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Article Text
OBJECTIVES To study exhaled nitric oxide (NO) as a marker of airway inflammation caused by potroom exposure, hypothesising that (a) workers exposed to potroom pollutants would have higher concentrations of NO in expired air than control subjects employed at the same plant but working outside of the potroom atmosphere, and (b) that concentrations of exhaled NO in potroom employees might be positively associated with concentrations of fluoride and exposure to dust.
METHODS A study group comprising 186 male subjects (aged 24–63 years), employed in the potrooms of one Norwegian aluminium smelter, and 40 comparable control subjects (aged 25–60 years) recruited from the same plant, were examined by measurements of exhaled and nasal concentrations of NO, spirometry, and a questionnaire on respiratory symptoms as a part of an annual health surveillance programme. Estimates of exposure to fluorides and dust for selected job categories were obtained by means of personal samplers carried by the workers.
RESULTS In the non-smokers, the concentrations of exhaled NO were higher in the potroom workers than in the controls (median (interquartile range) 9.3 (6.2–15.6) v 5.7 (4.6–8.3) ppb, p=0.001). The two groups did not differ in spirometry and asthma-like symptoms. Non-smoking potroom workers with asthma-like symptoms had higher concentrations of exhaled NO than those with no symptoms (median (interquartile range) 21.0 (19.3–41.4)v 8.5 (5.9–12.8) ppb, p=0.001), but had comparable spirometric values. In subjects who smoked, the concentrations of exhaled NO did not differ significantly between potroom workers and controls (median (interquartile range) 4.6 (3.3–8.0) v 4.0 (3.4–5.1) ppb. Exhaled NO was not significantly associated with either duration of employment or routine measurements of dust and fluorides.
CONCLUSIONS Exposure to potroom pollutants is associated with increased concentrations of exhaled NO in non-smoking subjects. Nitric oxide in exhaled air may be an early marker of airway inflammation in aluminium potroom workers.
- nitric oxide
- occupational asthma
- potroom workers
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A positive association between asthmatic symptoms and aluminium potroom exposure has been documented in cross sectional and longitudinal studies in workforces1-3 and in population studies.4 Whether the disorder (potroom asthma) is due to non-inflammatory bronchoconstriction provoked by exposure to airway irritants in the atmosphere of the workplace or is associated with increased bronchial responsiveness and airway inflammation has not been clarified.
Aluminium is produced by electrolysis of alumina (Al2O3) in electrolytic cells (pots). Alumina is reduced by carbon (from the anode) to form CO2 and aluminium. The alumina is dissolved in cryolite (Na3AlF6). There are two types of technology: prebake and Søderberg. In the prebake potroom, the anodes are moulded and baked in a separate plant before they are placed in the pots. In the Søderberg pot, coke paste is placed on top of the anode, and baked by the heat produced by the pot.
Aluminium pot emissions contain a complex mixture of pollutants, and 26 substances to which exposure can occur have been listed.5The emissions from prebake and Søderberg potrooms are principally the same and consist of particulates and gases. Particulates are mainly composed of alumina, carbon dust, and cryolite. Potroom fumes contain gases, such as hydrogen fluoride and sulphur dioxide, and these gases are also absorbed on the surfaces of particulates. Potential causal agents of potroom asthma are fluorides (gaseous and particulates), sulphur dioxide, aluminium oxide, and combinations of these agents.
Endogenous nitric oxide (NO) is thought to play an important part in the pathophysiology of airway diseases.6 Increased concentrations of NO have been detected in the exhaled air of patients with asthma7 and other inflammatory airway diseases,8-10 suggesting that expired NO may serve as a marker of airway inflammation. As it may provide a simple, non-invasive means of monitoring airway inflammation, the measurement of NO in exhaled air has attracted great interest over the past few years.11 12
Exhaled NO has been studied as a marker of airway inflammation in various groups of patients.7-10 However, the method has been applied outside clinical settings only to a limited extent. As aluminium potroom workers are at risk of developing asthma and bronchial hyperresponsiveness,13 14 a simple, non-invasive means of detecting early signs of airway inflammation would be particularly useful in this occupational setting.
We aimed to examine whether aluminium plant workers exposed to potroom pollutants would have higher concentrations of NO in expired air than control subjects employed at the same plant but working outside of the potroom atmosphere, and whether concentrations of exhaled NO in potroom employees would be positively associated with routine measurements of fluoride and dust exposure.
Materials and methods
The study group comprised all male subjects (n=218) employed in the potrooms at one Norwegian aluminium smelter. Of those, 186 subjects (85%) participated in the study. Reasons for not participating (n=32) were: declining the invitation (n=12), scheduled time off (n=10), respiratory infections within the past 3 weeks (n=7), illness other than respiratory infections (n= 3). The subjects lost to the study were comparable with those participating for mean age (42 v 40 years) and duration of employment (17 v 16 years). A control group was recruited from employees at the plant's laboratory and mechanical workshop. From a total of 50 male subjects, 40 were included in the study (mechanical workshop, n=30, laboratory, n=10). Six subjects declined, three were excluded because of recent airway infections, and one because of pneumonectomy (lung cancer). None of the control subjects had ever worked in potrooms, ingot mills, or anode production. As >95% of the workforce in the potrooms were men, the study was restricted to male subjects only. People who had had respiratory infections within 3 weeks of the study were not included. The characteristics of the study populations are outlined in table 1. The study was approved by the Regional Ethics Committee.
Since 1985 all potroom workers in the Norwegian aluminium industry have participated in an annual mandatory medical survey in which respiratory symptoms and spirometric measurements have been recorded. In the present study, we had the opportunity to measure exhaled and nasal NO as well as the other tests. The study was carried out in an aluminium smelter in northern Norway during a 2 week period in October 1997. The control group performed the same tests as the study group, and both groups were examined on the same days.
All subjects completed a modified version of a self administered questionnaire, validated in a previous study.15Reliability for the various questions had κ coefficients ranging between 0.58 and 0.86.15 Information about respiratory symptoms (dyspnoea, wheeze, and cough) and smoking habits were recorded. Asthma-like symptoms were defined as the occurrence of dyspnoea and wheezing, apart from during episodes of colds. Use of present medication was recorded. The subjects were classified as current smokers or non-smokers. Information about current job category and duration of employment was also recorded. The potroom workers were familiar with the questionnaire, whereas the control subjects were not.
Spirometry was performed with a pneumotachograph (Vitalograph, Birmingham, UK) which was calibrated daily by a 1 litre syringe. The measurements were performed in accordance with the guidelines recommended by the American Thoracic Society.16 Recorded variables were forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC×100 (FEV1%). The lung function variables were expressed in absolute values and as percentage of predicted, with the reference values of the European Coal and Steel Community (ECSC).17The potroom workers had performed spirometry on previous occasions, whereas most of the control subjects had not. All measurements were carried out by two trained and experienced technicians.
Nitric oxide was measured with a chemiluminescence analyser (LR 2000, Logan Research, Rochester, UK) adapted for on line recording of NO concentration. The analyser which is sensitive to NO from 1 to 5.000 parts per billion (ppb) by volume, has a resolution 0.3 ppb and response time <0.5 s. The analyser also measures CO2 by single beam infrared absorption, and sample pressure and volume in real time. The sampling rate of the analyser was set to 250 ml/min for all measurements. The analyser was calibrated daily with certified NO mixtures (100 ppb) in nitrogen (BOC Special Gases, Surrey Research Park, Guildford, UK). Ambient NO was recorded twice daily during the study period.
Exhaled and nasal NO measurements were performed in accordance with recommendations outlined in the European Respiratory Society's Task Force Report.12 Measurements of exhaled NO were made by slow exhalation (20–30 s) from total lung capacity through a Teflon mouthpiece, against a mild resistance (target mouth pressure of 4–5 cm H2O) to avoid nasal NO contamination. End expiratory NO values were measured at the plateau level of the last part of the exhalation curve. Nasal NO was measured with a Teflon tube inserted into one of the nares, while the subjects held their breath, and the value of the last plateau part of the trace was recorded. For both exhaled and nasal measurements, three technically acceptable measurements were obtained, and the mean of the two closest measurements was reported.
As part of the national authorities mandatory surveillance programme of the working atmosphere, measurements of fluorides and particulates are annually carried out in the Norwegian aluminium industry. Potroom workers are randomly selected to wear personal samplers for 8 hour shifts at different intervals (10–20 measurements a year). Eight hour time weighted mean estimates of exposure to total fluorides and particulates in selected job categories were calculated (table 2), representing the exposure during the past years. For job groups with expected low exposure, regular measurements are not carried out. In the present study, levels of exposure could be estimated for 144 out of 186 workers. Some misclassification of exposure will be unavoidable, owing to job rotation.
All calculations were performed with the SPSS/PC statistical computing package (version 7.5).
Categorical data were compared by the χ2 test. Two independent groups of data were compared by either an unpaired Student's t test or the Mann-Whitney test, depending on whether the data had normal distribution or were skewed. Multiple linear regression analysis was used to detect relations between exhaled NO and relevant independent covariates, controlling for extraneous effects. Values of NO were log transformed before being entered into the regression model, and antilog transformed when presented as results. A value of p<0.05 was consideredto be significant.
For the entire study group, mean values of FVC and FEV1 were above 90% of predicted (table 3). There were no significant differences between the potroom workers and the controls, neither did the smokers and the non-smokers differ for spirometric values (table 3). In the non-smoking subjects, the concentrations of exhaled NO were significantly higher in the potroom workers than in the controls, while the concentrations of nasal NO did not differ (table4). In the smokers, the exposed group and the controls had comparable NO concentrations (both exhaled and nasal, table 4).
Non-smoking potroom workers with asthma-like symptoms (n=12) had higher concentrations of exhaled NO (median (interquartile range) 21.0 (19.3–41.4) ppb, than those with no symptoms (n=87) (8.5 (5.9–12.8) ppb, p<0.001), whereas the smokers with asthma-like symptoms did not differ significantly from those with no symptoms. The FEV1and FEV1% were not significantly lower in the subjects with asthma-like symptoms than in those with no symptoms (non-smokers and smokers).
We found no significant correlation between concentrations of exhaled NO and spirometric values (FVC, FEV1, and FEV1%) in either the exposed group or the controls, or in any of the subgroups (smokers and non-smokers, subjects with asthma-like symptoms, and subjects without symptoms). Controlling for age, smoking, and potroom exposure in a multiple linear regression model, we found that smoking and potroom exposure were associated with respectively a decrease and an increase in exhaled NO (β coefficient -1.8, SE 1.0, p<0.001, and β coefficient 1.5, SE 1.1, p=0.05). We found no significant associations between concentrations of exhaled NO and routine measurements of total particulates and fluorides or duration of employment.
The main finding of this study was that exhaled NO concentrations in non-smoking potroom workers were 63% higher than in non-smoking control subjects recruited from the same plant. The two groups were otherwise comparable for occurrence of asthma-like symptoms and use of β2-agonists. No subject in either group used corticosteroids. The potroom workers were somewhat younger than the controls (mean age 40 v 46 years), but concentrations of exhaled NO have not been shown to vary with age.12 Although the exhaled NO concentration in the non-smoking potroom workers was not as high as that found in symptomatic asthmatic subjects, it was comparable to the concentration observed in atopic subjects with bronchial hyperresponsiveness.18
In smokers, we found no difference in exhaled NO between potroom workers and controls. This may be because chronic cigarette smoking itself decreases exhaled NO, both in healthy19 and in asthmatic subjects.20 In mildly asthmatic subjects, the effect of smoking on exhaled NO is comparable to that of inhaled steroids, and the correlation between exhaled NO and airway hyperresponsiveness found in non-smoking steroid naive asthmatic subjects is lost, both in steroid treated subjects and in smokers.20 This suggests that exhaled NO as a marker of airway inflammation is of limited value in subjects who smoke. Also, the number of smokers in our control group was small.
The increased concentrations of NO in exhaled air in potroom workers may reflect a subclinical degree of airway inflammation caused by exposure to pollutants in the work atmosphere. For decades it has been known that subjects working in aluminium potrooms are at risk of developing asthma.1-3 It has also been shown that bronchial hyperresponsiveness varies with concentrations of plasma fluorides,14 and that after removal from exposure bronchial responsiveness improves considerably.21 An increased risk of bronchial hyperresponsiveness and atopy as well as asthma has been shown in children living in the vicinity of an aluminium plant,22 23 and as the concentrations of pollutants are many times higher inside than outside the potrooms, the effect on respiratory health in children supports the hypothesis that potroom emissions may cause bronchial asthma and bronchial responsiveness in exposed workers. That potroom exposure may induce an inflammatory response in the airways has also been supported by experimental work. An increased number of lymphocytes has been found in bronchoalveolar lavage fluid 24 hours after provoked exposure to hydrogen fluoride in concentrations similar to those routinely measured in the aluminium industry.24
The non-smoking potroom workers did not differ from the control subjects for spirometric values. In fact, their lung function seemed to be well preserved with mean values >90% of predicted for both FVC and FEV1. This may primarily reflect a healthy worker selection bias. A preselection of workers without asthmatic symptoms is carried out before employment in Norwegian potrooms. All subjects who want to work in potrooms, must also undergo spirometric screening, and values >80% of predicted normal is a prerequisite for being employed. Consequently, subjects with respiratory limitations will never enter the workforce, but workers who develop clinically manifest asthma while employed in the potrooms will be relocated to different work. This selection of healthy workers to the potrooms does, in turn, imply a bias towards a potentially higher occurrence of respiratory disorders in the control subjects who were not originally screened and selected. The fact that we found increased concentrations of exhaled NO in the originally "healthiest" group, should therefore strengthen the significance of the observation.
That potroom workers with asthma-like symptoms did not have reduced spirometric values, may indicate that in this occupational setting such symptoms do not necessarily mean clinically manifest asthma, but rather a mild, subclinical condition. This would also explain why the NO concentrations of potroom workers were not as high as would be expected in a population of true asthmatic subjects. Furthermore, spirometry is probably too crude to detect early signs of asthma in a cross sectional study. Mildly asthmatic subjects have, in general, normal spirometric measurements, and only when inflammation has resulted in sufficient morphological changes to produce manifest obstruction, will FEV1 be reduced. To investigate whether the increased concentrations of NO found in the exposed subjects did in fact reflect airway inflammation, would have required comparison with methods more sensitive than spirometry—such as induced sputum or bronchoalveolar lavage. Positive correlations with other markers of airway inflammation would have contributed to strengthen the relevance of our findings, but in a large field study it was not possible to perform such complicated test procedures.
The occurrence of asthma-like symptoms was 17% among the potroom workers and 12% in the controls. This is higher than the prevalence of asthma in the general population,4 and might partly reflect overreporting of symptoms among workers who are regularly screened for airway disorders because of an occupational risk. In the exposed group, we found that subjects who reported asthma-like symptoms had 2.5-fold higher exhaled concentrations of NO than those who reported no symptoms. This strengthens the hypothesis that respiratory symptoms reported by potroom workers do in fact represent airway inflammation as in asthma. Although their symptoms were in all cases mild (which is also reflected by the fact that no subject used inhaled corticosteroids), their exhaled concentrations of NO were significantly increased compared with the control group. Examination of bronchial hyperresponsiveness, which is another marker of airway inflammation known to be associated with potroom exposure,2 might also have supported our hypothesis. However, in the present setting where we had to take healthy workers out of their jobs for test procedures, it was unfortunately not possible to carry out time consuming bronchial provocation tests on top of the other tests.
We found that levels of exposure to fluorides and dust as obtained by routine measurements, were neither associated with asthma-like symptoms nor with increased concentrations of NO in exhaled air. The three most likely explanations for this negative finding would be (a) that the measured concentrations (of both fluorides and particulates) lay within a too narrow range and well below the hygienic standards, (b) misclassification of the exposure variable, as it was based on routine measurements and not individually obtained measurements, and (c) peak exposures (to fluorides) were not measured. Without a control group, the lack of association between levels of exposure and concentrations of exhaled NO, would have masked the positive association between potroom exposure and exhaled NO. This shows the importance of having a control group for this kind of study.
No association was found between the number of years employed, which was used as a substitute for cumulative exposure, and concentrations of exhaled NO. However, this exposure variable does not take into account different job exposures over the years, and the possibility of a healthy worker effect as well as exposure misclassification is obvious. Consequently, the lack of an association does not exclude the possibility that cumulative exposure may have had an effect on exhaled NO.
Our analyses were primarily carried out on non-smoking subjects, as smokers are known to have low concentrations of exhaled NO.12 19 20 We chose to classify both ex-smokers and never smokers as non-smokers. The reason we did not split smoking habits into three categories, was that the number of never smokers in this industrial population was too small for meaningful analyses to be carried out. In fact, the number of current smokers among potroom workers was so high (47%) that it was not possible to recruit a matched control group for smoking habits. The proportion of smokers in our control group recruited from the mechanical workshop and laboratory was 25%. If we had chosen control subjects from the administrative staff, the proportion of smokers would have been <10%. However, as our aim was to study exhaled NO, we were primarily interested in comparing non-smoking subjects. Exhaled NO is not a useful marker of airway inflammation in smokers, as their concentrations of NO will invariably be decreased due to the effects of smoking itself.19 20
To our knowledge, there are no available data on concentrations of exhaled NO in healthy ex-smokers, only in ex-smokers with chronic obstructive pulmonary disease.25 Thus we do not know whether exhaled NO of healthy ex-smokers differs significantly from that of healthy never smokers. It may be speculated that a potential hangover effect of smoking would imply a trend towards lower exhaled NO concentrations in ex-smokers than in never smokers. If so, we might have introduced a bias towards lower NO values by grouping ex-smokers with never smokers.
We conclude that exposure to potroom pollutants is associated with increased concentrations of exhaled NO in non-smoking subjects. The NO in exhaled air may be an early marker of early airway inflammation in aluminium potroom workers.
The study was supported by grants from The Norwegian Research Council, Astra Norway, and Hydrogas Norway. We thank W Grøvnes and B Svendsen for practical assistance during the field study, and the employees at the aluminium plant for participating.


