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We present two perspectives on coal, alternative energy, and the future of China's industrialization in light of claims that its salvation lies in clean coal. Can advanced techniques for reducing carbon emissions in coal usher in the new wave of industrialization in China or elsewhere? Or is it new green technologies such as wind and solar power that will spearhead the next industrial revolution and transform the prospects for industry and the environment in the coming decades?
The ventricular assist device is being increasingly used as a “bridge-to-transplant” option in children with heart failure who have failed medical management. Care for this medically complex population must be optimised, including through concomitant pharmacotherapy. Pharmacokinetic/pharmacodynamic alterations affecting pharmacotherapy are increasingly discovered in children supported with extracorporeal membrane oxygenation, another form of mechanical circulatory support. Similarities between extracorporeal membrane oxygenation and ventricular assist devices support the hypothesis that similar alterations may exist in ventricular assist device-supported patients. We conducted a literature review to assess the current data available on pharmacokinetics/pharmacodynamics in children with ventricular assist devices. We found two adult and no paediatric pharmacokinetic/pharmacodynamic studies in ventricular assist device-supported patients. While mechanisms may be partially extrapolated from children supported with extracorporeal membrane oxygenation, dedicated investigation of the paediatric ventricular assist device population is crucial given the inherent differences between the two forms of mechanical circulatory support, and pathophysiology that is unique to these patients. Commonly used drugs such as anticoagulants and antibiotics have narrow therapeutic windows with devastating consequences if under-dosed or over-dosed. Clinical studies are urgently needed to improve outcomes and maximise the potential of ventricular assist devices in this vulnerable population.
Structured clinical judgement tools provide scope for the standardisation of forensic service gatekeeping and also allow identification of heuristics in this decision process. The DUNDRUM-1 triage tool was completed retrospectively for 121 first-time referrals to forensic services in South Wales. Fifty were admitted to medium security, 49 to low security and 22 remained in open conditions.
Results
DUNDRUM-1 total scores differed appropriately between different levels of security. However, regression revealed heuristic anchoring on the ‘legal process’ and ‘immediacy of risk due to mental disorder’ items.
Clinical implications
Patient placement was broadly aligned with DUNDRUM-1 recommendations. However, not all triage items informed gatekeeping decisions. It remains to be seen whether decisions anchored in this way are effective.
Declaration of interest
Dr Mark Freestone gave permission for AUC values from Freestone et al. (2015) to be presented here for comparison.
During the 2010/11 boreal winter, a distributed set of backscatter measurements was collected using a ground-based Ku-band (17.2 GHz) scatterometer system at 26 open tundra sites. A standard snow-sampling procedure was completed after each scan to evaluate local variability in snow layering, depth, density and water equivalent (SWE) within the scatterometer field of view. The shallow depths and large basal depth hoar encountered presented an opportunity to evaluate backscatter under a set of previously untested conditions. Strong Ku-band response was found with increasing snow depth and snow water equivalent (SWE). In particular, co-polarized vertical backscatter increased by 0.82 dB for every 1 cm increase in SWE (R2 = 0.62). While the result indicated strong potential for Ku-band retrieval of shallow snow properties, it did not characterize the influence of sub-scan variability. An enhanced snow-sampling procedure was introduced to generate detailed characterizations of stratigraphy within the scatterometer field of view using near-infrared photography along the length of a 5 m trench. Changes in snow properties along the trench were used to discuss variations in the collocated backscatter response. A pair of contrasting observation sites was used to highlight uncertainties in backscatter response related to short length scale spatial variability in the observed tundra environment.
One of the founders of literary realism and the serial novel, Honoré de Balzac (1799–1850) was a prolific writer who produced more than a hundred novels, plays and short stories during his career. With its dramatic plots and memorable characters, Balzac's fiction has enthralled generations of readers. 'La Comédie humaine', the vast collection of works in which he strove to document every aspect of nineteenth-century French society, has influenced writers from Flaubert, Zola and Proust to Dostoevsky and Oscar Wilde. This Companion provides a critical reappraisal of Balzac, combining studies of his major novels with guidance on the key narrative and thematic features of his writing. Twelve chapters by world-leading specialists encompass a wide spectrum of topics such as the representation of history, philosophy and religion, the plight of the struggling artist, gender and sexuality, and Balzac's depiction of the creative process itself.