Idiosyncratic Type Research Articles

Causality, Severity, and Avoidability of Adverse Drug Reactions in Hospitalized Children: A Prospective Cohort Study.

Adverse drug reactions are an important cause of morbidity and mortality in all patients. Information regarding adverse drug reactionsin the pediatric age group,especially with regard to the drugs involved and the clinical presentations is scanty. The aim of our study is to determine the incidence of adverse drug reactionsand to study theirfeatures in terms of causality, type, severity, avoidability, drugs implicated and their clinical presentations. The study was carried out on patients admitted to the pediatric ward and the pediatric intensive care unit over a one-year period (January 1, 2013 to December 31, 2013). Patientseither presenting with or developing an adverse drug reactionin the hospital were includedin the study. The incidence rate for adverse drug reactioncausing hospital admission was 1.79% (95% CI 1.48, 2.16) whereas it was 1.23% (95% CI 0.97, 1.53) for children exposed to a drug during their hospital stay. Type B (bizarre or idiosyncratic type) was seen in 114 (62.6%) of the ADRswhereas 53 (29.1%) were of type A (augmented pharmacologic effect). Severe ADRs were seen in 25 (13.7%) of the total ADRs. ADR was responsible for the death of two patients. 15.4% were rated as avoidable. Anti-microbials were the most common group responsible for ADRs (43.4%), followed by drugs acting on the immune system (15.9%) and drugs acting on the nervous system (14.3%). The most common ADRs were metabolic (29.3%) followed by neurological (17.6%). Adverse drug reactionscan occur in a substantial proportion of hospitalized patients with some of them being severe and potentially avoidable. Awareness among physicians should be encouraged regarding monitoring, documentation and notification of adverse drug reactions.

Drug-Induced Liver Injury in Tuberculosis: Mechanisms of Development and Diagnostic Methods

The review article discusses modern aspects of drug-induced liver injury (DILI) in patients with tuberculosis who are receiving etiotropic therapy. The main mechanisms of DILI, including toxic and idiosyncratic types, are described, as well as their pathogenetic, biochemical, and epidemiological differences. DILI can manifest as various clinicomorphological forms of liver damage, such as steatosis and steatohepatitis, acute and chronic hepatitis, mitochondrial cytopathy, cholestasis, sclerosing cholangitis, vascular injury, and others. The main diagnostic method for DILI is the detection of liver enzymes - transaminases and alkaline phosphatase - based on the degree of elevation and their ratio, which identify two main types of liver injury - hepatocellular and cholestatic - as well as a mixed variant. The article provides a scoring assessment of liver damage in a patient receiving chemotherapy to classify it as drug-induced liver injury.

S2952 Cefepime-Induced Liver Injury

Introduction: Drug induced liver injury can be a result of many medications and remains as one of the most challenging disorders faced by GI specialists. The most common causes in the Western world include antimicrobials, antiepileptics, anticancer medications, herbal and dietary supplements. It is important to make the distinction between intrinsic and idiosyncratic types of DILI. Intrinsic DILI is capable of causing injury in a predictable pattern in humans when given in high doses. Idiosyncratic DILI only affects susceptible individuals and has less of an association to dosing. The latter being the more difficult type to diagnose and treat. An important value, the R-factor, is used to define hepatotoxicity injury patters. An R-factor < 2 suggests a cholestatic pattern, R-factor > 5 suggests a hepatocellular pattern, and in between a mixed pattern of injury. Early withdrawal of the offending agent is the treatment of choice for any cause of DILI as this prevents progression of acute liver failure. Case Description/Methods: We present a case of a 61 year old male (S, J) with acute elevations in his liver enzymes and alkaline phosphatase. Patient was admitted for alcohol withdrawal. The following day, patient was intubated secondary to hypercapnic respiratory failure and days later developed ventilator associated pneumonia for which he was started on antimicrobial therapy, cefepime and vancomycin. After 9 days of receiving cefepime, patient’s alkaline phosphatase and liver transaminases acutely increased. Patient’s baseline levels were normal on arrival to the hospital. His lab values were the following: ALT 263, AST 507, and alkaline phosphatase 279 with an R factor of 2.8 showing a mixed injury pattern. A right upper quadrant ultrasound showed hepatomegaly and an acute hepatitis panel was ordered which resulted negative. No episodes of significant hypotension were reported. The antibiotic was immediately discontinued with resolution of patient’s levels back to normal. Discussion: Though not as commonly reported, increased ALT, AST or alkaline phosphatase can be a result of cefepime use. Our patient on admission did not have abnormal liver chemistry tests despite his history of alcohol use. R-factor for our patient showed a mixed pattern of liver injury. First line tests when suspecting DILI such as acute viral hepatitis serologies and imaging studies were ordered. Our patient was not re-started on cefepime and his liver enzymes returned to baseline.

