Personality Comparison between Lethal and Non-lethal Intimate Partner Violence Perpetrators and Their Victims.

Intimate partner violence against women (IPVAW) and femicide (intimate partner femicide, IPF), as a worldwide phenomenon, cannot be explained in a simple way. From an ecological point of view, there are individual factors contemplated. In the current studies, we consider personality as an individual factor to clarify what differentiates a non-lethal IPVAW situation from a femicide. Study 1 was designed to investigate the accuracy with which trained interviewers judged the personality of a group of IPVAW perpetrators during an interview. The target sample of study 1 was composed of 293 males who after being interviewed completed a measure of personality assessing the "Big Three" model of personality. The interviewers performed fairly accurate judgements about the personality of the target participants. Study 2 shows the differences in personality, using Eysenck's personality model, between the IPF and IPVAW perpetrators and their victims. The total sample study 2 was formed of 551 participants distributed among IPF perpetrators, IPVAW perpetrators, and the victims of both groups. Differences in proportions were observed between both groups of perpetrators as well as between each group and their respective victims. With these findings, we propose personality as a femicide risk factor that should be taken into consideration by police officers and other practitioners when receiving an IPVAW report.

Women Victims of Intimate Partner Violence and Intimate Partner Homicide: A Typology Based on Victimization Variables.

Intimate partner violence against women (IPVAW) and intimate partner homicide against women (IPHAW) are multidimensional phenomena. The aim of this study was to identify typologies of Spanish IPHAW and IPVAW victims, based on the differences between their characteristics and the determinants of aggression. The sample consisted of 381 cases from the Spanish Integral Monitoring System in Cases of Gender Violence. The instrument used was a semi-structured interview. Results showed differences between IPHAW and IPVAW victims, and latent class analysis suggested a three-profile solution: 1-fatal victims, with low neuroticism, low isolation, and feelings of loneliness, less reconciliation with the aggressor, lower perception of risk and low suicidal ideation; 2-non-fatal victims, with the loss of a loved one and the role of caregiver as stressors, low psychoticism and alcohol abuse, high feelings of loneliness, risk perception, and suicidal ideation; 3-mixed profile, with high neuroticism and psychoticism, alcohol abuse, isolation, and greater reconciliations with the aggressor, and absence of bereavement and caregiver role as stressors. Knowing the differences between IPHAW and IPVAW victims allows the design of more specific instruments for risk assessment and the design of more individualized prevention and treatment programs. This also facilitates police work in identifying victims and deploying more intense protection measures.

La violencia de pareja contra la mujer (violencia de género, VdG) y el homicidio de pareja contra la mujer (feminicidio) son fenómenos multidimensionales. El objetivo de este estudio fue identificar las tipologías de las víctimas españolas de feminicidio y VdG, basado en las diferencias entre sus características y los determinantes de la agresión. La muestra constaba de 381 casos del Sistema Español de Seguimiento Integral de Casos de Violencia de Género. El instrumento utilizado fue una entrevista semiestructurada. Los resultados mostraron diferencias entre las víctimas de VdG y las víctimas de feminicidios y el análisis de clases latentes sugirió tres perfiles: 1-víctimas mortales, con bajo neuroticismo, bajo aislamiento y sentimientos de soledad, menor reconciliación con el agresor, menor percepción de riesgo y baja ideación suicida; 2-víctimas no mortales, con la pérdida de un ser querido y el rol de cuidador como estresores, bajo psicoticismo y abuso de alcohol, sentimientos de soledad elevados, percepción de riesgo e ideación suicida; 3-perfil mixto, con neuroticismo y psicoticismo elevados, abuso de alcohol, aislamiento y una mayor reconciliación con el agresor y ausencia de duelo y del rol de cuidador como estresores. Conocer las diferencias entre víctimas de feminicidio y de VdG permite el diseño de instrumentos más específicos para la evaluación del riesgo y el diseño de programas de prevención y tratamiento más individualizados. También facilita la labor policial en la identificación de las víctimas y el despliegue de medidas de protección más intensas.

