protect this endemic species from extinction.The present study showed the comparison of 15 morphometric traits of None declared.Muhammad Faris Abdul Aziz: Formal analysis (lead); investigation (lead); methodology ; resources ; software (lead); writing‐original draft (lead). Marina Mohd. Top @ Mohd. Tah: Data curation ; Funding acquisition (lead); project administration (lead); supervision (lead); visualization ; writing‐review & editing . Shamarina Shohaimi: Funding acquisition ; methodology ; project administration ; software ; supervision ; writing‐review & editing . Nurul Izza Ab Ghani: Formal analysis ; funding acquisition ; methodology ; project administration ; software ; supervision ; writing‐review & editing . Christine Fletcher: Formal analysis ; funding acquisition ; methodology ; project administration ; supervision ; writing‐review & editing .This research approved by the Institutional Animal Care and Use Committee (IACUC) (Reference no: UPM/IACUC/AUP‐R007/2018) of Universiti Putra Malaysia and the Department of Wildlife and National Parks Peninsular Malaysia (PERHILITAN) (Permit no: HQ‐00131‐15‐70) ethical license.


Knee osteoarthritis is a disease with the degeneration of articular cartilage as its main feature. Cartilage thickness cannot become a single index to evaluate cartilage degeneration, so it is essential to also evaluate the stiffness. The purposes were as follows: (1) to examine test-retest reliabilities of the elastic modulus measurement in distal femoral articular cartilage (FAC) and compare the changes in specific-regional of distal FAC, (2) to explore the difference in distal FAC stiffness and thickness between the dominant and nondominant sides, and (3) to examine the correlation between the elastic properties of cartilage and the thickness of cartilage. Twenty healthy participants were recruited. The stiffness of distal FAC at the lateral femoral condyle (LFC), medial femoral condyle (MFC), and intercondylar notch (IN) was quantified using shear-wave elastography (SWE). Intra- and interrater reliabilities were excellent for measuring the stiffness of distal FAC (ICC: 0.83-0.98). About a 50% increase in the stiffness of LFC (40.78 kPa) was found when compared with IN (21.82 kPa) and MFC (18.34 kPa). No significant difference was found between the dominant and nondominant sides in distal FAC stiffness and thickness. There was no correlation between the stiffness and thickness of the distal FAC. In conclusion, SWE can quantify the stiffness of the distal FAC. Osteoarthritis (OA) is the most common form of arthritis and one of the leading causes of chronic disability in the elderly population worldwide –3. The kMore recently used, SWE is an ultrasound elastography technology for easily and noninvasively quantifying the elastic properties of tissue , 18. It Therefore, the aims of the study were as follows: (1) to assess the intra- and interrater reliabilities of the elastic modulus measurement in distal FAC and compare changes in specific-regional of distal FAC, (2) to investigate differences in distal FAC stiffness and thickness between the dominant and nondominant sides, and (3) to investigate the relationship between the elastic properties of cartilage and the thickness of cartilage.Participants were included if they were healthy  and could follow the instructions of the rater. The exclusion criteria were as follows: knee ligament injury, chronic ankle instability, knee pain or discomfort for 6 months before the experiment, a history of severe trauma, or knee surgery , 23, 24.This experiment was an observational study. The knee was fixed on a quadriceps femoris exercise board with 120° of flexion assessed by a joint goniometer . The stiThe shear modulus of the knee joint was quantified using the ultrasound shear wave elastography system with a 40 mm linear array transducer . The settings were as follows: the frequency was 2-10 MHz. The opacity was set to 85% . The meaUltrasound joint examination was performed using light pressure and a large quantity of visible scanning gel between the transducer and the skin . Once thTo assess the stiffness of the distal FAC, the knee was flexed to 120°. It was reported that 120° for measuring distal FAC could be successfully performed by every patient , 29. TheReference US measurement points of distal FAC thickness were perpendicular line distances (cm) that were drawn from the hyperechoic cartilage-bone interface to the synovial space-cartilage interface . The firr) was used to examine the correlation of distal FAC between stiffness and thickness. The intra- and interrater reliabilities were evaluated by calculating the intraclass correlation coefficient (ICC) with a 95% confidence interval. The intrarater (measurements taken on two occasions separated by 5 days) and interrater (measurements by two raters) reliability of the measurement of distal FAC stiffness was examined using ICC (3.1)  and ICC (2.2) . The standard error of the mean (SEM) was calculated by the formula p < 0.05), an independent t-test was used to compare the mean value of each relevant measurement data set, and post hoc Bonferroni testing was performed. Intraclass correlation coefficient values < 0.50 were considered poor, 0.50-0.60 were considered moderate, 0.60-0.80 were considered good, and 0.80-1.0 were considered excellent [p < 0.05, and all measurement data was expressed as means (standard deviations).Statistical analysis was performed using SPSS version 22.0 software . The Shapiro-Wilk test was used to determine the normality distribution. The Wilcoxon test was used to calculate the shear elastic modulus between dominant and nondominant legs. Pearson's correlation analysis , the LIN and the LLFC (p < 0.01), the LMFC and the LLFC (p < 0.01), the RIN and the RMFC (p = 0.15), the RIN and the RLFC (p < 0.01), and the RMFC and the RLFC (p < 0.01)  .There was no significant difference in the elastic modulus and thickness of the distal FAC between the dominant and nondominant sides .r values and p values of the distal FAC for stiffness and thickness are shown in No significant correlation was found between thickness and stiffness on both sides. The The most important finding of this study is that SWE is a feasible modality for assessing the shear modulus of the distal FAC in different regions. Intra- and interrater reliabilities for evaluating distal FAC stiffness by using SWE were excellent, with relatively low SEM and MDC values. The relatively low SEM and MDC values in the results may prove the accuracy of the measurement.In the present study, intra- and interrater reliability of elastic properties ranged from good to excellent for assessing distal FAC, which was consistent with those of previous studies evaluating cartilage. Gungor et al. used sonoelastography to detect the strain ratio measurements of femoral cartilage, and the result was high intraobserver reliability, with an ICC of 0.94 in IN . AnotherThe Bland-Altman plots of the present study data further verified the consistency of the findings. As shown in The stiffness of distal FAC in different regions was quantified using SWE in this study. Objective information on the stiffness of different regions of the FAC distal to healthy participants may be useful to clinicians. Furthermore, the cartilage was significantly stiffer in the LFC when compared with that in the MFC and IN. About a 50% increase in the stiffness of the LFC was found when compared with the IN and MFC. It is difficult to directly compare the present findings to those from previous studies of measurement. The range of elastic modulus from the results of this study was similar to a recent study . This stThere were no significant differences observed in the elastic modulus or thickness of the distal FAC between the dominant and nondominant sides. The present findings were consistent with previous studies that evaluated the elastic features of the quadriceps tendon and patella tendon in the dominant and non-dominant leg . In thisp values > 0.05), but a significant difference in thickness was observed between males and females in all test regions  except RIN. For stiffness, no significant difference was found between the dominant side and the non-dominant side, regardless of whether they were male or female. For thickness, a significant difference was found at IN in females between the dominant side and the nondominant side. However, different sports and doses affect stress on cartilage. Normal walking for 20 minutes causes significant strains on the articular cartilage [Then explore the potential gender impact. Age and BMI showed no significant differences between the genders. Interestingly, no significant difference in stiffness was observed between males and females in all test regions , which was consistent with previous studies and proved that BMI was one risk factor for KOA. On this basis, it seems to further prove that BMI was related to MFC on the dominant side. Unfortunately, there were no participants in this study whose left side was the dominant side.In addition, it was found that there was a negative correlation between BMI and MFC (dominant side) . In the view of biomechanics, when the cartilage is pressed, the fluid in the cartilage flies out, which results in a thinner cartilage [The validity of US for assessing the thickness of distal FAC has been proven . In the artilage . With leartilage . Increasartilage . The parartilage . Thus, SThere were several limitations to this study. First, the sample size was small. Second, resting for 45 minutes was advised for the cartilage to relax and return to its original size . Fluid sShear-wave elastography is a noninvasive modality for assessing distal FAC stiffness and detecting side-to-side differences. This information allows clinicians to clearly understand the relationship between distal FAC elastic properties and clinical manifestations. Although a relationship between thickness and stiffness in healthy participants was not found, further studies may help investigate the stiffness of distal FAC using SWE among knee osteoarthritis patients and the elderly healthy population.


