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South African Journal of Economic and Management Sciences
versión On-line ISSN 2222-3436
versión impresa ISSN 1015-8812
S. Afr. j. econ. manag. sci. vol.17 no.3 Pretoria jul. 2014
An exposition of resource capabilities for SMEs in the emerging markets
Ritam Garg; Kalyan Kumar De
International management, Thapar University, India
Emerging markets' small and medium sized enterprises (SMEs), despite having enormous growth potential and significance in the economy, have not been able to harness the advantages of internationalisation and subsequently have fallen short in facing the challenges of globalised competition. The purpose of this study was to review and explore the importance of the resource capabilities, building on the literature from the resource based view (RBV), (core) competency and dynamic capabilities theory, as the main rationale behind their significance in the SME internationalisation. This study intends to provide conceptual clarity about the resource capabilities and their importance in providing the SMEs in the emerging economies, the competitive edge to sustain themselves in today's business environment. The study concludes with an agenda for future research.
Key words: SMEs, resource capability, emerging markets
1 Introduction
While most research concerning internationalisation strategy has focused on large and multinational corporations (MNCs), this issue is becoming increasingly important for small and medium sized enterprises (SMEs) (Filatotchev, Liu, Buck & Wright, 2009), especially for those that internationalise during the early stages of their organisational life-cycle (Wright; Westhead & Ucbasaran, 2007). The existing literature often refers to these firms as 'born global' firms in the existing literature (Rennie, 1993; Oviatt & McDougall, 1994; Autio, Sapienza & Almeida, 2000; Zahra, Ireland & Hitt, 2000). According to many scholars, even though numerous studies have analysed the factors that drive the internationalisation of smaller firms (Gabrielsson & Kirpalani, 2004; Knight & Cavusgil, 2004) the overall understanding of this phenomenon is still limited, and previous studies have not been able to capture the dynamic nature of internationalisation decisions that occur over many years (Kamakura, Ramon-Jeronimo & Grave, 2012).
Research that examines new ventures, "born-global" firms, small and medium-sized enterprises (SMEs), and multinationals enterprises (MNEs) has provided an array of findings regarding the drivers of internationalisation and the factors that contribute to the success and performance of firms in international markets. Management literature has examined top management team (TMT) characteristics; and entrepreneurship literature has examined the innovativeness, risk-taking, and competitive aggressiveness of individuals and organisations as the first to act upon opportunities given various conditions of market risk (Radulovich, 2008). Concurrently, innovation research, encompassing new product development (NPD) and new service development (NSD), has shed light on the adaptation of a firm's products/ services to enhance market share and create performance advantages (Radulovich, 2008). However, with regard to the effects of internationalisation on firms, empirical results are mixed (Hitt, Hoskisson & Kim, 1997). Researchers have a limited understanding of the performance benefits of intangible resources (Radulovich, 2008), and how firms attain sustained competitive advantage (Parayitam & Guru-Gharana, 2010). Proponents of the resource based view posit that superior intangible resources provide sustainable competitive advantages and superior performance. However, the means by which advantages are created in international operations involves an understanding of firm resources and differences in consumer/ clients' needs across borders.
In emerging markets, like Asian, African and Latin American countries (e.g. India, South Africa, Mexico etc.) innovative actions are fundamental for the long-term success of the firm. Due to the increasing diversity of products and production processes (Coombs & Metcalfe, 1998) intangible assets and knowledge has become more important. Additionally, operating in foreign markets would allow small firms to become stronger players in their home market (Lages & Montgomery, 2004), and achieve growth (Kuuluvainen, 2012).
Internationalisation in general and exporting in particular; the first stage of internationalisa-tion (Jones, 2001), can enhance a firm's capability, and make it much more flexible for taking business risks (Young et al., 1989). After the topical review of the theories of internationalisation e.g. stage model, knowledge based view (KBV) and resource based view (RBV) etc., it was observed that resource based view and subsequently resource capabilities take precedence for this study. Hence, in the following paragraphs, a brief review of the streams of resource based view, competence approach, and dynamic capabilities approach, is presented as the three theoretical frameworks to describe the resource capability of a firm, and its importance to perform in dynamic environments. The study concludes with an agenda for future research.
