text:
SUTDA21
Freedom Programme
Stand up to Domestic Abuse
Still We Rise
Wednesday, 25 November 2020 is the international day for the elimination of violence against women.
@CountDeadWomen say 108 UK women have been killed by men since #IDEVAW last year.
Thank you Michael for your continued support for the cause and to me personally. You are an amazing advocate and I thank you!
#standuptodomesticabuse
#endviolenceagainstwomenandgirls
After 18 years in an abusive relationship, Rachel was shot and severely injured by her violent partner in 2011. He then committed suicide, as did her 16 year old son Jack, shortly after the attack.
Rachel spent several weeks in hospital and now lives with life altering injuries.
Rachel is an Ambassador for The Freedom Programme, Patron for SEEdS Wales and a SafeLives Pioneer.
She campaigns tirelessly and is committed to ending domestic abuse.
She has 4 successful petitions on change.org with a combined 1/2 million signatures.
A qualified IDVA, Rachel also runs an online awareness Facebook page called Don't Look Back.
Her ambition includes to set up the 'House that Jack Built' a children and young person's refuge and place of safety, in memory of her son.
Congratulations Rachel - Winner 2020 St Davids Award
Nominated for Humanitarian award
Rachel Williams is a leading advocate in the campaign against domestic violence. She is a survivor of 18 years of severe domestic abuse, which ended in 2011 when her abuser shot her with a sawn off shot gun before hanging himself. 6 weeks later her 16 year old son hung himself due to the trauma of the years of abuse and subsequent shooting of his mother. She survived by the skin of her teeth and now campaigns tirelessly to help other survivors.
She is at the forefront of pushing the domestic abuse bill through Parliament, and on 13th September 2019, hosted the first ever survivor-led domestic abuse conference in South Wales: Stand Up to Domestic Abuse (#sutda), which brought together many survivors and professionals. Rachel is brave, kind, and passionate, and has dedicated her life to helping women all over the country.
Rachel is an ambassador for The Freedom Programme, and she has been working with SafeLives for many years, first as a member of their 'Friends and Families Group' and now as a SafeLives Pioneer. She brings heart, honesty, bravery and absolute expertise to her work. SafeLives would be a completely different organisation without her.
From sitting on domestic abuse project boards, to speaking to the national media, Rachel shows authenticity in every action, every word she speaks. She changes the domestic abuse sector by bringing all of these voices together, and she changes the lives of the women she is representing.
https://gov.wales/st-david-awards/rachel-williams
Rachel's ambition is to have a world where domestic abuse is no longer. Where those who perpetrate abuse will be frowned upon, and put in the same spotlight as sex offenders. The shame must always lie at the feet of those who perpetrate abuse and we must be strong in reflecting this going forward.
Our aims are to:
improve the relationships between services and service users
make sure everyone who deals with domestic abuse is specialist trained to be able to help victims and survivors in the best possible way
to encourage services to put those with lived experience at the heart of everything they do. We are experts by experience and need to be heard
raise awareness of this epidemic, and progress with the petitions until the changes we are calling for are acted upon and implemented.
hold professionals to account (if needed)
Check out the SUTDA Shop
20% of sales go towards women coming out of refuge and funding the delivery of the Freedom Programme
2 Peaked/rounded breathable layered, washable face masks
2 Pleated breathable layered, washable, SUTDA Facemasks
Box of 100 Badges
Box of 50 Badges
The Devil at Home
The horrific true story of a woman held captive
Featured on ITV's Lorraine with Michael Sheen and Rachel Williams.
Kindly supported by the Moondance Foundation
Stand up to Domestic Abuse 2019