When compared to the control gels, the addition of 2% CG, either native or modified, reduced the syneresis of starch gels. However, further addition (5% CG) increased the gels’ syneresis. Furthermore, the syneresis for the first cycle on the fourth day was higher than the second cycle on the eighth day for all starches. The addition of native and acetylated CG reduced the hardness of starch gels at all concentrations tested. All of the starch dispersions had higher G′ than G″ values, indicating that they were more elastic and less viscous with or without the gums. The apparent viscosity of all starch gels decreased as shear was increased, with profiles indicating time-dependent thixotropic behavior. All of the starch gels, with or without gums, showed a non-Newtonian shear thinning trend in the shear stress vs. shear rate graphs. The addition of acetylated CG gum to CS resulted in a higher activation energy (Ea) than the native counterparts and the control. More specifically, starch gels with a higher gum concentration (5%) provided greater Ea than their native counterparts.This study was planned to explore the locally available natural sources of gum hydrocolloids as a natural modifier of different starch properties. Corn (CS), sweet potato (SPS), and Turkish bean (TBS) starches were mixed with locally extracted native or acetylated cactus (CG) and acacia (AG) gums at 2 and 5% replacement levels. The binary mixtures (starch–gums) were prepared in water, freeze dried, ground to powder, and stored airtight. A rapid viscoanalyzer (RVA), differential scanning calorimeter (DSC), texture analyzer, and dynamic rheometer were used to explore their pasting, thermal, textural, and rheological properties. The presence of acetylated AG or CG increased the final viscosity (FV) in all three starches when compared to starch pastes containing native gums. Plain SPS dispersion had a higher pasting temperature (PT) than CS and TBS. The addition of AG or CG increased the PT of CS, SPS, and TBS. The thermograms revealed the overall enthalpy change of the starch and gum blends: TBS > SPS > CS. The peak temperature ( Long-chain polymers known as hydrocolloids (gums) are widely used in the food industry. Fluid biopolymers with high molecular weight, such as food hydrocolloids, can be used as functional ingredients for improving product texture, shelf life, and microstructure . PolysacFood hydrocolloids are increasingly being used in the baking industry to achieve a variety of functionalities. To achieve the desired synergy between specific functional properties, a variety of gums can be used. The flour mixtures can be made texturally stable, freeze-thaw stable, and age resistant by adding gums before baking ,5. Gums When used as a gluten substitute in gluten-free bread formulations, hydrocolloids can also alter the properties of starch ,8,9. BakThe gums are exploited as an alternate way for chemical and enzymatic starch modification; a generally safe and low-cost technique of starch modification. Gums are derived from a variety of sources. Plant exudates , seeds , tubers (konjac mannan), algal , and microbial  are the most frequent . There aAcacia gum, also known as gum arabic, is an exudate from the acacia tree’s stems and branches. It is ground, dissolved in water, filtered, heated, and then spray or drum-dried . GalactoNatural gums are preferred because they are less expensive, more readily available, and less hazardous than the currently used methods  of starch modification . HydrocoFresh cactus cladodes and acacia gum exudates were collected from the Dirab Agriculture Research Station of King Saud University . The raw plant materials were then transported to the lab for further processing and use in experimental work. Commercial corn starch was purchased from ARASCO . g to separate it. Afterward, the layer on top was removed, and the white pellet at the bottom was re-suspended in distilled water and centrifuged at the same speed as before. This process was repeated. Finally, a white pure starch fraction was made after this process was done five times. The sweet potato tubers were carefully washed and skinned, then slurry was made by blending the diced tubers and distilled water (50/50) for 3 min in a heavy-duty blender. A muslin cloth was used to filter the resulting sludge. After that, the residue was re-suspended in distilled water (1:2 v/v) and filtered again. The filtrates were filtered once more via a 200-mesh sieve. The starch was allowed to settle at room temperature for 3 h before the supernatant was removed. The starch was re-suspended in distilled water and centrifuged for 15 min at 2000× g. The darkish waxy layer on top of the bottle was removed after centrifugation, and the white material at the bottom of the bottle was reconstituted with distilled water and centrifuged until pure white starch portion was obtained. The starch was then dried in acetone and pulverized in a coffee grinder. The starch powder was then placed in airtight glass bottles and kept in the freezer until needed.Turkish bean (TB) meal and water were mixed together in a heavy-duty blender for about five minutes. The slurry was poured through a 200-mesh sieve. The filtrate was then centrifuged for 15 min at a speed of 2000× g for 15 min to extract the cladodes gum. After centrifuging the material again, the supernatant was collected, neutralized, and freeze dried. Before being stored in airtight jars under refrigeration, freeze dried gum was pulverized into powders, passed through a 60-mesh screen, and labeled with the code CG [Cactus cladodes were washed and diced properly before being blanched in 80 percent ethanol to inactivate any enzymes present. They were then blended in 1:3 ratios with distilled water for 1 min before being filtered through muslin cloth and centrifuged at 5000×  code CG .Acacia gum nodes that had been taken from the plants were cleaned and dried in the shade. The dried nodules were ground with a heavy-duty grinder to make them into powder. They were then sieved through 60 mesh, coded as AG, and stored in airtight jars until they were used again.w/v) for 60 min at 40 °C. A total of 0.50 N sodium hydroxide was used to keep the pH between 8 and 8.5. Drops of acetic anhydride were added to the water, while the pH was kept between 8 and 8.5. At the end of the reaction, the pH of the contents was changed to between 6.0 and 6.5. The final product was freeze dried, passed through a 60-mesh sieve, and stored in airtight jars.Freeze dried CG or AG were mixed with water at 10%  was used to get the spectra of both natural and modified gums. This was done with a scan speed of 1 cm/s and a resolution of 4 cmAt 2 and 5% replacement levels, cactus gum (CG) and acacia gum (AG) powders (native or acetylated) were combined (in triplicate) with corn, sweet potato, and Turkish bean starches. To obtain homogeneous distribution of gum in the starch, the wet blending method was applied. The starch-gum mixtures were combined with water (1:2), thoroughly stirred, and then freeze dried. The freeze-dried mixtures were ground to a fine powder and stored in airtight jars until required.Rapid Visco analyzer  was used to study the pasting properties of starch-gum mixtures. Native starches or starch-gum mixtures (3 g at 14 percent moisture basis) were poured into aluminum canisters and distilled water was added to attain a total weight of 28 g. The slurry was heated to 95 °C in 4.40 min (at 10.23 °C/min), incubated for 4 min at 95 °C, and then cooled to 50 °C in 4.40 min (at 10.23 °C/min) and incubated for 2 min at 50 °C. Thermocline window software, which came with the device, was used to process the data for pasting parameters like peak viscosity, final viscosity, setback viscosity, and pasting temperature.oT), and peak temperature (pT).The thermal behaviors of starch-gum mixtures were investigated using DSC . In aluminum pans, samples (6–8 mg) and 10 µL distilled water were added. The pans were hermetically sealed and left to equilibrate for 4 h at room temperature. As a reference cell, an empty pan was employed. Thermal scanning of sealed samples was carried out at temperatures ranging from 25 to 110 °C/min at a rate of 10 °C/min. The Universal Analysis Software was used to determine thermal transitions such as enthalpy ∆H (J/g), onset temperature  was used to cook starch gels  as described in Starch gels were retained in aluminum containers  and stored at room temperature overnight after the RVA experiment (3 g starch at 14 percent moisture) as indicated in The dynamic rheological properties of cooked gels were studied by using a TA Discovery Hybrid Rheometer  equipped with a cone-plate measuring system . Following the calculation of the linear viscoelastic area, a constant strain of 5% was applied. Using frequency sweeps ranging from 0.1 to 100 rad/s, the storage moduli (G′), loss moduli (G″), and dynamic mechanical loss tangent (tan = G″/G′) were determined at 30 °C.w/v) were cooked in RVA under the same experimental conditions as described in K = consistency coefficient (Pa·sn), −1), and n = flow behavior index (dimensionless).The flow curves were determined at 30, 40, and 50 °C with shear rates ranging from 0 to 100 (1/s) using a TA Discovery Hybrid Rheometer  equipped with a cone-plate measuring system . The starch-gum mixtures The Arrhenius equation was used to calculate temperature dependence (Equation (2)).K values. Following the linear regression, the slope was multiplied by the universal gas constant (R = 8.314 J/mol·K) to obtain the value of Ea, and the inverse log of the intercept was used as oµ = frequency factor.The frequency factor is a constant that varies from reaction to reaction and relates the frequency of colliding molecules with enough energy to start a reaction. Temperature reciprocals  were plotted against the natural log of p ≤ 0.05 level of significance was performed on the data using PASW® Statistics 18 software to compare means.All measurements were carried out in triplicate to ensure accuracy. A one-way analysis of variance (ANOVA) and Duncan’s Multiple Range (DMR) test at a −1 was observed in native AG and CG, indicating -OH stretching vibrations, whereas the intensity of this peak was reduced in acetylated gums, indicating OH reduction after acetylation. Between 2927 and 2940 cm−1, a smaller but narrow peak was observed, indicating asymmetric stretching vibration of aliphatic -CH3 of the acetyl and methyl esters in polysaccharide gums [−1 [−1 suggested that no unreacted acetic anhydride remained in the gums. The acetylated CG had a higher absorption band than the AG, indicating that the gums had been