Victorian entertainments : "we are amused" : an exhibit illustrating Victorian entertainment.

Midwest Victorian Studies Association. Meeting (2007)published or submitted for publicationnot peer reviewe

Incidence of Gunshot Wounds: Before and After Implementation of a Shall Issue Conceal Carry Law

Introduction. This study examined the incidence of gunshot wounds before and after enacting a conceal carry (CC) law in a predominately rural state. Methods. A retrospective review was conducted of all patients who were admitted with a gunshot injury to a Level I trauma center. Patient data collected included demographics, injury details, hospital course, and discharge destination. Results. Among the 238 patients included, 44.6% (n = 107) were admitted during the pre-CC period and 55.4% (n = 131) in the post-CC period. No demographic differences were noted between the two periods except for an increase in uninsured patients from 43.0% vs 61.1% (p = 0.020). Compared to pre-CC patients, post-CC patients experienced a trend toward increased abdominal injury (11.2% vs 20.6%, p = 0.051) and increased vascular injuries (11.2% vs 22.1%, p = 0.026) while lower extremity injuries decreased significantly (38.3% vs 26.0%, p = 0.041). Positive focused assessment with sonography in trauma (FAST) exams (2.2% vs 16.8, p < 0.001), intensive care unit admission (26.2% vs 42.0%, p = 0.011) and need for ventilator support (11.2% vs 22.1%, p = 0.026) all increased during the post-CC period. In-hospital mortality more than doubled (8.4% vs 18.3%, p = 0.028) across the pre- and post-CC time periods. Conclusion. Implementation of a CC law was not associated with a decrease in the overall number of penetrating injuries or a decrease in mortality

Convergence in Income Inequality: Further Evidence from the Club Clustering Methodology across States in the U.S.

This paper contributes to the sparse literature on inequality convergence by empirically testing convergence across states in the U.S. This sample period encompasses a series of different periods that the existing literature discusses -- the Great Depression (1929–1944), the Great Compression (1945–1979), the Great Divergence (1980-present), the Great Moderation (1982–2007), and the Great Recession (2007–2009). This paper implements the relatively new method of panel convergence testing, recommended by Phillips and Sul (2007). This method examines the club convergence hypothesis, which argues that certain countries, states, sectors, or regions belong to a club that moves from disequilibrium positions to their club-specific steady-state positions. We find strong support for convergence through the late 1970s and early 1980s, and then evidence of divergence. The divergence, however, moves the dispersion of inequality measures across states only a fraction of the way back to their levels in the early part of the twentieth century

A review of nateglinide in the management of patients with type 2 diabetes

Impaired insulin secretion occurs early in the pathogenesis of type 2 diabetes mellitus (T2DM) and is chronic and progressive, resulting initially in impaired glucose tolerance (IGT) and eventually in T2DM. As most patients with T2DM have both insulin resistance and insulin deficiency, therapy for T2DM should aim to control not only fasting, but also postprandial plasma glucose levels. While oral glucose-lowering treatment with metformin and thiazolidinediones corrects fasting plasma glucose, these agents do not address the problem of mealtime glucose spikes that have been shown to trigger atherogenic processes. Nateglinide is a derivative of the amino acid D-phenylalanine, which acts directly on the pancreatic β-cells to stimulate insulin secretion. Nateglinide monotherapy controls significantly mealtime hyperglycemia and results in improved overall glycemic control in patients with T2DM by reducing glycosylated hemoglobin (HbA1c) levels. The combination of nateglinide with insulin-sensitising agents, such as metformin and thiazolidinediones, targets both insulin deficiency and insulin resistance and results in reductions in HbA1c that could not be achieved by monotherapy with other antidiabetic agents. In prediabetic subjects with IGT, nateglinide restores early insulin secretion and reduces postprandial hyperglycemia. Nateglinide has an excellent safety and tolerability profile and provides a lifetime flexibility that other antidiabetic agents could not accomplish. The aim of this review is to identify nateglinide as an effective “gate-keeper” in T2DM, since it restores early-phase insulin secretion and prevents mealtime glucose spikes throughout the day and to evaluate the results of ongoing research into its potential role in delaying the progression to overt diabetes and reducing its complications and mortality

