The Evolution of Grocery Wholesaling and Grocery Wholesalers in Ireland and Britain since the 1930s

Studies of industry evolution are relatively scarce outside of industries defined by narrow technological bases. Studies of wholesaling are rarer still. These are curious features given that it is probable that service industries behave differently to manufacturing ones and that wholesaling is such a key function of many economies. This paper looks at the evolution of grocery wholesaling and grocery wholesalers in Ireland and Britain since 1930. It focuses on the processes and drivers of the wholesale industry. Similarities and differences between the two countries are discussed. Particular emphasis is placed on the role of government action as a triggering mechanism for change and on the role of trade associations and industry leaders in developing and following through on market and non-market strategies. The pathways of industry evolution identified differ from those seen in manufacturing. They therefore raise a number of issues for the development of understanding and conceptualisation in industry evolution studies

Simulating the mid-Pliocene Warm Period with the CCSM4 model

This paper describes the experimental design and model results from a 500 yr fully coupled Community Climate System, version 4, simulation of the mid-Pliocene Warm Period (mPWP) (ca. 3.3–3.0 Ma). We simulate the mPWP using the "alternate" protocol prescribed by the Pliocene Model Intercomparison Project (PlioMIP) for the AOGCM simulation (Experiment 2). Results from the CCSM4 mPWP simulation show a 1.9 °C increase in global mean annual temperature compared to the 1850 preindustrial control, with a polar amplification of ~3 times the global warming. Global precipitation increases slightly by 0.09 mm day−1 and the monsoon rainfall is enhanced, particularly in the Northern Hemisphere (NH). Areal sea ice extent decreases in both hemispheres but persists through the summers. The model simulates a relaxation of the zonal sea surface temperature (SST) gradient in the tropical Pacific, with the El Niño–Southern Oscillation (Niño3.4) ~20% weaker than the preindustrial and exhibiting extended periods of quiescence of up to 150 yr. The maximum Atlantic meridional overturning circulation and northward Atlantic oceanic heat transport are indistinguishable from the control. As compared to PRISM3, CCSM4 overestimates Southern Hemisphere (SH) sea surface temperatures, but underestimates NH warming, particularly in the North Atlantic, suggesting that an increase in northward ocean heat transport would bring CCSM4 SSTs into better alignment with proxy data

The management of diabetic ketoacidosis in children

The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%–70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1–2 hours; an initial bolus of 10–20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%–10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort

Beyond Zero-Sum Environmentalism

Environmental law and environmental protection are often portrayed as requiring trade offs: “jobs versus environment,” “markets versus regulation,” “enforcement versus incentives .” In the summer of 2016, members of the Environmental Law Collaborative gathered to consider how environmentalism and environmental regulation can advance beyond this framing to include new constituents and offer new pathways to tackle the many significant challenges ahead . Months later, the initial activities of the Trump Administration highlighted the use of zero-sum rhetoric, with the appointment of government officials and the issuance of executive orders that indeed seem to view environmental issues as in a zero-sum relationship with jobs or economic progress . In the essays below, the authors explore the meaning and the role of zero-sum environmentalism as a first step in moving beyond it

Environmental Law, Disrupted by COVID-19

For over a year, the COVID-19 pandemic and concerns about systemic racial injustice have highlighted the conflicts and opportunities currently faced by environmental law. Scientists uniformly predict that environmental degradation, notably climate change, will cause a rise in diseases, disproportionate suffering among communities already facing discrimination, and significant economic losses. In this Article, members of the Environmental Law Collaborative examine the legal system’s responses to these crises, with the goal of framing opportunities to reimagine environmental law. The Article is excerpted from their book Environmental Law, Disrupted, to be published by ELI Press later this year

Standardized Outcomes in Nephrology-Transplantation: A Global Initiative to Develop a Core Outcome Set for Trials in Kidney Transplantation.

BACKGROUND: Although advances in treatment have dramatically improved short-term graft survival and acute rejection in kidney transplant recipients, long-term graft outcomes have not substantially improved. Transplant recipients also have a considerably increased risk of cancer, cardiovascular disease, diabetes, and infection, which all contribute to appreciable morbidity and premature mortality. Many trials in kidney transplantation are short-term, frequently use unvalidated surrogate endpoints, outcomes of uncertain relevance to patients and clinicians, and do not consistently measure and report key outcomes like death, graft loss, graft function, and adverse effects of therapy. This diminishes the value of trials in supporting treatment decisions that require individual-level multiple tradeoffs between graft survival and the risk of side effects, adverse events, and mortality. The Standardized Outcomes in Nephrology-Transplantation initiative aims to develop a core outcome set for trials in kidney transplantation that is based on the shared priorities of all stakeholders. METHODS: This will include a systematic review to identify outcomes reported in randomized trials, a Delphi survey with an international multistakeholder panel (patients, caregivers, clinicians, researchers, policy makers, members from industry) to develop a consensus-based prioritized list of outcome domains and a consensus workshop to review and finalize the core outcome set for trials in kidney transplantation. CONCLUSIONS: Developing and implementing a core outcome set to be reported, at a minimum, in all kidney transplantation trials will improve the transparency, quality, and relevance of research; to enable kidney transplant recipients and their clinicians to make better-informed treatment decisions for improved patient outcomes

Identifying and managing non-complex fractures

Clinical opinion piece on the role of the nurse in identifying and managing non-complex fractures