Are they a fully blown hurricane of a mere zephyr?
I decide to remain, metaphorically speaking, in the Middle East for this article because although interesting events are unfolding in Europe, it's still too soon to make any assumptions about what may or may not arise phoenix-like from the ashes. Make no mistake though, the European project is in tatters. It will survive in some shape or form, of that I am certain, but for the moment, as they used to say on a childrens TV program, 'anything can happen in the next half hour'.
Most of the news concerning the Middle East tends to be reported from a 'Western-centric' perspective, so I thought that it might be instructive to take a slightly sideways look at what's happening in the region, seen from a variety of Middle-Eastern sources. Dominating the Western media is of course the upcoming presidential elections in Egypt, so why don't we start there?
One aspect that has received some comment in the Western media is the fact the Islamist candidates are suffering a backlash at the moment. Ostensibly this has been caused by a demonstration organised by the Salafists, ultraconservative Islamists, outside the Egyptian Ministry of Defence building in Cairo, which resulted in the death of one soldier and injuries to others. Footage of gunmen seemingly firing from the minaret of a mosque at the soldiers was broadcast on Egyptian television and has received much negative comment. Predictably the Supreme Council of the Armed Forces, in effect the current Egyptian Government, has been using this footage to tap into the average Egyptians respect for the army and promptly and loudly blamed the Muslim Brotherhood for the violence. In point of fact they weren't involved in that particular demonstration and reportedly disbanded one that they had organised. However several Egyptian commentators have expressed the view that the Egyptian electorate doesn't distinguish between Islamic organisations. That might be so and as we all know the outcome of revolutions can turn on a single event, but I suspect there is more to this than is immediately apparent. Perhaps what we are seeing is the Egyptian electorate realising exactly who, or what, they did elect to parliament and are having second thoughts about the desirability of Sharia law and all its implications.
Related to this is a decision by Egypts highest administrative court which ruled that the presidential elections must proceed as scheduled on may 23rd. Additionally they upheld the right of the Election Commission to challenge a law barring some former members of the Mubarak administration from standing for president. The same Election Commission had previously barred the Muslim brotherhood's preferred presidential candidate from standing in the up coming election, which sparked off the protests outside the Ministry of Defence buildings. The Military Government of course appointed the Election Commision, so predictably and possibly quite accurately the Islamist parties who form the largest group in the recently elected parliament have accused the Military of trying to retain power. Also predictably, Israeli commentators in particular and Western commentators in general are focussing on the fact that the Islamists will control the parliament no matter which candidate wins the presidential election, but in the rush to be concerned they have missed a few interesting 'straws in the wind'.
The first straw that blew passed my window had one Mahmoud Zahar clinging to it. Zahar, described by various sources as a 'top Hamas official in Gaza', has just taken an interesting step that possibly has wider-reaching implications. He's claimed Egyptian citizenship under a law allowing the children of Egyptian mothers to obtain an Egyptian passport. This law has been either in existence for some time but the Mubarak regime wouldn't allow such claims or it's been passed since the fall of the former regime, the background is a little unclear. Zahar has proudly announced his intention to vote for an Islamist presidential candidate who he feels will be more pro-Palestinian than the Mubarak Government was. Well that's fine, he's entitled to vote now that he is an Egyptian citizen, and he's not alone. Several hundreds of Palestinians with Egyptian mothers have also been granted citizenship and reportedly there are thousands of Egyptian families with Palestinian children. This does mean of course that they are no longer refugees and they have a country of residence. Nobody is making much of this at the moment, but sooner or later somebody will ask an embarrassing question about UN funding for the now former refugees. That might lead to a look at the number of Palestinians on the West Bank who hold Jordanian passports. Previously, these individuals could claim that Jordanian law discriminated against them in the matter of land and property ownership in Jordan, but following recent legislation in that country this is no longer the case. So in effect, they are no longer refugees either. Anybody say anything about unforseen consequences? Remember you read it here first folks.
The second straw had a report from that stronghold of liberal thought and progressive social policies Saudi Arabia, tied to it. King Abdullah has just fired Sheikh Abdelmohsen al-Obeikan. Who? Formerly an advisor to the Royal Court and now spending more time with his family, al-Obeikan was very definitely not of a progessive bent and opposed amongst other things the relaxation of gender segregation. I take that to mean that he wasn't keen on the idea of men and women meeting socially or at work, God forbid that they should actually talk to each other, the women might actually express an opinion or two. According to the former advisor, not actually quoted in the Saudi press but he was elsewhere, there were moves afoot by "influential people to corrupt Muslim society by trying to change the natural status of women". As one of those 'influential people' just happened to be his former boss King Abdullah, there was no way that opposition to this radical, shameful idea was a good career move. So this 'corruption of Muslim society' is just a blatant attempt by the Saudi monarchy to prevent another outbreak of the 'Arab Spring' and hang on to absolute power then? Just possibly not, but you'll have to follow me whilst I join up the dots. In the meantime, just to prove that al-Obeikan himself is a bit of a closet reformer, this was his vision of how to go about relaxing gender-segregation. Several years ago he issued a decree suggesting that unrelated Saudi men and women could mix so long as the man drank the woman's breast milk, thus creating a maternal bond between them. He didn't specify as to whether this should be done before they met and did not propose a method of drinking of the breast milk. And that some people think that men and women shouldn't shake hands!
King Abdullah is not your average repressive absolute monarch, he has some strange ideas. He thinks that eventually women should be allowed to vote in elections, whatever they are, has opened a co-educational university in Saudi Arabia and has introduced measures against domestic violence, presumably this refers to violence against women and not other domestic animals. Additionally, last January he replaced the head of the Mutawa, the religious police, with somebody regarded as being more liberally-minded. More liberally-minded probably being a comparison and not a comment on the present-incumbents actual views. At this rate, they'll be allowing Princess Basma Bint Saud back home. Who? A journalist now living in London, she is the youngest daughter of the late King Saud. Taken by her Syrian mother to live in Beirut, when the civil war broke out in 1975 they went to London. Obviously a close-knit family then. She had attended a Christian missionary school whilst in Beirut (which might explain going to London not Riyad) and after finishing her education off in Switzerland at some point returned to Saudi Arabia and married. Despite her early education by French Missionary nuns, she is a committed Muslim. After her divorce and subsequently starting a chain of restaurants in Saudi Arabia, she moved back to London with three of her children. Unusual for a divorced Saudi woman to have custody of her children, nethertheless she managed it. She gave several interviews and wrote articles about the status of women in Saudi Arabia whilst in Saudi Arabia, particularly in favour of the reform reform of divorce laws, and her writing was censured. She says this had nothing to do with the decision to return to London, where she has also commented publicly on Sharia law, the role of women in Saudi society and perhaps tellingly the relaxation of the rules governing the segragation of men and women. She is careful to not blame the Saudi royal family for any repression; rather she blames 'govenors and middle managers.' Such as al-Obeikan perhaps. All in all, her comments are thoughtful and dare one say respectful but critical of certain aspects of the current Saudi interpretation of Islam. If she were to ask my advice I'd say buy a smart new set of luggage but don't buy the airline ticket home just yet.
So what's going on? Obviously there's an attempt to loosen the reins, but I feel there is more to it than that. Most people know, even if it's not a topic of daily conversation, that the brand of Islam in Saudi Arabia is Wahhabism. This is a very strict branch of Sunni Islam, and doesn't have many other adherents in the Arabian peninsular. Now it starts to get interesting. The current king, Abdullah, received a traditional religious education but is not known to share the puritanical view of Islam espoused by the religious authorities in Saudi Arabia. He does however have an empathy with the traditional Saudi way of life, and in that context is cautiously embarking on reform, believing that it will prevent internal strife. Another straw in the wind, the ruling Al Saud family, rulers of the area known as the Hejaz, were exiled to Kuwait in 1891 following a power struggle, before returning in 1902 and over a period of time seizing and consolidating power in what would become Saudi Arabia, with the help of the Ikwahan or brotherhood, a sect based on Wahhabism. The sect and the Al Sauds fell out in 1912 and what is happening now is possibly Abdullah finally starting to cut the remaining ties.
All very interesting, but where is this taking us? How about the tribal ties between the Gulf States (excluding Oman) and Saudi Arabia? The inhabitants of the remaining Gulf States, Kuwait, UAE, Qatar and Bahrain share a tribal heritage. Most of the populations originate from either what is now Saudi Arabia or Yemen and as we know, tribal alliegences are still strong in the Arab world. So what? Well you might have heard of the Cooperation Council Gulf for the Arab States of the Gulf (CCASG). Maybe you weren't sure exactly what it was called, but now you know. This organisation has been in existence since 1981.
Passing similar legislation in various fields such as economy, finance, trade, customs, tourism, legislation, and administration.
Encouraging scientific and technical progress in industry, mining, agriculture, water and animal resources.
Creating a unified military presence (Peninsula Shield Force).
Strengthening ties between their peoples.
The latter objective has fallen by the wayside. Oman pulled out in 2006 and the UAE was miffed when it was proposed that the central bank be located in Saudi Arabia.
The Gulf region had a rapidly growing economy and most of the Gulf countries had an eye to establishing sufficient currency reserves to cushion falling revenues as the oil begins to run out. Unfortunately, when confronted with an economic downturn, most of the countries resorted to what amounted to bribing their citizens to maintain internal stability. A fine example of this occurred in Saudi Arabia itself when the local stock market took a dive, along with every other stock market worldwide. A member of the Royal Family stepped up to the plate and injected several hundred million US dollars into the market by purchasing tanking stock. Predictably the price of the stock rose and everybody's portfolio recovered in value. Saudis thought their Royal family was wonderful. For now. This is not a workable long-term economic strategy. Most of the Gulf States import cheap labour. This means that citizens either do nothing or occupy senior management positions whilst still enjoying State handouts, based on the oil revenues. Saudi Arabia must have the highest number of Phds in Islamic studies per head of population in the entire world, perhaps good for the spiritual side of life but when you need doctors, engineers and scientists it's a drag on the economy rather than a stimulant.
Faced with a variety of external and internal problems, the CCASG countries announced in March 2012 that the organisation would be evolving from a regional bloc to a confederation. Now the word confederation has two meanings, but in 21st century political terms it has come to mean a permanent union of several political entities to deal with other political entities. This will eventually lead to a central government, but in the early stages of development will mean joint economic and military endeavours. So purely hypothetically, let's say that the Gulf States were becoming concerned about, oh I don't know, Iran, just mentioning a country off the top of my head for no particular reason. Let's just say that they, the Arab Gulf countries, decided to form a regional power block of Arab Monarchys, some more liberal and quasi-democratic than others, but all enjoying greater or lesser tribal links and similar cultures and the same language. And lets suppose that this regional bloc had had to intervene militarily in a member state, which for the purposes of this article we'll refer to as Bahrain, to preserve internal order. Or supress a revolt by the oppressed Shia majority, depending on your point of view. Let's further suppose that the largest of these countries, having control over the holy city of Mecca, regarded itself as the de facto leader of the Islamic World. If you were the absolute monarch of such a country, the strongest military and economic entity in the evolving confederation, wouldn't you sit in your desert palace and dream dreams of empire, or in modern 21st century terms, being the strong central government of a confederation? And of course, as an absolute monarch, you might feel moved to make your country more attractive to the citizens of the other confederation members by liberalising certain aspects of day to day life. You might even reflect on the fact that Switzerland is officially a confederation. Hmm, SaudGulfAbia? Switzerland sans cookoo clocks, chocolate and Alpenhorns. Dubai has a ski resort though.


