Ordinary Practice Research Articles

A real-world prospective study on dialysis-requiring acute kidney injury.

BackgroundCurrent information about acute kidney injury (AKI) epidemiology in developing nations derives mainly from isolated centers, with few quality multicentric epidemiological studies. Our objective was to describe a large cohort of patients with dialysis-requiring AKI derived from ordinary clinical practice within a large metropolitan area of an emerging country, assessing the impact of age and several clinical predictors on patient survival across the spectrum of human life.MethodsWe analyzed registries drawn from 170 hospitals and medical facilities in Rio de Janeiro, Brazil, in an eleven-year period (2002–2012). The study cohort was comprised of 17,158 pediatric and adult patients. Data were analyzed through hierarchical logistic regression models and mixed-effects Cox regression for survival comparison across age strata.ResultsSevere AKI was mainly hospital-acquired (72.6%), occurred predominantly in the intensive care unit (ICU) (84.9%), and was associated with multiple organ failure (median SOFA score, 11; IQR, 6–13). The median age was 75 years (IQR, 59–83; range, 0–106 years). Community-acquired pneumonia was the most frequent admission diagnosis (23.8%), and sepsis was the overwhelming precipitating cause (72.1%). Mortality was 71.6% and was higher at the age extremes. Poor outcomes were driven by age, mechanical ventilation, vasopressor support, liver dysfunction, type 1 cardiorenal syndrome, the number of failing organs, sepsis at admission, later sepsis, the Charlson score, and ICU admission. Community-acquired AKI, male gender, and pre-existing chronic kidney disease were associated with better outcomes.ConclusionsOur study adds robust information about the real-world epidemiology of dialysis-requiring AKI with considerable clinical detail. AKI is a heterogeneous syndrome with variable clinical presentations and outcomes, including differences in the age of presentation, comorbidities, frailty state, precipitation causes, and associated diseases. In the cohort studied, AKI characteristics bore more similarities to upper-income countries as opposed to the pattern traditionally associated with resource-limited economies.

American and European Guidelines on Disorders of Consciousness: Ethical Challenges of Implementation.

American and European Guidelines on Disorders of Consciousness: Ethical Challenges of Implementation.

해사안전법상 특수한 상황에 있어서 선원의 상무 규정 적용에 관한 연구

The Article 96 of Maritime Safety Act (hereafter, the Act) is a provision to implement the Rule 2, Responsibility of COLREG domestically within the Korean waters. In contrast, this Article does not include concept of the ordinary practice of seamen stated in the COLREG provision, and this may incur extension of application of the Article than that of the COLREG Rule 2. Also, such extension of application may bring more burden on subjects of the Article, any vessel, or the owner, master or crew thereof with respect of duty they should exercise. In recent maritime collision cases, the Korea Maritime Safety Tribunals applied the Article 96 of the Act and the ordinary practice of seaman of the COLREG Rule 2 in a same case without defining its concept, whereas this has raised uncertainty in the extent of the Article 96, especially, what extent of reasonable conduct a vessel, or the owner, master of crew thereof can take under the Article 96. Recognizing such matter, this paper firstly explores the norm of duty of care and the ordinary practice of seamen of COLREG under the common law system since the COLREG was originally written as an English law. Then, duty of care and reasonable person test in the Article 96 of the Act will be examined literally and systematically, considering its purpose within the Korean legal system. After that, the paper identifies differences between the Article 96 and the Rule 2 and also scrutinizes matters flowed from it, and lastly suggests what measures should be taken to address the matters, including its amendment or enactment of a separate legislation giving effect of the COLREG domestically.