modified. Another intermediate-intensity peak was observed for the native and acetylated AG and CG, representing the characteristic deformations for NH in primary amines. Andrade, et al. [−1 to downward wavenumber is referred to as the ‘fingerprinting region’. Because of the complex interacting vibration systems in this region, assigning an absorption peak to a precise vibration is difficult [−1 are consistent with the symmetric stretching of COO of the carboxylate groups in the gums, whereas the peaks between 1310 and 1230 cm−1 are consistent with C-O stretching of the carboxylic acids [−1 indicate C-O-C and secondary OH of the gums [The chemical structure of gums was evaluated for possible substitution of the acetyl functional group via FTIR analysis to verify the success of the acetylation of AG and CG, and the spectra are shown in ide gums . The acegums [−1 . The abs, et al.  reported, et al. , the proic acids . Peaks bp < 0.05) reduction in FV. When 5% gums were added versus 2% native and acetylated gums, the decrease in FV was more pronounced. The presence of acetylated AG or CG improved the FV in all three starches when compared to starch pastes containing native gums. This suggests that in the presence of modified gums, amylose undergoes greater retrogradation. Another study found that adding acetylated gum cordia to wheat flour pastes improved their FV more than the native gum [A rapid viscoanalyzer was used to estimate the pasting properties of CS, SPS, and TBS mixtures with native and acetylated gums, and the results are shown in tive gum . Accorditive gum , adding The setback (SB) is the difference in the FV viscosity and the breakdown viscosity attained during cooling of the starch pastes, whereas, the breakdown viscosity is achieved after the PV by continuous shear of starch dispersions under heat. Setback begins with the short-term recrystallization of amylose chains as the temperature is reduced from 95 to 50 °C. Higher FV pastes exhibited higher SB viscosities for the starch pastes. As a result, the TBS paste without the addition of gum provided the highest SB. The addition of native or acetylated AG or CG, on the other hand, reduced the SB viscosity of the TBS. In contrast, the CS and SPS pastes had higher SB viscosity than the control with the addition of CG and AG. In the presence of guar gum, von Borries-Medrano et al.  observedPasting temperature (PT) is the temperature at which the viscosity of the starch dispersion begins to rise due to swelling and rupturing of the starch granules during heating. SPS dispersion had a higher PT than CS and TBS. The addition of gums, AG or CG, to the starches, on the other hand, increased their PT. Among the starches, the SPS with the addition of 5% acetylated CG had the highest PT (79.96 °C), followed by the 5% AG. The control TBS without the gums, on the other hand, had the lowest PT (71.77 °C). When compared to the AG counterparts, starch dispersions with CG resulted in a greater change in PT. However, the starch dispersions containing acetylated gums showed a lower change in PT than the native gums, with a more significant change in PT observed at 5% gum addition. The increase in the PT of starches could be due to a lack of available water for starch swelling and gelatinization as a result of water absorption by the added gums. When compared to the control, the addition of AG or CG raised the PT of the starches by 2 to 3 °C. This implies that starch blends with gums would require a higher cooking temperature than native starches. In contrast to current findings, the addition of gum cordia to corn starch resulted in a decrease in the PT of the starch dispersions The heat energy required to gelatinize the starch in the dispersion is referred to as enthalpy. The thermograms revealed the following overall enthalpy of the starch and gum blends: TBS > SPS > CS > . The entT0) [T0 of all starch dispersions increased with the addition of AG or CG at both concentrations, 2 and 5%.  level of addition had the lowest. The difference in T0 was more pronounced for starch blends with CG versus AG, whether native or modified. The addition of CG improved the T0 for the CS, SPS, and TBS by 4.34, 3.67, and 1.93 °C, respectively. However, increasing the CG and AG (native or modified) from 2 to 5% resulted in a significant change in the T0 of the starches. Hussain et al. [T0 of starch.The temperature at which starch in dispersion begins to swell reversibly when heated is referred to as the onset temperature (T0) . The T0  and 5%. . Howevern et al.  also reppT) is a moisture-dependent property of starchy foods that is estimated at the peak of starch gelatinization under applied heat. The pT of all starches increased significantly (p ≤ 0.05) when AG or CG were added. The pT of starch increased with increasing gum concentration from 2 to 5%, for both AG and CG native and modified gums. This increase in the pT supported the data of pasting temperature observed during the evaluation of pasting properties. The overall pT observed in the thermograms  discovered that adding more gum cordia to corn starch gels increased syneresis. The gels containing acetylated gums, on the other hand, outperformed the native gums in terms of syneresis control. Several studies have shown that adding gums can improve the freeze-thaw stability of starch gels by lowering the syneresis ,40.The hardness of the starch gels is critical in determining the ease of mastication. The order of hardness among all the starch gels was as follows: SPS > TBS> CS > . TBS’s hThe bond strength that makes up the body of the starch gel is indicated by cohesiveness. The cohesiveness of the starch gels remained between 0.33 and 0.71. . The cohIn a previous study, the addition of the gum Cordia increased the cohesiveness of wheat flour gels . Howeverp ≤ 0.05) reduction in gumminess of starch gels. The reduction in gumminess was most noticeable in TBS, where the addition of 5% acetylated CG reduced gumminess from 284 to 230 g. The gumminess of AG was reduced when the concentration was increased from 2 to 5%, whether it was native or acetylated. The TBS gels containing 5% native AG showed the largest reduction in gumminess, with a decrease of 105 g. The structural alterations in the gums generated by acetyl substitution impacted the interactions between starch and AG, resulting in a considerable variation in the gumminess of starch gels with native and acetylated AG. Increasing the concentration of the gum cordia in wheat flour gel also reduces the gumminess of the gel, according to a previous study [Gumminess is the product of the gels’ cohesiveness and hardness . TBS hadus study .Similarly, without the addition of CG, SPS dispersions depicted better G′ than their counterparts. The addition of acetylated CG (2%) resulted in a similar dependence on the deformation rate. In dispersion, however, the least dependence of G′ on deformation was observed when 5% CG was added. However, acetylated CG outperformed the native CG in terms of G′. In contrast to the CG, the presence of a higher concentration of AG (5%) resulted in more elastic SPS dispersions, whereas the 2% AG showed the least dependence on deformation change. Thus, it shows that thermodynamic incompatibility did not favor intermolecular interactions between SPS and AG, but rather intramolecular interactions formed between molecules of the same type . HoweverTBS dispersion with CG resulted in a sharp rise in G′ at lower deformation rates, while relatively flatter plateaus were observed at higher frequencies. TBS, on the other hand, provided the highest G′ in the absence of CG. The addition of native CG reduced modulus dependence on frequency and left it less influenced, especially at higher deformation rates. This suggests that the addition of CG is not making a significant difference in the elastic properties of the starch dispersions. The superimposition of TBS dispersions with native CG (2 or 5%) indicated that both systems behaved similarly, especially at higher angular frequency. The acetylated CG, on the other hand, had the least effect on the TBS near the horizontal axis. It also implies that the system becomes independent of gum concentration and has a similar inner structure of the dispersion with comparable stability . The TBSIn general, the G′ trend for starches was TBS > SPS > CS. As a result, it implies that TBS could produce dispersions with improved elasticity and internal structure. However, because of the low dependency at higher frequencies, all of the starch dispersions with AC or CG could be considered weak gels. Such systems exhibit intermediate rheology between solution and gel, particularly at low deformation, while increasing deformation causes the three-dimensional network to break up into smaller clusters. Hussain et al.  observedThe existence of CG resulted in a very strong dependency on frequency for the SPS at first. The 5% native CG with SPS showed the most reliance, whereas the dispersions with acetylated CG showed the least. Large deformation imparted a rise in G″ for all dispersions, though not exponentially. Overall, there was a strong slope for the SPS with the CG. In the case of AG with SPS, the 5% acetylated dispersion had a larger G″, whilst the 2 percent AG (native or modified) had a lesser dependency on the applied deformation. The SPS dispersion with 2% acetylated AG, on the other hand, was unaffected by the deformation changes. Surprisingly, at the greatest angular frequency of 100 rad/s, all of the profiles overlapped. The total physical distance across profiles was less, indicating that the SPS and the AG interacted at a similar level.TBS dispersions with CG, like other starches, offered the greatest change in G″ at tiny deformations, while increasing the angular frequency resulted in an increase in G″, with native 5% CG providing the highest value. The sample with 5 percent acetylated CG had the smallest change in the G″ of all the samples. TBS samples with native AG, on the other hand, performed better than TBS samples with acetylated AG. All of the TBS dispersions with AG, on the other hand, had a lower G″ than the control TBS dispersion. G″ grew as the angular frequency was raised, although TBS with CG functioned well and had a larger G″ than AG equivalents. Rivera-Corona et al.,  found thA variety of additives are used in foods to improve their organoleptic properties. As a bulking agent, starch with various gums and mucilages is commonly used to provide body and texture to food gels. The shear behavior of gels varies depending on the additives and their level of interaction. In this study, three starches