Future Growth Potential Research Articles

Transformational Impact of Health Information Technology on the Clinical Practice of Child and Adolescent Psychiatry.

Compared with other medical specialties, psychiatrists have been slower adopters of health information technology (IT) practices, such as electronic health records (EHRs). This delay in implementation could compromise patient safety and impede integration into accountable care organizations and multidisciplinary treatment settings. This article focuses on optimizing use of EHRs for clinical practice, leveraging health IT to improve quality of care, and focusing on the potential for future growth in health IT in child and adolescent psychiatric practice. Aligning with other medical fields and focusing on transparency of mental health treatment will help psychiatrists reach parity with other medical specialties.

The Role of Health Tourism on Tourism Devlopment in Kerala State: An Evaluation

<div><p><em>Varkala is a tourist hub in Trivandrum in Kerala, India which has high inflow of visitors among other places in Kerala. The place possesses more than 100 resorts in which majority provides Ayurvedic spa and treatment to the customers.</em></p><p><em>Health and medical tourism is perceived as one of the fastest growing segments in marketing ‘Destination India’ today. While this area has so far been unexplored, we now find that not only the ministry of tourism, government of India, but also the various state tourism boards and even the private sector consisting of travel agents, tour operators, hotel companies and other accommodation providers are all eying health and medical tourism as a segment with tremendous potential for future growth. The main aim of this project is to find out the scope and relevance of Health Tourism in India particularly with special reference to Varkala. The paper tries to suggest customer friendly measures for the better growth in health tourism. The impact of health tourism on visitors is also analysed here in the study.</em></p></div>

Advantages of Calvarial Vault Distraction for the Late Treatment of Cephalocranial Disproportion.

Cephalocranial disproportion is a symptomatic condition related to a volume discrepancy between the calvarial vault and the brain. Traditional expansion techniques are unfavorable in older children due to inadequate dural ossification, lack of bone pliability, and limited future growth potential. The authors review their experience using distraction to close bone defects in this setting. A retrospective analysis was performed of all patients treated using distraction in this setting by a single surgeon. Demographic and outcomes data were collected. The efficacy of ossification of bone defects after expansion by distraction was measured using volume analysis of three-dimensional computed tomography (CT) scans. This required a CT scan at the completion of device activation and a follow-up CT scan 6 months or more beyond activation. Sixteen patients (17 distractions) met the imaging-based inclusion criteria. The average age at surgery was 3.97 (2.14-6.89) years. The mean initial bone defect volume after asymmetric transverse distraction was 7.26 (5.45-13.73) mL. The mean final defect volume was 2.18 (0.00-5.90) mL with a mean change of 5.08 (1.21-12.79) mL and mean interval time of 27.85 (7.13-56.39) months. This represents a mean percent defect closure of 72.30 (20.38-100.00). Distraction osteogenesis is a very effective tool for treating the older child with cephalocranial disproportion. The ability to ossify the bone defects without a donor site provides a considerable advantage in these patients.

Women and the Chinese Labor Market: Recent Patterns and Future Possibilities

While many economists have advanced potential future growth strategies for the Chinese economy, none to our knowledge have done so with a specific consideration of the impacts these policies may have on women’s welfare measured in terms of labor market outcomes. In this article, we first discuss the relative status of women’s position in the Chinese labor force from the perspective of their employment levels, occupational segregation, and wages. We then calculate segregation indices and present and interpret recent employment data from the National Bureau of Statistics of China to consider how the labor market has evolved for women in the last decade. Interestingly, we find that occupational segregation by gender has in fact intensified since the onset of the radical reforms in China in the mid-1990s. Next, we contribute to the literature by evaluating potential growth policies for their impacts on women’s relative welfare in terms of labor market outcomes using our unique criteria for evaluation. We find that switching to a service-centered growth strategy could work to increase women’s relative welfare if implemented concurrently with additional policies aimed at reducing the otherwise potential negative implications for women’s relative welfare. Finally, we provide our own gender sensitive growth strategy suggestions which include our argument that an education-led growth strategy, for example, may have the largest positive impact on both the Chinese economy and women’s relative welfare.

Types of Peroral Cholangioscopy: How to Choose the Most Suitable Type of Cholangioscopy.