text:
module Fog
  module CDN
    class AWS
      class Real

        require 'fog/aws/parsers/cdn/get_distribution_list'

        # List information about distributions in CloudFront.
        #
        # @param options [Hash] Config arguments for list.
         # @option options Marker [String] Limits object keys to only those that appear lexicographically after its value.
        # @option options MaxItems [Integer] Limits number of object keys returned.
        #
        # @return [Excon::Response]
        #   * body [Hash]:
        #     * IsTruncated [Boolean] - Whether or not the listing is truncated.
        #     * Marker [String] Marker specified for query.
        #     * MaxItems [Integer] - Maximum number of keys specified for query.
        #     * NextMarker [String] - Marker to specify for next page (id of last result of current page).
        #     * DistributionSummary [Array]:
        #       * S3Origin [Hash]:
        #         * DNSName [String] - Origin to associate with distribution, ie 'mybucket.s3.amazonaws.com'.
        #         * OriginAccessIdentity [String] - Optional: Used when serving private content.
        #       or
        #       * CustomOrigin [Hash]:
        #         * DNSName [String] - Origin to associate with distribution, ie 'www.example.com'.
        #         * HTTPPort [Integer] - HTTP port of origin, in [80, 443] or (1024...65535).
        #         * HTTPSPort [Integer] - HTTPS port of origin, in [80, 443] or (1024...65535).
        #       * OriginProtocolPolicy [String] - Policy on using http vs https, in ['http-only', 'match-viewer'].
        #       * Comment [String] - Comment associated with distribution.
        #       * CNAME [Array] - Array of associated cnames.
        #       * Enabled [Boolean] - Whether or not distribution is enabled.
        #       * Id [String] - Id of distribution.
        #       * LastModifiedTime [String] - Timestamp of last modification of distribution.
        #       * Origin [String] - S3 origin bucket.
        #       * Status [String] - Status of distribution.
        #       * TrustedSigners [Array] - Trusted signers.
        #
        # @see http://docs.amazonwebservices.com/AmazonCloudFront/latest/APIReference/ListDistributions.html
        #
        def get_distribution_list(options = {})
          request({
            :expects    => 200,
            :idempotent => true,
            :method   => 'GET',
            :parser   => Fog::Parsers::CDN::AWS::GetDistributionList.new,
            :path       => "/distribution",
            :query      => options
          })
        end

      end

      class Mock

        def get_distribution_list(options = {})
          response = Excon::Response.new
          response.status = 200

          distributions = self.data[:distributions].values

          response.body = {
            'Marker' => Fog::Mock.random_hex(16),
            'IsTruncated' => false,
            'MaxItems' => 100,
            'DistributionSummary' => distributions.map { |d| to_distribution_summary(d) }
          }

          response
        end

        private

        def to_distribution_summary(d)
          {
            'DomainName' => d['DomainName'],
            'Id' => d['Id'],
            'LastModifiedTime' => d['LastModifiedTime']
          }.merge(d['DistributionConfig'])
        end
      end
    end
  end
end

redpajama_set_name: RedPajamaGithub


text:
South Syria Rebels Sign Defence Treaty to Fight ISIS, Regime
Tuesday December 16th, 2014 by Zaman al-Wasl (Opposition website)
The risk of ISIS extending into Daraa has increased
A number of military formations from the southern front have signed a defense treaty in an attempt to unite in the face of looming battles.
Ibrahim al-Jebawi, the manager of the Syrian Media Organisation, the official representative of the Southern Front, told Zaman al-Wasl that the treaty was important to form united visions and goals, giving priority to the revolution and the country.
Jebawi confessed that the treaty targets the Islamic State of Iraq and Syria (ISIS) as much as the Syrian regime and others, as the risk of ISIS extending into Daraa has increased.
Military groups confirmed their determination to increase cooperation and solidarity, forming military courts and reconciliation committees.
The treaty threatened the dismissal of any military formation which rejected or failed to abide by the statement.
The signed treaty confirmed the need for enhancing the stability, security and confidence among people under the front's control, and gives them the trust of having a strong united power considered a stepping stone for a new Syrian army.

redpajama_set_name: RedPajamaCommonCrawl


text:
Remove This Item Author/s: Emanuel Berg
Remove This Item Author/s: J.F.S. Rumble
Remove This Item Author/s: Joel Johnson
Remove This Item Author/s: Maurice Ashley
Remove This Item Author/s: Paul Motwani
Lulu Press (7)
Quality Chess (3)
Gambit Publishing (1)
Attacking 101: Volume #003
The goal of the books in this series (Attacking 101: Volume #003) is to provide detailed analysis of my own attack games against lower rated players. The players are all rated in the range of 1700 to 2100. They make the same errors you regularly witness in your games but here you get to see a Chess Master dissect and exploit the moves, show why they are wrong, and how to punish the opponent's poor play.
The goal of the books in this series (Attacking 101: Volume #002) is to provide detailed analysis of my own attack games played against lower rated players.
Grandmaster Repertoire 16 - The French Defence - Vol. 3
Catalog Code: B0108QT
Grandmaster Repertoire 16 – The French Defence 3 concludes this ambitious three-volume series by offering a comprehensive repertoire against the Advance, Tarrasch, and other alternatives to 2.d4 d5 3.Nc3.
Positional Attacks
The third installment of the best-selling series of attack books - Formation Attacks, Formation Attack Strategies, and now, Positional Attacks is another 500 page book, full of great attack information with 532 fabulous attack games from all openings and all eras. The aim of Positional Attacks is to uncover the artistic side of attacking, one that is primarily centered on the creation and exploitation of weaknesses.
Grandmaster Repertoire - The French Defence - Vol. 2
The French Defence is one of the most popular and reliable responses to 1.e4. Grandmaster Repertoire 15 – The French Defence 2 covers the most critical variation of the Winawer, which occurs after the opening moves 1.e4 e6 2.d4 d5 3.Nc3 Bb4 4.e5 c5 5.a3 Bxc3† 6.bxc3 Ne7 7.Qg4. This volume presents three contrasting ways of meeting White's aggressive opening system: 7...cxd4 leading to the notorious Winawer Poisoned Pawn; 7...0–0 8.Bd3 f5, a solid yet strategically complex system; and 7...0–0 8.Bd3 Nbc6, which leads to a tense, full-blooded battle.
The French Defence is one of the most popular and reliable responses to 1.e4. Black invites his opponent to gain space in the centre, with the intention of undermining the enemy position and launching a counterattack. Although the amount of theory has expanded in recent years, the French often leads to positions where positional and strategic understanding prove more relevant than long sequences of computer-generated moves. Grandmaster Repertoire 14 - The French Defence 1 introduces the Winawer Variation after the opening moves 1.e4 e6 2.d4 d5 3.Nc3 Bb4, and provides expert recommendations against all of White's major possibilities
The Development of Chess Style
This is essentially a book on chess history, showing how different styles of chess play became popular and flourished and then faded in popularity, such as for example the Hyper-Modern Style of play that became ''All the Rage'' in the 1920s and 1930s.
The goal of the books in this series (Attacking 101: Volume #001) is to provide detailed analysis of my own attack games played against lower rated players
Formation Attack Strategies
The book also contains discussions about many attack philosophies, attack strategy and planning, identification and exploitation of weaknesses, and so much more.
The Logical Approach to Chess
This has long been one of the standard books on basic chess strategy. It takes the player from the middle game of chess and shows how to take it to a favorable conclusion.
Formation Attacks
As a Chess Master who has spent many years playing aggressive and attacking chess, I was quite dismayed during a recent visit to my local bookstore. I was in search of a book that covered an array of attacks against many Pawn formations in an organized fashion. Needless to say, my search came up empty. The books on attacking fell short in many ways. Many of the books were simply a small collection of attack games with no instruction about the art of attacking or about the skills required to become a great attacker.
The Most Valuable Skills in Chess
From the Basic Moves to Winning Your First Game - And Beyond
Catalog Code: B0138GB
This book makes his ideas and material available to all: teachers and students alike. He has been called the Tiger Woods of chess. In 1999, Maurice Ashley became the first African-American to qualify for the elite Grandmaster title, an achievement that was widely reported in the international media, including Time magazine, USA Today, New York Times, Sports Illustrated and The Times (London).
CLEARANCE - C.O.O.L. Chess
The sequel to H.O.T. Chess. Grandmaster Motwani continues to explain his easy-to-use approach to chess thinking, and shows how Creative Original Opening Lines can bring astonishing over-the-board success. The many brilliant games in this book includes victories by Motwani over some of the world's leading players, whom he has outwitted in the early stages of the game.


