Risk Factors in Fatal Cases of Anaphylaxis due to Contrast Media: A Forensic Evaluation.

BACKGROUND: Fatalities following contrast medium exposure are extremely rare in clinical routine, though they may occur as an exception. Some may fall under the purview of the inquiring authorities and forensic pathologists due to their in-hospital occurrence. The purpose of this study was to assess the risk factors for anaphylaxis due to contrast medium administration that can be identified in fatal cases. METHODS: Fatalities occurred during the course of clinical investigations with contrast media described in the literature and fatal reactions to contrast agents that had undergone forensic investigations in our medicolegal center were reviewed with respect to patient characteristics, administered contrast medium, performed biochemical investigations and potential risk factors identified based on clinical history and medical records. RESULTS: Biochemical investigations into the fatal cases examined in our facility revealed increased mast cell tryptase, total IgE and activated mast cells in all subjects. Data obtained from the literature and our own investigations indicated that in only a minority of the fatal cases had there been previous exposure to contrast compounds, while most cases of severe anaphylaxis involved patients who apparently reacted on initial exposure. CONCLUSIONS: Most fatal cases failed to present any identifiable predisposing conditions out of those traditionally considered as risk factors for an anaphylactic reaction to contrast compounds in the medical histories of the patients. Comprehensive clinical histories and thorough reviews of medical data, along with exhaustive forensic investigations, provide information that is relevant in order to better appreciate the interwoven relationships linking all factors potentially involved in the pathogenesis of fatal anaphylaxis to contrast media. © 2014 S. Karger AG, Basel.

Prominent use of distal 5’ transcription start sites and discovery of a large number of additional exons in ENCODE regions

This report presents systematic empirical annotation of transcript products from 399 annotated protein-coding loci across the 1% of the human genome targeted by the Encyclopedia of DNA elements (ENCODE) pilot project using a combination of 5' rapid amplification of cDNA ends (RACE) and high-density resolution tiling arrays. We identified previously unannotated and often tissue- or cell-line-specific transcribed fragments (RACEfrags), both 5' distal to the annotated 5' terminus and internal to the annotated gene bounds for the vast majority (81.5%) of the tested genes. Half of the distal RACEfrags span large segments of genomic sequences away from the main portion of the coding transcript and often overlap with the upstream-annotated gene(s). Notably, at least 20% of the resultant novel transcripts have changes in their open reading frames (ORFs), most of them fusing ORFs of adjacent transcripts. A significant fraction of distal RACEfrags show expression levels comparable to those of known exons of the same locus, suggesting that they are not part of very minority splice forms. These results have significant implications concerning (1) our current understanding of the architecture of protein-coding genes; (2) our views on locations of regulatory regions in the genome; and (3) the interpretation of sequence polymorphisms mapping to regions hitherto considered to be "noncoding," ultimately relating to the identification of disease-related sequence alterations.

Iowa Affirmative Action Data, 2004

Iowa Affirmative Action Data is developed annually to assist employers in creating affirmative action plans and evaluate the inclusion of women and minorities in their workforces. Data for the previous calendar year break out the following by gender and minority

Conscientization of Social Cryptomnesia Reduces Hostile Sexism and Rejection of Feminists

This paper develops a hypothesis concerning the conscientization of social cryptomnesia, claiming that it is possible to reduce the rejection of minorities by reminding the population that a certain value has been promoted by a certain minority. Participants (N = 93) first reported their attitudes toward women's rights and feminist movements. They were then confronted with their higher appreciation of women's rights over feminists (social cryptomnesia) and blamed for it (conscientization) in a more versus less threatening manner. Results indicated that conscientization can be effective not only in inducing a more positive attitude toward feminists, but also in decreasing hostile sexism when the threat is lower. Implications for minority influence research are discussed.

Doing Intersectionality: Repertoires of Feminist Practices in France and Canada

Intersectionality has been adopted as the preferred term to refer to and to analyze multiple axes of oppression in feminist theory. However, less research examines if this term, and the political analyses it carries, has been adopted by women's rights organizations in various contexts and to what effect. Drawing on interviews with activists working in a variety of women's rights organizations in France and Canada, I show that intersectionality is only one of the repertoires that a women's rights organization might use to analyze the social experience and the political interests of women situated at the intersection of several axes of domination. I propose a typology of four repertoires that activists use to reflect on intersectionality and inclusiveness. Drawing on a quantitative and qualitative analysis of the interview data, I show that hegemonic repertoires about racial or religious identity in one national context shape the way activists and organizations understand intersectionality and its challenges. The identity of organizations, as well as their main function (advocacy or providing service), also shape their understanding of intersectional issues.