Women Victims of Intimate Partner Violence and Intimate Partner Homicide: A Typology Based on Victimization Variables 1 / Las mujeres víctimas de violencia y homicidio de pareja: una tipología basada en variables de victimización

Intimate partner violence against women (IPVAW) and intimate partner homicide against women (IPHAW) are multidimensional phenomena. The aim of this study was to identify typologies of Spanish IPHAW and IPVAW victims, based on the differences between their characteristics and the determinants of aggression. The sample consisted of 381 cases from the Spanish Integral Monitoring System in Cases of Gender Violence. The instrument used was a semi-structured interview. Results showed differences between IPHAW and IPVAW victims, and latent class analysis suggested a three-profile solution: 1-fatal victims, with low neuroticism, low isolation, and feelings of loneliness, less reconciliation with the aggressor, lower perception of risk and low suicidal ideation; 2-non-fatal victims, with the loss of a loved one and the role of caregiver as stressors, low psychoticism and alcohol abuse, high feelings of loneliness, risk perception, and suicidal ideation; 3-mixed profile, with high neuroticism and psychoticism, alcohol abuse, isolation, and greater reconciliations with the aggressor, and absence of bereavement and caregiver role as stressors. Knowing the differences between IPHAW and IPVAW victims allows the design of more specific instruments for risk assessment and the design of more individualized prevention and treatment programs. This also facilitates police work in identifying victims and deploying more intense protection measures. (AU)

La violencia de pareja contra la mujer (violencia de género, VdG) y el homicidio de pareja contra la mujer (feminicidio) son fenómenos multidimensionales. El objetivo de este estudio fue identificar las tipologías de las víctimas españolas de feminicidio y VdG, basado en las diferencias entre sus características y los determinantes de la agresión. La muestra constaba de 381 casos del Sistema Español de Seguimiento Integral de Casos de Violencia de Género. El instrumento utilizado fue una entrevista semiestructurada. Los resultados mostraron diferencias entre las víctimas de VdG y las víctimas de feminicidios y el análisis de clases latentes sugirió tres perfiles: 1-víctimas mortales, con bajo neuroticismo, bajo aislamiento y sentimientos de soledad, menor reconciliación con el agresor, menor percepción de riesgo y baja ideación suicida; 2-víctimas no mortales, con la pérdida de un ser querido y el rol de cuidador como estresores, bajo psicoticismo y abuso de alcohol, sentimientos de soledad elevados, percepción de riesgo e ideación suicida; 3-perfil mixto, con neuroticismo y psicoticismo elevados, abuso de alcohol, aislamiento y una mayor reconciliación con el agresor y ausencia de duelo y del rol de cuidador como estresores. Conocer las diferencias entre víctimas de feminicidio y de VdG permite el diseño de instrumentos más específicos para la evaluación del riesgo y el diseño de programas de prevención y tratamiento más individualizados. También facilita la labor policial en la identificación de las víctimas y el despliegue de medidas de protección más intensas. (AU)

Intimate partner homicide risk assessment by police in Spain: the dual protocol VPR5.0-H / La valoración policial del riesgo del homicidio de pareja en España: el protocolo dual VPR 5.0-H

Spanish police makes an extensive use of intimate partner violence (IPV) risk assessment on a daily basis. Improved prediction procedures have encouraged the search for greater refinement of IPV predictors by adjusting to specific targets, such as lethal outcomes or potential victimization of children. This paper describes the evolution of the VPR5.0 tool (VioGén System Police Risk Assessment) as an algorithm aimed at improving predictability of intimate partner homicides (IPH). A sample of 2,159 records was used, 159 of whom were IPH victims. The sample was divided into two comparable groups of cases (IPH) and controls (N-IPH) to validate the results. The results showed that 13 out of 35 risk factors were significantly related to IPH with an effect size different to that of general N-IPH (with OR values ranging between 1.507 and 8.087). Binary logistic regression showed six significant factors that correctly classified 86.3% of the IPH. The new H-Scale performance parameters were comparable to those obtained in studies with the same objective (sensitivity 84%, specificity 60%, OR = 8.130, AUC = .80, PPV = .19 and NPV = .97)