text:
Photo: RPBW, Sergio Grazia
De lege artis: Renzo Piano Building Workshop designs Tribunal de Paris
With their new Tribunal de Paris, Renzo Piano Building Workshop have designed a monumental structure which serves as an extension to the historical courthouse on the Île de la Cité. With its striking design, the green skyscraper in a prominent place near the Porte de Clichy fits into its built environment.
Client: Etablissement Public du Palais de Justice de Paris + Bouygues Bâtiment
Architect: Renzo Piano Building Workshop
Location: 29-45 Avenue de la Porte de Clichy, 75017 Paris (FR)
Text: Edina Obermoser
In contrast to the French government's preliminary ideas to split the new structure into two functionally separated buildings, the architects decided in favour of one monumental edifice. With a height of about 160 m, the new courthouse is one more in a series of remarkable buildings in the French capital. Distributed over 40 storeys, courtrooms and offices are accommodated in around 100,000 square metres.
The courthouse building is located at the edge of the centre of Paris. It is bordered to the north by the Périphérique and to the east by the Parc Martin Luther King. It comprises four volumes. The lowest level forms a plinth; three more parts are stacked atop it to create a tapering tower. While the plinth's L-shaped floor plan echoes the shape of the lot, the size of the upper storeys decreases as the height of the building increases. This produces a tiered effect. Despite its enormous proportions, the skyscraper looks light and airy. This impression is accentuated by an intelligent, double-glazed façade which gives the building a uniform shell that is interrupted only along its longitudinal sides by external panorama elevators. These seem to hold the building together, rather like a spine.
The architects conceptualized the courthouse as a green building. There are large rooftop terraces on top of the stacked-up bodies. Trees and plants provide leisure areas and give the impression that the adjacent park extends over the new structure. Photovoltaic panels, natural ventilation and rainwater use round out the sustainable concept.
Facing the park to the east, a triangular forecourt stretches out in front of the palace of justice, inviting visitors to come in. Positioned centrally to the east façade, this courtyard also leads to the main entrance, which in turn leads into the spacious lobby. In some areas, this lobby takes up the entire height of the plinth, measuring up to 28 m, and is zoned by delicate steel supports. Along with two small adjoining atriums, it coordinates circulation through the building and brings everything together as one functional unit. The access paths are organized around this central area in the form of escalators, stairways and open galleries. Round skylights lie like a skin on the roof and are an eye-catcher in themselves. Daylight streams in through these skylights and the generous glazing of the façade.
Programmatically, the plinth houses the 90-odd courtrooms as well as rooms for meetings and discussions. The tower accommodates offices and smaller units. The design of the interior spaces laid great value on wood, particularly in the courtrooms. They are clad in parquet flooring and beech panelling; along with white accents, they give the courtrooms and the sleek interior a warm character.
Photo: Guignard / air-images.net
Photo: RPBW, Francesca Avanzinelli
Photo: Laurent Zylberman
Photo: RPBW, Maxime Laurent
Photo: Michel Denancé
Photo: RPBW, Stefano Marrano
Ground plot stand, Graphic: RPBW
Cross section, Grafik: RPBW
Paris France courthouse extension sustainable sustainability
At the Foot of the Cliffs: Fishery Plant in Bonifacio
A hard shell and a wooden core: apartment house in Alfortville
Emerging: Rooftop Addition by 2b architectes
Floating Elegance: Arena du Pays d'Aix
Equal Opportunity for All: Education Centre in Sri Lanka
Innovative Wood Hybrid: Award-Winning H7 by Andreas Heupel Architekten


The Affordable Care Act (ACA) added 20 million people to the ranks of the insured, comprising our country's largest coverage expansion since the creation of Medicare and Medicaid more than 50 years ago. But millions still remain without coverage, giving states an opportunity to build on the ACA's progress by pioneering innovative strategies to cover the remaining uninsured, often while stabilizing insurance markets and lowering premiums. In this report, we describe seven state options to achieve these goals, typically building on efforts already under way in vanguard states. We hope this analysis will inform the development of state policy agendas that can move forward in 2019, achieving important gains for consumers while laying the groundwork for bolder national coverage expansions in the future.


This is pretty impressive. What could have been a disaster turned into an epic save. Moto3 racer Jakub Kornfeil managed to launch his bike into an air jump after using the crashed bike in front of him as a ramp. That's awesome.


text:
Q: Find a Global Atom from a partial string I can create an Global Atom using GlobalAddAtom and I can find that atom again using GlobalFindAtom if I already know the string associated with the atom. But is there a way to find all atoms whose associated string matches a given partial string?
For example, let's say I have an atom whose string is "Hello, World!" How can I later find that atom by searching for just "Hello"?

A: Unfortunately, the behavior you're describing is not possible for Atom Tables. This is because Atom Tables in Windows are basically Hash Tables, and the mapping process handles strings in entirety and not by parts.
Of course, it almost sounds like it would be possible, as quoted from the MSDN documentation:
Applications can also use local atom tables to save time when searching for a particular string. To perform a search, an application need only place the search string in the atom table and compare the resulting atom with the atoms in the relevant structures. Comparing atoms is typically faster than comparing strings.
However, they are referring to exact matches. This limitation probably seems dated compared to what is possible with resources currently available to software. However, Atoms have been available as far back as Win16 and in those times, this facility allowed a means for applications to manage string data effectively in minimal memory. Atoms are still used now to manage window class names, and still provide decent benefits in reducing the footprint of multiple stored copies of strings.
If you need to store string data efficiently and to be able to scan by partial starting matches, a Suffix Tree is likely to meet or exceed your needs.

A: It actually can be done, but only through scanning them all. In LINQPad 5 this can be done in 0.025 seconds on my machine, so it is quite fast. Here is an example implementation:
void Main()
{
  const string atomPrefix = "Hello";
  const int bufferSize = 1024;
  ushort smallestAtomIndex = 0XC000;
  var buffer = new StringBuilder(bufferSize);
  var results = new List<string>();
  for (ushort atomIndex = smallestAtomIndex; atomIndex < ushort.MaxValue; atomIndex++)
  {
    var resultLength = GlobalGetAtomName(atomIndex, buffer, bufferSize);
    if (buffer.ToString().StartsWith(atomPrefix))
    {
      results.Add($"{buffer} - {atomIndex}");
    }
    buffer.Clear();
  }

  results.Dump();
}

[DllImport("kernel32.dll", CharSet = CharSet.Auto, SetLastError = true)]
public static extern uint GlobalGetAtomName(ushort atom, StringBuilder buffer, int size);

redpajama_set_name: RedPajamaStackExchange


BHI reprint, with an introduction by Jonathan Betts.
Celluloid dust jacket, marbled boards with gilt tooled leather spine (the deluxe binding), Introduction, Harrison 31 pages, 10 plates, Arnold & Earnshaw 67 pages, 3 plates. Originals 1768 and 1806, BHI reprint, 1984.
Facsimile of Papers published by order of the Commissioners of Longitude. Essential reading for anyone with an interest in the topic, made that much better having the introduction by Jonathan Betts.
A fine example of the leather bound reprint that has long been out of print.


