Journal articles on the topic 'Accident denominators'

Low-speed “back-over” injuries comprise a small number of pediatric automobile versus pedestrian (AVP) trauma, however these injuries tend to be more severe and have a higher rate of mortality. The objective of this study was to determine environmental, mechanistic, and demographic factors common in pediatric back-over injuries resulting in death. Patients were identified from the trauma registry of an urban Level I trauma center over a 15-year period. Charts for all pediatric AVP injuries in ages 4 years and younger were reviewed. Mortalities due to back-over injuries were identified. For the study period reviewed (1995–2010) we identified 535 cases of auto versus pedestrian injury in children less than 4-years-old. Of these, 31 (5.79%) were mortalities. Among those 31 mortalities, six (19.3%) were identified as resulting from back-over trauma. Mean age was significantly lower in back-over injuries as compared with non back-over AVP trauma (1.33 ± 0.23 years, vs 3.5 ± 1.0 years, P = 0.001). We noted a trend toward female gender (67%) and Hispanic ethnicity (67%). All sustained massive blunt head trauma as the cause of death. There were no significant differences in Injury Severity Score or Revised Trauma Score in the back-over group. Environmental analysis revealed that cars were the perpetrating vehicle 50 per cent of the time, and sport utility vehicles, vans, or trucks 50 per cent of the time. In all cases, the accidents occurred in the patient's own driveway and by either a family member (67%) or acquaintance (33%). These data suggest that key characteristics of back-over trauma resulting in mortality include very young age, massive head trauma, injury occurring in the patient's own driveway, and with a family member or acquaintance behind the wheel. This may help identify points of injury prevention to decrease the number of victims of back-over trauma in the pediatric population.

Background It is widely recognised that drink driving is a leading cause of road traffic accidents (RTAs). There is evidence that changing the drink-drive limit from a blood alcohol concentration of 0.08 to 0.05 g/dl is effective in reducing RTAs. Scotland changed the blood alcohol concentration limit to 0.05 g/dl on 5 December 2014. Aims To assess whether or not the numbers and rates of RTAs and per capita alcohol consumption in Scotland were reduced because of the 2014 drink-drive legislation. To assess whether or not the 2014 change in legislation provided good value for money. Design A natural experimental, quantitative study. The control group was England and Wales, that is, the other countries in Great Britain, where the drink-drive legislation remained unchanged. Setting Great Britain. Participants The entire population of Scotland, England and Wales for the period of January 2013–December 2016. Intervention The change to drink-drive legislation in Scotland. Outcome measures The counts and rates of RTAs; and per capita alcohol consumption. Methods For the numbers and rates of RTAs (both traffic flow and population denominators were used), and separately for the intervention and control trial groups, negative binomial regression models were fitted to panel data sets to test for a change in outcome level after the new 2014 legislation was in place. To obtain a ‘difference-in-differences’ (DiD)-type measure of effect, an interaction term between the intervention group indicator and the binary covariate for indicating pre and post change in legislation (‘pseudo’-change for the control group) was assessed. For off- and on-trade per capita alcohol sales, and separately for the intervention and control trial group, seasonal autoregressive integrated moving average error models were fitted to the relevant time series. Results The change to drink-drive legislation was associated with a 2% relative decrease in RTAs in Scotland [relative risk (RR) 0.98, 95% CI 0.91 to 1.04; p = 0.53]. However, the pseudo-change in legislation was associated with a 5% decrease in RTAs in England and Wales (RR 0.95, 95% CI 0.90 to 1.00; p = 0.05). For RTA rates, with traffic flow as the denominator, the DiD-type estimate indicated a 7% increase in rates for Scotland relative to England and Wales (unadjusted RR 1.07, 95% CI 0.98 to 1.17; p = 0.1). The change to drink-drive legislation was associated with a 0.3% relative decrease in per capita off-trade sales (–0.3%, 95% CI –1.7% to 1.1%; p = 0.71) and a 0.7% decrease in per capita on-trade sales (–0.7%, 95% CI –0.8% to –0.5%; p < 0.001). Conclusion The change to drink-drive legislation in Scotland in December 2014 did not have the expected effect of reducing RTAs in the country, and nor did it change alcohol drinking levels in Scotland. This main finding for RTAs was unexpected and the research has shown that a lack of enforcement is the most likely reason for legislation failure. Future work Investigations into how the public interpret and act on changes in drink-drive legislation would be welcome, as would research into whether or not previous change in drink-drive legislation effects on RTAs in other jurisdictions are associated with the level of enforcement that took place. Trial registration Current Controlled Trials ISRCTN38602189. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 12. See the NIHR Journals Library website for further project information.

By definition, hospitals should be among the places with the highest safety index (1). But often, on these premises, we have occasional accidents which may be dangerous and which illustrate the way hospitals are exposed to various and often undervalued risks.The incidences of unforeseen, dangerous situations involving sudden accidents, of uncontrollable emergency conditions and also of larger catastrophes are awful. Recent accidents proved inadequate safety inside hospitals. In Parma (2) escaping gas was followed by an explosion that destroyed a division of the hospital and resulted in wounded and dead. In Mondovi, an explosion in the central heating system of the hospital caused the death of an employee. A fire that broke out in an old people's home in Southern Italy brought about the death of three persons. The first shocks of the earthquake in 1980 caused the death of many patients and staff (including six physicians) in the so called “safe” hospital of San Angelo Dei Lombardi. In the earthquake in 1976 many patients and some personnel of the hospital staff in Gemona, Friuli lost their lives (3)Apparently these facts are not closely linked together. Some were caused by human error, others by inadequacy of buildings, age of structures, even where the disaster was due to natural causes. However all these events show the presence of the common denominator of “high risk,” typical of hospital structures (4,5). The principle dangerous situations are: (a) risks coming from the structures of the premises (no earthquake-proof principles of modular structure); and (b) risks connected with the working activities (6,7).

Background: Faciomaxillary injuries are increasing in incidence in Tirunelveli district due to the increasing number of vehicles on the street which are inadequate and due to assault. The common denominator in both these situations is alcohol abuse. This study aims to assess the incidence, causative factors and management options of Faciomaxillary trauma.Methods: Around 50 case of faciomaxillary injuries admitted in the Department of Plastic surgery, TVMCH were taken up for study. The cases were studied for age, sex, personal habits, mode of injury, associated injuries, involved bones and type of fracture, clinical features, treatment modalities, and complications.Results: Road Traffic Accident (RTA) was the most common cause. Males aged 20-30 were the most commonly involved. Alcohol abuse and Intoxication was the most common antecedent event. Associated head, limbs and chest injuries were common. Mandible was the commonest bone to be fractured followed by zygoma, maxilla and nasal bones. ORIF and IMF was the common surgery performed.Conclusions: Alcohol abuse is the leading cause of faciomaxillary injuries. Educating the public about the traffic rules and the ill effects of drunken driving will go a long way to prevent these injuries.

