The Means of an End: A Study of the Serial Endings in BLEAK HOUSE

Perhaps more so than any other writer of his era, Charles Dickens knew how to tell a story that would draw readers in and keep them wanting more. This was especially important in a novel like Bleak House, which was originally published in nineteen monthly installments between March 1852 and September 1853. This essay examines the endings of the serial numbers in Bleak House and evaluates the extent to which Dickens used these endings to propel story, heighten physical or emotional drama, and keep readers engaged. By conducting a distant reading of the text and building on existing research, I will show that when the number endings are not suspenseful, they function in other ways—most notably to promote sympathy

Learning to Live with the New Foreign Nongrantor Trust Rules

The Small Business Job Protection Act of 1996 (the 1996 Act) was intended to deal a heavy blow to the appeal of foreign trusts to U.S. persons. The results were mixed. On the one hand, the 1996 Act imposes an array of reporting requirements, imposes harsh penalties on failures to comply with these requirements, increases the interest charge imposed on taxes paid on distributions of accumulated income from foreign trusts, treats loans of cash from foreign trusts as distributions, and expands the kinds of gifts that can be treated as indirect transfers from foreign trusts. On the other hand, curiously, the 1996 Act encourages the creation of foreign trusts by its adoption of a set of criteria for foreignness that is both more objective than the criteria formerly used and more biased in favor of foreign status. This Article discusses how to create foreign trusts, examines their exposure and the exposure of their U.S. beneficiaries to U.S. income tax, and describes the reporting requirements imposed on their creators, their beneficiaries, and the trusts themselves. In addition to explaining the rules, this Article also considers the extent to which foreign trusts continue to be useful planning tools for U.S. persons

A Synthesis of the Producer-Consumer Problem Using NowPit

In recent years, much research has been de- voted to the visualization of multicast applications; on the other hand, few have enabled the simulation of IPv6. In our research, authors prove the construction of write-ahead logging. Our focus in this position paper is not on whether the UNIVAC computer and robots are rarely incompatible, but rather on proposing new self-learning archetypes (NowPit)

Practice variation in late-preterm deliveries: a physician survey

Objective: Late preterm (LPT) neonates account for over 70% of all preterm births in the US. Approximately 60% of LPT births are the result of non-spontaneous deliveries.The optimal timing of delivery for many obstetric conditions at LPT gestations is unclear, likely resulting in obstetric practice variation. The purpose of this study is to identify variation in the obstetrical management of LPT pregnancies. Study design: We surveyed obstetrical providers in NC identified from NC Medical Board and NC Obstetrical and Gynecological Society membership lists. Participants answered demographic questions and 6 multiple-choice vignettes on management of LPT pregnancies. Result: We obtained 215/859 (29%) completed surveys; 167 (78%) from Obstetrics/Gynecology, 27 (13%) from Maternal-Fetal Medicine, and 21 (10%) from Family Medicine physicians. Overall, we found more agreement on respondents’ management of chorioamnionitis (97% would proceed with delivery), mild preeclampsia (84% would delay delivery/expectantly manage), and fetal growth restriction (80% would delay delivery/expectantly manage). We found less agreement on the management of severe preeclampsia (71% would proceed with delivery), premature preterm rupture of membranes (69% would proceed with delivery), and placenta previa (67% would delay delivery/expectantly manage). Management of LPT pregnancies complicated by PPROM, FGR, and placenta previa vary by specialty. Conclusion: Obstetrical providers report practice variation in the management of LPT pregnancies. Variation might be influenced by provider specialty. The absence of widespread agreement on best practice might be a source of modifiable LPT birth

Better informing decision making with multiple outcomes cost-effectiveness analysis under uncertainty in ost-disutility space

© 2015 McCaffrey et al. Introduction: Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and nonhealth outcomes, while partial analyses - where outcomes are considered separately, with their joint relationship under uncertainty ignored - lead to incorrect inference regarding preferred strategies. Objective: The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison. Methods: Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL.Results: Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home ( K1) exceeds 1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when K1=2,000 and K2=2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective. Conclusion: Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding transparent and robust joint comparison of costs and multiple effects under uncertainty across potential threshold values for effect, better informing net benefit assessment and related reimbursement and research decisions

Powers of 10: seeking ‘sweet spots’ for rapid climate and sustainability actions between individual and global scales