Chronic fatigue syndrome or CFS is the name given to a debilitating disorder characterized by conditions of extreme and lasting fatigue. Chronic fatigue syndrome is also commonly referred to as myalgic encephalomyelitis or ME. The name chronic fatigue can be somewhat confusing since chronic or persistent fatigue is also a symptom of several conditions such as rheumatoid arthritis and lupus. Fatigue is the feeling of exhaustion that results from exertion, lack of sleep and illnesses. However, ordinary fatigue is not extreme or persistent, and the patient generally gets better after getting some rest.
Chronic fatigue happens when this sensation of extreme exhaustion and lack of energy persists for over six months. The exact cause of chronic fatigue is not known but it is believed that several factors play a role in its symptoms, such as stress, hormone levels and infection. Lack of sleep, insomnia and other sleep disturbances can also result to chronic fatigue. Other factors that contribute to the development of chronic fatigue are poor diet, lack of exercise and certain medications.
Diagnosing chronic fatigue syndrome can be quite tricky since there are no physical signs that identify it. There are also no diagnostic laboratory tests that confirm chronic fatigue syndrome. A diagnosis of CFS is given if the symptoms recur for six consecutive months or more and there are no apparent explanations for the fatigue such as disease. However, it should be noted that there are other conditions that overlap and sometimes coexist with CFS and have similar symptoms.
A study of patients suffering from CFS revealed that only 38% of the patients were diagnosed solely with the syndrome. The rest had a diagnosis of a number of diseases such as fibromyalgia and multiple chemical sensitivity or both. Doctors are still unsure whether these conditions are direct causes or have common causes with CFS; or whether that have no relationship whatsoever with chronic fatigue syndrome.
There is still no known cure for CFS so treatments are aimed at relieving the symptoms and improving the body's functions. To achieve this, doctors usually recommend a combination of medications and non-drug therapies. Lifestyle changes, dietary restrictions, nutritional supplements are also recommended as an addition to drug therapy. Patients who suffer from CFS are also urged to have regular exercise to help reduce the symptoms of chronic fatigue.
It is important that the patient discuss his/her symptoms with the doctor. It is also important that doctors know what other medications the patient is taking since some medications can exaggerate the symptoms of CFS. Recovery rates from chronic fatigue syndrome are varied.
Have You Tried Escada? Do You Have Chronic Fatigue Syndrome?


