ABSTRACT Competitive advantage arises from a superior value that, rather than delivered by suppliers, is co-created by tourists. Using a set of destination competitiveness attributes, this study investigates the importance of destination competitiveness attributes in a 'hypothetical successful scuba diving destination' from the perspective of scuba diving tourists. Further, this study also investigates to what extent level of experience as a scuba diver influences the importance given to destination competitiveness attributes. An online survey (n = 712) identified 10 underlying factors (groups of attributes): diving operations, risk perception, diving conditions, price, destination management, big wildlife encounters, diving training, tech diving, general tourist attraction and visa policy. Furthermore, this research established that the attributes related to diving operations are the most important and that divers with different levels of experience value differently 6 of the 10 destination competitiveness factors. This research presents evidence that destination competitiveness may be explored through unique demands in tourism niches (and within niches) rather than generally for a destination.


A peculiar form of pigmented nevus consisting of grouped pigmented papules clinically was examined. It was found that these nevus cell nevi have a unique pattern of proliferation around and in the eccrine sweat duct in epidermal-dermal structures. I propose to call this type of nevus ``eccrine-centered nevus."


Purpose: To determine the independent effect of visual acuity on individual activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility. Methods: Cross-sectional survey on a sample representing the Finnish population aged 55 years and above. Of the 3392 eligible people, 3185 (93.9%) were interviewed, 2870 (84.6%) attended a comprehensive health examination, and 2781 (82.0%) had distance visual acuity (VA) assessed. A home interview included assessment of ADL, IADL and mobility, demographic variables and chronic conditions. Mobility measurements and binocular VA were assessed during the examination. Results: Prevalence of ADL, IADL, and mobility limitations increased with decreasing VA (p < 0.001). Visually impaired persons (VA ≤ 0.25) had ADL disabilities four times more likely than those with good VA (VA ≥ 0.8) after adjustment for socio-demographic and behavioral factors, and chronic conditions (OR 4.36, 95%CI 2.44–7.78). Limitations in IADL and measured mobility were five times as likely (OR 4.82, 95%CI 2.38–9.76 and OR 5.37, 95%CI 2.44–7.78, respectively), and self-reported mobility limitations were three times as likely (OR 3.07, 95%CI 1.67–9.63) as in persons with good VA. Conclusions: Decreased VA is strongly associated with functional limitations, and even a slight decrease in VA was found to be associated with limitations in functioning.


The concept of gene therapy dates back to the 1960s and 1970s and it is yet to come of age, as there is a paucity of reliable, long-term data on the safety and efficacy of this novel therapy. It is fast emerging as a promising approach to treat, cure or prevent genetic based diseases by correction of defective genes that are responsible for disease development. Gene therapy is a key treatment strategy for disorders caused by a missing or faulty gene. It involves introduction of functional genes into appropriate cells so that they can produce sufficient amounts of proteins, encoded by the transferred gene or turn off genes that are causing problems and eventually resulting in permanent correction of the disorder. While the concept of gene replacement therapy is mostly suitable for recessive diseases, novel strategies have been suggested that are capable of also treating conditions with a dominant pattern of inheritance. Gene therapy treatments are of broadly two types, Germline gene therapy, & Somatic Germline gene therapy. There are two methods for administering gene therapy -Ex vivo & in-vivo. There are two main parts to gene replacement: Genes and Vectors. Gene therapy is useful for hematologic conditions as Hemoglobinopathies, Hemophilia and Inherited bone marrow failure. Future Prospective of Gene Therapy in Transfusion Medicine ,work is being done to explore ex vivo generation of RBCs utilizing various cell fractions, including hematopeitic progenitor cells from cord blood and adult sources. Cost of therapy and ethical issues are the limiting factors for the use of Gene therapy.


Metal ions, which are present in ocular fluids, can significantly decrease the bioavailability of fluoroquinolones. This in vitro study investigated the bioavailability of ofloxacin and ciprofloxacin in the presence of two balanced salt solutions, BSS-Plus and AMO Endosol, commonly used as irrigants in cataract surgery. Minimum inhibitory concentrations (MICs) and antibiotic susceptibility were determined through broth dilution methods and a standard disk diffusion bioassay with Escherichia coli. Although neither solution affected the in vitro antimicrobial activity of ofloxacin, both markedly decreased that of ciprofloxacin. In BSS-Plus and AMO Endosol, the MICs of ciprofloxacin for several ocular isolates were increased, indicating decreased susceptibility to that drug; the activity of ciprofloxacin against E. coli was also decreased. Because the composition of BSS-Plus is similar to that of human aqueous humor, the clinical efficacy of ofloxacin may be unaffected by the ionic composition of the aqueous humor. In contrast, because the antimicrobial activity of ciprofloxacin was diminished in BSS-Plus, the clinical efficacy of this fluoroquinolone against deep ocular infections may not be as great as indicated by standard laboratory antibiotic susceptibility testing.


The relatively new and rapidly expanding field of comparative genomics provides a wealth of data useful for testing the hypothesis that humans and other forms of life share common ancestry. Numerous independent lines of genomics evidence strongly support the hypothesis that our species shares a common ancestor with other primates. Additional lines of evidence also indicate that our species has maintained a population size of at least several thousand individuals since our speciation from the ancestors of other great apes. This article will provide an overview of genomics evidence for common ancestry and hominid population sizes, and briefly discuss the implications of these lines of evidence for scientific concordist approaches to the Genesis narratives.


As an extension of the VaR-constrained hedging, we propose a closed-form solution to the problem of optimizing portfolios, based on price and weather. For electric power companies, price and quantity are volatile, and in hydro-electricity generation quantity can be related to weather conditions. An optimum portfolio is derived from expected utility maximization problem, including weather indices to minimize losses. Due to electric power features, agents in this market are facing price and volume risks, the difficulty to storage efficiently electric power cannot permit to mitigate volumetric risk and alternatively weather instruments can be used in order to hedge unexpected changes in weather; the purpose of weather derivatives is to smooth out the temporal fluctuations in the company´s revenues. For electric power companies price and quantity are volatile, and quantity is correlated to the weather conditions. Moreover, exposures to price and volume risks make necessary the inclusion of the weather pay-off. Thus, we derive the optimal portfolio from the expected utility maximization problem including electric power and weather derivatives whose payoffs will minimize losses.


Retail industry is fast changing. All facets of business are undergoing a change. The global and the local business are causing as well as adapting a change. Jewellery buying for a very long tie has had a traditional pattern of buying behaviour. There were family jewellers, and a family purchase. While the money was given by the father or husband the final decision maker was the women. All models of consumer buying behaviour has adopted to the change. The diamond jewellery buying that too on-line has a generated a curiosity, because it has a route of high tradition. The present paper examines the growth, factors and current scenario of purchasing diamond jewellery through online retail formats as well as buying behaviour from branded retailers. It is a descriptive research , survey method has been used for data collection through a structured questionnaire. The first part of the research which was a qualitative research had personal interview with experts and review of lieterature, followed by secondary data search. Some of the key findings were that Indian consumer buy precious jewellery like diamond jewelleries for fashion as well as special occasions and to have a strong attributes in maintaining social status during social function and gathering and they always buy from trusted branded outlets. Other Attributes are like store service for branded jewellers seem to be far superior to the traditional outlets and quality satisfaction is very high with branded jewellers. Working women are greater purchasers of diamond jewellery and indulge more in impulse purchase. Online currently has arelatively low reach in India. It is more like a pre-purchase tool. In India, 12per cent of women use the internet to pre-select designs or learn more about diamond jewellery. However, as internet penetration and sales of smart phones accelerate, online buying is likely to gain importance, both as a sales channel and as search tool. The changing socio-economic perspectives adds boon to the jewellery industry.


Despite the technological progress in robotics, mechatronic limbs still lack functionality, reliability and comfort. This work builds upon osseointegration and implanted neuromuscular interfaces for the realization of an embedded system for artificial upper limb control. The controller allows for bioelectric signals acquisition, processing, decoding and prosthetic control. It includes a neurostimulator to provide direct neural feedback aimed for restoration of tactile sensations. It was designed to be reliably used in activities of daily living, as well as a research platform to monitor prosthesis usage and training, machine learning based control techniques and neural stimulation paradigms. The system has passed bench tests and its functionality was proven in a first pilot patient.


: The stenting of the tracheobronchial tree has become common method of palliative treatment in inoperable cases. The patients with malignant tracheal stenosis constitute the most numerous group. The airway patency should be restored prior to inserting the stent. The stent protects both trachea and bronchi from narrowing their lumen with malignant tissue. When malignant infiltration is accompanied by airway compression the stenting is the method of choice. The own model of tracheobronchial prosthesis has been invented. It enables the protection of both trachea and the bronchi. The stent is inserted endoscopically on rigid bronchoscope. It is the method of stenting, which allows the visual control during the whole procedure.


ABSTRACT Swanson, R.L.; Giglio, K.W., and Chi, L., 2021. Restoring a degraded, sentinel New England salt marsh to mid-20th century conditions (Flax Pond, New York, U.S.A.). Journal of Coastal Research, 37(5), 993–1011. Coconut Creek (Florida), ISSN 0749-0208. Flax Pond, located between Crane Neck and Old Field Point on the north shore of Long Island, is designated as a Significant Coastal Fish and Wildlife Habitat by the U.S. Fish and Wildlife Service and as a Scenic Recreational Reserve by the New York State Department of Environmental Conservation. The pond's tidal prism has been reduced about 18% over the past half-century as its inlet has shoaled and its tidal range diminished 33%, 0.6 m, all in low water. Reduced flushing has led to loss of wetlands, reduced water quality, increased pond salinity, and nighttime summertime hypoxia with concomitant reduction in pH. Historic charts, topographic surveys, and vertical aerial photographs were used to study the evolution of the pond's inlet from Long Island Sound (LIS). Tide, tidal current, and water quality observations were made and/or historical measurements were acquired at these locations: the pond's inlet, a proposed seawater intake for the Flax Pond Marine Laboratory, and the U.S. Geological Survey (USGS) water quality station some 650 m into the pond. The flux of water through the inlet from LIS and the change in bed slope through the pond inlet were measured. USGS data within the pond were used to determine when hypoxic conditions are likely to occur: an increase in bottom-water salinity of 2.1 in 9 years and in the elevation of low water of 18 mm y–1 from 2008–14. The environmental benefits of reconfiguring the inlet to increase the tidal prism to that of the 1970s were explored. This would reduce the existing flushing time by more than 50%. The design of the cross-sectional shape for the inlet is based on this tidal prism and a compatible depth entering LIS; it should stabilize the inlet opening and improve much needed pond flushing.


