Big Trouble Research Articles

New Opioids: Expensive Distractions or Important Additions to Practice?

Russell K. Portenoy, M.D.: I have been involved in doing a lot of the studies with the new rapid-onset fentanyl formulations, including the very first one that was on the market, oral transmucosal fentanyl citrate. These formulations have all been developed in response to the view that breakthrough pain is an unmet need largely because the time course of a typical breakthrough pain is much shorter than the timeaction relationship of a typical oral short-acting drug like oxycodone or morphine. The vast majority of breakthrough pain, when evaluated in these epidemiologic studies, last less than 1 hour and have a time to maximum intensity of 10 minutes or less. When you compare that to the time-action relationship of an oral drug like morphine, you can see that there is a mismatch. Oral transmucosal fentanyl was commercially successful. The second formulation, fentanyl buccal citrate, has also been successful for the pharmaceutical company. This success has induced other companies to formulate new products and get them on the market. The Holy Grail with these drugs has been to try to have a time-action relationship that almost approximates an intravenous bolus, with the goal of translating a rapid effect into clinical benefit by addressing the mismatch I mentioned. Interestingly, there has been very, very little research comparing the standard oral agents, like morphine or oxycodone, with any of the rapid-onset fentanyl formulations. Although the very few studies that have been done have had methodological concerns, they have found greater satisfaction and greater pain control with the fentanyl formulations. This cannot be viewed as definitive, however, because of the methodological issues and the need for replication in broader clinical populations and real world settings. Right now on the market we have the oral transmucosal fentanyl citrate, the fentanyl buccal tablet, and the new bioerodible mucoadhesive patch, which just got approved. Coming on the market in relatively short order will be a sublingual dissolvable tablet, intranasal formulations, and possibly aerosolized formulations that will be inhaled. These drugs all will have company-initiated Risk Evaluation and Mitigation Strategies (REMS), which the U.S. Food and Drug Administration has been required by law to put into place. In the case of the patch and with others coming, these REMS programs appear to add some burden to doctors to make sure that they are aware of risks, including drug abuse and unintentional overdose, and the management guidelines to minimize them. Doctors are going to have to get used to the concept of REMS and be willing to spend an extra few minutes to review guidelines, document that they are knowledgeable about the risks, and be entered into a registry. To the extent that REMS affects the newer rapid onset fentanyl formulations before affecting other opioid formulations, they may slow down the uptake of the new products as they come on the market.