text:
postmedieval FORUM
A space for discussion and debate about all things post/medieval
FORUM I: Historicity without Historicism? Responses to Paul Strohm
FORUM II: The State(s) of Review
FORUM III: DISSENT
FORUM IV: PEDAGOGY
FORUM V: PUBLIC MIDDLE AGES
In the Shape of a Crowd /Jen Boyle
In the Shape of a Crowd
Jen Boyle, Department of English, Coastal Carolina University, Conway, SC
1. As co-editor of the postmedieval "Becoming Media" issue (3.1, 2012) I have spent considerable time over the last year thinking about "open" scholarly peer review. Alongside my colleague, Martin Foys, I have also spent more than a few rewarding but frustrating hours working with an alternative peer review system. Real labor was shared with the willful network objects and actors of the review system itself: interfaces, discrete disciplinary networks, typeface fonts, blog personas, comment plug-ins, missing paragraph numbers, the ethos of vetting, and WordPress (.com, .org), were all determinative, and sometimes resistant, actants in the system that was (and is) the crowd review experiment. It is this network of actants that I want to touch on in relation to recent discussions of peer review in the humanities. Before doing so, I offer some background on the concept of the "crowd."
2. Eileen Joy, co-editor of postmedieval, was the first to suggest that the process we were envisioning for "Becoming Media" would be better described as a crowd review than as an open review. We had already selected the essays that would be included in the issue, and thus, the entirety of the editorial process was not completely open. Crowd aptly described the processes and configuration of our review: as editors we gathered together to make decisions about what to include in the issue; networks of scholars and graduate students, accessed through conversation, personal requests, and social media, then "gathered" to offer feedback on the essays, along the way digitally mingling with one another; and finally, the entire text of those exchanges was archived as a component of the journal issue, as a kind of living imprint of the event as a collection of texts and as a lingering conversation. In a further sense, however, the crowd concept indelibly outlines the often hidden or erased messiness to peer review in any shape or form.
3. As Kathleen Fitzpatrick and Bonnie Wheeler beautifully elucidate, the premise of traditional "closed" (or, more problematically, "blind") review is that of filtering and purification (Fitzpatrick, 2010; Wheeler, 2011). Fitzpatrick's project expands on the contradictory tenor of filtering: a device for both vetting/improvement and censorship. The concept of purification is an even more interesting register. Fitzpatrick draws on the relevance of Bill Readings's model of the university to the system of peer review. Readings argues that we have been lulled into complicity with the corporate, University of Excellence — an empty designation that implies a quantitative measure of achievement in the most obscure terms possible. Fitzpatrick extends this notion of empty consensus to the current model of closed peer review, and she points to how this system relies on a "forced agreement" about the purity of the process: clear and exhaustive standards; a common and translatable language among readers, reviewers and authors. Wheeler highlights how this process is perceived often as not preserving excellence so much as inhibiting the emergence of "new work." (Wheeler, 2011, 313). Both Wheeler and Fitzpatrick speculate profoundly on how we might reform the culture of excellence and purification that informs traditional peer review (moving away from individual reputation and toward "community" and distributed reward and responsibility). The value of such a transition, however, is still highly contested.
4. One of the concerns about open review is that it is not, in the end, really open. Some of the most insightful critiques illuminate a seeming disconnect between the rhetorical frameworks surrounding digital review and exchange and the actualities of its manifestations. Sharon O'Dair identifies many of the most worrying, fast-approaching "catalysts" of "internet-based cultural democracy" (O'Dair, 2011). Argued for as "open," "democratic," and "non-hierarchical," she points to how these gestures often obscure the realities of online commentary writ large: a few, often uniformed interlocutors offering up highly reductive surface engagements. Most significant from my perspective is the further implicit disclosure of how these systems feed back into a creeping, all-encompassing neo-liberal control of discourse and the production of knowledge.1
5. I am not convinced, however, that the salve for as much can be found in the status quo of academic professionalism (in the guise of traditional peer review or otherwise). And here again, the "crowd" takes on an important role. Many of the arguments made in favor of traditional peer review deploy the ideals associated with individuated professional expertise. Such expertise is defended as rigorous, objective, and most saliently, as a discrete embodiment of evaluative "standards." Further assertions along these lines associate this class of professional judgment with an ethos resistant to a consumerist model of education and neoliberalism. Amid a reductive gesture not unlike the sweeping claims for online democracy, the crowd is shaped as an indistinct contaminant to this sphere of skilled and professional evaluation. In many senses, this argument relies on an image of the individual scholar protected from the contaminating influences of the tyranny of the uniformed: the crowd, the mob, the naïve and many.
6. Ironically, it is an early media theorist, Marshall Mcluhan, who offers a very different tracing of this trajectory from the naïve crowd to the expert professional (Mcluhan, 1964). As Mcluhan argues, there is a highly anxious but symbiotic relationship between crowd psychology and the aggrandizement of "ratio": numbers, digits, and rational measure. The appeal to the singularity of quantification is born out of an anxiety that is a piece with the crowd, the horde, or the heap. Ratios and numbers, whether conceived behind the abstractions of "standards" or "excellence," are not a classificatory system separate from the crowd but an extension of it. The "shadow of number," as Mcluhan refers to it, is not an image that guides one above Plato's cave, but a phantasmagoria that proffers the illusion that numbers and digits are natural extensions of the mind/body of the authoritative ("non-tribal") individual. As Mcluhan shows, the Greek notion of "common sense" initiates this sleight-of-hand between figures of the crowd and the sensorium of the private body as a rational calculus (the one; the individual).
7. We can extend Mcluhan's observations via Bruno Latour to describe how "modern" systems like academic review require that this ratio of excellence eradicate attention to the specifics of "translation networks." (Latour, 1993). Translation networks refer to the effects and distributed causation of a multiplicity of actors in any given system – human and non-human. There is an unstated assumption that the main authority in peer evaluation is the judgment of an authoritative expert. Yet, the reality of the peer review process is closer to Latour's concept of a "parliament of things": an equal constitution between humans, objects and networks. This is true of both traditional and alternative models of review: the design of a commenting interface or the tardiness of a correspondence between reviewer and reviewed have as much impact as an evaluating scholar on what we might regard as a "decision." The process is never pure, but within traditional review the shadow show of the "work of purification" trumps the "work of mediation" (Latour, 1993, 131-138).
8. Graham Harman offers up an image of Latour's take on democratizing that cannot simply be dismissed as "pandering to the spirit of our age": production of knowledge not as "one against the crowd, but as one in the shape of a crowd of allies" (Harman, 2009, 88). Allies in this passage does not imply consensus (with the crowd or the expert) as much as it does an attention to the shifting alliances and networks that make thought realizable. This emphasis on shape versus reduction via ratio or number I think has tremendous power for speculating about what peer review might become.
9. Shape invokes a model that is as much descriptive as it is evaluative; a model that does not exclude the work of mediation. Though not designed specifically for academic production, the in-progress internet evaluation system, Hypothes.is, offers a future example of such a model: a system of platforms that make transparent how categories of evaluation ("domain experts"; "merit") form up in direct relationship to their emergent and constitutive judgments of content. This would require a limited departure from the exclusive emphasis on individual reputation and isolated evaluative judgment within thought communities (See also Martin Foys's response in this Forum on a companion image, the scholar in isolation). This model will work only if we can embody dissensus as a shape that does not necessarily have to become a discrete judgment. It also requires attention to how things help constitute thought as a category. How might we include the determinative influence of interface design, network nodes, and blog correspondence as real actants in the process and development of the meaning and value of communicated thought?
10. As Latour would argue, descriptive realism does not imply a lack of judgment, but opens up the representational field in ways that expose the myth that epistemology and political valuation can be cordoned off from one another (politics here including the polemics of professional communities as well). We now have systems available to us that make such a peer-to-peer model possible (digital networks, blogs, electronic archives). What remains to be seen is if we can find merit and value in peer review as a shape in "plain view" (Felski, 2009, 30).2
1 In particular, we can think of how far apart the claims for digital democracy are from the realities of the too often behind the scenes struggles over corporate control of databases and network protocols; proprietary software; and legal rights to everything from broadband access to academic journals.
2 For similar "descriptive turns" within academic methodology see, Love (2010) and Moretti (2005).
Felski, R. 2009. After Suspicion. Profession. 28-35.
Fitzpatrick, K. 2010. "Peer Review." Planned Obsolescence: Publishing, Technology and the Future of the Academy < http://mediacommons.futureofthebook.org/mcpress/plannedobsolescence/>.
Harman, G. 2009. On Behalf of the Mob. Prince of Networks: Bruno Latour and Metaphysics. Melbourne: re.press.
Hypothes.is < http://hypothes.is/>. Accessed 7 Dec 2011.
Latour B. 1993. We Have Never Been Modern, trans. C. Porter. Brighton: Harvester Wheatsheaf.
Love, H. 2010. Close but not Deep: Literary Ethics and the Descriptive Turn. New Literary History 41 (2): 371-91.
Mcluhan, M. 1964. Profile of the Crowd. Understanding Media: the Extensions of Man. Mcgraw Hill: New York.
Moretti, F. 2005. Graphs, Maps, Trees: Abstract Models for a Literary History. New York: Verso.
O'Dair, S. 2011. 'Pretty Much How the Internet Works', or, Aiding and Abetting the Deprofessionalization of Shakespeare Studies. In Shakespeare Survey (64), ed. P. Holland. Cambridge: Cambridge University Press.
Wheeler, B. 2011. The Ontology of the Scholarly Journal and the Place of Peer Review. Journal of Scholarly Publishing 42 (3): 307-22.
In the Shape of a Crowd by Jen Boyle is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
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Public Medievalism and the Common Life
Unsticking Time
The Disorientation of Writing as a Public Medievalist
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Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial
Extended report
H A Capell1,
R Madhok1,
J A Hunter3,
D Porter3,
E Morrison4,
J Larkin5,
E A Thomson3,
R Hampson1,
F W Poon2,
on behalf of the WOSERACT Group*
1Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow, UK
2Department of Radiology, Glasgow Royal Infirmary
3Rheumatology Department, Gartnavel General Hospital, Glasgow
4Rheumatology Department, Southern General Hospital, Glasgow
5Rheumatology Department, Victoria Infirmary, Glasgow
Dr H A Capell
Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow University NHS Trust, Castle St, Glasgow G40SF, UK; Hilary.Capellnorthglasgow.scot.nhs.uk
Background: Evidence for disease modifying activity of low dose corticosteroid treatment in rheumatoid arthritis is contradictory. Studies showing radiological benefit suggest that continued treatment is required to sustain the effect.
Objective: To evaluate the effect of low dose oral prednisolone in early rheumatoid arthritis on disease activity over two years.
Design: Double blind placebo controlled trial.
Methods: Patients with rheumatoid arthritis, duration <3 years (n = 167), were started on a disease modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by stratified randomisation to prednisolone 7 mg/day or placebo. Primary outcome measure was radiological damage, assessed by the modified Sharp method. Clinical benefit was a secondary outcome. A proactive approach to identifying and treating corticosteroid adverse events was adopted. Patients who discontinued sulphasalazine were offered an alternative DMARD.
Results: 90 of 257 patients eligible for the study refused to participate (more women than men). Of those enrolled, 84% were seropositive for rheumatoid factor, median age 56 years, median disease duration 12 months, female to male ratio 1.8:1. Prednisolone was given to 84 patients; of these 73% continued prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There were no significant differences in radiological score or clinical and laboratory measures at 0 and 2 years.
Conclusions: Low dose prednisolone conferred no radiological or clinical benefit on patients maintained on a DMARD over two years. Low dose corticosteroids have no role in the routine management of rheumatoid arthritis treated with conventional disease modifying drugs.
ACR, American College of Rheumatology
ARC, Arthritis Research Council
COBRA, combinatietherapie bij reumatoide artritis study
DMARD, disease modifying antirheumatic drug
HAQ, health assessment score
WOSERACT, West of Scotland early rheumatoid arthritis corticosteroid therapy study
http://dx.doi.org/10.1136/ard.2003.014050
Rheumatoid arthritis is a chronic inflammatory disorder primarily of synovium which results in pain, stiffness, impaired function, bone erosion at the cartilage–synovium interface, and loss of cartilage. Radiological progression of disease is best documented in x rays of the hands and feet and is manifested as loss of joint space and bone erosions in the periarticular areas. In the majority of patients erosions appear early in the disease and progress in a constant manner, in close association with the extent of the acute phase response. Current evidence advocates the early and sustained use of disease modifying anti-rheumatic drugs (DMARD),1 which not only control the inflammatory component of the disease but also reduce the rate of radiological progression.
Since their introduction in 1949,2 the role of corticosteroids in rheumatoid arthritis has been controversial. Despite early evidence that they may alter disease progress,3 steroids fell from favour in the United Kingdom. More recent studies include a retrospective analysis of patients on intramuscular gold which showed that oral corticosteroids provided no radiological benefit,4 and a study from van Gestel et al, who reported similar results in a small prospective randomised double blind controlled study using oral steroids as a bridge with intramuscular gold.5 In established rheumatoid arthritis, a marginal radiological benefit in patients receiving a mean of 4.5 mg of oral prednisolone in combination with a DMARD has been reported.6 In a randomised double blind controlled trial, the Arthritis Research Council (ARC) Low Dose Corticosteroid Group compared 7.5 mg of prednisolone with placebo and reported that radiological progression was reduced in prednisolone treated patients.7 In that study DMARD use was left to the discretion of the treating rheumatologist. The strength of the ARC study was that it was adequately powered, prospective, randomised, and double blind. However, the groups were not well matched at the outset, and DMARD use was suboptimal. On withdrawal of prednisolone, erosion and cartilage loss recurred.8
While one recent study of low dose oral corticosteroids without DMARD has shown a beneficial effect on clinical measures of disease activity and on radiological damage,9 using low dose oral corticosteroids without DMARD is not current rheumatological practice in most centres. The COBRA (Combinatietherapie Bij Reumatoide Artritis) study of high dose step down oral prednisolone with methotrexate and sulphasalazine showed radiological advantage over sulphasalazine alone but the study was not powered to detect differences in x ray change.10 In addition high dose steroids are associated with greater toxicity.
The evidence base for low dose oral corticosteroids is thus contradictory and the value of using them in early rheumatoid arthritis is debated.11,12 If the positive low dose studies can indeed be confirmed, and adverse events prevented or minimised, prednisolone offers a cheap effective treatment to prevent long term disability. The main concern is cumulative toxicity, notably accelerated bone loss, susceptibility to infection, and a tendency to premature atheromatous vascular disease. All of these are comorbidities that are a feature of rheumatoid arthritis itself.13–17
To justify exposing patients with rheumatoid arthritis to the risks of prolonged low dose oral corticosteroid treatment, it is therefore necessary to confirm radiological benefit in well matched groups in a controlled study, and demonstrate clinically significant risk–benefit advantage.
In this study we aimed to evaluate the effect of low dose oral prednisolone in addition to a DMARD (sulphasalazine) in early rheumatoid arthritis on radiological damage and clinical indices of disease activity over two years. We also documented possible corticosteroid toxicity at each visit and were proactive in the introduction of treatment to mitigate side effects.
Four hospital based rheumatology units within Glasgow and four outside the city cooperated in the West of Scotland early rheumatoid arthritis corticosteroid therapy (WOSERACT) study.
Patients with rheumatoid arthritis, as defined by the American College of Rheumatology,18 between the ages of 18 and 75 years and with symptoms for less than three years, were included in the study if they had three of the following: ⩾six painful joints; ⩾three swollen joints; ⩾20 minutes early morning stiffness; erythrocyte sedimentation rate (ESR) ⩾28 mm in the first hour; or C reactive protein ⩾10 mg/l. We excluded patients known to have peptic ulcer disease and not on gastro-protection with either an H2 antagonist, a proton pump inhibitor, or a prostaglandin analogue, or who had received DMARD treatment other than hydroxychloroquine in the previous four weeks. No patient was on hydroxychloroquine at time of initiation of the study.
Patients were started on 500 mg/day of sulphasalazine and the dose was increased weekly by 500 mg/day to a target dose of 40 mg/kg unless toxicity limited increments. Sulphasalazine was monitored as advised by the British Society of Rheumatology. NSAID treatment was at the discretion of the individual physician, as was further DMARD use if sulphasalazine failed.
Randomisation to prednisolone 7 mg daily or placebo was undertaken at the main study centre. Patients were stratified according to rheumatoid factor status, sex, age, and the presence or absence of erosions by a minimisation method.19,20 Changes in the appearance of prednisolone and placebo occurred over the six years of the study because 5 mg and 1 mg tablets had to be sourced from various different suppliers during the study. Pyridoxine was the original placebo; in 1997 following a Committee of Safety Medicines directive about long term pyridoxine use,21 ascorbic acid tablets similar in appearance and size were substituted. Patients in both groups were alerted to the change in appearance of the drug but not to treatment allocation. The patients, clinicians, and nurse specialists were made aware of the difficulties but remained unaware of the drug allocation. The study coordinator (EAT) was aware of the allocation and coordinated supplies for the centres. The integrity of the study was thus maintained as both agents changed in appearance at times during the study. After two years, gradual withdrawal of steroid/placebo was undertaken over five months (reducing initially 7 mg to 5 mg then by 1 mg every month).
Baseline information collected included: age, disease duration (as defined from symptom onset rather than time of diagnosis), sex, rheumatoid factor status, initial presence of erosions, smoking habit, and Carstairs deprivation score.22 Clinical measures at baseline and every 12 months included pain score, physician and patient global assessment of activity (rated on 10 cm visual analogue scale), Ritchie articular index,23 and health assessment score (HAQ)24 with British modification.25 Laboratory measures included haemoglobin, ESR, and C reactive protein measured as clinically indicated and on an annual basis.