해사안전법 제96조의 적용상 쟁점과 개선방안

Convention on the International Regulations for Preventing Collisions at Sea adopted in 1972 for the purpose of preventing collisions of ships at sea is accepted as a domestic law called the Maritime Safety Act. In particular, Rule 2(Responsibility) of the Convention on the International Regulations for Preventing Collisions at Sea is set forth in Rule 96 of Maritime Safety Act. However, in the process of adoption as domestic law, the absence of ordinary practice of seaman and the requirements for immunity of seafarers are different from those of the Convention. Many issues are being raised. These responsibility rule stipulate the neglect of any precaution of the captain, navigator and pilot who are the culprits, and since they are the basis for punishment in the event of a marine accident, interpretation and application of the law is of paramount importance. Therefore, this paper, the issues related to the application of Rule 96 of the Maritime Safety Act are reviewed with a focus on Rule 2 of the Convention on the International Regulations for Preventing Collisions at Sea, and amendments to the Maritime Safety Act are presented to improve them.

A self-destructing narration. The egocentricity of language, transcendence of poetry, and psychoanalysis in P. J. Jouve’s novel <i>Hecate</i>

Hitherto untranslated into Russian, P. J. Jouve’s Hecate (1928) not only interprets myths about the mysterious Greek goddess, doing it in the guise of a love-and-crime chronicle, but also represents the author’s unique attempt to construct a work of fiction on the principle of permanent self-destruction. Y. Muratov sets out to examine the novel’s plot and structure in the first study of its kind. According to the scholar, Jouve, in full adherence to modernist laws and simultaneously experimenting with them, purposely destroys his narrative, turning the destruction into a method: just as the characters in Hecate cannot be sure who they are and try to see themselves in other people’s reflections, the reader is deprived of the means to tell who they are reading about — neither quotation marks, nor the dialogue form, nor context offer any point of reference. Interestingly, Jouve does not play with grammatical person in order to shift the viewpoint of the narration, as in ordinary narrative practice, but to dismantle classical narration and immerse it in the process of creation, luring the reader into a kind of Plato’s cave of linguistically symbolical metafiction.

Edible zombis: fresh fish and the industry of cosmetic corpses

AbstractDoing research on fishery commodities in Portugal led us to an enigma: for a dead fish to befresco(fresh) it must be alive. This paradox manifests at a popular, commercial, and legal level. It denotes the interruption of the difference between being dead and being alive in the commodity form. In Portugal, we suggest, the commercialization ofpeixefresco(fresh fish) is based on the production and consumption of edible ‘zombis’: seafood corpses technologically and symbolically crafted as undead. An open concept, ‘edible zombis’ is part of an experimental vocabulary that foregrounds the productive agency of undeadness, both biological and commercial, in the seafood economic complex. It relates to the ordinary practice of necromancy in the commodity‐based world. Edible zombis are commodity fetishes that fetishize their producers and consumers, suspending them from the capitalist system in which they live.

Case Analysis and Proposal for the Effective Application of “Ordinary Practice of Seaman” as Seafarers’ Responsibility for Marine Accidents

Case Analysis and Proposal for the Effective Application of “Ordinary Practice of Seaman” as Seafarers’ Responsibility for Marine Accidents

Exploring drug cost and disease outcome in rheumatoid arthritis patients treated with biologic and targeted synthetic DMARDs in Norway in 2010\u20132019 \u2013 a country with a national tender system for prescription of costly drugs

BackgroundIn Norway, an annual tender system for the prescription of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) has been used since 2007. This study aimed to explore annual b/tsDMARDs costs and disease outcomes in Norwegian rheumatoid arthritis (RA) patients between 2010 and 2019 under the influence of the tender system.MethodsRA patients monitored in ordinary clinical practice were recruited from 10 Norwegian centers. Data files from each center for each year were collected to explore demographics, disease outcomes, and the prescribed treatment. The cost of b/tsDMARDs was calculated based on the drug price given in the annual tender process.ResultsThe number of registered RA patients increased from 4909 in 2010 to 9335 in 2019. The percentage of patients receiving a b/tsDMARD was 39% in 2010 and 45% in 2019. The proportion of b/tsDMARDs treated patients achieving DAS28 remission increased from 42 to 67%. The estimated mean annual cost to treat a patient on b/tsDMARDs fell by 47%, from 13.1 thousand euros (EUR) in 2010 to 6.9 thousand EUR in 2019. The mean annual cost to treat b/tsDMARDs naïve patients was reduced by 75% (13.0 thousand EUR in 2010 and 3.2 thousand EUR in 2019).ConclusionsIn the period 2010–2019, b/tsDMARD treatment costs for Norwegian RA patients were significantly reduced, whereas DAS28 remission rates increased. Our data may indicate that the health authorities’ intention to reduce treatment costs by implementing a tender system has been successful.