La policía española hace un uso diario y extenso de la evaluación del riesgo de violencia en casos de violencia de género (VCP). El perfeccionamiento de los sistemas de predicción de VCP ha impulsado la búsqueda de procedimientos ajustados a objetivos concretos, como puede ser el resultado letal o la inclusión de menores como posibles víctimas. En el presente trabajo se describe la evolución de la herramienta VPR5.0 (Valoración Policial del Riesgo del Sistema VioGén) a un algoritmo diferenciado cuyo objetivo es predecir mejor los homicidios de mujeres por su pareja (HCP). Se analizaron 2,159 registros, 159 de los cuales correspondían a HCP, dividiendo la muestra en dos grupos comparables con casos (HCP) y controles (N-HCP) para validar los análisis. Los resultados pusieron de manifiesto que de los 35 factores de la herramienta 13 estaban asociados significativamente con el HCP, con un tamaño del efecto diferente al de N-HCP (con valores OR entre 1.507 y 8.087). La regresión logística binaria mostró seis factores significativos que clasificaban correctamente el 86.3% de los HCP. Los parámetros de rendimiento de esta escala-H resultaron comparables a los obtenidos en estudios con el mismo objetivo (sensibilidad 84%, especificidad 60%, OR = 8.130, AUC = .80, VPP = .19 y VPN = .97)

Guía de manejo clínico del paciente con infección por SARS-CoV-2 / Guidelines for clinical management of SARS-Cov-2 infection

Resumen En infección por SARS-CoV-2 (COVID-19), las manifestaciones más comunes son las de vías aéreas superiores; en casos complicados se presenta neumonía intersticial bilateral, insuficiencia respiratoria aguda grave y falla orgánica múltiple que ameritan tratamiento hospitalario y soporte ventilatorio por puntas nasales o mascarilla, así como oxígeno con flujo a presión alta o intubación orotraqueal y ventilación mecánica. No hay antivirales específicos por lo que el manejo es sintomático, así como con antiplaquetarios (ácido acetilsalicílico, dipiridamol), heparina de bajo peso molecular ante hipercoagulabilidad (dímero D aumentado), dexametasona ante indicadores altos de inflamación. Previo consentimiento informado, experimentalmente se emplean antibióticos según los resultados microbiológicos, interferón beta 1b, favipiravir, tocilizumab, ivermectina e inmunoglobulina G. Cuando se presenta gastroenteritis se puede indicar nitazoxanida.

Abstract In SARS-CoV-2 infection (COVID-19), the most common manifestations involve the upper airways; in complicated cases, bilateral interstitial pneumonia, severe acute respiratory failure and multiple organ failure occur, which require hospital treatment and ventilatory support with nasal cannula or mask and high flow oxygen, or orotracheal intubation and mechanical ventilation. There are no specific antivirals, and thus management is symptomatic, as well as with antiplatelet drugs (acetylsalicylic acid, dipyridamole), low molecular weight heparin when there is hypercoagulability (increased D-dimer), dexamethasone when inflammation indicators are elevated; experimentally, under informed consent, antibiotics are used according to microbiological results, as well as interferon beta 1b, favipiravir, tocilizumab, ivermectin and immunoglobulin G. When gastroenteritis occurs, nitazoxanide can be indicated.

Guidelines for clinical management of SARS-CoV-2 infection.

In SARS-CoV-2 infection (COVID-19), the most common manifestations involve the upper airways; in complicated cases, bilateral interstitial pneumonia, severe acute respiratory failure and multiple organ failure occur, which require hospital treatment and ventilatory support with nasal cannula or mask and high flow oxygen, or orotracheal intubation and mechanical ventilation. There are no specific antivirals, and thus management is symptomatic, as well as with antiplatelet drugs (acetylsalicylic acid, dipyridamole), low molecular weight heparin when there is hypercoagulability (increased D-dimer), dexamethasone when inflammation indicators are elevated; experimentally, under informed consent, antibiotics are used according to microbiological results, as well as interferon beta 1b, favipiravir, tocilizumab, ivermectin and immunoglobulin G. When gastroenteritis occurs, nitazoxanide can be indicated.En infección por SARS-CoV-2 (COVID-19), las manifestaciones más comunes son las de vías aéreas superiores; en casos complicados se presenta neumonía intersticial bilateral, insuficiencia respiratoria aguda grave y falla orgánica múltiple que ameritan tratamiento hospitalario y soporte ventilatorio por puntas nasales o mascarilla, así como oxígeno con flujo a presión alta o intubación orotraqueal y ventilación mecánica. No hay antivirales específicos por lo que el manejo es sintomático, así como con antiplaquetarios (ácido acetilsalicílico, dipiridamol), heparina de bajo peso molecular ante hipercoagulabilidad (dímero D aumentado), dexametasona ante indicadores altos de inflamación. Previo consentimiento informado, experimentalmente se emplean antibióticos según los resultados microbiológicos, interferón beta 1b, favipiravir, tocilizumab, ivermectina e inmunoglobulina G. Cuando se presenta gastroenteritis se puede indicar nitazoxanida.

