A randomized clinical trial of hydroxymethylglutaryl-Coenzyme A reductase inhibition for Acute Lung Injury (The HARP study)

Rationale: There is no effective pharmacological treatment for acute lung injury (ALI). Statins are a potential new therapy because they modify many of the underlying processes important in ALI.

Objectives: To test whether simvastatin improves physiological and biological outcomes in ALI.

Methods: We conducted a randomized, double-blinded, placebo-controlled trial in patients with ALI. Patients received 80 mg simvastatin or placebo until cessation of mechanical ventilation or up to 14 days. Extravascular lung water was measured using thermodilution. Measures of pulmonary and nonpulmonary organ function were assessed daily. Pulmonary and systemic inflammation was assessed by bronchoalveolar lavage fluid and plasma cytokines. Systemic inflammation was also measured by plasma C-reactive protein.

Measurements and Main Results: Sixty patients were recruited. Baseline characteristics, including demographics and severity of illness scores, were similar in both groups. At Day 7, there was no difference in extravascular lung water. By Day 14, the simvastatin-treated group had improvements in nonpulmonary organ dysfunction. Oxygenation and respiratory mechanics improved, although these parameters failed to reach statistical significance. Intensive care unit mortality was 30% in both groups. Simvastatin was well tolerated, with no increase in adverse events. Simvastatin decreased bronchoalveolar lavage IL-8 by 2.5-fold (P = 0.04). Plasma C-reactive protein decreased in both groups but failed to achieve significance in the placebo-treated group.

Conclusions: Treatment with simvastatin appears to be safe and may be associated with an improvement in organ dysfunction in ALI. These clinical effects may be mediated by a reduction in pulmonary and systemic inflammation.

The Crowned Harp: Policing Northern Ireland (reprint 2006, 2010)

The Crowned Harp provides a detailed analysis of policing in Northern Ireland. Tracing its history from 1922, Ellison and Smyth portray the Royal Ulster Constabulary (RUC) as an organisation burdened by its past as a colonial police force. They analyse its perceived close relationship with unionism and why, for many nationalists, the RUC embodied the problem of the legitimacy of Northern Ireland, arguing that decisions made on the organisation, composition and ideology of policing in the early years of the state had consequences which went beyond the everyday practice of policing.

The authors provide an extended discussion of policing after the outbreak of civil unrest in 1969, ask why policing was cast in a paramilitary mould, and look at the use of special constabularies and the way in which the police dealt with social unrest which threatened to break down sectarian divisions. Examining the reorganisations of the RUC in the 1970s and 1980s, Ellison and Smyth focus on the various structural, legal and ideological components, the professionalisation of the force and the development of a coherent, if contradictory, ideology. The analysis of the RUC during this period sheds light on the problematic nature of using the police as a counter insurgency force in a divided society. Perceptions of the police, and the opinions of rank and file members are examined and an assessment is made of the various alternative models of policing, such as community policing and local control. This book offers important lessons about the nature of policing in divided societies.

Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in Acute lung injury to Reduce Pulmonary dysfunction (HARP-2) trial: study protocol for a randomized controlled trial

Background: Acute lung injury (ALI) is a common devastating clinical syndrome characterized by life-threatening respiratory failure requiring mechanical ventilation and multiple organ failure. There are in vitro, animal studies and pre-clinical data suggesting that statins may be beneficial in ALI. The Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in Acute lung injury to Reduce Pulmonary dysfunction (HARP-2) trial is a multicenter, prospective, randomized, allocation concealed, double-blind, placebo-controlled clinical trial which aims to test the hypothesis that treatment with simvastatin will improve clinical outcomes in patients with ALI.

Methods/Design: Patients fulfilling the American-European Consensus Conference Definition of ALI will be randomized in a 1: 1 ratio to receive enteral simvastatin 80 mg or placebo once daily for a maximum of 28 days. Allocation to randomized groups will be stratified with respect to hospital of recruitment and vasopressor requirement. Data will be recorded by participating ICUs until hospital discharge, and surviving patients will be followed up by post at 3, 6 and 12 months post randomization. The primary outcome is number of ventilator-free days to day 28. Secondary outcomes are: change in oxygenation index and sequential organ failure assessment score up to day 28, number of non pulmonary organ failure free days to day 28, critical care unit mortality; hospital mortality; 28 day post randomization mortality and 12 month post randomization mortality; health related quality of life at discharge, 3, 6 and 12 months post randomization; length of critical care unit and hospital stay; health service use up to 12 months post-randomization; and safety. A total of 540 patients will be recruited from approximately 35 ICUs in the UK and Ireland. An economic evaluation will be conducted alongside the trial. Plasma and urine samples will be taken up to day 28 to investigate potential mechanisms by which simvastatin might act to improve clinical outcomes.

Superimposition: A composition for harp, saxophone and live electronics

Superimposition is built on a live-scoring system. Computer animated graphics combined with computer generated algorithms produce the score in real time based on preferences input by the composer. Notably, this system introduces a methodology for eliciting complex and coordinated rhythms from instrumentalists through notation generated in real time. This work also incorporates a system for live electronics and live sampling and processing.

"The harp the monarch minstrel swept" [Rezension]

L. H.

(Table 2) Fatty acid profile of blubber from harp seals and hooded seals from the Greenland Sea and Denmark Strait

Sub-Arctic marine ecosystems are some of the most productive ecosystems in the world's oceans. The capacity of herbivorous zooplankton, such as Calanus, to biosynthesize and store large amounts of lipids during the short and intense spring bloom is a fundamental adaptation which facilitates the large production in these ecosystems. These energy-rich lipids are rapidly transferred through the food chain to Arctic seals. The fatty acids and stable isotopes from harp seal (Phoca groenlandica) and hooded seal (Cystophora cristata) off East Greenland as well as their potential prey, were analysed. The results were used to describe the lipid dynamics and energy transfer in parts of the East Greenland ecosystem. Even if the two seal species showed considerable overlap in diet and occurred at relatively similar trophic levels, the fatty acid profiles indicated that the bases of the food chains of harp and hooded seals were different. The fatty acids of harp seals originate from diatom-based food chain, whereas the fatty acids of hooded seals originate from dinoflagellate and the prymnesiophyte Phaeocystis pouchetii-based food chain. Stable isotope analyses showed that both species are true carnivores on the top of their food chains, with hooded seal being slightly higher on the food chain than harp seal.

A choice collection of 51 Welsh airs, adapted for the harp, piano-forte, harpsichord, violin, or flute.

Mode of access: Internet.

Concerto for the organ with orchestra (strings, brass, harp and drums), op. 55 /

Mode of access: Internet.

Fantaisie : for the harp : op. 3 /

Mode of access: Internet.

Two sonatas : for the French pedal harp with an accompaniment for a violin ad libitum : op. 1 /

Lacking optional violin part.

Lison dormoit : with an introduction and variations arranged for the harp /

Mode of access: Internet.

A new introduction and a Piemontois air : with variations for the harp /

Mode of access: Internet.

Album of solo pieces for the harp. [music] /

V. 1. Prelude / W. Loukine. The music-box / Franz Poenitz. Prayer ; Will-o'-the-wisp / A. Hasselmans. Slumber-song / Gabriel Fauré. Marguerite at the spinning-wheel. Polonaise / Margaret Hoberg -- v. 2. Minuet / L. van Beethoven. Serenade / Christian Sinding. Aeolian harp ; The brook / A. Hasselmans. Pattuglia Spagnuola / L.M. Tedeschi. Romance / A. Zabel. Harp solo from the opera Lucia di Lammermoor / Gaetano Donizetti ; arranged by Albert Zabel.