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Objective: Cyclophosphamide (CYC) is used in clinical practice off-label for the induction of remission in childhood polyarteritis nodosa (PAN). Mycophenolate mofetil (MMF) might offer a less toxic alternative. This study was undertaken to explore the relative effectiveness of CYC and MMF treatment in a randomized controlled trial (RCT). Methods: This was an international, open-label, Bayesian RCT to investigate the relative effectiveness of CYC and MMF for remission induction in childhood PAN. Eleven patients with newly diagnosed childhood PAN were randomized (1:1) to receive MMF or intravenous CYC; all patients received the same glucocorticoid regimen. The primary end point was remission within 6 months while compliant with glucocorticoid taper. Bayesian distributions for remission rates were established a priori for MMF and CYC by experienced clinicians and updated to posterior distributions on trial completion. Results: Baseline disease activity and features were similar between the 2 treatment groups. The primary end point was met in 4 of 6 patients (67%) in the MMF group and 4 of 5 patients (80%) in the CYC group. Time to remission was shorter in the MMF group compared to the CYC group (median 7.1 weeks versus 17.6 weeks). No relapses occurred in either group within 18 months. Two serious infections were found to be likely linked to MMF treatment. Physical and psychosocial quality-of-life scores were superior in the MMF group compared to the CYC group at 6 months and 18 months. Combining the prior expert opinion with results from the present study provided posterior estimates of remission of 71% for MMF (90% credibility interval [90% CrI] 51, 83) and 75% for CYC (90% CrI 57, 86). Conclusion: The present results, taken together with prior opinion, indicate that rates of remission induction in childhood PAN are similar with MMF treatment and CYC treatment, and MMF treatment might be associated with better health-related quality of life than CYC treatment.

Objective: Cyclophosphamide (CYC) is used in clinical practice off-label for the induction of remission in childhood polyarteritis nodosa (PAN). Mycophenolate mofetil (MMF) might offer a less toxic alternative. This study was undertaken to explore the relative effectiveness of CYC and MMF treatment in a randomized controlled trial (RCT). Methods: This was an international, open-label, Bayesian RCT to investigate the relative effectiveness of CYC and MMF for remission induction in childhood PAN. Eleven patients with newly diagnosed childhood PAN were randomized (1:1) to receive MMF or intravenous CYC; all patients received the same glucocorticoid regimen. The primary end point was remission within 6 months while compliant with glucocorticoid taper. Bayesian distributions for remission rates were established a priori for MMF and CYC by experienced clinicians and updated to posterior distributions on trial completion. Results: Baseline disease activity and features were similar between the 2 treatment groups. The primary end point was met in 4 of 6 patients (67%) in the MMF group and 4 of 5 patients (80%) in the CYC group. Time to remission was shorter in the MMF group compared to the CYC group (median 7.1 weeks versus 17.6 weeks). No relapses occurred in either group within 18 months. Two serious infections were found to be likely linked to MMF treatment. Physical and psychosocial quality-of-life scores were superior in the MMF group compared to the CYC group at 6 months and 18 months. Combining the prior expert opinion with results from the present study provided posterior estimates of remission of 71% for MMF (90% credibility interval [90% CrI] 51, 83) and 75% for CYC (90% CrI 57, 86). Conclusion: The present results, taken together with prior opinion, indicate that rates of remission induction in childhood PAN are similar with MMF treatment and CYC treatment, and MMF treatment might be associated with better health-related quality of life than CYC treatment.