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What happens if I do not have LPAs in place?
What happens if I do not have Lasting Powers of Attorney in place?
First, what are Lasting Powers of Attorney?
Lasting Powers of Attorney appoint someone (often a relative or close friend) to act on your behalf in the situation where you are unable to do so for yourself owing to either physical or mental incapacity. The person appointed is called an "attorney".
Lasting Powers of Attorney are not just advisable for the elderly but for all of us. What happens if you lose capacity and you do not have Lasting Powers of Attorney in place? What is the default position and who makes those important decisions on your behalf?
What is a "deputy"?
In the absence of a Lasting Power of Attorney (or its predecessor known as an Enduring Power of Attorney), no-one has the right to take decisions for that person who has become mentally incapable of managing their affairs until a "deputy" is appointed by the Court of Protection.
As with Lasting Powers of Attorney, there are two types of Deputyship Orders:
- Property and Financial Affairs, which are used, for example, to pay bills, dealing with banking affairs and selling property; and
- Health and Welfare, which are used, for example, to take decisions about care and medical treatment.
Who becomes a deputy and how?
Anyone (although usually family members or professional advisors) who satisfy certain eligibility criteria and who want to take on the responsibility of a deputy must apply to the Court of Protection. If no-one comes forward, the Court of Protection will appoint a third party professional.
So why do we need to appoint attorneys if deputies are appointed in default?
- You choose your attorney – You ensure that a person you trust has the authority to act as an attorney, rather than an unknown third party or someone you would not want to be appointed as your deputy.
- Consideration for those wanting to care for you – At what may be a difficult time for you and your closest friends and family, you alleviate any arguments about who should act and when they should act. You also minimise the stress for those who want to care for you if they do not need to apply (and possibly argue) to become your deputy.
- Peace of mind – As well as leaving written instructions, you can talk to your attorney in advance of losing capacity about how you would like them to act on your behalf and how you would expect them to take decisions in different scenarios. This personal touch can be more comforting for all involved.
- Costs for you and the burden for those caring for you – The application process to become a deputy is more time consuming, exacting and expensive for you than the application process to appoint an attorney. It is estimated that the cost of applying to become a deputy could be as much as £5,000.00 payable from your estate. The cost of putting in place LPAs is much less than this. The ongoing administrative burden and safeguarding requirements on deputies is also greater and more cumbersome than for attorneys.
Further help?
The Office of the Public Guardian supervises and investigates deputies and attorneys and its website contains much helpful information. Catchpole Law is also very happy to have a "no obligation" conversation about how to put Lasting Powers of Attorney in place and what to do if you want to apply to become someone's deputy. We will be able to give you an estimate of the costs involved as well.