Leptin is thought to regulate energy balance through effects on food intake and thermogenesis. In addition, leptin may serve as a mediator of the neuroendocrine response to starvation, and may modulate the stress response and the timing of puberty. A role for leptin in development is suggested by the presence of neuroendocrine and structural neuronal abnormalities in ob/ob mice with genetic leptin deficiency. Here, we sought to determine the ontogeny of leptin expression and its relationship to the developing neuroendocrine axis. Leptin increased 5-10-fold in female mice during the second postnatal week independent of fat mass, and declined after weaning. The rise in leptin preceded the establishment of adult levels of corticosterone, thyroxine, and estradiol. In contrast to adult mice, leptin was not acutely regulated by food deprivation during the early postnatal period. Circadian rhythms of leptin, corticosterone, and thyroxine were regulated by food intake in adult mice. When ad libitum feeding was restricted to the light cycle, peak corticosterone levels were shifted to the beginning of the light cycle and coincided with the nadir of leptin. The inverse relationship between leptin and corticosterone was maintained such that a rise in leptin after feeding was associated with a decline in corticosterone. To determine whether changes in corticosterone during food restriction are mediated by leptin, we compared the patterns of corticosterone levels among ob/ob, db/db, and lean mice. Despite their higher basal levels of corticosterone, leptin deficiency in ob/ ob mice did not prevent the nocturnal rise in corticosterone. In contrast, the nocturnal surge of corticosterone was blunted in db/db mice. Therefore, it is likely that factors in addition to leptin are involved in the regulation of the circadian rhythm of corticosterone. The temporal relationship between leptin and other hormones in neonatal and adult mice suggests that leptin is involved in the maturation and function of the neuroendocrine axis.


In this case report we present a singular case of metabolic acidosis seen in a 78-year-old female who was admitted to the intensive care unit (ICU) with dyspnoea, tachypnoea and tachycardia due to paracetamol and flucloxacillin usage. Laboratory examination revealed a high anion gap metabolic acidosis caused by accumulation of 5-oxoproline, otherwise known as pyroglutamic acid. Treatment consisted of discontinuation of the offending drugs and supportive care with sodium bicarbonate, inotropic medication and mechanical ventilation. Seven days after ICU admission, treatment was complicated by recurrence of metabolic acidosis after discontinuation of sodium bicarbonate. Our patient also developed 5-oxoproline-associated metabolic encephalopathy. We demonstrate that the elimination of 5-oxoproline will take longer than expected. Furthermore, this case clearly illustrates the potentially unexpected delayed clearance of 5-oxoproline. We also briefly discuss treatment modalities.


Aims To determine the effectiveness of acupuncture as a therapy complementary to the pharmacological treatment of osteoarthritis of the knee. Methods Randomised, single blind, placebo controlled trial. Patients with osteoarthritis of the knee were randomly assigned to either 12 sessions of true acupuncture or 12 sessions of placebo acupuncture (Streitberger needle), these sessions taking place once a week. A baseline measurement was carried out, followed by further observations at 4, 8, 12 and 16 weeks. The clinical variables were the WOMAC (Western Ontario and McMaster Universities Osteoarthritis) index, knee pain measured by a visual analogue scale (pain VAS), the weekly consumption of diclofenac and the Profile of the Quality of Life of the Chronically Ill (PQLC). The two groups were compared for each of the clinical variables per protocol and by intention to treat. A multiple linear regression model for the dependent variables was constructed. Results Ninety seven outpatients were selected, with 88 remaining for the per protocol analysis; the analysis of homogeneity concluded that the lost subjects were not significantly different from those that completed the study. The multivariate per protocol model for the relative pain VAS variable showed a difference in improvement of 43.7% (95% CI 29.4% to 58.0%) for acupuncture, compared with the control group. In an intention to treat analysis, the relative improvement was 32.4% (20.3% to 44.4%). In a per protocol analysis, the total WOMAC showed a relative decrease of 52.0% (34.3% to 69.6%) in favour of the acupuncture group, or 37.6% (22.4% to 52.8%) in an intention to treat analysis. Conclusions The group treated with acupuncture showed significantly better effects, both clinically and statistically, in the reduction of pain intensity as measured by pain VAS, on the WOMAC index and in decreased consumption of diclofenac.


An online survey was conducted to assess the feasibility of providing training on the use of social media for the Extension Master Gardener (EMG) program. Volunteers (n = 1,275) and coordinators (n = 111) responded. Findings indicate the existence of sufficient interest in a nationally coordinated social media training. Inclusion of social media as a qualifying activity in EMG programs should be explored. Findings support inclusion of volunteers in future surveys and the possible need for increased involvement of volunteers in setting program direction. Training is being developed on the basis of the data. Future surveying of the EMG population by using random sampling to more accurately define the audience is strongly encouraged.


White mice of the Nya: NYLAR strain were infected with coxsackie B1 or B4 virus and studied for persistence of virus, antibody conversion, histologic changes, and glucose tolerance during periods up to 13 months. Pancreatitis was observed during the acute phase of infection. Suggestions of subclinical diabetes were found during the first six months after virus inoculation. A normal glucose tolerance at 10 to 13 months suggests that the functional lesion is temporary.


In this paper, we report the breakup dynamics of double emulsion droplets, as they flow through the bifurcating junction in bi-layer microchannel. Two cases have been investigated: the first involves double emulsion with core of water and shell of silicone oil with constant interfacial tension, this case shows that breakup dynamics of double emulsion can be demarcated into three regimes when the thermal effect is not dominant; whilst the second involves double emulsion with core of water and shell of dodecanoic acid where the thermocapillarity effect arises from change of interfacial tension subject to temperature variations. As demonstrated in the case, the Marangoni stress induced by the thermocapillary effect plays an important role in controlling the stability and release kinetics of double emulsion when flowing through complex microstructures. Our work will inspire novel applications, including droplet fission and actuation controlled by Marangoni flow via thermal mediation.


This study explored the social support among women impacted by human immunodeficiency virus (HIV) living in the Province of San Pedro de Macoris, Republica Dominicana. Social support is one way that social networks can influence health status. Social networks impact health behaviors and overall health outcomes which include infectious diseases, morbidity rates, and mortality rates. Social networks can promote health and minimize risky behavior: "cohesive, supportive networks may themselves blunt stressful experiences and enable people to resist risky behavior and maintain healthier choices" (Berkman, Kawachi, & Krishna, 2014, p. 248). Qualitative methods were used to explore how social support systems impacted the personal experience of women living with HIV. Each Dominican woman described her own moral trajectory ranging from non-acceptance of HIV as an incurable disease to acceptance of living with HIV as a health condition in everyday life. The thematic analysis indicates that social support was instrumental for each woman throughout her journey and process of coming to terms with her HIV diagnosis and taking control of her life. Family, God, the Clinica Esperanza y Caridad (Clinic) and the support group were forms of social support frequently expressed in their narratives and represented their social networks.


Prairie dog (Cynomys ludovicianus) control has historically consisted of lethal methods to maintain, reduce, or eliminate populations in South Dakota and throughout the species range. Non-lethal methods of control are desired to meet changing management objectives for the black-tailed prairie dog. The use of naturally occurring buffer strips as vegetative barriers may be effective in limiting prairie dog town expansion. The objectives of this study were: 1) to evaluate effective width of vegetative barriers in limiting prairie dog towns expansion in western South Dakota; and 2) to document effect native vegetation height on expansion of prairie dog towns in western South Dakota. Five study sites were established in western South Dakota on rangelands containing prairie dog towns of adequate size. Electric fences were constructed for the purpose of excluding cattle and creating buffer strips of native grasses and shrubs. Prairie dogs were poisoned to create a prairie dog free buffer zone adjacent to active prairie dog towns. Grazing was allowed on both sides of the buffer strip. When grazing pressure was not sufficient, mowing was used to simulate grazing. Buffer strips were 100 meters long and 10, 25, and 40 meters in width. A zero meter control was included on all study sites. Quadrats (25) were randomly distributed throughout the buffer strips. Evaluation of study sites included visual obstruction, vegetation cover, vegetation frequency, vegetation height, and vegetation identification. Barrier penetration was evaluated by the presence of new active burrows behind vegetative barriers. Significant relationships were documented for both VOR and vegetation height. No significant difference was found between frequency of breakthroughs and buffer widths.