Correction: Evolution and study of a copycat effect in intimate partner homicides: A lesson from Spanish femicides.

[This corrects the article DOI: 10.1371/journal.pone.0217914.].

Evolution and study of a copycat effect in intimate partner homicides: A lesson from Spanish femicides.

OBJECTIVES: This paper focuses on the issue of intimate partner violence and, specifically, on the distribution of femicides over time and the existence of copycat effects. This is the subject of an ongoing debate often triggered by the social alarm following multiple intimate partner homicides (IPHs) occurring in a short span of time. The aim of this research is to study the evolution of IPHs and provide a far-reaching answer by rigorously analyzing and searching for patterns in data on femicides. METHODS: The study analyzes an official dataset, provided by the system VioGén of the Secretaría de Estado de Seguridad (Spanish State Secretariat for Security), including all the femicides occurred in Spain in 2007-2017. A statistical methodology to identify temporal interdependencies in count time series is proposed and applied to the dataset. The same methodology can be applied to other contexts. RESULTS: There has been a decreasing trend in the number of femicides per year. No interdependencies among the temporal distribution of femicides are observed. Therefore, according to data, the existence of copycat effect in femicides cannot be claimed. CONCLUSIONS: Around 2011 there was a clear change in the average number of femicides which has not picked up. Results allow for an informed answer to the debate on copycat effect in Spanish femicides. The planning of femicides prevention activities should not be a reaction to a perceived increase in their occurrence. As a copycat effect is not detected in the studied time period, there is no evidence supporting the need to censor media reports on femicides.

Arrhythmia Mechanism and Scaling Effect on the Spectral Properties of Electroanatomical Maps With Manifold Harmonics.

INTRODUCTION: Spatial and temporal processing of intracardiac electrograms provides relevant information to support the arrhythmia ablation during electrophysiological studies. Current cardiac navigation systems (CNS) and electrocardiographic imaging (ECGI) build detailed 3-D electroanatomical maps (EAM), which represent the spatial anatomical distribution of bioelectrical features, such as activation time or voltage. OBJECTIVE: We present a principled methodology for spectral analysis of both EAM geometry and bioelectrical feature in CNS or ECGI, including their spectral representation, cutoff frequency, or spatial sampling rate (SSR). METHODS: Existing manifold harmonic techniques for spectral mesh analysis are adapted to account for a fourth dimension, corresponding to the EAM bioelectrical feature. Appropriate scaling is required to address different magnitudes and units. RESULTS: With our approach, simulated and real EAM showed strong SSR dependence on both the arrhythmia mechanism and the cardiac anatomical shape. For instance, high frequencies increased significantly the SSR because of the "early-meets-late" in flutter EAM, compared with the sinus rhythm. Besides, higher frequency components were obtained for the left atrium (more complex anatomy) than for the right atrium in sinus rhythm. CONCLUSION: The proposed manifold harmonics methodology opens the field toward new signal processing tools for principled EAM spatiofeature analysis in CNS and ECGI, and to an improved knowledge on arrhythmia mechanisms.

Fetal Heart Rate Analysis for Automatic Detection of Perinatal Hypoxia Using Normalized Compression Distance and Machine Learning.