2 Literature review
Extant international business theory suggests that internationalising firms possess certain ownership advantages such as size, superior technology, unique products, or special managerial/marketing know-how (Chen & Chen, 1998). However, many firms with international activities are small and seemingly with few resources and capabilities, and conventional theory does not provide an adequate explanation for either their motivation or the mechanism of their internationalisation (Wright et al., 2007). Previous research suggests that born global firms create sustainable competitive advantages based on unique technologies and innovation, which they leverage worldwide (Oviatt & McDougall, 1994; Bell, 1995; Keeble, Lawson, Lawton, Moore, & Wilkinson, 1998; Rugman & Wright, 1999; Jones, 2001; Stray, Bridgewater & Murray, 2001; Hashai & Almor, 2004; Knight & Cavusgil, 2004). The ability to create proprietary technologies and transform product and process innovations into business activities allows small firms to create competitive advantages that may support their inter-nationalisation strategy. Studies show that born global companies frequently have a superior capability to perform R&D activities (Manalova, 2003; Knight & Cavusgil, 2004). The resource based and dynamic capabilities perspectives also suggest that network partner-ships are important to many small firms as they provide important social capital (Davidson & Honig, 2003). These partnerships may be especially important in the emerging markets as they enable firms with relatively weak internal resources to access complementary resources and capabilities within the wider network (Bruton et al., 2003). Redding (1996) portrays these firms as weak organisations linked by strong networks, suggesting that network-related factors should play an important role within the context of their internationalisation decisions and performance.
The resource based view of the firm focuses on the internal organisation of firms and factor market imperfections. Clark (2000) emphasises that this focus of resource based view toward a firm highlights the heterogeneity of firms, their varying degrees of specialisation, and the limited transferability of corporate resources. The strategy process then revolves around identification and exploitation of idiosyncratic resources and distinctive competencies. Resource based view also conceptualises firms as unique collections of resources and routines from which competitive advantages can be drawn when those are valuable, rare, inimitable and non-substitutable (e.g. Penrose, 1959; Wernerfelt, 1984; Barney, 1991). The logic of the resource based view has been taken further in the (core) competence approach to formulate strategies. This view, developed by Prahalad and Hamel (1990), argues that unlike the physical assets of a firm, which diminish over time, the core competencies of a firm are enhanced as they are applied and used, and are the source of sustainable competitive advantage. These core competencies in turn lie behind the firm's ability to bring together intangible resources (such as skills and technologies) enabling it to provide unique value to the customers.
More recently, the resource based view has been extended to the dynamic markets by the scholars. The logic is that the resource based view does not satisfactorily explain how and why certain firms sustain their competitive advantage in dynamic business environments. Teece, Pisano and Shuen (1997) expanded the resource based view of the firm to explore the possibility of a theory of dynamic capabilities, which they define as 'the firm's ability to appropriately adapt, integrate, and reconfigure internal and external organisational skills, resources and functional competences' or in other words, intangible assets like knowledge, expertise, skills, and processes of learning take a precedence. Zollo and Winter (2002) on the other hand, have suggested that dynamic capability should be defined more specifically in terms of the generation and modification of a firm's operational routines. Although dynamic capabilities as such are idiosyncratic to each firm due to path dependencies and firm-specific resource configurations as well as related to specific industrial settings, it is emphasised in the literature that their formation and articulation also depends on external relations (Peteraf, 1993; Coombs & Metcalfe, 1998). Furthermore, it is possible to identify fundamental capability patterns across a range of firms, which allows for drawing general conclusions (Eisenhardt & Martin, 2000).