subset: commoncrawl


text:
Sirolimus Treatment in Hospitalized Patients With COVID-19 Pneumonia (SCOPE)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT04341675
Recruitment Status : Unknown
Verified May 2020 by Nishant Gupta, MD, MS, University of Cincinnati.
Recruitment status was: Recruiting
First Posted : April 10, 2020
Last Update Posted : May 20, 2020
- Study Details
- Tabular View
- No Results Posted
- Disclaimer
- How to Read a Study Record
|Condition or disease
|Drug: Sirolimus Drug: Placebo
|Phase 2
|Study Type :
|Interventional (Clinical Trial)
|Estimated Enrollment :
|30 participants
|Intervention Model:
|Parallel Assignment
|Intervention Model Description:
|Randmized, double blind, placebo controlled
|Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
|Primary Purpose:
|Official Title:
|Sirolimus Treatment in Hospitalized Patients With COVID-19 Pneumonia (The SCOPE Trial)
|Actual Study Start Date :
|April 24, 2020
|Estimated Primary Completion Date :
|July 2020
|Estimated Study Completion Date :
|September 2020
Active Comparator: Sirolimus
Sirolimus 6mg on day 1 followed by 2mg daily for the next 13 days or until hospital discharge, whatever happens sooner.
Drug: Sirolimus
Sirolimus 6mg daily on Day 1 followed by 2mg daily for the next 13 days for a total treatment duration of 14 days or hospital discharge, whatever happens sooner.
Other Name: Rapamycin
Placebo Comparator: Placebo
Matching placebo
Drug: Placebo
Matching placebo
Other Name: placebo capsules
- Proportion of patients who are alive and free from advanced respiratory support measures at day 28. [ Time Frame: 28 days ]
Death or progression to respiratory failure requiring advanced support measures, either due to inadequate ventilation (non-invasive or invasive mechanical ventilation) or inadequate oxygenation (CPAP* or high flow supplemental oxygen at rates ≥ 15 liters/minute), in patients given sirolimus compared to the placebo group.
* CPAP use for known obstructive sleep apnea will not be considered as disease progression.
- Proportion of patients who require escalation in care [ Time Frame: 14 days ]Progression to a higher level of care, e.g. ICU
- Change over time in study-specific biomarkers (LDH, Ferritin, D-dimer, lymphocyte count) [ Time Frame: 14 days ]Change over time in study-specific biomarkers (LDH, Ferritin, D-dimer, lymphocyte count)
- Proportion of patients surviving to hospital discharge [ Time Frame: days ]Survival to hospital discharge
- Drug safety profile [ Time Frame: 14 days ]Incidence and type of adverse events
- Duration of advanced respiratory support [ Time Frame: days ]Number of days spent on advanced respiratory support measures
- Duration of hospital stay [ Time Frame: days ]Length of hospitalization (in patients who survive to discharge)
- Time from treatment initiation to death [ Time Frame: days ]Number of days between study initiation and death (in the subset of patients who die during the hospitalization)
- Time to resolution of fever [ Time Frame: 14 days ]Time (in days) to resolution of fever
- Proportion of patients who require initiation of off-label therapies [ Time Frame: 14 days ]Patients needing off-label treatments such as Anti-IL-6 inhibitors at the discretion of primary clinicians
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
|Ages Eligible for Study:
|18 Years and older (Adult, Older Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
Subjects enrolled in the trial must meet all of the following criteria.
- Confirmed COVID-19 pneumonia
- Hypoxia as defined by room air oxygen saturation less than 92% or supplemental oxygen requirement
- Presence of at least one additional biomarker that has been shown to predict poor prognosis: a) serum ferritin ≥500ug/l, b) LDH ≥250U/L, c) d-dimer ≥1ug/L, or d) lymphopenia as defined by absolute lymphocyte count <1,000/uL
- Age ≥ 18 years
- Completed informed consent
Exclusion Criteria:
Subjects who meet ANY of the following criteria are not eligible for enrollment as study participants:
- Known allergy or hypersensitivity to sirolimus
- Inability or refusal to provide informed consent
- Advanced respiratory support (high flow oxygen ≥ 15 L/min, CPAP, non-invasive or invasive mechanical ventilation)
- Active enrollment in other interventional clinical drug trials. Co-enrollment in observational studies and biorepositories is allowed.
- Pregnant women
- Breast feeding
- On chronic immunosuppression for other medical conditions such as rheumatological disorders, inflammatory bowel disease, or in patients with organ transplants. A list of these medications is provided in Section 12.3.4
Any clinically significant medical disease which in the opinion of the investigator precludes the patient from enrolling in the trial, including (but not limited to):
- History of liver cirrhosis
- End stage renal disease or need for renal replacement therapy
- Decompensated heart failure
- Known active tuberculosis or history of incompletely treated tuberculosis
- Uncontrolled systemic bacterial or fungal infections
- Active viral infection other than COVID-19
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04341675
|Contact: Nishant Gupta, MD
|United States, Illinois
|Loyola University Medical Center
|Active, not recruiting
|Chicago, Illinois, United States, 60153
|United States, Ohio
|University of Cincinnati
|Cincinnati, Ohio, United States, 45267
|Contact: Davis Alexandria 513-558-2187 firstname.lastname@example.com
|Principal Investigator: Nishant Gupta, MD
|Principal Investigator:
|Nishant Gupta, MD
|University of Cincinnati
|Responsible Party:
|Nishant Gupta, MD, MS, Adjunct Associate Professor, University of Cincinnati
|ClinicalTrials.gov Identifier:
|Other Study ID Numbers:
|First Posted:
|April 10, 2020 Key Record Dates
|Last Update Posted:
|May 20, 2020
|Last Verified:
|May 2020
|Individual Participant Data (IPD) Sharing Statement:
|Plan to Share IPD:
|Plan Description:
|De-identified aggregate data will be made available to other researchers on a case-by-case basis.
|Studies a U.S. FDA-regulated Drug Product:
|Studies a U.S. FDA-regulated Device Product:
|Product Manufactured in and Exported from the U.S.:
Pneumonia, Viral
Respiratory Tract Infections
Virus Diseases
Coronavirus Infections
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Lung Diseases
Respiratory Tract Diseases
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antineoplastic Agents
Antifungal Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs


text:
J W Giles (Artist) George French Angas (After)
Entrance to a house at Raroera Pah, Waipa
Artwork Detail Request a print
Angas's description:
SOME of the finest Māori works of art still extant, are to be met with in the ruined and deserted Pah of Raroera, about four miles beyond Otawhao, near the River Waipa. In one of the former plates was given a representation of the elaborately carved mausoleum erected in this Pah by the great chief Te Wherowhero, above the remains of his favorite daughter; not many yards from that tomb is the house which forms the subject of the present illustration; differing from the usual style of Māori architecture, with the pointed gable roof, the entrance to this building displays the more simple form of porch belonging to the dwellings of some of the inhabitants of the earliest ages, and its close affinity to many of the temples of Egypt is at once obvious: there is a nearer relation between the architecture of this Māori dwelling-house, and that of the temple of the Serpent Knuphis in Upper Egypt, or the ancient temple of Taetfa, than one might at first be disposed to imagine; but the singular resemblance the works of these people bear to those both of Egypt and Mexico, is a fact to be accounted for by theory alone."
- Title
- Entrance to a house at Raroera Pah, Waipa
- Artist/creator
- Production date
- 1847
- Medium
- lithograph in tints, handcoloured paper
- Dimensions
- 256 x 335 mm
- Credit line
- Auckland Art Gallery Toi o Tāmaki, purchased with funds from the M A Serra Trust, 1987
- Accession no
- 1987/16/6
- Other ID
- Copyright
- No known copyright restrictions
- Department
- New Zealand Art
- Display status
- Not on display
To find out which artworks are available for print requests and reproduction please enquire here. This service only applies to select artworks in the Gallery's collection.Request a print


text:
Dedicated to Quality
We enjoy a well-earned reputation for meeting the highest standards in processing, distribution and service, which means that our customers receive only the highest-quality products and services. At Randall Metals Corporation, our commitment to excellence and customer satisfaction is clearly demonstrated through our achievement of an ISO 9001:2015 registration.
ISO 9001:2015 Certified
Randall Metals has met the rigorous requirements for the 2015 ISO certification regarding The Procurement, Processing and Distribution of Flat Rolled Steel and Tin Mill Products to Customer Specifications.
Business Awards
Randall Metals is the proud recipient of Supplier of the Year awards from both Cummins Filtration and MANN + HUMMEL. We are thrilled to be recognized among the "best of best."
The Quality Is Built In
In addition to our certification, compliance and awards, we build quality into every process, product and service we offer. We ensure high quality by:
- Staying up-to-date on relevant industry standards
- Constantly improving our quality programs
- Relying on our decades of experience in tin plate
- Operating the industry's cleanest, best-run facilities
- Providing the most advanced, precision custom slitting in the market today


text:
Flowpack machines from BARSCH enable performance. Their high-quality components make them particularly reliable and durable.
A modular machine design allows uncomplicated adaptations. Long-term improvements are expressed in a pleasant use. The highest priority is the trouble-free operation of our packaging machines.
For us, service means accessibility. Our structures are compact and personal. Barsch is a reliable partner – for years.


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Mahurin Honors College Capstone Experience/Thesis Projects
Document Type
Invasive species serve as a threat to native biodiversity and ecosystem sustainability. Combatting the spread of invasive species requires long-term physical and monetary commitments. In Balule Nature Reserve of Greater Kruger National Park, South Africa, Opuntia ficus-inidica (the common prickly pear) has been a relentless invader, displacing the local flora and fauna. The goal of this project is to battle invasive species such as prickly pear using efficient and inexpensive technology: unmanned aerial vehicles (UAVs or drones) and multispectral sensors.
Using a 4-bandwidth Parrot Sequoia multispectral sensor in tandem with the DJI Phantom Pro 3TM UAV, images of land plots were collected in the summer of 2018 on Balule Nature Reserve and surrounding areas in South Africa. From the images collected, maps were created using the mapping software Pix4D Mapper. Vegetation indices were created in which certain properties of vegetation are highlighted, assisting in plant identification. Using geographical informational system (GIS) software, classifications will be performed in which the multispectral data serves an important role. Multispectral sensors capture images in varying bandwidths; by collecting images in the red, green, red edge, and near-infrared bandwidths, there is potential for creating unique spectral signatures specific to individual objects such as prickly pear. Once a spectral signature is determined, a computer can then potentially perform unsupervised classifications to identify prickly pear solely from aerial images.
Advisor(s) or Committee Chair
Michael Stokes, Ph.D.
Biology | Geographic Information Sciences | Other Ecology and Evolutionary Biology | Remote Sensing
Recommended Citation
Ahmed, Tithe, "Using Unmanned Aircraft Systems to Identify Invasive Species" (2020). Mahurin Honors College Capstone Experience/Thesis Projects. Paper 873.
Included in
Biology Commons, Geographic Information Sciences Commons, Other Ecology and Evolutionary Biology Commons, Remote Sensing Commons


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The Inn Collection Talk Some of Their Most Bizarre Requests
PoliticMag Press Release : November 27, 2020
For many of us, spending a night away in a hotel comes with only a few basic requirements; fresh bed sheets, a working shower, tea and coffee-making facilities, and adequate hygiene and cleanliness. We've all heard the expression 'the customer is always right'. But there's no denying that some requests hotels have received in the past challenge this statement. Of course, every hotel will have received some negative form of criticism from guests in the past. All this feedback should be taken with a pinch of salt and used to help improve the hotel for future guests.
However, how can hotels respond to complaints and requests that demand some rather bizarre and seemingly impossible requirements? The Inn Collection have looked through their records to reveal some of the strangest and most amusing requests and complaints that they have received in the last few years.
Questionable Complaints
From hotels in the centre of the UK's busiest cities to cosy countryside getaways in Ambleside accommodation in the Lake District, British weather tends not be on our side wherever we are. But one guest in particular once complained because "it was a foggy day and they couldn't see much of the sea from their 'Seaview room'". Of course, any guest would be disappointed—but as far as the hotel goes, there's nothing much it can do the fog!
Beyond hotel rooms, restaurants have also received some strange demands. A guest from Australia requested "the ingredient list for the Cock-a-leekie Soup, as he was worried they would be similar to what you find in a Bushtucker Trial". Although the name may be misleading, it's a given that no hotel would want to feed its guests with an I'm A Celebrity-style dish for their evening meal!
As far as a wishful wedding goes, for some guests this did not seem to go as planned with one groom's requests: "on the morning of his wedding, he asked housekeeping if they could do anything with his suit trousers as he had dropped them outside in the rain and not realised he had also stood on them—it looked like he had been playing five-a-side! It was one hour before the wedding was meant to begin". Hopefully, housekeeping came to his rescue—and fast.
With location being on the top of most guests' minds when booking for a weekend away, it seemed some guests mixed up a lake view for an ocean one and complained. "They'd seen a picture of the view from one of our hotels beside the North Sea from a bedroom, then booked a 'lake view' room at one of our other hotels and complained that they couldn't see the sea from their room… In the middle of the Lake District". It's fair to say that geography isn't everyone's strong point.
Hotelier Middle East's Complaints Compilation
The largest Middle East hotel provider and hospitality news portal has pulled together a list of what it thinks are the most comical complaints and requests from guests around the world.
As far as complaints goes, hotels can only fix what they have control over—and the sea being too blue and the waves too loud is not one of them! Speaking of the sea, another guest complained that there was no ocean view from their London hotel room. Perhaps they meant a different London?
It appears that some of the most basic hotel commodities have caused some humorous misunderstandings too. One guest mistook the gravy for soup and complaint that the soup was too thick!
Although we expect to get what we pay for when it comes to hotel suites, some guests appear to take this to new extremes. So much so, one guest complained that the bed was too high and requested the legs be shortened by 12 inches.
Too Many Complaints & Requests
Hotel staff go above and beyond to provide the best overnight stay for their guests. However, for some people, their efforts appear too much. Some guests have even complained that the ice cream was too cold, the bath is too big, and the sheets are too white—quality and cleanliness are a good thing, right?
Speaking of too many requests, some guests asked for a glass of water to be brought to them every hour throughout the night. Not only that, but for 15 cucumbers to be provided per day and 16 pillows for a single person. It seems the 'make yourself at home' expression has been taken too literally.
One final complaint seems more of a compliment if anything else—with one guest complaining the waiter is too handsome! At least someone had a good day.
Constructive criticism is something that all hotels should appreciate from their guests every now and then. After all, how else are they supposed to know what customers want? However, these bizarre complaints suggest that maybe, just sometimes, the customer is not always right!


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The Columbia Center on Sustainable Investment, the Sustainable Development Solutions Network (SDSN), and Laurent Fabius, President of the Constitutional Council of the French Republic, will host this one-day conference to discuss the draft for a Global Pact for the Environment.
In its November 2015 report titled, 'Increasing the Effectiveness of International Environmental Law: Duties of States, Rights of Individuals,' the Environmental Commission of Le Club des Juristes (CDJ) proposed the adoption of a Global Pact for the Environment to serve as a binding, universal "umbrella text" synthesizing the principles outlined in the Rio Declaration on Environment and Development, the Earth Charter, the World Charter for Nature, and other instruments shaping environmental governance. Subsequently, a draft pact was developed and presented to an event in Paris in June 2017, during which French President Emmanuel Macron promised to present the draft to the UN in September.
date: 20 September 2017
location: New York City, US
www: http://ccsi.columbia.edu/2017/09/20/conference-on-the-global-pact-for-the-environment/


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The first time she went to Burning Man, Kate Raudenbush was not an artist. Not yet. She made her first journey into Nevada's Black Rock Desert in 1999 and five years later built her first art installation there. In the decade-and-a-half since, her monolithic, immersive sculptures have become a regular delight in the temporary metropolis of Black Rock City as well as being exhibited in galleries across the world from the Smithsonian to Seoul. "Burning Man was truly an awakening for me," says Raudenbush, speaking over Zoom from her home in New York. "I say I'm self-taught, but really, Burning Man was the school where I learned how to make art."
Raudenbush is just one of the many artists featured in Burning Man: Art On Fire, a new documentary by BAFTA-winning director Gerry Fox which looks past the event's famed orgiastic debauchery to instead focus on the incredible feats of creativity and ingenuity required to bring large-scale art to one of the planet's most inhospitable environments. In doing so, it gets close to the heart of what makes Burning Man so different from other festival experiences. I've been going since 2014 – my friends and I run a British pub-turned-pink-hued-drag club there called the Queen Dick – so I've felt firsthand the magical way Burning Man converts its 80,000 attendees from wide-eyed gawkers into fully-fledged participants.


