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Oral corticosteroids (OCS) carry serious health risks. Innovative treatment options are required to reduce excessive exposure and promote OCS stewardship.This study evaluated the trajectories of OCS exposure (prednisolone-equivalent) in patients with severe eosinophilic asthma before and after starting mepolizumab and the predictors of becoming OCS free after 6 months of mepolizumab therapy.This real-world observational study included 309 patients from the Australian Mepolizumab Registry who were followed up for 1 year (n = 225).Patients had a median age of 60 (interquartile range: 50, 68) years, and 58% were female. At baseline, 48% used maintenance OCS, 96% had ≥1 OCS burst, and 68% had received ≥1 g of OCS in the previous year. After commencing mepolizumab, only 55% of those initially on maintenance OCS remained on this treatment by 12 months. Maintenance OCS dose reduced from median 10 (5.0, 12.5) mg/day at baseline to 2 (0, 7.0) mg/day at 12 months (P.001). Likewise, proportions of patients receiving OCS bursts in the previous year reduced from 96% at baseline to 50% at 12 months (P.001). Overall, 137 (48%) patients required OCS (maintenance/burst) after 6 months' mepolizumab therapy. Becoming OCS free was predicted by a lower body mass index (odds ratio: 0.925; 95% confidence interval: 0.872-0.981), late-onset asthma (1.027; 1.006-1.048), a lower Asthma Control Test score (1.111; 0.011-1.220), and not receiving maintenance OCS therapy at baseline (0.095; 0.040-0.227).Mepolizumab led to a significant and sustained reduction in OCS dependence in patients with severe eosinophilic asthma. This study supports the OCS-sparing effect of mepolizumab and highlights the pivotal role of mepolizumab in OCS stewardship initiatives.

OBJECTIVESPalivizumab is a monoclonal antibody approved for the prevention of serious lower respiratory tract infections caused by respiratory syncytial virus (RSV) in high-risk pediatric patients. While palivizumab is more effective if used correctly, compliance with the monthly dosing is suboptimal. We established a pharmacist-managed RSV prevention clinic in an effort to improve compliance. The primary objective of this study was to determine the impact of a pharmacist-managed RSV prevention clinic on palivizumab compliance.METHODSA chart review was performed. Patients who received palivizumab between September 2009 and April 2012 were identified. Compliance was determined as the number of patients who received eligible doses at 28- to 30-day intervals, consecutively.RESULTSOne hundred seventy-two patients received at least 1 dose of palivizumab. An average of 92% of patients who received at least 1 dose subsequently received all doses of palivizumab during the RSV season. Of those, 88% received all eligible doses in consecutive 28-to 30-day intervals.CONCLUSIONA pharmacist-managed RSV prevention clinic can assist physicians in the prevention of RSV by increasing compliance with palivizumab dosing.

The need for brief, low-cost, easily disseminable and effective interventions to promote healthy lifestyles is high. This is especially true for mental health providers. We developed two studies to compare the impacts of Cognitive Behavioral Stress Management (CBSM) and Yoga Based Stress Management (YBSM) interventions for healthcare professionals. Study 1 offered an 8-week YBSM intervention to 37 mental healthcare participants and collected health data pre and post. Study 2 offered YBSM and CBSM classes to 40 randomly assigned mental healthcare providers and collected mental and physical health data at four time points. In Study 1, using t-tests, the YBSM intervention affected a number of mental and physical wellbeing indices pre to post. In Study 2, using linear mixed modeling, both YBSM and CBSM groups improved significantly (p

Work on global health law is often based on a diffusionist and functionalist model which sees legal initiatives from ‘centres’, such as Washington or Geneva, responding to new disease threats and a lack of capacity at the ‘periphery’, say in Sierra Leone or southern China. This approach overlooks the significance of national institutions and contexts, and neglects the rhetorical dimension of global governance, obscuring the influence of colonial idioms and practices. This paper proposes an alternative model, based on nodal governance theory, capable of accounting for these neglected dimensions. It argues that global health interventions are structured discursively by a range of spatio-temporal figures (‘chronotopes’) which have persuasive force owing to their wider historic resonances. This is explored through the example of a 2010 United States effort to secure pathogens stored in East African research laboratories against terrorist groups. A high-level team argued that Congress should fund training and infrastructure. The case was shaped rhetorically by various chronotopes including that of Africa as a natural source of disease, the ‘regression’ of states in the region to failed status, and the ineffectiveness of national borders after globalisation.