Thrillers, Detective Stories, and Bloody Narratives

Thrillers, Detective Stories, and Bloody Narratives Bryant Simon (bio) Beverly Gage. The Day Wall Street Exploded: A Story of America in Its First Age of Terror. New York: Oxford University Press, 2008. Illustrations, appendix, notes, and index. 416 pp. $27.95. As I read Beverly Gage’s engaging, smart, insightful, and crisply written new book, I couldn’t stop thinking about J. Anthony Lukas. Before he took his own life in 1997, Lukas stood tall as one of the nation’s preeminent historians. Trained as a journalist, with apprenticeships at the Baltimore Sun and New York Times, he wrote sprawling, dramatic stories for a wide, yet still well-informed audience. He wrote epic tales built around fully fleshed-out characters, both the famous and the not-so-famous. The men and women that interested him the most typically found themselves embroiled in and affected by revealing and explosively violent moments: the death of a troubled New England socialite lost in the darkness of the counterculture, the vicious opposition to busing in Boston, and the 1905 murder of an Idaho governor.1 In his essays and books, Lukas crafted what Gage has called in another context (borrowing a phrase from the historian Robert Darnton) “incident stories.”2 Lukas would take a moment, a flash point from the past, freeze it on the page, then show how the people caught up in the incident got there: how their experiences—and even more, how their ideas about justice, race, and class—brought them to this point and conditioned them to respond and think about the event the way they did. Recreating this milieu and with it an emotional connection with the past, much more than contributing directly to historiography, was his intention and mode of operation. When it came to the storytelling itself, Lukas took long, meandering trips deep into the past. Lukas was, in fact, the master of the backward journey. In his Pulitzer Prize–winning study of the Boston busing battles, Common Ground, he told the richly detailed and carefully documented stories of three families—one upper-middle-class white, one working-class white, and one African American—ensnarled in the conflict. To explain the thoughts and actions of his hard-scrabble, reactionary white Charlestown characters, he went back to Ireland: to the bogs, to the famine, and to the heavy-handed rule of the [End Page 114] countryside in the seventeenth century. Again, in his version of history, what matters in the past is how characters—people—came to understand the world they lived in at the moment that Lukas is trying to comprehend, although he usually tied his books up—as his subtitles suggested—in some larger, somewhat vague moral lesson about the nature of class or race in America. In her new book, Gage works in a similar, if significantly slimmed-downed, fashion. Following the incident story arc and plotline that Lukas used in his very last book, Big Trouble, Gage’s The Day Wall Street Exploded is, in many ways, a traditional detective story (and it is more like this than it is a traditional university press historiographic monograph). Gage starts with several bodies and devotes most of her book to trying to solve the case. Along the way, she draws on familiar understandings of the past to tell us about the complex motivations and rich backgrounds of her characters. The story begins just before noon on September 16, 1920. Someone steers a horse-drawn cart up to the sidewalk outside the headquarters of the financial capital of the United States, the House of Morgan. Just as the driver parked, thousands and thousands of office workers, clerks, and stockbrokers criss-crossed the streets and strolled the sidewalks, grabbing something to eat and hurriedly doing errands on their lunch breaks. As the clock inched toward twelve, a bang sounded. Dynamite launched hundreds and hundreds of lethal shards of metal shrapnel through the air. The projectiles tore at people’s limbs. Walls crumbled and glass shattered. Moans and wails could be heard for blocks. When the police and doctors made their final tally, they added up twenty-six dead and many more maimed and injured. Given the proximity of...

202 PVCとPETを含む廃プラスチック油化リサイクルの現状と課題 : 札幌プラスチック油化処理施設の最大油化処理達成と課題(循環型廃棄物処理技術(1))

Sapporo Plastics Recycling Corp., Ltd. (SPR) which had started commercial operation of waste plastics liquefaction plant in 2000 when "The Containers and Packaging Recycling Law" had been enforced fully, has entered 10th year of operation. Only hydrocarbon oil has been recognized as recycled product derived from the waste plastics liquefaction plant of SPR by law. As a result, SPR has achieved high recycling rate, in addition, more than 90% of the recycled products have been reused in Hokkaido. Overcoming the operational obstacle caused by corrosion and clogging, SPR has been working towards maximizing recycling rate. In 2009, SPR accomplished full operation to recycle 14,000t municipal waste plastics without big troubles. Moreover, cascade recycle which chemical recycle (CR) will be done for selected waste plastics mixed with material recycle (MR) residues after material recycle was studied in 2008.

UNIT COMMITMENT BASED ON IDENTIFICATION METHOD FOR VALID OPTIMIZING SPACE

Unit commitment is one of the most important issues in power system operation, and solving this problem with mature optimizing algorithms has been the general trend now. However, too many integers which are needed to be branched are the biggest trouble to obtain the optimal solution in limited time. Different from most of the published papers, which mainly focused on the improvement of a certain optimizing algorithm, a novel notion of optimizing space of unit commitment and its scientific identification method are proposed in this paper from the perspective of model optimization. Based on the analysis on both units and binary variables of each time interval, this method can identify the invalid integer variables which need not to be branched, and turn them into continuous variables. Besides, in response to the failure of the traditional formulation of mixed integer linear programming (MILP), a novel one based on the valid optimizing space is proposed. Based on the work in this paper, the optimizing range is narrowed efficiently, and the calculating efficiency is improved greatly, under the premise of guaranteeing feasibility and optimality of original problem. The effectiveness of this method is demonstrated by the theoretical analysis and numerical experiments.

