Use of Hy's law and a new composite algorithm to predict acute liver failure in patients with drug-induced liver injury.

BACKGROUND & AIMS Hy's Law, which states that hepatocellular drug-induced liver injury (DILI) with jaundice indicates a serious reaction, is used widely to determine risk for acute liver failure (ALF). We aimed to optimize the definition of Hy's Law and to develop a model for predicting ALF in patients with DILI. METHODS We collected data from 771 patients with DILI (805 episodes) from the Spanish DILI registry, from April 1994 through August 2012. We analyzed data collected at DILI recognition and at the time of peak levels of alanine aminotransferase (ALT) and total bilirubin (TBL). RESULTS Of the 771 patients with DILI, 32 developed ALF. Hepatocellular injury, female sex, high levels of TBL, and a high ratio of aspartate aminotransferase (AST):ALT were independent risk factors for ALF. We compared 3 ways to use Hy's Law to predict which patients would develop ALF; all included TBL greater than 2-fold the upper limit of normal (×ULN) and either ALT level greater than 3 × ULN, a ratio (R) value (ALT × ULN/alkaline phosphatase × ULN) of 5 or greater, or a new ratio (nR) value (ALT or AST, whichever produced the highest ×ULN/ alkaline phosphatase × ULN value) of 5 or greater. At recognition of DILI, the R- and nR-based models identified patients who developed ALF with 67% and 63% specificity, respectively, whereas use of only ALT level identified them with 44% specificity. However, the level of ALT and the nR model each identified patients who developed ALF with 90% sensitivity, whereas the R criteria identified them with 83% sensitivity. An equal number of patients who did and did not develop ALF had alkaline phosphatase levels greater than 2 × ULN. An algorithm based on AST level greater than 17.3 × ULN, TBL greater than 6.6 × ULN, and AST:ALT greater than 1.5 identified patients who developed ALF with 82% specificity and 80% sensitivity. CONCLUSIONS When applied at DILI recognition, the nR criteria for Hy's Law provides the best balance of sensitivity and specificity whereas our new composite algorithm provides additional specificity in predicting the ultimate development of ALF.

The Relationship between Media and Political Agendas : Variations across Decision-Making Phases

Previous studies have demonstrated that the extent to which media coverage influences the issue priorities of policy makers is contingent on the type of issue, media, and political agenda. This article contends that the relationship between media and political agendas varies across the phases of the decision-making process. Based on a comprehensive dataset on issue attention in media coverage and various policy-making channels covering the years 1996-2003, the article analyses the level of media coverage and, more importantly, the distribution and correspondence of issue attention between media and political agendas across the four successive phases of the decision-making process (initiation, preparatory, parliamentary, and referendum phases) in Switzerland. Despite inversely distributed levels of attention for successive decision-making phases, both media and political agendas are concentrated on fewer issues in the initiation and referendum phases, and they are more strongly correlated in the most decisive stages of the process, that is, the preparatory and referendum phases.

Pigment production by Streptococcus agalactiae in quasi-defined media.

A quasi-defined medium that supports the growth of Streptococcus agalactiae as pigmented colonies has been developed. The medium contains starch, a peptic digest of albumin, amino acids, nucleosides, vitamins, and salts. The presence of free cysteine, which could be replaced with other sulphur-containing compounds and to a lesser degree by reducing agents, was required for pigment formation.

Social media and political change: The case of the 2011 revolutions in Tunisia and Egypt

Throughout the past decade, social media have come on the scene of various popular revolts. Their role as tools of information and coordination of social movements, from the Iranian Green Movement in 2009 to the Arab uprisings in 2011, has been widely debated. In most cases, online activism through blogs, Facebook, Twitter or other forms of social media has allowed citizens to be part of a social networking exercise and to engage in a public sphere that would have otherwise been unreachable to them due to severe repression. In Tunisia and Egypt, social media helped protests start and expand thanks to their ability to coordinate and disseminate information quickly. The new information and communication tools were an influential factor in accelerating the revolutionary processes across the Arab world, albeit they cannot be seen as neither the spur nor the drivers of any revolution.