Teece et al. (1997) argue that dynamic capabilities are in fact organisational and strategic routines by which managers alter a firm's resource base and renew competencies in order to generate new sources of competitive advantage. Furthermore, organisational processes have three roles: coordination/integration, learning, and reconfiguration. First, effective coordination and integration of activities is important both inside the firm and with external sources. Second, learning has been conceptualised as an individual and organisational process, by which repetition and experimentation enables tasks to be performed better and quickly to identify new production opportunities. Accordingly, improvements in organisational processes also lead to the creation of new strategic capabilities (Argote, 1999). Third, the ability to sense the need to reconfigure a firm's asset structure is particularly valuable in volatile environments (Augier & Teece, 2009). In order for an organisation to exhibit dynamic capabilities, however, it must properly adjust responsive actions and move to implement a new system effectively and efficiently. During this process the organisation receives and interprets messages about new markets, new technologies, and competitive threats (Teece, 1998).
3 Theory development
In spite of a significant number of theoretical and conceptual contributions, empirical evidence of the nature of dynamic capabilities and their influence on firm performance is still relatively inadequate. Previous researchers have suggested the following problems: lack of consensus on a common definition (Henderson & Cockburn, 1994), potential tautology (Priem & Butler,
2001), difficulty to measure (Wernerfelt, 1984) and operational limitations (Williamson, 1999). On the other hand, Eisenhardt and Martin (2000), suggest that dynamic capabilities consist of many well-known processes that create, integrate, reconfigure and release resources and competences. In the following paragraphs a brief review of studies that have addressed those aspects of dynamic capabilities is presented.
Dynamic capabilities related to the integrating of dynamic capabilities are described as routines to develop products and make strategic decisions. Product development routines are considered as dynamic capabilities as managers combine their diverse skills and functional backgrounds to create new products and services (Helfat & Raubitschek, 2000). Brown and Eisenhardt (1997) examined continuous change in organisations in the context of multiple product innovation and found that firms successful in multiple product innovation exhibit the following characteristics:
- blending limited structure around responsibilities;
- prioritising with extensive communication;
- providing design freedom to create improvisation;
- relying on a wide variety of low cost measures to develop new products; and,
- linking present and future technologies together through step by step, time bound transition processes.
Strategic decision making is an integrating dynamic capability since it involves the pooling of business, functional, and personal expertise (e.g. Eisenhardt 1989; Olejnik & Swoboda, 2012; Welter, Bosse & Alvarez, 2013).
Researchers also suggest that integrative knowledge underlying dynamic capabilities can be a source of strategic advantage (Brusoni, Prencipe & Pavitt, 2001; Henderson & Cockburn, 1994).
Another type of dynamic capability identified in the literature is creation of new resources, which includes knowledge creation routines as well as alliance and acquisition routines that bring new resources into the firm from external sources (Powell, Koput & Smith-Doerr, 1996). McGrath, Ming-Hone, Venkataraman and Macmillan (1996) developed a framework that explains the creation and evolution of competences that are necessary for innovation. They point out that process counts, stressing the fact that team processes of learning and of developing proficiency shapes the economic outcome of an innovation attempt. Pisano (1994) observed significant differences in environments of firms, and concluded that approaches to learning are different in different environments. In yet another study, by Katzy, Dissel and Blindow (2001) two streams of dynamic capabilities were identified, e.g. incubating and grafting. These were instituted to coordinate processes of creation of internal ventures and their integration in the existing set up.
Some other examples of dynamic capabilities that focus on reconfiguration are resource allocation routines (Burgelman 1994) and transfer processes, including routines for reproduction and brokering (Hargadon Sutton, 1997; Hansen, 1999). Sull (1999) suggests that there are dynamic capabilities that release resources i.e. giving up a resource combination that no longer provides competitive advantage to the firm, which might prove to be crucial in firm's ability to remain competitive.
Researchers have made significant efforts to deal with the problem of measurement difficulties as well by constructing measures of dynamic capabilities. Zott (2003) explored how the dynamic capabilities of firms may be linked to differential firm performance within an industry. Zott (2003) proposed three performance-relevant attributes of dynamic capabilities (timing, cost and learning of resource deployment) and developed appropriate measures. The study concluded that effects of timing, cost and learning significantly contribute to intra-industry differences in performance. In another study, Macher and Mowery (2009) examined the role of the R&D based organisation and information technology practices for problem solving and learning-based improvement in innovation in semiconductor manufacturing firms. Their results indicated that allocation of human resources to problem-solving activities and the use of information technology in the manufacturing facility determine (semiconductor) manufacturers' problem-solving abilities and subsequently their performance.