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From late 2015 -2018, Ian Gray served as CEO of Vodafone Qatar, a company listed on the Qatar Stock Exchange with a market cap of around $2.5bn, leading the company through a turnaround. Although Gray retired from his executive role as Regional Director of Vodafone Group in 2010, he continued as Chairman of Vodafone Egypt until April 2017, having served on the board for over 16 years as CEO, Managing Director or Chairman including time as CEO of the company, living in Cairo 2002-2007.
Vodafone Egypt is the leading Technology operator in Egypt with over 10,000 staff, 40million Mobile subscribers and a number of subsidiaries in outsourced and web services.
Gray now provides advisory services for companies and clients including previous employers. Prior to Vodafone, he was CEO of the FTSE listed companies Brown and Jackson PLC and later General Cable PLC. For nearly 20 years prior to this, he held various senior roles in the Thorn EMI Group.
Ian Gray is the Chairman of the Egyptian-British Chamber of Commerce and is also UK Co-Chairman of the Egyptian British Business Council (EBBC) which was set up under the auspices of the Egyptian and British Governments in 1998 as a top level strategic body to facilitate trade and investment links between Egypt and the UK. In May 2018 he has taken up the Chairmanship of the revived Middle East Association.
Jennette Bradbury is an Executive Member of the Board. Jennette has lots of experience in working and living in the Far East and in Europe. Jennette co-founded Egyptian Experience in 2002 and was at the forefront of the Residential Tourism scene in Egypt. Egyptian Experience are builders and developers. They have built quality apartments with lots of design details and delivered on time. They are the first to build a residential tourist resort on the banks of the Nile. Both their resorts in Sharm el Sheikh and Luxor have won prestigious awards. Jennette regularly features in articles on Egypt and is happy to help anyone interested is carrying out business activities in Egypt.
Iman has worked as a Business Relationship Manager for several international companies for the past 6 years, including Infracon and Shimco International. Before that she worked as a Business Development Manager at the Medical Office of the Egyptian Embassy in London in which she used British expertise to lead collaboration programs in the medical field to improve medical services in Egypt (such as nursing, ambulance, GP surgeries, etc.). She worked in the international department of the Chartered Institute for Securities and Investment and was leading the project between the UK and capital market authorities in Egypt, UAE, Lebanon, and Saudi Arabia to create a duplicate of the institute in those countries. The aim was to introduce obligatory CPD (continuing professional education) to brokerage firms to ensure the professional level in the industry. Before she arrived to the UK in 2004, she worked as a Communications Advisor at the USAID project (CMD) for 4 years, in which she worked very closely with the Chairman of the Capital Market Authority.
Mr Eissa is a producer & exporter of horticultural products since 1975. He is the Chairman of Nahdet Misr Company for Agro Industries (S.A.E).. Nahdet Misr is a leading producer, packer & exporter of all horticultural crops, especially citrus, potatoes, onions, grapes, pomegranates, peaches & sweet potatoes. The company has its EureGap, Natures choice certified farms with a total area of 1500 hectares. Mr Eissa is the Chairman of Nahdet Misr Company for Advanced Agriculture, and the Chairman of Egypt's Agriculture Export Council (AEC). He is also an Executive Board Member of the Egyptian-British Chamber of Commerce.
Andrew Baker qualified as a solicitor in London in 1972 and has worked in corporate finance and international transactions for many years. Andrew is now Chairman of Allenby Capital Limited, a well-known corporate broker and nominated adviser to companies whose equity capital is quoted on the AIM market of The London Stock Exchange. Andrew was involved in the establishment of the Chamber and has been a director since its inception. He is now also its Secretary and a Counsellor.
Dr. Taha M. Khaled is the founder of BDO Khaled & Co. in Egypt, being a member firm of BDO International (established in 1985 as a member firm of Ernst & Young until 1999). He is a Fellow of the Institute of Chartered Accountants in England and Wales (1980), a Fellow of the Egyptian Society of Accountants & Auditors, and a Fellow of the Egyptian Society of Taxation. As a Chairman and Senior Partner, he is responsible for the overall activities of the firm, which includes Audit, Tax, and Business Advisory Services, all being areas of which he possesses over 40 years of experience. Dr. Khaled expanded the business in 2008 to establish, and become the Chairman of, the very first Business Process Outsourcing company in Egypt to provide Finance & Accounting Outsourcing/Offshoring, Market Research Outsourcing, and Contact Centers services, named BDO Esnad S.A.E. He is also a Board Member of Telecom Egypt, Chairing the Audit Committee, a Board Member of the Egyptian Society of Accountants and Auditors, a Board Member of the Egyptian British Chamber of Commerce, as well as a Board Member of the Egyptian Businessmen Association.
Mr El Kerdany is a quality oriented design professional and team leader with over 35 years of hands-on experience in architectural design, project, and construction management in the Middle East, Canada, and the US. He has extensive experience in business development and representing owners in the coordination of major construction field operations and lease back promotional activities, in addition to property and asset management. His specific expertise includes shopping centers, high rise residential condominiums, office buildings, five stars hotels, recreational facilities, custom and spec home development. He is a board member of the Federation of Egyptian Chambers of Commerce, Executive board member of the Egyptian-British Chamber of Commerce, President of Egyptian Council of Shopping Centers, Ex-President of Cairo Al Uruba Rotary Club, and a member of the Syndicate of Engineers, Cairo, Egypt.
Member of the Board and Executive Committee of the Chamber, Executive Director of the Egyptian British Business Council (EBBC) and Director General of the Libyan British Business Council (LBBC).
Robin is a retired British Ambassador who studied Arabic at Oxford and in Lebanon. He spent over thirty-five years with the FCO, working in London and the Arab world, including Egypt and Libya. Lately HM Ambassador Bahrain (2003-06) and Consul-General Basra (2006), he left government service in April 2007. After working with the Arab British Chamber of Commerce and the Middle East Association, he took up his appointments with the EBBC and the LBBC in April 2009. He is a Trustee of the British University in Egypt (BUE) and a member of the UK-Egypt Higher Education Board of Governance. He joined the EBCC Board in February 2016 and was elected to the Executive Committee.
Dr Effat El Sadat is a former member of Parliament, and current president of the Sadat Democratic Party. He is a board member of several associations including Egyptian European Council, a founder of Itmana for social responsibility among other projects for social development in Egypt. Dr El Sadat is the Vice president of the Egyptian Council for Sustainable development and member of the Rotary Club of Alexandria Cosmopolitan. He holds an MBA in Business Administration. BS in Accounting Management from Ain shams University, a PHD in Business Administration, Diploma in the Global Economy and Crisis Management from the Arab Academy.
Mr Omran was the Misr International Systems (MIS) Chairman and co-founder since mid 1982. During this period MIS grew from small company to one of the largest reputable data communications & security providers in Egypt. He helped many institutions and organizations establish their own data comms. such as Egypt Air, National Bank of Egypt and Stock Exchanges. Mr. Omran was the Chairman and CEO of MIST (Misr for Information Services & Trading) company, the leading information provider in Egypt was established in 1993, for the purpose of providing real time financial markets & on line trading information services. Mr Omran has become the first CEO & founder of The Information Technology Industry Development Agency of Egypt (ITIDA). This agency helps to develop the ICT industry in Egypt. Mr Omran remained in his position as the CEO of ITIDA until 2007.
Dr Amr Hassanein is the Chairman of MERIS – Middle East Rating & Investors Service (Moody's Affiliate for Egypt and other countries in the region) and FinBi – Finance & Banking Consultants International. Dr. Hassanein is involved as a Board Member of the Electricity Regulatory Authority of Egypt, Smart Aviation, Cequens, Iskan Insurance Company, Edara Al Tameer for Real Estate Management and AMA Arab Environment Company (AAEC). He is also a Board Member of the Egyptian European Council. Dr. Hassanein has extensive experience in local and international development, credit rating; credit information; finance, financial services; privatization, concession contracts, and PPP; company valuation and restructuring; mortgage systems; credit mechanisms; SMMES (Small, Medium and Micro enterprises) institutional setups; and credit guarantee schemes for M/SMEs.
On October 2014, Eng. Akil Beshir was appointed non-executive Vice Chairman of Orascom Telecom Media and Technology Holding. At present, Akil serves as Chairman of Al-Enmaa for Agricultural Development and Livestock Company.He served as a Vice Chairman of Al-Ahly Computer Equipment Company (SAE) in 1996. In 2000, and prior to joining Juhayna Food Industries, he was Chairman and CEO of Telecom Egypt. During his career, Eng. Akil has held several positions including Vice President of the Board of Vodafone Egypt, Board Member of the National Agency for Quality Assurance and Accreditation of Education, Board Member of Egyptian National Railways Authority, Board Member of Nokia Siemens Networks, Board Member of the National Telecommunications Institute and Chairman of the Board of Trustees of the Egyptian Foundation for Technological Education and Development.
Director of Project Development, General Mediterranean Holding S.A.
Mr Al Miqdadi is the Director & President of established equity and construction development concerns with extensive global reach; He is currently the Director of Project Development for General Mediterranean Holding (The GMH Group). Established in 1979 this diversified global business conglomerate comprises 120 organisations and over 11,000 employees, with a strong industry portfolio comprising Banking & Finance, Real Estate & Construction, Hotel & Leisure, Industrial, Pharmaceuticals, Communications, Shipping and Aviation. Prior to this, Mr Al Miqdadi was the President, Global Equities Inc; a global real estate and construction management concern. Mr Al Miqdadi is in charge of various development projects in Egypt and Iraq, including the construction of medical factories, a paper mill, hotels, tourist villages and restaurants.
Dr. Hani Sarie-Eldin is a prominent legal practitioner in Egypt and Middle East with an expertise of twenty-seven years in corporate, banking, and capital market. Sarie-Eldin is a professor of Commercial and Maritime Law Department at Cairo University and a Visiting Professor of Development Law & Capital Markets, Queen Mary and Westfield College at University of London. In addition to his private professional career, Dr. Sarie-Eldin had served in executive and non-executive public positions including the following: Chairman of Capital Market Authority, Board member of the central bank of Egypt, General Authority For Investment. Dr. Sarie-El din holds a Ph.D in International Business Law from Queen Mary and Westfield College, university of London.
Mark Lipton was appointed as Managing Director of G4S Egypt in Jun 2014, he leads a successful and growing business of over 8000 employee's providing a range of risk and security solutions to local, regional and international clients. In late 2017 Mark was promoted and appointed as Programme Director for G4S North Africa leading new projects in the region including Egypt. Mark is also an active board member with the British Egyptian Business association.
Mark is a British citizen with extensive experience working in Africa and the Middle East both in the public and private sectors, now managing businesses that deliver professional Risk, Security and Resilience Based Solutions to wide variety of industry sectors and global partners.
Prior to life in the private sector Mark had a distinguished career in the British Army, specializing and supporting UK Government departments overseas in high threat environments, he possess operational and command experience amassed over 23 years in over sixty countries worldwide in; Africa, South America, Indonesia, Europe, Scandinavia, Middle East and Asia.
Post his service career he joined De La Rue Currency within their Risk and Business Continuity Division, initially responsible for the Risk Management of the Bank of England contract and subsequently the European Central Bank Accreditation Project in Europe.
In Jul 2010 Mark was appointed Risk and Business Continuity Director for G4S Kenya with regional business development responsibilities for Ethiopia, South Sudan, Somalia and Uganda. Mark was instrumental in the creation of the G4S East African Risk Framework advising clients and government departments on external threats and mitigation from conventional criminal activity to the wider threat from terrorism.
In his spare time Mark is an accomplished mountaineer and endurance athlete. He enjoys a passion for the outdoors, adventure travel and is strong supporter of animal charities and community projects where ever he is based.
G4S Secure Solutions (Egypt) LLC .
Mr. Zaki is Managing Director and Director of Operations in Egypt, for Dar Al-Handasah Consultants (Shair and Partners). In 1994 he was appointed Managing Director of Dar Al-Handasah Consultants (Egypt) Limited (the Egyptian affiliate of Dar Al-Handasah), a post he still holds to date. Through his 41 years of practical experience, he has been involved in a broad spectrum of management applications ranging from business development to marketing and management of operations. Mr. Zaki has had successful contributions to a wide range of residential, commercial, industrial and healthcare projects, most of which were in Egypt. Duties on such projects have included project management, involving elaborate contract administration whether at the planning and design stages or during construction; contract negotiations; monitoring of various consultants; follow-up and monitoring of progress with due concern for budget and time limitations and quality assurance and control; tendering and evaluation of contractors; comprehensive monitoring of construction contracts in view of budget, time, quality, handing-over and payments. Mr. Zaki is also a Senior Architect with extensive experience in project and construction management, as well as design and production activities. His experience embraces tourist, technical, commercial, residential and town planning projects.


text:
//============================================================================
// Name        : Client.cpp
// Author      : Filip Wasil
// Version     :
// Copyright   : none
// Description : Fillwave engine example full
//============================================================================

#include <example.h>

/* Audio */
//#include <portaudio.h>

/* Graphics */
#include <CallbacksGLFW/MoveCameraCallback.h>
#include <CallbacksGLFW/AnimationKeyboardCallback.h>
#include <CallbacksGLFW/TimeStopCallback.h>
#include <ContextGLFW.h>
#include <fillwave/Fillwave.h>
#include <TerrainConstructors/MountainConstructor.h>