Balkan melting pot of cultures and denominationsin light of the 19th-century works of Polish travellersOut of numerous available Polish trip descriptions written at the end of the 19th century we have chosen the works by three Jesuits, Marcin Czermiński, Jan Badeni, and Julian Antoni Łukaszewicz, and a historian and ethnologist Aleksander Jabłonowski. Those works were by no means accidental: all the authors were experts in the matter of specific Balkan culture. We particularly analyse the authors’ interesting remarks on different denominations: Catholicism, Greek Orthodox Church, Islam and Judaism and relationships between members of these denominations. In their works the Polish authors frequently referred to the existing feeling of Slavic unity. At the same time they noticed the complexity of historical and political backgrounds which were then easily perceived in the region. Балкански конгломерат култура и вероисповестиу пољским путописима друге половине 19. векаЗа анализу насловног проблема избрани су из многих релација путописи пољских исусоваца Марћина Чермињског Marcin Czermiński, Јана Баденија Jan Badeni, Јулиана Антонија Лукашкјевича Julian Antoni Łukaszkiewicz и историчара и етнолога Александра Јаблоновског Aleksander Jabłonowski. Сви аутори су били добро припремљени и добро су познавали специфику културе балканских Словена. Обраћали су пажњу на разне верои­сповести: католицизам, православље, ислам и јудеизам а такође на односе међу њиховим припадницима. Пољски аутори често су се позивали на братство Словена и истовремено су подвлачили комплицирану историју овог региона и текуће политичке услове.

The chainsaw, as a work equipment, is considered one of the most dangerous in the field of occupational health and safety. The chainsaw is especially used in the forestry sector, although it is also used in other different sectors such as agriculture, construction or gardening. This study was carried out using an ad-hoc questionnaire as a research tool in order to assess the weaknesses in the training received by workers who use chainsaws in Andalusia, Spain, since it has never been addressed before. To achieve the objective set, the questionnaire was completed by 378 operators working with chainsaw and their responses were analysed. The results of this study show that there are obvious shortcomings related to work with chainsaws in very significant aspects for the occupational health and safety. Of special importance is the lack of training detected on rescue techniques and work at height, since these are aspects of special risk for workers’ health that could cause accidents with severe injuries. Also, a common denominator in all aspects studied was the lack of safety inspections and the state of the equipment to be used. These results evidence that there is a need to regulate chainsaw operator training.

Abstract The construction of wind farms involves a mixture of – often centrally deployed – highly specialized experts and local resources depending on the type of activity. The common denominator is that crews are increasingly multinational. For the prevention of accidents and adverse impacts, safety requirements have to be communicated to the workforce in a form which is adequate to the workforce composition and easy to deploy to remote worksites. Field work performed by the authors indicates that visual and/or digital tools for effective safety communication are not yet widely employed, and many field safety trainings and toolbox talks rely on written communication of rules with often repetitive content and no checks of effectiveness. Ways of effective field safety communication are analysed and an approach is presented for enhancing in-the-field conversations and toolbox talks for field sites with limited access to digital learning tools. Simple and easy-to-deploy visuals will remain to be important in-the-field aids for safety communication in remote areas, even as advanced immersive training methods become increasingly available. Any tools should be designed for or should be adaptable to the composition of workforces in terms of language skills, workers qualifications and demographic aspects such as age or diversity. Lastly, field safety communication and training should always be accompanied by personal interactions between workers and supervisors and/or peer multipliers to highlight the “why” behind safety, i.e. the role of every single individual for providing a sound and healthy operating environment and ultimately protecting human lives.

The 2011 Great East Japan Earthquake (within Fukushima, Iwate, and Miyagi prefectures) was a complex disaster; it caused a tsunami and the Fukushima Daiichi Nuclear Power Plant accident, resulting in radiation exposure. This study investigated the earthquake’s effects on the migration patterns of pregnant women and their concerns regarding radiation exposure. We also considered the following large-scale earthquakes without radiation exposure: Great Hanshin-Awaji (Hyogo prefecture), Niigata-Chuetsu, and Kumamoto. Pregnant women were categorized as outflow and inflow pregnant women. Data on the annual number of births three years before and after the earthquake were used as a denominator to calculate the outflow and inflow rates per 100 births. The odds ratios of annual outflow and inflow rates after the earthquake, using three years before the earthquake as the baseline, were calculated. The odds-ratio for outflow significantly increased for Hyogo, Fukushima, Miyagi, and Kumamoto prefectures after the earthquake, particularly for Fukushima, showing a significant increase until three years post the Great East Japan Earthquake (disaster year: odds-ratio: 2.66 [95% confidence interval: 2.44–2.90], 1 year post: 1.37 [1.23–1.52], 2 years post: 1.13 [1.00–1.26], 3 years post: 1.18 [1.05–1.31]), while the remaining three prefectures reported limited increases post one year. The inflow decreased after the earthquake, particularly in Fukushima, showing a significant decrease until 2 years post the Great East Japan Earthquake (disaster year: 0.58 [0.53–0.63], 1 year post: 0.76 [0.71–0.82], 2 years post: 0.83 [0.77–0.89]). Thus, pregnant women’s migration patterns changed after large-scale earthquakes, suggesting radiation exposure concerns possibly have a significant effects. These results suggested that plans for receiving assistance and support that considers the peculiarities of disaster related damage and pregnant women’s migration patterns are needed in both the affected and non-affected areas.

AbstractObjective:To analyze the rate of occupational exposure to blood and body fluids from all sources and specifically from human immunodeficiency virus (HIV)-infected sources among hospital workers, by job category and work area.Design:Multicenter prospective study. Occupational exposure data (numerator) and full-time equivalents ([FTEs] denominator) were collected over a 5-year period (1994-1998) and analyzed.Setting:18 Italian urban acute-care hospitals with infectious disease units.Results:A total of 10,988 percutaneous and 3,361 mucocutaneous exposures were reported. The highest rate of percutaneous exposure per 100 FTEs was observed among general surgery (11%) and general medicine (10.6%) nurses, the lowest among infectious diseases (1.1%) and laboratory (1%) physicians. The highest rates of mucocutaneous exposure were observed among midwives (5.3%) and dialysis nurses (4.7%), the lowest among pathologists (0%). Inadequate sharps disposal and the prevalence of sharps in the working unit influence the risk to housekeepers. The highest combined HIV exposure rates were observed among nurses (7.8%) and physicians (1.9%) working in infectious disease units. The highest rates of high-risk percutaneous exposures per 100 FTE were again observed in nurses regardless of work area, but this risk was higher in medical areas than in surgery (odds ratio, 2.1; 95% confidence interval, 1.9-2.5; P<.0001).Conclusion:Exposure risk is related to job tasks, as well as to the type and complexity of care provided in different areas, whereas HIV exposure risk mainly relates to the prevalence of HIV-infected patients in a specific area. The number of accident-prone procedures, especially those involving the use of hollow-bore needles, performed by job category influence the rate of exposure with high risk of infection. Job- and area-specific exposure rates permit monitoring of the effectiveness of targeted interventions and control measures over time.