Objective: Cyclophosphamide (CYC) is used in clinical practice off-label for the induction of remission in childhood polyarteritis nodosa (PAN). Mycophenolate mofetil (MMF) might offer a less toxic alternative. This study was undertaken to explore the relative effectiveness of CYC and MMF treatment in a randomized controlled trial (RCT). Methods: This was an international, open-label, Bayesian RCT to investigate the relative effectiveness of CYC and MMF for remission induction in childhood PAN. Eleven patients with newly diagnosed childhood PAN were randomized (1:1) to receive MMF or intravenous CYC; all patients received the same glucocorticoid regimen. The primary end point was remission within 6 months while compliant with glucocorticoid taper. Bayesian distributions for remission rates were established a priori for MMF and CYC by experienced clinicians and updated to posterior distributions on trial completion. Results: Baseline disease activity and features were similar between the 2 treatment groups. The primary end point was met in 4 of 6 patients (67%) in the MMF group and 4 of 5 patients (80%) in the CYC group. Time to remission was shorter in the MMF group compared to the CYC group (median 7.1 weeks versus 17.6 weeks). No relapses occurred in either group within 18 months. Two serious infections were found to be likely linked to MMF treatment. Physical and psychosocial quality-of-life scores were superior in the MMF group compared to the CYC group at 6 months and 18 months. Combining the prior expert opinion with results from the present study provided posterior estimates of remission of 71% for MMF (90% credibility interval [90% CrI] 51, 83) and 75% for CYC (90% CrI 57, 86). Conclusion: The present results, taken together with prior opinion, indicate that rates of remission induction in childhood PAN are similar with MMF treatment and CYC treatment, and MMF treatment might be associated with better health-related quality of life than CYC treatment.

This chapter investigates the historiography of the cult of the Holy Tear of Christ, La Sainte Larme, and explores the materiality and affective life of the relic. The apocryphal narrative tells that an angel caught the tears Christ shed on hearing about Lazarus’ death and gave them to Mary Magdalene for safekeeping. Around 1040, Geoffrey Martel received the relic of the Holy Tear as a reward for his military efforts. Enshrined at the Abbey of La Trinité, Vendôme, France, the Holy Tear enjoyed a robust devotion during the Middle Ages, attracting pilgrims from all over Europe. The end point for La Sainte Larme’s fame is the French Revolution, when the relic disappears. Christ’s Tear provides an exemplary case for emotion studies and material culture because it encapsulates religious piety and feeling, but, as an ephemeral bodily excretion, it presents interpretive challenges as an object.

In Congenial Souls (2002), Stephanie Trigg placed Chaucer scholarship at a crossroads, declaring that ‘it may be time to refigure both our understanding of the past and our relation to the future of literary studies’.1 A decade and a half on, this volume evinces the positive and productive response to Trigg’s call for change by considering both how that future has come to form the present critical moment, and what the Chaucerian past means to us now.

BACKGROUND: Convulsive status epilepticus (CSE) is the most common life-threatening neurological emergency in childhood. These children are also at risk of significant morbidity, with acute and chronic impact on the family and the health and social care systems. The current recommended first-choice, second-line treatment in children aged 6 months and above is intravenous phenytoin (fosphenytoin in the USA), although there is a lack of evidence for its use and it is associated with significant side effects. Emerging evidence suggests that intravenous levetiracetam may be effective as a second-line agent for CSE, and fewer adverse effects have been described. This trial therefore aims to determine whether intravenous phenytoin or levetiracetam is more effective, and safer, in treating childhood CSE. METHODS/DESIGN: This is a phase IV, multi-centre, parallel group, randomised controlled, open-label trial. Following treatment for CSE with first-line treatment, children with ongoing seizures are randomised to receive either phenytoin (20 mg/kg, maximum 2 g) or levetiracetam (40 mg/kg, maximum 2.5 g) intravenously. The primary outcome measure is the cessation of all visible signs of CSE as determined by the treating clinician. Secondary outcome measures include the need for further anti-seizure medications or rapid sequence induction for ongoing CSE, admission to critical care areas, and serious adverse reactions. Patients are recruited without prior consent, with deferred consent sought at an appropriate time for the family. The primary analysis will be by intention-to-treat. The primary outcome is a time to event outcome and a sample size of 140 participants in each group will have 80% power to detect an increase in CSE cessation rates from 60% to 75%. Our total sample size of 308 randomised and treated participants will allow for 10% loss to follow-up. DISCUSSION: This clinical trial will determine whether phenytoin or levetiracetam is more effective as an intravenous

