Ten reasons why rigid contact lenses are obsolete

There have only been minor improvements in rigid lens material developments since silicone acrylates and fluoro-silicone acrylates were introduced over a quarter of a century ago. Although there have been enhancements in mechanical lathing technology in the rigid lens field - primarily as a result of developments in computer-controlled systems - rigid lenses are still manufactured using labour-intensive lathing processes, which is why the lens unit cost remains much higher than for disposable soft lenses.

Absolute forms in the poetry of the Gogynfeirdd: functionally obsolete archaisms or working system?

Rodway, S. (2002). Absolute forms in the poetry of the Gogynfeirdd: functionally obsolete archaisms or working system? Journal of Celtic Linguistics. 7, pp.63-84. RAE2008

Has investor protection been rendered obsolete by the Argentine crisis?

Includes bibliography

A METHODOLOGY TO EVALUATE OBSOLETE INVENTORY IN HEALTH CARE

Many organizations are currently facing inventory management problems such as distributing inventory on-time and maintain the correct inventory levels to satisfy the customer or end users. Organizations understand the need for maintaining the accurate inventory levels but sometimes fall short leading a wide performance gap in maintaining inventory accurately. The inventory inaccuracy can consume much of the investment on purchasing inventory and many times leads to excessive inventory. The research objective of thesis is to provide a decision making criteria to the management for closing or maintaining the warehouse based on basic purchasing and holding cost information. The specific objectives provide information regarding the impact of inventory carrying cost, obsolete inventory, inventory turns. The methodology section explains about the carrying cost ratio that would help inventory managers to adopt best practices to avoid obsolete inventory and also reduce excessive inventory levels. The research model was helpful in providing a decision making criteria based on the performance metric developed. This research model and performance metric had been validated by analysis of warehouse data and results indicated a shift from two-echelon inventory supply chain to a one-echelon or Just In Time (JIT) based inventory supply chain. The recommendations from the case study were used by a health care organization to reorganize the supply chain resulting in the reduction of excessive inventory.

Is hysterectomy nowadays an obsolete procedure?

After the general morbidity reduction at the beginning of the century and the routine use of prophylactic antibiotics, a hysterectomy was generously, sometimes to generously indicated in the middle of the 20th century. This might be one of the major reasons why the procedure got a bad reputation. Furthermore, in the last decade, several new treatments for benign uterine pathologies have been developed which can be proposed to the patients instead of performing a hysterectomy. Therefore, the question might be asked, if nowadays there are still some indications for a hysterectomy or if the procedure is obsolete.

Detection of haemorrhagic shock: Are vital signs obsolete? A commentary by Dr M. Luginbühl