Let's compare the map of religions of the world and the map of the religious network of Ukraine. The first thing that catches the eye is the presence on our map (maybe only in a different percentage) of almost all those denominations that are on the first. We have virtually no Ukraine of our own, our own religions. Unless we can boast of our Great White Brotherhood. Therefore, all religious movements (since the baptism of Ukraine-Russia) have been brought to us from abroad, and therefore are not in the full understanding of the word a manifestation of our ethnic mentality. They are either adapted to it, or they exist as something accidental, alien to our lives. Let us remember at least the Krishnaites who, in their tufts and sari, take to our snow-covered streets, sing the Ganges and offer us, as holy, His water to the Ukrainians. At the same time we have our national clothes, our native Dnipro-Slavuta. Think of the same Christianity that, in adapting to our reality, replaced the palm branches that threw at the feet of Jesus as he traveled to Jerusalem on the willow. Yes, and many other things it took for granted from the previous Ukrainian paganism, sort of assimilating it.

Introduction The activities of Risk Management at a department of urology involve specialist health workers, technical and administrative staff as the common denominator is communication, simplification of processes and the quality of health care provision. The Authors present their experience on the management of risk in urology and an attempted classification of adverse events with possible dysfunction in the clinical management in urology department. Materials and Methods Our analysis included those adverse events that occurred from January to December 2008. A total of 18 adverse events were identified from 638 urological procedures divided according to diagnosis, treatment and type of hospitalization. Results The following events were assessed: number of cases with wound infection: 5 (4.7%), diastasis of the surgical wound: 3 (0.47%), catheter obstructions that required therapeutic endoscopic or surgical haemostatic procedures: 5 (0.78%), delayed administration of treatment: 3 (0.47%) and accidental fall out of bed: 2 (0.31%). Conclusions The transition from a reactive to a preventive system remains the key to provide the citizen with the best health care in safety conditions. The involvement of different organizational and managerial levels in an optimal atmosphere in the absence of stress appears to be the most balanced and successful approach, especially putting aside the attitude of assigning error culpability. The transmission of individual experiences at a regional and national level will allow refining the project, which foresees the identification and classification of possible events and especially the ways and preventive procedures to achieve them.

A Toponímia, ciência que se dedica ao estudo dos nomes de lugar, é de grande relevância para o conhecimento dos aspectos históricos e socioculturais de um povo, uma vez que permite reconhecer, nos topônimos investigados, fatos linguísticos, ideologias e crenças de um povo. Desse modo, vinculado ao ATEMIG — Atlas Toponímico do Estado de Minas Gerais —, projeto em desenvolvimento na FALE/UFMG desde 2005, este trabalho tem como objetivo apresentar um estudo do léxico toponímico do Estado de Minas Gerais, focalizando os nomes de lugar que receberam suas denominações a partir do vocábulo esperança. Relacionado à ideia de prosperidade e bastante frequente no léxico toponímico brasileiro, esse item lexical geralmente revela, em sua motivação, o estado de espírito otimista do denominador no ato da nomeação, o que justifica, segundo o modelo teórico-metodológico da Toponímia, a sua classificação como animotopônimos. Nessa perspectiva, pautando-se pelos princípios dessa ciência onomástica, fez-se um levantamento dos topônimos referentes aos acidentes físicos (rio, lago, montanha etc.) e humanos (vila, cidade, ponte etc.) que foram nomeados a partir dessa lexia, tanto em formas simples quanto em formas compostas, presentes nos 853 municípios mineiros. Desse levantamento, verificou-se a presença de 401 topônimos distribuídos geograficamente em todas as mesorregiões mineiras, com destaque especialmente para os acidentes humanos na Zona da Mata e no Vale do Rio Doce.Palavras-chave: léxico; cultura; toponímia; animotopônimo; esperança; Minas Gerais.Toponymy, a science dedicated to the study of place-names, is of great relevance for the knowledge of the historical and sociocultural aspects of a people, once it allows recognizing, in the investigated toponyms, linguistic facts, ideologies and beliefs of a people. Thus, linked to ATEMIG — Toponymic Atlas of Minas Gerais State —, a project under development at FALE/UFMG since 2005, this work aims to present a study of the toponymic lexicon of the State of Minas Gerais, focusing on the place-names that received their denomination from the word esperança. Related to the idea of prosperity and frequently present in the Brazilian toponymic lexicon, this lexical item usually reveals, in its motivation, the optimistic state of mind of the denominator in the act of naming, which justifies, according to the theoretical-methodologicalmodel of Toponymy, its classification as animotoponyms. In this perspective, based on the principles of this onomastic science, a survey was made of toponyms referring to physical accidents (river, lake, mountain, etc.) and human (village, city, bridge, etc.) of the 853 cities of Minas Gerais that were named from this lexia, both in simple forms and in compound forms. From this survey, it was verified the presence of 401 toponyms geographically distributed in all of Minas Gerais mesoregions, with special emphasis on human accidents in Zona da Mata and Vale do Rio Doce.Keywords: lexicon; culture; toponymy; animotoponym; hope; Minas Gerais.

