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Both systemic and local infections caused by bacterial, fungal, and parasitic agents may cause significant hepatic dysfunction. This chapter will attempt to delineate clinical syndromes caused by some of these organisms in the pediatric patient.
The practice of asceticism may represent a rupture with the world, but in the early medieval West it notably encouraged the establishment of “small worlds,” to use the expression of Wendy Davies to describe the numerous, largely cloistered groups that came to replace the social and political institutions of the ancient world. The structure of these small monastic worlds was defined, in the first place, by a way of life regulated according to written norms and by the establishment of well-defined, hierarchically organized complexes of space. Several contributions to this volume demonstrate that this twofold process, characteristic of the history of Western monasticism, emerged only gradually. It took centuries for religious experience to become equated with a disciplined way of life, let alone a single monastic rule, and for the conception and establishment of a topography specific to the requirements of monastic living to develop.
Our clinical experience at a specialized brain injury clinic suggests that numerous patients with traumatic brain injury (TBI) are using cannabis to alleviate their symptoms. While this patient population often inquires about the evidence of using cannabis post-head injury for the neurosensory, neurocognitive, and neuropsychiatric sequelae, most health professionals have little to no knowledge of this evidence. Given the recent legalization of recreational cannabis in Canada, questions and guidance related to cannabis use following a TBI are likely to become more common. This article reviews the evidence for cannabis use in psychiatric disorders with or without TBI. Overall, we found that the evidence for the use of cannabis among TBI patients is sparse and that patients tend to have little knowledge of the proven benefits and diverse effects of cannabis use. We feel this paper can serve as a stepping stone for future studies that explore the impact of cannabis use in a TBI population and can guide clinicians in advising their patients.
Mass gatherings attended by large crowds are an increasingly common feature of society. In parallel, an increased number of studies have been conducted to identify those variables that are associated with increased medical usage rates.
To identify studies that developed and/or validated a statistical regression model predicting patient presentation rate (PPR) or transfer to hospital rate (TTHR) at mass gatherings.
Prediction modeling studies from 6 databases were retained following systematic searching. Predictors for PPR and/or TTHR that were included in a multivariate regression model were selected for analysis. The GRADE methodology (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence.
We identified 11 prediction modeling studies with a combined audience of >32 million people in >1500 mass gatherings. Eight cross-sectional studies developed a prediction model in a mixed audience of (spectator) sports events, music concerts, and public exhibitions. Statistically significant variables (p<0.05) to predict PPR and/or TTHR were as follows: accommodation (seated, boundaries, indoor/outdoor, maximum capacity, venue access), type of event, weather conditions (humidity, dew point, heat index), crowd size, day vs night, demographic variables (age/gender), sports event distance, level of competition, free water availability, and specific TTHR-predictive factors (injury status: number of patient presentations, type of injury). The quality of the evidence was considered as low. Three studies externally validated their model against existing models. Two validation studies showed a large underestimation of the predicted patients presentations or transports to hospital (67-81%) whereas one study overestimated these outcomes by 10-28%.
This systematic review identified a comprehensive list of relevant predictors which should be measured to develop and validate future models to predict medical usage at mass gatherings. This will further scientifically underpin more effective pre-event planning and resource provision.
Dans cette contribution, nous nous intéressons à l'origine et au développement de la construction [adverbe de degré + nom]: C'est très théâtre, c'est-à-dire très faux. De nos jours, cette construction se présente comme un puissant outil de recatégorisation contextuelle pour exprimer un rapport de ressemblance basé sur une analogie avec un concept nominal. Sur la base d'une recherche de corpus outillée, nous montrons que la construction-hôte [ADVdegré + ADJ] a pu s'ouvrir à la catégorie nominale à partir d'un petit noyau dur de noms humains, en partie qualitatifs, tirant profit de certaines propriétés structurelles du français de l’époque. Par la suite, la construction s'est diversifiée vers d'autres classes sémantiques (noms inanimés, noms propres, etc.) et a progressivement attiré une gamme plus diversifiée de types lexicaux dans son orbite. Elle n'a cessé de gagner en productivité, tout en réduisant son fonds lexical d'origine à la portion congrue.
La présente contribution porte sur tourner et virer, deux verbes attributifs (p. ex. elle a viré/tourné folle) qui ne sont pas encore reconnus pleinement par la tradition grammaticale normative ni dans les travaux des linguistes. Elle vise à établir le profil distributionnel / collocationnel de ces deux verbes qui semblent opérer dans le même domaine sémantico-fonctionnel, afin de mettre à nu les subtiles divergences au niveau de leur profil sémantique. Celles-ci sont rattachées à la sémantique de base du verbe lexical, laissant entrevoir dans ces emplois grammaticalisés des effets dus à la « persistance lexicale » (lexical persistence). Afin d'objectiver au maximum les profils distributionnels des deux verbes (et partant leur profil sémantique), les outils statistiques offerts par la méthode collostructionnelle (Stefanowitsch et Gries 2003; Gries et Stefanowitsch 2004) sont mis à profit. En outre, la combinaison de l'approche collocationnelle et de l'analyse morphosyntaxique amène à distinguer l'emploi proprement attributif des deux verbes d'un emploi directionnel abstrait homonymique (l'entreprise a viré solaire), qui est encore proche de la construction prépositionnelle (virer à / tourner à).