Background Students enrolled for the Bachelor of Radiography degree at the Central University of Technology Free State in Bloemfontein, South Africa, spent many weeks off campus at hospitals during workplace learning. A design-based research approach was applied to analyse an educational problem, namely that students apparently fail to apply the theory of radiation safety regulations to protect themselves and patients. Aims The purpose of the study was to develop authentic activities and assessment for radiation safety requirements, to provide flexible learning in a blended environment to students off campus. Setting The second-year radiography students of 2016 and 2017 responded off campus to the QuestionPro survey. Method Authentic learning and assessment opportunities were contextualised and compiled to align with learning outcomes of the safety regulations as confirmed during a Delphi process. Flexible learning opportunities were delivered via electronic mail (email) and WhatsApp. Assessment responses from the students were received via mobile phones with a Web-based software tool, QuestionPro. Results Of the 117 students, 92.3% responded to the QuestionPro survey. From the incorrect responses, learning areas that needed revision were identified, as well as the areas in the X-ray departments of the hospitals showing non-compliance with the requirements for radiation safety. Conclusion The three outcomes of this design-based research included the formulation of design principles, a designed product in the form of a Website and professional development of the researcher. The design-based research principles that were tested involved the use of knowledge in real life and measuring if students were effective performers with acquired knowledge.


On March 22, 2012, the Select Committee on Dying with Dignity of the National Assembly of Quebec released its final report recommending the adoption of "medical aid in dying" in the province of Quebec, Canada.  The majority of palliative care physicians, professed experts in end of life care, rejected the committee's conclusion.  And yet, the recommendation of the committee, in framing euthanasia as "medical aid in dying," placed the practice squarely within the realm of their putative expertise. The objective of this project is to examine the role of palliative care physicians in the Dying with Dignity debate in Quebec and to answer the following question: why were palliative care practitioners unable to influence the outcome of the debate? My methods include a detailed analysis of the committee proceedings of the Select Committee on Dying with Dignity and a review of the sociological literature on committees and on expertise, the philosophical literature on euthanasia, and the historical literature on palliative care. I draw broad conclusion about: (i) committees, and the way in which committee formation and format prioritize certain societal values; (ii) medical expertise, and the devaluation of certain forms of knowledge in the evidence-based medicine framework; (iii) moral expertise, and its presumed absence in Western democratic society.


Randomized controlled trials have demonstrated that the collaborative care model for depression in primary care is more effective than usual care, but little is known about the effectiveness of this approach in real-world settings. We used patient-reported outcome data from 11,303 patients receiving collaborative care for depression in 135 primary care clinics to examine variations in depression outcomes. The average treatment response across this large sample of clinics was substantially lower than response rates reported in randomized controlled trials, and substantial outcome variation was observed. Patient factors such as initial depression severity, clinic factors such as the number of years of collaborative care practice, and the degree of implementation support received were associated with depression outcomes at follow-up. Our findings suggest that the level of implementation support could be an important influence on the effectiveness of collaborative care model programs.


The breakdown process of the initial large‐scale structures into substructures near the end of the potential core is examined and the production of aerosound as a result is discussed. The quadrupole‐like directivity pattern of jet noise is numerically obtained by applying the large‐eddy simulation (LES) technique for the fluid flow. The Lighthill analogy is used to obtain the acoustic far field. Most of the sound comes from a region near the end of the potential core. A discussion to explain this quasiaxisymmetric directivity pattern is given. The directivity maximum is obtained at about 45° from the axis of the jet exhaust. This will be explained in terms of turbulent velocities. The convective effect on sources is introduced by ray tracing to calculate retarded times. The result is to obtain more radiation downstream, as is observed. The relation of this correction to the Lighthill theory will be discussed.


Finding an operational parameter vector is always challenging in the application of hydrologic models, with over‐parameterization and limited information from observations leading to uncertainty about the best parameter vectors. Thus, it is beneficial to find every possible behavioural parameter vector. This paper presents a new methodology, called the patient rule induction method for parameter estimation (PRIM‐PE), to define where the behavioural parameter vectors are located in the parameter space. The PRIM‐PE was used to discover all regions of the parameter space containing an acceptable model behaviour. This algorithm consists of an initial sampling procedure to generate a parameter sample that sufficiently represents the response surface with a uniform distribution within the "good‐enough" region (i.e., performance better than a predefined threshold) and a rule induction component (PRIM), which is then used to define regions in the parameter space in which the acceptable parameter vectors are located. To investigate its ability in different situations, the methodology is evaluated using four test problems. The PRIM‐PE sampling procedure was also compared against a Markov chain Monte Carlo sampler known as the differential evolution adaptive Metropolis (DREAMZS) algorithm. Finally, a spatially distributed hydrological model calibration problem with two settings (a three‐parameter calibration problem and a 23‐parameter calibration problem) was solved using the PRIM‐PE algorithm. The results show that the PRIM‐PE method captured the good‐enough region in the parameter space successfully using 8 and 107 boxes for the three‐parameter and 23‐parameter problems, respectively. This good‐enough region can be used in a global sensitivity analysis to provide a broad range of parameter vectors that produce acceptable model performance. Moreover, for a specific objective function and model structure, the size of the boxes can be used as a measure of equifinality.


Welcome to this decades first edition of Journal of Child Health Care. Before moving on I would like to take this opportunity and thank all those who have helped make the previous decade a successful one for this journal. With this New Year and decade comes some journal changes. As you may have heard Philip Darbyshire has now stepped down as Editor in Chief. I am honoured to have been offered this role.

Taking on an Editor in Chief role for the Journal of Child Health Care entails attempting to fill some big shoes. Both Bernie Carter and Philip Darbyshire (Carter and Darbyshire, 2018) have their place in paediatric nursing's hall of fame, yet they are both kind and generous with their time. Certainly both warrant being listed as part of Nursing's 'thriller elite' (Darbyshire and Thompson, 2014).

As Philip steps back from Journal of Child Health Care and attempts to retire, I thought I would offer some personal reflection on Philip's impact on my career. Back in 1995, when I started my children's nursing training, 'Living With a Sick Child in hospital' had just been published (Darbyshire, 1994). I devoured this book. Not least because this important research had been carried out in the same hospital that I was training to be a children's nurse but because insights from this book helped shaped my practice as a paediatric nurse.

In a foreword for 'Living With a Sick Child in hospital' Living Legend Patricia Benner (American Academy of Nursing, 2019) describes this book as a 'profound work'. High praise indeed. In Alison Copley's (1997: p 23) book review she stated that this 'book is relevant for both the undergraduate and the post-graduate nurse'. In delivering content to aspiring, and current, children's nurses I still continue to recommend this relevant highly book. Now out of print it is available for free from https://philipdarbyshire.com.au/books

Another, more personal, impact on me was the realisation that nurses (and males) could earn the title of Doctor. This fact was part of my inspiration to start and continue my doctoral journey. It was an awkward moment in 2012 when at the International Council of Nurses Conference in Melbourne I first met Phillip and attempted to explain this in person. Later in my career, further valuable insights into nursing academia came from articles exploring Thriller and Killer Elite of nursing (Darbyshire and Thompson, 2014; Thompson and Darbyshire, 2013).

Phillip, thank you for all that you have done for nursing and for the Journal of Child Health Care.

As one chapter closes another edition begins. As a new Editor-in-Chief I look forward to receiving and reviewing your future manuscripts. A frustration for many authors can be publication delays. These delays can happen at multiple phases in a manuscript's life. The Journal of Child Health Care team, and I, will endeavour to reduce these delays as far as possible. However, some delays can be reduced by authors and reviewers.

During my doctoral journey I learned to edit. For a previously below par at English secondary school student, this was a new skill. Learning to edit was aided by some useful texts (Kaplan, 2012; Strunk and White, 2000) and advice from many tolerant friends. For those aspiring authors, hoping to publish with Journal of Child Health Care, you are advised to continue your editing discovery journey. This will help expedite your manuscript through our journal processes and increase your chances of manuscript acceptance.

An integral and indispensable part of a peer reviewed journal are its reviewers. This is an essential element that sets journals such as Journal of Child Health Care apart from the deluge of 'predatory' non-journals, whose spam emails no doubt clog up your email inbox. Many frustrating publishing delays are caused by an inability to find reviewers. If we are to continue a fight against predatory publishers (Darbyshire et al., 2016; Darbyshire, 2019), when a review request is received from a reputable journal such as ours please try to say yes. This will help maintain academia's valued peer reviewed basis and help ensure that when you read something or see something cited in 'the literature', that it absolutely deserves to be there.


Abstract. We examined the vertical and temporal dynamics of nutrients, ectoenzymatic activities under late summer-fall transition period (September–October 2004) in NW Mediterranean Sea in relation to temporal change in factors limiting bacterial production. The depth of the mixed layer (12.8±5.3 m) was extremely stable until the onset of the destratification period after 11 October, creating a zone where diffusion of nutrient from the much deeper phosphacline (69±12 m) and nitracline (50±8 m) was probably strongly limited. However after 1st October, a shallowing of nutriclines occured, particularly marked for nitracline. Hence, the nitrate to phosphate ratio within the mixed layer, although submitted to a high short term variability, shifted the last week of the cruise from 1.1±1.2 to 4.6±3.8, and nitrate increased by a factor 2 (0.092±0.049 μM). A corresponding switch from more than one limitation (PN) to P-only limitation of bacterial production was observed during the month as detected by enrichment bioassays. Differences in the identity of the limiting nutrient in surface (5 m: N and P at the beginning, strictly P at the end of the study) versus 80 m (labile carbon) influence greatly bacterial community structure shift between these two layers. The two communities (5 and 80 m) reacted rapidly (24 h) to changes in nutrient concentrations by drastic modification of total and active population assemblages resulting in changes in activity. For bacterial production values less than 10 ng C l−1 h−1 (associated to deeper layers), aminopeptidase and lipase exhibited higher activity relative to production whereas phosphatase varied in the same proportions than BP on the range of activities tested. Our results illustrate the effect of bottom-up control on bacterial community structure and activities in the epipelagic NW Mediterranean Sea.


The lordship of the Beccaria, a branch of the great family from Pavia, on Arena Po, was established at the end of the thirteenth century, taking advantage of both the financial difficulties of the small municipality and the power of the family in Pavia. It was meant to last for centuries. Managed in a consortium form by various Beccaria exponents, it encountered difficulties also in relation to the political events of the duchy. Various documents are examined to investigate the nature, modalities and reality of the relations between the lords and the land in the final centuries of the Middle Ages, especially from the fiscal, economic and agricultural point of view.