Abstract BACKGROUND: Attention deficit hyperactivity disorder is considered the most common childhoodneurobehavioral disorder worldwide with well documented adverse consequences in adolescence and adulthood, yet 60-80% of cases go undiagnosed. Routinescreening for the condition is not practiced in most pediatric outpatient services andlittle information exists on factors associated with the condition in developingcountries. OBJECTIVES: This was a questionnaire based cross-sectional survey whose primary objective was to determine prevalence of attention deficit hyperactivity disorder (ADHD) symptoms in children aged 6-12 years attending the Accidents and Emergency unit of a tertiary care hospital in Nairobi. Secondary objectives were to (i) ascertain if physical injury and poor academic performance were associated with ADHD, (ii) compare diagnostic utility of parent-filled Vanderbilt Assessment Scale (VAS) against Statistical Manual of Mental Disorders-IV (DSM-IV) as the gold reference and (iii) establish if there exists an association between ADHD symptoms cluster and comorbid conditions. DESIGN/METHODS: The study was undertaken at the paediatric accidents and emergency (A&E) section of the Aga Khan University Hospital (AKUHN) between March and June 2012. AKUHN is a private, not for profit, tertiary health care facility based in Nairobi, Kenya. Paediatrics A&E offers a 24-hour service provided by paediatric residents and senior house officers under the supervision of paediatric registrars. Children aged 6-12 years were enrolled provided guardians demonstrated ability to read and write in English. A written signed informed consent was also required from the primary care provider. Children on methylphenidate, antidepressants or behavioral therapy and those with neurological disorders, hearing and visual impairments or need for emergency care were excluded. Those who consented were clinically evaluated and treated for the ailments that brought them to hospital prior to completion of the self-administered study questionnaire. Sample size was estimated at 240 based on estimated ADHD prevalence of 6% reported by Kashala et al from a neighboring country with similar socio-economic setting as Kenya. Study approval was obtained from the Aga Khan University Hospital Scientific and Ethical Review Committees. Enrolling of children was done after written consent from parents or primary guardians as required by the institutional review board for children under the age of 18 years. It was made clear that recruitment was entirely voluntary and that refusal to participate would not in any way compromise provision of care. Study records were secured in a locked cabinet to safeguard confidentiality. Study was carried out using a two-stage ascertainment procedure. Children were evaluated for eligibility after registration at the reception between 9am to 8pm during week days. A maximum of 10 participants were recruited on any given day to minimize burden in the department and to hopefully capture a wider spectrum of medical conditions. Details about the study were explained to the parents by the principal investigator or the research assistant after patients had been seen by the clinician for the presenting problem. Information necessary for DSM-IV classification was obtained from parents who also completed VAS form. Care providers of study children were requested to complete the risk assessment form with assistance provided as needed. It contained questions about school performance such as repetition of class and average end of term marks which was categorized as; below 25%, 25-50%, 50-75% or above 75%. A grade above 50% was considered as acceptable performance. Only injuries for which medical treatment was sought were considered for inclusion and categorized into burns,fractures and open wounds. Information on causes of injuries was classified under falls, fight, car accident and others. Completion of an assessment form took approximately 15 minutes after which questionnaire was scored and tabulated before providing feedback to parents. Data were entered in Microsoft Excel® and analysis done using STATA®Version 11 (StataCorp). Prevalence of ADHD symptoms was calculated using the number of positive cases as numerator and study population as denominator. Chi square or Fischer’s exact test were used as appropriate to compare categorical variables with P-value below 0.05 considered significant. Wilcoxon test was used for ordinal data. Odds ratios (OR) were used to determine association between ADHD symptoms and categorical variables and 95% confidence interval (CI) to determine precision around individual estimates. RESULTS: Prevalence of cluster of symptoms consistent with ADHD was 6.3% (95% CI; 3.72-10.33) in 240 children studied. Those affected were more likely to repeat classes than the asymptomatic (OR 20.2; 95%CI 4.02-100.43). Additionally, 67% of the symptomatic had previously experienced burns and 37% post-traumatic open wounds. The odds of having an injury in the symptomatic was 2.9 (95%CI; 1.01-8.42) compared to the asymptomatic. Using DSM-IV as the reference, VAS had a low sensitivity of 66.7% (95%; CI 39.03-87.12) but specificity of 99.0% (95%CI; 96.1-99.2). Its positive predictive value was 83.0% (95%CI; 50.4-97.3) and the negative predictive value 98.0% (CI 95.1-99.1). Positive and negative likelihood ratios were 75(95%CI; 18.3-311.2) and 0.3 (95%; CI 0.21-0.73) respectively. Oppositional defiant disorder symptoms, anxiety, depression and conduct problems were not significantly associated with ADHD cluster of symptoms. CONCLUSION: A relatively high prevalence of symptoms associated with ADHD was found inchildren visiting the Paediatric Accidents and Emergency department. Symptomaticchildren had also experienced more poor school performance. These findings makea strong case for introduction of a policy on routine screening for ADHD in pediatricoutpatient service in a similar setting. Positive history of injury, especially burns, and poor academic performance is associated with symptoms of ADHD which should trigger need forfurther evaluation for ADHD and appropriate referral. Even though easier toadminister than DSM-IV, Vanderbilt assessment scale has low sensitivity hence itwould not be appropriate for use in ADHD screening. However, in view of its highspecificity and ease of administration, it could be used as an alternative confirmatorytest to determine who among clinically symptomatic patients would require referral to a psychiatrist for further evaluation and management.

The relevance of the results of this empirical research is based on a number of factors. Firstly, the knowledge of the causes and dynamics of different psychological states makes it possible to single out psychological patterns emerging in similar circumstances, accurately predict the behavior of the person under investigation, identify atypical situational or accidental conditions, and avoid mistakes in their description. Secondly, the study of mental states of a person deprived of liberty is valuable for the organization of the whole correctional process and the development of recommendations on preventing the destructive behavior of persons under investigation when it is caused by their mental state. The study touches upon little-studied issues of changes in the mental states of persons put in the temporary detention facilities. The analysis of the obtained data showed that longer periods spent in detention facilities lead to such negative changes in mental states of people under investigation as an increase of unmotivated anxiety, psycho-emotional tension, emotional lability, irritation, sadness, boredom, low spirits, poor well-being and activity, inmates develop sensory deprivation, frustration, hypoxia, and a deeper depression. At the same time, there is an increase in sociability, activity, and extraversion. Limitation of the freedom of actions and motor activity is compensated by a considerable increase in verbal activity, there is a greater desire for a trustful and open interaction with other people, a growth in self-criticism. To satisfy the need for communication and verbal activity, it is necessary to give people under investigation a chance to meet representatives of different religious denominations and the detention facility’s psychologist. After longer periods of detention persons under investigation begin to express characteristics typical of criminal behavior: boldness, inappropriate familiarity, tendency to take risks, resourcefulness, impatience, maximalism, love of freedom, courage and decisiveness. Time spent in a detention facility is most effective for optimizing the mental state of persons under investigation, developing constructive scenarios of serving a sentence and future successful re-socialization. When persons under investigation are transferred to penal colonies, their mental state is predicted to deteriorate.

The subject of analysis comprises 287 Lithuanian sheep’ names. According to the author, traditionally the naming of sheep rests on somatic motivation (204 names, or 70.7 percent), including the animal’s color, its inborn or acquired bodily peculiarities or shortcomings, height, complexion, and age. Along with visible features, tactile appreciation of the wool’s quality and audible perception of the animal’s sounds are also important. 25 names (or 8.7 percent) of ethologically motivated zoonyms are related to denotative sphere, being influenced by the animal’s character, habits and manner. 53 (or 18.5 percent) names of evaluative and 5 names (1.7 percent) of subjective motivation reflect not only emotional, but also pragmatic relations between humans and animals. In order to emphasize belonging of the animal as a tangible property to a certain person, the sheep may acquire its owner’s name, surname or a metaphorical denomination of a specific mark that is exclusive to the owner and is tied onto the animal, or cut out on it, etc.Comparison of the motivation and metaphoric character of the names with broader linguistic, ethnological and folkloric context (including stable epithets, parallels, paremias, nicknames, zoomorphisms, the devil’s names and other mythical denominations, endearing names of the animals, customs of herding, relics of folk magic, etc.) shows that naming of animals is such a sphere, research of which enables experiencing vitality of the ancient beliefs, customs, and the mythical worldview. In terms of ethnology, the mythological contents of motivation for the name Rasa (‘dew’) seems particularly fascinating. The name has a magical function, as its etymon relates to the notion of water, thus naming of the sheep aims at ensuring and enhancing the quantity of its milk. In addition, this onomastic situation is far from accidental: a goat is known of having acquired a similar name (in diminutive, Raselė) for similar reasons. Besides, cows are also frequently given names deriving from appellatives or hydronyms related to water, e. g.: Banga (Lith. banga ‘wave’), Upė (Lith. upė ‘river’), or Agluona, Šešupė (Lithuanian hydronyms). Therefore, such phenomenon may be considered a systematic quality of the Lithuanian zoonyms.