INTRODUCTION: We present a case of a medically nonadherent 16 years-old female with a history of moderate persistent asthma and vaping of nicotine and marijuana products who presented in severe respiratory distress during the COVID-19 pandemic She had poor response to continuous inhaled albuterol, scheduled intermittent ipratropium, systemic steroids, intravenous magnesium, and non-invasive ventilator support which led to intubation and mechanical ventilation Because of ongoing bronchospasm, heliox, terbutaline, and ketamine infusions were initiated, but she continued to exhibit worsening respiratory failure, poor lung compliance, and severe bronchospasm She then developed hypotension requiring an epinephrine infusion Given this picture, sevoflurane (SEVO) was initiated resulting in an immediate clinical response with normalization of blood gases and lung compliance without any adverse effects METHODS: SEVO was titrated to effect between 1-3% over the next 24 hours Multiple attempts to wean off SEVO were unsuccessful despite the addition of an aminophylline infusion She received SEVO for a total of 96 hours and mechanical ventilation for 11 days Extensive evaluation revealed chest x-ray with mild left lower lobe infiltrates, an otherwise negative CT chest, and negative workups for COVID-19, respiratory and blood cultures, allergic bronchopulmonary aspergillosis, sarcoidosis, and leptospirosis An echocardiogram was obtained and she was found to have a trabeculated myocardium, with an ejection fraction (EF)

The technical activities of the International Commission on Irrigation and Drainage (ICID) are organized under four Strategy Themes: On Farm, Systems, Basin, and Knowledge. Strategy Theme Basin deals with the basin level environmental aspects that affect agricultural water management and their impact on the environment. This review of Strategy Theme Basin and its six Working Groups (WG) examines its unique multi-disciplinary role in delivering ICID's contribution to Integrated Water Resource Management (IWRM), its effectiveness in meeting that role, and its future needs toward fulfilling that role. A formal set of objectives, of mechanisms to meet those objectives, and of suitable outputs for Strategy Theme Basin are proposed. Recommendations for future activities of the WG are made to improve multi-disciplinary collaborations with relevant outside organizations, to facilitate greater participation by ICID members, to improve WG functionality, and to effectively disseminate knowledge to IWRM professionals. Copyright © 2016 John Wiley & Sons, Ltd.

In this paper we explore a case for judicial review brought against the Secretary of State for International Development by an Ethiopian national, Mr O. The claimant alleged that the Department for International Development (DfID) had failed adequately to assess evidence of human rights violations in Ethiopia to which funds provided by DfID had contributed. Warby J ruled that the claim merited a full hearing. DfID is unaccustomed to judicial review: the O case is the first time since the 1995 Pergau Dam case that UK development aid has been reviewed by the courts. We study Warby J's judgment and its implications for accountabiity for aid decisions. We argue that both the wider context for aid and the legal framework governing development assistance have changed significantly in the 20 or so years since Pergau. In particular, we show that despite the UK's new legal commitment, made in 2015, to spend 0.7% of gross national income (GNI) on official development assistance, the existing mechanisms for scrutinising aid decisions are inadequate. We argue that there is an accountability gap in relation to the UK's now considerable development spending and explore the role of judicial review in this context.

Experiments to investigate the effect of varying jet hole diameter and jet spacing on heat transfer and pressure loss from jet array impingement on a curved target surface are reported. The jet plate configurations studied have varying hole diameters and geometric spacing for spatial tuning of the heat transfer behavior. The configuration also includes a straight section downstream of the curved section, where the effect on heat transfer and pressure loss is also investigated. The jet plate holes are sharp-edged. A steady-state measurement technique utilizing temperature-sensitive paint (TSP) was used on the target surface to obtain local heat transfer coefficients. Pressure taps placed on the sidewall and jet plate of the channel were used to evaluate the flow distribution in the impingement channel. For all configurations, spent air is drawn out in a single direction which is tangential to the target plate curvature. First row jet Reynolds numbers ranging from 50,000 to 160,000 are reported. Further tests were performed to evaluate several modifications to the impingement array. These involve blocking several downstream rows of jets, measuring the subsequent shifts in the pressure and heat transfer data, and then applying different turbulator designs in an attempt to recover the loss in the heat transfer while retaining favorable pressure loss. It was found that by using W-shaped turbulators, the downstream surface average Nusselt number increases up to ∼13% as compared with a smooth case using the same amount of coolant. The results suggest that by properly combining impingement and turbulators (in the post impingement section), higher heat transfer, lower flow rate, and lower pressure drop are simultaneously obtained, thus providing an optimal scenario.