Can Urban Regeneration improve Walkability? A space-time assessment for the Tintoretto area in Brescia

In recent years, shared programs have shown that one of the most critical challenges to promote sustainability in the contemporary city is mobility. The actions on physical context can be divided into two correlated themes: (i) the urban regeneration of existing city with a particular focus on public services for each urban unit and (ii) the planning of their accessibility. Nevertheless, if the correlation is clear and generally recognised in theory, an evaluation of how the urban regeneration projects can contribute to achieving sustainability goals in technical and ordinary practice still struggles to consolidate. Hence, the contribution aims to observing and evaluating the effects of local urban regeneration projects from a people-and-climate perspective, highlighting the pros of integrated urban planning and mobility management approaches.The paper presents an assessment framework that consists of a GIS-based time-space analysis of the walkability scenarios of public open spaces. It maps the urban spaces’ pedestrian permeability in a cells grid, which is applied to an algorithm able to measure the isochronic curve of access time. The approach proposed is applied to the case study of the urban regeneration project of the Tintoretto tower unit in Brescia, which is analysed in two temporal instant, ex-ante and ex-post. The results’ framework reflects on the proactive importance of measuring public space’s systemic regeneration strategies towards "projects people-and-climate oriented".

We Should Improve Personalization of Management in Patients with a Diagnosis of Schizophrenia.

The current management of patients with schizophrenia is marked by a lack of personalization. After the diagnosis is made, a second-generation antipsychotic is usually prescribed based on the current clinician’s preferences, sometimes accompanied by a psychosocial intervention which is typically not evidence-based and not targeted to the specific needs of the individual patient. In this opinion paper, some steps are outlined that could be taken in order to address this lack of personalization. A special emphasis is laid on the clinical characterization of the patient who has received a diagnosis of schizophrenia. Considerations are put forward concerning the assessment of the negative dimension in ordinary clinical practice, which is often neglected; the evaluation of cognitive functioning using a simple test battery which requires limited professional training and takes no more than 15 min to administer; the evaluation of social functioning using a validated instrument focusing on personal care skills, interpersonal relationships, social acceptability, activities, and work skills; and the assessment of the unmet needs of the person (including practical, social, and emotional needs, and existential or personal recovery). The implications of the assessment of these domains for the formulation of the management plan are discussed.

Playhouse Markings and the Revision of Hamlet

The archives at the Stratford Festival create a composite script for each of Shakespeare’s plays that records textual alterations introduced by Festival directors. The palimpsest of productions traced in the composite Hamlet captures some of the crafting that goes into any modern staging, the occasional rainbow of color in the script’s pages serving as a visual reminder that certain scenes and speeches have proven over the years, at least for this company, especially susceptible to theatrical tightening.1 The habit of cutting Hamlet for performance almost certainly stretches back to Shakespeare’s own company. Although there remains debate about early modern running times and the willingness of standing spectators and governing authorities to tolerate performances lasting longer than two hours, the prevalence of cuts in surviving playhouse manuscripts indicates that trimming a play—often it would seem, though not only, for length—was an ordinary practice.2 Without access to a company’s playbook,...