The development of a global model for oxygen steelmaking and its validation against industrial data was reported in Part 1 of this paper. This paper focused on the development of one sub-model on the decarburization reaction in the emulsion zone incorporating the bloated droplet theory. This paper also critically evaluated the current knowledge on the kinetics of decarburization reaction in the emulsion phase and discussed the repercussions of the new model for industrial practices. The decarburization model, in conjunction with the industrial data, indicates that the decarburization rates in the emulsion phase reaches up to approximately 60% of the overall decarburization rate during the main blow. It was found that the residence time of droplets as well as decarburization reaction rate via emulsified droplets was strong function of bloating behavior of metal droplets in the emulsion phase. The estimated residence times of the metal droplets in the emulsion were between 0.4 to 45 s throughout the blow. The influence of variations in droplet size and ejection angle on residence time and decarburization rates via emulsified droplets was also investigated. It was shown in this study that the decarburization rates in the emulsion were accelerated if droplet size was decreased or if the ejection angle was decreased.


Alexander Vassiliev's notebooks fill in long-standing gaps in historians' understanding of Soviet nuclear espionage in the western United States during the Second World War and Cold War. Scholars are, in effect, finally able to see some of the most notorious spy cases in modern history from the Soviet side. The notebooks exonerate some individuals who were accused of spyingand whose careers were ruined as a resultwhile confirming the guilt of others. These revelations include an arguably definitive answer to a question that has been the centerpiece of Cold War controversy for more than half a century: whether the renowned American physicist J. Robert Oppenheimer was, as alleged at the time, an agent of the Soviet Union. The new evidence indicates that he was not a spy.


Introduction: The Region of North Denmark has a high incidence of malignant mesothelioma (MM) of 6.2/100.000 for men and 1/100.000 for women mainly due to large-scale use of chrysotile asbestos. Aims: The aim of the study is to investigate gender differences in asbestos exposure and disease location for MM. Methods: Histopathological samples of 236 men and 91 women with MM were retrieved from the Institute of Pathology, Aalborg University Hospital. Asbestos exposure information was harvested from medical records and Danish registries. Asbestos exposure type was categorized as primary, for asbestos workers; domestic, referring to patients living with an asbestos worker; environmental, defined as living or working within 10.000 meters from asbestos emitting location; unknown, where no source of asbestos exposure could be identified. MM location was classified as pleural (MPM) or peritoneal (MAM) disease. Paired T-tests were used to compare the groups (men versus women). Results: Primary asbestos exposure was observed in 88% of men and 9% of women. Significantly more women than men had secondary (domestic, environmental or both) asbestos exposure (P Conclusions: The main cause of MM in men seems to be primary, in women secondary asbestos exposure. MAM was significantly more frequent in women. Both findings need further study.


Summary This master?s thesis is focused on the design of grid connected PV power stage inverter. This inverter will be used for solar power application in the renewable energy laboratory at NTNU. The designed power stage inverter is a single phased 1kW, 230 V at the output. The DC/AC power stage converter is able to convert the minimum available voltage at the PV array of about 100V DC. The grid connected PV power stage inverter is designed in Multism and implemented in NI labView for simulation and analysis of output voltage and current. To achieve this goal, several literatures will be studied related to the work in this thesis. The choice of the best circuitry topology must be made and important parameters for the power stage inverter should be calculated/estimated. The control strategy for the power stage inverter shall be proposed and the expected desired output shall be analyzed in LabView and compared to the standard one (Grid output). Problem Description At NTNU a laboratory for renewable energy is under construction. This lab emulates several different renewable energy sources connected together. The power from the PV panels mounted outside on the building will be available for connection in the laboratory. A survey of control structures for the inverter when used as a grid connected PV inverter will be made. Based on this a suitable control will be chosen, which will include methods for grid synchronization, maximum power utilization, anti-islanding and current/voltage control. System models must be developed, which shall form a basis for controller parameter estimation. In the project the instrumentation system for collection of operation information of the PV plant into a database will be designed based on EtherCAT network. The purpose of this database is to collect and archive performance, reliability and operating cost data for this PV based distributed power systems. This thesis focused on the design of the single phase converter power stage. Important parameters for the inverter stage will be proposed. The converter is designed in Multism and implemented in LabView for the control of the output and user interface. The remaining task to accomplish the whole NTNU project in this laboratory will be the proposal of the control system.


Particulates from diesel engine consisting of particles of carbon, sulphates, oil, fuel and water are measured by filtering a sample diluted in a partial or full flow tunnel according to strict standards and weighing them. However, these methods suffer from high initial and running costs. On the other hand, filter smoke meters measure the light reflected from a filter paper through which a known volume of exhaust gas is passed and Opacity meters measure light absorbed by a standard column of exhaust. They measure visible black smoke easily at reasonable expenditure. Today, these simple instruments are highly developed to control measurement noise, resolution and repeatability, and can be used to estimate carbon soot precisely. Adding contribution of oil and sulphates from fuel helps in estimating the Particulate Matter measured in ISO 8178 R49, D2 and C1 as well as ESC cycles up to EUStage IIIA, India CEV Stage IIIA, Euro III (India BS III on-road) and India CPCB2 emission standards. In this paper, a method is given to predict PM from fuel properties, engine oil consumption and measured smoke. The estimated values of PM compared favourably with the estimated values with confidence margins enough to go for type testing.


This study compares the ability of four data mining techniques in the prediction of audit opinions on companies' financial statements. The research data consists of 37,325 firm-year observations for companies listed on the New York Stock Exchange (NYSE), the American Stock Exchange (AMEX), and the NASDAQ from 2001 to 2017. The dataset consists of U.S. companies' variousfinancial and non-financial variables. This study uses Decision Trees (DT), Support Vector Machines (SVM), K-Nearest Neighbors (k-NN), and Rough Sets (RS) to develop the prediction models. While all models developed by these four techniques predict the audit opinions with relatively high accuracy, the SVM models developed by RBF kernel demonstrate the highest performance in terms of overall prediction accuracy rates and Type I and Type II errors. The results indicate that all models developed using different algorithms demonstrate their highest performance in predicting going-concern modifications, ranging from 84.2 to 100 percent.


This article initially analyzes the 2016 political landscape to pinpoint the forces that fueled Donald J. Trump's campaign and election. Turning to artist Robert Lopez's performance as El Vez at San Diego's Taco Fest, I discuss how his performance conjoins Chicanidad with popular entertainment, using humour, spectacle, and music to forestall the defensive moves of white fragility, allowing him to speak across divisive lines. Lopez-as-El-Vez deftly sidesteps defensive reactions as he asserts uncomfortable racial truths. By grounding this show in the shared culture of popular entertainment, he uses performance to make a pointed political, cultural, and racialized intervention. In performance, El Vez not only outmaneuvers white fragility, but also constructs a contact-zone audiotopia that allows for the practice of a fun, messy, raucous collectivity. His performances lay bare the structures of racism as they simultaneously envision a more equitable future, accessible through El Vez himself. Karen Jean Martinson is an Assistant Professor in the Communications, Media Arts and Theatre programme. She also works professionally as a dramaturg and director.


Surface plasmon resonance (SPR) has been widely used as a powerful analytical technique for the study of a broad range of biomolecular interactions. With the capability of real-time detection, SPR allows convenient and nondestructive measurement of analyte concentration and binding kinetics. To improve the performance of SPR biosensing, we have developed a series of novel methods that lead to ultrasensitive detection via signal amplification by coupling inline atom transfer radical polymerization (ATRP) to a biospecific interaction. To adapt this enhancement method to the fragile lipid membrane-based system, initiator functionalized gold nanoparticles (AuNPs) has been used with in situ ATRP reaction, which allows sensitive measurement of lipid membrane binding proteins. In addition, conjugated nanoparticles AuNPs and Fe3O4 NPs have been employed to enhance protein detection sensitivity with SPRimaging. A novel Au-well microarray, fabricated based on spatial variation of metal thickness, is utilized to eliminate background resonance and provide better performance. To mimic cell membrane recognition processes, a membrane bilayer has been assembled onto a nanoglassified surface, and a synthesized water-soluble deep cavitand was incorporated into the supported lipid membrane. The incorporated cavitand retains its host properties and real-time analysis of the host:guest properties is carried out by SPR and fluorescence microscopy. To further explore the biomolecule interactions on cell membrane, we have studied the polymer growth at the lipid membrane-water interface using functional guest initiator that triggers an ATRP process. A variety of functional polymers have been grown at the lipid membrane surface, demonstrating different hydrophilicity and protein binding properties. Mass spectrometry in combination with SPR for comprehensive protein analysis has been explored to build a new technical platform. We have designed a thermoresponsive poly(N-isopropylacrylamide) (PNIPAAM) grafted surface, which demonstrates temperature-mediated hydrophobicity for enrichment of proteins based on hydrophobic interaction. SPR quantitatively measures the binding of proteins and peptides, and the biochip is directly interfaced with matrix assisted laser desorption/ionization (MALDI)-MS to characterize the bound analytes. It provides outstanding results in simple steps of on-plate desalting, offering news tools for effective proteomic analysis.