In this review to mark the 25th anniversary of Social and Legal Studies ( SLS), we offer an assessment of the evolution of socio-legal scholarship on the Third World. We seek to locate the journal in the broader history of socio-legal studies and legal education in the United Kingdom and to consider its engagement with the work of Third World scholars. In order to do this, we recall the founding commitment of the journal’s first editorial board to non-western perspectives on law and locate this commitment both historically and biographically. We explore a number of important interventions concerned with socio-legal studies in the Third World, but also point to significant gaps and omissions since 1992. To end, we argue for a reassertion of SLS’s founding commitments to anti-imperial scholarship and the challenges posed by critical, non-western perspectives.

This comment pursues some of the ‘multiplicity of possible uses’ to which chronotopical analysis can be put, as Mariana Valverde’s text shows. It sketches briefly the potential of a chronotopical analysis of British medical law to generate novel readings of doctrinal figures and to extend the insights of feminist and other critiques. It follows Valverde in indicating the profound connection between specific spatio-temporalities and the jurisdictional struggles which provide much of the substance for litigation and academic debate. It proposes that the field of medical law can be understood as a genre marked out by a set of diverse, though related chronotopes, which mutates over time (10).

This paper analyzes the Kenya Supreme Court's ruling in Odinga v IEBC, a petition challenging the declared outcome of the 2013 presidential election. The case was immediately significant given the hope that recourse to the courts would help to avoid widespread civil unrest which had followed the disputed presidential election of 2007. It was also a crucial test for the new dispensation established under the 2010 Constitution widely held to have broken with the authoritarian and unaccountable regimes which dominated Kenya both under colonialism and after independence. The paper critically reviews the reasoning of the Supreme Court on six key issues raised in the petition attending to the broader normative and political implications of the judgment. We argue that both in its substantive conclusions and in the style of reasoning adopted, Odinga v IEBC is inconsistent with the transformative ambitions underpinning the new constitution. Through its emphasis on evidential and procedural rules, rather than principled analysis, the judgment tends to reinforce the powers of the executive and the model of a unitary state beyond the reach of the law.

Our understanding of critical illness is transforming as we develop a better understanding of the impact pathogen-associated molecular patterns and damage-associated molecular patterns (DAMPs) have on the pathogenesis of disease. Of the known DAMPs, there is a growing interest in mitochondrial DNA (mtDNA) as a DAMP capable of propagating the inflammatory response seen in sepsis and other conditions. In this review, we describe the varying mechanisms by which mtDNA is translocated from mitochondria into cytosol and the extracellular space where it can illicit an inflammatory response. In addition, we present some of the most recent clinical studies to examine mtDNA in critical illness.Basic science research provides convincing data that mtDNA can influence the immune system through toll-like receptor 9 and inflammasomes. Clinical trials provide evidence that mtDNA is elevated in critically ill patients and is associated with mortality.Although mtDNA is a DAMP shown to be elevated in numerous conditions, the clinical ramifications of this finding remain elusive. Further work is needed to determine if mtDNA can be utilized as a biomarker of disease severity or mortality.