Ermenilerin Tehcir Edilmesi Kararında Etkili Olan Faktörler ve Maraş-Zeytun Ermenilerinin Tehciri

Osmanlı Devleti, XX. yüzyıla girerken siyasî, ekonomik ve askerî yönden sıkıntılar içerisindeydi ve yüzyılın başında önce Trablusgarp daha sonra Balkanlarda ağır kayıplar verdi. Osmanlı Devleti'nin Balkan savaşları sonucunda Balkanlardaki topraklarını kaybetmesi bağımsızlıklarını elde etmek isteyen Anadolu Ermenilerini heyecanlandırdı(1) ve onların devlete bağlılık duygularını zayıflattı. Bunun sonucunda meselâ Zeytun Ermenileri, Birinci Dünya Savaşı'nda seferberlik emrine uymayarak Osmanlı ordusuna asker göndermediler, aksine silâhlanıp dağlara çıktılar ve Osmanlı Devleti'nin düşmanlarıyla işbirliği yaparak devlete meydan okudular. Kafkasya'da da benzer bir durum yaşandı ve Osmanlı Devleti'nin Almanya tarafında savaşa girmesini fırsat bilen Taşnak Komitesi, Anadolu Ermenileri adına Rusya ile anlaştı. Bu anlaşmaya bağlı olarak Osmanlı ordusunda silâh altına alınan Ermeniler Rus tarafına geçtiler ve küçük çeteler hâlinde örgütlenip Osmanlı ordusuna karşı Rus ordusunun ileri ucunda görev aldılar. Ermenilerin bir kısmının bu ihaneti, Osmanlı hükümetinin savaşın bütün hızıyla devam ettiği bir anda bütün Ermenilerin sadakatinden şüphe duymasına sebep oldu(2).

Economic Crisis Taking Toll on Americans' Mental Health

Economic Crisis Taking Toll on Americans' Mental Health

Big Trouble in Little Chinatown: Australia, Taiwan and the April 2006 Post-Election Riot in Solomon Islands

South Pacific has emerged as a source of contention between two key Asia-Pacific middle powers, Australia and Taiwan. Taiwan 's effort to maintain and expand the list of countries with which it has formal diplomatic relations, in the face of hostility from China, has clashed with Australia's governance reform agenda for the Pacific Islands. This conflict is particularly acute in Solomon Islands, which has longstanding ties with Taiwan and a close association with Australia. However, while this divergence of interests is real, Australia has fuelled this conflict through imputing Taiwan for Australia's difficulties in an apparent attempt to avoid acknowledging the ambitious nature of Australia's agenda relative to the political, economic and social conditions in Solomon Islands. This inclination to make Taiwan a scapegoat brought about sustained public Australian criticism of Taiwan following the April 2006 post-election riot in the Solomon Islands, based on little more than the unsubstantiated claims of a single Solomon Islands politician. This episode inflicted serious harm on Taiwan's reputation in Australia. The incident also contributed to the Chen Shui-bian Taiwan government's perception of Australia as being increasingly pro-China. This article draws on local media and interviews conducted in Australia, Solomon Islands and Taiwan to analyze the development of this recent Australia-Taiwan conflict in Solomon Islands. First, it provides a brief background of Australia's and Taiwan's involvement in the South Pacific, followed by an examination of Taiwan's role in the Solomon Islands Crisis and the subsequent Australian-led intervention. It then discusses the involvement of the Australian and Taiwan governments in the events

DEA Agent Advises Diversion Vigilance

DEA Agent Advises Diversion Vigilance

World Stroke Day 2008

See World Stroke Day Proclamation Appendix, pages 2409–2420. World Stroke Day is a day with a message for every day: “Stroke is a treatable and preventable catastrophe.” This year and every subsequent year it will be on October 29th. The theme for this year is “Little strokes, big trouble”. During the World Stroke Congress in Vancouver in 2004, a working group was organized to develop a global agenda for stroke. This agenda was subsequently incorporated into a World Stroke Proclamation launched in Cape Town on October 26, 2006 (supplemental video, available online at http://stroke.ahajournals.org). The 2007 World Stroke Day theme was “Stroke is a treatable and preventable catastrophe and hypertension is its most common and treatable factor”. This year the stroke global agenda will be highlighted at the forthcoming 6th World …

An Increase in Cardiopulmonary Bypass Outflow Resistance: Small Flap, Big Troubles

An Increase in Cardiopulmonary Bypass Outflow Resistance: Small Flap, Big Troubles