Achieving the goals of the Paris Agreement and related sustainability initiatives will require halving of global greenhouse gas emissions each decade from now on through to 2050, when net zero emissions should be achieved. To reach such significant reductions requires a rapid and strategic scaling of existing and emerging technologies and practices, coupled with economic and social transformations and novel governance solutions. Here we present a new ‘Powers of 10’ (P10) logarithmic framework and demonstrate its potential as a practical tool for decision makers and change agents at multiple scales to inform and catalyze engagement and actions, complementing and adding nuance to existing frameworks. P10 assists in identifying the suitable cohorts and cohort ranges for rapidly deploying climate and sustainability actions between a single individual and the globally projected ∼ 10 billion persons by 2050. Applying a robust dataset of climate solutions from Project Drawdown’s Plausible scenario that could cumulatively reduce greenhouse gas emissions by 1051 gigatons (Gt) against a reference scenario (2190 Gt) between 2020 and 2050, we seek to identify a ‘sweet spot’ where these climate and sustainability actions are suitably scaled. We suggest that prioritizing the analyzed climate actions between community and urban scales, where global and local converge, can help catalyze and enhance individual, household and local practices, and support national and international policies and finances for rapid sustainability transformations

Preliminary development and validation of a new endof-life patient-reported outcome measure assessing the ability of patients to finalise their affairs at the end of life

Introduction:The ability of patients to finalise their affairs at the end of life is an often neglected aspect of quality of life (QOL) measurement in palliative care effectiveness research despite compelling evidence of the high value patients place on this domain. Objective: This paper describes the preliminary development and evaluation of a new, single-item, end-of-life patientreported outcome measure (EOLPRO) designed to capture changes in the ability of patients to finalise their affairs at the end of life. Methods: Cognitive interviews with purposively sampled Australian palliative care patients (N = 9) were analysed thematically to explore content validity. Simultaneously, secondary analysis of data from a randomised controlled trial comparing ketamine and placebo for the management of cancer pain (N = 185) evaluated: construct validity; test-retest reliability; and responsiveness. Results:Preliminary findings suggest patients interpret the new measure consistently. The EOLPRO captures the ability to complete physical tasks and finalise practical matters although it is unclear whether emotional tasks or resolution of relationship issues are considered. Personal and financial affairs should be separated to allow for differences in ability for these two types of affairs. The significant correlation between performance status and EOLPRO scores (r = 0.41, p,<.01, n = 137) and expected relationships between EOLPRO and proximity to death and constipation demonstrated construct validity. Pre-and post-treatment EOLPRO scores moderately agreed (n = 14, k = 0.52 [95% CI 0.19, 0.84]) supporting reliability. The measure's apparent lack of sensitivity to discriminate between treatment responders and non-responders may be confounded. Conclusion:Based on the preliminary findings, the EOLPRO should be separated into 'personal' and 'financial' affairs with further testing suggested, particularly to verify coverage and responsiveness. Initial evaluation suggests that the single-item EOLPRO is a useful addition to QOL outcome measurement in palliative care effectiveness research because common palliative care specific QOL questionnaires do not include or explicitly capture this domain. © 2014 McCaffrey et al

A comparison of terrestrial laser scanning and structure-from-motion photogrammetry as methods for digital outcrop acquisition

Terrestrial laser scanning (TLS) has been used extensively in Earth Science for acquisition of digital outcrop data over the past decade. Structure-from-­motion (SfM) photogrammetry has recently emerged as an alternative and competing technology. The real-world performance of these technologies for ground-based digital outcrop acquisition is assessed using outcrops from North East England and the United Arab Emirates. Both TLS and SfM are via­ble methods, although no single technology is universally best suited to all situations. There are a range of practical considerations and operating conditions where each method has clear advantages. In comparison to TLS, SfM benefits from being lighter, more compact, cheaper, more easily replaced and repaired, with lower power requirements. TLS in comparison to SfM provides intrinsically validated data and more robust data acquisition in a wide range of operating conditions. Data post-processing is also swifter. The SfM data sets were found to contain systematic inaccuracies when compared to their TLS counterparts. These inaccuracies are related to the triangulation approach of the SfM, which is distinct from the time-of-flight principle employed by TLS. An elaborate approach is required for SfM to produce comparable results to TLS under most circumstances