Efficiency analysis is used for assessing links between technical efficiency (TE) of livestock farms and animal diseases. However, previous studies often do not make the link with the allocation of inputs and mainly present average effects that ignore the often huge differences among farms. In this paper, we studied the relationship between exposure to gastrointestinal (GI) nematode infections, the TE and the input allocation on dairy farms. Although the traditional cost allocative efficiency (CAE) indicator adequately measures how a given input allocation differs from the cost-minimising input allocation, they do not represent the unique input allocation of farms. Similar CAE scores may be obtained for farms with different input allocations. Therefore, we propose an adjusted allocative efficiency index (AAEI) to measure the unique input allocation of farms. Combining this AAEI with the TE score allows determining the unique input-output position of each farm. The method is illustrated by estimating efficiency scores using data envelopment analysis (DEA) on a sample of 152 dairy farms in Flanders for which both accountancy and parasitic monitoring data were available. Three groups of farms with a different input-output position can be distinguished based on cluster analysis: (1) technically inefficient farms, with a relatively low use of concentrates per 100 l milk and a high exposure to infection, (2) farms with an intermediate TE, relatively high use of concentrates per 100 l milk and a low exposure to infection, (3) farms with the highest TE, relatively low roughage use per 100 l milk and a relatively high exposure to infection. Correlation analysis indicates for each group how the level of exposure to GI nematodes is associated or not with improved economic performance. The results suggest that improving both the economic performance and exposure to infection seems only of interest for highly TE farms. The findings indicate that current farm recommendations regarding GI nematode infections could be improved by also accounting for the allocation of inputs on the farm.
We address the question, in decision theory, of how the value of risky options (gambles) should be assessed when they have no finite standard expected value, that is, where the sum of the probability-weighted payoffs is infinite or not well defined. We endorse, combine and extend (1) the proposal of Easwaran (2008) to evaluate options on the basis of their weak expected value, and (2) the proposal of Colyvan (2008) to rank options on the basis of their relative expected value.
Other considerations and issues in pediatric hepatology
Donald A. Novak, Department of Pediatrics, University of Florida, and Division of Pediatric Gastroenterology, Shands Hospital, Gainesville, FL, USA,
Gregory Y. Lauwers, Gastrointestinal Pathology Service and Department of Pathology, Massachusetts General Hospital; and Department of Pathology, Harvard Medical School, Boston, MA, USA,
Richard L. Kradin, Gastrointestinal Pathology Service and Department of Pathology, Massachusetts General Hospital; and Department of Pathology, Harvard Medical School, Boston, MA, USA
The aim of this paper is threefold: descriptive, methodological and theoretical. It offers a distinctive collexeme analysis of two pairs of near-synonymous complex prepositions (sous le coup de SN/sous le choc de SN; sous l’emprise de SN/sous l’empire de SN), completed by a qualitative analysis. The analysis of the statistically significant co-occurrents suggests that sous le coup de has a more abstract and general meaning than sous le choc de, while the semantics of the second pair are less differentiated. The analysis touches upon several methodological issues; thus, examination of the problem addressed allows for assessment of the method. It also shows that the collostructional analysis offers an interesting contribution to the debate on the existence of a constructional semantics by identifying repelled collexemes that may yield coercion effects.
During the last week of May 1986, a 1-week prospective study on antibiotic utilization in surgical patients was held in 104 (42%) of the 247 Belgian acute care hospitals. All surgical patients with a post-operative stay of at least 3 days were studied, involving 3112 patients. Each patient was observed for 7 days, starting from the day before surgery. Antibiotics were administered to 71·9% of all patients; 21·9% received therapeutic antibiotics and 52·9% prophylactic antibiotics; 2·9% received both. Of the 1285 patients undergoing a surgical procedure with no indication for antimicrobial prophylaxis, 50·7% nevertheless received prophylaxis; 92·8% of patients with a generally recognized indication for prophylaxis received antibiotic prophylaxis. Less than one fifth (17·1 %) of all prophylactic courses were stopped on the day of the intervention whilst 26·3% were continued up to the fifth post-operative day or beyond. The most frequently prescribed drugs for this indication included first and second generation cephalosporins and nitroimidazoles. The number of different generic drugs utilized per hospital ranged from 1 to 18 (mean: 7·7).
This paper uses a Markov chain model to analyse the dynamics in farm-size distribution among the Flemish dairy sector and the impact of quota policy regulation on such changes. The model predicts a decline of 24% in number of farms in 2014 compared with the current situation with a more liberal exchange policy and a decline of 18% with a restricted quota exchange policy. From these Markov chain model results, we analysed the impact of farm-size distribution on eight different milk quality parameters (total bacterial count, somatic cell count, coliform count, freezing point, urea-N, fat content and protein content and penalty-points). In general, larger farms produce higher quality milk than smaller farms, especially with respect to the microbiological parameters (total bacterial count, somatic cell count and coliform count). The change in farm-size distribution from a liberal quota exchange policy would decrease the average total bacterial count by 18·0%, the somatic cell count by 2·1% and the coliform count by 11·0%. The aggregate performance of the other parameters are smaller with improvements in all cases of <1%.