Membership and internal democracy. Immigrant organisations in the city of Oslo

Immigrant organisations in the City of Oslo receive support from the government for their daily operation. In order to receive such support, each organisation must be membership-based and have internal democratic procedures. This paper raises the question of how we can understand this combination of support for ethnic based organisations and requirements of membership and internal democracy. It explores the usefulness of two partly overlapping ways of understanding this policy and discusses their interrelationship. Firstly, within the context of the crisis of multiculturalism, the paper discusses whether this combination is based on the aim of strengthening the organisations’ procedural commitment to liberal-democratic principles. Secondly, the paper analyses whether requirements of membership and internal democracy can mainly be understood within the framework of the Nordic model of voluntary organisation. By comparing the policy at three empirical levels, the paper concludes that this combination can mainly be understood within the framework of the traditional historical Nordic model, but that there is an ambiguity in this policy related to minority rights.

Recognition and political accommodation: from regionalism to secessionism. The Catalan case

Having lived through a bloody civil war in the 1930s followed by four decades of General Franco’s dictatorship, the Spanish state carried out a transition to a democratic system at the end of the 1970s. The 1978 Constitution was the legal outcome of this transition process. Among other things, it established a territorial model – the so-called “Estado de las Autonomías” (State of Autonomous Communities) – which was designed to satisfy the historical demands for recognition and self-government of, above all, the citizens and institutions of Catalonia and the Basque Country .In recent years support for independence has increased in Catalonia. Different indicators show that pro-independence demands are endorsed by a majority of its citizens, as well as by most of the political parties and organizations that represent its civil society. This is a new phenomenon. Those in favour of independence had been in the minority throughout the 20th century. Nowadays, however, demands of a pro-autonomy and pro-federalist nature, which until recently had been dominant, have gradually lost public support in favour of demands for self-determination and secession. This paper analyses the massive increase in support for secession in Catalonia during the early years of the 21st century. After describing the different theories of secession in plurinational liberal democracies (section 1), we analyse Catalonia’s political evolution over the past decade focusing on the shortcomings with regard to constitutional recognition and accommodation displayed by the Spanish political system. The latter have been exacerbated by the reform process of Catalonia’s Statute of Autonomy (2006) and the subsequent judgement of Spain’s Constitutional Court regarding the aforementioned Statute (2010) (section 2). Finally, we present our conclusions by linking the Catalan case with theories of secession applied to plurinational contexts

Identity, immigration, and prejudice in Europe: a recognition approach

Social identity is a double-edged sword. On the one hand, identifying with a social group is a prerequisite for the sharing of common norms and values, solidarity, and collective action. On the other hand, in-group identification often goes together with prejudice and discrimination. Today, these two sides of social identification underlie contradictory trends in the way European nations and European nationals relate to immigrants and immigration. Most European countries are becoming increasingly multicultural, and anti-discrimination laws have been adopted throughout the European Union, demonstrating a normative shift towards more social inclusion and tolerance. At the same time, racist and xenophobic attitudes still shape social relations, individual as well as collective behaviour (both informal and institutional), and political positions throughout Europe. The starting point for this chapter is Sanchez-Mazas' (2004) interactionist approach to the study of racism and xenophobia, which in turn builds on Axel Honneth's (1996) philosophical theory of recognition. In this view, the origin of attitudes towards immigrants cannot be located in one or the other group, but in a dynamic of mutual influence. Sanchez-Mazas' approach is used as a general framework into which we integrate social psychological approaches of prejudice and recent empirical findings examining minority-majority relations. We particularly focus on the role of national and European identities as antecedents of anti-immigrant attitudes held by national majorities. Minorities' reactions to denials of recognition are also examined. We conclude by delineating possible social and political responses to prejudice towards immigrants.

Naiskomiikka : huumorista stand upiin, naurusta valtaan

The final project deals with the question of female comedy and the comedy made by women. Comedy has traditionally been made by men and the woman has been the one who laughs. A funny woman has been a rare phenomenon. Although times have changed and gender roles have become more flexible, female comedians still remain in a minority compared to their male colleagues. The essay reviews the social and historical structures that influence the position of women in general and on the field of comedy in particular. The teoretical basis to this is feminist theory. Female comedy and humour have features of their own, that are being examined in the essay. It also makes a difference between feminine comedy and feminist comedy. Largely the project handles stand up comedy. The popularity of stand up comedy has changed the field of professional entertainment and brought a number of widely gifted comedians to a common knowledge. Stand up has an opportunity to be a political tool, which is essential for marginal comedians, which also includes female comedians. One of the fundamental subjects of the project is the political character of comedy. The essay also portrays the historical roots of stand up comedy in the Finnish and in the American tradition. It reflects on the fore mothers of the modern female comedian. The reasons that make a woman become a comedian are under consideration, as well as the strategies that help her to get her voice and message delivered. Since a woman is still held in the marginal, it gives female comedy a feature of its own. This way comedy can become a tool for a feminist battle.

Genetic testing in patients with obesity.