/* Physics */
//#include <bullet>

using namespace fillwave;
using namespace fillwave::framework;
using namespace std;

int main(int argc, char* argv[]) {
	ContextGLFW mContext(argc, argv);
	ContextGLFW::mGraphicsEngine->insertResizeScreen(mContext.getScreenWidth(),
	      mContext.getScreenHeight());
	init();
	perform();
	showDescription();
	mContext.render();
	exit(EXIT_SUCCESS);
}

void init() {
	/* Scene and camera */
	ContextGLFW::mGraphicsEngine->setCurrentScene(make_unique<Scene>());
	ContextGLFW::mGraphicsEngine->getCurrentScene()->setCamera(
	   make_unique<CameraPerspective>(glm::vec3(0.0, 0.0, 16.0),
	                                  glm::quat(),
	                                  glm::radians(90.0),
	                                  1.0,
	                                  0.1,
	                                  1000.0));

	/* Lights */
	auto light = ContextGLFW::mGraphicsEngine->storeLightSpot(glm::vec3 (1.0, 20.0,
	             6.0),
	             glm::quat (),
	             glm::vec4 (1.0, 1.0, 1.0, 0.0));
	light->rotateTo(glm::vec3(1.0, 0.0, 0.0), glm::radians(-90.0));

	/* Engine callbacks */
	/* Engine callbacks */
	ContextGLFW::mGraphicsEngine->registerCallback(make_unique<TimeStopCallback>(
	         ContextGLFW::mGraphicsEngine));
	ContextGLFW::mGraphicsEngine->registerCallback(make_unique<MoveCameraCallback>(
	         ContextGLFW::mGraphicsEngine, eEventType::eKey, 0.1));
	ContextGLFW::mGraphicsEngine->registerCallback(make_unique<MoveCameraCallback>(
	         ContextGLFW::mGraphicsEngine, eEventType::eCursorPosition, 0.1,
	         ContextGLFW::mWindow));
}

void perform() {
	ContextGLFW::mGraphicsEngine->configureFPSCounter("fonts/Titania",
	      glm::vec2(0.7, 0.9), 100.0);

	puMeshTerrain terrain = make_unique<MeshTerrain>(ContextGLFW::mGraphicsEngine,
	                        ProgramLoader(ContextGLFW::mGraphicsEngine).getDefault(),
	                        new MountainConstructor(),
	                        Material(),
	                        "textures/test.png",
	                        "textures/testNormal.png",
	                        "",
	                        20,
	                        16);
	terrain->scaleTo(1.0);
	terrain->addEffect(make_shared<Fog>());
	ContextGLFW::mGraphicsEngine->getCurrentScene()->attach(std::move(terrain));
}

void showDescription() {
	/* Description */
	pText hint0 =
	   ContextGLFW::mGraphicsEngine->storeText("Fillwave example terrain",
	         "fonts/Titania",
	         glm::vec2(-0.95, 0.80), 100.0);
	pText hint5 =
	   ContextGLFW::mGraphicsEngine->storeText("Use mouse to move the camera",
	         "fonts/Titania", glm::vec2(-0.95, -0.40), 70.0);
	pText hint3 = ContextGLFW::mGraphicsEngine->storeText("Use 'S' for camera back",
	              "fonts/Titania",
	              glm::vec2(-0.95, -0.50), 70.0);
	pText hint4 =
	   ContextGLFW::mGraphicsEngine->storeText("Use 'W' for camera forward",
	         "fonts/Titania",
	         glm::vec2(-0.95, -0.60), 70.0);
	pText hint1 =
	   ContextGLFW::mGraphicsEngine->storeText("Use 'T' to resume/stop time",
	         "fonts/Titania",
	         glm::vec2(-0.95, -0.70), 70.0);
	pText hint6 =
	   ContextGLFW::mGraphicsEngine->storeText("Use 'D' for toggle debugger On/Off",
	         "fonts/Titania", glm::vec2(-0.95, -0.80), 70.0);
}