Aterosclerosis cérvico-cerebral subclínica: evaluación del índice REGICOR, el grosor íntima-media y el índice tobillo-brazo en la detección de sujetos en riesgo en la población

La aterosclerosis cérvico-cerebral es una de las principales causas de ictus isquémico, y por tanto, de morbimortalidad en nuestro medio. La detección de la misma en su fase asintomática mediante instrumentos como la función REGICOR, el grosor íntima-media y el índice tobillo-brazo podría mejorar las estrategias de prevención primaria. Comprobamos que, en nuestra cohorte de 933 sujetos sin antecedentes cardiovasculares, los tres factores (REGICOR≥10, GIM≥0.9, ITB≤ 0.9) se asociaron de forma independiente con la presencia de aterosclerosis cérvico-cerebral y de cualquier localización (extracraneal-intracraneal-combinada). La utilización conjunta de REGICOR e ITB podría facilitar el diagnóstico precoz de la aterosclerosis cérvico-cerebral subclínica.

Speed of reaction-diffusion fronts in spatially heterogeneous media

The front speed problem for nonuniform reaction rate and diffusion coefficient is studied by using singular perturbation analysis, the geometric approach of Hamilton-Jacobi dynamics, and the local speed approach. Exact and perturbed expressions for the front speed are obtained in the limit of large times. For linear and fractal heterogeneities, the analytic results have been compared with numerical results exhibiting a good agreement. Finally we reach a general expression for the speed of the front in the case of smooth and weak heterogeneities

La geografía en los relatos de viajes castellanos del ocaso de la Edad Media : análisis del discurso y léxico

Résumé Le travail poursuit un triple objectif: A) présenter la place qu'occupe la géographie physique et la géographie urbaine dans un corpus de cinq récits de voyages castillans de la fin du Moyen-Age, en se centrant particulièrement sur le relief, les eaux continentales, les mers, les côtes, le climat, la végétation, la faune et les villes; B) analyser les ressources discursives dont se servent les rédacteurs pour transmettre ces contenus; C) et réunir le lexique géographique des textes, en l'organisant autour des thématiques mentionnées, en définissant les mots et en faisant ressortir leur valeur dans le contexte discursif. L'étude est introduite par une analyse de la situation communicative dans laquelle se forgent les récits du corpus: contexte historique, social, culturel et textuel, d'une part; identité des voyageurs- rédacteurs, identité des destinataires, et objectifs divers aussi bien des voyages que de leur mise en écriture, d'autre part. De cette analyse ressortent quelques intentions et préoccupations communes aux voyageurs-rédacteurs qui pourraient se résumer en: A) une conscience de la difficulté du voyage; B) une conscience de réaliser un mouvement vers un monde éloigné et étrange; C) une volonté de transmettre des connaissances sur le monde; D) un désir de présenter ce qu'ils racontent comme le fruit d'une expérience vécue et de le faire avec véracité. L'analyse introductoire montre également que cette approche du voyage et la conception du récit qui en découle déterminent le choix de certains contenus géographiques et une façon précise d'exposer l'expérience du voyage: les textes transmettent des connaissances sur le monde et construisent un discours informatif sur l'espace, tout en décrivant un univers étrange et en insistant sur leur caractère testimonial. Le corps du travail est articulé en trois parties. Le premier volet permet de faire émerger la place réservée à la géographie, surtout physique, dans les récits. Il dévoile l'intérêt naissant manifesté par les voyageurs-rédacteurs pour la géographie physique et témoigne de la typologie diversifiée des descriptions urbaines. Il éclaire également le rapport intime liant les thématiques privilégiées dans les textes, les intérêts des rédacteurs et de leur public, et les objectifs de chaque récit. La géographie transmise est non-livresque, issue de l'expérience et, par conséquent, partielle. Le deuxième volet montre le fonctionnement d'une description qui est porteuse d'informations sur l'espace et qui véhicule des savoirs sur le monde, en particulier sur le monde inconnu. Les opérations de nommer, mesurer et adjectiver l'espace parcouru, en le comparant ensuite à l'espace connu sont analysées en détail. Cette partie du travail met en exergue les connaissances, les croyances et les valeurs partagées entre rédacteurs et récepteurs sur lesquelles se construit un discours destiné à transmettre de nouveaux savoirs sur le monde. Les textes se présentent, en outre, comme un témoignage basé sur l'expérience des voyageurs: l'importance de l'information acquise par l'ouïe porte les rédacteurs à incorporer dans leurs récits de nombreuses voix qui racontent le monde et fait du discours géographique un discours clairement polyphonique. Enfin, le troisième volet réunit pour la première fois le lexique géographique castillan en usage à la fin du Moyen-Âge. Procédant de textes rédigés par des non spécialistes, il nous permet d'évaluer les connaissances géographiques d'un homme de l'époque et inclut définitions, exemples d'usage des mots en contexte, données étymologiques, diachroniques, morphosyntaxiques, sémantiques et encyclopédiques. Dans son ensemble, la thèse témoigne de l'intérêt d'une approche des récits de voyage par le triple axe thématique, discursif et lexical.