On an idiosyncratic type of an Old English simile

ABSTRACT This paper describes a manner of expressing similarity through an Old English construction employing the noun gelicnes “likeness” (or its variants) as a comparison marker. The constructions in question are scrutinised with regard to their structure and their semantics, and these turn out to show direct interdependency and interconnectedness. The result is a detailed description of two major structural types of simile in Old English with the gelicnes component, distinguishable by their number of verbalised components, their positioning, and grammatical expression. The uniqueness of this structure is its capability to create similes without an explicitly expressed, but undefined tenor, which is no longer the case in Modern English. A simile with a non-verbalised undefined tenor is closer to metaphor than other poetic comparisons.

Model Based Evaluation of Hypersensitivity Adverse Drug Reactions to Antimicrobial Agents in Children.

Drug use in children is–in most cases–supported by extrapolation of data generated from clinical trials in adult populations. This puts children at higher risk of developing adverse drug reactions (ADRs) due to “off-label” use of drugs and dosing issues. Major types of ADRs are drug hypersensitivity reactions, an idiosyncratic type of ADRs that are largely unpredictable and can cause high morbidity and mortality in a hard-to-identify specific population of patients. Lack of a complete understanding of the pathophysiology of DHRs and their unpredictive nature make them problematic in clinical practice and in drug development. In addition, ethical and legal obstacles hinder conducting large clinical trials in children, which in turn make children a “therapeutic orphan” where clear clinical guidelines are lacking, and practice is based largely on the personal experience of the clinician, hence making modeling desirable. This brief review summarizes the current knowledge of model-based evaluation of diagnosis and management of drug hypersensitivity reactions (DHRs) to antimicrobial drugs in the pediatric population. Ethical and legal aspects of drug research in children and the effect of different stages of child development and other factors on the risk of DHRs are discussed. The role of animal models, in vitro models and oral provocation test in management of DHRs are examined in the context of the current understanding of the pathophysiology of DHRs. Finally, recent changes in drug development legislations have been put forward to encourage drug developers to conduct trials in children clearly indicate the urgent need for evidence to support drug safety in children and for modeling to guide these clinical trials.

The Dynamic Dialectic and the Eclectic Plaintive Rhythm in Bembeya Jazz’s, Black Beats Music

The foremost line of the post-independent music evolves especially, from a simple to a more compound whole within the understanding of convention of representation and the association of experience become structural materials. Thereby, the basic component of conventional imagery, and the colonialist dynamic straightforward influences frame a new idiosyncratic type that evaluates the establishment of realty, memory and symbol. Correspondingly, through the foundation of intellectual and artistic image, the commensurate imagination of the musical nationalism schedule moves afar unconscious and insensate sensitivity. Indeed, the cultural and artistic body of the Bembeya Jazz and the Black Beats Band deconstruct the colonialist conventional perception of productivity; then, through extensive collective relation with their time and space, their nationalistic music exhibits boundaries of cross-examination regarding the realm of recombination, reconciliation and re-appropriation. Within the respect of material imagination and objective reality, verbal text, and contemporary Western musical instruments become the developing artistic cosmos within a new social and linguistic narrative is structured. Hence, the commitment of this article stands as a diagnostic process within we try to grasp the rapport of the indigenous value of imagination and the transcontinental stylistic effects inside the historio-context of redefining the self, sociolinguistic reflectivity, and perceptive sensibility in post-independent era.