The obesity epidemic is associated with the recent availability of highly palatable and inexpensive caloric food as well as important changes in lifestyle. Genetic factors, however, play a key role in regulating energy balance and numerous twin studies have estimated the BMI heritability between 40 and 70%. While common variants, identified through genome-wide association studies (GWAS) point toward new pathways, their effect size are too low to be of any use in the clinic. This review therefore concentrates on genes and genomic regions associated with very high risks of human obesity. Although there are no consensus guidelines, we review how the knowledge on these "causal factors" can be translated into the clinic for diagnostic purposes. We propose genetic workups guided by clinical manifestations in patients with severe early-onset obesity. While etiological diagnoses are unequivocal in a minority of patients, new genomic tools such as Comparative Genomic Hybridization (CGH) array, have allowed the identification of novel "causal" loci and next-generation sequencing brings the promise of accelerated pace for discoveries relevant to clinical practice.

Appropriateness of early management of newly diagnosed Crohn's disease in a European population-based cohort.

OBJECTIVE: The European Panel on the Appropriateness of Crohn's disease Therapy (EPACT) has developed appropriateness criteria. We have applied these criteria retrospectively to the population-based inception cohort of Crohn's disease (CD) patients of the European Collaborative Study Group on Inflammatory Bowel Disease (EC-IBD). MATERIAL AND METHODS: A total of 426 diagnosed CD patients from 13 European centers were enrolled at the time of diagnosis (first flare, naive patients). We used the EPACT definitions to identify 247 patients with active luminal CD. We then assessed the appropriateness of the initial drug prescription according to the EPACT criteria. RESULTS: Among the cohort patients 163 suffered from mild-to-moderate CD and 84 from severe CD. Among the mild-to-moderate disease group, 96 patients (59%) received an appropriate treatment, whereas for 66 patients (40%) the treatment was uncertain and in one case (1%) inappropriate. Among the severe disease group, 86% were treated medically and 14% required surgery. 59 (70%) were appropriately treated, whereas for one patient (1%) the procedure was considered uncertain and for 24 patients (29%) inappropriate. CONCLUSION: Initial treatment was appropriate in the majority of cases for non-complicated luminal CD. Inappropriate or uncertain treatment was given in a significant minority of patients, with an increased potential risk of adverse events.

Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline.

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.

Survival after lung metastasectomy in colorectal cancer patients with previously resected liver metastases.

BACKGROUND: Resection of hepatic metastases is indicated in selected stage IV colorectal cancer (CRC) patients. A minority will eventually develop pulmonary metastases and may undergo lung surgery with curative intent. The aims of the present study were to assess clinical outcome and identify parameters predicting survival after pulmonary metastasectomy in patients who underwent prior resection of hepatic CRC metastases.¦METHODS: We performed a retrospective analysis of 27 consecutive patients (median age 62 years; range: 33-75 years) who underwent resection of pulmonary metastases after previous hepatic metastasectomy from CRC in two institutions from 1996 to 2009. All patients underwent complete resection (R0) for both colorectal and hepatic metastases.¦RESULTS: Median follow-up was 32 months (range: 3-69 months) after resection of lung metastases and 65 months (range: 19-146 months) after resection of primary CRC. Three- and 5-year overall survival rates after lung surgery were 56 and 39%, respectively, and median survival was 46 months (95% CI 35-57). Median disease-free survival after pulmonary metastasectomy was 13 months (95% CI 5-21). At the time of last follow-up, seven patients (26%) had no evidence of recurrent disease and 6 of these 7 patients presented initially with a single lung metastasis.¦CONCLUSIONS: Resection of lung metastases from CRC patients may result in prolonged survival, even after previous hepatic metastasectomy. Yet, prolonged disease-free survival remains the exception, and seems to occur only in patients with a single lung lesion.

Married to intolerance: Attitudes towards intermarriage in Germany, 1900-2006

Marriage is amongst the biggest decisions in life. In general, there is a tendency towards assortative matching people marry others who are relatively similar to themselves. Intermarriage between different social, religious and ethnic groups in most societies is relatively rare (Blossfeld and Timm 2003). Where it occurs, it is associated with more rapid assimilation (Meng and Gregory 2005). The frequency of intermarriage can therefore serve as a useful indicator of tolerant attitudes towards a minority, and of the desire to integrate (Bisin, Topa, and Verdier 2004).In this paper, we analyze under which conditions intermarriage can be used as an indicator of tolerance, and whether such tolerant attitudes persisted in Germany during the last century. We combine information on individual-level attitudes from the German social survey (GESIS) with historical data on marriage patterns.

Dependent Adult Abuse Professional Forums, 2006

Nine forums were held across the state to continue the ongoing dialogue with professionals and stakeholders about how the service delivery and protection system for dependent adults and elders is functioning. Opinions were sought on what was working well, what could work better and their suggestions for improvements and/or changes at the local and state level.