A Novel Easy-to-Use Prediction Scheme for Upper Gastrointestinal Bleeding Cologne-WATCH ( C-WATCH) Risk Score

Acute upper gastrointestinal bleeding (UGIB) is the leading indication for emergency endoscopy. Scoring schemes have been developed for immediate risk stratification. However, most of these scores include endoscopic findings and are based on data from patients with nonvariceal bleeding. The aim of our study was to design a pre-endoscopic score for acute UGIBincluding variceal bleedingin order to identify high-risk patients requiring urgent clinical management.The scoring system was developed using a data set consisting of 586 patients with acute UGIB. These patients were identified from the emergency department as well as all inpatient services at the University Hospital of Cologne within a 2-year period (01/2007-12/2008). Further data from a cohort of 322 patients who presented to our endoscopy unit with acute UGIB in 2009 served for external/temporal validation.Clinical, laboratory, and endoscopic parameters, as well as further data on medical history and medication were retrospectively collected from the electronic clinical documentation system.A multivariable logistic regression was fitted to the development set to obtain a risk score using recurrent bleeding, need for intervention (angiography, surgery), or death within 30 days as a composite endpoint. Finally, the obtained risk score was evaluated on the validation set.Only C-reactive protein, white blood cells, alanine-aminotransferase, thrombocytes, creatinine, and hemoglobin were identified as significant predictors for the composite endpoint. Based on the regression coefficients of these variables, an easy-to-use point scoring scheme (C-WATCH) was derived to estimate the risk of complications from 3% to 86% with an area under the curve (AUC) of 0.723 in the development set and 0.704 in the validation set. In the validation set, no patient in the identified low-risk group (0-1 points), but 38.7% of patients in the high-risk group ( 2 points) reached the composite endpoint.Our easy-to-use scoring scheme is able to distinguish high-risk patients requiring urgent endoscopy, from low-risk cases who are suitable candidates for outpatient management or in whom endoscopy may be postponed. Based on our findings, a prospective validation of the C-WATCH score in different patient populations outside the university hospital setting seems warranted

Book Reviews

Rodney A s t (Hrsg.), Late Antique Greek Papyri in the Collection of the Friedrich-Schiller-Universität Jena (P.Jena II), Bonn 2010 (A. Benaissa: 235)Michael B l ö m e r, Margherita F a c e l l a, Engelbert W i n t e r (Hrsg.), Lokale Identität im Römischen Nahen Osten. Kontexte und Perspektiven, Stuttgart 2009 (L. Cappelletti: 239)Klaus B r i n g m a n n, Kleine Kulturgeschichte der Antike, München 2011 (W. Schmitz: 243)Hélène C a d e l l, Willy C l a r y s s e, Kennokka R o b i c (Hrsg.), Papyrus de la Sorbonne(P.Sorb. III nos 70–144), Paris 2011 (S. Scheuble-Reiter: 245)Sarah J. C l a c k s o n, It is Our Father Who Writes: Orders from the Monastery of Apollo at Bawit, Cincinnati 2008 (T. S. Richter: 248)John Granger C o o k, Roman Attitudes Toward the Christians. From Claudius to Hadrian, Tübingen 2011 (H. Förster: 253)Armin E i c h (Hrsg.), Die Verwaltung der kaiserzeitlichen römischen Armee. Studien für Hartmut Wolff, Stuttgart 2010 (P. Probst: 256)Lin F o x h a l l, Hans-Joachim G e h r k e, Nino L u r a g h i (Hrsg.), Intentional History. Spinning Time in Ancient Greece, Stuttgart 2010 (M. Dreher: 258)Wiebke F r i e s e, Den Göttern so nah. Architektur und Topographie griechischer Orakelheiligtümer,Stuttgart 2010 (J. Piccinini: 263)Julia H o f f m a n n - S a l z, Die wirtschaftlichen Auswirkungen der römischen Eroberung. Vergleichende Untersuchungen der Provinzen Hispania Tarraconensis, Africa Proconsularis und Syria, Stuttgart 2011 (P. Herz: 265)M. Çetin Ş a h i n (Hrsg.), The Inscriptions of Stratonikeia. Part III, Bonn 2010 (L. Meier:266)Darío N. S á n c h e z V e n d r a m i n i, Eliten und Kultur. Eine Geschichte der römischen Literaturszene (240 v. Chr.–117 n. Chr.), Bonn 2010 (J. Fugmann: 269)Klaus S c h e r b e r i c h, Koinè symmachía. Untersuchungen zum Hellenenbund Antigonos’ III.Doson und Philipps V. (224–197 v. Chr.), Stuttgart 2009 (B. Smarczyk: 274)Rainer W i e g e l s, Kleine Schriften zur Epigraphik und Militärgeschichte der germanischen Provinzen,Stuttgart 2010 (M. A. Speidel: 276)Reinhard W i l l v o n s e d e r, Corpus der römischen Rechtsquellen zur antiken Sklaverei, Teil IV: Stellung der Sklaven im Privatrecht, 1: Eheähnliche Verbindungen und verwandtschaftliche Beziehungen, Stuttgart 2010 (É. Jakab: 278)

Fragmented Self and Fragmented Responsibility: Pasiphae in Euripides\u2019 Cretans

This chapter analyses the particularly complex representation of responsibility and selfhood present in the speech of Pasiphae in Euripides\u2019 Cretans, in which the queen defends her act of falling in love with the bull. The chapter shows how Pasiphae is able to dissociate herself completely from her past actions by appealing to divine intervention, the role of her husband Minos, and an understanding of human morality and motivation that is rooted in hedonistic principles. Pasiphae\u2019s defence thus relies on a concept of the fragmentation of the self that reveals her as one of Euripides\u2019 most philosophically sophisticated female speakers