Strategic Timing of IPOs and Disclosure: A Dynamic Model of Multiple Firms

We study a dynamic timing game between multiple firms, who decide when to go public in the presence of possible information externalities. A firm's IPO pricing is a function of its privately observed idiosyncratic type and the level of investor sentiment, which follows a stochastic, mean-reverting process. Firms may wish to delay their IPOs in order to observe the market reception of the offerings of their peers. We characterize the unique symmetric threshold equilibrium, whereby pioneer firms with high idiosyncratic types endogenously emerge. The results provide novel implications regarding variation in IPO timing, sequential clustering, IPO droughts, the composition of new issues over time, and how IPO volume fluctuates over time. These include, among others, that in more populated industries, a lower proportion of firms emerge as industry pioneers, but follower IPO volume is intensified. Additionally, heightened uncertainty over investor sentiment exacerbates delay and leads to lower IPO volume.

Strategic Timing of IPOs and Disclosure: A Dynamic Model of Multiple Firms

ABSTRACT We study a dynamic timing game between multiple firms, who decide when to go public in the presence of possible information externalities. A firm's IPO pricing is a function of its privately observed idiosyncratic type and the level of investor sentiment, which follows a stochastic, mean-reverting process. Firms may wish to delay their IPOs in order to observe the market reception of the offerings of their peers. We characterize the unique symmetric threshold equilibrium, whereby pioneer firms with high idiosyncratic types endogenously emerge. The results provide novel implications regarding variation in IPO timing, sequential clustering, IPO droughts, the composition of new issues over time, and how IPO volume fluctuates over time. These include, among others, that in more populated industries, a lower proportion of firms emerge as industry pioneers, but follower IPO volume is intensified. Additionally, heightened uncertainty over investor sentiment exacerbates delay and leads to lower IPO volume.

Drug Induced Hepatotoxicity – An Ongoing Challenge

Drug induced liver injury is one of the main factor of liver failure and acute liver damage world wide with high incidence in western countries. Liver injury can be intrinsic (dose dependant) or idiosyncratic (dose independent). However idiosyncratic type is considered to be mainly responsible for drug induced liver damage. Binding of reactive metabolites of drugs to tissue proteins and oxidative stress is the possible cellular mechanism involved in this process. Moreover, some antibiotics, anti-epileptics, nonsteroidal anti-inflammatory drugs etc are more likely to induce liver damage in high risks groups that includes females, elderly and obese people. HLA halotype and variation in protein expression also plays an important role in this context. Various studies are available regarding clinical features, histopathological features, diagnosis and management related to antibiotics and acetaminophen induced liver damage. N acetylcysteine is commonly available antidote for drug induced hepatic damage. Role of other pharmacological agents as an antidote requires further studies. However, liver transplantation should be considered with drug induced lethal liver failure

Pinnacles in Long-form Literary Texts: Cross-textual Evidence for the Pervasiveness of Megametaphorical Expression

Various scholars have recognized how literary authors use mega-metaphor (scattered metaphorical domain references) to unobtrusively shape their narratives. Corpus analysis proves useful not only in identifying the presence of such metaphorical systems in long-form texts but also in assessing their relative prominence across multiple texts. This article will examine 50 randomly selected literary narratives so as to discern the extent to which the relatively uncommon but metaphorically replete word pinnacle contributes surreptitious metaphorical meaning to the literary texts in which it is found. Results of the study confirm that the word “pinnacle,” when it is used at all, is nearly always placed so as to highlight climactic scenes or emphasize key turning points in protagonist character development. The fact that metaphorical lines of interpretation relating to certain words and phrases may be detected, not only by way of critical intuition but also through the electronic searching of multiple text corpora, demonstrates the value of cross-textual analysis strategies in certain cases. It also hints that megametaphor, rather than being a rare and idiosyncratic type of literary artifice, may be more prevalent than has been previously acknowledged.