Standard postero-anterior x rays of hands and feet were obtained at baseline and at one and two years. All radiographs were scored using the van der Heijde modification of the Sharp method.26 The maximum erosion score is 160 for the hands and 120 for the feet, and the maximum score for hand joint space narrowing is 120 and for the feet 48. The maximum possible total score is 448. Two observers independently scored x rays of the hands and feet for erosions and joint space narrowing. JH, a rheumatologist, scored them in an entirely random order, and FWP, a radiologist, score them knowing the chronological sequence.27 Neither was aware of patient details or treatment allocations.
Measurements of prednisolone toxicity at each centre included: body mass index (BMI), blood pressure, random cholesterol, high density lipoprotein (HDL) cholesterol, and glucose. Patients from all but one centre had bone mineral density measured (using dual energy x ray absorptiometry, DEXA). It was recognised that low dose steroids could lead to adverse effects. Therefore where baseline assessments of BMI, blood pressure, DEXA, lipids, or glucose were abnormal, or when these became abnormal in the course of the study, appropriate intervention was left to the discretion of the rheumatologist responsible for that patient. All concomitant treatment was also recorded.
We calculated that 160 patients were required to have 90% power to detect a 50% reduction in progression of total joint erosions over two years with a significance of p<0.05. No interim analysis was carried out. The primary outcome measure was radiological change in the hands and feet (joint space narrowing and erosions).26 Secondary outcome measures included clinical and laboratory measures of benefit and frequency of toxicity. An intention to treat analysis was used. Total joint count (narrowing and erosions in hands and feet) in the active and placebo groups was compared using the Mann–Whitney U test. Clinical variables were analysed similarly and within-group changes were evaluated using Wilcoxon matched pairs signed ranks test. Strengths of associations were obtained by Spearman rank correlations.
Enrolment began in February 1996 and the last patient completed two years of follow up in May 2001. We recorded all eligible patients including those reluctant to participate (fig 1). In all, 257 patients were assessed for the study. Of these, 90 were excluded either because they did not want corticosteroid treatment, or did not meet entry criteria on closer assessment, or did not wish to participate for reasons unspecified. Figure 1 also shows the flow of all participants through each phase of the study.
Flow of participants through the WOSERACT study. FU, follow up; pred, prednisolone; SASP, sulphasalazine
Of the 167 patients started on sulphasalazine, 84 were randomised to prednisolone 7 mg daily and 83 to matching placebo. Table 1 shows the baseline demographic information and clinical and laboratory variables. The female to male ratio was 1.8:1. Patients in the prednisolone and placebo groups were equally distributed in Carstairs groupings, an index of deprivation. Only 10% of patients were from affluent areas, while 34% lived in the most deprived districts.
WOSERACT demographic data at baseline
Intention to treat analysis at one year was possible in 77 individuals allocated to prednisolone and 74 to placebo. Seven in the prednisolone group and three on placebo were lost to follow up. One in the prednisolone group withdrew consent to continue in the study. Analysis at two years was possible in 70 prednisolone and 72 placebo patients. One patient died in each treatment group of causes unrelated to treatment. At two years, 25 patients from the prednisolone group were no longer on sulphasalazine and 23 were no longer taking prednisolone. In the placebo group 30 had stopped sulphasalazine and 18 were no longer on placebo.
DMARD treatment
Adverse events leading to withdrawal were as expected for sulphasalazine. Nausea and vomiting (active 3, placebo 7), rash (2, 3), mouth ulcers (2, 0), leucopenia (1, 3), dizziness (1, 0), or abnormal liver function tests (0, 3) led to withdrawal of treatment in prednisolone and placebo groups. At two years 57 patients were on sulphasalazine in the active group (68%) and 54 in the placebo group (65%). More side effects necessitated withdrawal of sulphasalazine (18/83 (22%) in the placebo group v 9/84 (11%) on prednisolone). Seventeen patients on prednisolone and 23 placebo treated patients discontinued sulphasalazine and were on an alternative DMARD. Eight of the placebo treated patients and 11 of the active group were no longer on a DMARD at two years. Methotrexate, intramuscular gold, and hydroxychloroquine were the commonly used alternative DMARDs after sulphasalazine withdrawal.
Steroid/placebo treatment
Seventy three per cent remained on prednisolone and 80% on the placebo at two years. One patient withdrew consent after starting in the study. A further 11 were lost to follow up. Withdrawals from the steroid or placebo for side effects considered attributable to that treatment were rare—six in the prednisolone cohort (facial swelling 1, weight gain 3, nausea 1, gastrointestinal bleed 1) and two in the placebo cohort (nausea 1, diarrhoea 1).
Radiology was available in 64/83 (77%) on active prednisolone and 66/84 (79%) on placebo. The correlation coefficient between the total score for all x rays read in random order and those read in chronological sequence was r = 0.8 (p = 0.01). Twenty three patients had no erosions at the start of the study; eight had developed erosions after two years; two were on prednisolone and six on placebo. Of patients with erosions at onset, 59% and 61% showed progression in the placebo and prednisolone groups, respectively. Comparison of initial and two year total scores in both placebo and prednisolone groups showed significant deterioration (table 2). There was no difference between the groups in total scores or in any other radiological variable examined individually for both random (JH) and chronological (FWP) scoring (table 2, fig 2). The results were similar when reading hands and feet separately and when scoring erosions/narrowing separately (data not shown).
Radiological data (van der Heijde modification of Sharp method)
Changes in total x ray score over two years. FWP, F W Poon (radiologist), chronological scoring; JH, J A Hunter (rheumatologist), random scoring.
There was an improvement in clinical measures and in a "modified ACR" (20% improvement in Ritchie articular index and in four of five variables (ESR, pain score, physician global, patient global, HAQ24) in both groups. At one year, 53% of prednisolone treated patients showed a "modified" 20% response, compared with 39% on placebo (p = 0.07). At two years, 41% on prednisolone and 43% on placebo showed a "modified" ACR 20% response. The group receiving oral prednisolone had a lower ESR at year 1 (p = 0.05) but not at year 2. There were no other significant differences between the groups at years 1 or 2 in other clinical or laboratory measures or in functional ability. The results are detailed in table 3.
Clinical and laboratory change in the two groups
Toxicity data relating to blood pressure, weight, BMI, and DEXA are shown in table 4.
Toxicity data relating to blood pressure, weight, body mass index, and bone mineral density over two years
Antihypertensive and anti-bone-resorptive treatment was more often used in the prednisolone group (table 5). Despite this there was a trend towards higher diastolic blood pressure in the active group at year 1 (table 4). There was also a significant weight gain in the active group in years 1 and 2, with an associated increase in BMI. The placebo group did not show an increase in weight at year 1 but there was a borderline change at year 2. There was no significant difference in the lipids at outset or at 2 years in those patients in whom it was measured (total cholesterol/HDL cholesterol).
Concomitant treatment
The percentage change in femoral neck and L2–L4 DEXA scores in the active prednisolone and placebo groups were compared using the Mann–Whitney U test. There was no significant difference between the two groups for either score (p = 0.315 and 0.215, respectively).
Concomitant treatment is shown in table 5. Use of non-steroidal anti-inflammatory drugs (NSAID) decreased in both groups to a similar extent, in keeping with a DMARD response. Low dose aspirin and treatment for ischaemic heart disease remained similar, whereas the use of antihypertensive agents increased in both groups, as did prescription of lipid lowering agents. The use of any treatment for osteoporosis also increased in both groups.
Additional intramuscular or intra-articular corticosteroids
Additional intramuscular or intra-articular steroids were given to 43% of the placebo group and 49% of the active group over the course of the study (mean dose 55 mg of triamcinolone acetate and 52 mg in placebo and active groups, respectively).
The most striking finding in this study was that there was no demonstrable benefit of low dose prednisolone on progression of erosions, a marker of bone damage, or on reducing the extent of joint space narrowing, an indicator of cartilage loss, as noted on x rays of hands and feet. This was true when x rays were read in chronological or totally random order. Low dose prednisolone provided marginal clinical benefit in early rheumatoid arthritis but this was not sustained beyond 12 months. This is similar to the results of other studies and suggests that when used with early DMARD treatment oral prednisolone provides no additional sustained advantage in symptoms or in measures of the inflammatory component of the disease.
Of the previous studies that have shown radiological benefit from low dose oral corticosteroid therapy, the largest and most rigorous is the ARC multicentre study. Scrutiny of factors that might explain the discrepancy in results reveals that conventional DMARD use was more consistent in WOSERACT than in the ARC study. All the patients in WOSERACT received sulphasalazine initially (and a subsequent DMARD in 14% if sulphasalazine was not tolerated), whereas only 66% of patients in the ARC study received a DMARD and there was no consistency across the two treatment allocations in that study. It is possible—although there is no evidence base—that sulphasalazine does not synergise with corticosteroid treatment. The female to male ratio, age distribution, disease duration, clinical disease severity, and rheumatoid factor positivity were similar (acute phase response and rheumatoid factor status28,29 have been shown to have an influence on radiological progression), and the proportion of patients in whom x rays were available was also similar (83% in the ARC study and 78% in ours). The studies differed in that the proportion of patients with erosive disease was different in WOSERACT from the ARC study. Significantly more patients in our study had erosive disease (71% had erosive disease of hands in this study, compared with 31% in the ARC study, p = 0.03 by χ2; the data were similar at the end of year 1). However, in the ARC study more patients in the placebo group compared with the prednisolone group had erosive disease at the outset, whereas the WOSERACT groups were well matched, probably as a result of randomisation with stratification using a minimisation technique.
The natural history of non-erosive rheumatoid disease is well documented—few patients without erosive disease at the time of diagnosis progress. This contrasts with those who had erosive changes at the start of the study; in these the progression was the result of damage increasing in the eroded joints over time, rather than more non-eroded joints developing erosions. It is therefore possible that the difference in results partly reflects the populations studied, with a bias towards erosive disease in the WOSERACT cohort. Long term more severe disability is more likely to develop in such patients.
We used a different method to measure x ray damage in WOSERACT than was used in the ARC study—namely, the van der Heidje modification of the Sharp method rather than the Larsen score.30 JH, using the random method, had higher scores than FWP, who used the chronological method. It was nevertheless reassuring that the change in x ray score was consistent between the two readers. The modified Sharp method is the preferred measurement in evaluating change over time, has a larger range and a greater sensitivity to change, and takes into account changes in the feet, one of the first sites to be affected in rheumatoid arthritis. It has also been the more common method used in recent studies of DMARD in rheumatoid arthritis.31 Furthermore, to be 95% confident to detect true change by the Larsen score an increase in score of 8 units is required over one year; the mean increase in the ARC study was 5.4 units over two years.
An alternative explanation of the divergent results of the two studies may be a genetic difference in the populations studied. We have previously observed that there is an over-representation of HLA-DR4 in the west of Scotland32; this allele is associated with more severe clinical and radiological disease. Differences in corticosteroid metabolism or in the frequency of the CRF gene polymorphisms—which have been shown in one rheumatoid arthritis cohort—may be another explanation that requires further evaluation.
The male to female ratio in this study is unlike many other DMARD studies in that comparatively greater numbers of men than women were willing to accept the risk of steroids. Men comprised 35% of our group, which is considerably more than in the other DMARD studies but similar to that in the ARC and COBRA studies.7,10 It may be that women are more concerned about the perceived cosmetic problems associated with corticosteroids, and were therefore more likely to refuse to take part.
It is noteworthy that the prescription of antihypertensive agents and osteoporosis treatments increased in both groups. Weight gain occurred in the prednisolone group at years 1 and 2. The borderline change in the placebo group might reflect improvement in disease activity. These trends probably in part reflect monitoring of risk factors. While observed toxicity from corticosteroids in terms of hypertension, weight gain, and osteoporosis could be reduced by active assessment and prompt intervention, there is no room for complacency. Such interventions are expensive and long term sequelae cannot all be prevented, as has been highlighted in observational cohorts.
Our study failed to demonstrate any radiological or clinical benefit over two years from low dose prednisolone in patients with rheumatoid arthritis. It is possible that the standardised DMARD (sulphasalazine) and extensive use of alternative DMARDs in patients who failed on sulphasalazine conferred benefits in this study which outweighed any prednisolone effect. These results suggest that the routine use of low dose prednisolone provides no benefit in patients with rheumatoid arthritis receiving DMARD.
Study design: Dr H A Capell, Dr R Madhok, Dr J A Hunter, Dr D Porter, and Dr E Morrison.
Study co-ordinator: E A Thomson
Randomisation: A Tierney
X Ray scoring: Dr J A Hunter, Dr F W Poon
Data collection: Rosie Hampson
Data analysis: Dr H A Capell, Dr D Porter, and Dr R Madhok
Manuscript preparation: Dr H A Capell, Rosie Hampson, Dr J Larkin, and Dr R Madhok
Patient recruitment: Dr Maciej Brzeski (Falkirk and District General Hospital); Dr Hilary A Capell, Dr Max Field, Professor Iain McInnes, Dr Rajan Madhok, Professor Roger Sturrock (Glasgow Royal Infirmary); Dr Susan Fraser and Dr Elaine Morrison (Southern General Hospital, Glasgow); Dr Paul McGill (Stobhill Hospital, Glasgow); Dr Elizabeth Murphy (Law Hospital, Lanarkshire); Dr Malcolm Steven (Raigmore Hospital, Inverness); Dr Asad Zoma (Stonehouse Hospital, Lanarkshire).
We are grateful to Ann Tierney for typing the manuscript, Dorothy McKnight for computing assistance, and Drs Alistair Forrester and Denis Pitkeathley for reading some x rays. Metrology assistance was provided by Sylvia Armstrong, Fiona McDonald, Darryl McGhee, Fiona McGhee, Elizabeth McIvor, Anne Paterson, and Anne Stirling. Dr A Kelman, University of Glasgow, assisted with the statistical method of minimisation.
The Centre for Rheumatic Diseases receives an integrated clinical arthritis centre grant from the Arthritis Research Council (UK). We are also grateful to The Sir Hugh Fraser Foundation (Glasgow) for financial support to purchase prednisolone and placebo tablets.
Scottish Intercollegiate Guidelines Network. Management of early rheumatoid arthritis. Edinburgh: SIGN Executive, Royal College of Physicians of Edinburgh, No 48, December 2000.
Hench PS, Kendall EC, Slocumb CH, Polley HF. The effect of a hormone of the adrenal cortex (17-hydroxy-11-dehydrocortisone: Compound E) and of pituitary adrenocorticotrophic hormone on rheumatoid arthritis. Preliminary report. Prof Staff Meet Mayo Clin1949;24:181–97.
Joint Committee of the Medical Research Council and Nuffield Foundation. A comparison of prednisolone with aspirin or other analgesics in the treatment of rheumatoid arthritis. Ann Rheum Dis1959;18:173–87.
Corkhill M , Kirkham BW, Chikanza IC, Gibson T, Panayi GS. Intramuscular depot methylprednisolone induction of chrysotherapy in rheumatoid arthritis: a randomised clinical trial. Br J Rheumatol1990;29:274–9.
van Gestel AM, Laan RFJM, Haagsma CJ, van de Putte LBA, van Riel PLVM. Oral steroids as bridge therapy in rheumatoid arthritis patients starting with parenteral gold. A randomized double-blind placebo-controlled trial. Br J Rheumatol1995;34:347–51.
Hansen M , Podenphant J, Florescu A, Stoltenberg M, Borch A, Kluger E, et al. A randomised trial of differentiated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side-effects. Ann Rheum Dis1999;58:713–18.
Kirwan JR for the Arthritis and Rheumatism Council low-dose glucocorticoid study group. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med1995;333:142–6.
Hickling P , Jacoby RK, Kirwan JR. Joint destruction after glucocorticoids are withdrawn in early RA. Arthritis and Rheumatism Council low dose glucocorticoid study group. Br J Rheumatol1998;37:930–6.
Van Everdingen AA, Jacobs JWG, Siewertsz van Reesema DR, Bijlsma JWJ. Low-dose prednisolone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side-effects: a randomised, double-blind, placebo-controlled clinical trial. Ann Intern Med2002;136:1–12.
Boers M , Verhoeven AC, Markusse HM, van de Laar MAFJ, Westhovens R, van Denderen JC, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet1997;350:309–18.
Boers M . The case for corticosteroids in the treatment of early rheumatoid arthritis. Rheumatology1999;38:95–7.
Morrison E , Capell HA. Corticosteroids in rheumatoid arthritis – the case against. Rheumatology1999;38:97–100.
de Nijs RNJ, Jacobs JWG, Bijlsma JWJ, Lems WF, Laan RFJM, Houben HHM, et al. Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis. Rheumatology2001;40:1375–83.
Gudbjornsson B , Juliusson UI, Gudjonsson FV. Prevalence of long term steroid treatment and the frequency of decision making to prevent steroid induced osteoporosis in daily clinical practice. Ann Rheum Dis2002;61:32–6.
Saag KG. Low-dose corticosteroid therapy in rheumatoid arthritis: balancing the evidence. Am J Med1997;103:31–9S.
Saag KG. Resolved: low-dose glucocorticoids are neither safe nor effective for the long-term treatment of rheumatoid arthritis. Arthritis Care Res2001;45:468–71.
Wolfe F , Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA, et al. The mortality of rheumatoid arthritis. Arthritis Rheum1994;37:481–94.
Arnett FC, Edworthy SM, Bloch DA, McShare DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987: Revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum1988;31:315–24.
Taves DR. Minimization: a new method of assigning patients to treatment and control groups. Clin Pharmacol Ther1974;15:443–53.
Treasure T , MacRae KD. Minimisation: the platinum standard for trials? Randomisation doesn't guarantee similarity of groups; minimisation does [Editorial]. BMJ1998;317:362–3.
Department of Health. Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Statement on vitamin B6 (pyridoxine) toxicity. London: Department of Health, 1997.
Carstairs V , Morris R. Deprivation and health in Scotland. Aberdeen: Aberdeen University Press, 1991.
Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med1968;147:393–406.
Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: the Health Assessment Questionnaire, disability and pain scales. J Rheumatol1982;9:789–93.
Kirwan JR, Reeback JS. Standford health assessment questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol1986;25:206–9.
van der Heijde DMFM. Plain x-rays in rheumatoid arthritis: overview of scoring methods, their reliability and applicability. Baillieres Clin Rheumatol1996;10:435–53.
Bruynesteyn K , van der Heijde D, Boers M, Saudan A, Peloso P, Paulus H, et al. Reading films with or without known sequence: does it influence the accuracy to detect clinically important changes in the individual [abstract]. San Francisco: ACR 65th Annual Scientific Meeting, November, 2001.
Jansen LMA, van der Horst-Bruinsma IE, van Schaardenburg D, Bezemer PD, Dijkmans BAC. Predictors of radiographic joint damage in patients with early rheumatoid arthritis. Ann Rheum Dis2001;60:924–7.
Bukhari M , Lunt M, Harrison BJ, Scott DGI, Symmons DPM, Silman AJ. Rheumatoid factor is the major predictor if increasing severity of radiographic erosions in rheumatoid arthritis. Arthritis Rheum2002;46:906–12.
Larsen A , Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn1977;18:481–91.
Smolen JS, Kalden JR, Scott DL, Rozman B, Kvien TK, Larsen A, et al. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. Lancet1999;353:259–66.
Crilly A , Maiden N, Capell HA, Madhok R. Genotyping for disease associated HLA DR β1 alleles and the need for early joint surgery in rheumatoid arthritis: a quantitative evaluation. Ann Rheum Dis1999;58:114–17.
↵* West of Scotland Early Rheumatoid Arthritis Corticosteroid Trial
Lay summaries
EULAR textbooks
Copyright © 2023 BMJ Publishing Group Ltd & European Alliance of Associations for Rheumatism. All rights reserved.