A number of case studies have described the usefulness of peroral cholangioscopy for diagnosis and therapy, performed by visualizing the inner cavity of the bile duct. Currently available types of peroral cholangioscopy include peroral videocholangioscopy (POCS) using a mother-baby scope system (MBSS), direct peroral videocholangioscopy (D-POCS), and SpyGlass™ Direct Visualization System (SGDVS). POCS started with cholangioscopy using MBSS, requiring two skilled endoscopists using two endoscopic systems. On the other hand, D-POCS and SGDVS were developed as single-operator techniques. In MBSS, the videocholangioscope is inserted into the bile duct through the accessory channel of a conventional therapeutic duodenoscope. MBSS enables comparatively easy scope insertion into the bile duct and stable scope positioning. POCS using MBSS provides excellent images and can be coupled with an image-enhanced function system. However, it has a smaller accessory channel, limiting the devices that can be used. Additionally, scope fragility is serious problem. D-POCS using an ultraslim upper endoscope has been introduced to overcome the drawback of POCS using MBSS. D-POCS has a larger working channel and requires only one endoscopist. D-POCS allows a greater variety of procedures under excellent imaging even with an image-enhanced function system; however, scope insertion is still challenging. SGDVS is designed for single-operator use and is dedicated to procedural purposes. It comprises a reusable optical probe and disposable delivery catheter, which has four-way deflected steering and dedicated irrigation channels. These features lead to good maneuverability, although image quality is poor due to its optical probe system. All systems' features should be recognized and the appropriate system used depending on the need. Cholangioscopy has shown dramatic progress from diagnosis to therapy with high future growth potential.

Frontiers of research on Chinese management

Purpose The purpose of this paper is to provide a brief yet insightful survey of papers in the first issue of Chinese Management Studies. In the process, the founding Editor focuses on the key concepts and how scholars may further extend and build on the research undertaken. Design/methodology/approach The Editor provides a snapshot of the research undertaken in the papers selected for this issue. Instead of simply summarizing the work undertaken, the Editor, where it is highly appropriate, incorporates aspects of underlying Chinese culture. For instance, how the Confucian concept of the doctrine of mean – very broad as it is in scope – is supported in research reported here. Also, in contradiction to what authors may have argued on meaningfulness of work per se, to highlight an old Chinese adage: for example, 工字不出头 (gong-zhi-bu-chu-tuo). A literal translation into English will fail to render the true intent of the phrase. What it means is that the Chinese character for “work” implies a much deeper meaning: The horizontal line on top of the vertical limits the potential of future growth. Other concepts are visualized for ease of readers grasping the key concepts. Findings The series of papers here highlight the significance of research into managerial behaviors (negatively, tax aggression and abuse of power for self-enrichment), meaningfulness of work, reading of timeless Chinese novels, innovation (ZTE) and the knowledge organization, changing and transforming China and of Russian-Chinese (Taiwan) strategic alliances. The insights gained through these intensive research efforts ought to be shared with scholars globally. Social implications The research in this issue has wide practical relevance as in highlighting the critical importance of a range of topics: Jiang Hu organizing theory, managerial behaviors, innovation and knowledge, Russo-Chinese strategic alliances, fit in strategic management and China-in-transition. This paper ties these together for the reader. Originality/value Through a review of these papers, the Editor provides insights for scholars on the possibilities for extending the frontiers of research on Chinese management. Where relevant the Editor highlights additionally, perspectives from deeply rooted Chinese beliefs, values and philosophy.

Simulating the Macroeconomic Impact of Future Water Scarcity: An Assessment of Alternative Scenarios

In this paper we consider some of the economic implications of climate change scenarios as described in the Shared Socioeconomic Pathways (SSPs). By comparing potential water demand with estimates of (sustainable) water availability in different regions, we identify regions that are likely to be constrained in their future economic growth potential by the scarcity of water resources. We assess the macroeconomic impact of water scarcity under alternative allocation rules finding that, by assigning more water to sectors in which it has a higher value, shifting production to less water intensive sectors, and importing more water intensive goods, constrained regions can effectively neutralize these water related climate risks and adapt to a changing water environment. However, this adaptation effort is likely to imply some radical changes in water management policies.