Broadcast Yourself! Internet and playful media practices

In this paper we want to present a work- in-progress research about video self production on the Internet that is part of a broader research project which explores the ways current media practices convey a 'playful' relationship with digital technologies in popular culture.

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.

Evaluation of Composite Pavement Unbonded Overlays: Phases I and II, April 2003

In recent years, thin whitetopping has evolved as a viable rehabilitation technique for deteriorated asphalt cement concrete (ACC) pavements. Numerous projects have been constructed and tested; these projects allow researchers to identify the important elements contributing to the projects’ successes. These elements include surface preparation, overlay thickness, synthetic fiber reinforcement usage, joint spacing, and joint sealing. Although the main factors affecting thin whitetopping performance have been identified by previous research, questions still existed as to the optimum design incorporating these variables. The objective of this research is to investigate the interaction between these variables over time. Laboratory testing and field-testing were planned in order to accomplish the research objective. Laboratory testing involved shear testing of the bond between the portland cement concrete (PCC) overlay and the ACC surface. Field-testing involved falling weight deflectometer deflection responses, measurement of joint faulting and joint opening, and visual distress surveys on the 9.6-mile project. The project was located on Iowa Highway 13 extending north from the city of Manchester, Iowa, to Iowa Highway 3 in Delaware County. Variables investigated included ACC surface preparation, PCC thickness, synthetic fiber reinforcement usage, and joint spacing. This report documents the planning, equipment selection, construction, field changes, and construction concerns of the project built in 2002. The data from this research could be combined with historical data to develop a design specification for the construction of thin, unbonded overlays.

Digital storytelling: un’applicazione didattica per ripensare ai media attraverso i media

El presente trabajo de investigación propone un proyecto de investigación centrado en los pre-adolescentes para estudiar, a través deautobiografías digitales (digital storytelling, DST) producidas por ellos, laspracticas cultural-medial y las representaciones que ellos han construido sobre los medios, en relación con los contextos de uso significativos, como el hogar, la escuela o su grupo de par. Los medios forman parte de las actividades cotidianas de los niños quien los emplean en prácticas de socialización, aprendizaje, juego y de construcción de la identidad y del conocimiento. Los digital storytelling,insertados en el contexto escolar, serán empleados como metodología didácticapara la adquisición de competencias tecnológicas y como instrumento de lainvestigación. Los DST, como practica cultural de los chicos, constituirán nuestrocampo para la observación de las modalidades de uso de los medios por parte delos jóvenes y sus capacidad de recombinar lenguajes y construir contenidos. LosDST proporcionaran, además, la posibilidad de acceder al universo simbólicoinfantil para comprender el significado que las tecnologías tienen en sus cotidianidad

Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors.

AIMS: Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. METHODS AND RESULTS: We combined CCIMT data obtained by echotracking on 24 871 individuals (53% men; age range 15-101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n = 4234) used to establish sex-specific equations for percentiles of CCIMT across age. With these equations, we generated CCIMT Z-scores in different reference sub-populations, thereby allowing for a standardized comparison between observed and predicted ('normal') values from individuals of the same age and sex. In the sub-population without CVD and treatment (n = 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized βs 0.19 (95% CI: 0.16-0.22) and 0.18 (0.15-0.21)], smoking [0.25 (0.19-0.31) and 0.11 (0.04-0.18)], diabetes [0.19 (0.05-0.33) and 0.19 (0.02-0.36)], total-to-HDL cholesterol ratio [0.07 (0.04-0.10) and 0.05 (0.02-0.09)], and body mass index [0.14 (0.12-0.17) and 0.07 (0.04-0.10)]. CONCLUSION: We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CV-RFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.

[Recueil composite].

Contient : Job, cum commentariis ; Fridegisus, Tractatus de grammatica (34-36). - S. Bonifatius, Ars grammatica (36v-47v, 58-70). - Tatuinus, Ars grammatica (48, 57, 49-56v, 79-86, 71-78v)