redpajama_set_name: RedPajamaGithub


text:
The effect of high-frequency oscillatory ventilation or airway pressure release ventilation on children with acute...
The effect of high-frequency oscillatory ventilation or airway pressure release ventilation on children with acute respiratory distress syndrome as a rescue therapy
Botao Ning1#, Lingfang Liang2#, Yi Lyu3#, Ying Yu4, Biru Li1
1Pediatric Intensive Care Unit, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China; 2Pediatric Intensive Care Unit of Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China; 3Department of Anesthesia, Minhang Hospital, Fudan University, Shanghai, China; 4Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
Contributions: (I) Conception and design: B Ning; (II) Administrative support: B Li, B Ning; (III) Provision of study materials or patients: L Liang; (IV) Collection and assembly of data: Y Lyu, Y Yu; (V) Data analysis and interpretation: Y Lyu, Y Yu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
#These authors contributed equally to this work and are co-first authors.
Correspondence to: Professor Botao Ning; Professor Biru Li. Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China. Email: ningbotao@126.com; 18930830605@163.com.
Background: To investigate the effects of high-frequency oscillatory ventilation (HFOV) or airway pressure release ventilation (APRV) as a rescue therapy on children with moderate and severe acute respiratory distress syndrome (ARDS).
Methods: We retrospectively enrolled 47 children with ARDS who were transitioned from synchronized intermittent mandatory ventilation (SIMV) to either HFOV or APRV for 48 h or longer after failure of SIMV. The parameters of demographic data, arterial blood gases, ventilator settings, oxygenation index (OI), and PaO2/FiO2 (PF) ratio during the first 48 h of HFOV and APRV were recorded.
Results: There was no significant difference between the HFOV and APRV groups with survival rates of 60% and 72.7%, respectively. Compared to pre-transition, the mean airway pressures at 2 and 48 h after transition were higher in both groups (P<0.01), and the PF ratio at 2 and 48 h in both modes was significantly improved (P<0.001). PF ratio and PaCO2 have significant differences at 48 h between two groups. The OI at 2 h after transition had no improvement in either group and was substantially lower at 48 h relative to the pre-transition level (P<0.001) in both groups. At 48 h after the transition to both HFOV and APRV, the survivors had lower mean airway pressures, higher PF ratios, and a lower OIs than non-survivors (P<0.01).
Conclusions: There was no significant difference on the survival rates of HFOV and APRV application as a rescue therapy for ARDS, but improved oxygenation at 48 h reliably discriminated survivors from non-survivors in both groups.
Keywords: High-frequency oscillatory ventilation (HFOV); airway pressure release ventilation (APRV); children; acute respiratory distress syndrome (ARDS)
Submitted Dec 28, 2019. Accepted for publication Jun 04, 2020.
doi: 10.21037/tp-19-178
Children with acute respiratory distress syndrome (ARDS) who invasive mechanical ventilation experience high mortality. They are often rescued with modes of nonconventional mechanical ventilation. It includes high-frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV). ARDS is a common critical disease in pediatric intensive care units (PICUs) with a prevalence of 7.6% (1,2). Commonly, the effect of conventional comprehensive therapies, such as synchronized intermittent mandatory ventilation (SIMV), fluid management, and administration of medication, have been unsatisfactory with low oxygenation and high PaCO2 levels, which has resulted in high mortality in critically ill children (3). In theory, as part of a lung protection strategy, HFOV can be used to reduce induced injury (4,5) by delivering small tidal volumes at high rates (3–15 breaths/second) (6,7). HFOV is performed as elective and rescue therapy for ARDS in the PICU. It can optimize alveolar recruitment and lung volume, it can also improve oxygenation through the application of high flow rates and frequencies (900 cycles/minute) with low tidal volumes. A high and persistent medium airway pressure is maintained due to the minimal differences in expiratory and inspiratory pressures.
Some studies have shown that HFOV is effective in treating premature infants or neonates with respiratory failure (8,9). However, in recent years, some researchers, such as Gupta et al. (10) and Goffi and Ferguson (11), have presented the opposite viewpoint, finding that HFOV does not reduce mortality compared to ventilation in adults and may in fact be associated with worse outcomes in children.
In recent years, APRV has been considered as an alternate mode for refractory hypoxemia (12). Compared with SIMV, using lower peak pressures and inspiratory flow rates can prolong continuous positive airway pressure to recruit available lung units of varying time constants, and it also uses periodic time-cycled releases to facilitate CO2 clearance. The experience of using APRV is limited, but some studies suggest potential benefits, such as improved vasopressor requirement, cardiac output, and cardiorespiratory advantages of permissive spontaneous respiration throughout the ventilator cycle. In our department, HFOV and APRV are used as rescue therapy in children with acute respiratory failure after failure of SIMV in lung protection strategies. However, to our best knowledge, no study to support its use has been found (13,14). In this retrospective study, we aim to describe the effects of the application of HFOV and APRV as rescue ventilatory support in children with moderate and severe ARDS. We present the following article in accordance with the STROBE reporting checklist (available at http://dx.doi.org/10.21037/tp-19-178).
A retrospective study of children with moderate and severe ARDS in the PICU was conducted from January 2014 to February 2019. Children who had been switched to APRV or HFOV after failure of SIMV were included. The trial was conducted in accordance with the Declaration of Helsinki. The study was approved by the Ethics Committee of Children's Hospital of Zhejiang University School of Medicine (No. 2020-IRB-048) and informed consent was taken from all the patients.
Patient and data selection
Forty-seven ARDS patients between 1 month and 6 years old were recruited. They were divided into two groups: HFOV (SIMV switched to HFOV) group and APRV (SIMV switched to APRV) group. All children were transitioned from SIMV to either HFOV or APRV for 48 h or longer after failure of SIMV. There was no statistic difference between the two groups in terms of age, sex, body weight, or PRISM (Pediatric Risk of Mortality) III scores. The diagnosis of ARDS was established according to the conference in intensive care medicine (15). The application of HFOV or APRV was performed randomly in cases of failure of SIMV, no improvement in oxygenation, and retention of CO2. In addition to demographic data, the following items were recorded: arterial blood gases, ventilator settings, oxygenation index (OI), and PaO2/FiO2 (PF) ratio during the first 48 h of HFOV and APRV.
SMIV strategy
All patients were managed initially with SIMV using a Dräger Evita 4 ventilator (Drägerwerk AG & Co. KGaA, Lübeck, Germany) in the early stages of ARDS. Initiating conventional ventilation with a minimum of 5 cmH2O of positive end-expiratory pressure (PEEP) and 6–8 mL/kg of tidal volume and to attempt to reduce FiO2 to ≤0.6 is our institutional practice for ARDS. The inability to reduce FiO2 prompts escalation of PEEP and subsequent repeat efforts to reduce FiO2, with the goal to maintain peak inspiratory pressures (PIP) <30 cmH2O, oxygen saturation >88–90%, and permissive hypercapnia up to a PaCO2 of 55–60 mmHg, with maintenance of a pH >7.25–7.30. When patients suffered persistently elevated PIP (≥35 cmH2O), oxygenation difficulties (inability to decrease FiO2 to ≤0.60 despite increasing PEEP), or ongoing hypercarbia (PaCO2 ≥80 or pH <7.25) we prompted the consideration of changing the ventilation mode of HFOV or APRV as a rescue therapy.
APRV strategy
APRV would be initiated by selecting a peak pressure (Phigh) and inspiratory time (Thigh) to at least match the mean airway pressure (mPaw) being delivered by conventional ventilation, with stepwise increases in mPaw by adjusting Phigh or Thigh if we were unable to reduce FiO2 to ≤0.60. Our practice is setting low pressure (Plow) to 0 to facilitate rapid emptying and adjusting expiratory time (Tlow) to terminate at 1/2–3/4 of peak expiratory flow.
HFOV strategy
Patients were converted to HFOV in cases of failure of CMV through setting the mPaw to at least match that delivered by conventional ventilation, and with mPaw escalation until the FiO2 could be reduced to under 0.60. The amplitude was set to achieve oscillations visible in the pelvis. We set the initial frequency based on patient weight and age. Specifically, we used the following HFOV settings: a FiO2 of 0.4–1.0, an oscillatory frequency of 6–12 Hz, an inspiration time of 33% of the respiratory cycle, and a pressure amplitude (∆P) of 25–50 mbar. The oxygenation goal was oxygen saturation of ≥88% on FiO2 ≤0.60, and the ventilation goal was PaCO2 ≤60 with a pH ≥7.3. Muscle relaxants were given in combination with a sedative to patients who had acute deterioration of gas exchange during excessive spontaneous activity.
Data collection and definitions
We conducted a detailed retrospective review of all medical records. The review included demographics, admission diagnoses, indications for mechanical ventilation, length of mechanical ventilation, ventilator variables (including duration of APRV and HFOV, blood gas analysis, OI, and ventilator settings), vasopressor use in the first 48 h after transition (from SIMV to HFOV or APRV), and mortality.
The calculated measures of oxygenation were the PF ratio and the OI [(mPaw×FiO2×100)/PaO2]. The PF ratio and OI before transition are designated "PFpre" and "OIpre", respectively; the values at 2 and 48 h after transition to HFOV are designated PF2h or PF48h and OI2h or OI48h.
Continuous variables were described as the means ± standard deviations when they were normally distributed, and median when they were skewed Categorical variables are reported as frequencies and percentages. Continuous data was compared using Student's t-test or the Wilcoxon rank-sum test (16). Categorical data was compared using a two-tailed Fisher's exact test or a Chi square test. P<0.05 was considered as statistically significant. Analyses were performed with SPSS 17.0 (IBM Corporation, New York, NY, USA).
Patient characteristics
Forty-seven patients (26 males, 55%) with moderate and severe ARDS were transitioned from conventional ventilation (SIMV strategy) to either APRV or HFOV during the study period as shown in Table 1. The most common diagnoses were viral pneumonia and bacterial pneumonia; 16 and 14 patients with viral or bacterial pneumonia were transitioned to APRV and HFOV, respectively. All patients met the radiographic and oxygenation criteria for ARDS at the time of transition. No significant differences were observed with regard to age, length of SIMV, oxygenation, mPaw, PIP, and PaCO2 between the two groups before transition to APRV or HFOV. Three patients were eventually converted to extracorporeal membrane oxygenation (ECMO), and one patient survived (previously in the HFOV group). Patients with ARDS failed conventional ventilation and transitioned to APRV or HFOV at a median length of 1.9 days (1.94±0.73 days) of SIMV and at a median PIP of 35 cmH2O (35.26±2.56 cmH2O) before transitioning to APRV or HFOV (Table 2).