The characterization of unconventional reservoirs in the Bowland sequence using onshore 3D seismic data, Cleveland Basin, UK

The Lambda-Mu-Rho (LMR) approach of characterizing reservoir intervals in seismic data is a useful tool for efficient well placement and completion. The successful exploitation of unconventional hydrocarbons in the UK could play a fundamental role in helping to satisfy the growing energy demand. To achieve this, it has been proved necessary to differentiate the more brittle from ductile rocks to maximize reservoir recovery. Economic gas production in unconventional plays requires hydraulic fracture stimulation. This study utilizes the impedance, density and the Lame parameters (Lambda, λ and Mu, μ) logs derived from the Amplitude Variation with Offset (AVO) inversion to compute the more seismically intuitive LMR logs and the elastic properties Poisson’s Ratio and Young’s Modulus. The optimal Carboniferous tight sandstone reservoir intervals at Kirby Misperton in the Cleveland Basin were successfully characterized using the LMR crossplot method. Tight gas-filled sandstones are characterized by a low λρ and a high μρ value as a result of their low incompressibility, high rigidity and intrinsic brittleness. The analysis confirmed that the Lower Bowland sequence is prospective from an unconventional perspective due to its high quartz content and therefore is likely to respond positively to hydraulic fracturing. Unconventional resources currently account for 43% of US gas production with gas consumption expected to increase between 2010 and 2030 (Rogers, 2011). Tight gas sandstones represent approximately 70% of all global unconventional gas production and reserves that are yet to be developed (Khlaifat et al., 2011). Although commercial exploration and production of unconventional gas in the UK is in its infancy, it offers significant potential for future gas production growth and will become increasingly important as the easily exploitable conventional gas reserves are exhausted (Law and Curtis, 2002). Most tight gas reservoirs are often characterized by a multi-layered reservoir system that are often hydraulically fractured to enhance recovery rates from the reservoir intervals (Meckel and Thomasson, 2008).

Causal effects of threat and challenge appraisals on coping and pain perception.

Numerous studies have found appraisals of pain as a source of potential threat or tissue damage influence pain perception and coping. Conversely, causal effects of challenge appraisals reflecting potential future benefits of bearing pain have received little attention. This experiment was designed to elucidate effects of appraising laboratory pain as a source of potential threat and challenge on pain perception and coping. Before engaging in a cold pressor test (CPT), young adult women (N=112) and men (N=49) were randomly assigned to one of three conditions: a higher threat group in which participants read an orienting passage describing symptoms and consequences of frostbite (pain as a signal for nociception), a lower threat group in which participants read about CPT safety (pain independent of nociception) or a challenge appraisal group in which participants read a passage describing how persistence in the face of discomfort predicts future life success and satisfaction. The higher threat group had lower pain tolerance and catastrophized more during the task than lower threat and challenge appraisal groups. Conversely, the challenge appraisal group reported using more cognitive strategies (ignoring, diverting attention, coping self-statements) in managing pain than either threat group. Structural equationmodelling indicated paths of subjective threat and challenge appraisals with pain tolerance were fully mediated by individual differences in reported cognitive coping and/or pain catastrophizing. Findings underscore causal effects of pain appraisals on coping responses and pain perception. WHAT DOES THIS STUDY ADD?: Effects of challenge appraisals of pain as a source of potential future growth or development have not been considered in experimental pain research. Causal effects of primary appraisals of laboratory pain as a source of potential threat and challenge were elucidated in relation to pain perception and coping.

Protocols and Mechanisms to Recover Failed Packets in Wireless Networks: History and Evolution

The emergence of multihop wireless networks and the increase in low-latency demands of error tolerant applications, such as voice over internet protocol, have triggered the development of new protocols and mechanisms for recovering failed packets. For example, recovering partially corrupt packets instead of retransmission has emerged as an effective way to improve key network performance metrics, such as goodput, latency, and energy consumption. A number of similar and interesting solutions have been proposed recently to either reconstruct or process corrupt packets on wireless networks. The proliferation of multimedia services on 3G and long term evolution networks, and the stringent quality of service requirements for these applications have given birth to robust codes and new error tolerant mechanisms for packet delivery. Despite years of active research in the field, we lack a comprehensive survey that summarizes recent developments in this area and highlights avenues with potential for future growth. This survey tries to fill in this void by providing a comprehensive review of the evolution of this field and underscoring areas for future research.