Neurocognition and social cognition in patients with schizophrenia spectrum disorders with and without a history of violence: results of a multinational European study

ObjectiveNeurocognitive impairment has been extensively studied in people with schizophrenia spectrum disorders and seems to be one of the major determinants of functional outcome in this clinical population. Data exploring the link between neuropsychological deficits and the risk of violence in schizophrenia has been more inconsistent. In this study, we analyse the differential predictive potential of neurocognition and social cognition to discriminate patients with schizophrenia spectrum disorders with and without a history of severe violence.MethodsOverall, 398 (221 cases and 177 controls) patients were recruited in forensic and general psychiatric settings across five European countries and assessed using a standardized battery.ResultsEducation and processing speed were the strongest discriminators between forensic and non-forensic patients, followed by emotion recognition. In particular, increased accuracy for anger recognition was the most distinctive feature of the forensic group.ConclusionsThese results may have important clinical implications, suggesting potential enhancements of the assessment and treatment of patients with schizophrenia spectrum disorders with a history of violence, who may benefit from consideration of socio-cognitive skills commonly neglected in ordinary clinical practice.

Grotian Moments and Peremptory Norms of General International Law: Friendly Facilitators or Fatal Foes?

Abstract The concept of a Grotian moment remains rather obscure in international law. On the one hand, it can refer simply to an empirical fact which galvanises the ordinary law-making processes, whether treaty-making or State practice, resulting in major shifts in international law. On the other hand, a Grotian moment might be seen as an event so significant that it results in an extraordinary shift in international law without full adherence to the processes for law-making. The former understanding has little legal significance, while the latter, which would be legally significant, would be controversial and without legal basis. Against this background the article discusses the intersections between peremptory norms and Grotian Moments. It does this by looking at the intersection between the two concepts as well as the intersection between Grotian Moments, on the one hand and, on the other hand, particular jus cogens norms. With respect to the former, for example, the article will consider whether the high threshold of peremptory status facilitates and hinders Grotian moments. With respect to the latter, the article will consider particular norms that have been said to have shifted on account of the Grotian moments, namely the right to use of force in self-defence as well humanitarian intervention.

Masters in the Things of War: Rethinking Military Justice during the Thirty Years War

Abstract Some historians have proposed that common soldiers in various parts of Europe lost a previous judicial independence around 1600 and have linked this development to a contemporary increase in discipline and in control over them. Meanwhile, historians of the Thirty Years War rarely mention military justice at all or depict this war as a time when military justice did not function. In contrast, this article examines the ordinary practice of military law during the Thirty Years War through a close reading of low-level legal paperwork generated by electoral Saxon units. Although military justice was not egalitarian, common soldiers in these units took an active role in the administration of justice, even in the early seventeenth century. The practice of law in early seventeenth-century electoral Saxon military units was similar to pre-existing structures of military justice, but subtly modified.

An Optimized Collision Avoidance Decision-Making System for Autonomous Ships under Human-Machine Cooperation Situations

Maritime Autonomous Surface Ships (MASSs) are attracting increasing attention in recent years as it brings new opportunities for water transportation. Previous studies aim to propose fully autonomous system on collision avoidance decisions and operations, either focus on supporting conflict detection or providing with collision avoidance decisions. However, the human-machine cooperation is essential in practice at the first stage of automation. An optimized collision avoidance decision-making system is proposed in this paper, which involves risk appetite (RA) as the orientation. The RA oriented collision avoidance decision-making system (RA-CADMS) is developed based on human-machine interaction during ship collision avoidance, while being consistent with the International Regulations for Preventing Collisions at Sea (COLREGS) and Ordinary Practice of Seamen (OPS). It facilitates automatic collision avoidance and safeguards the MASS remote control. Moreover, the proposed RA-CADMS are used in several encounter situations to demonstrate the preference. The results show that the RA-CADMS is capable of providing accurate collision avoidance decisions, while ensuring efficiency of MASS maneuvering under different RA.