Table 1 Diagnosis of patients
Table 2 Patient characteristics (n=47)
The mPaw at 2 h (26.56±1.78 cmH2O) and at 48 h after transition (25.91±1.64 cmH2O) was higher in both modes than the pre-transition value (22.40±1.95, P<0.01). The PF2h and PF48h in both modes were significantly improved compared to pre-transition values (P<0.001). Significant differences were observed in PF48h and PaCO2 at 48 h between the APRV and HFOV groups (P<0.01). The OI2h was not improved in either group (P>0.05), and the OI48h of the APRV and HFOV groups were substantially lower than the OIpre (P<0.001) in both groups. The OI of survivors in both cohorts improved over time.
The overall mortality was 34%, with no significant difference between the APRV and HFOV groups. Three patients (one APRV and two HFOV) transitioned to ECMO at a median of 3.5 [3–8] days after transition to APRV or HFOV and at a median of 6 [4–10] days after starting any mechanical ventilation. And the median OI at the time of ECMO cannulation was 36 [33–67] days. All three ECMO patients were cannulated while on HFOV. Two of these three patients died; the one survivor was cannulated to venovenous ECMO after 3 days of HFOV with a pre-ECMO OI of 38.
Ten of 25 patients (40%) with ARDS who transitioned to APRV died. Six of 22 patients (27%) who transitioned to HFOV died. We found no demographic or physiologic variable was associated with mortality before transition to either APRV or HFOV in the two groups. At 48 h after transition to both APRV and HFOV, the survivors had higher PF ratio, lower mPaw, and lower OI values (Table 3) than the non-survivors.
Table 3 Characteristics of patients transitioned to APRV (n=25) and HFOV (n=22)
In this study, pediatric patients with ARDS who transitioned to either APRV and HFOV had a high mortality rate (40% and 27%, respectively). Although the survival rates of the two groups show no significant difference, but the primary analysis indicates that the HFOV group may have more favorable oxygenation than the APRV group at an early stage. Survival was statistically associated with the improvement in oxygenation variables at 48 h after transition to APRV or HFOV. Pediatric patients failing SIMV transitioned to APRV or HFOV relatively early in the course of respiratory failure, with substantial oxygenation defects. The median mPaw before switching to APRV and HFOV was 22.40±1.95 cmH2O, which was somewhat lower than the pressures used to determine failure of conventional ventilation in a previous pediatric study (17) in which pediatric patients with respiratory failure were transitioned to HFOV at a median mPaw of 26 cmH2O. However, the present value is similar to the mPaw of 22 cmH2O at which 60 pediatric patients with an immunocompromised condition and ARDS were transitioned to HFOV or APRV (18). The relatively early transition may be associated with greater comfort with HFOV or APRV in our institution and an unwillingness to increase the peak inflating pressures of 35 cmH2O. At 2 and 48 h, the mPaw increased substantially with the improvement in the PF ratio but not in the OI. It suggested the increased alveolar recruitment at the cost of higher mPaw. No significant difference in mortality was observed between the two modes (40% in the APRV cohort and 27% in the HFOV cohort, P=0.542), and mortality was slightly lower than the 56% mortality rate of ARDS patients which was reported in a previous study (19). Patients in our study had well oxygenation, such as a low OI and high P/F, which may explain the lower mortality in our study compared to other previous reported data. Since this paper was a retrospective study, and the application of HFOV and APRV was a rescue therapy, we did not analyze the merely SIMV applied patients.
For patients who transitioned to either APRV or HFOV, the most useful predictors of mortality were measures of oxygenation at 48 h after transition as a fraction of the pre-transition values, which was reported as the PF48h/PFpre and OI48h/OIpre. In both the APRV and HFOV cohorts, the median OI48h of survivors was nearly 45% lower than the median OIpre, whereas in non-survivors, the OI48h and OIpre were nearly identical (Table 3). The discriminating values of PF48h/PFpre and OI48h/OIpre might reflect more highly recruitable lung tissue in the survivors. These patients experienced a much larger increase in the PF ratio at 48 h (>75% increase in the PF ratio on APRV, >90% increase on HFOV) with the increased mPaw than non-survivors. This result is corroborated by the relative improvements in OI (>45% reduction in OI on APRV, >50% reduction on HFOV). It suggests that survivors with more recruitability can improve their PF ratio at a relatively lower mPaw, in contrast to non survivors. PF48h/PFpre and OI48h/OIpre are also useful early markers to distinguish success or failure of APRV or HFOV. Therefore, this allows more invasive therapies to be instituted earlier in children with ARDS. To early detect the children with ARDS transitioned to either APRV or HFOV who have high risk of mortality will allow more directed use of potentially beneficial treatments, including prone positioning, extracorporeal support, or exogenous surfactant. The earlier transition potential to ECMO may bring benefits as prolonged time on any type of mechanical ventilation pre-ECMO has been related to higher mortality (20-22).
The relationship between the mortality and the improvement in the OI and PF ratio within 48 h after transition to APRV or HFOV should be further determined in prospective studies. Recent adult studies showed that the increased mortality (23) or no effect (24) of HFOV compared to conventional ventilation, calling into question the use of early oscillatory ventilation. In our study, children with ARDS were transitioned to APRV or HFOV with higher OIs and lower PF ratios than in either adult HFOV trial, and the two modes were used to "rescue" hypoxemia refractory to conventional ventilation. But given these adult studies results, the current use of HFOV as rescue ventilation seems justified.
This research had some limitations, first, it had a small sample size, and it was a retrospective observational study. Secondly, we designed a short follow-up time. Though the association between survival and improved oxygenation was robust, these results should be determined in a prospective study with larger population.
There was no significant difference in mortality rate between the two groups failing SIMV and transitioning to either APRV or HFOV. Improving the oxygenation at 48 h expressed as PF48h/PFpre and OI48h/OIpre can reliably discriminate survivors from non-survivors. Due to the small sample size, single center and retrospective study, considerably more research is needed before this conclusion can be verified.
Funding: The project was supported by Shanghai shenkang new transformation project (No. 16CR3085B) and the Shanghail Natural Science Foundation of China (No. 19ZR1432900).
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at http://dx.doi.org/10.21037/tp-19-178
Data Sharing Statement: Available at http://dx.doi.org/10.21037/tp-19-178
Peer Review File: Available at http://dx.doi.org/10.21037/tp-19-178
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tp-19-178). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The trial was conducted in accordance with the Declaration of Helsinki. The study was approved by the Ethics Committee of Children's Hospital of Zhejiang University School of Medicine (No. 2020-IRB-048) and informed consent was taken from all the patients.
Farias JA, Frutos F, Esteban A, et al. What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study. Intensive Care Med 2004;30:918-25. [Crossref] [PubMed]
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Zivanovic S, Peacock J, Alcazar-Paris M, et al. Late outcomes of a randomized trial of high-frequency oscillation in neonates. N Engl J Med 2014;370:1121-30. [Crossref] [PubMed]
Kessel I, Waisman D, Barnet-Grinnes O, et al. Benefits of high frequency oscillatory ventilation for premature infants. Isr Med Assoc J 2010;12:144-9. [PubMed]
Gupta P, Green JW, Tang X, et al. Comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. JAMA Pediatr 2014;168:243-9. [Crossref] [PubMed]
Goffi A, Ferguson ND. High-frequency oscillatory ventilation for early acute respiratory distress syndrome in adults. Curr Opin Crit Care 2014;20:77-85. [Crossref] [PubMed]
Habashi NM. Other approaches to open-lung ventilation: airway pressure release ventilation. Crit Care Med 2005;33:S228-40. [Crossref] [PubMed]
Slee-Wijffels FY, van der Vaart KR, Twisk JW, et al. High-frequency oscillatory ventilation in children: a single-center experience of 53 cases. Crit Care 2005;9:R274-9. [Crossref] [PubMed]
Faqih NA, Qabba'h SH, Rihani RS, et al. The use of high frequency oscillatory ventilation in a pediatric oncology intensive care unit. Pediatr Blood Cancer 2012;58:384-9. [Crossref] [PubMed]
Saguil A, Fargo M. Acute respiratory distress syndrome: diagnosis and management. Am Fam Physician 2012;85:352-8. [PubMed]
Zhang Z. Univariate description and bivariate statistical inference: the first step delving into data. Ann Transl Med 2016;4:91. [Crossref] [PubMed]
Ben Jaballah N, Khaldi A, Mnif K, et al. High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure. Pediatr Crit Care Med 2006;7:362-7. [Crossref] [PubMed]
Yehya N, Topjian AA, Thomas NJ, et al. Improved oxygenation 24 hours after transition to airway pressure release ventilation or high-frequency oscillatory ventilation accurately discriminates survival in immunocompromised pediatric patients with acute respiratory distress syndrome. Pediatr Crit Care Med 2014;15:e147-56. [Crossref] [PubMed]
Willson DF, Thomas NJ, Markovitz BP, et al. Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA 2005;293:470-6. [Crossref] [PubMed]
Zabrocki LA, Brogan TV, Statler KD, et al. Extracorporeal membrane oxygenation for pediatric respiratory failure: survival and predictors of mortality. Crit Care Med 2011;39:364-70. [Crossref] [PubMed]
Musick MA. Critical appraisal of Zabrocki et al: Extracorporeal membrane oxygenation for pediatric respiratory failure: survival and predictors of mortality. Crit Care Med 2011; 39:364-370. Pediatr Crit Care Med 2013;14:85-8. [Crossref] [PubMed]
Minneci PC, Kilbaugh TJ, Chandler HK, et al. Factors associated with mortality in pediatric patients requiring extracorporeal life support for severe pneumonia. Pediatr Crit Care Med 2013;14:e26-33. [Crossref] [PubMed]
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Cite this article as: Ning B, Liang L, Lyu Y, Yu Y, Li B. The effect of high-frequency oscillatory ventilation or airway pressure release ventilation on children with acute respiratory distress syndrome as a rescue therapy. Transl Pediatr 2020;9(3):213-220. doi: 10.21037/tp-19-178
Reporting Checklist
Data Sharing Statement
Peer Review File

