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Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine: The NACSELD Experience
Background
Women have lower serum creatinine values than men for similar renal function.
Aims
We aimed to determine the differential effect of baseline, peak, and delta creatinine between genders on outcomes in infected hospitalized cirrhotic patients.
Methods
North American Consortium for the Study of End-Stage Liver Disease is a 15-center consortium of tertiary care hepatology centers prospectively enrolling infected cirrhotic inpatients. Baseline, peak, and delta creatinine during hospitalization were compared between genders, and their impact on overall survival, transplant-free survival, probability of transplantation, and need for renal replacement therapy (RRT) was analyzed.
Results
In total, 532 patients with cirrhosis (males = 59% median admission MELD = 20) had significantly lower median baseline (1.07 vs. 1.30 mg/dL,
p
< 0.0001) and peak creatinine (1.47 vs. 1.59 mg/dL,
p
= 0.024) in women than men during hospitalization for an infection, but both genders had similar delta creatinine levels (0.30 vs. 0.30 mg/dL,
p
= 0.957). Thirty-day mortality was similar between genders. RRT was not used more often in women (19 vs. 12%,
p
= 0.050), and women were 1.8 times more likely than men to receive RRT at the same creatinine (
p
= 0.028). Both peak and delta creatinine significantly predicted 6-month overall and transplant-free survival (
p
< 0.0001), but the probability of liver transplantation was affected by the interaction between gender and both peak and delta creatinine.
Conclusions
Infected hospitalized cirrhotic women are significantly more likely than men to receive RRT at similar creatinine levels. Gender-specific differences in baseline, peak, and delta creatinine need further investigation to determine whether women need acute kidney injury treatment at lower creatinine thresholds than men.
Journal Article
Playwright, Space and Place in Early Modern Performance
Analyzing Elizabethan and Jacobean playtexts for their spatial implications, this innovative study discloses the extent to which the resources and constraints of public playhouse buildings affected the construction of the fictional worlds of early modern plays. The study argues that playwrights were writing with foresight, inscribing the constraints and resources of the stages into their texts. It goes further, to posit that Shakespeare and his playwright-contemporaries adhered to a set of generic conventions, rather than specific local company practices, about how space and place were to be related in performance: the playwrights constituted thus an overarching virtual 'company' producing playtexts that shared features across the acting companies and playhouses. By clarifying a sixteenth- to seventeenth-century conception of theatrical place, Tim Fitzpatrick adds a new layer of meaning to our understanding of the plays. His approach adds a new dimension to these particular documents which-though many of them are considered of great literary worth-were not originally generated for any other reason than to be performed within a specific performance context. The fact that the playwrights were aware of the features of this performance tradition makes their texts a potential mine of performance information, and casts light back on the texts themselves: if some of their meanings are 'spatial', these will have been missed by purely literary tools of analysis.
eBook
Crayfish optimization algorithm
This paper proposes a meta heuristic optimization algorithm, called Crayfish Optimization Algorithm (COA), which simulates crayfish’s summer resort behavior, competition behavior and foraging behavior. The three behaviors are divided into three different stages to balance the exploration and exploitation of algorithm. The three stages are summer resort stage, competition stage and foraging stage. The summer resort stage represents the exploration stage of the COA. The competition stage and foraging stage represent the exploitation stage of the COA. Exploration and exploitation of COA are regulated by temperature. When the temperature is too high, crayfish will enter the cave for summer vacation or compete for the same cave. When the temperature is appropriate, crayfish have different foraging behaviors according to the size of food. Among them, the amount of food eaten by crayfish is related to food intake. Through temperature regulate exploration and exploitation process in COA, the COA has higher randomness and global optimization effect. To verify the optimization effect of COA, in the experimental part, 23 standard benchmark functions and CEC2014 benchmark functions are used to test, and 9 algorithms are selected for comparative experiments. The experimental results show that COA can balance the exploration and exploitation, and achieve good optimization effect. Finally, the COA is tested in five engineering problems, and finally achieves better results. The source code website for COA is https://github.com/rao12138/COA-s-code.