Abstract As part of an international,multicentered project, the burden of care, health, and subjective well-being experienced by select Australian family carers supporting a relative with disability at home were investigated. Some 448 family carers residing in New South Wales and Tasmania completed a battery of instruments, including a self-report demographic survey, the Family Caregiver Burden Inventory, the General Health Questionnaire, and the Personal Wellbeing Index. Respondents were predominantly females (mean age = 48 years), married, and supporting a son or daughter with an intellectual disability (mean age = 18 years). Although caring for their family member was not perceived to be a burden, respondents reported notable limitations on their social networks and social activities. They reported higher levels of unemployment than would be expected for the general population and were over represented in lower income groups. They reported seriously low levels of mental health and personal well-being when compared with the general population. The findings revealed that this group of family carers were at high risk of social and economic disadvantage and at high risk of mental health challenges. Social policy makers and service providers should take these factors into account, both in the interests of promoting the health and well-being of the carers and considering the long-term needs of family members with disability who rely on family carers for daily support when designing services.


Corn, with C4 photosynthetic
metabolism, often has no photosynthetic or yield response to elevated carbon
dioxide concentrations. In C3 species, the yield stimulation at elevated carbon dioxide concentrations often
decreases with nitrogen limitation. I tested whether such a nitrogen
interaction occurred in corn, by growing sweet corn in field plots in open top
chambers at ambient and elevated (ambient + 180 mmol·mol-1) carbon
dioxide concentrations for four
seasons, with six nitrogen application rates, ranging from half to twice the
locally recommended rate. At the recommended rate of nitrogen application, no
carbon dioxide effect on production occurred. However, both ear and leaf plus stem biomass were
lower for the elevated carbon dioxide treatment than for the ambient treatment at less than the recommended rate
of nitrogen application, and higher at the highest rates of nitrogen application. There were no significant
responses of mid-day leaf gas exchange rates to nitrogen application rate for either carbon dioxide treatment, and
elevated carbon dioxide did not significantly increase leaf carbon dioxide assimilation rates at any nitrogen
level. Leaf area index during vegetative growth increased more with nitrogen
application rate at elevated than at ambient carbon dioxide. It is concluded
that elevated carbon dioxide increased the responsiveness of corn growth to nitrogen
application by increasing the response of leaf area to nitrogen application
rate, and that elevated carbon dioxide increased the amount of nitrogen
required to achieve maximum yields.


The human complement Factor H–related 5 protein (FHR5) antagonizes the main circulating complement regulator Factor H, resulting in the deregulation of complement activation. FHR5 normally contains nine short complement regulator (SCR) domains, but a FHR5 mutant has been identified with a duplicated N-terminal SCR-1/2 domain pair that causes CFHR5 nephropathy. To understand how this duplication causes disease, we characterized the solution structure of native FHR5 by analytical ultracentrifugation and small-angle X-ray scattering. Sedimentation velocity and X-ray scattering indicated that FHR5 was dimeric, with a radius of gyration (Rg) of 5.5 ± 0.2 nm and a maximum protein length of 20 nm for its 18 domains. This result indicated that FHR5 was even more compact than the main regulator Factor H, which showed an overall length of 26–29 nm for its 20 SCR domains. Atomistic modeling for FHR5 generated a library of 250,000 physically realistic trial arrangements of SCR domains for scattering curve fits. Only compact domain structures in this library fit well to the scattering data, and these structures readily accommodated the extra SCR-1/2 domain pair present in CFHR5 nephropathy. This model indicated that mutant FHR5 can form oligomers that possess additional binding sites for C3b in FHR5. We conclude that the deregulation of complement regulation by the FHR5 mutant can be rationalized by the enhanced binding of FHR5 oligomers to C3b deposited on host cell surfaces. Our FHR5 structures thus explained key features of the mechanism and pathology of CFHR5 nephropathy.


Electronic voice phenomenon (EVP) refers to the purported manifestation of voices of the dead and other discarnate entities through electronic means. This has typically involved tuning radios between stations and recording the output on audiotape, although more recently anomalous voices, visual images and text have purportedly been found using telephones, television sets and computers in a phenomenon known as instrumental transcommunication. Given the lack of documentation of EVP in mainstream scientific journals, a review of its history is given based on English language information found in psychical research and parapsychology periodicals and various trade publications and newsletters. An effort was made to replicate EVP by having research assistants simulate interaction with discarnate entities while taping the output from two radios tuned between stations onto audio cassettes. There were 81 sessions with an average of approximately 45 minutes per session for a total of about 60 hours and 11 minutes of recording. While there are some apparent voices and interesting noises upon playback, none of these is sufficiently distinctive to merit being considered anomalous. Some speculative reasons are given for the negative result although the possibility that there are no anomalous phenomena associated with EVP is offered as an explanation for consideration alongside the hypothesis that experimenters create EVP effects through anomalous human—machine interactions and an exosomatic theory of actual influence of electronic equipment by discarnate entities.


The thesis gives details of a series of design investigations carried out on mild steel, welded, plate girders, having a constant I section and supported laterally and torsionally only at the ends of the span. The main aim is to establish a General Method for expediting the design calculations for obtaining the optimum cross sectional dimensions of such a girder, essentially in accordance with the regulations as laid down in the British Standard Specification (B.S.449, while observing some rules for efficient or economical design. Here Minimum Weight Design has been chosen as the criterion of efficiency, though the methods devised can readily be extended or adapted to deal with other criteria. The moment of resistance, as reduced by lateral buckling, is deemed to be the significant factor in each design, though the various other effects are considered as well. A review of the problem is given, and an empirical investigation is then carried out to obtain the sectional dimensions of girders at Minimum Weight, spanning 100 feet, and resisting various moments. This work is then extended to a wider application by means of a theoretical analysis, and a General Method is obtained. Suggestions are made as to how this Method may be applied, viz: by the construction of charts and tables or by the writing of an all embracing computer programme to give automatic design. Various additional effects are described and finally an outline is given as to how this work can be extended to deal with more complicated practical girders.


Abstract Multiplayer online games form complex semiotic ecologies that include game-generated texts, player-to-player communication and collaboration, and associated websites that support in-game play. This article describes an exploratory study of the massively multiplayer online game (MMO) World of Warcraft (WoW), with specific attention to its qualities as a setting for second language (L2) use and development. This empirical study seeks to answer the following question: What is the nature of the linguistic ecology that WoW players are exposed to? Many studies have described the developmental opportunities presented by commercially available gaming environments (e.g., Gee, 2003, 2007), their value as sites of literacy development (e.g., Squire, 2008a; Steinkuehler, 2008), and their potential as venues for second language (L2) use and learning (e.g., Peterson, 2010; Thorne, Black, & Sykes, 2009; Thorne & Fischer, 2012; Zheng, Young, Wagner & Brewer, 2009). There are, however, numerous outstanding questions regarding the quality and complexity of the linguistic environments associated with online commercially available games. This primarily descriptive research addresses this issue and aims to finely characterize the linguistic complexity of game-presented texts (or 'quest texts') as well as player generated game-external informational and strategy websites that form the expansive semiotic ecology of WoW game play. Questionnaires and interviews with Dutch and American gamers helped to identify a variety of widely used game-external websites. This information then informed the selection of texts that were analyzed for their linguistic complexity. By analysing the linguistic complexity of the texts that players regularly engage with, this study aims to empirically assess the resources and limitations of a representative and widely played MMO as an environment for L2 development.


Layered gallium sulphide (GaS) with hexagonal symmetry is a typical metal mono-chalcogenide and is mechanically stable under tension. In this work, we used first-principles density functional theory to study the performance of monolayer (ML) GaS as an anode material for Li, Na, K, Mg, and Al-ion batteries. The most stable binding sites for the metal atoms on ML GaS are all in the hollow sites, and the Fermi level of ML GaS moves upward into the conduction band after adsorption of Li, Na, K, and Al atoms, showing a semiconductor-to-metal transition of ML GaS, with the exception of Mg atoms. The binding energies of the metal atoms with ML GaS are all negative at all the studied densities, indicating a steady adsorbing process. The Li, Na, K, and Al ions prefer to move along the zigzag direction on ML GaS, with relatively low diffusion barrier heights of 0.110, 0.078, 0.037, and 0.034 eV, respectively. Such low diffusion barriers endow ML GaS with high rate capacity. The maximum theoretical specific capacities for Li, Na, K, and Al-ion batteries are 526.74, 32.92, 32.92, and 98.76 mA h g−1, respectively. Noticeably, the theoretical specific capacity of ML GaS for Li-ion batteries (LIBs) is even higher than the theoretical one (372 mA h g−1) of commercially used graphite. Besides, an appropriate average open circuit voltage of 0.53 V is generated for ML GaS based LIBs. Our study suggests that ML GaS is a suitable anode material for LIBs.


In this paper, a new objective function (OF) within the genetic algorithm (GA) approach is presented to solve the optimization problem of coordination of overcurrent and distance relays. The existing objective function of overcurrent (O/C) relays coordination is improved and extended to include the coordination of O/C and distance relays. Various O/C relays characteristics are considered within the approach to select the best of them by GA to fulfill optimal coordination. The proposed method is applied to two different power system networks. Simulation results demonstrate that the method can obtain feasible and effective solutions for optimal coordination in the practical power system networks.


LEDs are likely to be used for general lighting applications due to their high efficiency and longer life. To cover wide output range on lighting application some of control methods are adopts. In the proposed method, the interleaved DCM fly back converter is favoured. DCM operation can accomplish high PF for wide output power range. To achieve high efficiency, new pulse duty cycle control method with pulse frequency modulation for an interleaved single-stage fly back ac–dc converter is proposed. The proposed converter provides high efficiency under heavy loads with low ac line condition and under light loads with high ac line condition. As a result, the recital of the proposed circuit is validated by the simulation results using MAT LAB software with PDPFM control method. Experimental results show the functionality of the on the whole system.