Assessment of the Spatial QRS-T Angle by Vectorcardiography: Current Data and Perspectives

The concept of the ventricular gradient (VG) was conceived in the 1930s and its calculation yielded information that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand and its computation time-consuming. Spatial vectorcardiography is based on the concept of the VG. Its current major clinical use is to identify primary [heterogeneity of ventricular action potential (VAP) morphology] in the presence of secondary [heterogeneity in ventricular depolarization instants] T-wave abnormalities in an ECG. Nowadays, the calculation of the spatial VG can be computed on the basis of a regular routine ECG and contributes to localization of arrhythmogenic areas in the heart by assessing overall and local VAP duration heterogeneity. Recent population-based studies suggest that the spatial VG is a dominant ECG predictor of future cardiovascular events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified primary and secondary prevention efforts and can be included in everyday clinical practice. This review addresses the nature and diagnostic potential of the spatial VG. The main focus is the role of the spatial VG in ECG assessment of dispersion of repolarization, a key factor in arrhythmogeneity

The World City of Gaming

There are many routes to world city status. Most places get there by being financial, trade, or manufacturing hubs, or as is the case with the biggest and most connected world cities, a concentration of all three. Las Vegas took a different path. It achieved world city status via one key sector—gaming

Three-dimensional low Reynolds number flows near biological filtering and protective layers

Mesoscale filtering and protective layers are replete throughout the natural world. Within the body, arrays of extracellular proteins, microvilli, and cilia can act as both protective layers and mechanosensors. For example, blood flow profiles through the endothelial surface layer determine the amount of shear stress felt by the endothelial cells and may alter the rates at which molecules enter and exit the cells. Characterizing the flow profiles through such layers is therefore critical towards understanding the function of such arrays in cell signaling and molecular filtering. External filtering layers are also important to many animals and plants. Trichomes (the hairs or fine outgrowths on plants) can drastically alter both the average wind speed and profile near the leaf's surface, affecting the rates of nutrient and heat exchange. In this paper, dynamically scaled physical models are used to study the flow profiles outside of arrays of cylinders that represent such filtering and protective layers. In addition, numerical simulations using the Immersed Boundary Method are used to resolve the 3D flows within the layers. The experimental and computational results are compared to analytical results obtained by modeling the layer as a homogeneous porous medium with free flow above the layer. The experimental results show that the bulk flow is well described by simple analytical models. The numerical results show that the spatially averaged flow within the layer is well described by the Brinkman model. The numerical results also demonstrate that the flow can be highly 3D with fluid moving into and out of the layer. These effects are not described by the Brinkman model and may be significant for biologically relevant volume fractions. The results of this paper can be used to understand how variations in density and height of such structures can alter shear stresses and bulk flows.Comment: 28 pages, 10 figure

Diabetic cardiomyopathy: from the pathophysiology of the cardiac myocytes to current diagnosis and management strategies

Diabetic cardiomyopathy (DCM), although a distinct clinical entity, is also a part of the diabetic atherosclerosis process. It may be independent of the coexistence of ischemic heart disease, hypertension, or other macrovascular complications. Its pathological substrate is characterized by the presence of myocardial damage, reactive hypertrophy, and intermediary fibrosis, structural and functional changes of the small coronary vessels, disturbance of the management of the metabolic cardiovascular load, and cardiac autonomic neuropathy. These alterations make the diabetic heart susceptible to ischemia and less able to recover from an ischemic attack. Arterial hypertension frequently coexists with and exacerbates cardiac functioning, leading to the premature appearance of heart failure. Classical and newer echocardiographic methods are available for early diagnosis. Currently, there is no specific treatment for DCM; targeting its pathophysiological substrate by effective risk management protects the myocardium from further damage and has a recognized primary role in its prevention. Its pathophysiological substrate is also the objective for the new therapies and alternative remedies