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Links to Variables & Lists // Collections // Python editor // Conditions // Loops // Exercises
Read from a text file
Create a textfile with the song of the previous chapter – or something else. Save your textfile as a plain textfile, using the extension .txt
source = open('song.txt', 'r', encoding = "utf-8")
text = source.read()
We use the
open() function to create a file object source, which we can use to access the actual text content of the file. Make sure that you do not pass the
'w' parameter ("write") to
open(), instead of
'r' ("read"), since this would overwrite and thus erase the existing file.
After assigning the string returned by
source.read() to the variable
text, we print the
text. Don't forget to close the file again after you have opened or strange things could happen to your file! One little trick which is commonly used to avoid having to explicitly open and close your file is a
with block (mind the indentation):
with open('song.txt', 'r', encoding = "utf-8") as source:
text = source.read()
This code block does exactly the same thing as the previous one but saves you some typing.
Write to a text file
Once you get familiar with the with block, it becomes quite evident.
with open('new_song.txt', 'w', encoding = "utf-8") as destination:
Note that we changed the reading mode 'r' into the writing mode 'w'; we changed the name of the file object from source to destination; we used the function .write() instead of .read(). Once you have written your output to a new textfile, you can open the new file and read from it again…
By using 'w' you will overwrite and thus erase the existing content of your destination file. Use 'a' (from 'append') to add words to your existing file.


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The energy regulator has revoked the supply licence of URE Energy, after the small supplier failed to meet its Renewables Obligation.
Under the Renewables Obligation scheme, suppliers must source a portion of their electricity from renewable sources or pay into a buy-out fund run by Ofgem.
URE Energy failed to meet the deadlines for either presenting RO Certificates or paying into the fund last year, for energy sourced and supplied during 2017/2018. It reportedly owes the scheme £209,000.
URE was one of a small number of suppliers which failed to pay into the RO fund last year. Two of those—Economy Energy and Spark Energy—have since exited the market.
Meanwhile, Ofgem gave URE Energy and Eversmart until 31 March 2019 to pay what they owned in monthly instalments. Eversmart Energy scraped together what they owed but URE failed to do so, prompting Ofgem to take enforcement action.
With the loss of their legal ability to supply energy, URE Energy will most likely fold, becoming the 14th energy supplier to go bust since January 2018 and the second this week, following the collapse of renewable supplier Solarplicity.
In June Ofgem introduced tougher licensing procedures to stop rogue suppliers from entering the market. Under the new requirements, prospective suppliers must demonstrate they have adequate funds for their first year of operation. They must also detail how they'll provide customer service, including provisions for handling complaints and assisting vulnerable customers.
Meanwhile, Citizens Advice has urged Ofgem to introduce new tests for suppliers already on the market. The consumer group has raised concerns that customers are being ripped off and mistreated by unscrupulous and unprepared suppliers and that the cost of these company's failures is being felt across all energy bills.
Earlier this year City A.M. has exposed the chequered past of its URE's chair John Coombs, who has run a series of failed businesses.


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Jurassic World – 3 stars
Very much in the vein of Godzilla, Jurassic World is just gripping and exciting enough, you almost look past its flaws.
The script is cobbled-together from the Spielberg factory and is largely a knock-off. We come to the park with kids scarred by impending divorce bond (two, like in the first movie) where they are met by their aunt, a park executive, who has no parenting instincts (ala' Sam Neill, in the first movie). There is also a bad guy who wants to use velociraptors for, you guessed it, military purposes, and plenty of discussions about the ethics of all of this (much less impressive coming from the likes of B.D Wong and Chris Pratt, as opposed to Sir Richard Attenborough and Jeff Goldblum). And our heroes live because the dinosaurs fight amongst themselves (again, as in the first movie).
Speaking of Pratt, he's in a bit of bind here. Pratt's wheelhouse is a certain goofy but childishly masculine charm, best represented in Guardians of the Galaxy and Moneyball (as the confused, boyish catcher-turned-first-baseman). Here, when Pratt flashes that charm – mainly in banter with the aunt, Bryce Dallas Howard – he's fun to watch. But Pratt also tries to play it straight, and he simply lacks the gravitas to do so. A fair comparator is Bruce Willis, who went from the light comedy of TV and Moonlighting to the sarcastic aside of John McClane in the Die Hard flicks to a plausible straight hero. But Willis started late and had the rough look of an older man, coupled with a menace he could draw upon. Pratt ain't there yet and it's hard to tell when he is being serious or joking.
There's also a fair amount of lazy plotting. It is never adequately explained why certain features of the new, terrifying animal – Indominus Rex – were allowed to manifest themselves in the creature (such as its ability to think like George Patton) without also injecting a kill switch. Also, the response of the park staff is less professional than what you might get on a windy day at Busch Gardens, and if Busch Gardens keeps you on a metal track for the Old Time Antique Car Ride, there is no way a park would allow its patrons to self-navigate dinosaurs in one of these:
Still, this is an easy and fun movie which, at last count, has made enough dough to bail out Greece.


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Choose a country in the list to show prices and articles for that country
When mountain guides need eyewear to rely on, they usually go for Julbo. No other manufacturer takes extreme optics as seriously as the venerable French company that provide the world's top mountaineers with eye protection since 1888. Today Julbos glasses are equally appreciated by skiers, anglers, cyclists and runners.
We sell clothes and gear for Nordic conditions. These products we proudly use ourself in the daily work as mountainering guides - behind a team of dogs or on a bike. Nordic Adventure is part of Fjälläventyr AB, with over 40 years guiding costumers in Swedish mountains.


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Joseph: Carpenter of Steel
Joseph: Carpenter of Steel • Documentary
The early chapters of Matthew and Luke give intriguing details about the principal players in the Christmas story but tantalizingly few about Joseph. Joseph: Carpenter of Steel offers a look at the foster-father of Jesus. Joseph's unwavering trust in God, his obedience in the face of ridicule and disruption gives us a unique example of biblical manhood. As carpenter, guardian, and parent, Joseph was, above all, faithful.
Follow along as Rev. Gregory Seltz, speaker for The Lutheran Hour, hosts this documentary that will get you looking at the Nativity story from a fresh angle. Complementing Seltz' narrative is Dr. Paul L. Meier, who—with typical finesse and fervor—adds historical depth and perspective to one of Scripture's greatest unsung heroes. Available subtitles: English


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SelectPdf Online REST API is a platform independent PDF manipulation API. SelectPdf REST API is cloud based and it can be used with any language: .NET (C# or VB.NET), Java, PHP, Python, Go, Ruby, Node.js, Perl and many more. We are presenting today the dedicated .NET client library for SelectPdf API.
Using the SelectPdf Online REST API .NET client library you can easily take advance of the API features offered by SelectPdf:
HTML to PDF REST API – SelectPdf HTML To PDF Online REST API is a professional solution that lets you create PDF from web pages and raw HTML code in your applications.
PDF to TEXT REST API – SelectPdf Pdf To Text REST API is an online solution that lets you extract text from your PDF documents or search your PDF document for certain words.
PDF Merge REST API – SelectPdf Pdf Merge REST API is an online solution that lets you merge local or remote PDFs into a final PDF document.
All these APIs can be easily integrated with .NET using the dedicated client library, that can be used with .NET Framework 2.0 and above, .NET Core 2.1 and above, .NET 5, .NET 6, etc.
Continue reading


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Cold Sesame Noodles
Cook up one pound of pasta "al dente." It will go easier later if you break the pasta in half before cooking. (I use whole-wheat spaghetti but you can use vermicelli, regular spaghetti, soba noodles, Chinese rice noodles, etc...) Drain and cool pasta with cold water then drain again. Set it aside in the pot you cooked it in.
Prepare your "add-ins" and toss them into the pot with the pasta. I used one bunch of scallions cut into julienne strips, one can baby corn, 1/2 pound peas, one can sliced water chestnuts and one can mandarin orange segments. (Drain and rinse the canned ingredients of course!) If you eat meat, poached chicken breast is excellent and the original recipe called for 5 oz. ham cut into julienne strips.
Measure 1/3 cup soy sauce, hot chili oil (1 tablespoon or to taste) and 3 tablespoons ground coriander seeds into a cup and set aside.
Now heat 3/4 cups vegetable oil (I used half olive oil, half peanut oil but anything works!), 2 1/2 tablespoons sesame oil (adds good flavor) and 2 tablespoons (or more) sesame seeds in a skillet or saucepan on medium heat until the sesame seeds just begin to turn light brown.
Turn off the heat and immeidately add the soy sauce mixture. Be careful! It sizzles.
Pour the hot dressing over the pasta and add-ins. Mix together immediately. The best/easiest way is to use your (very clean) hands. Refrigerate. I sprinkled on some extra sesame seeds and mandarin orange segments for decoration. Eat.