I investigate the caustics produced by the fall of collisionless dark matter in and out of a galaxy in the limit of negligible velocity dispersion. The outer caustics are spherical shells enveloping the galaxy. The inner caustics are rings. These are located near where the particles with the most angular momentum are at their distance of closest approach to the galactic center. The surface of a caustic ring is a closed tube whose cross-section is a D −4 catastrophe. It has three cusps amongst which exists a discrete Z 3 symmetry. A detailed analysis is given in the limit where the flow of particles is axially and reflection symmetric and where the transverse dimensions of the ring are small compared to the ring radius. Five parameters describe the caustic in that limit. The relations between these parameters and the initial velocity distribution of the particles are derived. The structure of the caustic ring is used to predict the shape of the bump produced in a galactic rotation curve by a caustic ring lying in the galactic plane.


A proposal by the Canadian Radio-Television and Telecommunications Commission (CRTC) to mandate "pick-and-pay" television offerings for Canadians is deeply misguided, according to a report from the C.D. Howe Institute. In "Let the Market Decide: The Case Against Mandatory Pick-and-Pay," authors Lawson Hunter, Edward Iacobucci and Michael Trebilcock find that mandating consumers to be able to subscribe to pay and specialty services on a service-by-service basis would be a slippery slope to still more regulation, and would become irrelevant at best in the ongoing telecom revolution.


On a model of experimental myocardial infarction there is demonstrated the stimulating effect of inosine (most distinctly) and also of stimulants of the nucleic acids synthesis and of retabolil on the formation of the post-infarction scar, the processes of compensatory hyperfunction and hypertrophy, all this finally speeding up the restoration of the myocardial function as a whole. At the root of this research carried out on 276 rabbits there lie histological, histochemical, electron microscopic, biochemical, electrographic findings and determination of the intracardiac hemodynamics.


The paper has twofold objectives. Firstly, the impact of the inflation rate on economic growth with the possibility of two threshold levels for Pakistan using annual data from 1961 to 2008 is examined and secondly, nonlinear relationship between inflation and investment has been investigated. Inflation and growth models support the existence of a nonlinear relationship with two thresholds (6 percent and 11 percent). Inflation below the first threshold affects economic growth positively but insignificantly; at moderate rates of inflation, between the two threshold levels, the effect of inflation is significant and strongly negative and at high rates of inflation, above the second threshold, the ma rginal impact of additional inflation on economic growth diminishes but is still significantly negative. Investment is one of the possible channels through which inflation influences economic growth and the analysis indicates the nonlinear relationship between these two variables with only one threshold at 7 percent. Rate of inflation below the threshold level has positive but insignificant impact, while above the threshold it has strong negative and significant impact on the investment. Therefore, it is desirable to keep the inflation below 6 percent because it may be helpful for the achievement of robust economic growth and investment.


The production of xanthylium cation pigments was greatly increased when an aged, tartaric acid buffered, 12% (v/v) aqueous ethanol solution was used in a model white wine system. This suggested the formation of a precursor to the pigments during the ageing of the tartaric acid solution. On examining factors responsible for the generation of tartaric acid oxidation products in wine-like solutions it was observed that on exposure of samples to sunlight, glyoxylic acid, a known precursor to xanthylium cations, was produced. The production of glyoxylic acid was achieved in both the absence and presence of ethanol and copper(II). Hydrogen peroxide was also detected in these solutions. The results were consistent with the presence of glyoxylic acid in the aged tartaric acid buffered, 12% (v/v) aqueous ethanol solution that had frequent aeration and periodic exposure to sunlight throughout its storage. Studies on the role of hydrogen peroxide in the production of glyoxylic acid were also investigated. On the addition of hydrogen peroxide to tartaric acid solutions, with heating at 45°C in darkness, glyoxylic acid was only determined in solutions without ethanol.


The material constants of the new plasticity model proposed in the first part of the paper can be divided into two independent groups. The first group, c (i) and r (i) (i = 1, 2,..., M), describes balanced loading and the second group, X (i) (i = 1, 2,..., M), characterizes unbalanced loading. We define balanced loading as the case when a virgin material initially isotropic will undergo no ratchetting and/or mean stress relaxation, and unbalanced loading as the loading under which a virgin material initially isotropic will produce strain ratchetting and/or mean stress relaxation. The independence of the two groups of material constants and the interpretation of the model with a limiting surface concept facilitated the determination of material constants. We describe in detail a computational procedure to determine the material constants in the models from simple uniaxial experiments. The theoretical predictions obtained by using the new plasticity model are compared with a number of multiple step ratchetting experiments under both uniaxial and biaxial tension-torsion loading. In multiple step experiments, the mean stress and stress amplitude are varied in a stepwise fashion during the test. Very close agreements are achieved between the experimental results and the model simulations including cases of nonproportional loading. Specifically, the new model predicted long-term ratchetting rate decay more accurately than the previous models.


Medicinal cannabis use has increased exponentially with widespread legalization around the world. Cannabis-based products are being used for numerous health conditions, often in conjunction with prescribed medications. The risk of clinically significant drug-drug interactions (DDIs) increases in this setting of polypharmacy, prompting concern among health care providers. Serious adverse events can result from DDIs, specifically those affecting CYP-mediated drug metabolism. Both cannabidiol (CBD) and Δ9-tetrahydrocannabinol (Δ9-THC), major constituents of cannabis, potently inhibit CYPs. Cannabis-based products contain an array of cannabinoids, many of which have limited data available regarding potential DDIs. This study assessed the inhibitory potential of 12 cannabinoids against CYP-mediated drug metabolism to predict the likelihood of clinically significant DDIs between cannabis-based therapies and conventional medications. Supersomes™ were used to screen the inhibitory potential of cannabinoids in vitro. Twelve cannabinoids were evaluated at the predominant drug-metabolizing isoforms: CYP3A4, CYP2D6, CYP2C9, CYP1A2, CYP2B6, and CYP2C19. The cannabinoids exhibited varied effects and potencies across the CYP isoforms. CYP2C9-mediated metabolism was inhibited by nearly all the cannabinoids with estimated Ki values of 0.2–3.2 μM. Most of the cannabinoids inhibited CYP2C19, whereas CYP2D6, CYP3A4, and CYP2B6 were either not affected or only partially inhibited by the cannabinoids. Effects of the cannabinoids on CYP2D6, CYP1A2, CYP2B6, and CYP3A4 metabolism were limited so in vivo DDIs mediated by these isoforms would not be predicted. CYP2C9-mediated metabolism was inhibited by cannabinoids at clinically relevant concentrations. In vivo DDI studies may be justified for CYP2C9 substrates with a narrow therapeutic index.


This paper uses data on registered manufacturing from the Annual Survey of Industries (ASI) for the post global financial crisis period (2008-09 to 2017-18) and examines the convergence pattern of 21 major states in India and their key drivers. While poorer states are found to have exhibited convergence to the mean Net Value Added per capita (NVApc), richer and middle-income states displayed divergence. Poorer states registered the fastest rate of growth among the three groups, driven by the highest rate of growth in fixed capital. They experienced the lowest rate of growth in labour and the contribution of total factor productivity growth (TFPG) was also negative, suggesting the role of high capital intensity in driving convergence. Richer states exhibited highest rate of growth in labour and the contribution of TFPG was also positive, which enabled them to perform better on overall growth compared with the states in the middle-income category. Within each group, this paper finds evidence of convergence to the mean NVApc. JEL classification: O14, O16, O47, O53


Plasma ACTH and corticosterone were measured under basal conditions and after ether or tourniquet stress during the nadir (a.m.) and zenith (p.m.) of the nycterohemeral pituitary-adrenal cycle. Exogenous ACTH was also given at these 2 times to assess adrenal sensitivity to ACTH and the maximal adrenal capacity for corticosterone secretion. Ether stress caused a greater rise in plasma ACTH in the a.m. than in the p.m., even though basal plasma ACTH and corticosterone concentrations were lower in the a.m. than in the p.m. When given in the p.m., pentobarbital anesthesia depressed plasma corticosterone and ACTH to the a.m. level; under these conditions the rise in plasma ACTH produced by tourniquet stress was the same in the a.m. and p.m. Both tourniquet and ether stresses caused maximal activation of adrenal corticosterone secretion, but ether produced a much greater rise in plasma ACTH. It is concluded that: (1) the greater ether-induced rise in plasma ACTH in the a.m. than in the p.m. is probably due to the lower plasma (and probably tissue) corticosterone concentration at that time; (2) the plasma ACTH concentration for inducing maximal adrenal activation is relatively low; and (3) the higher basal levels of plasma corticosterone in the p.m. than in the a.m. are due to a slight increase in basal ACTH secretion in the p.m.


The final objective of the present work is the accurate prediction of the dynamic stiffness behaviour of complex rubber parts using finite element simulation tools. For this purpose, it becomes necessary to perform a complex rubber compound material characterisation and modelling work; this needs two important previous steps. These steps are detailed in the present document together with a theoretical review of viscoelastic visco-elasto-plastic models for elastomers.

Firstly, a new characterisation method is proposed to determine the degree of cure of rubber parts. It is known that the degree of cure of rubbers bears heavily on their mechanical properties. This method consists of the correlation of swelling results to rheometer data achieving a good agreement.

Secondly, the influence of the strain rate used in static characterisation tests is studied. In this step, a new characterisation method is proposed. The latter characterisation method will be used to fit extended hyperelastic models in Finite Element Analysis (FEA) software like ANSYS. The proposed method improves the correlation of experimental data to simulation results obtained by the use of standard methods.

Finally, the overlay method proposed by Austrell concerning frequency dependence of the dynamic modulus and loss angle that is known to increase more with frequency for small amplitudes than for large amplitudes is developed. The original version of the overlay method yields no difference in frequency dependence with respect to different load amplitudes. However, if the element in the viscoelastic layer of the finite element model are given different stiffness and loss properties depending on the loading amplitude level, frequency dependence is shown to be more accurate compared to experiments. The commercial finite element program Ansys is used to model an industrial metal rubber part using two layers of elements. One layer is a hyper viscoelastic layer and the other layer uses an elasto-plastic model with a multi-linear kinematic hardening rule. The model, being intended for stationary cyclic loading, shows good agreement with measurements on the harmonically loaded industrial rubber part.