시차공간영상에서의 구간별 시차 경로 탐색을 이용한 중간 영상 생성

In this paper, we present an algorithm for synthesizing intermediate view image from a stereoscopic pair of images. An image of multiview is need for people in order to easily recognize 3D image. However, if many cameras are use for that, not only does system get more complicated but also transmission rating cause a big trouble. Hence, stereo images are photograph and issue on the sending side and algorithm to generate several intermediate view image is able to be use on the receiving side. The proposed method is based on disparity space image. First of all, disparity space image that is depicted by the gap of pixel followed by disparity of stereo image is generated. Disparity map is made by utilizing disparity space image for searching for optimal disparity path then eventual intermediate view image is generated after occlusion region which does not match is processed. Experimental results illustrate the performance of the proposed technique and we obtained a high quality image of more than 30 dB PSNR.

Little strokes, big trouble and more.

Little strokes, big trouble and more.

China's New Anti-Monopoly Law: Big Trouble in Little China?

China's New Anti-Monopoly Law: Big Trouble in Little China?

2212 紙しわに対するローラ形状の影響(要旨講演,一般セッション:柔軟媒体ハンドリング/画像形成機器)

Paper wrinkle or crease is generated in the process fixing the toner to the paper. Especially, paper crease is a big trouble of printing process. This paper deals with this paper wrinkle and crease. In the first approach, a experimental apparatus is made and experiments for confirming paper crease are carried out with changing forms of roller. In the second approach, simulation model is composed of a driven rubber roller divided solid elements, a rigid cylindrical shaft and a paper divided shell elements. The simulation is conducted using explicit method by FEM software. Simulation and experiment results are compared and the relationship between roller form and paper wrinkle is discussed. Finally, conditional equation related to paper wrinkle is derived adapting buckling theory of thin plate and the mechanism of paper crease is explained by strain, contact pressure and friction on the contact area of roller and paper.

Patent reform acts ugly

Controversial US patent system reforms and rule changes currently being proposed spell big trouble for biotech.

Ambitious scheme for developing world trials in 'big trouble'

Ambitious scheme for developing world trials in 'big trouble'

The Spectacle of the Other: Representations of Chinatown in Michael Cimino’s Year of the Dragon (1985) and John Carpenter’s Big Trouble in Little China (1986)

Since the late nineteenth century, Chinatowns have always been portrayed on the silver screen as spaces of danger, spiritual and moral decadence, and 'otherness.' This paper examines the representations of Chinatowns in two movies released in the 1980s, Year of the Dragon (1985) and Big Trouble in Little China (1986), while addressing plausible reasons for the endurance and durability of the negative depictions of Chinatown.

Not Following the Law Can Cause Big Trouble

Not Following the Law Can Cause Big Trouble

Specialybės teksto supratimo sunkumai dėl žodžių darybos

The article deals with some difficulties, concerning word-building and similar phenomena in French, such as composition, conversion transfer. Written speciality texts are investigated as they convey scientific ideas in the best way. Differently from the difficulties in syntax and semantics the lexical word-building is not a big trouble and therefore not a subject dealt with by linguists, still we can not neglect the changes of meanings of word-building and affixes, new lexical units, carrying out other semantic and syntactic functions. Article in English

Korean Textile Firms' FDI in China: An Empirical Analysis on the Management Practices

China is top FDI destination for Korean Textile firms. This paper, using survey data for 41 Korean textile firms invested in China, measured their performance and analysed its determinants. Regression results show that localization of the business management, level of wages, the investment-to-employee ratio, ratio of raw materials sourced from Korea, and export ratio of the parent company have positive relations with the firm's performance. On the contrary, domestic sales (i.e. sales within China) ratio is not significantly related with the performance. This survey also reveals some difficulties which Korean-invested textile firms in China usually face in the operation stages of investment. The biggest trouble is the rapid rise of production cost, and many firms feel growing competition from local competitors and have difficulties with entering local market. They also suffer from lack of skilled workers and high ratio of labor turnover. Besides, they have trouble financing operation funds in China. Meanwhile, according to the survey result, the ratio of local procurement of raw materials continues to rise rapidly, being expected to amount 77 percent within the next few years. This indicates that the export induction effect of FDI would be in a sharp decline, possibly resulting in enlargement of Korean textile industry's trade deficit with China.