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2021-02-08 07:54:10 | British bid to produce Apple cars 'no-brainer' say MPs – live updates
MPs are calling for the UK to make a bid to Apple to manufacture its electric cars here in Britain.
Reports suggest the tech giant is planning to produce a vehicle with "breakthrough battery technology" in 2024, leading to intense speculation about where the car will be manufactured.
James Sunderland, Conservative MP for Bracknell, called the idea of Britain bidding for Apple to build cars in The UK a "no brainer".
"I'm supportive," said Sunderland. "Let's bring new car production to the UK, use the high-tech workforce that we already have, create new jobs and build electric cars."
Nick Fletcher, Conservative MP for Doncaster added: "As the economy recovers from the Covid-19 pandemic this year, we should be engaging with new, innovative industries that help boost economic growth while helping the environment."
Over the weekend, Hyundai and Kia both backed away from reports that they are in talks with Apple about manufacturing the new car, increasing speculation about the manufacturing partner the tech giant will pick.
Marco Longhi, Conservative, Dudley North, said attracting Apple could be a major boost for areas of the country with a long-standing connection to the automotive industry.
"This would be a fantastic investment for the Midlands and the Black Country," he said.
"This will mean jobs for people locally and it would buy an endorsement of U.K. plc in a post Brexit environment."
A Government spokesperson for the Department for Business, Energy and Industrial Strategy said they could not comment on speculation around commercial contracts.
Story continues…
The post 2021-02-08 07:54:10 | British bid to produce Apple cars 'no-brainer' say MPs – live updates
appeared first on http://justlatestnews.com


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Serbia is an independent nation in Southern Europe. With the capital city of Belgrade, Serbia 2020 population is estimated at 8,737,382 according to countryaah. In the Balkans there was a powerful Serbian empire with the center of Kosovo from the 11th century. From the end of the 1300s, this came to obey the Ottoman Turks for almost 500 years. After the First World War, a united, South Slavic kingdom was established under the reign of Serbia's Aleksandar. During the Second World War, the country was occupied and divided. After bloody internal struggles, Communist leader Tito 1945 was able to form the Socialist Republic of Yugoslavia with Serbia as the largest sub-republic.
- AbbreviationFinder.org: Comprehensive guide to and popular abbreviations of Serbia, covering history, economy, and social conditions.
Following the division of the Roman Empire into a western and an eastern part in 395, various peoples formed battles with each other and with the Eastern Roman Empire, Byzantium, new states in the Balkans. The states had varying scope and longevity. By the mid-600s, the slaves, who came from the northeast, had colonized almost the entire Balkans. For Serbia political system, please check computerminus.
In the 1000s, the medieval Serbian empire emerged. It was recognized by the Byzantine emperor in 1187 and received its own Serbian Orthodox Archbishop 1219 with its seat in Peć (Peja) in present-day Kosovo. The church became a unifying force and became of great importance to the Serbs' national and cultural identity.
Under Stefan Dušan, who was crowned king in 1346, the Serbs experienced a great time. In Kosovo, which the Serbs count as their cultural cradle, during this era a number of churches and monasteries were built. However, the kingdom soon collapsed and could not withstand the Ottoman Turks as they began to advance across the Balkans in the late 13th century. A great battle between Serbs and Turks was in 1389 at the Kosovo police (Trast field). In 1396, Serbia became a Turkish sound state and then fully incorporated into the Ottoman Empire in 1459.
The Krajina border area
The Serbs came to live under Turkish and Muslim domination for nearly 500 years. However, the population stuck to the Serbian Orthodox religion and its culture. At the end of the 16th century, the Habsburg emperor established a military border area against the Turks in present-day Croatia (the so-called Krajina, that is, border). The Habsburgs gave land to Serbian peasants, who in exchange lined up with soldiers and protected the Habsburg provinces from the Turks. This created the Serbian enclaves in Croatia.
The modern Serbian state grew in the early 1800s and after the Russo-Turkish war of 1877-1878, the Turkish sultan was forced to give the Serbs full independence. In 1882 Serbia became a kingdom.
In the first Balkan War of 1912–1913, Serbia, Montenegro, Bulgaria and Greece defeated the Turks and then fought for prey in the Second Balkan War in 1913. Serbia and Greece acquired large parts of Macedonia, and Serbia and Montenegro split in the Sandžak area.
Bosnia-Herzegovina had been annexed by the Habsburg double monarchy in 1908, where the successor Franz Ferdinand intended to give the South Slavic people self-government to reduce its willingness to join Serbia. When Serbia wanted to free the Bosnian Serbs from Austrian rule, the country came into direct conflict with Austria-Hungary. During a visit to Sarajevo in Bosnia on June 28, 1914, Franz Ferdinand was shot to death by Gavrilo Princip, a member of the Serbian nationalist organization Black Hand. The murder became the prelude to World War I.
Serbs, Croats and Slovenes
The Habsburg monarchy collapsed in October 1918 and in December the "Kingdom of the Serbs, Croats and Slovenes" was proclaimed under the reign of Serbia's Aleksandar Karađorđević (Karadjordjevic). However, very tense conditions existed from the beginning between Serbs and Croats / Slovenes. The latter, who were Catholics and had experience of Western administration under Habsburg, wanted the new state to become a loose federation with great internal self-government. The Serbs, whose administration was influenced by Turkish tradition, wanted a centralized state. The parties that wanted a centralized unitary state won a scarce majority in the 1920 election.
In the late 1920s, the country was on the brink of civil war. In January 1929, King Aleksandar dissolved the parliament. The constitution was put out of play and the king made himself a dictator. At the same time, the country was renamed the Kingdom of Yugoslavia (Yugo = South). A period of economic decline, political contradictions and increased violence followed. In Macedonia, the revolutionary organization VMRO worked for a state that gathered all Macedonians. In Croatia, the fascist party Ustaša (Ustasja) grew, although it was banned and its leaders were in exile in Mussolini's Italy. In 1934, King Aleksandar was murdered in Marseilles by a VMRO terrorist, but Ustaša was thought to be behind.
The guardianship that took over after the murdered king (his eldest son was incapacitated) supported the Germans at the beginning of the Second World War. By that time, Yugoslavia was financially dependent on Nazi Germany. At the end of March 1941, however, officers supporting the Allies against the Germans made a coup. Therefore, on April 6, Yugoslavia was attacked by the Axis powers Germany and Italy and its supporters Hungary and Bulgaria. Montenegro was almost completely incorporated into fascist Italy, which also brought together Albania, Kosovo and parts of Macedonia into a Great Banana under its rule. Most of Serbia was occupied by the Germans, who set up a puppet government in Belgrade. In most of Croatia and Bosnia and Herzegovina, with German support, a fascist sound state was formed (so-called Free Croatia).
Tito comes to power
Two rival resistance groups fought against the invaders: royalist četniks (Chetniks) under Colonel Draža Mihajlović, supported by the Yugoslav exile government in London, and the National Liberation Army, under Yugoslav Communist Party leader Josip Broz (Tito). Attempt to unite the movements into a bloody mutual feud between the ether and the leftist. The allies, who first supported the royalists, went to Tito in 1943 and in November of the same year Tito in the city of Jajce in Bosnia proclaimed a party government in the liberated areas.
At the same time, parts of Yugoslavia were ravaged by internal political and religious terror. The Ustašar regime in Croatia devoted itself to barbaric persecution of Jews, Roma and political opponents. An attempt was also made to force Orthodox Serbs to convert to Catholicism. Many Croatian Serbs managed to escape to Serbia. Serbian groups, including the Czechs, responded with brutal assaults on Croats. The worst battles raged in Bosnia in 1943-1944. By the end of the war, a tenth of the population of Yugoslavia had been killed and 3.5 million were homeless. More victims had been harvested in the internal battles than in the fight against the occupying powers.
The royalists were finally defeated in 1944, when the kingdom was formally abolished, and on March 7, 1945, Tito was able to establish a government. Serbia became the largest of six sub-republics in the Communist-run Socialist Federal Republic of Yugoslavia. The Serbian capital Belgrade also became the seat of all joint administration and capital of the new republic.


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The eCopy Paper Connection Forum 2008 was held at The Westin Hotel, Boston, and the welcome dinner was at the beautiful John F. Kennedy Library.
Guests were given a mini-tour of Boston via duckboats on their way to the library. Upon arrival, guests were greeted by singing from a student acapella group before enjoying a delicious lobster clambake dinner and entertainment by a jazz quartet. The library's archives and museum were also open to guests.
Our keynote speaker for that year's event was Ken Schmidt, a marketing guru from Harley-Davidson.
eCopy senior management supported my "wacky" idea to give away a special 105th Anniversary Street Glide Harley-Davidson to a participant at this event. High quality miniature versions of the motorcycle (with working gear shifters and saddlebags) were sent as promotional gifts to VIPs and drew an overwhelmingly positive response. The bike was placed in the exhibition area during the event and it garnered a lot of attention and impromptu photography.
I was the events manager for this highly successful event.