The article is devoted to one of the key subjects of the detente period – the history of development and adoption of Jackson-Vanik Amendment to the Trade Act of 1974. The significance of the human rights problem in the USSR, in particular – the right to emigrate, for the development of American-Soviet relations at the peak of detente is shown. Special attention was paid to trilateral negotiations between the Soviet leadership, Nixon and Ford administrations and the legislators headed by Senator Henry Jackson. The Amendment, adopted in December 1974, created serious obstacles for the development of trade and economic relations between the superpowers, and it had a number of negative political consequences also. The Amendment constituted the issue of human rights in the USSR as one of the important components of the U.S. foreign policy, created a negative background for the American-Soviet dialogue, which significantly complicated the outlined convergence of superpowers and contributed to the curtailment of detente.The political struggle around the Jackson-Vanik Amendment became the quintessence of detente. Each of the parties involved regarded the Amendment differently: Soviet leaders saw it as a rude interference in the internal affairs of the USSR; Kissinger saw it as an untimely and too radical in form and methods attempt to transform the Soviet system; Jackson saw it as a good way to increase his popularity by exploiting a popular in the post-Vietnam era theme that was naturally consistent with American national values and traditions. Both the Kremlin and Jackson had a fairly clear set of concessions that they could make. However, in the context of the systemic crisis of power caused by Watergate, the US administration did not have enough resources to bring them to a common denominator. The Soviet leadership soon also faced new economic and political challenges, and the problem of restoring trade relations with the United States ceased to be a priority.The Jackson-Vanik Amendment of 1974 became the watershed separating the “high détente” from its downward phase. Its real significance far exceeded its immediate meaning embedded in the arguments of its creators. It was not an accident that the Amendment was not canceled in 1987 after the USSR liberated its emigration policy. After the collapse of the USSR American leadership used it as a political leverage against Russian Federation. Boris Yeltsin appealed to Bill Clinton multiple times in 1993-1994 requesting removal of discrimination measures in trade and economic relations inherited from the soviet times. The Amendment was not cancelled it was only temporarily suspended. It was officially canceled only in 2012, but only in order to give way to a law that allows the United States, at its discre tion, to impose sanctions on individuals allegedly responsible for human rights violations in Russia (the so-called Magnitsky Act) and remains an obstacle to the development of equal Russian-American economic ties.

Abstract CVD risk factors of age, hypertension, high cholesterol (HC), smoking, diabetes are expressed in the Framingham coronary risk score. Previous data suggest that hemophilia may protect against CVD. However, CVD risk factors may place HP at risk as they age. HIV infected patients are a rapidly developing group with CVD. No data address the effect of established risk factors on CVD prevalence in HP. We report an extensive analysis of a single hemophilia treatment center (HTC) database for CVD risk factors and prevalence in HP. Framingham coronary risk scores were calculated for HP patients with documented CVD events, using age at time of event to calculate risk. HTC population ≥40 yrs, used as denominator, comprised 156 with FVIII deficiency (63 severe, 16 moderate, 77 mild);109 with FIX deficiency (24 severe, 53 moderate, 31 mild). Forty-eight HP had HIV infection, 113 had hepatitis C, and 25 had HIV/hepatitis C coinfection. Twenty-one HP, 10 with viral infection, ranging 49 to75 years, experienced 23 CVD events. They included 11 FVIII (0 severe, 1 moderate, 10 mild),10 FIX (2 severe,6 moderate, 2 mild). CVD events included 13 myocardial infarction (MI); 5 cerebrovascular accidents (CVA); 1 patient with carotid stenosis and 4 HP with coronary artery disease on catheterization. Two patients each had both MI and CVA. Four patients underwent coronary artery bypass graft surgery. Of 8 patients on antiplatelet therapy, 2 had major bleeds (CNS and GI bleed); one had a minor bleed (epistaxis). Of these 21 HP with CVD, one patient had HIV disease; 8 had hepatitis C, 1 had co-infection with HIV and hepatitis C. One patient was on Vioxx® at the time of his CVD event.Six are deceased, all due to CVD. Overall, CVD affected 7.9% of HP aged &gt;40 years in this population. Of all HP with viral infection in this HTC population, 40% experienced CVD. Ten-year CVD risk per Framingham model at time of event ranged from 10% to 37% (mean 20.1%; median 16%). All HP patients with CVD met the definition of high coronary risk per AHA guidelines with 10-year risk of CVD&gt;10%. Management of established CVD in HP is difficult due to need for invasive procedures and bleeding risk with antiplatelet therapy. Primary prevention of CVD is thus crucial. Aggressive risk factor modification is indicated in all HP with 10-year risk score &gt;10% for primary prevention of CVD. To our knowledge, this is the first application of the well validated Framingham score in the HP population.We conclude that the easily calculable Framingham score should be assessed in all HP over age 40, especially those with viral infections, and incorporated into the comprehensive care model.

Abstract CVD, acute coronary syndrome (ACS)/cerebrovascular accident (CVA), is a leading cause of morbidity and mortality in the US. Risk factors are hypertension, hypercholesterolemia (HC), smoking and diabetes. Therapeutic advances allow PWBD to live longer; CVD may emerge as in the general population. No data address prevalence and treatment of CVD in PWBD. Previous data suggest that hemophilia may protect against CVD. A single HTC analysis of PWBD for CVD prevalence and outcome was performed. Query of HTC database identified patients with hemophilia/ von Willebrand disease(vWD) with CVD and retrospective chart analysis performed for risk factors. Coronary risk assessment score, expressed as a percentage(Framingham model), was calculated; unknown HC values assigned level 1 (scale maximum level 3) to avoid bias. Age at CVD event was used for risk comparison to age/ sex matched general population. HTC population was analyzed for bleeding disorder, severity, age ≥ 40 yrs, sex and utilized as the denominator for population event analysis. PWBD demographics ≥ 40 yrs revealed 146 with FVIII deficiency (60 severe, 18 moderate, 68 mild); 99 with FIX deficiency (20 severe, 52 moderate, 27 mild); 164 vWD (106 Type 1, 48 Type 2, 10 Type 3). Twenty-four PWBD, all ≥ 40 yrs of age, had experienced 26 CVD events. These PWBD included 8 FVIII (0 severe, 1 moderate, 7 mild), 6 FIX (2 severe, 4 moderate, 0 mild), and 10 vWD (5 Type 1, 4 Type 2, 1 Type 3). Events included 20 ACS; 6 were CVA; two patients each had both ACS and CVA. Six were deceased at time of analysis; five deaths due to CVD; one death (type III vWD) due to lung cancer. Framingham risk scores were comparable to expected general population scores. Eight patients received anti-platelet therapy. Of these, two had major bleeds (CNS and GI bleed); one had a minor bleed (epistaxis). Approximately one in 20 US population over age 40 yrs has CVD. Given this prevalence, we would expect 20 patients with CVD in our patient population. If bleeding disorders, specifically hemophilia and vWD, conferred protection against CVD, then we would expect decreased prevalence of CVD in our patient population. This putative protective effect would likely manifest in PWBD with severe deficiencies than in PWBD with mild deficiencies. Interestingly, we identified three patients with severe deficiency (two severe FIX; one type III vWD) with CVD; one of whom (type III vWD) had a higher calculated CVD risk score that age matched general population. CVD patients with mild/moderate deficiencies appear more similar to the general population for CVD risk than their severely affected counterparts. CVD prevalence in the former group could approach expected general population prevalence given Framingham scores equal to or higher than expected compared to the general population. In fact, Framingham score for identified CVD patients revealed 10 year comparative risk of CVD similar to general population risk. Accurate prevalence rates will be determined through prospective risk factor screening/CVD evaluation in PWBD over 40 yrs. Further study is warranted as prophylaxis becomes more widely utilized converting patients with severe disease to a more moderate disease state and possibly altering CVD prevalence. Invasive procedure outcome and optimal CVD therapy in PWBD require prospective investigation. This single center analysis represents the largest reported registry of PWBD analyzed for CVD to date.