Accurate identification of Perinatal Hypoxia from visual inspection of Fetal Heart Rate (FHR) has been shown to have limitations. An automated signal processing method for this purpose needs to deal with time series of different lengths, recording interruptions, and poor quality signal conditions. We propose a new method, robust to those issues, for automated detection of perinatal hypoxia by analyzing the FHR during labor. Our system consists of several stages: (a) time series segmentation; (b) feature extraction from FHR signals, including raw time series, moments, and usual heart rate variability indices; (c) similarity calculation with Normalized Compression Distance, which is the key element for dealing with FHR time series; and (d) a simple classification algorithm for providing the hypoxia detection. We analyzed the proposed system using a database with 32 fetal records (15 controls). Time and frequency domain and moment features had similar performance identifying fetuses with hypoxia. The final system, using the third central moment of the FHR, yielded 92% sensitivity and 85% specificity at 3 h before delivery. Best predictions were obtained in time intervals more distant from delivery, i.e., 4-3 h and 3-2 h.

Effects of a physical activity program on the urinary collagen crosslinks in pre- and postmenopausal women.

BACKGROUND: This study analyzes the effects of physical exercise on urinary collagen crosslinks, pyridinoline (PYD) and deoxipyridinoline (DPD), in women. METHODS: Thirty premenopausal (PRE) and 40 postmenopausal (PST) women took part in a six month randomized controlled trial of moderate physical exercise. Moreover, skinfold thickness, muscle strength and flexibility were evaluated. RESULTS: Basal values of urinary PYD and DPD were higher in postmenopausal women versus premenopausal women (P<0.01). Physical exercise increased in both groups urinary PYD levels (P<0.05) and urinary DPD levels in postmenopausal women (P<0.05). After the exercise program, no changes were observed in the levels of urinary DPD in premenopausal women. Significant improvements in flexibility, muscle strength and decrease in skinfolds thickness were observed in the exercise group. No changes were observed in non-exercise group. CONCLUSIONS: In conclusion, the physical activity program produced beneficial effects on muscle strength and flexibility and changes in the musculoskeletal system. Also, the physical activity program led to a non-pathological increase in the urinary elimination of bone reabsorption and collagen metabolism biomarkers.

AP-1 Inhibition by SR 11302 Protects Human Hepatoma HepG2 Cells from Bile Acid-Induced Cytotoxicity by Restoring the NOS-3 Expression.

The harmful effects of bile acid accumulation occurring during cholestatic liver diseases have been associated with oxidative stress increase and endothelial nitric oxide synthase (NOS-3) expression decrease in liver cells. We have previously reported that glycochenodeoxycholic acid (GCDCA) down-regulates gene expression by increasing SP1 binding to the NOS-3 promoter in an oxidative stress dependent manner. In the present study, we aimed to investigate the role of transcription factor (TF) AP-1 on the NOS-3 deregulation during GCDCA-induced cholestasis. The cytotoxic response to GCDCA was characterized by 1) the increased expression and activation of TFs cJun and c-Fos; 2) a higher binding capability of these at position -666 of the NOS-3 promoter; 3) a decrease of the transcriptional activity of the promoter and the expression and activity of NOS-3; and 4) the expression increase of cyclin D1. Specific inhibition of AP-1 by the retinoid SR 11302 counteracted the cytotoxic effects induced by GCDCA while promoting NOS-3 expression recovery and cyclin D1 reduction. NOS activity inhibition by L-NAME inhibited the protective effect of SR 11302. Inducible NOS isoform was no detected in this experimental model of cholestasis. Our data provide direct evidence for the involvement of AP-1 in the NOS-3 expression regulation during cholestasis and define a critical role for NOS-3 in regulating the expression of cyclin D1 during the cell damage induced by bile acids. AP-1 appears as a potential therapeutic target in cholestatic liver diseases given its role as a transcriptional repressor of NOS-3.

Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence.

Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG) analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indices, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indices in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indices which are tackled from the aforementioned viewpoints, namely, heart rate turbulence (HRT), heart rate variability (HRV), and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future.

GCDCA down-regulates gene expression by increasing Sp1 binding to the NOS-3 promoter in an oxidative stress dependent manner.