were combined with native and acetylated CG and AG: corn starch (CS), sweet potato starch (SPS), and Turkish bean starch (TBS), and their shear viscosity profiles are shown in The apparent viscosity of all starch gels decreased as shear was increased, with profiles indicating time-dependent thixotropic behavior. All of the starch gels, with or without gums, showed a non-Newtonian shear thinning trend and yield stress in the shear stress vs. shear rate graphs. The thinning of starch gels under shear is caused by molecular chain alignment along the field of applied shear, which weakens the physical entanglement of polymeric chains at the starch-starch and starch-gum interfaces . Among t−1) shear rate, the gap was greater between starch gels with CG (native or modified) and also for the AG. However, among starches, CG remained close to control, whereas AG showed greater shear thinning. The starch gels with CG provided improved firmness, demonstrating a synergistic interaction between the starch and the CG. Higher shear thinning was observed with AG, whereas CG performed better than the control, improved gel rheology, and provided greater strength.The slant or slope of CS with 2% acetylated AG, on the other hand, was the highest, while gels with 5% native AG remained close to the horizontal axis. The highest shear thinning was observed for AG at higher concentrations (5%) and the lowest for 2% acetylated CG. At the start of shearing, the physical gap between starch profiles was close, but at 100 , which also had higher yield stress and firmer gels than the control. Higher shear thinning was observed in the starch gels with AG, especially when a higher concentration was added. This implies that the AG interaction with TBS was comparable to that of the CS gels. The apparent gap between the profiles of control and TBS with AG, on the other hand, was larger, which could indicate partial phase separation of gums and starch. With a given change in shear rate, the overall change in shear stress was greater for the TBS. As a result, starch gels containing CG performed better under applied shear and may be capable of providing a cohesive structure for foods.Similarly, all of the gels for CS with CG had a sharper slope and higher yield stress than the control. However, higher concentrations of AG in CS gels resulted in greater shear thinning than CG. Among the gums, AG retained the firmness of the gels better due to higher slope and lower shear thinning. CS gels containing 2% AG or CG, on the other hand, outperformed CS gels containing 5% AG or CG in terms of firmness. While native AG or CG interacted better with the starch chains in the CS gels and retained firmness better. As a result, it was possible to conclude that native and acetylated gums altered the functionality of the starch gels differently and exhibited different yield stress. Among all starches, SPS gels with native CG could provide firmer gels.n) and consistency index (k) of starch gels were calculated using the power law model. The flow behavior index (n) indicates whether material shear thickening or thinning occurs under applied shear. While the consistency index (k) is an indirect measure of gel viscosity. All of the starch-gum blends exhibited non-Newtonian behavior because the n was less than one, and shear thinning was observed (The flow behavior index (observed . The nonn), with n = 0.39. Temperatures ranging from 30 to 50 °C caused only minor changes in the pseudoplasticity of CS gels containing either native or acetylated AG and CG. However, for SPS gels, temperature changes reduced pseudoplasticity at all levels of native or modified AG and CG. The presence of CG and AG in the TBS gels, on the other hand, increased the n, indicating that shear had the least influence on the gel structure. The overall variation in the n was as follows: SPS > CS > TBS. This variation could be attributed to the SPS’s higher amylose content and intact granular structure [TBS gels had the highest shear thinning and lowest pseudoplasticity (lowest tructure .k) measures the viscosity of starch gels with various gums. The increase in temperature resulted in a decrease in the k of all starch gels containing AG or CG. The SPS had the highest k value among the starches, with a value of 6.85 at 30 °C without the addition of gums (k (3.77), which decreased to 2.68 as the temperature increased from 30 to 50 °C. The addition of either native or acetylated CG increased the k values of CS, TBS, and SPS. With the addition of AG to the starch gels, the reduction in k was dramatic, especially at high levels of AG (5%).The consistency index  resulted in lower k due to greater mobility of the polymeric chains in the direction of applied shear. The extent of k reduction in gels of different starches could be attributed to their amylose contents and different levels of interaction with added gums.When acetylated AG was present in the starch blends, the reduction in oµ) and activation energy (Ea), and the results are shown in 2) remains sufficiently higher (0.75–0.99) for all estimations, confirming the model’s suitability for starch gels.The Arrhenius model was used to compute frequency factor (oµ) is a constant that determines the abundance of energy in colliding molecules, which is required for a reaction to occur. Starch gels containing native AG and CG had a higher frequency factor (oµ) than starch gels containing modified gums. Mahmood et al. (2019) reported an increase in (oµ) of wheat flour in the presence of Cordia gum, either native or acetylated. The SPS gels with CG had the highest (oµ), followed by CS and TBS. The addition of AG to SPS gels resulted in a higher o than the gels containing CG. However, increasing shear (ramping up shears) reduced o for the same gels when compared to ramping down shear (from 100 to 0 s−1).The frequency factor (Ea represents the energy barrier that must be overcome in order to initiate the flow process in the gels [Ea than the native counterparts and the control. The gels with native cactus gum (2%) had the lowest Ea, indicating the least energy barrier, and lower temperatures can initiate the flow process. In the case of SPS, adding CG reduced the Ea for the gels. However, the control gel for SPS had the highest Ea. The acetylated CG blend with TBS, like the CS, had a higher Ea and temperature dependency, while native gums had the lowest (at 5%). As a result, the native and acetylated gums changed the level of interaction at the intra and intermolecular levels, resulting in different Ea for different starches. Lower Ea values indicate lower temperature dependence when compared to higher values. With the addition of CG, either native or acetylated, most of the starch gels displayed a similar order of Ea when the shear was ramped up or down. Overall, the starch gels with CG provided higher Ea as shear decreased from 100 to 0 s−1.the gels . The addEa. The gels with TBS had the highest Ea, while the gels with SWS and native AG had the lowest at 2%. For the starch gels, increasing the level of AG resulted in a consistent pattern of increasing Ea. This implies that the presence of a higher gum concentration (5%) in the starch gels makes the viscosity less responsive to temperature change than a lower or no gum addition. More specifically, starch gels with a higher gum concentration (5%) provided greater Ea than their native counterparts. The Ea of starch gels with AG was higher when ramping down than when ramping up; higher Ea values were observed for profiles when shear was reduced from higher to lower. In contrast to the current study, a higher level of gum Cordia resulted in a lower Ea of wheat flour gels. Overall, the temperature dependency of starch gels with CG was lower than that of gels with AG, as lower Ea was observed for blends with CG. Again, the acetylated CG outperformed the native counterparts in terms of Ea. Except for SPS, native gums with starches provided higher Ea than acetylated gums in the case of AG. In a previous study, adding native gum Cordia to wheat flour resulted in higher Ea of the gels than acetylated wheat flour [When compared to starch/CG mixtures, starch mixtures with AG, whether native or acetylated, increased at flour .n for all samples was less than one. The k of all starch gels containing gums decreased when the temperature was increased. G′ and G′′ magnitudes were also affected by gum concentration. Both with and without gums, the Turkish bean starch was more stable in the two freeze-thaw cycles. The presence of all types of gums had a significant effect on the hardness, cohesiveness, and chewiness of gels.Locally extracted cactus and acacia gums were used to modify the different properties of corn, sweet potato, and Turkish bean starches. In the presence of both natural and acetylated gums, significant increases in starch gelatinization temperatures, enthalpies, peak viscosities, final viscosities, and setback viscosities were found. All starch gels’ apparent viscosity decreased as shear was increased, showing time-dependent thixotropic behavior. All starch gels, with or without gums, displayed a non-Newtonian shear thinning tendency, and the value of