Abstract The aim of the article is to present the application of the lean management method as appropriate for the management of the organizational system of psychiatric care in the Zealand region of Denmark. The organizational solutions of the Danish psychiatric care system presented in this paper are individualized and adapted to the regional needs of the residents. In Denmark, there are five administrative regions, in which each independently organizes its own system of medical (psychiatric) care. This means that the regions have considerable independence in choosing the acceptable and necessary methods of management, including – as is clear from the conducted research – the use of methods put-upon other areas of economy. Although the national laws in Denmark define certain conditions and guidelines for the functioning of psychiatric care (e.g. regarding the use of direct coercion/restrains for patients treated in the centres), there is a distinct separation of structures and methods of functioning throughout the whole country, which constitutes unique observation material – from the cognitive point of view. The authors of this paper conduct extensive research and analyse the systems of psychiatric care organizations in various countries (including Spain, Italy and Japan) and, as a result, the obtained results may lead to the selection of the best models from other systems (good organizational practices and management, the management methods in use), which can be applied in the currently reorganised system of the Polish psychiatric care. The choice of Denmark for the observational study is not accidental and is related not only to the fact that there is a large degree of systemic identity within the country and between the regions, but also because the country applies solutions addressed to patients with very different cultural conditions and needs, resulting from their descent, religion, and (world)-views. Denmark is one of those European countries that express a significant acceptance of diversity and tolerance, which is why communities with very different imponderables, denominations, and worldviews co-exist. In the area related to the organization of the psychiatric system, these conditions are of key importance. In the period from January 2015 to December 2017 the authors participated in study visits in Denmark, conducting research aimed at identifying the key success factors of the psychiatric care organization system in the country. The conducted analysis is also based on the analysis of literature and own and participant observations. The conclusions concerning this subject are also the result of interviews conducted with employees of the visited hospitals and system users, both professionals and patients. As the search for an optimal organizational model of psychiatric care is currently an ongoing concern in Poland, it seems justified to review the existing solutions in Europe and perform their critical analysis. A comparison of the adopted solutions was performed, in the context of, above all, the improvement of the quality of these services, their availability, and the satisfaction of patients and their families from the proposed organizational changes. The economic benefits of these solutions are also significant.

The aim of this research was to investigate mortality among young Nicaraguan immigrants to Costa Rica (disease versus injury deaths) and compare it with the young native population. The study focused on persons aged 15 to 34 years, due to the relative importance of the injury deaths in this age group. Deaths (numerators) and population data (denominators), which were obtained from the 10th Population and Housing Census 2000, were used to calculate the mortality rates per 100,000 inhabitants. The relative risk (RR) results from dividing each set of causal standardized mortality rates. Approximately 66% of deaths among Nicaraguan immigrants are injury deaths versus 57% for the native population. Immigrants have higher relative risks (RR) of mortality than natives for injury deaths (homicides RR=2.00, other accidents RR=1.70, and vehicular accidents RR=1.17). We emphasize that Nicaraguan immigrants have twice the risk of dying from homicide than the native population.

Traffic accidents are, today, accepted as a global problem and activities are being undertaken to adapt and transfer successful practices from the most developed countries to underdeveloped and developing countries. The impact of a road transport system is so significant that its safety or lack of safety affects a wide range of social needs. Road safety or mobility without risk of death or injury affects health, poverty, equality, the environment, employment, education, gender equality and the sustainability of communities. Many nations around the world have improved the effect of pillar interventions by applying them selectively and strategically in accordance with the principles of the safe system approach. The safe system approach addresses problems closer to their root cause and on a broader level than conventional methods. The five pillars of road safety identified in the Global Plan for the Decade of Action 2011-2020 include a set of evidence-based interventions that can measurably improve road safety. Preparation and adoption of strategic documents - a traffic safety system development policy and strategy is a great way to demonstrate traffic safety management. The most important common denominator for all successful traffic safety practices is science-based strategic traffic safety management, which has clear, honest and publicly expressed political support. The paper presents the analysis of the third pillar „safer vehicles“ and its influence on the approach of the safe system from different aspects.

We reviewed the current state of knowledge regarding visual function and its suitability as part of medical examinations for driving licenses. We focused only on Group 1 drivers. According to previous studies, visual acuity, which is the most common test, is weakly associated with a higher risk of road accidents, with a greater role of visual field. The inclusion of the visual field test in medical examinations is therefore important, but the actual limit value is still unclear and further research in specific situations is needed. Color vision impairment was not found a threat to traffic safety. Contrast sensitivity decreases with age and is affected by abnormal eye conditions. Resulting glare can lead to an increased risk of traffic accidents during night driving in the elderly and others with conditions that impair contrast sensitivity. However, the universal cut-off limits have not been established either. The current European Union (EU) regulations therefore reflect minimum common denominator across the member states which may not entirely translate to optimal driving safety. Due to these open questions, standardized testing in simulators or on polygons that simulate real life conditions would be needed to better determine safe limits of visual function in different conditions. As there is a need to have better standardization across Europe regarding the requirements and rules regarding driving licenses in European countries, we first analyzed existing rules and compared them with each other, also in terms of deviations from the EU directive itself. We reviewed the literature in this field and prepared proposals for a more optimal regulation of the rules in the future. Particular attention is paid to the new method of examining the visual field that was created to respect the European directive. The paper can serve as a basis of information for research teams to design further protocols, as it gathers research findings to date on the importance and impact of various visual functions on driving safety, as well as a starting point for a debate on revising existing rules for obtaining and maintaining licenses, as it compares the current regulations in European countries and differences between them.