Abstract Findings from neuroscience research hold promise for improved treatments for and prevention of substance use disorders (SUD), but ethical concerns about psychopharmacological research involving SUD may potentially undennine scientific progress. This article reviews the literature pertaining to seven ethical requirements that elucidate a coherent framework for evaluating the ethics of clinical SUD research protocols. Those requirements are social or scientific value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for potential or enrolled subjects. An evidence-based analysis suggests that sound pharmacological research in SUD can safeguard the welfare of research participants while collecting valuable scientific data and benefiting society.


. Video games are complex systems that combine technical and artistic processes. The specification of this type of system is not a trivial task, making it necessary to use diagrams and charts to visually specify sets of requirements. Therefore, the underlying proposal of this work is to present an approach based on the formalism of Petri nets for aiding in the design process of video games. The activities of the game are represented by a specific type of Petri net called WorkFlow net. The definition of a topological map can be represented by state graphs. Using Colored Petri nets, it is possible to define formal communication mechanisms between the model of activity and the model of the map. The simulation of the timed models allows then to produce an estimated time that corresponds to the effective duration a player will need to complete a level of a game. Furthermore, a kind of Soundness property related to gameplay in a game Quest can be verified through state space analysis. For a better understanding of the approach, the video game Silent Hill II is used.


Horseradish peroxidase was activated by periodate oxidation of the carbohydrate moiety and then modified by the covalent attachment of alpha-N,N-bis[carboxyethyl]lysine (CM-Lys) by reductive alkylation using sodium cyanoborohydride. The resultant CM-Lys peroxidase was charged with nickel ions and then used as a specific labeling reagent for histidine-tagged recombinant proteins. This labeling method was effective for proteins that are soluble or insoluble in the absence of chaotropic agents. The labeled proteins were very effective in direct sandwich enzyme-linked immunosorbent assay for detecting antibodies against the protein in sera as demonstrated by assays for antibodies to such diverse viral proteins as hepatitis B surface and core proteins, hepatitis C core and helicase protein (NS3), and retroviral core proteins.


Despite the large progress during the last decades in the medical treatment of HIV/AIDS infection, people living with HIV nevertheless face multiple adversities at various levels of their lives. Mental disorders, in particular, are the most common comorbidities in HIV infection with negative consequences in adherence to antiretroviral medication, disease progress and overall quality of life. HIVrelated stigma, still quite intense in Greece, is one of the most debilitating factors concerning people's living with HIV mental health. The present study looked at the clinical presentation at intake and treatment requests of 191 (83% males) people living with HIV who addressed the psychological support service of the non-governmental organization 'Centre for Life' during the years 2016- 18. Data were collected through a semi-structured clinical interview and administration of adapted questionnaires (PHQ-9, BAI, CAGE), which resulted in 7 dichotomous variables related to clinical presentation and 13 dichotomous variables related to treatment requests at intake. To analyze data, we constructed frequency tables and performed chi-square tests. In the whole sample, 42.2% presented anxiety disorders, 40.3% depression, 28.8% occasional substance use, 17.5% problematic use of alcohol and 13.6% intravenous drug use. Moreover, 14% reported at least one suicide attempt in the past and 9.2% current suicidal ideation. Apart from more frequent intravenous drug use among heterosexual males and more frequent occasional/recreational drug use among men who have sex with men, no other differences related to gender, age group, sexual orientation or ethnicity were observed in the initial clinical presentation. Similarly, the most frequent treatment requests were homogenously distributed in our sample, such as depressive symptoms (58.6%), difficulties in romantic relationships (48.7%), accepting being HIV positive (42.9%), anxiety symptoms (42.4%) and issues of negative self-esteem (40.8%). The presence of clinically significant depression was found to be related to a wider range of treatment requests compared to other mental health problems. A large group of requests focused on interpersonal relationships difficulties (e.g. disclosure anxiety, social isolation, disturbed relationships with familiar persons). This indicates an important area of psychological intervention. HIV infection may affect many levels of an individual's life, including their mental health. Respectively, HIV treatment needs to adopt a more holistic approach.


Uncontrolled weed growth in the early stages of crop establishment, can decrease final crop yield. Phytochemical compounds from bamboo's (Dendrocalamus sasper) leaves known as flavonoids, phenolic and coumarin that inhibit the growth and development of weeds. The objective of this study was to utilizing bamboo's leaves litter as bioherbicide for sustainable agricultural system. Weedy area used for observation of the effectiveness solution of bamboo's leaves litter as bioherbicide is 1 m², first area for solution of bamboo's leaves litter 10%, the second area for solution of bamboo's leaves litter 5% and third plot only distilled water as a control treatment. Weeds SDR observations was done before spraying and 7 days after spraying bamboo's leaves litter. The selected plot is a plot with diverse species of weeds. Observations SDR weeds to determine the level of effectiveness of a solution of bamboo's leaf litter, was conducted used quadrant plots Weed species that dominated on our plot are Mikania micrantha, Eleusine indica, Cyperus rotundus, Cynodon stolon, Cynodon dactylon, Axonopus compressus dan Sanchus arvensis. Solution of bamboo's leaves litter as bioherbicide are only capable controlled bermuda grass (Cynodon dactylon), both at a dose of 5 % and 10 %. For other species, solution of bamboo's leaves litter did not work at


The most common presenting symptoms of prostate cancer, a common cancer in males worldwide, are lower urinary tract symptoms. In rare cases, however, urinary symptoms may not be apparent, and patients can present with gastrointestinal symptoms instead. Even rarer is the involvement of non-regional lymph nodes such as the cervical nodes. Here, we report a case of a 50-year-old male who initially presented with constipation and an enlarging left lateral neck mass. Further work-up revealed metastatic prostatic adenocarcinoma and the patient dramatically responded to chemotherapy, androgen deprivation therapy and bone support therapy. This case highlights the importance of considering a prostate malignancy in a male patient presenting with gastrointestinal symptoms and a neck mass even in the absence of lower urinary tract symptoms. Serum prostate specific antigen, pathologic findings and immunohistochemistry staining are important to guide the clinician in making the correct diagnosis and treatment.


OBJECTIVES
To determine the role of antiphospholipid antibodies (aPL) and of Raynaud's phenomenon (RP) in the development of migraine in patients with systemic lupus erythematosus (SLE).

METHODS
50 unselected SLE patients and 20 rheumatoid arthritis (RA) controls underwent an interview to define the presence of migraine according to the guidelines of the International Headache Society (1988). Serological tests for aPL were performed in all patients. SLE patients were divided according to positivity for RP and/or aPL into 4 subsets: R-/aPL-, R-/aPL+, R+/aPL- and R+/aPL+. Data were analysed using Fisher's exact test, Chi-square test and U Mann-Whitney test.

RESULTS
SLE and RA patients were similar for demographic and clinical features; aPL positivity was found in a greater proportion of SLE patients versus RA controls (68% vs 25%, p=0.0036). 31 of the 50 lupic patients (62%) and 7 of the 20 RA controls (35%) suffered from migraine (OR=3, CI:1-8.9). Among SLE and RA patients, migraine was associated with aPL positivity (p=0.027 and p=0.019). Analysing the combined effect of aPL and RP on migraine, in R+/aPL+ patients we detected an higher frequency of migraine (85.7%) with respect to the patients negative for these two features (27%, p=0.0051, OR=16, CI:2.2-118) and to the patients positive only for aPL (65%, p=0.0031, OR=6.2, CI:1.2-32).

CONCLUSIONS
Migraine in SLE and RA associates with aPL positivity. The simultaneous presence of RP increases by 2,5 times the probability of having migraine, suggesting that cerebral vasospasm might be more common in patients with peripheral vasospasm, given the presence of aPL.


Percutaneous cannulation of central veins by Seldinger technique is a
popular approach in intensive care settings. We report a case of
embolization of a complete guide-wire during such a procedure. Our case
differs from the few earlier reported cases in that subclavian vein was
the entry site. While reviewing the available literature, we discuss
few reasons and management of such a mishap.


International scientific journals dealing with the broad subject of emergency medicine are listed. The following standards were applied: only journals from Europe or North America published in English or German were selected; whenever possible, the actual number of copies printed is mentioned; listing in the "Index Medicus" is stated; and, finally, the time course of the so-called "impact factor" from 1984 to 1992 is shown. The impact factor is a measure of how often the "average article" in a journal has been cited in a particular year. Basically it describes a ratio between actual citations and citable items published. It permits some qualification of quantitative data since it discounts the advantage of large journals over small journals and that of frequently published journals over less frequently issued ones. Journals from 12 different medical specialties have been selected for analysis: Emergency Medicine; Anesthesiology and Critical Care Medicine; Biomedical Engineering; Neurosciences; General Internal Medicine; Internal Medicine: Cardiology, Pulmonary Medicine, Infectious Diseases, and Public Health; Surgery; Pediatrics; Pharmacology; Physiology; Experimental Medicine. In addition, a few remarks are made dealing with ethics of publication and the increasing number of medical authors per article published. The terms "irresponsible authorship", "author inflation", "wasteful publication", and "abstract creep" are introduced and explained. Furthermore, strategies adopted from the literature to restrain those developments are introduced.