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The world keeps getting stranger and stranger!
This year, BLACK SWAN actress Natalie Portman (35) will not be attending the Oscars. Portman wrote in a statement: "Due to my pregnancy, I am unable to attend the Independent Spirit Awards and the Academy Awards. I feel so lucky to be honored among my fellow nominees and wish them the most beautiful of weekends."
Portman married her BLACK SWAM co-star: French dancer Benjamin Millepied in 2012 and they already have a son together and now are obviously getting more.


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Romania will actively participate in debates on specific country recommendations issued by the European Commission, according to a press statement released on Wednesday by the Foreign Ministry (MAE).
"The Ministry of Foreign Affairs has taken note of specific country recommendations published by the European Commission in the framework of the European Semester 2018 and will coordinate the process of drawing up the national position on this issue in order to secure active participation in the decision-making process, which will result the Council of the European Union adopting such recommendations," says MAE.
The European Commission is said to have addressed Romania three country specific recommendations on fiscal policy (1), employment, health, education (2) and public administration (3).
"The number of recommendations addressed to Romania has ranged from eight in 2013 to three in 2018, with the European Commission noticing that Romania has made progress with 68pct of the recommendations of the last five years. In addition, the Country Report 2018 places Romania in the category of member states without macroeconomic imbalances, which is why it does not contain an in-depth review. For 2018, the commission has drawn up in-depth reviews of 12 member states, namely France, Germany, the Netherlands, Bulgaria, Croatia, Ireland, Italy, Portugal, Slovenia, Spain and Sweden," according to MAE.
In the period immediately ahead, according to MAE, the proposals for recommendations submitted by the European Commission will be subject to an in-depth analysis at the level of the ministries responsible for the areas concerned so that the concrete implementation measures can be identified.
MAE informs that the National Reform Programme and the Convergence Program, unveiled by Romania in May, include measures in line with the Romanian Government Programme 2018-2020 and other strategic priorities taken up at the government level, "which largely converge with the recommendations made by the European Commission and contain measures to respond to these challenges."
"In the process of decision-making related to country-specific recommendations, Romania and the other member states may make comments on the text proposed by the European Commission by May 28, 2018, in the spirit of the constant and constructive dialogue that takes place as part of the European Semester. In its capacity as a national coordinator and technical contact point for the Europe 2020 Strategy, MAE is paying increased attention to drawing up and monitoring the implementation of the National Reform Programme, designed to correlate the main action priorities with the Government Programme and involving a wide range of organisational players."
Further steps will be taken to consult with the relevant stakeholders on the subjects covered by the European Semester, and a new meeting with high-level representatives of stakeholders is expected to take place in the next period, MAE says.
MAE mentions that on Wednesday the European Commission published the European Semester 2018 Spring Package, which comprises country- specific recommendations for EU member states, including Romania. These are based on the priorities taken up as a result of the Annual Growth Survey 2018 and the challenges highlighted by the European Commission in the country reports unveiled in March 2018. The recommendations are intended to guide member states in implementing national reforms, thus supporting the achievement of the Europe 2020 objectives," MAE explains.
"Procedurally speaking, the country-specific recommendations will be discussed at the different levels of the Council of the European Union with a view to being endorsed by the June 2018 European Council meeting and formally adopted in July. The publication of country-specific recommendations is part of the European Semester, a tool for coordinating economic policies and structural reforms in the European Union."
According to MAE, the role of these recommendations is to provide member states with guidance on actions to be taken on macroeconomic, budgetary and structural reform policies, in accordance with Articles 121 and 148 in the Treaty on the Functioning of the EU.
"The country-specific recommendations 2018 are based on the European Commission's assessments included in the country reports released on March 7, 2018, after bilateral meetings and review visits in the context of the European Semester, as well as on the elements provided by member states in their national reform programmes and stability and convergence progra


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Point Decor Black Wall 248mm x 498mm x 8.5mm
A loose linear patterned tile in a rich black. The rectangular 248x498mm Linea Point Décor Black tile teamed with the plain Black tile from the Linea Plain collection will make for a beautifully zen living space.
Point Decor Black Wall 248mm x 498mm x 8.5mm
USE Wall COLOUR Black ROOM Bathroom, Bedroom, Living room TYPE Tile SHAPE Rectangle MATERIAL Ceramic FINISH Matt STYLE Structured, Textured PLACEMENT Internal WIDTH 248mm HEIGHT 498mm DEPTH


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Saturday, July 2.
Second day and off to the palace, by vintage bus.
Past the Abbey, but back there later.
One of the turrets on the old moat around the palace.
View from front of palace across the pond to the village of Beaulieu.
Cairn to King William in the gardens, who was mysteriously shot.
Remains of the old estate wall.
We had a look through the walled garden first.
Note the monorail in the background. This runs around part of the estate.
The steel rock tree.
Topiary in the garden.
Mad Hatters tea party.
The palace.
One of the many sculptures in the grounds.
Detour via the Abbey and church.
Front of the palace.
The Lord of the Manor.
Dining room.
For Royal bums only, Victoria and Elizabeth ll.
Children's table. With named plates.
The second Lord was very good friends of Mr Rolls and Mr Royce.
1300's chair.
The lady of the manor.
Views from the monorail going back to the museum.
The palace is currently occupied by the 5th Lord of Bailieu. The 4th passed away in August of last year, aged 84, after loosing a battle with cancer. It was his fathers conception to develop the museum and develop the grounds in 1905, starting with five cars in the foyer of the palace,for access by the public. Had to knock down a wall to get them in, rebuild, and then knock down and rebuild when the museum was built.
More shots from the museum, including the era garage.
A write off Morris Cowley.
Jack Findlays name is on the is trophy for rider of the year in 1976. It was Jack's bike we were involved with at Goodwood. There is a statue in Mooroopna dedicated to him.
Sir Jack Brabhams first trophy.
Some of the top 21 riders of all time, on the wall at the museum, four we met at Goodwood, and Guy Martin at the Isle of Mann last year.
Some icons from the past.
Lady racer.
Familiar looking machine.
Now this is old and powered by steam.
The whisper mount as opposed to the normal flying lady on Rolls Royces. There were only five made and only two known to be still in existence. Known as Elenour, named after Elsnour Thornton, the mistress of the 3rd Lord of Beaulieu.
Need a fat cheque book here. Four cars total around £85,000,000.
A legend.
Mouth watering.
Who is this dag?
What an amazing two days we have spent here. For years we have heard about the Beaulieu Museum and palace, so it was a must see. Quite chuffed actually.
Six thirty and back on the road as we had a four hour trip back to Nettleton to surprise Lynton and Sarah who were having their annual summer BBQ tomorrow. Need to pray for sunshine.
He he.😉😉


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Healthcare Provider Moral Distress as a Leadership Challenge
Bell, Jennifer
Breslin, Jonathan M.
Bibliographic Citation
JONA'S Healthcare Law, Ethics and Regulation 2008 October-December; 10(4): 94-97; quiz 98-99
Healthcare leaders are responsible for using strategies to promote an organizational ethical climate. However, these strategies are limited in that they do not directly address healthcare provider moral distress. Since healthcare provider moral distress and the establishment of a positive ethical climate are both linked to an organization's ability to retain healthcare professionals and increase their level of job satisfaction, leaders have a corollary responsibility to address moral distress. We recommend that leaders should provide access to ethics education and resources, offer interventions such as ethics debriefings, establish ethics committees, and/or hire a bioethicist to develop ethics capacity and to assist with addressing healthcare provider moral distress.
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Top 10 Health Care Ethics Challenges Facing the Public: Views of Toronto Bioethicists Breslin, Jonathan M.; MacRae, Susan K.; Bell, Jennifer; Singer, Peter A. (University of Toronto Joint Centre for Bioethics. Clinical Ethics Group, 2005-06-26)BACKGROUND: There are numerous ethical challenges that can impact patients and families in the health care setting. This paper reports on the results of a study conducted with a panel of clinical bioethicists in Toronto, ...


