Acute kidney injury (AKI) is a common and devastating complication in patients with cirrhosis. However, the definitions of AKI employed in studies involving patients with cirrhosis have not been standardized, lack sensitivity and are often limited to narrow clinical settings. We conducted a multi-center, prospective observational cohort study of patients with cirrhosis and AKI, drawn from multiple hospital wards, utilizing the modern acute kidney injury network (AKIN) definition and assessed for the association between AKI severity and progression with inhospital mortality. Of the 192 patients that were enrolled and included in the study, 85 (44%) patients progressed to a higher AKIN stage after initially fulfilling AKI criteria. Patients achieved a peak severity of AKIN stage 1, 26%, stage 2, 24%, and stage 3, 49%. The incidence of mortality, general medical events (bacteremia, pneumonia, urinary tract infection) and cirrhosis specific complications (ascites, encephalopathy, spontaneous bacterial peritonitis) increased with severity of AKI. Progression was significantly more common and peak AKI stage higher in non-survivors than survivors (p < 0.0001). After adjusting for baseline renal function, demographics and critical hospital and cirrhosis associated variables, progression of AKI was independently associated with mortality (adjusted OR = 3.8, 95% CI 1.3–11.1). Conclusion AKI, as defined by AKIN criteria, in patients with cirrhosis is frequently progressive and severe and is independently associated with mortality in a stage-dependent fashion. Methods for earlier diagnosis of AKI and its progression may result in improved outcomes by facilitating targeted and timely treatment of AKI.

Tim Maudlin has influentially argued that Humeanism about laws of nature stands in conflict with quantum mechanics. Specifically Humeanism implies the principle Separability: the complete physical state of a world is determined by the intrinsic physical state of each space‐time point. Maudlin argues Separability is violated by the entangled states posited by QM. We argue that Maudlin only establishes that a stronger principle, which we call Strong Separability, is in tension with QM. Separability is not in tension with QM. Moreover, while the Humean requires Separability to capture the core tenets of her view, there's no Humean‐specific motivation for accepting Strong Separability. We go on to give a Humean account of entangled states which satisfies Separability. The core idea is that certain quantum states depend upon the Humean mosaic in much the same way as the laws do. In fact, we offer a variant of the Best System account on which the systemization procedure that generates the laws also serves to ground these states. We show how this account works by applying it to the example of Bohmian Mechanics. The 3N‐dimensional configuration space, the world particle in it and the wave function on it are part of the best system of the Humean mosaic, which consists of N particles moving in 3‐dimensional space. We argue that this account is superior to the Humean account of Bohmian Mechanics defended by Loewer and Albert, which takes the 3N‐dimensional space, and its inhabitants, as fundamental.

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Many events in every day life are coincidences. When I went to Denver last year I ended up sitting next to the same person on both my flight there and my flight back. That was a coincidence. Owens (1992, pp.8-9) considers the coincidence of him ending up on a cruise with his old enemy. Lando (2017, p. 133) describes the event of 'the only two people in a supermarket aisle…wearing the same pair of 1980's red Nike Air Ship high-tops' as a coincidence.So it is common to take certain everyday events to be coincidences. But as well as being an everyday notion, the notion of coincidence is theoretically important. In particular, there is pressure for scientific or philosophical theories to avoid coincidences. This pressure is evident in influential arguments in both philosophy and science.For example, Kitcher (2001, p. 71) discusses the discovery of eighteenth century doctor John Arbuthnot who found that more males had been born than females in London in each of the last 82 years. There is a possible microphysical explanation of this fact, one which lays out separately all of the physical details which led to each male or female birth. But, Kitcher argues, such an explanation would make the regularity seem like a 'gigantic coincidence'. However, there is an alternative evolutionary explanation of the regularity. There is an evolutionary tendency to produce a 1:1 sex ratio

Sepsis-induced cholestasis is a complication of infection. Infections cause systemic and intrahepatic increase in proinflammatory cytokines which result in impaired bile flow ie. cholestasis. Several other mediators of impairment in bile flow have been identified under conditions of sepsis such as increased nitric oxide production and decreased aquaporin channels. The development of cholestasis may also further worsen inflammation. The molecular basis of normal bile flow and mechanisms of impairment in sepsis are discussed.