redpajama_set_name: RedPajamaCommonCrawl


As an Admission Counselor and Assistant Field Hockey Coach at Nichols, every day I look forward to helping students form the relationships that will help them accomplish so much in four short years. Because that's one of the things Nichols does best. I know from firsthand experience, since I'm also a graduate of Nichols College.
When I was Nichols student, the College's close-knit community helped me explore outside my comfort zone and succeed. I had a ready network of professors, coaches and peers who helped me find new opportunities and get myself out there. I was a varsity field hockey player, women's ice hockey manager, call center specialist, and sport management club member. And I owe it all to their support.
Now as an Admissions Counselor and Coach here, I enjoy seeing the students I've helped go on to discover what they're capable of, just like I did. So if you have any questions, just contact me. I'm always ready to talk about how Nichols can help you step out on your own path—and define your career.
You can find me on the beach on most warm, sunny days. I also love to travel! Of all the places I've traveled to so far, Maui and Argentina are my favorites. I've always been an athlete, and I love to play field hockey and ice hockey.
Fun fact about me: Whenever I see a dog, I have to stop and pet it! I'm obsessed with dogs; I have a dog named Shelby who is part Husky, part German Shepherd and part wolf.


text:
Home Business Meet Dr Ram Niranjan, The Brand Ambassador Of Leading Sports Nutrition Brand...
Meet Dr Ram Niranjan, The Brand Ambassador Of Leading Sports Nutrition Brand 'My Protein'
Dr Ram Niranjan
Every person has a story to tell. Everyone around us has their own share of struggles, and they fight them to lead a better life. Dr Ram Niranjan is also one of those people who had a tough life. But nothing broke his spirits, and today, he's working for the benefit of humanity. This month, the doctor was appointed as the brand ambassador of My Protein.
Sometimes, the food we eat doesn't always help us provide all the nutrients, especially if you are an athlete. But My Protein ensures one gets all the required elements in the body to stay fit and healthy. It's a leading sports nutrition brand that delivers a range of quality products, including protein powder, vitamins and minerals, high-protein foods, snack alternatives, and performance clothing.
My Protein is a top European brand since 2014 and has consumers from over 70 countries. With Dr Ram Niranjan being the brand ambassador of My Protein in India, it's a great achievement for the brand and the doctor to spread the message of healthy life among people.
Talking about Dr Ram Niranjan's life, he ventured professionally in Fitness and Nutrition in 2014. He has been a fighter twice as he had two major surgeries. The first surgery happened in 2018, and it was myxomatosis degeneration, a collagen disorder that affected his heart valve ( mitral valve). As a result, he developed a clot in the site of repair and nearly 14 TIA (transient ischemic attack ), commonly known as a mini-stroke and 3 major strokes. He eventually recovered and started training.
Dr Ram Niranjan's second surgery was a planned one with his existing collagen disorder. However, his valve was coping up with the repair done in the first surgery. So he decided to replace the valve with a metal one. Now, he doesn't have a tissue valve but a metal pipe that ticks on every beat instead of "Lub Dub", which we are all used to.
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Delightful home with a Pocket Park behind and East facing Patio for pleasant summer evenings. Expansive tile greets into the freshly painted Living areas. The delightful large Kitchen has Granite, fresh painted cabinets and a large dining area with a bay of windows for Pocket Park views. Office/ Study. MIL Plan. Just the right size for low maintenance so you can enjoy Sun City amenities or a perfect Lock & Go for part timers who travel. Quiet neighborhood, nice large back yard. Priced to sell MUST SEE!!


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This week our democracy worked! Town halls, phone calls, emails and visits to Congress made a difference. They heard loud and clear that the American public did not want to replace the Affordable Care Act with a crappy piece of legislation that would have left millions without coverage, increase costs for those that did manage to keep coverage, and reduce benefits—all for the sake of a tax cut for the wealthy. Celebrate last week's win, but stay focused!
Our work is only beginning. The Administration and Congress have told us that their next move is to put the Trump tax reform plan into action. We can expect that they will propose dramatic tax cuts that will mostly benefit the wealthy, and try to sell us a bill of goods that these tax cuts will be good for all. Because after all when rich people get richer, they invest in the American economy and everyone will do better, right? Horseshit. However, I digress. More on tax reform in another post.
This post is an open letter to all who oppose the proposals of the current administration. Now is not the time to gloat and dust the dirt of your shoulders. Instead, we must all double down, roll our sleeves up even more, and stay busy resisting anything that will hurt us, our families and communities. There are three things you need to do ASAP.
Make sure you know who your legislators are and their positions on issues. Just because the presidential election is over, you cannot stop paying attention to what elected officials say and do. They are making decisions every single day that affects your life! Don't think so? In less than 100 days in office, the Trump Administration has proposed a Muslim travel ban; promised support to Historically Black Colleges and Universities-and then didn't deliver anything; overturned Clean Water rules, making unsafe water a reality across America; appointed scary (read unqualified or maliciously qualified) people to his Cabinet; and supported the Dakota Access Pipeline that will ruin sacred American Indian burial grounds. There's more, but we do not have time or space. Do you get it? A lot of bad things have already happened, and more is to come.
Tell Your Elected Official Do Not Gloat-Govern. Clearly, Congress remains a crazy partisan gaggle that can't seem to get anything done. Both sides need to understand that we expect them to collaborate and work together to get things DONE! There are too many serious issues in play for either side to sit down and play the blame game. I understand that the Republicans control the debate; however, they still work for us-the Democrats must resist the temptation to gloat about the GOP's failure to pass a healthcare bill and start using all the rules and tools at their disposal to get stuff done.
Volunteer for WE CAN! Many of you want to know what you can do and WE CAN will Together WE CAN make a difference. We are much stronger than we think we are!
We are in for a long fight to protect our rights and not roll back decades of progress for civil and women's rights. WE CAN do it together!
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Please note, due to the different variations of the leaf spring set up on all single and twin wheel Ivecos we no longer supply a kit for the single wheel. We can supply a Spring Kit for the twin wheel but would need to see the underside first to confirm the correct kit.
This can be done via photos or calling in to our workshop for us to confirm.
All twin wheel models only but we will need to see the underside of the vehicle to confirm which kit you require.
We can also supply Rear shocks for the Iveco. These are heavy duty gas shocks and are rated at 800kgs. £60 each, £130 for a pair which includes £10 P&P.


Texting My Pancreas: It Makes Me Happy.
It's been pointed out to me, quite a bit lately, that cartoons I've drawn are showing up on various sites - some with credit back to the artist (that's me!), and some without. Some were shared as they were originally presented, and some have been edited in some way.
I thought I'd take a minute to establish my thoughts on sharing the content found on this site.
I draw this stuff because it makes me happy to do so. It makes me happy when I can create something that can not only make me laugh (it's totally self-therapy), but make others smile as well. LOL's make my day! It's labor-intensive and for a full-length cartoon like this one, for example, I'm pretty much dedicating an entire day (8 to 10 hours) to creating it.
Because making others happy makes me happy, I share what I've done online. Anyone who uploads a Facebook profile picture, writes a blog post, tweets a photo or shares a video on YouTube is automatically agreeing to the fact that that content is no longer theirs to control. That's not to say that this is fair, but that is simply how this all works. Just about everything online is downloadable and editable in some way, and I'm fully aware of that when I share things.
It's also true that when I see that someone has pinned my stuff or an image of mine is on Facebook, it makes me smile, big time. Warm fuzzies abound!
That said, I share these cartoons with a deliberate credit on the image. You'll either find my site address or my name on every cartoon I share. You'll also see on my right sidebar that what I share on this site is protected under a specific kind of Creative Commons license, which in very simplified terms means that content originating from this site is available to share freely, given that it happens under certain circumstances, and with my permission can be used in other ways.
I don't want to be an jerk about things. If you like what I do enough to share it, I'm very flattered by that, and I'm honored that you think enough of it to point it out to other people. Pin it! Make it your FB profile photo! Tweet 'til you drop! Tumblr the heck out of it!
That said, if you're going to share my stuff, please abide by the Creative Commons protection I have on them. If an image already has my name or website on it, then you're golden. But please don't doctor my images so that the credit is removed. I don't want you to be a jerk, either.
i'm glad you've made a statement about this. you work hard, and deserve all the credit!
I agree as well, and have done what I can to post a link to your blog on those posts of your photo (by others) where I see credit has been removed. Sarah and I LOVE your cartoons, and when she's having a tough day (for diabetes reasons or otherwise) we often come back to your blogs for a chuckle. They always lighten our load and make us smile.
Interesting. I saw one of the cartoons and noticed your name was not on it. I was even going to write you about it this evening. I don't know where I saw it but if I see one again with no credit, I'll try to remember where I was.
Love the cartoons. They always make me smile or... burst out laughing!
One of my teammates from Haiti showed up on campus one day last year and saw a flyer for an event using one of her pictures (loaned by a fellow teammate). She was really upset. It wasn't that she didn't want her picture used - we wouldn't take pictures if we didn't want people to see them. But because they didn't ask permission, they didn't know that was a picture of Stephenson. They didn't hear his story or know her story of taking the picture. I think that's why credit is important - so you don't lose the story or the passion behind the art.
Thanks, Kim, for allowing me the use of your cartoons. The kids thought they were great! I think they learned something and had fun while they did.
It's happened to me too with my video... I see it pop up in places with no credit, or people Make postcard with some of my saying in the video. Just have to shrug my shoulders, say oh well and be flattered by it. I guess.
Glad you wrote about this, Kim. Glad you can spread some joy and see the results of others loving what you've created. It is totally awesome art, my friend.
Please ignore the grammatical errors in my comment above. My i Pad is being temperamental and won't let me fix any errors. Grrrr.