Photopoetics: Sisyphus Outdone, the Apostrophal Subject and the Elusive Image

AbstractIn Sisyphus Outdone (2012), Nathanaël’s particular tribute to Albert Camus’ The Myth of Sisyphus (1942), the reader faces a challenging hybrid text in which the verbal and visual dimensions intermingle to produce an idiosyncratic type of narrative. Fragmentary, elliptical, a web of quotations, dictums, and meditations on the difficult condition of the individual in the current image-saturated scenario of the first decades of the 21st century, the text manages to propose a rigorous reflection upon crucial aspects of representation from History and temporality, to the Subject now, photography, catastrophe theory, architecture, failure and translation, among the most salient. Sisyphus, I suggest, exhibits a strategic photopoetics which operates as a self-reflective mechanism contributing to the persistence of an impermanent liminal subject and to the (re)production of textuality and the proliferation of voices against silence.

Misinterpreting Others and the Fragility of Social Learning

We exhibit a natural environment, social learning among heterogeneous agents, where even slight misperceptions can have a large negative impact on long‐run learning outcomes. We consider a population of agents who obtain information about the state of the world both from initial private signals and by observing a random sample of other agents' actions over time, where agents' actions depend not only on their beliefs about the state but also on their idiosyncratic types (e.g., tastes or risk attitudes). When agents are correct about the type distribution in the population, they learn the true state in the long run. By contrast, we show, first, that even arbitrarily small amounts of misperception about the type distribution can generate extreme breakdowns of information aggregation, where in the long run all agents incorrectly assign probability 1 to some fixed state of the world,regardlessof the true underlying state. Second, any misperception of the type distribution leads long‐run beliefs and behavior to vary only coarsely with the state, and we provide systematic predictions for how the nature of misperception shapes these coarse long‐run outcomes. Third, we show that how fragile information aggregation is against misperception depends on the richness of agents' payoff‐relevant uncertainty; a design implication is that information aggregation can be improved by simplifying agents' learning environment. The key feature behind our findings is that agents' belief‐updating becomes “decoupled” from the true state over time. We point to other environments where this feature is present and leads to similar fragility results.

Misinterpreting Others and the Fragility of Social Learning

We study to what extent information aggregation in social learning environments is robust to slight misperceptions of othersi?½ characteristics (e.g., tastes or risk attitudes). We consider a population of agents who obtain information about the state of the world both from initial private signals and by observing a random sample of other agentsi?½ actions over time, where agentsi?½ actions depend not only on their beliefs about the state but also on their idiosyncratic types. When agents are correct about the type distribution in the population, they learn the true state in the long run. By contrast, our first main result shows that even arbitrarily small amounts of misperception can generate extreme breakdowns of information aggregation, wherein the long run all agents incorrectly assign probability 1 to some fixed state of the world, regardless of the true underlying state. This stark discontinuous departure from the correctly specified benchmark motivates independent analysis of information aggregation under misperception. Our second main result shows that any misperception of the type distribution gives rise to a specific failure of information aggregation where agentsi?½ long-run beliefs and behavior vary only coarsely with the state, and we provide systematic predictions for how the nature of misperception shapes these coarse long-run outcomes. Finally, we show that how sensitive information aggregation is to misperception depends on how rich agentsi?½ payoff-relevant uncertainty is. A design implication is that information aggregation can be improved through interventions aimed at simplifying the agentsi?½ learning environment.

The Power of Image in the American Abolitionism

This paper emphasizes the power of image as a principal tool of political strategy in the American Abolitionism during the mid-nineteenth century. It attends first to the nature of an image with the issue of control and power. Then it moves to how an image was utilized by three actors of the time, the anti-abolitionists, the pro-abolitionists—both developed stock images of race for the opposing purposes—and the slaves who had to get the better of stereotypes to reach a black reality. With photography as the more accurate medium of image in the War era, the paper traces how the white sympathizers and the blacks overcame the white prejudice. Delia is introduced to show that even in a forced situation the subject could transfer her reality. Then the making of Gordon’s whipped-back image is traced to show how a type and an idiosyncrasy were fused into an image, followed by military images as idiosyncratic types. Anderson’s, Truth’s and Bibb’s portraits are discussed as diverse ways to reach their reality, whether by collaborating with the photographer, by manipulating a self-portrait as a type of a black lady, or by undermining the whites’ norm of the social status. The power of image allowed them to get their black reality.