Liver retransplantation remains as the only treatment for graft failure. This investigation aims to assess the incidence, post‐transplant outcomes, and risk factors in liver retransplantation recipients in Canada.  The Canadian Organ Replacement Register was used to obtain and analyse data on all adult liver retransplant recipients, matched donors, transplant-specific variables, and post‐transplant outcomes from January 2000 to December 2018. p < 0.001) and lower overall survival (p < 0.001). The graft failure and patient survival rates were comparable between second transplant and repeat retransplant recipients. Furthermore, there were no differences in graft failure and patient survival when stratified according to time to retransplantation. Recipient and donor age , recipient HCV status , and donor cytomegalovirus status  were predictors of patient mortality.  377 (6.5%) patients underwent liver retransplantation. Autoimmune liver disease and hepatitis C virus (HCV) were the most common underlying diagnoses. Graft failure was 7.9% and 12.5%, and overall survival was 77.1% and 65.6% at 1 year and 5 years, respectively. In contrast to recipients receiving their first graft transplant, the retransplantation group had a significantly higher incidence of graft failure ( This analysis of liver retransplantation demonstrates that this is a safe treatment for early and late graft failure. Furthermore, even in patients requiring more than two grafts, similar outcomes to initial retransplantation can be achieved with careful selection. Liver retransplantation was first performed by Starzl et al. in 1968, with efforts being described to “have borne bitter fruit,” as only 6 of 27 (22%) patients survived past six months [Despite more contemporary reports, the allocation of donor livers continues to be an area of debate not only for primary liver transplantation but also for orthotopic liver retransplantation, which has inherently different medical, ethical, and economic considerations. Specifically, the opportunity cost of liver retransplantation is that it denies an already scarce resource to first-time liver transplant candidates. More broadly, the economic costs of liver retransplantation may have substantial downstream effects in a constrained healthcare system as it costs over twice that of primary transplantation , 9. GiveTo date, liver retransplantation has yet to be studied broadly in Canada. Thus, this investigation aims to assess the incidence, post‐transplant outcomes, and risk factors in recipients of liver retransplantation in Canada. Furthermore, with this nationwide study group, we aim to conduct a subgroup analysis of the characteristics and outcomes of those undergoing more than two liver transplants ).st January 2000 to 31st December 2018. CORR is a national registry maintained by the Canadian Institute for Health Information (CIHI) that collects information on the majority of Canadian liver transplants but does not include those performed in Quebec. Distinction between different centers are not available in this registry. For this study, simultaneous multiorgan transplants were excluded. The study was approved by CIHI and the research ethics board of University Health Network, Toronto, Canada (REB#19-5835).Our study population included all adult (≥18 years) liver retransplant recipients and their matched donors registered on the Canadian Organ Replacement Register (CORR) from 1Patient-level transplant data included information on liver recipients at the time of LT  score, creatinine, serum bilirubin, international normalized ratio (INR), HCV status, liver disease diagnosis, and cytomegalovirus (CMV)), matched donors , transplant-specific variables (cold ischemic times), and distance from the donor procurement facility to the transplant facility. Furthermore, post‐transplant outcome data including graft failure, death, reason for death and graft failure, and date of last follow-up were collected. Medical status of a patient was defined as Status 1, patients at home; Status 1T, patients with tumors; Status 2, hospitalized patients; Status 3, patients hospitalized in intensive care unit (ICU); Status 3F, patients with fulminant failure in ICU; Status 4, patients in ICU with intubation/ventilation; and Status 4F, patients with fulminant failure in ICU with intubation/ventilation.Trends in the number and proportion of yearly retransplantations were assessed with a linear regression least-squared model. A descriptive analysis was performed of all patients receiving retransplantation and stratified by those receiving second, third, and fourth grafts. Descriptive data for continuous variables were expressed as means with standard deviation if the distribution was normal and median with interquartile range (IQR) for non‐normal distribution. Categorical variables were expressed as numbers and percentages.Given that a patient may die with a functioning graft, the cumulative incidence of graft failure was assessed with a competing risk analysis and compared with the Gray test with death as a competing event . PatientFor comparative purposes, post‐transplant survival and graft failure in those with single  liver transplantations, which met the same inclusion criteria as the retransplantation group, were described. Additionally, to investigate the temporal effects on post‐transplant survival and graft failure in LT, especially for patients who received LT for HCV, the transplant patients were divided into two groups (pre-DAA era: 2000–2010 and post-DAA era: 2011–2018) and were compared.p < 0.15 on univariate analysis. Statistical significance was defined as a value of p < 0.05. All statistical analyses were performed using IBM SPSS Statistics for Windows, version 26.0 , R (R Core Team (2019) R: A language and environment for statistical computing), and Statistical Analysis System (SAS) version 9.4 .The association between various predictors and graft failure and patient survival was evaluated using the Fine–Gray competing risk model and Cox regression analyses, respectively. The Fine–Gray model fits a proportional subdistribution hazards' regression model and assesses the effects of covariates on the subdistribution hazard ratio of a particular type of failure in a competing risk setting, in this case, graft failure . The prop < 0.001), as shown in p=0.002)  having retransplantations. Of these, 340 90.2%) received a second graft, 34 (9.0%) a third graft, and 3 (0.8%) a fourth graft. Retransplantation numbers significantly increased over the study period, in which the yearly increase in retransplantations was 1.1  . The med% receiveWith regard to the timing of transplantation, the median time between the initial and the second transplants was 47 (IQR: 10–642) days, the second and the third transplants was 546  days, and the third and the fourth transplants was 805 (IQR: NA) days. Retransplantation occurred within 30 days in 123/273 (45.1%) patients in the second transplant group and 5/28 (17.9%) patients in the RRT group.p < 0.001) and lower overall survival (p < 0.001) at 1, 5, and 10 years, respectively , 7–30 days , and >30 days ), there were no significant differences in graft survival and overall survival.In all patients with a retransplantation, the rate of graft failure was 7.9%, 12.5%, and 13.0% and patient survival was 77.1%, 65.6%, and 60.0% at 1, 5, and 10 years, respectively . Causes ectively . For patectively . Furtherectively . When thp < 0.001, other etiologies: p=0.03) (p=0.15). For other etiologies, there were no statistically significant improvements in post‐transplant survival over time (p=0.38).There were temporal effects on post‐transplant overall survival in primary LT from the first era (2000–2010) to the second era (2011–2018) (HCV:  p=0.03) . For thop < 0.15): blood group, weight, donor CMV status, and recipient CMV status. In the overall survival model, the following parameters were included: recipient and donor age, recipient HCV and CMV status, medical status (ventilation), donor CMV status, DCD donor, and facility volume.In the univariate analysis for graft failure, the following parameters were included in the backward stepwise model selection . The association of donor CMV status with survival was not constant over time and therefore was evaluated as a time-dependent covariate. Donor positivity for CMV was only associated with an increased risk for death following three years after retransplantation . Whether donor CMV and recipient CMV status were matched had no impact on post‐transplant outcomes. In univariate analysis of post‐transplant survival, the HR for CMV match was 1.13  and 1.06  in multivariable analysis. For graft survival, CMV match had an HR of 1.13  and 0.91  in univariate and multivariable analysis, respectively. Furthermore, there were no significant interactions between donor CMV status and recipient CMV status, suggesting that the effect of donor CMV on outcomes is consistent irrespective of recipient CMV status.In multivariable analysis, donor CMV status was the only factor significantly associated with graft failure .Given that the HCV status of recipients was available in a limited number of patients, a secondary model was created, which also included HCV status in the backward stepwise selection, in which it was demonstrated to be associated with overall survival  had this within 30 days of their primary transplantation. In contrast, only 17.9% (n = 5) of the RRT group had their subsequent transplantation within 30 days.Multiple earlier studies have addressed the interval from previous transplantation as an essential predictor for outcome , 17, 18.Given its rarity, minimal data on RRT are available in the current literature. In a single-center review of RRT, the overall incidence was noted to be 2.1% and was performed most commonly for chronic rejection (33%), arterial thrombosis (28%), or primary nonfunction (17%) . In thesp=0.036) correlates with lower mortality along with MELD score <23  in their single-center series [p < 0.001) [p=0.01) and patient survival following 3 years post‐retransplantation . Contrastingly, CMV match status between the donor and the recipient had no impact on post‐transplantation outcomes in addition to donor CMV status, as shown in our multivariable analysis of post‐transplant outcomes.Over the years, there has been an effort in the literature to identify independent predictors of patient and graft survival after liver retransplantation. Recipient age, creatinine, bilirubin, ventilatory status, MELD, United Network for Organ Sharing (UNOS) status, urgency of retransplantation, cold ischemia time, and causes of graft failure have been noted to be significant variables , 22, 23.r series . This war series . Althoug< 0.001) . CMV-pos< 0.001) . Our Canp=0.014). Historically, HCV positivity as an indicator for worse outcomes in retransplantation has been controversial. Rosen et al. identified HCV infection as an independent risk factor for death after retransplantation  [p < 0.001). However, for those retransplanted for HCV, the difference in post‐transplant survival was only observed without statistical significance likely due to the small number of patients (p=0.15).In the current study, HCV was the second most common underlying liver diagnosis  and associated with increased patient mortality  . Watt et=0.0038) . This wa=0.0038) . These dThis study is limited in that we do not address death on the waitlist in patients listed for retransplantation. Additionally, selection bias cannot be accounted for given the multicenter design of this study and the lack of insight into donor and recipient matching considerations. Furthermore, inherent to the dataset, the analysis was limited by each center's accuracy and completeness of data entered into the national registry.This report represents the largest analysis of liver retransplantation in Canada. It demonstrates that this is a feasible and safe treatment for early and late liver graft failure. Furthermore, even in patients requiring RRT, with careful selection, similar outcomes to initial retransplantation can be achieved.