Facilities for Bunkering of Liquefied Natural Gas in Ports

Emission reduction targets are driving a new way of thinking and a range of technological solutions within the shipping and port sectors. So far, four major solutions have been identified for cleaner ship fuels: (i) Marine Gas Oil, (ii) Heavy Fuel Oil + Scrubber, (iii) Liquefied Natural Gas – herein referred to as LNG, and (iv) Methanol. From those alternatives, most experts recognise LNG as the most developed fuel solution, both in the short- and in the medium-term. In 2014, the United States Energy Information Administration (EIA) as well as the International Gas Union (IGU) reported a significant growth of terminals for LNG liquefaction and regasification. Moreover, the European Commission, as part of its Clean Power for Transport package, has adopted in 2014 a Directive ‘on the deployment of alternative fuels, recharging and refuelling infrastructure’. Nevertheless, there are several constraints that need to be addressed yet, more particularly in LNG importing countries in order to meet the future demand of the expected LNG-powered fleet. They include facilities for storage and transhipment of LNG for fuelling berths, barges and ships. This paper provides an overview of the use of LNG for the maritime industry and examines its potential for future growth on the basis of the LNG-powered fleet (current and in order) and planned expansion of LNG bunkering facilities, mainly in European ports. Most data here presented come from a variety of sources including international databases such as IHS Maritime, ports websites, and reports from LNG-related organisations. In addition, the results from past and current EU-funded projects in this field were reviewed and consultations were conducted among representatives from participating ports. Overall, it was found that the LNG powered fleet is expanding slowly and the trend is towards building LNG-propelled vessels for smaller ship sizes and short distances. Although Norway is the newbuilding front runner, other countries, mainly in Europe (e.g. the Netherlands, Denmark, Italy, and Malta), have ordered an important amount of new buildings. Similarly, European ports are expanding considerably their LNG bunkering capacities. Remarkable are the activities conducted by the ports of Spain and Italy with planned expansion for LNG handling and storage facilities beyond 2020. Finally, with regards to regulations, while international standards have been adopted for the construction and operation of LNG powered ships and crew's training, no harmonisation exists yet for LNG facilities in ports. The latter have allowed major ports to undertake independent initiatives to overcome the situation.

North Korea's Economic Integration and Growth Potential

This paper analyzes the future growth potential of the North Korean economy, conditional on economic reform and integration with South Korea. The growth projections based on cross-country evidence show that, if North Korea embarks on substantial policy reforms toward a market-oriented and open economy, it could achieve higher economic growth in the long run. Using an empirical gravity model of trade and direct investment, we forecast that, when the two Koreas pursue economic integration and cooperation without military conflicts, North Korea’s trade with South Korea can increase significantly, that is, up to 36 percent of North Korea's gross domestic product (GDP) and its foreign direct investment (FDI) flows from South Korea up to 6 percent of GDP. Overall, by promoting trade and FDI integration with South Korea, North Korea can boost its GDP growth by about 3 percentage points per year. Combined with a market-oriented reform, which can bring an additional boost to GDP growth, the North Korean economy could grow by about 4.7 percent per year over the next decades. Conversely, if more rigid sanctions imposed on North Korea become effective, its trade and investment will decrease and its GDP growth rate is expected to fall by approximately 2 percentage points per year.

Nisarg Nirman: the social farming venture from India

Subject area Entrepreneurship, Business Strategy. Study level/applicability The case is designed for business students at the undergraduate or MBA levels in courses that deal with social entrepreneurship. The case describes the future growth potential of the exotic vegetable/fruit market in emerging economy India and lends itself for use in Rural Management courses as well. Case overview Nisarg Nirman Agro Products Private Limited (hereafter referred as NNPL), a social farming venture, was started by Anjali Churi in the year 1997 in India. Churi, an agriculturist at heart, was always interested in experimenting and conducting research on new crops. What started as a small research experiment soon prospered to become a commercial venture producing and selling exotic vegetables to the Indian business customers, such as the five-/four-star hotels, premier clubs, hypermarkets, etc. NNPL was one among the pioneers to start the cultivation of exotic vegetables in the country. Their indigenous produce was of high quality. Their business customers were benefitted by the freshness of their products as well as competitive pricing as compared to their earlier imports. In her journey to commercial prosperity, she adopted co-operative farming, thus providing employment and livelihood opportunities to Indian farmers. Over the period, NNPL was invited to provide agriculture consulting to some of the other countries, such as Maldives, Thailand and Israel. In 2014, the company boasted of an indigenous produce of 95 different varieties of exotic vegetables and fruits, with 34 clients across the country, revenues to the tune of INR40 million and touching lives of more than 600 farmers across the country. The Indian exotic vegetables market had a promising future. Churi desired to expand her venture but in a manner that could systematically impact and generate employment opportunities for the rural Indians. She was at crossroads to deciding what could be such a venture, agro-processing or agro-tourism? Any such expansions required substantial investments for agricultural research activities. The case is structured to achieve the following pedagogical objectives: a social entrepreneur's ability to identify and exploit the market opportunity for growing own venture as well as generating a larger social impact; understand the industry's change trajectory and its impact on the venture; understand the importance of such business models of cooperative farming in populous emerging economies such as India where 70 per cent of the population resides in rural India. Expected learning outcomes The case that maps the growth/challenges of a social farming venture and allows students to: understand that small social venture also has the ability to generate a larger social impact; evaluate the venture's strategic positioning and scope in a competitive environment; and evaluate the need and potential of business models as cooperative farming to generate employment at the base of the pyramid in populous emerging economy as India. Supplementary materials Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Acid deposition in the Athabasca Oil Sands Region: a policy perspective.