text:
CORY McCARTAN
I'm a Ph.D. candidate in statistics at Harvard University, working with Prof. Kosuke Imai. My methodological research focuses on Bayesian modeling, causal inference, and sampling, and my applied projects are centered around redistricting, political geography, and fairness. As part of the Algorithm-Assisted Redistricting Methodology (ALARM) Project, I work on open-source R software for redistricting and political analysis.
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Individual and Differential Harm in Redistricting. With Christopher T. Kenny. Replication code
Social scientists have developed dozens of measures for assessing partisan bias in redistricting. But these measures cannot be easily adapted to other groups, including those defined by race, class, or geography. Nor are they applicable to single- or no-party contexts such as local redistricting. To overcome these limitations, we propose a unified framework of harm for evaluating the impacts of a districting plan on individual voters and the groups to which they belong. We consider a voter harmed if their chosen candidate is not elected under the current plan, but would be under a different plan. Harm improves on existing measures by both focusing on the choices of individual voters and directly incorporating counterfactual plans. We discuss strategies for estimating harm, and demonstrate the utility of our framework through analyses of partisan gerrymandering in New Jersey, voting rights litigation in Alabama, and racial dynamics of Boston City Council elections.
Sequential Monte Carlo for Sampling Balanced and Compact Redistricting Plans. Under Review. With Kosuke Imai. Software implementation.
Covered by The Washington Post.
Random sampling of graph partitions under constraints has become a popular tool for evaluating legislative redistricting plans. Analysts detect partisan gerrymandering by comparing a proposed redistricting plan with an ensemble of sampled alternative plans. For successful application, sampling methods must scale to large maps with many districts, incorporate realistic legal constraints, and accurately and efficiently sample from a selected target distribution. Unfortunately, most existing methods struggle in at least one of these areas. We present a new Sequential Monte Carlo (SMC) algorithm that generates a sample of redistricting plans converging to a realistic target distribution. Because it draws many plans in parallel, the SMC algorithm can efficiently explore the relevant space of redistricting plans better than the existing Markov chain Monte Carlo (MCMC) algorithms that generate plans sequentially. Our algorithm can simultaneously incorporate several constraints commonly imposed in real-world redistricting problems, including equal population, compactness, and preservation of administrative boundaries. We validate the accuracy of the proposed algorithm by using a small map where all redistricting plans can be enumerated. We then apply the SMC algorithm to evaluate the partisan implications of several maps submitted by relevant parties in a recent high-profile redistricting case in the state of Pennsylvania. We find that the proposed algorithm converges to the target distribution faster and with fewer samples than a state-of-the-art MCMC algorithm. Open-source software is available for implementing the proposed methodology.
The use of differential privacy for census data and its impact on redistricting: The case of the 2020 U.S. Census. 2021. Science Advances 7(41), eabk3283. With Christopher T. Kenny, Shiro Kuriwaki, Evan T. R. Rosenman, Tyler Simko, and Kosuke Imai. Originally a Public Comment to the Census Bureau (May 28, 2021). FAQ; Reaction to the Bureau's Response; Supplementary information; Replication materials.
Covered by The Washington Post, the Associated Press, the San Francisco Chronicle, NC Policy Watch, and others.
Census statistics play a key role in public policy decisions and social science research. However, given the risk of revealing individual information, many statistical agencies are considering disclosure control methods based on differential privacy, which add noise to tabulated data. Unlike other applications of differential privacy, however, census statistics must be postprocessed after noise injection to be usable. We study the impact of the U.S. Census Bureau's latest disclosure avoidance system (DAS) on a major application of census statistics, the redrawing of electoral districts. We find that the DAS systematically undercounts the population in mixed-race and mixed-partisan precincts, yielding unpredictable racial and partisan biases. While the DAS leads to a likely violation of the "One Person, One Vote" standard as currently interpreted, it does not prevent accurate predictions of an individual's race and ethnicity. Our findings underscore the difficulty of balancing accuracy and respondent privacy in the Census.
Measuring and Modeling Neighborhoods. Under Review. With Jacob R. Brown and Kosuke Imai. Survey tool; Poster
With the availability of granular geographical data, social scientists are increasingly interested in examining how residential neighborhoods are formed and how they influence attitudes and behavior. To facilitate such studies, we develop an easy-to-use online survey instrument that allows respondents to draw their neighborhoods on a map. We then propose a statistical model to analyze how the characteristics of respondents, relevant local areas, and their interactions shape subjective neighborhoods. The model also generates out-of-sample predictions of one's neighborhood given these observed characteristics. We illustrate the proposed methodology by conducting a survey among registered voters in Miami, New York City, and Phoenix. We find that across these cities voters are more likely to include same-race and co-partisan census blocks in their neighborhoods. Net of other factors, White respondents are 6.1 to 16.9 percentage points more likely to include in their neighborhoods a census block composed entirely of White residents compared to one with no White residents. Similarly, Democratic and Republican respondents are 8.6 to 19.2 percentage points more likely to include an entirely co-partisan census block compared to one consisting entirely of out-partisans. Co-partisanship exhibits a similar, independent, influence. We also show that our model provides more accurate out-of-sample predictions than the standard distance-based measures of neighborhoods. Open-source software is available for implementing the proposed methodology.
Widespread Partisan Gerrymandering Mostly Cancels in Aggregate, but Reduces Competition and Responsiveness. Under Review. With Christopher T. Kenny, Tyler Simko, Shiro Kuriwaki, and Kosuke Imai.
Congressional district lines in many U.S. states are drawn by partisan actors, raising concerns about gerrymandering. To isolate the electoral impact of gerrymandering from the effects of other factors including geography and redistricting rules, we compare predicted election outcomes under the enacted plan with those under a large sample of non-partisan, simulated alternative plans for all states. We find that partisan gerrymandering is widespread in the 2020 redistricting cycle, but most of the bias it creates cancels at the national level, giving Republicans two additional seats, on average. In contrast, moderate pro-Republican bias due to geography and redistricting rules remains. Finally, we find that partisan gerrymandering reduces electoral competition and makes the House's partisan composition less responsive to shifts in the national vote.
Simulated redistricting plans for the analysis and evaluation of redistricting plans in the United States. 2022. Nature Scientific Data 9, 689. With Christopher Kenny, Tyler Simko, Shiro Kuriwaki, George Garcia III, Kevin Wang, Melissa Wu, and Kosuke Imai. Project website; Replication code; Data
A collection of simulated congressional districting plans and underlying code developed by the Algorithm-Assisted Redistricting Methodology (ALARM) Project. The data allow for the evaluation of enacted and other congressional redistricting plans in the United States. While the use of redistricting simulation algorithms has become standard in academic research and court cases, any simulation analysis requires non-trivial efforts to combine multiple data sets, identify state-specific redistricting criteria, implement complex simulation algorithms, and summarize and visualize simulation outputs. We have developed a complete workflow that facilitates this entire process of simulation-based redistricting analysis for the congressional districts of all 50 states. The resulting data include ensembles of simulated 2020 congressional redistricting plans and necessary replication data. We provide the underlying code, which serves as a template for customized analyses. All data and code are free and publicly available.
Comment: The Essential Role of Policy Evaluation for the 2020 Census Disclosure Avoidance System. Forthcoming in the Harvard Data Science Review. With Christopher T. Kenny, Shiro Kuriwaki, Evan T. R. Rosenman, Tyler Simko, and Kosuke Imai. Response to boyd and Sarathy (2022)
In "Differential Perspectives: Epistemic Disconnects Surrounding the US Census Bureau's Use of Differential Privacy," boyd and Sarathy argue that empirical evaluations of the Census Disclosure Avoidance System (DAS), including our published analysis, failed to recognize how the benchmark data against which the 2020 DAS was evaluated is never a ground truth of population counts. In this commentary, we explain why policy evaluation, which was the main goal of our analysis, is still meaningful without access to a perfect ground truth. We also point out that our evaluation leveraged features specific to the decennial Census and redistricting data, such as block-level population invariance under swapping and voter file racial identification, better approximating a comparison with the ground truth. Lastly, we show that accurate statistical predictions of individual race based on the Bayesian Improved Surname Geocoding, while not a violation of differential privacy, substantially increases the disclosure risk of private information the Census Bureau sought to protect. We conclude by arguing that policy makers must confront a key trade-off between data utility and privacy protection, and an epistemic disconnect alone is insufficient to explain disagreements between policy choices.
Recalibration Of Predicted Probabilities Using the "Logit Shift": Why does it work, and when can it be expected to work well? Forthcoming in Political Analysis. With Evan T. R. Rosenman and Santiago Olivella.
The output of predictive models is routinely recalibrated by reconciling low-level predictions with known quantities defined at higher levels of aggregation. For example, models predicting vote probabilities at the individual level in U.S. elections can be adjusted so that their aggregation matches the observed vote totals in each county, thus producing better calibrated predictions. In this research note, we provide theoretical grounding for one of the most commonly used recalibration strategies, known colloquially as the "logit shift." Typically cast as a heuristic adjustment strategy (whereby a constant correction on the logit scale is found, such that aggregated predictions match target totals), we show that the logit shift offers a fast and accurate approximation to a principled, but computationally impractical adjustment strategy: computing the posterior prediction probabilities, conditional on the observed totals. After deriving analytical bounds on the quality of the approximation, we illustrate its accuracy using Monte Carlo simulations. We also discuss scenarios in which the logit shift is less effective at recalibrating predictions: when the target totals are defined only for highly heterogeneous populations, and when the original predictions correctly capture the mean of true individual probabilities, but fail to capture the shape of their distribution.
Geodesic Interpolation on Sierpinski Gaskets. 2021. Journal of Fractal Geometry 8(2), 117-152. With Caitlin M. Davis, Laura A. LeGare, and Luke G. Rogers.
We study the analogue of a convex interpolant of two sets on Sierpiński gaskets and an associated notion of measure transport. The structure of a natural family of interpolating measures is described and an interpolation inequality is established. A key tool is a good description of geodesics on these gaskets, some results on which have previously appeared in the literature.
Estimation of Racial Disparities When Race is Not Observed. With Robin Fisher, Daniel E. Ho, Jacob Goldin, and Kosuke Imai.
Bayesian Improved Surname Geocoding (BISG) is widely used to provide estimates of racial disparities from microdata that do not contain individual race information. However, in most applications, the existing approach to estimating these disparities relies on an implausible independence assumption. We provide an alternative identifying assumption and develop a Bayesian model that can provide accurate estimates of racial disparities. We apply the proposed method to the problem of estimating party identification by race in North Carolina and find that it improves significantly on the existing approach.
Two-stage Experiments and Stochastic Intervention. With Shusei Eshima and Kosuke Imai.
Regression of the Conditional Median. With Xiao-Li Meng.
Algorithm-Assisted Redistricting Methodology (book). With Kosuke Imai, Christopher Kenny, and Tyler Simko.
redist: Simulation Methods for Legislative Redistricting
This R package enables researchers to sample redistricting plans from a pre-specified target distribution using Sequential Monte Carlo and Markov Chain Monte Carlo algorithms. The package supports various constraints in the redistricting process, such as geographic compactness and population parity requirements. Tools for analysis, including computation of various summary statistics and plotting functionality, are also included.
redistmetrics: Redistricting Metrics
Reliable and flexible tools for scoring redistricting plans using common measures and metrics. These functions provide key direct access to tools useful for non-simulation analyses of redistricting plans, such as for measuring compactness or partisan fairness. Tools are designed to work with the redist package seamlessly.
easycensus: Quickly Find, Extract, and Marginalize U.S. Census Tables
Extracting desired data using the proper Census variable names can be time-consuming. This package takes the pain out of that process by providing functions to quickly locate variables and download labeled tables from the Census APIs.
PL94171: Tabulate P.L. 94-171 Redistricting Data Summary Files
Tools to process legacy format summary redistricting data files produced by the United States Census Bureau pursuant to P.L. 94-171. These files are generally available earlier but are difficult to work with as-is.
adjustr: Stan Model Adjustments and Sensitivity Analyses using Importance Sampling
Functions to help assess the sensitivity of a Bayesian model (fitted using the rstan package) to the specification of its likelihood and priors. Users provide a series of alternate sampling specifications, and the package uses Pareto-smoothed importance sampling to estimate posterior quantities of interest under each specification.
conformalbayes: Jackknife(+) Predictive Intervals for Bayesian Models
Provides functions to construct finite-sample calibrated predictive intervals for Bayesian models, following the approach in Barber et al. (2021). These intervals are calculated efficiently using importance sampling for the leave-one-out residuals. By default, the intervals will also reflect the relative uncertainty in the Bayesian model, using the locally-weighted conformal methods of Lei et al. (2018).
alarmdata: Download, Merge, and Process Redistricting Data
Utility functions to download and process data produced by the ALARM Project, including 2020 redistricting files and 50-State Redistricting Simulations.
blockpop: Estimate Census Block Populations for 2020
2020 Census data is delayed and affected by differential privacy. This package uses FCC block-level population estimates from 2010–2019, which are based on new roads and map data, along with decennial Census and ACS data, to estimate 2020 block populations, both overall and by major race/ethnicity categories (using iterative proportional fitting).
ggredist: Scales, Palettes, and Extensions of ggplot2 for Redistricting
Provides ggplot2 extensions for political mapmaking, including new geometries, easy label generation and placement, automatic map coloring, and map scales, palettes, and themes.
tinytiger: Lightweight Interface to TIGER/Line Shapefiles
Download geographic shapes from the United States Census Bureau TIGER/Line Shapefiles. Functions support downloading and reading in geographic boundary data. All downloads can be set up with a cache to avoid multiple downloads. Data is available back to 2000 for most geographies.
wacolors: Colorblind-friendly Palettes from Washington State
Candy cane shortages and the importance of variation. December 21, 2021. International Statistical Institute: Statisticians React to the News.
Where will the rocket land? May 12, 2021. International Statistical Institute: Statisticians React to the News.
Who's the most electable Democrat? It might be Warren or Buttigieg, not Biden. October 23, 2019. The Washington Post.
I-405 Express Toll Lanes: Usage, benefits, and equity. 2019. Technical report for the Washington State Department of Transportation. With Shirley Leung, C.J. Robinson, Kiana Roshan Zamir, Vaughn Iverson, and Mark Hallenbeck. Project website
Congestion is increasing in cities around the country, and particularly in the Seattle region. Local governments are increasingly experimenting with congestion pricing schemes to manage congestion. The Washington State Department of Transportation (WSDOT) opened a congestion pricing facility in 2015 on I-405, which runs through the eastern suburbs of Seattle. The facility operates by selling extra space in the high-occupancy vehicle (HOV) lanes to single-occupancy vehicles (SOVs), and dynamically changing the price of entry to manage demand and keep the lanes operating. These combined HOV and tolled SOV lanes are called High Occupancy Tolling (HOT) lanes.
While the HOT lanes have been operative for over three years, there has been little research into the equity impacts of the lanes. Using data on each trip made on the I-405 HOT lanes in 2018, demographic data on census block groups, and lane speed, volume, and travel time data, we tried to answer this question. We studied how the express toll lanes are used, the benefits they provide to the region, and how these benefits are distributed among different groups of users.
cmccartan@fas.harvard.edu
@CoryMcCartan
Science Center, Ste. 400
1 Oxford St.
HOMEPAGE • CONTACT
© 2023 Cory McCartan. All Rights Reserved.