Tissue transfer has been used in urethral reconstruction for decades, and several grafts have been described , 2. The A 33-year-old male with no history of urethral instrumentation, trauma, or infection presented with obstructive lower urinary tract symptoms. On retrograde urethrogram a 6cm bulbar urethral stricture was identified. Several options were discussed, and the patient opted for a one-sided onlay dorsal urethroplasty  using a Equipment used to harvest the graft included an 18.5Fr continuous flow laser endoscope with a Kuntz working element (RZ) and a 60W Holmium Laser (Quanta) with 550μm laser fiber.The procedure was started by making a perineal incision, urethral mobilization and incision of the stricture segment. The laser endoscope was then introduced via the perineum. Settings of 0.5J, 30 Hz, and long pulse were used and a 7 x 2.5cm graft was harvested from the posterior bladder wall. Hemostasis of the harvest site was performed. The bladder mucosal graft was thinned in similar fashion to a buccal mucosal graft and sutured as per previously described techniques.Endoscopic Holmium Laser harvesting of bladder mucosal graft is feasible and may allow this graft to become an alternative to buccal mucosa. Further studies are required to define its role in urethral reconstruction.


We propose, implement, and evaluate a natural human-machine control interface for a variable stiffness transradial hand prosthesis that achieves tele-impedance control through surface electromyography (sEMG) signals. This interface, together with variable stiffness actuation (VSA), enables an amputee to modulate the impedance of the prosthetic limb to properly match the requirements of a task while performing activities of daily living (ADL). Both the desired position and stiffness references are estimated through sEMG signals and used to control the VSA hand prosthesis. In particular, regulation of hand impedance is managed through the impedance measurements of the intact upper arm; this control takes place naturally and automatically as the amputee interacts with the environment, while the position of the hand prosthesis is regulated intentionally by the amputee through the estimated position of the shoulder. The proposed approach is advantageous since the impedance regulation takes place naturally without requiring amputees' attention and diminishing their functional capability. Consequently, the proposed interface is easy to use, does not require long training periods or interferes with the control of intact body segments. This control approach is evaluated through human subject experiments conducted over able volunteers where adequate estimation of references and independent control of position and stiffness are demonstrated. According to the WHO, there are about 40 million amputees living in developing countries  A natural human-machine interface compatible with a variable stiffness transradial hand prosthesis is proposed. (ii) A muscle fatigue compensator responsible for the reference signal generation is designed and embedded into the proposed control architecture. (iii) The independent and simultaneous stiffness and position controls of variable stiffness hand prosthesis have been experimentally verified. (iv) Evidence is provided through human-subject experiments conducted over able volunteers on various tasks that the upper and lower arm impedance modulation display similar characteristics and impedances of both parts of the arm are modulated simultaneously for many tasks. (v) Experimental verification of the effectiveness of stiffness modulation and the need for short training periods have been demonstrated.The rest of the article is organized as follows: Section 2 introduces sEMG-based tele-impedance control of the variable stiffness transradial hand prosthesis, details the construction of control references through sEMG based stiffness and position estimations, explains the independent control of the position and stiffness for the antagonist VSA, presents the compensation strategy used against muscle fatigue, and provides a set of experiments to verify the hypothesis that the stiffness modulation of the upper arm and the forearm are correlated. Section 3 experimentally verifies the independent control of the position and stiffness through the sEMG-based tele-impedance control of a VSA transradial hand prosthesis and provides evidence that the natural human-machine interface is an effective strategy in control. Section 4 concludes the article and discusses the limitations of the study.This section conveys the technical details of our approach and presents the experimental verification of the effectiveness of each module in the approach. Accordingly, the tele-impedance control paradigm of a variable stiffness hand prosthesis is introduced in section 2.1, the modules constituting the paradigm are detailed, and experimental evaluations of each function in the modules are elaborated in sections 2.1.1 and 2.1.2. The compensation technique proposed for muscle fatigue due to co-contraction of the muscle pairs is circumstantiated through human-subject experiments in section 2.1.3. Moreover, the experimental validations of the methodologies to estimate the stiffness and position parameters through sEMG signals to be employed for the control of hand prosthesis are detailed in section 2.1.4. Section 2 is concluded with the experimental verification of the correlated stiffness adaptation of antagonistic muscle pairs.Surface electromyography based tele-impedance controller is developed to control a VSA transradial hand prosthesis  modulation of a joint to properly interact with different environmental conditions. Particularly, impedance matching to the varying environment dynamics is carried out by means of the prominent features of muscles, such as regulation of co-contraction levels and reflex gains. The mechanical impedance of joints is an important parameter in the control of limbs under both static and dynamic conditions.In the literature, many researchers have addressed the characterization of joint stiffness by focusing on multi-joint arm movements –(2) for stiffness estimation of the joint  and anta(sEMG) denote the normalized muscular activity of the agonist and antagonist muscles, respectively. Symbols κ and λ capture the moment arms in charge of converting muscle activity to muscle tension responsible for generating muscle torque. The relation between the muscle torque and the muscle impedance , where κ and λ are estimated according to Equation (1).Here, In this study, Equations (1)–(2) were used to estimate the joint stiffness through a series of experiments as follows. Eight healthy volunteers , who were students of Sabancı University participated in the experiments. Participants had no prior experience with the experimental setup. The participants did not report any sensory or motor impairment. All participants in all experimental studies presented in this article signed informed consent forms approved by the IRB of Sabancı University.The experimental task was to grasp a dumbbell while positioning the elbow at 90°, as shown in Participants started by lifting their forearm when their hand was free, and then the load was gradually increased using dumbbells of 0.5 kg, 1 kg, 1.28 kg, 2.26 kg, 2.76 kg, and 3.76 kg, respectively. Each condition was tested for 20 trials, where each trial lasted 20 s, on average.Wload and the weight of the forearm Wforearm together with the moment arm corresponding to the load Lld and the center of gravity of the forearm Lf with respect to the elbow joint.The net torque applied at the elbow joint is calculated using the weight of the load The antagonistic muscle pairs, biceps and triceps, responsible for generating the sEMG signals for the stiffness estimation are shown in The sequential processes of signal conditioning and reference estimation are illustrated in agon(sEMG), anta(sEMG), and τ. For this linear model, the regression coefficients were obtained with 95% confidence bounds. The estimations for a subject are presented in R2 > 0.99 and RMSE < 0.03. Please note that this estimation procedure is repeated for each subject, before each use of the prosthetic hand.The parameters in Equation (1) were estimated using multiple linear regression by means of recorded data streams of In order to achieve independent and simultaneous position and stiffness control, the overlap of sEMG signals corresponding to the stiffness reference with sEMG signals corresponding to the position reference has to be avoided. All muscle groups on the arm take part in the isometric contraction. Since sEMG signals measured from the upper arm are used to estimate stiffness reference, to avoid any overlap, pectoralis major and trapezius muscles placed in the chest and shoulder, shown in The position of the underactuated variable stiffness hand prosthesis is controlled intentionally under visual feedback. The hand prosthesis in this study is a highly underactuated mechanism, as all fingers are connected to two main joints responsible for flexion and extension. VSA mechanism is actuated by two DC motors and controls the position and stiffness of the fingers. For the position control of the fingers, the required position reference signal is provided by the sEMG signals of the amputee. The exact positions of the fingers depend on the interaction between the prosthesis and the environment, as well as the position controller tracking the reference signal generated by the amputee. In this application, the precise estimation of position reference is not of critical importance, since the amputee can adjust the position of the prosthetic hand based on visual feedback. The position of the transradial prosthetic hand is controlled through a direct proportional relation between the intensity of sEMG signals with the desired joint angle of the fingers. Along these lines, the normalized sEMG signal responsible for position reference is expressed as ten discrete values, and each value is matched between the angular positions of the fingers in the rest and the fist states. In other words, different contraction levels of the responsible muscle groups indicate different ranges of normalized sEMG signals, and these values are mapped to different closure states of the fingers. For example, while the volunteer's normalized sEMG signals increase from 0 to 1 by contracting his/her muscles intentionally, the fingers start to rotate from their rest positions to reach a fist state. Since the required angular positions of the fingers to grasp the different geometric shapes of objects are different, volunteers adjust the contraction level of their muscles responsible for position control to different ranges based on visual feedback.Another design parameter while constructing the position control references is the MVC percentage that is used for normalization. Instead of mapping 100% MVC to fully close/open the hand, a lower MVC can be set to decrease muscle fatigue to a great extent. In our study, the MVC level is selected as 70%, such that the position reference for the actuation of VSAs is calculated using the following normalized sEMG signalsEMGnormpos denotes the normalized sEMG signals corresponding to position reference, sEMGposition represents the conditioned sEMG signals measured from pectoralis major and trapezius muscles, sEMGMVC%70 is 70% MVC of the responsible muscles, and sEMGbias is the bias on the signal.where Another undesirable condition is the contamination of sEMG signals generated by pectoralis major responsible for the opening of the hand by electrocardiography (ECG) signals. ECG crosstalk effect is prevented from sEMG signals by