Industrial emissions of sulphur (S) and nitrogen (N) to the atmosphere associated with the oil sands industry in north-eastern Alberta are of interest as they represent the largest localized source in Canada (with potential for future growth) and the region features acid-sensitive upland terrain. Existing emission management policy for the Regional Municipality of Wood Buffalo, where the industry is located, is based on a time-to-effect approach that relies on dynamic model simulations of temporal changes in chemistry and features highly protective chemical criteria. In practice, the policy is difficult to implement and it is unlikely that a scientifically defensible estimate of acidification risk can be put forward due to the limitations primarily associated with issues of scale, chemical endpoint designation (selection of chemical limit for ecosystem protection from acidification) and data availability. A more implementable approach would use a steady-state critical load (CL) assessment approach to identify at-risk areas. The CL assessment would consider areas of elevated acid deposition associated with oil sands emissions rather than targeted political jurisdictions. Dynamic models should only be (strategically) used where acidification risk is identified via CL analysis, in order to characterize the potential for acidification-induced changes that can be detrimental to sensitive biota within the lifespan of the industry.

Phenomenological study of decline of personal health records: Empirical evidence from thematic analyses of blogs’ content

AbstractThis study examines the current state of personal health records (PHRs) in electronic health care. Surveys report that the PHR usage is generally increasing, and yet, even an influential organization such as the Google decided to end its “Google Health” venture. If the potential for use and future growth is high, why are there so many obstacles to the adoption of PHRs? We analyze comments to articles and blogs related to PHRs in order to identify the current status, barriers to adoption, and future potential of PHRs. This study identifies issues of PHRs clustering mainly around certain key ideas: trust, communication, markets, standards, usability, politics, usefulness, and data ownership. It appears that disparity among the multiple stakeholders as to the expected benefits is the main barrier to its adoption.

Prediction of ash-induced agglomeration in biomass-fired fluidized beds by an advanced regression-based approach

Energy crops and biogeneous residues offer the highest potential for future growth in biomass utilization. Traditional forest grown wood types, along with their consistent combustion characteristics, will thus be replaced by fuels with highly heterogeneous composition. Reliable prediction of their combustion characteristics and in particular of their ash behavior is essential for plant designers and operators trying to harvest this potential for energy conversion. In fluidized bed combustion, the fuel–ash induced agglomeration of the bed materials is one such behavior that needs to be described. In this paper a black-box model for agglomeration prediction was created through multivariate regression modeling using R-statistics v3.0.2. It based on the input variables bed ash concentration, particle size, fluidization velocity and fuel ash composition and predicts the maximum operable agglomeration-free temperature. Three linear and nine non-linear modeling algorithms have been applied to the data, optimized and validated in independent subsets. This validation was performed on results of controlled agglomeration tests, partly performed on our own test reactors and partly derived from literature. The final data set comprises 350 test results, covering 83 different fuels tested in seven different reactors. The validation revealed good predictive performance of the regression models, in particular of non-linear ensamble algorithms such as random forests, or cubist. These exhibit average deviations of around 60K between model predictions and experimental results, which is very promising given the complexity of the system. After transformation of these prediction errors into agglomeration probabilities, a set of operational parameters unlikely to cause agglomeration can reliably be identified. A final evaluation of selected cases in controlled long-term tests could confirm the validity of these predictions.

Urban change analysis and future growth of Istanbul.