This article will survey the colour yellow in early modern England using resources chiefly from medicine but also literature, sumptuary law, and quotidian culture. In doing so, it interrogates the extent to which this colour changed in symbolism and meaning from the early 15th to the early 17th century. It takes as its starting point humoural theory, which was a vital component of not only medieval but early modern medical diagnosis. The discernment of a person’s underlying disposition relied on knowledge of humoural properties: phlegmatic, sanguine, melancholic or choleric. In especial, the humours were “colour-tagged”, with the choleric temperament usually described in medieval medical treatises as “yellow”. Michel Pastoureau has alerted us to the ambiguity of interpretation the medieval world imposed on particular hues. An examination of colour in early modern England also illuminates the perceptual edges that flow from a society’s chromatic practice, medical understanding and cultural symbolism. Although we cannot assume a transhistorical shared optics of any colour, “yellow”, by its affinity with various bodily byproducts, holds a special place in medical diagnosis. This leads us to question how we might interpret its meanings, both fluid and complex, within early modern England. Cet article vise à analyser la couleur jaune dans l’Angleterre pré-moderne en utilisant les ressources de la médecine, de la littérature, des lois somptuaires, et de la culture quotidienne de l’époque. Ce faisant, il étudiera comment cette teinte a changé de symbolisme et de sens entre le début du XVe et le début du XVIIe siècle. Il prend comme point de départ la théorie humorale, élément essentiel du diagnostic non seulement médiéval mais aussi renaissant. Le discernement de la disposition humorale sous-jacente d’un individu s’est en effet longtemps appuyé sur la connaissance des propriétés de cette disposition (propriétés flegmatique, sanguines, mélancoliques ou colériques). Or, les

This report contains and annotated bibliography of the literature search conducted in support of Conflagration Analysis: System II. It is divided into two phases. Phase I discusses the literature reviewed to explore fire spread within a city block. Phase Ii reviews the literature examined for fire spread between blocks. Originator supplied keywords include: Conflagration, Mass fire, Fire spread analysis; Emergency management; Fire protection master planning; Urban redevelopment; Fire department.

This study examines the current relevance of the Gag e-Babcock system for local assessment of conflagration potential of urban areas. Concerned with validation of the block assessment program, the study points to a need for an analytic approach for prediction of mass fire spread when wartime causal factors are not responsible for ignition. The report contains a revised block rating methodology that applies to the following factors: The fuel load and fire severity in compartments; Perimeter building wall construction; and Roof coverings and roof construction. The study also assesses the need to develop additional methodologies relating to fire spread between urban blocks. A variety of urban fire spread cases are included. The findings of the project are reported in the following documents: A Study Document for Conflagration Analysis: System II; A Local Assessment Guide for Conflagration Analysis: System II; and Configuration Analysis System II-Bibliography. Originator supplied keywords include: Conflagration, Mass Fire, Fire Spread Analysis, Emergency Management, Fire Protection Master Planning, Urban Redevelopment, Fire Department.

This study is concerned with the validation of the block assessment program, and the necessity to develop an alternative approach to block risk analysis that may be used to predict the relative potential for mass fire spread after ignition from other than wartime factors. An extensive literature search concerning both the concept and the methodology of the Gage-Babcock block rating analysis strongly suggests the need for modifying the numerical parameters associated with some of the functional analysis items. Further, the literature search indicated the need to expand the scope of the study to encompass fire spread between blocks. A revised block rating methodology has been constructed based on the literature search findings. An initial validation study of both the original block rating methodology and the revised block rating methodology was conducted. On the basis of the validation program, a number of significant refinements and component changes were made to the local assessment method for measuring mass fire spread potential in urban blocks. Originator supplied keywords include: Conflagration, Mass Fire, Fire Spread Analysis, Emergency Management, Fire Protection Master Planning, Urban Redevelopment, Fire Department.