Experiments to investigate the effect of target wall curvature on heat transfer and pressure loss from jet array impingement are performed. A jet plate configuration is studied with constant hole diameters and spacings. The geometry of the jet plate has streamwise jet spacings of 5.79 jet diameters, spanwise jet spacings of 4.49 jet diameters, and a jet-to-target plate distance of 3 jet diameters. For the curved case, the radius of the target plate is r/D=31.57. A flat target wall setup with identical geometric spacing is also tested for direct comparison. Jet spacings were chosen such that validation and comparison can be made with open literature. For all configurations, spent air is drawn out in a single direction which is tangential to the target plate curvature. Average jet Reynolds numbers ranging from 50,000 to 150,000 are tested. A steady-state measurement technique utilizing Temperature Sensitive Paint is used on the target surface to obtain Nusselt number distributions. Pressure taps placed on the sidewall of the channel are used to evaluate the flow distribution in the impingement channel. Alongside the experimental work, CFD was performed utilizing the v2-f turbulence model to better understand the relationship between the flow field and the heat transfer on the target surface. The main target of the current study is to quantify the impact of target wall radius, the decay of heat transfer after the impingement section and to check the open literature correlations. It was found that the target wall curvature caused higher heat transfer levels, with array-average Nusselt numbers increasing by an average of 28% when compared to the similar plane case. In the post-impingement section, increases in heat transfer levels were also seen with the curved case by up to 60%. Finally, CFD results were able to show agreement in stagnation point Nusselt number levels with experimental results for the curved target plate.Copyright © 2015 by ASME and Alstom Technologie AG

Addressing an audience in Dublin’s Shelbourne Hotel in 1960, Kwame Nkrumah, first President of the recently independent Ghana, spoke of the connections between Ireland and Africa and his admiration for the Irish people's campaign for freedom. Inspired by the humanitarian and anti-colonial career of Roger Casement, Nkrumah remarked on “those Irish leaders of the last century who realised that the struggle of Ireland for independence was not the struggle of one country alone, but part of a world movement for freedom”. The speech coincided with the high point of the so-called ‘golden age’ of Irish diplomacy when the country played a leading role in promoting decolonization and a rule-based international system through the United Nations. It also highlights the place of Ireland in the imagination of African and Indian independence movements; and suggests furthermore that this affinity is built on law as much as politics: from the question of whether sovereignty is conceded or won on the departure of the imperial power, to the priority of international law, and the urgency of humanitarian and human rights principles. Such affinities are constituted by more than abstract principles. They involve real, human connections over time. The term we are using for these affinities, which we will argue offers an orientation and inspiration for our own work in legal education today, is ‘cosmopolitan kinship’. We will give three brief examples, before explaining that term a little more.

This paper draws on theories of nodal governance and discursive framing to investigate the rhetorical strategies adopted by campaigners in the ongoing contest over access to medicines and the protection of intellectual property rights in Kenya. It focuses specifically on debates surrounding the implementation of the WTO's TRIPs Agreement in 2001 and the passage of anti-counterfeit legislation in 2008. A survey of parliamentary debates and media sources, as well as interviews conducted with key participants, indicates that “the nation” provided a common overarching frame for arguments made by opposing sides to these debates. The salience of specifically national considerations confirms our view that studies of framing and health governance need to extend their focus beyond developments in international and developed country fora. It also highlights the continued purchase of the national interest as a means of mobilizing the key state institutions needed to implement global legal regimes in Africa.

This article develops a model of change in medical law. Drawing on systems theory, it argues that medical law participates in a dynamic of 'deparadoxification' and 'reparadoxification' whereby the underlying contingency of the law is variously concealed through plausible argumentation, or revealed by critical challenge. Medical law is, thus, thoroughly rhetorical. An examination of the development of the law on abortion and on the sterilization of incompetent adults shows that plausibility is achieved through the deployment of substantive common sense and formal stylistic devices. It is undermined where these elements are shown to be arbitrary and constructed. In conclusion, it is argued that the politics of medical law are constituted by this antagonistic process of establishing and challenging provisionally stable normative regimes.

The efficacy, and to a lesser extent, effectiveness, of individual cognitive behavioral therapy (CBT) for anxiety disorders has been demonstrated, but whether manualized treatments work in a group format in community settings is less established. We investigated the predictors of retention and outcome in 26 groups (11 Generalized Anxiety Disorder, 11 Panic, 4 Social Phobia groups), conducted for more than 10 years in a semirural community mental health center by 19 therapists. Members of the Anxiety Disorders Treatment Team delivered manualized group CBT treatments. Analysis of standard symptom measures at pre- and posttreatment and archival data revealed significant pre–post decreases in anxiety, retention rates comparable to past findings on group retention, and several significant predictors of retention and outcome. Manualized group CBT for anxiety appears to be a viable treatment in community settings. Limitations of the study as well as related practice–research implications of the findings are discussed.