This study is aimed at analyzing urban change within Istanbul and assessing the city's future growth potential using appropriate approach modeling for the year 2040. Urban growth is a major driving force of land-use change, and spatial and temporal components of urbanization can be identified through accurate spatial modeling. In this context, widely used urban modeling approaches, such as the Markov chain and logistic regression based on cellular automata (CA), were used to simulate urban growth within Istanbul. The distance from each pixel to the urban and road classes, elevation, and slope, together with municipality and land use maps (as an excluded layer), were identified as factors. Calibration data were obtained from remotely sensed data recorded in 1972, 1986, and 2013. Validation was performed by overlaying the simulated and actual 2013 urban maps, and a kappa index of agreement was derived. The results indicate that urban expansion will influence mainly forest areas during the time period of 2013-2040. The urban expansion was predicted as 429 and 327km(2) with the Markov chain and logistic regression models, respectively.

Interpreting Stand Structure through Diameter Distributions

Diameter distributions, whether depicted through histograms, modeled with fitted curves, or assigned categorical shape names, often serve as a representation of stand structure and may be interpreted to suggest future growth potential of a stand. An established method of describing the shape of diameter distributions is fitting multiple linear regressions to binned diameter frequency data. This method has been applied in the United States and in Europe to classify the shapes of managed and unmanaged stands. The sensitivity of the methodology was tested using various procedures to bin data from both old-growth and managed hardwood stands. Curves fit to histograms using various bin widths showed that most stands were ascribed multiple named distribution shapes, and no strong patterns relating bin widths to curve shapes were discernible. This suggests that the categorical naming of diameter distribution curves is sensitive to the underlying bin configuration. Applying remedial measures to address the usual linear regression assumptions also affected classification. The sensitivity of the polynomial regression-based classification methodology suggests that conclusions from its application may not be reliable or readily comparable within and between studies.

Economic growth versus climate balancing: some reflections on the sustainable management of forest resource in India

Designing of a sustainable forest policy is of extreme importance in our present world where the process of rapid economic growth is causing imbalance in the climatic cycles by denying ecosystems sufficient time for adaptation and the socioeconomic systems adequate opportunity for mitigation. In this paper, the forests are considered highly resilient natural resource that plays a major role in reducing the impact of global climate change through carbon sequestration, heat absorption, watershed protection, acid deposition, etc. This paper examines the prospect of sustainable forest management for an emerging economy like India, where forest coverage has gone up over the last three decades in spite of population growth, rapid urbanization, and fast economic growth. To assess the possibility of sustainable future growth in a globally congenial environment, the extent of ecological stress on Indian economy has been checked and pattern of public as well as private expenditure along with import and export of forestry and related products analyzed. The import of forestry-based products are increasing in terms of volume, value and unit prices throughout this period and the major importers of raw and semi-finished forestry-based inputs are the South and East Asian countries. From the perspective of material balance, the results of structural decomposition analysis reveal increasing dominance of economic growth over other effects indicating necessity of designing intervention to decouple potential future economic growth from forest resources to ensure long run sustainability.

PREDICTING PEACH FRUIT SIZE POTENTIAL FROM GDD 30 DAYS POST-BLOOM

Early flower bud or fruitlet removal in peach is known to increase peach fruit size at harvest. However, early spring temperatures during and after bloom are not actively tracked to see if they affect future growth potential of peach fruit. Growing degree days or hours (GDD/GDH) have been used previously with a Relative Growth Rate (RGR) Fruit Model to estimate fruit growth potential and to provide a decision making tool for cultural practices such as timing of thinning for specific cultivars. Weather data were converted via the “Averaging Method” to growing degree days base 7°C for 30 days post-bloom for years 2002-2010 at Ridge Spring, South Carolina. Percent packout for number one fruit, 70 mm or greater, was collected from a packing¬house for 30 cultivars. Years 2004, 2005 and 2008 were above average years for larger fruit size and 2002, 2009 and 2010 were below average fruit size years. Packout for large fruit sizes in years with GDD of 468 or less 30 days post-bloom were not affected. However, years that GDD were near 700 at 30 days post-bloom had significantly less large (>70 mm) fruit packed. GDD greater than 494 the first 30 days post-bloom resulted in less than 60% packout of large fruit in the years studied suggesting that potential fruit size may be lost unless early flower/fruitlet thinning is initiated under warm post-bloom temperatures.