The Highlanders went back to work yesterday ahead of eight games in eight weeks, which will define their season.
Otago will have three warm-up games - two involving Ranfurly Shield challenges - before the Mitre 10 Cup kicks off.
Change is in the air for the Mitre 10 Cup and it is not hard to see why.
The New Zealand Universities team will make a rare appearance in Dunedin next weekend as the side becomes part of the University of Otago's 150th celebrations.
The clubs have won the first round in their bid to get a voice on the board of the Otago Rugby Football Union.
Every dad wants to see his son succeed and does not mind helping out.
Otago fielding a team made up of players from overseas competitions will simply not happen, a meeting was told last night.
Highlanders coach Aaron Mauger has just pulled a rabbit out of the hat.
Filippo Inzaghi is a name which raises very few eyebrows in New Zealand.
What has gone wrong with Naholo?
What has gone wrong with Waisake Naholo? Steve Hepburn talked to former Highlanders and All Black winger Jeff Wilson about his plight.
The Highlanders have slipped out of the playoff positions but thankfully the season did not end this weekend.
Metropolitan clubs wanting a place on the board of the Otago Rugby Football Union are not critical of the board's role - they simply believe the board would be better if it had club representation.


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Ruislip Gardens – stacja londyńskiego metra położona na trasie Central Line pomiędzy stacjami South Ruislip i West Ruislip. Mieści się w piątej strefie biletowej, w dzielnicy Ruislip, w zachodniej części miasta.

Niedaleko stacji znajduje się Polish War Memorial, pomnik wzniesiony by uczcić polskich lotników.

Połączenia
Stację obsługują autobusy linii E7 i 696.

Galeria

Przypisy

Stacje linii Central
Stacje metra w London Borough of Hillingdon

redpajama_set_name: RedPajamaWikipedia


All applicants must be able to demonstrate proficiency in the English language.
The use of chemotherapeutic agents to target and kill cancer cells is a central strategy in the treatment of cancers. This course describes the nature of the disease at the systems, cellular and molecular levels, and focuses on the drugs which are used to treat different cancers and on how they work.
Worldwide the incidence of cancer is increasing, and is expected to reach 22 million new cases per year by 2030. In addition to treatments such as radiotherapy and surgery, chemotherapy has a vital role to play in prolonging the lives of patients.
deliver a programme of advanced study to equip you for a future career in anti-cancer drug development.
Assessment is a combination of coursework, which includes tests and essays, the research project and its oral defence and examination.