Due to the extremely corrosive environments inside many exhaust ducts fabricated from combustible materials, the mechanical integrity of fire sprinkler system components is often prematurely compromised, leaving the system unable to protect against fires originating within these ducts [FM Global Loss Prevention Data Sheet, 7–78, Industrial Exhaust System, 2011; Understanding the Hazard, Fire in Industrial Exhaust Systems, FM Global, Johnston, RI, 2006]. Pilot testing of a new fire sprinkler system was conducted to protect the fiber-reinforced plastic duct at a nitric/hydrofluoric (HF/HNO3) mixed acid pickling operation. Based on previous laboratory and field tests [Su and Doerr, Process Saf Prog 29 (2010) 70–78], this fire sprinkler system was composed of corrosion resistant sprinkler nozzles, a linear heat detector, flexible mounting connections, sprinkler piping, and controls. Pilot testing results have led to development and recommendation of a new fire protection system capable of protecting combustible exhaust ducts from fire in extremely corrosive environments. © 2013 American Institute of Chemical Engineers Process Saf Prog 32: 277–282, 2013

Corruption in Kenya has been a matter of intense concern for foreign donors and the international financial institutions. External efforts to change the ‘governance culture’ in this regard are not simply instrumental, composed of material restrictions and incentives. They are also inherently rhetorical, seeking to establish the plausibility of a set of values rooted in political economy. This paper examines two widely reported speeches of a former British High Commissioner that can be read together as a highly figurative satire on political standards in Kenya. Having developed a reading of anti-corruption governance as satire, we extend it to the role of the legal profession in the illegal and irregular allocation of public land. We argue that, as well as demonstrating an application of the rhetorical analysis of neo-liberal governance, the case of land grabbing in Kenya also highlights the instability of many of the key binary oppositions underpinning dominant anti-corruption strategies. This instability can be understood in rhetorical terms by drawing on the work of post-colonial writers and critics on the category of excremental satire. Rather than a clear binary opposition, these suggest the interrelation, or more precisely the mutual contamination, of corruption and normal capitalist accumulation.

The present study aims to investigate the heat transfer and pressure loss characteristics for multiple rows of jets impinging on a curved surface in the presence of rib turbulators. The target plate contains a straight section downstream of the impingement section. The rib turbulators are added only over the straight section, in an attempt to enhance the heat transfer while minimizing the pressure loss. The jet plate configuration in this study has fixed jet hole diameters and hole spacing. For the curved plate, the radius of the target plate is 32 times the diameter of the impingement holes. Impingement array configuration was chosen such that validation and comparison can be made with the open literature. For all configurations, crossflow air is drawn out in the streamwise direction. Average jet Reynolds numbers ranging from 55,000 to 125,000 were tested. Heat transfer characteristics are measured using steady state temperature sensitive paint (TSP) to obtain local heat transfer distribution. The experimental results are compared with CFD simulations. CFD results show that CFD simulations predict the heat transfer distribution well in the post-impingement area with turbulators.

Experiments to investigate the effect of varying jet hole diameter and jet spacing on heat transfer from jet array impingement on a curved target surface are reported. The jet plate configurations studied have varying hole diameters and geometric spacing for spatial tuning of the heat transfer behaviour. The configuration also includes a straight section downstream of the curved section, where the effect on heat transfer and pressure loss is also investigated. For all configurations, spent air is drawn out in a single direction which is tangential to the target plate curvature. First row jet Reynolds numbers ranging from 50,000 to 160,000 are reported. The jet plate holes are sharp-edged. A steady-state measurement technique utilizing temperature sensitive paint (TSP) was used on the target surface to obtain heat transfer coefficients. Pressure taps placed on the sidewall and jet plate of the channel were used to evaluate the flow distribution in the impingement channel. Alongside the experimental work, CFD simulations were performed utilizing the v2-f eddy viscosity turbulence model to understand better the relationship between the flow field and the heat transfer on the target surface. The results from this study are compared against past results for uniform array impingement on flat surfaces.