OTHER CONDITIONS AND ISSUES IN PEDIATRIC HEPATOLOGY
Donald A. Novak, M.D., Professor of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Florida College of Medicine, Shands AGH Children's Hospital, Gainesville, Florida,
Gregory Y. Lauwers, M.D., Associate Professor of Pathology, Department of Pathology, Harvard Medical School, Boston, Massachusetts; Director of Gastrointestinal Pathology, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts,
Richard L. Kradin, M.D., Associate Professor, Department of Pathology, Harvard Medical School, Boston, Massachusetts; Associate Pathologist and Physician, Departments of Pathology and Medicine, Massachusetts General Hospital, Boston, Massachusetts
Both systemic and local infections caused by bacterial, fungal, and parasitic agents may cause significant hepatic dysfunction. This chapter attempts to delineate clinical syndromes caused by some of these organisms in the pediatric patient.
Hyperbilirubinemia Associated with Sepsis
Although jaundice in association with bacterial sepsis may occur in adult patients, it appears to be significantly more common during infancy. Historically, infections of the urinary tract predominate; however, sepsis originating from other sites may contribute [1–4]. Accordingly, gram-negative bacilli, and especially Escherichia coli, are responsible for the majority of cases, although gram-positive organisms have been associated. Abnormal liver chemistries are found in approximately 50% of premature neonates with gram-negative bacteremia . Clinical and laboratory manifestations are primarily those of the underlying disease state. Hyperbilirubinemia may be marked, with the direct fraction predominant . Alkaline phosphatase levels are often elevated, and serum aminotransferase values remain normal or minimally increased [6, 7]. Hepatic biopsy usually demonstrates canalicular cholestasis, with minimal evidence of hepatocyte damage or inflammatory response  (Figure 37.1). On occasion, the biopsy may demonstrate prominent acute cholangitis with portal bile ductular proliferation, pathologic changes often seen in large bile duct obstruction. In these cases, the possibility of large duct obstruction must be excluded by ultrasound or endoscopic retrograde cholangiopancreatography (ERCP). Jaundice resolves with appropriate treatment of the underlying infection; duration of jaundice may vary from several days to several weeks.
Dans cette contribution, nous proposons une analyse des noms attributs inanimés dépourvus de déterminant. Partant d'une typologie globale des emplois attestés dans Frantext, nous nous concentrerons surtout sur les emplois nominaux ‘productifs’, c'est-à-dire les emplois nominaux qui ne sont ni figés (X est fonction de), ni liés à une série d'items lexicaux particuliers (X est affaire/question…de). Il s'avère que les emplois nominaux se situent entre deux pôles sémantiques, qui correspondent à deux profils syntaxiques: un pôle [+ catégorisation] (Bruxelles est capitale de l'Europe) et un pôle [+ association conceptuelle] (Dieu est amour; un visage qui fut révélation). Le premier pôle se trouve dans le prolongement de la construction prédicative des noms humains (Pierre est médecin) et constitue l'interprétation par défaut. Les emplois se rattachant au second pôle se fondent sur un calcul inférentiel.
We address the question of how finitely additive moral value theories (such as utilitarianism) should rank worlds when there are an infinite number of locations of value (people, times, etc.). In the finite case, finitely additive theories satisfy both Weak Pareto and a strong anonymity condition. In the infinite case, however, these two conditions are incompatible, and thus a question arises as to which of these two conditions should be rejected. In a recent contribution, Hamkins and Montero (2000) have argued in favor of an anonymity-like isomorphism principle and against Weak Pareto. After casting doubt on their criticism of Weak Pareto, we show how it, in combination with certain other plausible principles, generates a plausible and fairly strong principle for the infinite case. We further show that where locations are the same in all worlds, but have no natural order, this principle turns out to be equivalent to a strengthening of a principle defended by Vallentyne and Kagan (1997), and also to a weakened version of the catching-up criterion developed by Atsumi (1965) and by von Weizsäcker (1965).
Effects of alloying Ni with Pt and Ta on silicide properties for CMOS technology have been studied. It was found that Pt is soluble in NiSi, which is in line with literature, whereas Ta segregates towards the surface during thermal treatment. Additionally, Ta retards NiSi formation at low temperature. Thermal stability of NiSi on Si is improved more efficiently by alloying Ni with Pt compared to Ta. Silicide/diffusion contact resistance is extracted using the Transmission Line Structure. In our experiments, contact resistivity appeared to be virtually unaffected with respect to the alloying element. Thermal stability on narrow poly Si structures was also improved when Ni was alloyed with Pt. Similar leakage currents for Ni and Ni(Pt) silicides on N+ and P+ junctions were obtained. The results presented in this work suggest that Pt is a better candidate as alloying element to improve NiSi thermal stability for CMOS processes than Ta.