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Magic in the Moonlight
Stanley (Colin Firth), a renowned magician, and Sophie (Emma Stone) a young American spiritualist meet at Côte d'Azur in the late 1920s. Stanley is convinced that he can unmask Sophie as a fraud, but instead succumbs to her own brand of magic.
A Woody Allen is a Woody Allen is a Woody Allen. Every Woody Allen film has good actors, sharp dialogue, a confident production design, relationship confusions and, as always, the God question. The mood changes often, sometimes romantic, sometimes childish, and then wickedly nihilistic as in his earlier "European" films such as VICKY CRISTINA BARCELONA, MATCH POINT or CASSANDRA'S DREAM. Since his 2009 film WHATEVER WORKS, most of Allen's films, with the exception of BLUE JASMINE, have been considered lightweights, but MAGIC IN THE MOONLIGHT is even more of a disappointment. His period piece takes us back to 1929 complete with top hats, long pearl necklaces and see-through dresses. The film is set on the French Riviera at the home of the wealthy Catledge family where the English magician Stanley (Colin Firth), whose stage name is Wei Ling Soo, travels to meet the young American clairvoyant Sophie (Emma Stone). Stanley, a convinced atheist, a cynic and a pessimist, in fact the alter ego of his stage personality, resolves to show that Sophie is a fraud. Yet her predictions are incredibly accurate and the priggish Englishman soon falls for her magic – and her American charm. Allen has done a better job with the dichotomies one finds in this film: the old and new world, spiritualism and atheism, god. As Stanley said: There might be a higher power or maybe not, but there is definitely magic.
USA 2014, 97 min
Language: English
Genre: Liebeskomödie
Director: Woody Allen
Author: Woody Allen
DOP: Darius Khondji
Montage: Alisa Lepselter
Distributor: Warner Bros.
Cast: Erica Leerhsen, Colin Firth, Jacki Weaver, Eileen Atkins, Simon McBurney, Emma Stone, Marcia Gay Harden, Hamish Linklater, Ute Lemper
FSK: oA
Release: 04.12.2014
- OV Original version
- OmU Original with German subtitles
- OmeU Original with English subtitles
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With the original nine holes constructed over 75 years ago by an avid group of local volunteers, Pembroke Shores Golf Course is part of the history and traditions of its namesake area. The addition of a second nine, designed by well known golf architect Graham Cook, was completed in 1982 in response to an increasing demand for more play in the area. Pembroke Shores Golf Course today is a magnificent 6,730 yard championship course. Pembroke Shores Golf Course's small, fast greens set the pace for this always challenging layout. The first two holes border the Ottawa River, where keeping to the left should allow you to move quickly and confidently. However, prepare to slow down after that, as the many bunkers, trees and subtle slopes will punish anything less than careful play.
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It's time for an Invicta FC 38 Preview. Here's what to expect in Kansas City.
Invicta FC 38 will go down Friday night in Kansas City. The card is headlined by a pair of title fights that should be very interesting. In the feature bout, Vanessa Porto will defend her Flyweight title against challenger Karina Rodriquez. We previewed Invicta FC 37 and that was a great event as well.
Vanessa Porto vs. Karina Rodriguez
Vanessa Porto is currently the Invicta FC flyweight champion. She won the title back at Invicta FC 34 after the fight was stopped in the fourth round following an illegal eye-poke that forced an early end to festivities. They went to the cards and Vanessa Porto won a clear decision over Pearl Gonzalez.
Porto brings to the cage a wealth of experience and enters this fight having won three in a row, two via stoppage. She possesses a well-rounded game and has victories over respected fighters like Milana Dudieva, Zoila Frausto, Tara LaRosa, and Jennifer Maia among others.
Karina Rodriquez has a giant opportunity here to leave Kansas City the champion of the world. She earned her way into this fight by winning five of her last six, including her last two consecutive fights in an elimination tournament. At Invicta FC 35 she bested DeAnna Bennett and that moved her into this title fight.
Heading into this fight Vanessa Porto is the favorite, and rightfully so. She's the more technical and experienced fighter. That being said, Rodriguez is craft and she brings a lot of skills to the cage. In the end, expect this fight to go all five rounds, and in the end, Vanessa Porto should hold onto her belt via unanimous decision.
Kanako Murata vs. Emily Ducote
This fight is for the vacant strawweight championship, a title left vacated after Brianna Van Buren handed the belt she won in the Phoenix series tournament back to Shannon Knapp for an opportunity to compete in the UFC.
Kanako Murata (10-1) enters this fight having won six consecutive fights. She won her debut in Invicta FC over Liana Pirosin via Rear Naked Choke. Before that, she won three straight fights for Invicta. She's a very talented wrestler and brings a strong grappling game to the cage.
Emily Ducote came over to Invicta FC after a run in Bellator that saw her compete against Ilima-Lei Macfarlane for the flyweight title. It was the first of three consecutive losses in Bellator before being released. She made her promotional debut with Invicta FC in great fashion earning a first-round stoppage victory over Janaisa Morandin.
This should be a good fight, but expect Kanako Murata to bring too much wrestling to the table for Ducate. In the end, Murata will likely leave as the new strawweight champion following a stoppage.
The Rest of the Card
Mallory Martin vs. Cynthia Arceo – Mallory Martin should win here. She's a Contender Series veteran and a talented fighter. Areco is also a talented KOTC veteran. It should be a fun fight, perhaps FOTN material.
Shanna Young vs. Maiju Suotama – Shanning Young probably comes out victorious here, although neither of these fighters have looked great in their Phoenix series tournament fights.
Lisa Verzosa vs. Kerri Kenneson – Lisa Verzosa has a ton of potential and comes into this fight undefeated in her career.
Shaianna Rincón vs. Auttumn Norton – This could be fun, but Rincon likely pulls this off, as she has a lot of stoppage victories in her young career and has more experience than Norton.
Serena DeJesus vs. Taneisha Tennant – There is not much information available on either of these fighters, as they are each making their second professional MMA appearance and their Invicta FC debuts.


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I love everything about skirt suits, but they are hard to find today outside of super professional ones. They're so ladylike and emulate the sophistication that women, such as Jacki Onassis Kennedy, wore in the 1960's. My husband gave me a vintage wool skirt suit for Christmas and needless to say it was perhaps my favorite gift. He found it from this Etsy shop, Daisy & Stella Vintage, that has tons of really stylish retro dresses.
2 Comments on The Vintage Skirt Suit
Love this post!! You look fabulous!!


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Revista geológica de Chile
versión impresa ISSN 0716-0208
GORDILLO, Sandra; RABASSA, Jorge y CORONATO, Andrea. Paleoecology and paleobiogeographic patterns of mid-Holocene mollusks from the Beagle Channel (southern Tierra del Fuego, Argentina). Rev. geol. Chile [online]. 2008, vol.35, n.2, pp.321-333. ISSN 0716-0208. http://dx.doi.org/10.4067/S0716-02082008000200007.
As the Beagle Channel lies between the Atlantic and the Pacific oceans, this is a critical region for the interpretation of faunal distributions in the Magellan Region. This work proposes a paleoenvironmental interpretation of the Holocene, inferred from malacological data. The development of different local benthic paleocommunities during the mid-Holocene is associated with the diversity of habitats inside this channel. The analysis of records of Venus antigua and Ensis macha through time and their geographic links to ecological factors showed that these taxa are typical elements of the cold-temperate seas throughout the Magellan Region, showing a similar range of distribution and paleodistribution. The presence of these taxa in life position (AMS 14C of 6,276±41 years BP) suggests that during the mid-Holocene the Beagle Channel was a path for dispersion of these taxa between the two oceans. Whether Venus antigua andEnsis macha are Pleistocene survivors or Holocene migrants is herein discussed. In the future, integrated cross-disciplinary studies will be necessary for a better understanding of the biogeographic relationships among magellanic mollusks.
Palabras clave : Paleoecology; Mollusca; Holocene; Tierra del Fuego.


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He's been a leading thinker on health care issues for more than 25 years and has had the attention of numerous lawmakers on the health policy issue of managed competition, including former President Bill Clinton and Tennessee Rep. Jim Cooper. Now Alain Enthoven is coming to Vanderbilt Law School on Nov. 9 to discuss "Health Reform: From the Managed Competition Act of 1992 to the Campaign of 2008."
Enthoven, the Marriner S. Eccles professor of public and private management emeritus at the Stanford Business School, is considered the "father of managed competition." He advocates a type of universal health care that relies on private companies, using market-based incentives that he believes reduces medical costs and increases economic accountability and quality of care.
Enthoven was a consultant to the Department of Health and Human Services in the Carter administration, where he designed a plan for universal health insurance based on managed competition in the private sector. He provided the foundation for what became the Clinton administration's proposed health care reform plan in the early 1990s and worked closely with Cooper in 1993 and 1994 during the debates about health care reform. He was also influential in the development of the market-based reforms to health care adopted when Margaret Thatcher was prime minister of Britain.
Enthoven is the inaugural speaker for the first Cooper Health Policy Lecture, being held Nov. 9 at 2:30 p.m. in the Hyatt Room of the Vanderbilt Law School. The lecture is free and open to the public.
The annual lecture honors Cooper and is designed to bring a leading thinker on health policy issues to Vanderbilt and the Nashville community. It is also intended to recognize the important health policy contributions of the late Vice Chancellor for Health Affairs, Emeritus Dr. Roscoe (Ike) Robinson.
The series is sponsored by the Vanderbilt Law School, Vanderbilt Institute for Public Policy Studies (VIPPS) and the Vanderbilt University Medical Center. The organizers of the lecture are Vice Chancellor for Health Affairs Dr. Harry Jacobson and University Professor James F. Blumstein, who has appointments at the law school and the medical school and serves as director of the Health Policy Center at VIPPS.
Special thanks are extended to Vice Chancellor for Health Affairs Harry Jacobson, Vanderbilt Law School Dean Edward Rubin, Vanderbilt Medical School Dean Steven Gabbe and Dr. Robert Collins of the medical school in facilitating this lecture series.
Media contact: Amy Wolf, (615) 322-News