During the course of cholestatic liver diseases, the toxic effect of bile acids accumulation has been related to the decreased expression of endothelial nitric oxide synthase (NOS-3) and cellular oxidative stress increase. In the present study, we have investigated the relationship between these two biological events. In the human hepatocarcinoma cell line HepG2, cytotoxic response to GCDCA was characterized by the reduced activity of the respiratory complexes II+III, the increased expression and activation of the transcription factor Sp1, and a higher binding capacity of this at positions -1386, -632 and -104 of the NOS-3 promoter (pNOS-3). This was associated with a decreased promoter activity and a consequent reduction of NOS-3 expression. The use of antioxidants in GCDCA-treated cells caused a lower activation of Sp1 and the recovery of the pNOS-3 activity and NOS-3 expression and activity. Similarly, the specific inhibition of Sp1 resulted in the improvement of NOS-3 expression. Both, antioxidant treatment and Sp1 inhibition were associated with the reduction of cell death-related parameters. Bile duct ligation in rats confirmed in vitro results concerning the activation of Sp1 and the reduction of NOS-3 expression. Our results provide direct evidence for the involvement of Sp1 in the regulation of NOS-3 expression during cholestasis. Thus, the identification of Sp1 as a potential negative regulator of NOS-3 expression represents a new mechanism by which the accumulation of bile acids causes a cytotoxic effect through the oxidative stress increase, and provides a new potential target in cholestatic liver diseases.

Sensitivity to anti-Fas is independent of increased cathepsin D activity and adrenodoxin reductase expression occurring in NOS-3 overexpressing HepG2 cells.

Stable overexpression of endothelial nitric oxide synthase (NOS-3) in HepG2 cells (4TO-NOS) leads to increased nitro-oxidative stress and upregulation of the cell death mediators p53 and Fas. Thus, NOS-3 overexpression has been suggested as a useful antiproliferative mechanism in hepatocarcinoma cells. We aimed to identify the underlying mechanism of cell death induced by NOS-3 overexpression at basal conditions and with anti-Fas treatment. The intracellular localization of NOS-3, the nitro-oxidative stress and the mitochondrial activity were analysed. In addition, the protein expression profile in 4TO-NOS was screened for differentially expressed proteins potentially involved in the induction of apoptosis. NOS-3 localization in the mitochondrial outer membrane was not associated with changes in the respiratory cellular capacity, but was related to the mitochondrial biogenesis increase and with a higher protein expression of mitochondrial complex IV. Nitro-oxidative stress and cell death in NOS-3 overexpressing cells occurred with the expression increase of pro-apoptotic genes and a higher expression/activity of the enzymes adrenodoxin reductase mitochondrial (AR) and cathepsin D (CatD). CatD overexpression in 4TO-NOS was related to the apoptosis induction independently of its catalytic activity. In addition, CatD activity inhibition by pepstatin A was not effective in blocking apoptosis induced by anti-Fas. In summary, NOS-3 overexpression resulted in an increased sensitivity to anti-Fas induced cell death, independently of AR expression and CatD activity.

Lack of agreement for defining 'clinical suspicion of rejection' in liver transplantation: a model to select candidates for liver biopsy.

The gold standard to diagnose acute cellular rejection (ACR) after liver transplantation (LT) is histological evaluation, but there is no consensus to select patients for liver biopsy. We aimed to evaluate the agreement among clinicians to select candidates for liver biopsy early after LT. From a protocol biopsy population (n = 690), we randomly selected 100 LT patients in whom the biopsy was taken 7-10 days after LT. The clinical information between LT and protocol biopsy was given to nine clinicians from three transplant centres who decided whether a liver biopsy was needed. The agreement among clinicians to select candidates for liver biopsy was poor: κ = 0.06-0.62, being κ < 0.40 in 76% of comparisons. The concordance between indication for liver biopsy and moderate-severe ACR in the protocol biopsy was κ < 0.30 in all cases. A multivariate model based on the product age-by-MELD (OR = 0.81; P = 0.013), delta eosinophils (OR = 1.5; P = 0.002) and mean tacrolimus trough concentrations <6 ng/ml within the prior 4 days (OR = 11.4; P = 0.047) had an AUROC = 0.84 to diagnose moderate-severe histological ACR. In conclusion, the agreement among clinicians to select patients for liver biopsy is very poor. If further validated the proposed model would provide an objective method to select candidates for liver biopsy after LT.