4 Resource capabilities approach
It has been observed that in the light of the definition put forth by Teece et al. (1997) of dynamic capabilities, the research has put more emphasis on a firm's ability to integrate, build and reconfigure its internal competencies. However, there is not enough evidence in the literature on the dynamic capabilities employed to integrate, build and reconfigure external competencies. Extant strategic management theory highlights that firms use alliances as a medium for acquiring external competencies, technology innovation and enhancing core business activities (e.g. Mitchell & Canel, 2013). However, so far only few studies have been conducted that analyse practices and processes that firms employ to codify and disseminate knowledge of managing alliances. A study by Kale, Dyer and Singh (2002), discussed the concept of 'alliance capability' that would rest upon 'how effectively the firm is able to capture, share and disseminate the alliance management know-how associated with prior experience'. They reported that firms that create a dedicated alliance capability realise greater success with alliances. Their research explicitly addresses managerial practices strategically employed to build the capability of a firm to enter and manage alliances, and, suggests that deploying dynamic capabilities to manage strategic alliances is beneficial for overall firm performance. This study theorises the potential of acquisition and integration of external competencies in emerging markets' small and medium-sized enterprises (SMEs) that are involved in exporting or are in the process of internationalisation. A topical review of the relevant literature on alliances and networks suggests that there is a growing number of research on networks. The research addresses the concept of social networks and considers embeddedness an important factor in defining the alliance opportunities and other forms of inter-firm partnerships a firm might build (Gulati, 1998). Furthermore, developing such partnerships can provide the firms with opportunities to acquire new skills and improve existing ones (Terziovski, 2010; Thorgren, Wincent & Ortqvist, 2012). This necessary intelligence may lead to inter-nationalisation (Senik, Scott-Ladd, Entrekin & Adham, 2011), and achieve different organisational goals, and overcome inherent challenges such as lack of resources (O'Dwyer, Gilmore & Carson, 2011). However, emerging markets' SMEs typically lack relevant embeddedness in international social networks of firms. They rely on social contacts of their owners/ managers, which may not always be sufficient for the establishment of appropriate partnerships with other firms and may prove to be an impediment to their competitiveness. Similarly, Boeker (1989) argues that SMEs lack status in the international arena, which is especially true for SMEs from the developing countries (Podolny, 1994). All of these factors gathered together may further affect the chances of potential partnerships with more established firms, who have already built competencies relevant for acquiring and integration, needed by SMEs in the emerging markets.
One of the alternate ways for smaller firms to gain access to external competencies was put forth by Iansiti and Levien (2004a, 2004b). They drew on analogies from the field of biology, and innovatively treated business networks as ecosystems, and suggested that there are three types of firms in a business ecosystem: keystones, dominators and niche players. According to the authors, the bulk of an ecosystem is composed of niche players, and since, on average, SMEs account for approximately 50 per cent of GDP and 60 per cent of employment in national economies (OECD, 2004), and 25 per cent to 35 per cent of world manufactured exports (Schreyer, 1996; Hall, 2002; Sakai, 2002), it would be proper to term SMEs as niche players. On the other hand, a keystone player would be a firm that occupies the centre of asset-sharing relationships, employs keystone strategy and by doing so improves the performance of an ecosystem, which is assessed by measuring ecosystem's health on three dimensions: productivity, robustness and niche creation. Keystone strategy is aimed at enabling other firms in the ecosystem to create value, and sharing that value with the ecosystem.
For Example, The Tirupur Exporter's Association, in Tirupur, one of the SME clusters in the southern state of Tamil Nadu in India, through the setting up of a special purpose vehicle called G-Tech Info Solutions, adopted Wipro's next generation enterprise resource planning (ERP) solution for all manufacturing units in the clusters. Exporters in Tirupur's $2-billion plus knitwear industry now share a common software platform on pay-as-you-go basis, as they seek to bring down operational costs and compete effectively with rivals from countries like Bangladesh and China. Among India's industrial hubs, this was the first time that small exporters joined hands to create a common technology platform. The cloud solution, based on Microsoft Dynamics ERP platform helped to improve the efficiency of over 4,000 small units in Tirupur (Tirupur partners, Microsoft & Wipro for cloud connect, 2011). By integrating such a set of solutions in their own organisational processes, SMEs can gain access to external competencies that would otherwise be hard to attain.