Journal Article
Current and future cancer staging after neoadjuvant treatment for solid tumors
Until recently, cancer registries have only collected cancer clinical stage at diagnosis, before any therapy, and pathological stage after surgical resection, provided no treatment has been given before the surgery, but they have not collected stage data after neoadjuvant therapy (NAT). Because NAT is increasingly being used to treat a variety of tumors, it has become important to make the distinction between both the clinical and the pathological assessment without NAT and the assessment after NAT to avoid any misunderstanding of the significance of the clinical and pathological findings. It also is important that cancer registries collect data after NAT to assess response and effectiveness of this treatment approach on a population basis. The prefix y is used to denote stage after NAT. Currently, cancer registries of the American College of Surgeons' Commission on Cancer only partially collect y stage data, and data on the clinical response to NAT (yc or posttherapy clinical information) are not collected or recorded in a standardized fashion. In addition to NAT, nonoperative management after radiation and chemotherapy is being used with increasing frequency in rectal cancer and may be expanded to other treatment sites. Using examples from breast, rectal, and esophageal cancers, the pathological and imaging changes seen after NAT are reviewed to demonstrate appropriate staging.
Journal Article
Introduction to the art of stage management : a practical guide to working in the theatre and beyond
\"How do you develop the craft and skills of stage management for today's theatre industry? And how can these same skills be applied in a variety of entertainment settings to help you develop a rewarding and successful career? Drawing on his diverse experience working with companies from across the performing arts spectrum in venues from the Hollywood Bowl to the Barbican Centre in London, Michael Vitale offers a practical resource on the art of stage management for new and established stage managers. Besides providing detailed coverage of the role within theatre, the book uniquely explores the field of stage management in numerous branches of the entertainment industry. From theatre, opera, and theme parks, to cruise ships, special events, and dance, stage managers are an integral part of keeping productions running, and this book offers guidance on each distinct area to equip you for a varied and successful career. Written with candour and filled with real-world examples, the book examines the nuts and bolts of the job at each stage of the production process: from preproduction, room rehearsal, technical rehearsal, through to running the show. Vitale considers the skills needed to work with a myriad of different people, explores the traits of a successful stage manager, and helps you to hone and evaluate your own practice. Whether you are exploring the field for the first time or are a veteran looking to diversify your resumé, Introduction to the Art of Stage Management will provide insight, practical information, and useful tips to help along the way. An accompanying Companion Website features a range of time-saving templates and forms, such as schedule templates and scene samples\"-- Provided by publisher.
Book
Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: population based cohort study
AbstractObjectivesTo quantify mortality rates for patients successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals and compare these rates with those of the general population.DesignPopulation based cohort study.SettingBritish Columbia, Scotland, and England (England cohort consists of patients with cirrhosis only).Participants21 790 people who were successfully treated for hepatitis C in the era of interferon-free antivirals (2014-19). Participants were divided into three liver disease severity groups: people without cirrhosis (pre-cirrhosis), those with compensated cirrhosis, and those with end stage liver disease. Follow-up started 12 weeks after antiviral treatment completion and ended on date of death or 31 December 2019.Main outcome measuresCrude and age-sex standardised mortality rates, and standardised mortality ratio comparing the number of deaths with that of the general population, adjusting for age, sex, and year. Poisson regression was used to identify factors associated with all cause mortality rates.Results1572 (7%) participants died during follow-up. The leading causes of death were drug related mortality (n=383, 24%), liver failure (n=286, 18%), and liver cancer (n=250, 16%). Crude all cause mortality rates (deaths per 1000 person years) were 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively. All cause mortality was considerably higher than the rate for the general population across all disease severity groups and settings; for example, all cause mortality was three times higher among people without cirrhosis in British Columbia (standardised mortality ratio 2.96, 95% confidence interval 2.71 to 3.23; P<0.001) and more than 10 times higher for patients with end stage liver disease in British Columbia (13.61, 11.94 to 15.49; P<0.001). In regression analyses, older age, recent substance misuse, alcohol misuse, and comorbidities were associated with higher mortality rates.ConclusionMortality rates among people successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals are high compared with the general population. Drug and liver related causes of death were the main drivers of excess mortality. These findings highlight the need for continued support and follow-up after successful treatment for hepatitis C to maximise the impact of direct acting antivirals.
Journal Article