This paper considers the importance of temporal categories in medical law argumentation. Proceeding from a view of time as plural, rhetorical, and socially produced, it argues that decision making in areas such as the access of minors to contraception, abortion law, end of life care, and emergency caesarian sections can be usefully read as struggles over appropriate time frames. Judges, legislators, and commentators seek to establish the plausibility of a given legal development with reference to the common sense understanding of time which it embodies. Such understandings may be plausible because of their resonance with the diverse temporalities of the law itself. Alternatively, they may reproduce the temporal frames proper to medical science. Not only is time represented in medical law rhetoric, but deliberation in such cases is also subject to temporal pressures which may significantly affect their outcome. The paper concludes by considering the broader political stakes of intertemporal struggles in medical law.

This Part-Special Issue seeks to capitalize on emerging work at the intersection of studies of global health, the right to health and ‘the spatial turn’ in the social sciences. The articles included address globally applicable research from a range of disciplines. The relevance of the right to health cuts across traditional disciplinary boundaries. The Part-Special Issue contributes to debates by presenting empirical and theoretical work from public health, social policy, political science, geography, anthropology and socio-legal studies. Attention to the right to health has increased in the last three decades mainly due to HIV/AIDS. Nevertheless, the spatial component of how to implement the right to health has been neglected by researchers, policy makers and practitioners compared to other, legal aspects of the right to health.

Cranfield University is in the process of implementing a Current Research Information System (CRIS). The system is intended to ensure a single and accurate source of Cranfield’s research information to allow for effective planning, monitoring, reporting, communication and future modelling of its research activity. It will therefore play a key role in helping the University to prepare for the Research Excellence Framework (REF) in 2014. Phase one of the project, publications management, has recently been completed and the system is being rolled out to the University’s research communities.The article briefly describes the institutional context, the business case and the requirements for the new system and reflects on the lessons learned from this implementation.

The addition of a transmitted electron detector to a scanning electron microscope (SEM) allows the recording of bright and dark field scanning transmission electron microscope (STEM) images and the corresponding in-lens secondary electron images from the same region of a thin sample. These combined imaging techniques have been applied here to the analysis of ultrathin sections of cells exposed in vitro to nanomaterials for toxicology investigation. Electron microscopy in general permits the exact nature of the interaction of nanomaterials and cells to be elucidated, and in addition the use of STEM mode in the SEM enables the easy identification and exclusion of artefacts produced by ultramicrotome sectioning. The imaging and analysis obtained by using the STEM mode in the SEM configuration from three different nanomaterial systems of importance (iron oxide nanoparticles, single-walled carbon nanotubes and cadmium selenide quantum dots) indicate that it is a simple, practical and cost-effective tool for nanotoxicological research.

Summary All biological tissues are three dimensional and contain structures that span a range of length scales from nanometres through to hundreds of millimetres. These are not ideally suited to current three-dimensional characterization techniques such as X-ray or transmission electron tomography. Such detailed morphological analysis is critical to understanding the structural features relevant to tissue function and designing therapeutic strategies intended to address structural deficiencies encountered in pathological states. We show that use of focused ion beam milling combined with scanning electron microscopy can provide three-dimensional information at nanometre resolution from biologically relevant volumes of material, in this case dentine.

Thin films of barium strontium titanate (BST), lanthanum modified bismuth titanate (LBT) and lead zirconate titanate (PZT) were fabricated by sol-gel methods onto sapphire substrates. They were transferred to a second substrate by using UV eximer laser radiation to delaminate the films from the fabrication substrate. Scanning electron microscopy revealed melting at the interfacial region of the LBT and PZT films, thus providing the delamination mechanism, but melting was not observed in the BST films. Only the PZT film, after laser transfer, retained its ferroelectric properties, with remnant polarisation of ∼30 μC/cm2, and a high coercive field of 150 kV/cm.

Laser transfer processing (LTP) offers the potential to overcome the problems of integrating ferroelectric thin and thick film materials with polymers and other technologically useful substrate materials that cannot sustain the high process temperatures, 600–1,000 °C, required for normal film deposition. The LTP technique involves the fabrication of a ceramic film on a high-temperature substrate material such as sapphire, and subsequent release by application of pulsed ultra-violet laser radiation. Here, the LTP technique is reviewed in the context of ferroelectric thin and thick films, and current developments are presented. Micro- and nanostructural features of the films before and after transfer to a second substrate are revealed using scanning and transmission electron microscopy. The consequences of laser-generated structural changes on ferroelectric properties are illustrated, and measures to mitigate the effects of an amorphous damage-layer are discussed.