Beyond the hype

The paper explores art and the city beyond the ‘hype’ of large cultural investment, urban creative titles and cultural place branding programmes. It emphasises the importance of exploring the neglected perspective of the role that everyday culture can play in cities, especially in moments of crisis. It investigates Athens and the economic crisis that affected urban life in the last decade to consider the impact this has had on everyday cultural practices, arts institutions and the experience of the city. Drawing on de Certeau’s concept of everyday practice and using the case study of Athens Fringe Festival, we highlight how ordinary artistic practice and everyday creativity in the city can shape new patterns of cultural participation, urban dialogue and, possibly, cultural citizenship, in a moment of crisis. The paper concludes by arguing for the need to re-orient academic scholarship and future research agendas on art and the city towards everyday creative practice, moving beyond conventional city marketing and institutional, cultural regeneration discourses and strategies.

MHC-I Antigen Presentation Role in Immune Escape of Acute Myeloid Leukemia with High Burden of Genomic Aberration

Background:MHC I antigen presentation is a key pathway in immune response against tumor. It involves degradation of tumor associated antigens, folding and loading of immune epitopes on MHC-I molecules and MHC-I associated presentation on tumor cell surface. Evidence suggests that solid and hematological tumors with high mutational burden or high load in newly tumor associated antigens needs to escape immune surveillance to develop. Acute myeloid leukemia (AML) is not usually believed to be an immunogenic tumor, but patients with complex karyotype, or patients with TP53 alterations have a hypothetical high load of mutation or genomic aberrations.Our study aims to check the entire genome of a large set of newly diagnosed AML to discover if alterations in MHC I antigen presentation could explain the immune escape of the small set of out-layer AML with a high neo-antigen load.Method:We collected 300 bone marrow samples of AML patients at diagnosis from 3 hematological Institutions. Affymetrix Cytoscan HD or 6.0 single nucleotide polymorphism (SNP) array was performed for every samples. Germline SNP array was performed in 114/300 patients, the remaining 186/300 were normalized with a reference pool of 222 healthy donors. Clinical data were collected retrospectively, TP53 , IDH1 , IDH2 , FLT3 , NPM1 , DNMT3A and RUNX1 mutations were tested at diagnosis according ordinary practice. We selected genes involved in MHC class I antigen presentation basing on Reactome pathway. For each patient, we considered MHC-I antigen presentation altered if pathway's alteration rate (altered genes in a pathway/gene in a pathway ratio) scored in the 4th quartile in the alterations rate of all pathways.Results:Twenty out of 300 patients (6.7%) had alteration in MHC I antigen presentation. Patients had alterations in one or more genes: overall 53 genes was founded altered in our set.Patients with alteration in MHC I antigen presentation (group A) did not have differences in age (figure 1a), and in white blood count at diagnosis (figure 1b) compared with other patients in our set (group B). Group A had a prevalence of complex karyotype (14/20 patients, p<.001), and isolated del(5q) (3/30) and abundance in patients harboring TP53 mutation (11/20 patients, p<.001). In group A, a patient harbored FLT3 ITD mutation, a patient IDH2 mutation and 3 patients out of 4 patients tested harbored RUNX1 mutation. In group B, 39/271 patients (13.9%, 9 patients had missing data) harbored TP53 mutation and 56/280 patients had a complex karyotype (29.0%, 9 patients had missing data). Patients in group A had a higher burden of alterations per pathway than patients in group B (0.08 vs 0.04, p<.001).Patients in group A had a median overall survival (OS) of 3.0 months, group B had an OS of 15.7 months (figure 1c, p<.001). MHC class I alteration did not result an essential factor in Cox-hazard ratio model with age, induction therapy, karyotype at diagnosis, TP53, FLT3 and NPM1 mutations.Conclusion:MHC I alteration conferred poor OS at patients in group A; as expected, dismal OS was not confirmed in a multivariable model. We demonstrate that MHC I alteration frequently co-occurred with TP53 mutations and complex karyotype. MHC I alteration was not proved to be a driver alteration in AML, but in the subset of AML with a high number of karyotype aberrations it could favor immune escape and be permissive toward leukemia development and maintenance. Furthermore our approach could be useful in identifying a cohort of patients that are unlikely to respond to immune check-point inhibitors or similar drugs for the dysfunctions in antigen presentation, and a second cohort of patients with TP53 alteration and/or complex karyotype in which these drugs could be administered.Acknowledgments: ELN, AIL, AIRC, project Regione-Università 2010-12 (L. Bolondi), FP7 NGS-PTL project, HARMONY project, Fondazione del Monte BO e RA project. [Display omitted] DisclosuresMartinelli:Amgen: Consultancy; Pfizer: Consultancy; Celgene: Consultancy; Ariad/Incyte: Consultancy; Johnson&Johnson: Consultancy; Roche: Consultancy.