text:
REMOTE...LOCAL
A SPACE FOR YOUNG MIGRANTS
Remote...Local is a space for young migrants, those who are first, second, third or more generation migrants, as well as migrant allies, to think and write about their experiences in/relation to St Leonard's.
In an ongoing series of workshops, the group is documenting and mapping the migrant and international narratives of the town using live writing, speculative fiction, sound walks, zines, photography and other forms of making and writing. We are exploring who and what counts as local and investigating how heritage and cultural differences shape a different relationship to a community and place.
Remote… Local was an idea was developed by a community group of local migrants and allies who formed the working group, and shaped the vision of the project.
The project is facilitated by Critical Interruptions, a migrant-led cooperative founded by Diana Damian-Martin and Bojana Janković. Together, Diana and Bojana talk, perform, write and think about migration, borders, internationalism and Eastern European identities and diasporic cultures.
Remote...Local was coordinated by Vanessa Farinha, a creative producer, artist and co-founder of The Nothing productions. The project is now coordinated by Khadija Kahn.
If you have any questions or queries regarding Good Stuff please email hannah@goodstuffinstlens.com


Here are this week's Friday Fun Facts about Diana Gabaldon's books. This is a collection of some of my favorite items from previous FFF posts. All of these were originally posted between April, 2012, and March, 2013. I hope you enjoy them!
3) I had never heard the term "blue vitriol" before I read "The Space Between", and I was surprised to learn that it's an archaic term for copper (II) sulfate (CuSO4) -- a chemical that you may remember from chemistry classes in school. Isn't that a gorgeous color? I thought the Comte's use of it in the story was fascinating.
He found the blue vitriol by smell, and wrapped the cloth tightly around the head of one torch, then--whistling under his breath--did three more, impregnated with different salts. He loved this part. It was so simple, and so astonishingly beautiful.
He paused for a minute to listen, but it was well past dark and the only sounds were those of the night itself--frogs chirping and bellowing in the distant marshes by the cemetery, wind stirring the leaves of spring. A few hovels a half-mile away, only one with fire-light glowing dully from a smoke-hole in the roof.
Almost a pity there's no one but me to see this. He took the little clay firepot from its wrappings and touched a coal to the cloth-wrapped torch. A tiny green flame flickered like a serpent's tongue, then burst into life in a brilliant globe of ghostly color.
The beautiful blue color arises from water molecules attached directly to the copper(II) ion. The water/copper ion complex absorbs photons of yellow or red light. Absorption of a photon promotes an electron from the water to the copper(II) ion. Since only yellow or red light is absorbed, blue light is transmitted, and the crystals appear blue.
Here's a short video showing how you can make your own green flames using common household chemicals.
5) One of the many 20th-century pop culture references in the books is the Yogi Bear theme song. I am old enough to remember watching Yogi Bear cartoons on TV as a child, so the references in THE FIERY CROSS make me laugh.
"It must be a particularly clever bear, no? To have been walking in and out of their village for months, I mean, and no one with more than a single glimpse of it?"
"Smarter than the average bear," Brianna agreed, her mouth twitching slightly. Jamie gave her a narrow look, which he switched to me as I choked on a swallow of beer.
"Nothing," I gasped. "Nothing at all."
For those of you who may be unfamiliar with the Yogi Bear TV series, look here.
I hope you enjoyed this third installment of the Best of the Friday Fun Facts! In case you missed it, here's the Best of the Friday Fun Facts: Collection #1 and Best of the Friday Fun Facts: Collection #2. Look here to see all of my Friday Fun Facts blog posts. And please come back next week for more!
Oh I love how you give us all this behind the scenes history. I wonder how Diana finds these facts in the first place. I can understand the modern ones but things like that blue vitriol, Oh yeah, lol she's a scientist. Fabulous post!