avoiding the electrode placement in the contamination zone and by adding extra bias term to the sEMG signals until the ECG signal effect is suppressed.Muscle fatigue can be defined as a decline in the muscle strength to generate force, that is, a decrease in the sEMG amplitude as a result of the reduction in active muscle fibers during ceaseless muscle activity  feature of sEMG signals to compensate for the fatigue effect . Once these linear estimates are at hand, they can be incorporated in the stiffness reference estimation as a feed-forward compensation term denoted by Cfi in Cfp=0 in S and θ represent the joint stiffness and angle, respectively.Given the sEMG based position and stiffness reference estimation and fatigue compensation processes, the second module of the interface is a controller that ensures tracking of these references by the VSA prosthetic hand. In particular, the position and stiffness of the VSA are controlled through position control of Bowden cables driven by two geared DC motors. r and stiffness Sr can be calculated asUnder quasi-static conditions –(5) with τload = 0 and motors are motion controlled to these values under real-time control.where  Patoglu , while tintact muscle groups of the upper arm. This control strategy, in which the prosthesis mimics the impedance of an intact portion of the limb, relies on the assumption that the impedance of the upper and lower arm change similarly, during energetic interactions with the environment.The stiffness of the prosthesis is regulated automatically based on the estimated stiffness of the We have conducted a series of experiments to test the validity of this assumption. During these experiments, the stiffness of both the forearm and upper arm of participants is estimated through the sEMG signals collected from the relevant antagonistic muscle pairs, using the technique detailed in section 2.1.1. Hence, during these experiments, the stiffness estimations of the upper and lower arm are performed based on sEMG signals and the load applied. Eight healthy volunteers took place in the experiments. The experiments were conducted for two tasks: i) a load bearing task and ii) interaction with the various objects with different impedance characteristics.The first task aims to observe resistance of the hand, forearm, and upper arm against displacement stemmed from the weight of an object with respect to the arm's normal posture. During the first task, participants were asked to keep their arms straight and forward as depicted in Wload, the hand Whand, the forearm Wforearm, and the upper arm Wupperarm together with their respective moment arms.Stiffness estimation was performed as detailed in section 2.1.1. sEMG signals were collected from the antagonistic muscle groups of flexor digitorum profundis and extensor digitorum at the forearm, and biceps and triceps at the upper arm. Since the stiffness of both the upper arm and forearm was estimated, two separate biomechanical models were derived around the elbow and wrist joints, respectively. The net torque applied on the joints was calculated considering the weight of the grasped load p < 0.05). More importantly, one can observe from these plots that the stiffness increase in the forearm and the upper arm are strongly correlated, and there exists no statistically significant difference between the forearm and the upper arm stiffness levels for each loading condition, for the load bearing task.The second task tested the adaptation of the upper arm and the forearm impedance levels while interacting with several objects, to mimic common interactions taking place during ADL. In particular, participants started at a rest position, lifted their arm, reached toward the object, grasped it, held it for a while, released it on the table, and returned to their initial configuration. Three different object types were included in the experiment: A sponge, an empty glass, and a water-filled glass were employed for different impedance requirements. Each object was grasped five times and each trial took about 7 s. Sufficient rest time was provided to volunteers between sequential trials to prevent muscle fatigue.The objects were selected such that their manipulation emphasized different control strategies, ranging from precise motion control to robust force control. Due to the complexity of the task that involved multiple sub-movements, participants' stiffness levels went over continual changes throughout the trials. To quantitatively characterize the correlation between the stiffness of the upper arm and the forearm for each subject, a moving average filter is used to extract average stiffness variations from the instantaneous estimates. In this section, we present the evaluation of the integrated system, where stiffness and position estimation modules and sEMG based control are utilized simultaneously. We verify the feasibility and effectiveness of the proposed sEMG based human-machine interface that automatically modulates the impedance of VSA prosthetic hand while users intentionally control the hand position. For this purpose, we present two experiments where the independent control of hand position and stiffness were demonstrated. Section 3.1 details the experimental set-up and procedure used to verify the effectiveness and utility of the proposed sEMG-based control architecture to control VSA prosthesis. Section 3.2 presents the position and stiffness control tasks and experimental procedures used in the experiments. Section 3.3 details the results of the experiment, while Section 3.4 provides illustrative experiments where volunteers perform various grasps for different stiffness and geometric shape of objects.Human-subject experiments on able volunteers were conducted using the VSA transradial hand prosthesis detailed in Hocaoglu and Patoglu . In the Throughout the experiments, sEMG signals were collected from biceps and triceps muscles for stiffness modulation and from trapezius and pectoralis major muscles for position control using a data acquisition system with active electrodes. Stiffness and position references were estimated as discussed in section 2.1 and fed to the tracking controller that controlled two geared Direct Current (DC) motors under Proportional Derivative (PD) control in real-time at 500 Hz through a PC based Data Acquisition (DAQ) card. The robust position controller of each DC motor enables the system to achieve the desired joint position and joint stiffness settings as computed according to Equations (4)–(5) by properly actuating the angular positions (α and β) of the motors. A direct drive linear actuator combined with a precision position encoder was placed under the fingers of the hand prosthesis, as shown in Experiments were conducted to test the independent control of the position and the stiffness of the prosthetic hand under sEMG based tele-impedance control interface.Throughout the experiments, the transradial hand prosthesis was worn by the volunteers, such that interaction forces with the environment provided direct power coupling with the volunteer. Note that such feedback is a crucial part of any prosthesis; however, has been neglected in Virtual Reality (VR) based studies  and elasticities , as shown in The proposed tele-impedance controller interface emphasizes simplicity, ease of use, and adaptability; hence, implements automatic modulation of prosthetic hand stiffness to match that of the upper arm, while intentional control of the position of the underactuated prosthetic hand is left to the user. Under the observation that humans tend to modulate the impedance of their limb as a whole while executing different tasks (as shown in section 3), the tele-impedance controller implemented for the prosthesis automatically modulates the stiffness of the hand to match that of the intact part of the arm. Automatic stiffness modulation increases the dexterity of the prosthetic hand, without introducing complexity to the human control interface.Successful interactions with the prosthesis depend on the amputee making proper decisions on how to interact with the object under visual feedback and physical coupling. Our extensive experiments with six healthy volunteers indicate that humans are very skillful at learning how to interact with the environment with such a device under the proposed sEMG based natural control interface. All volunteers were able to adapt to the device on average in 3.2 ± 1.3 min and successfully complete the required manipulation tasks without any prior training. Furthermore, it has been observed that the stiffness modulation property is effective in increasing the performance of the transradial prosthesis.Volunteers suffer from the high complexity of the controller when intentional control of both the stiffness and the position of the device is left to the user. During our tests, volunteers indicated a strong preference for the automatic impedance adjustment property. Furthermore, it has been observed that volunteers are more successful at interactions when the impedance of the prosthesis is automatically adjusted.Tele-impedance control of a VSA prosthetic hand is implemented through stiffness and position estimates decoded from sEMG signals of muscle groups embedded in the upper arm, chest, and shoulder. In particular, the IMCJ method is used to estimate the stiffness of the intact upper arm through agonist/antagonist muscle pairs, while shoulder/chest muscles are employed to estimate position references. Then, these stiffness and position estimates are used to control a VSA prosthetic hand.The feasibility of tele-impedance control through the proposed human machine interface is demonstrated with two human subject experiments, where the position and the stiffness of the VSA prosthetic hand were successfully modulated. The results demonstrate that both position and stiffness estimations from sEMG signals are adequate for the control of a VSA transradial hand prosthesis.Variable stiffness actuation hand prosthesis together with the proposed control interface necessitates less effort and concentration to control and is easier for the amputee to learn to use. Impedance modulation takes place naturally from task to task or while performing a task, i.e., ADL, without requiring amputees' attention, and this feature improves the performance of the prosthesis while interacting with unstructured environments.The human subject experiments presented in this study have been performed on able volunteers. Our future studies include validation of the results on amputees. While special attention has been given to the selection of muscle groups used for sEMG based control, such that the same muscle groups can be recruited for transradial amputees, possible complications may arise in amputees due to muscle weakness stemming from infrequent use of the remnant limbs in ADL. Along these lines, the lack of verifications with amputees is a limitation of this study.Second, the position and impedance regulation experiments have been performed on carefully controlled environments, as tight control of the experimental conditions was necessary to ensure that the results are statistically reliable with no confounding factors. Furthermore, sEMG based position and stiffness models can only provide rough estimations of human behavior. This study aims to provide easy control of a variable stiffness prosthetic hand instead of actually copying human behavior. While the same level of accuracy with the human arm may not be achieved in real-life use, our experiments with healthy volunteers presented in section 3.4 provide evidence that the level of control that can be achieved during grasping different objects is adequate to provide the required level of performance.As part of future study, different control modes may be introduced to the system, for instance, to avoid the need for voluntary contraction once an object is successfully grasped. Additional feedback pathways, such as vibrotactile feedback, may be added to the system to decrease the need for visual feedback during grasping. Furthermore, sEMG related coefficients can be identified online to avoid the need for calibration of device.