Drawing on an analogy with a notion of alliance capability (Kale et al. 2002) which suggests that a firm's critical resources may be embedded in inter-firm resources and routines, this study; has examined managerial practices and processes employed to integrate competencies external to the firm by application of platforms in the context of emerging markets' SMEs.
5 Concluding remarks
Small firms in emerging economies and developing countries have difficulty competing successfully in the international environment. The review presented in this study, intends to demonstrate the importance of resource capabilities as the central capability for SMEs in a growing economy, like India or, South Africa etc., that can facilitate SMEs in better managing their resources and capabilities in order to streamline their international activities. This is an issue of great significance in the internationalisation process of smaller firms. Furthermore this study proposes that the development of resource capabilities in SMEs needs to be adapted according to their area of expertise. Their specific strengths should be aligned with their expertise to increase their alliance capability. On the other hand the SMEs should also identify the bottlenecks in the process of increasing their resource capability and should amend them. The review presented in this study represents the theoretical framework for the further development of theory. It is expected that the extension of this study combined with perhaps a field study or a case study will help to gain further insights in this field of research.
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Accepted: August 2013


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paulro needed a new logo design and created a contest on 99designs.
A winner was selected from 70 designs submitted by 24 freelance designers.
I want a logo for my organizational consulting practice I recently launched. My company name is Same Page Solutions, LLC. Our mission is to help organizations, teams, and individuals overcome challenges, seize opportunities, and develop capability. In a nutshell, I provide services that help people in organizations coordinate and collaborate. That is, I help people get on the "same page" to achieve desired business results and create a great place to work.
Same Page Solutions, LLC
I want a company logo that communicates the concept of organizational members getting on the same page so they can achieve great results. I want to use the logo for my business cards, web page, and marketing materials.
I am the founder and managing principal of the company.
Key Services include:
1. Strategic Planning and Alignment
2. Culture Analysis and Development
3. Team Effectiveness (e.g., meeting design and facilitation; within and across group coordination)
4. Assessment, Feedback, and Action Planning Processes
5. Leadership Development (e.g., succession planning, executive coaching, group-based development)
6. Process Improvement
7. Transition and Change Management
Some of the company's values and principles:
1. We ask targeted and probing questions and listen to clients to ensure the situation and the need is accurately and thoroughly understood.
2. Solutions are data-based and practical.
3. Solutions are custom-built according to the challenge and what works in the client situation.
4. Solutions are designed to most simply and directly achieve the desired result.
5. Solutions focus on cultivating values, beliefs, attitudes, and behaviors that lead to a healthy and effective organization now and in the long run.
6. We work ourselves out of our jobs by developing self-sustaining capabilities and capacity.
7. Client members are less resistant and more committed to the solutions implemented because we actively enlist stakeholders in the data collection and action planning process.
8. Solutions will work in most any industry and organization because they are inherently based on the client situation, client needs, and what will work for the client and their people.
- I like blue and white...the same color blue that Intel Corp. has on their logo. I also like red, but I'm open to other colors.
- Tagline: Same Page Solutions, LLC: Helping organizations help themselves.
- I like simplicity.
- I want the logo artwork in vector format like that produced by Adobe Photoshop or Adobe Illustrator so that I can resize without any loss of quality.
- I don't want anything overly complicated.
Find out how a design contest works or learn more about our logo design services.

subset: commoncrawl


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Ithaca College's MBA program is one of 15 graduate business programs named to the Princeton Review's "Student Opinion Honors for Business Schools" in the operations category. The list appears in the April 2009 issue of Entrepreneur, the nation's leading publication for and about entrepreneurs.