Background Shared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews the current evidence for how to present numerical probabilities within patient decision aids. Methods Following the 2013 review method, we assembled a group of 9 international experts on risk communication across Australia, Germany, the Netherlands, the United Kingdom, and the United States. We expanded the topics covered in the first review to reflect emerging areas of research. Groups of 2 to 3 authors reviewed the relevant literature based on their expertise and wrote each section before review by the full authorship team. Results Of 10 topics identified, we present 5 fundamental issues in this article. Although some topics resulted in clear guidance (presenting the chance an event will occur, addressing numerical skills), other topics (context/evaluative labels, conveying uncertainty, risk over time) continue to have evolving knowledge bases. We recommend presenting numbers over a set time period with a clear denominator, using consistent formats between outcomes and interventions to enable unbiased comparisons, and interpreting the numbers for the reader to meet the needs of varying numeracy. Discussion Understanding how different numerical formats can bias risk perception will help decision aid developers communicate risks in a balanced, comprehensible manner and avoid accidental “nudging” toward a particular option. Decisions between probability formats need to consider the available evidence and user skills. The review may be useful for other areas of science communication in which unbiased presentation of probabilities is important.

Resumo. A nomeação da riqueza hídrica do município de Sinop (MT) justifica o interesse desta pesquisa. Com base nas cartas topográficas atuais e com apoio teórico da Toponímia e da Linguística Cognitiva, buscou-se apreender o processo de interação social e valores culturais marcados neste ato denominativo. Não há atenção à dimensão humana de conceptualização, sem preocupação com o processo de cognição, formação do conceito e nomeação; é como se o conceito existisse antes mesmo de ser designado por um termo. Os hidrônimos foram classificados física e antropologicamente visando à percepção da motivação do homem denominador, seguindo as classificações toponímicas propostas por Dick. Observou-se não ser tão numerosa a tipologia dos acidentes (córrego, ribeirão, cabeceira, rio, lagoa e cachoeira) em comparação à riqueza taxionômica dos sessenta e cinco hidrônimos. Também a significativa presença de antropônimos femininos desvela o modelo metafórico-conceptual de que a riqueza da natureza hídrica amazônica, abstrata e “mágica”, é concretizada em um domínio próximo e familiar – a sublime abundância da bondade feminina. Palavras-chave: Toponímia; hidrônimo; Sinop. Abstract. The nomination of the hydrographic richness of the municipality of Sinop (MT) justifies the interest of this research. Based on current topographic charts and with theoretical support from Toponymy and Cognitive Linguistics, we sought to understand the process of social interaction and cultural values marked in this denominational act. There is no attention to the human dimension of conceptualization, without concern for the process of cognition, concept formation and appointment; it is as if the concept existed before it was even designated by a term. The hydronyms were classified physically and anthropologically aiming at the perception of the motivation of the denominator, following the toponymic classifications proposed by Dick. It was observed that the typology of the accidents (creek, stream, headwater, river, lagoon and waterfall) was not so numerous as the taxonomic richness of the sixty-five hydrographies. Also the significant presence of female anthropomorphs reveals the metaphorical-conceptual model that the wealth of Amazonian, abstract, and "magical" water-nature is embodied in a familiar and familiar domain - the sublime abundance of feminine goodness. Keywords: Toponymy; hydronimide; Sinop.

Mortality in acute dissecting type A aortic aneurysm remains high. The existing classifications are intended to give an accurate, and, very importantly (given the acute course of the pathology), a prompt answer to the clinician’s and the cardiac surgeon’s questions: how the patients should be treated, and which of them should undergo surgical intervention, and which procedure is to be used. Aim. A review and analysis of the existing classifications of dissecting aortic aneurysms and their transformation taking into account the advances in diagnostic technologies and methods of surgical management. The first classification was proposed by DeBakey; it systematized morphological variants of the disease and explained the origin of its accompanying phenomena such as heart tamponade, acute aortic valve insufficiency, and visceral and limb ischemia, but provided no guidelines on treatment techniques. A more recent Stanford classification was based on the principle of differentiation into conservative or operative approach. Owing to the use of CT and MRI angiography, new dissection subtypes were discovered and formulated in the Svensson classification. The Penn classification recommends that the choice of management can be based on the extent of aortic dissection, the site of the primary intimal tear, and the presence of malperfusion. The latest TEM classification identifies type A and type B dissection, as well as additional non-A-non-B type, in which the descending aorta and the arch, but not the ascending aorta, are involved. The most appropriate surgical procedures for the retrograde type A aortic dissection treatment are discussed as well. Conclusions. 1. The purpose of clinical classification of acute aortic dissection is, in addition to systematizing concepts and categories, facilitating the selection of an optimal state-of-the-art treatment method. 2. Introducing such classifications as Penn or TEM will bring to a common denominator the results of surgical management of acute type A dissection by unifying the characteristics of the patients and eliminating their deliberate or accidental pre-selection, which possibly accounts for the difference in mortality rates among different surgical groups.