We show that in the decoupling limit of an F-theory compactification, the internal directions of the seven-branes must wrap a non-commutative four-cycle S. We introduce a general method for obtaining fuzzy geometric spaces via toric geometry, and develop tools for engineering four-dimensional GUT models from this non-commutative setup. We obtain the chiral matter content and Yukawa couplings, and show that the theory has a finite Kaluza-Klein spectrum. The value of 1/αGUT is predicted to be equal to the number of fuzzy points on the internal four-cycle S. This relation puts a non-trivial restriction on the space of gauge theories that can arise as a limit of F-theory. By viewing the sevenbrane as tiled by D3-branes sitting at the N fuzzy points of the geometry, we argue that this theory admits a holographic dual description in the large N limit. We also entertain the possibility of constructing string models with large fuzzy extra dimensions, but with a high scale for quantum gravity. May, 2010 ∗e-mail: firstname.lastname@example.com †e-mail: firstname.lastname@example.com ar X iv :1 00 5. 30 33 v2 [ he pth ] 1 2 O ct 2 01 0


In this paper, four different nondestructive testing (NDT) methods and the static bending test were conducted on the pine (Pinus sylvestris L. Var. mongolica Litven.) laminated veneer lumber (LVL). The NDT methods included the longitudinal transmission method, longitudinal vibration method, in-plane and out-plane flexural vibration method. The effects of the compression ratio on the Young's modulus and bending strength (MOR) of LVL were investigated. There were four compression ratios for different ply numbers of LVL, 8.1% for eight-ply samples, 18.3% for nine-ply samples, 26.5% for ten-ply samples, 33.1% for eleven-ply samples, respectively. The microscopic structure of the LVL was analyzed with a scanning electron microscope (SEM). The results showed that the microstructure of LVL changed greatly between different compression ratios. And the dynamic Young's modulus and static bending (MOE) and bending strength (MOR) were greatly increased when the compression ratio increased form 18.3% to 26.5%.


Considerations to multistep development of B-lymphocytic chronic leukaemia are presented under the following aspects: experimental in vitro cultures of bone marrows B lymphocyte precursors, polyclonal nature of proliferating B lymphocytes in the early stage of CLL, especially in the autoimmune status, the role of viruses, the effect of nonrandom chromosome abnormalities and associated alterations in gene functions, clonal evolution during terminal stages of CLL.


Adjuvant therapy remains necessary for all ovarian cancers expanding outside the ovary, and should be adjusted to stage and persistent tumor burden. Many problems need precise answers. Although progresses have been made, results are still unsatisfactory. The need for multicentric studies and trials is utmost underlined.


A mathematical model of a lead-acid battery is presented. This model takes into account self-discharge, battery storage capacity, internal resistance, overvoltage, and environmental temperature. Nonlinear components are used to represent the behavior of the different battery parameters thereby simplifying the model design. The model components are found by using manufacturers specifications and experimental tests. A comparison between the model and experimental results obtained from a battery evaluation test system was used for verification. This model can be used to accurately evaluate battery performance in electrical systems. >


As canine mammary tumours (CMT) and human breast cancer share clinical and prognostic features, the former have been proposed as a model to study carcinogenesis and improved therapeutic treatment in human breast cancer. In recent years, it has been shown that transient receptor potential vanilloid 1 (TRPV1) is expressed in different neoplastic tissues and its activation has been associated with regulation of cancer growth and progression. The aim of the present research was to demonstrate the presence of TRPV1 in human and canine mammary cancer cells, MCF-7 and CF.41, respectively, and to study the role of TRPV1 in regulating cell proliferation. The images obtained by Western blot showed a signal at 100 kDa corresponding to the molecular weight of TRPV1 receptor. All tested TRPV1 agonists and antagonists caused a significant decrease (P < 0.05) of cell growth rate in MCF-7 cells. By contrast, in CF.41 cells capsaicin and capsazepine induced a significant increase (P < 0.05) in cell proliferation, whereas resiniferatoxin (RTX) and 5-iodo-resiniferatoxin (5-I-RTX) had no influence on CF.41 cell proliferation. Further studies are needed to elucidate the underlying molecular mechanism responsible for the different effects evoked by TRPV1 activation in MCF-7 and CF.41 cells.


Obtaining soluble proteins in sufficient concentrations is a major obstacle in various experimental studies. How to predict the propensity of targets in large-scale proteomics projects to be soluble is a significant but not fairly resolved scientific problem. Chaos game representation (CGR) can investigate the patterns hiding in protein sequences, and can visually reveal previously unknown structure. Fractal dimensions are good tools to measure sizes of complex, highly irregular geometric objects. In this paper, we convert each protein sequence into a high-dimensional vector by CGR algorithm and fractal dimension, and then predict protein solubility by these fractal features together with Chou's pseudo amino acid composition features and support vector machine (SVM). We extract and study six groups of features computed directly from the primary sequence, and each group is evaluated by the 10-fold cross-validation test. As the results of comparisons, the group of 445-dimensional vector gets the best results, the average accuracy is 0.8741 and average MCC is 0.7358. The resulting predictor is also compared with existing methods and shows significant improvement.


What kinds of CHOS compounds might be formed in a prebiotic milieu by reducing CO2 in the presence of H2 and H2S? How might the presence of sulfur influence the chemical composition of the mixture? We explore these questions by using first-principles quantum chemistry to calculate the free energies of CHOS compounds in aqueous solution, by first generating a thermodynamic map of one- and two-carbon species. We find that while thiols are thermodynamically favored, thioesters, thioacids, and thiones are less favorable than their non-sulfur counterparts. We then focus on the key role played by mercaptoacetaldehyde in sulfur analogs of the autocatalytic formose reaction, whereby the thiol group introduces asymmetry and potential thermodynamic selectivity of some compounds over others.


Thyme Essential oils (EO) with antimicrobial and antioxidant properties are widely used in pharmaceutical, cosmetic, and perfume industry. It is also used for flavoring and preservation of several foods. Nowadays, packaging research is receiving a considerable attention due to the development of eco-friendly materials made from natural polymers such as starch and chitosan. In this study Thymus kotschyanus EO concentrations ranging from 0 to 2.0%, incorporated in starch-chitosan composite (S-CH) film were used. Antimicrobial and antioxidant properties significantly increased with the incorporation of EO (p < 0.05). Incorporating EO, increased total color differences (DE), yellowness index (YI) and whiteness index (WI) which were significantly higher than control and its transparency was reduced. Our results pointed out that the incorporation of Thymus kotschyanus EO as a natural antibacterial agent has potential for using the developed film as an active packaging.


Compared to the wealth of research on single homeless adults, there is little known about homeless families. This paper describes a study of 75 homeless families in Ottawa, Ontario, conducted in 2012-2013. This sample of homeless families includes a large number of newcomer families, including immigrants and refugees. Participants are poor and unemployed, but many are educated, and there is little evidence of alcohol or substance abuse. Nonetheless, participants report poor mental health and high levels of family stress. Whereas newcomer families tended to be larger and include more two-parent families than did Canadian-born families, there were no differences in the physical and mental health of the participants. These findings add to our growing understanding of homeless families and point to notable similarities and differences in homeless families in this city in Canada, and in the United States.


We present a 51-year-old Caucasian woman, with a medical history of systemic lupus erythematosus (SLE) who had dyspnoea at exertion. The SLE was clinically quiescent but serologically active. Echocardiography showed preserved left ventricular (LV) systolic function, pseudonormal mitral inflow pattern (diastolic dysfunction grade III), absence of wall motion abnormalities and elevated E/e' at exercise. An exercise right heart catheterisation was performed, confirming the diagnosis of heart failure with preserved ejection fraction (HFpEF). In the absence of other possible causes, we assumed that HFpEF was mediated by systemic inflammation secondary to SLE. Based on the Paulus' paradigm, that systemic inflammation may lead to diastolic dysfunction, we decided to add belimumab (a biological agent against soluble B-lymphocyte stimulator protein). After 16 weeks of treatment, patient reported an improved condition. Also, cardiopulmonary exercise test and echocardiography results improved, confirming resolution of the underlying LV diastolic dysfunction. This case supports the idea that targeting inflammation has therapeutic potential in a subset of HFpEF-patients.


From the civil rights movement through the Obama administration, each successive redistricting cycle involved ever-greater regulation of the mapmaking process. But in the past decade, the Supreme Court has re-written the ground rules for redistricting. For the first time in fifty years, Southern States will redistrict free of the preclearance process that long protected minorities from having their political power diminished. Political parties can now openly engage in egregious partisan gerrymandering. The Court has withdrawn from the political thicket on every front except race. In so doing, the Court has engaged in decision-making that is both activist and restrained, but the end result is a deregulated redistricting process. This tactical retreat, however, has left more questions that it has answered. In light of these decisions, the question whether redistricting plans are discriminating on the basis of race or partisanship is more important than ever. The long-standing practice of redistricting based on total population is up for grabs, as conservative activists push to use citizen voting age population as the relevant denominator for equalizing districts. Doubts about the constitutionality of Section 2 of the Voting Rights Act have grown. This Article canvasses the redistricting decisions of the 2010s and forecasts how they will impact the 2020 redistricting cycle. Instead of treating each redistricting decision in isolation, this Article synthesizes the relevant cases, predicts how they will interact, and answers unresolved questions. In short, it puts the pieces of the redistricting puzzle together. Thus, this Article provides a comprehensive guide to the upcoming redistricting process for mapmakers, lawyers, judges, and scholars.


SIR,-We all have recently become aware of the 700/% increase in the standard subscription rates to the medical defence bodies, with the prospect of American sized premiums on the horizon. The societies point out that we are paying less for our cover than comparable professionals such as architects and solicitors, but for these groups the cover may be a practice expense. This premium falls unfairly on the hospital doctor, who does not have this option, and to whom it is a substantial expense. The time has come for our employing authorities to take over the responsibility for paying the subscrption, as dtey do for the non-medical staff they employ. In the past there has been resstance to this from doctors not wholly employed in the NHS, but for them the health authority could contribute a proportiion of the premium de ng on the number ofsessions they are employed for. PEIER COE Depatmet of Anasathetics, WsHospind, TLoudo SEI