Why Do Sustainable Mergers Fail to Manage Entrepreneurship?

This paper proposes a conceptual model using four failed mergers (Federated -Fingerhut, KCPL and Western Resources, Daimler–Chrysler and Alcatel–Lucent) and distinguishes two types of dimensions: type of failure (tangible and intangible) and degree of failure (fixable and unfixable). Using case studies as a research strategy and focusing on the Alcatel–Lucent merger, as an example of an idiosyncratic type of “merger of equals”, the model identifies the entrepreneurial conflict variable as a missed step for obtaining a sustainable merger process over time.

Misinterpreting Others and the Fragility of Social Learning

We study to what extent information aggregation in social learning environments is robust to slight misperceptions of others’ characteristics (e.g., tastes or risk attitudes). We consider a population of agents who obtain information about the state of the world both from initial private signals and by observing a random sample of other agents’ actions over time, where agents’ actions depend not only on their beliefs about the state but also on their idiosyncratic types. When agents are correct about the type distribution in the population, they learn the true state in the long run. By contrast, our first main result shows that even arbitrarily small amounts of misperception can generate extreme breakdowns of information aggregation, wherein the long run all agents incorrectly assign probability 1 to some fixed state of the world, regardless of the true underlying state. This stark discontinuous departure from the correctly specified benchmark motivates independent analysis of information aggregation under misperception. Our second main result shows that any misperception of the type distribution gives rise to a specific failure of information aggregation where agents’ long-run beliefs and behavior vary only coarsely with the state, and we provide systematic predictions for how the nature of misperception shapes these coarse long-run outcomes. Finally, we show that how sensitive information aggregation is to misperception depends on how rich agents’ payoff-relevant uncertainty is. A design implication is that information aggregation can be improved through interventions aimed at simplifying the agents’ learning environment.

The perceived relationship between population growth and current ecological problems using repertory grid technique

ABSTRACTPopulation growth (PG) is one of the main drivers of environmental deterioration. Understanding lay perception of PG is important for mobilizing public opinion and support for environmental protection.A range of real-life current ecological problems, including PG, was presented to a sample of a hundred Israeli students without environmental education. We employed George Kelly's repertory grid technique along with principal component analysis to: (a) examine risk perceptions about PG in relation to various ecological problems and (b) identify the perceived risk attributes that influence risk perception of PG.We found that: (a) PG severity was perceived as extremely modest, and that very few respondents viewed it as a catalyst of all other ecological problems that warranted prevention. (b) The most significant predictors of risk evaluation were the perceived certainty of the risk and the level of emotional response it evoked.PG emerges as an idiosyncratic type of risk that is as psychologically distant as possible from most other ecological problems. This reflects a profound lack of understanding of the long-term effects of PG and the underlying causes behind many of today's ecological problems. The importance of raising awareness about demographic factors in environmental degradation is discussed.

Copper‐base Metallurgy in Metal‐Age Bali: Evidence from Gilimanuk, Manikliyu, Pacung, Pangkung Paruk and Sembiran