Created and compiled by the Princeton Review, each list names the 15 graduate schools of business that were most highly rated by their students in six categories: accounting, finance, general management, global management, marketing, and operations. The schools appear on the lists in alphabetical order; they are not ranked 1 to 15. The lists are also posted online at www.entrepreneur.com/magazine/entrepreneur/index.html.
In 2007, Ithaca's MBA program was also ranked sixth in the nation for best administered programs, and has been named to Princeton Review's Best Business Schools publication in 2007, 2008, and 2009.
Said Robert Franek, Princeton Review vice president and publisher: "For nearly 20 years, our company has gathered student opinions about colleges, law and b-schools to give applicants feedback they can't find elsewhere: what the schools' own customers think of them. We salute the business schools on these lists for the outstanding job they are doing both academically and professionally in preparing their students to apply their MBA training beyond the classroom to successful job searches and productive careers. We know this will be particularly meaningful to applicants and MBA grads in these challenging economic times."
About Ithaca College's MBA Program
The School of Business offers a master's degree in business administration (MBA) and an MBA in professional accountancy. Both are intensive, 10-month programs which ground students in the advanced concepts of business management; the professional accountancy program enables graduates to meet the educational requirements necessary to take the certified public accounting exam. The School of Business is accredited by AACSB International and housed in the Dorothy D. and Roy H. Park Center for Business and Sustainable Enterprise. For more information, visit www.ithaca.edu/business/mba.


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On 1 April 2006, responsibility for health and safety policy and enforcement on the railways transferred from HSC/E to the Office of Rail and Road (ORR). This transfer affects the regulation of the operation of railways and other guided transport systems, including heritage, metros and light rail systems. HSC/E will retain responsibility for guided buses and trolley vehicle systems.
Please go to the Office of Rail Regulation website for more information.
More specific information and guidance can be found on safety and occupational health in railways
HSC Chair Bill Callaghan thanked HSE Railways for their work at HSE in a speech on the transfer of responsibility for railway health and safety to the Office of Rail and Road.


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Trauma and Post-Traumatic Stress Disorder in Patients With HIV/AIDS
December 2007
Table of Contents
I. Introduction
Exposure to a traumatic event is normally accompanied by distress. For most individuals such distress resolves spontaneously without the onset of any psychiatric illness. Among a subset of people, the type, severity, and duration of symptoms that develop following trauma will meet criteria for either acute stress disorder (ASD) or post-traumatic stress disorder (PTSD).
ASD is not as well studied as PTSD. Some trauma researchers feel ASD is on a continuum with PTSD and that the cut-off times for the two disorders are arbitrary. Therefore, a more detailed description of trauma and its treatment is provided in Section II: Post-Traumatic Stress Disorder.
Trauma can affect both psychological and physical functioning. Some research has suggested that the physical effects of trauma have been related to significant health problems, such as diminished functioning of the immune system and increased susceptibility to infections. The psychological effects of PTSD may manifest in increased risk-taking behavior, such as substance use, poor eating habits, or unsafe sexual activity. In addition, patients with PTSD may suffer from depression, social isolation, impairments in trust and attachments, and feelings of anger. Patients with HIV/AIDS may be affected by past trauma to the point that it manifests in problems with disease management, such as disrupted or negative interactions with medical personnel and/or medication non-adherence.
II. Post-Traumatic Stress Disorder (PTSD)
PTSD can result from a single traumatic event, such as a car accident, rape, or experience of a natural disaster, or from an ongoing pattern of traumatic experiences, such as childhood abuse (physical and/or sexual), domestic violence, homelessness, military duty or combat, or severe chronic illness. Because the psychological symptoms that commonly occur following a traumatic event may remit spontaneously over time for most people, some researchers conceptualize PTSD as a disorder of recovery.
The rate of PTSD following exposure to a particular trauma ranges from 12% to 70%, with the higher rates occurring in populations exposed to traumas that involve interpersonal violence (e.g., rape, sexual abuse, torture). Women have higher rates of PTSD than men. Among women, sexual assault is the most common precipitating trauma, whereas among men, the most common trauma is combat exposure.