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the University Research Ethics Council of Sabancı University. The patients/participants provided their written informed consent to participate in this study.EH was responsible for the design and experimental evaluation of the natural control interface of the variable stiffness hand prosthesis. VP conceived and supervised the study. Both authors contributed to the editing and scientific presentation of the article.This work has been partially supported by Tubitak Grants 219M586, 111M186, 115M698 and Marie Curie IRG Rehab-DUET.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The liberal international order is being challenged and international organizations (IOs) are a main target of contestation. COVID‐19 seems to exacerbate the situation with many states pursuing domestic strategies at the expense of multilateral cooperation. At the same time, IOs have traditionally benefited from cross‐border crises. This article analyzes the policy responses of IOs to the exogenous COVID‐19 shock by asking why some IOs use this crisis as an opportunity to expand their scope and policy instruments? It provides a cross‐sectional analysis using original data on the responses of 75 IOs to COVID‐19 during the first wave between March and June 2020. It finds that the bureaucratic capacity of IOs is significant when it comes to using the crisis as an opportunity. It also finds some evidence that the number of COVID‐19 cases among the member states affects policy responses and that general purpose IOs have benefited more. Cross‐border crises such as COVID‐19 can present IOs with windows of opportunity to expand their scope and develop new policy instruments. International organizations have responded very differently to COVID‐19. Evidence from 75 international organizations shows that those with broad policy objectives have further expanded their scope and instruments. International organizations with a narrow focus have stuck to existing instruments.Bureaucratic capacity explains the ability of international organizations to use crises as an opportunity for institutional development. It is imperative that member states further invest in the bureaucratic capacity of international organizations, particularly in professional staff, to handle future crises.When considering future reforms of international organizations, member states should focus on strengthening the competences of the executive bodies to initiate policy to help organizations work better during crises.As we exit the pandemic it is tempting to concentrate on domestic affairs, including revisiting healthcare and pandemic response systems, but policy makers are advised to further develop global governance in these areas as well. While COVID‐19 was initially seen as a major challenge to the liberal international order, it may well result in a deepening of global governance in the longer term.1The liberal international order is in crisis and international organizations (IOs) are a main target of contestation.This article analyzes the policy responses of 75 major IOs in the context of the exogenous COVID‐19 shock by asking why some IOs use this crisis as an opportunity to expand their scope and policy instruments, whereas other IOs use existing instruments or barely engage with COVID‐19 at all? The purpose is not to assess the effectiveness of IOs, but rather to examine whether IOs proactively used this exogenous shock as an opportunity to expand their activities during the first wave between March and June 2020. Even though the COVID‐19 crisis continues to date, we assume that the initial responses of IOs were essential because critical junctures are brief moments in time and future developments with regard to legalization of policy expansions are likely path dependent on these initial responses  dataset by Hooghe et al.   used their existing policy instruments and/or stayed within their existing scope to deal with the challenges (coded 2 or 3). They collected data, offered webinars, or coordinated between member states. An example is the Universal Postal Union (UPU), which had to deal with the fact that international postal services were heavily disrupted. In May 2020, only one‐in‐two postal items reached their international destination due to the cancellation of passenger flights . The Organization for Security and Co‐operation in Europe (OSCE) started to provide humanitarian aid. The International Monetary Fund (IMF) initiated and repurposed a number of funding instruments to support least developed countries and provided short‐term liquidity lines. Some IOs even used the crisis to propose some potentially far‐reaching changes: the EU agreed to joint debt, the WHO has taken up global supply change management in coordination with the World Food Programme (WFP), and the Council of Europe (CoE) ventured into health policy by financing liquidity shortages. The CoE also used the COVID‐19 crisis to reposition itself, through a public relations offensive, as the focal institution for human rights in Europe, with a number of initiatives surrounding the organization and legality of cyber justice.IOs have responded differently to COVID‐19. Some have barely engaged at all, whereas others have seen an opportunity in this crisis. The remainder of the article seeks to explain such variation. It is, in this respect, important to reiterate that our dependent variable should not be equated with effectiveness of response. Some IOs have actually been heavily contested for their slow or inadequate initial response. The EU and WHO are perhaps the most prominent examples of IOs of which many people expected more Johnson, . An init3authority and the bureaucratic capacity of IOs. It posits that IOs with more authority and bureaucratic capacity are better able to respond to exogenous shocks and have the ability to strategically use the crisis to their advantage.This article argues that variation in institutional design of IOs conditions the likelihood to be able to respond and adapt to unforeseen crises such as COVID‐19  often provide impetus for (renewed) cooperation  mostly having administrative budgets and operational IOs (e.g. World Bank) having sizeable funds  and the degree of joint decision‐making in the collective IO body (pooling). We use the values for the last available year in the dataset (2010). Since pooling and delegation are relatively stable measures and have not drastically changed between 2005 and 2010  to deal with the skewed distribution. Where the Yearbook does not provide data, we have done additional online research on the websites of the organizations. To measure budget size (budget), we have collected data on the budgets of IOs in the fiscal year 2019–2020 from annual reports. Ideally, we would have included variables for the type of budgetary funding as well as the flexibility of budgetary rules during crisis situations. These are unfortunately not available for these 75 IOs. Indeed, even exact budget numbers are not available for 29 of the 75 IOs. We therefore decided to measure budget in categorical form, differentiating between IOs with small (<US$100 million), medium (100 million to 1 billion) and large budgets (>1 billion). We infer budget size for those IOs that do not provide exact numbers for 2019 from reporting in previous years or descriptions in secondary literature. As robustness check, we also included a variable using exact budget numbers , budget_est, with estimations for missing values based on the average budgets of all IOs in the reference category  has previous high‐level political experience .We test hypotheses 2a–c on the basis of the readily available data. To measure secretariat size, we use data on permanent staff provided by the Yearbook of International Organizations for the last reported year and include the logged number of staff  of all IO member states by 31 March 2020 as compiled by Johns Hopkins University. We expect that IOs whose members were particularly badly affected by COVID‐19 at the start of the pandemic will feel more pressure to respond to the exogenous shock. In addition, we include a control variable policy field   instead of shutting down and doing nothing (dv = 0). The left‐hand side of In contrast, neither budget nor leadership seniority are significant predictors, leading us to reject H2b and H2c. However, when including real budgetary data with estimates for missing values Table D, , budget Finally, model (5) tests to what extent larger bureaucracies with more delegated authority are more likely to expand their scope and policy instruments. Arguably, bureaucracies will only be able to move forward if they have at least some delegated authority to set the agenda and push for their proposals. However, the interaction effect itself is not significant, while the main effect of staff size remains highly significant. This could indicate that large bureaucracies are relevant during the COVID‐19 crisis even if they do not have the formal power of agenda‐setting. The interaction effect is significant in the alternative model with collapsed categories for the dependent variable  experienced a leadership crisis with its Director‐General stepping down in the middle of the first wave. The United Nations Educational, Scientific and Cultural Organization (UNESCO)  was marred by continuous budgetary restraints over recent years, which may have prevented it from the development of more innovative solutions for the heavily affected policy domain of education. These findings thus also further underline the need for cross‐sectional data gathering on the bureaucratic capacity of IOs.all IOs to branch out and take on new tasks.The control variables furthermore deserve attention. The number of COVID‐19 cases and the policy scope of IOs are significant predictors of the probability of scope expansion during the pandemic. IOs that are active in regions with high initial numbers of cases were more likely to not only provide a continuity of functions, but also to come up with innovative instruments and take on new tasks. Likewise, general purpose IOs are also more likely to expand their scopes and instruments which fits with expectations that task‐specific IOs have more stable policy portfolios  is significant to explain this variation, and to a lesser extent also the delegation of agenda‐setting authority. Furthermore, as previously found, this article also shows that general purpose IOs can more easily expand their scope than task‐specific IOs (Hooghe et al., Significantly, we find that bureaucracies might be able to push their agenda even when they are lacking the formal authority to do so. When IO bureaucrats manage to use crisis moments as windows of opportunities to expand their scope and instruments, plenary bodies might well follow suit later on to legalize these practices and thus equip the IO with more authority (Jones et al., of liberal international order or within the liberal international order (Eilstrup‐Sangiovanni and Hofmann, The current COVID‐19 crisis presents a clear test case to take stock of the current state of liberal international order. Just as Drezner  claimed Appendix S1Click here for additional data file.