The Indonesian Archipelago extends over 5000 km of latitude, from 95°E to 141°E, and hosts some of the world's largest active metal mines. While some fascinating ethnographic and historical sources exist, virtually nothing is known of the country's prehistoric metallurgical traditions. Given Indonesia's scale, this situation cannot be remedied in short order, but with this paper we seek to elucidate some metal production and consumption behaviours on Bali, located around 115°E, during the last centuries of the first millennium bc and the early to middle first millennium ad. The studied early Metal Age assemblage of 27 copper‐base artefacts from the sites of Pacung, Sembiran, Bangkah, Pangkung Paruk, Gilimanuk and Manikliyu includes bangle, bowl, drum, hook, mirror and ornamental typologies, and fragments thereof. Fourteen of the 27 samples were suffering from corrosion, but a strong tendency towards leaded copper alloys (21 of 27) can be distinguished, with some bronzes, a high‐tin bronze and a leaded high‐tin bronze. The high proportion of leaded artefacts mean that lead isotope data cannot be used to identify possible sources of copper, but there is good consistency with Mainland South‐East Asian Iron Age leaded alloy signatures for the bulk of the assemblage, possibly indicating the existence of long‐range (~2000–3000 km one way) exchange systems at the outset of the Island South‐East Asian Metal Age, and perhaps as far as China and India in the case of the mirror and bowl, respectively. Of particular note, the Manikliyu ‘Pejeng’ drum, a stylistically idiosyncratic type known from Bali and Java, and for which there is local production evidence, transpired to be consistent in terms of elemental composition and lead signature with Mainland ‘Dong Son’ drums. This could suggest that Pejeng drums were produced not just from metal imported from the Mainland but with melted down Mainland drums; an intriguing case of local reinterpretation of foreign elite material culture and iconography.

A student of Jewish languages reads Michał Németh’s Unknown Lutsk Karaim Letters in Hebrew Script (19th–20th Centuries). A Critical Edition

The Karaite language has justifiedly attracted the attention of Turkologists though it should also be of interest to students of Jewish languages (= the languages of Rabbanite and Karaite Jews); and what students of Jewish languages have to say about it should interest Turkologists, just as what the latter have to say should interest the former.&#x0D; By looking at Karaite (as exemplified in Michał Németh’s Unknown Lutsk Karaim Letters in Hebrew Script (19th–20th Centuries): A Critical Edition)from the viewpoint of other Jewish languages, researchers can:&#x0D; &#x0D; Add new questions to the agenda of Karaite research. For example, the existence of an idiosyncratic type of periphrastic verb in at least Karaite, Judezmo, Yidish, and Ultra-Orthodox Ashkenazic English prompts the question of what the genetic relationships between the tokens of that type are.&#x0D; Reopens old questions. For example, the derivation proposed for Karaite כניסא '[Karaite (and/or Rabbanite?)] synagog', with phonological variants, according to which the word comes from Arabic. The author proposes a different etymology (possibly not original with him) , involving only Jewish languages (a more appropriate derivation for a Karaite word having that meaning), which takes the Karaite word back to Hebrew and/or to Jewish Aramaic.&#x0D;

Perceived Control and Hedonic Tone Dynamics During Performance in Elite Shooters

Purpose: The purpose of the study was to investigate the individuals' dynamics of perceived control and hedonic tone over time, with respect to the 4 performance states as conceptualized within the multiaction plan (MAP) model. We expected to find idiosyncratic and differentiated trends over time in the scores of perceived control and hedonic tone, typified by fluctuations among 2 optimal and 2 suboptimal types of processing during performance. Method: Ten elite-level shooters participated in the study. They were asked to identify the most relevant, idiosyncratic core component of their shooting action and perform 120 shots distanced 10 m from the target. Subjective accounts of perceived control and hedonic tone of the core component of action were assessed prior to and after each shot. We used a probabilistic approach to derive the 4 performance categories according to 2 × 2 interactions of perceived control and performance and hedonic tone and performance. Results: Logistic ordinal regression analysis enabled the identification of 4 idiosyncratic performance types for each athlete with respect to perceived control and hedonic tone intensity scores. Within- and between-individual differences in intensity bandwidth and probability levels were apparent across the 4 performance types. Changes among 4 types of processing were also observed during performance. Conclusion: Consistent with the MAP model conceptualization, the findings provided support for the different patterns of perceived control and hedonic tone intensity scores during performance. The results suggest applied arguments for using action- and emotion-centered strategies to help athletes in reaching and sustaining optimal performance states.