It used to be so simple. If you turn on your TV or radio, your choices are limited: in Australia, there is a maximum of five or six free-to-air TV channels, depending on where you're located, and with a few minor exceptions, the programming is relatively uniform; you know what to expect, and when to expect it. To a slightly lesser degree, the same goes for radio: you might have a greater choice of stations, but you'll get an even smaller slice of the theoretically possible range of programming -- from Triple J to B105, there's mainstream, easy listening, format radio fodder, targetted at slightly different audience demographics, but hardly ever anything but comfortably agreeable to them. Only late at night or in some rare timeslots especially set aside for it, you might find something unusual, something innovative, or simply something unexpected. And of course that's so. How could it possibly be any other way? Of course radio and TV stations must appeal to the most widely shared tastes, must ensure that they satisfy the largest part of their audience with any given programme on any given day -- in short, must find the lowest common denominator which unifies their audience. That the term 'low' in this description has come to be linked to a negative meaning is -- at first -- only an accident of language: after all, mathematically this denominator constitutes in many ways the most fundamental of shared values between a series of fractions, and metaphorically, too, this commonality is certainly of fundamental importance to community culture. The need for radio and TV stations to appeal to such shared values of the many is twofold: where they are commercially run operations, it is simply sound business practice to look for the largest (and hence, most lucrative) audience available. In addition to this, however, the use of a public and limited resource -- the airwaves -- for the transmission of their programmes also creates significant obligations: since the people, represented by their governmental institutions, have licenced stations to use 'their' airwaves for transmission, of course stations are also obliged to repay this entrustment by satisfying the needs and wants of the greatest number of people, and as consistently as possible. All of this is summed up neatly with the word 'bandwidth'. Referring to frequency wavebands, bandwidth is a precious commodity: there is only a limited range of frequencies which can possibly be used to transmit broadcast-quality radio and TV, and each channel requires a significant share of that range -- which is why we can only have a limited number of stations, and hence, a limited range of programming transmitted through them. Getting away from frequency bands, the term can also be applied in other areas of transmission and publication: even services like cable TV frequently have their form of bandwidth (where cable TV systems have only been designed to take a set number of channels), and even commercial print publishing can be said to have its bandwidth, as only a limited number of publishers are likely to be able to exist commercially in a given market, and only a limited number of books and magazines can be distributed and sold through the usual channels each year. There are in each of these cases, then, physical limitations of one form or another. The last few years have seen this conception of bandwidth come under increased attack, however, and all those apparently obvious assumptions about our media environment must be reconsidered as a result. Ever since the rise of photocopiers and personal printers, after all, people have been able to create small-scale print publications without the need to apply for a share of the commercial publishers' 'bandwidth' -- witness the emergence of zines and newsletters for specific interest groups. The means of creation and distribution for these publications were and are not publicly or commercially controlled in any restrictive way, and so the old arguments for a 'responsible' use of bandwidth didn't hold any more -- thus the widespread disregard in these publications for any overarching commonly held ideas which need to be addressed: as soon as someone reads them, their production is justified. Publishing on the Internet drives the nail even further -- here, the notion of bandwidth comes to an end entirely, in two distinct ways. First, in a non-physical medium, the argument of the physical scarcity of the publication medium doesn't hold anymore -- space for publication in newsgroups and on Web pages, being digital, electronic, 'virtual', is infinitely expandable, much unlike frequency bands with their highly fixed and policed upper and lower boundaries. New 'stations' being added don't interfere with existing ones here, and so there's no need to limit the amount of individual channels available on the Net; hence the multitude of newsgroups and Websites available. Again, whatever can establish an audience (even just of a few readers) is justified in its existence. Secondly, available transmission bandwidth is also highly divisible along a temporal line, due to the packet-switching technology on which the medium is based: along the connections within the network, information that is transmitted is chopped up into small packets of data which are recombined at the receiver's end; this means that individual transmissions along the same connection can coexist without interfering with one another, if at a somewhat reduced speed (as anyone navigating the Web while downloading files has no doubt experienced). Again, this is quite different from the airwaves experience, where two radio stations or TV channels can't be broadcasting on the same frequency without drowning each other out. And even the reduction of transmission speed is likely to be only a temporary phenomenon, as network hardware is constantly being upgraded to higher speeds. Internet bandwidth, then, is infinite, in both the publication and the transmission sense of the word. If it's impossible to reach the end of available bandwidth on the Net, then, this means nothing less than that the very concept of 'bandwidth' on the Net ends: that is, it ceases to have any practical relevance -- as Costigan notes, reflecting on an all too familiar metaphor, "the Internet is in many ways the Wild West, the new frontier of our times, but its limits will not be reached. ... The Internet does not have an edge to push past, no wall or ocean to contain it. Its size and shape change constantly, and additions and subtractions do not inherently make something new or different" (xiii). But that this is so, that we have come to this end of 'bandwidth' by never being able to come to an end of bandwidth on the Net, is in itself something fundamentally new and different in media history -- and also something difficult to come to terms with. All those of courses, all those apparently obvious and natural practices of the mainstream media have left us ill prepared for a medium where they are anything but natural, and even counterproductive. Old habits are hard to break, as many of the apparently well-founded criticisms of the Internet show. Let's take Stephen Talbott as an example here: in one of my favourite passages of overzealous Net criticism, he writes of The paradox of intelligence and pathology. The Net: an instrument of rationalisation erected upon an inconceivably complex foundation of computerised logic -- an inexhaustible fount of lucid 'emergent order.' Or, the Net: madhouse, bizarre Underground, scene of flame wars and psychopathological acting out, universal red-light district. ... The Net: a nearly infinite repository of human experience converted into objective data and information -- a universal database supporting all future advances in knowledge and economic productivity. Or, the Net: perfected gossip mill; means for spreading rumours with lightning rapidity; ... ocean of dubious information. (348-9) Ignoring here the fundamental problem of Talbott's implicit claim that there are objective parameters according to which he can reliably judge whether or not any piece of online content is 'objective data' or 'dubious information' (and: for whom?), and thus his unnecessary construction of a paradox, a binary (no pun intended) division into 'good' and 'bad' uses, a second and immediately related problem is that Talbott seems to claim that the two sides of this 'paradox' are somehow able to interfere with each other, to the point of invalidating one another. This can easily be seen as a result of continuing to think in terms of bandwidth in the broadcast sense: there, the limited number of channels, and the limited amount of transmission space and time for each channel, have indeed meant that stations must carefully choose what material to broadcast, and that the results are frequently of a mainstream, middle-of-the-road, non-challenging nature. On the Net, this doesn't hold, however: here, the medium can be used for everything from the Human Genome Project to peddling sleeze and pirated 'warez', without the two ends of this continuum of uses ever affecting one another. That's not to say that what goes on in some parts of the Net isn't unsavoury, offensive, illegal, or even severely in violation of basic human rights; and where this is so, the appropriate measures, already provided by legal systems around the world, should be taken to get rid of the worst offenders -- notably, though, this won't be possible through cutting off their access to bandwidth: where bandwidth is unlimited and freely available to anyone, this cannot possibly work. Critical approaches like Talbott's, founded as they are on an outdated understanding of media processes and the false assumption of a homogeneous culture, won't help us in this, therefore: rather, faced with the limitless nature of online bandwidth, we must learn to understand the infinite, and live with it. The question isn't how many 'negative' uses of the Net we can point to -- there will always be an abundance of them. The question is what anyone of us, whoever 'we' are, can do to use the Net positively and productively -- whatever we as individuals might consider those positive and productive uses to be. References Costigan, James T. "Introduction: Forests, Trees, and Internet Research." Doing Internet Research: Critical Issues and Methods for Examining the Net. Ed. Steve Jones. Thousand Oaks, Calif.: Sage, 1999. Talbott, Stephen L. The Future Does Not Compute: Transcending the Machines in Our Midst. Sebastopol, Calif.: O'Reilly & Associates, 1995. Citation reference for this article MLA style: Axel Bruns. "The End of 'Bandwidth': Why We Must Learn to Understand the Infinite." M/C: A Journal of Media and Culture 2.8 (1999). [your date of access] <http://www.uq.edu.au/mc/9912/bandwidth.php>. Chicago style: Axel Bruns, "The End of 'Bandwidth': Why We Must Learn to Understand the Infinite," M/C: A Journal of Media and Culture 2, no. 8 (1999), <http://www.uq.edu.au/mc/9912/bandwidth.php> ([your date of access]). APA style: Axel Bruns. (1999) The end of 'bandwidth': why we must learn to understand the infinite. M/C: A Journal of Media and Culture 2(8). <http://www.uq.edu.au/mc/9912/bandwidth.php> ([your date of access]).