Factors affecting signal quality in implantable cardiac monitors with long sensing vector.

PurposeElectrical artefacts are frequent in implantable cardiac monitors (ICMs). We analyzed the subcutaneous electrogram (sECG) provided by an ICM with a long sensing vector and factors potentially affecting its quality.MethodsConsecutive ICM recipients underwent a follow‐up where demographics, body mass index (BMI), implant location, and surface ECG were collected. The sECG was then analyzed in terms of R‐wave amplitude and P‐wave visibility.ResultsA total of 84 patients (43% female, median age 68 [58‐76] years) were enrolled at 3 sites. ICMs were positioned with intermediate inclination (n = 44, 52%), parallel (n = 35, 43%), or perpendicular (n = 5, 6%) to the sternum. The median R‐wave amplitude was 1.10 (0.72‐1.48) mV with P waves readily visible in 69.2% (95% confidence interval, CI: 57.8%‐79.2%), partially visible in 23.1% [95% CI: 14.3%‐34.0%], and never visible in 7.7% [95% CI: 2.9%‐16.0%] of patients. Men had higher R‐wave amplitudes compared to women (1.40 [0.96‐1.80] mV vs 1.00 [0.60‐1.20] mV, P = .001), while obese people tended to have lower values (0.80 [0.62‐1.28] mV vs 1.10 [0.90‐1.50] mV, P = .074). The P‐wave visibility reached 86.2% [95% CI: 68.3%‐96.1%] in patients with high‐voltage P waves (≥0.2 mV) at surface ECG. The sECG quality was not affected by implant site.ConclusionIn ordinary clinical practice, ICMs with long sensing vector provided median R‐wave amplitude above 1 mV and reliable P‐wave visibility of nearly 70%, regardless of the position of the device. Women and obese patients showed lower but still very good signal quality.

Discourse (re)-framing

Abstract Focusing on the move from gakusei ‘student’ to shakaijin ‘working adult, lit. fully socialized adult’ during a period of continuing economic stagnation and social dislocation, the current study analyzes contemporary Japanese university students’ alignments with respect to ideologies surrounding adulthood including entering the job market and marriage. Data includes naturally occurring conversations with male and female students at a mid-high ranked city university on the outskirts of Yokohama as well as media materials associated with job-hunting practices. Analyzing individuals’ discursive (re)-framing of economic practice, this study demonstrates how individuals convey complex alignments towards future economic and social practices and their attendant ideologies. These complex alignments are analyzed as instances of ‘making do’ (de Certeau, 1984). Attending to subtle shifts in discursive (re)-framing, this paper demonstrates how micropolitical alignments are enacted in language at the level of everyday, ordinary practice.

OCR with the Deep CNN Model for Ligature Script-Based Languages like Manchu

Manchu is a low-resource language that is rarely involved in text recognition technology. Because of the combination of typefaces, ordinary text recognition practice requires segmentation before recognition, which affects the recognition accuracy. In this paper, we propose a Manchu text recognition system divided into two parts: text recognition and text retrieval. First, a deep CNN model is used for text recognition, using a sliding window instead of manual segmentation. Second, text retrieval finds similarities within the image and locates the position of the recognized text in the database; this process is described in detail. We conducted comparative experiments on the FAST-NU dataset using different quantities of sample data, as well as comparisons with the latest model. The experiments revealed that the optimal results of the proposed deep CNN model reached 98.84%.