text: Q: Evolving magikarp So I have done the impossible and managed to catch 101 magikarp which gets me a little over 400 candies. I can now evolve him into a gyarados (which I'm super excited about!) but my question is about evolution CP points. Is there a calculator or equation to use to determine what CP the gyarados will be? I have worked really hard to gain 400+ candies and want to evolve my magikarp at the best possible time. Does anyone know the CP cap for a magikarp? I am a level 16 and my magikarp is 124CP points.


text:
int main ( int argc, char **argv )
{
    std::cout << "xWebProcessor v" << MAJOR_VERSION << "." << MINOR_VERSION << "." << PATCH_VERSION << std::endl;

    try{
        // Declare the supported options.
        boost::program_options::options_description desc("Allowed options");
        desc.add_options()
                ("help", "shows the help for the program options")
                ("projectfile", boost::program_options::value<std::string>(), "Sepcify project file")
                ("stringparam", boost::program_options::value<std::vector< std::string> >(), "Sepcify list of string paramteres which overrides project file strings")
                ;

        boost::program_options::variables_map vm;
        boost::program_options::store(boost::program_options::parse_command_line(argc, argv, desc), vm);
        boost::program_options::notify(vm);

        if (vm.count("help")) {
            std::cout << desc << "\n";
        }
        else if ( vm.count("projectfile")) {
            std::string projectfile = vm["projectfile"].as<std::string>();

            xWebProcessor processor;
            processor.setExecutableFilePath(argv[0]);
            processor.setProjectFilePath(projectfile);

            if ( vm.count("stringparam") )
            {
                const std::vector<std::string>& strings = vm["stringparam"].as< std::vector<std::string> >();

                for ( std::vector<std::string>::const_iterator it = strings.begin(); it != strings.end(); it++ )
                {
                    std::string str = *it;
                    std::string delim = ":";

                    std::string::const_iterator start = str.begin();
                    std::string::const_iterator end = str.end();
                    std::string::const_iterator pos = std::search(str.begin(), str.end(), delim.begin(), delim.end());
                    std::string key(start, pos);

                    start = pos + delim.size();
                    std::string value(start, end);

                    processor.addCLIStringParam(key, value);
                }
            }

            processor.run();
        }

    }
    catch(const std::exception &e){
        std::cout << "Application interrupted because of an abnormal exception caught" << std::endl;
        std::cout << "Exception class: std::exception" << std::endl;
        std::cout << "message: " << e.what() << std::endl;

        return 1;
    }
    catch(...){
        return 1;
    }

    return 0;
}


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