The ATLS program by the American college of surgeons is probably the most important globally active training organization dedicated to improve trauma management. Detection of acute haemorrhagic shock belongs to the key issues in clinical practice and thus also in medical teaching. (In this issue of the journal William Schulz and Ian McConachrie critically review the ATLS shock classification Table 1), which has been criticized after several attempts of validation have failed [1]. The main problem is that distinct ranges of heart rate are related to ranges of uncompensated blood loss and that the heart rate decrease observed in severe haemorrhagic shock is ignored [2]. Table 1. Estimated blood loos based on patient's initial presentation (ATLS Students Course Manual, 9th Edition, American College of Surgeons 2012). Class I Class II Class III Class IV Blood loss ml Up to 750 750–1500 1500–2000 >2000 Blood loss (% blood volume) Up to 15% 15–30% 30–40% >40% Pulse rate (BPM) <100 100–120 120–140 >140 Systolic blood pressure Normal Normal Decreased Decreased Pulse pressure Normal or ↑ Decreased Decreased Decreased Respiratory rate 14–20 20–30 30–40 >35 Urine output (ml/h) >30 20–30 5–15 negligible CNS/mental status Slightly anxious Mildly anxious Anxious, confused Confused, lethargic Initial fluid replacement Crystalloid Crystalloid Crystalloid and blood Crystalloid and blood Table options In a retrospective evaluation of the Trauma Audit and Research Network (TARN) database blood loss was estimated according to the injuries in nearly 165,000 adult trauma patients and each patient was allocated to one of the four ATLS shock classes [3]. Although heart rate increased and systolic blood pressure decreased from class I to class IV, respiratory rate and GCS were similar. The median heart rate in class IV patients was substantially lower than the value of 140 min−1 postulated by ATLS. Moreover deterioration of the different parameters does not necessarily go parallel as suggested in the ATLS shock classification [4] and [5]. In all these studies injury severity score (ISS) and mortality increased with in increasing shock class [3] and with increasing heart rate and decreasing blood pressure [4] and [5]. This supports the general concept that the higher heart rate and the lower blood pressure, the sicker is the patient. A prospective study attempted to validate a shock classification derived from the ATLS shock classes [6]. The authors used a combination of heart rate, blood pressure, clinically estimated blood loss and response to fluid resuscitation to classify trauma patients (Table 2) [6]. In their initial assessment of 715 predominantly blunt trauma patients 78% were classified as normal (Class 0), 14% as Class I, 6% as Class II and only 1% as Class III and Class IV respectively. This corresponds to the results from the previous retrospective studies [4] and [5]. The main endpoint used in the prospective study was therefore presence or absence of significant haemorrhage, defined as chest tube drainage >500 ml, evidence of >500 ml of blood loss in peritoneum, retroperitoneum or pelvic cavity on CT scan or requirement of any blood transfusion >2000 ml of crystalloid. Because of the low prevalence of class II or higher grades statistical evaluation was limited to a comparison between Class 0 and Class I–IV combined. As in the retrospective studies, Lawton did not find a statistical difference of heart rate and blood pressure among the five groups either, although there was a tendency to a higher heart rate in Class II patients. Apparently classification during primary survey did not rely on vital signs but considered the rather soft criterion of “clinical estimation of blood loss” and requirement of fluid substitution. This suggests that allocation of an individual patient to a shock classification was probably more an intuitive decision than an objective calculation the shock classification. Nevertheless it was a significant predictor of ISS [6]. Table 2. Shock grade categories in prospective validation study (Lawton, 2014) [6]. Normal No haemorrhage Class I Mild Class II Moderate Class III Severe Class IV Moribund Vitals Normal Normal HR > 100 with SBP >90 mmHg SBP < 90 mmHg SBP < 90 mmHg or imminent arrest Response to fluid bolus (1000 ml) NA Yes, no further fluid required Yes, no further fluid required Requires repeated fluid boluses Declining SBP despite fluid boluses Estimated blood loss (ml) None Up to 750 750–1500 1500–2000 >2000 Table options What does this mean for clinical practice and medical teaching? All these studies illustrate the difficulty to validate a useful and accepted physiologic general concept of the response of the organism to fluid loss: Decrease of cardiac output, increase of heart rate, decrease of pulse pressure occurring first and hypotension and bradycardia occurring only later. Increasing heart rate, increasing diastolic blood pressure or decreasing systolic blood pressure should make any clinician consider hypovolaemia first, because it is treatable and deterioration of the patient is preventable. This is true for the patient on the ward, the sedated patient in the intensive care unit or the anesthetized patients in the OR. We will therefore continue to teach this typical pattern but will continue to mention the exceptions and pitfalls on a second stage. The shock classification of ATLS is primarily used to illustrate the typical pattern of acute haemorrhagic shock (tachycardia and hypotension) as opposed to the Cushing reflex (bradycardia and hypertension) in severe head injury and intracranial hypertension or to the neurogenic shock in acute tetraplegia or high paraplegia (relative bradycardia and hypotension). Schulz and McConachrie nicely summarize the various confounders and exceptions from the general pattern and explain why in clinical reality patients often do not present with the “typical” pictures of our textbooks [1]. ATLS refers to the pitfalls in the signs of acute haemorrhage as well: Advanced age, athletes, pregnancy, medications and pace makers and explicitly state that individual subjects may not follow the general pattern. Obviously the ATLS shock classification which is the basis for a number of questions in the written test of the ATLS students course and which has been used for decades probably needs modification and cannot be literally applied in clinical practice. The European Trauma Course, another important Trauma training program uses the same parameters to estimate blood loss together with clinical exam and laboratory findings (e.g. base deficit and lactate) but does not use a shock classification related to absolute values. In conclusion the typical physiologic response to haemorrhage as illustrated by the ATLS shock classes remains an important issue in clinical practice and in teaching. The estimation of the severity haemorrhage in the initial assessment trauma patients is (and was never) solely based on vital signs only but includes the pattern of injuries, the requirement of fluid substitution and potential confounders. Vital signs are not obsolete especially in the course of treatment but must be interpreted in view of the clinical context. Conflict of interest None declared. Member of Swiss national ATLS core faculty.

The complete dramatic and poetical works of William Shakspeare .... from the text of the latest corrected editions. To which is annexed a graphic life of the poet, and an alphabetical index to the characters of the plays ... with a glossarial index of obsolete words and words varying from their modern signification.

At head of title: Scarlet border edition.

The annals of Wakefield house of correction for three hundred years; with notices of ancient prisons and obsolete punishments ...

Mode of access: Internet.

Special study of administrative laws considered to be obsolete, unenforcable, unnecessarily burdensome, duplicative, or having no administrative benefit /

"February 1995"

The New Testament of our Lord and Saviour Jesus Christ : with an introduction giving an account of Jewish and other sects : with notes illustrating obscure passages and explaining obsolete words and phrases : for the use of schools, academies, and private families /

Advertisements (with prices) on p. [532]-[533]; following leaf blank.

A school dictionary; or, Entick's English dictionary, : abridged and adapted to the use of schools; containing only the roots of words, and those of importance and utility, and omitting derivative, obsolete, vulgar and unusual words.

Reproduction of original in British Library, London.

An index to the works of Shakspere giving references, by topics, to notable passages and significant expressions; brief histories of the plays; geographical names, and historical incidents; mention of all characters, and sketches of important ones; together with explanations of allusions and obscure and obsolete words and phrases,

Mode of access: Internet.

Lament for a lost running order? obsolescence and academic journals

This is the lead article for an issue of M/C Journal on the theme ‘obsolete.’ It uses the history of the International Journal of Cultural Studies (of which the author has been editor since 1997) to investigate technological innovations and their scholarly implications in academic journal publishing; in particular the obsolescence of the print form. Print-based elements like cover-design, the running order of articles, special issues, refereeing and the reading experience are all rendered obsolete with the growth of online access to individual articles. The paper argues that individuation of reading choices may be accompanied by less welcome tendencies, such as a decline in collegiality, disciplinary innovation, and trust.