Although PTSD has a lifetime prevalence rate of approximately 1.3% to 7.8% in the general population, the rates of PTSD in the HIV-infected population are higher. The prevalence of PTSD in HIV-infected individuals may be as high as 42%.1 Although onset of a severe, life-threatening illness (such as HIV/AIDS) can sometimes in itself be a traumatic experience leading to PTSD, more often a history of physical or psychological trauma (and diagnosis of PTSD) co-occurs with an individual's HIV status. Among people with the most severe mental illnesses, specifically schizophrenia, schizoaffective disorder, and bipolar disorder, comorbid PTSD is an important predictor of HIV infection.2
A. Presentation
Patients with PTSD may show a variety of symptoms, which must persist for more than 1 month to meet the criteria for PTSD. The symptoms may be straightforward or may vacillate between overwhelming emotions caused by memories of the event and emotional numbness and dissociation. Dissociation is a disruption in the ordinary integration of consciousness, memory, or identity. It can present as flashbacks, depersonalization, derealization, and/or episodes of lost time.
B. Diagnosis
The primary care clinician should screen for PTSD annually or more often as clinically indicated.
Clinicians should use the criteria listed in the DSM-IV for a diagnosis of PTSD in patients with HIV/AIDS (see Table 1).
Clinicians should screen patients with PTSD or significant trauma histories for clinical depression, anxiety disorders, or alcohol or other substance use disorders.
C. Management of Survivors of Trauma
Clinicians should refer patients with symptoms of PTSD to a mental health professional as soon as possible for evaluation for psychotherapy or other forms of psychiatric treatment. The goal of treatment should be to reduce symptoms and fully reintegrate a safe sense of self.
If specialized services are unavailable, the primary care clinician should prescribe medications (see Appendix II) and monitor the degree of improvement achieved with this strategy alone.
During the acute phase of treatment, clinicians should assess the patient's risk for harm to him/herself or others.
Some patients respond to medication and brief supportive interventions; most require psychotherapy and specialized mental health intervention. However, if such services are not available, the primary care clinician should prescribe medication and monitor the degree of improvement achieved with this strategy alone.
There is no single medication that treats all of the symptoms of PTSD. Currently, sertraline and paroxetine are the only FDA-approved medications for PTSD. Paroxetine should be avoided in patients less than 18 years old because of its possible association with increased suicide risk. All SSRIs (in the same doses used for depression) are helpful in treating symptoms of depression and anxiety. Moreover, controlled and open studies of various SSRIs as well as other classes of antidepressants have shown benefit in treating PTSD symptoms.3 Open trial studies of mood stabilizers have also shown some benefits. Long-term benzodiazepine use is not a preferred treatment. If benzodiazepines are prescribed, careful monitoring is required due to the potential for abuse and concerns about disinhibition in those with significant dissociative symptoms.
This article was provided by New York State Department of Health AIDS Institute.
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How to Use
the Readings
Inquiry Question
Reading 1
Reading 3: The New Town Rises as the Old Fort Declines
Today, the remaining portions of the Las Vegas Mormon Fort stand as the oldest structures in Nevada. Its historical importance was recognized at the turn of the 20th century, but little was done to preserve it. The fort property belonged to the San Pedro, Los Angeles and Salt Lake City Railroad and served as a home for Walter Bracken, the railroad's local representative and an official of Las Vegas Land and Water Company. Bracken was also a postmaster for the area in 1904. The post office continued at the ranch until the town opened and then it was moved to the new commercial center. Bracken lived and worked at the ranch prior to the sale of township sites in May 1905. He also farmed at the ranch producing both meat and produce. Unfortunately, the railroad dumped waste and oil into the Las Vegas creek, damaging the crops and detracting from the recreational area before the railroad finally halted the procedure. Until 1929, the ranch continued as a resort, dairy, and picnic spot for the town as a precursor of the resort town it would become in later years.
In 1929, the Bureau of Reclamation leased the old adobe building closest to the creek within the original fort, and rebuilt most of the east wall and other portions of the structure for a laboratory to test concrete for use in constructing Hoover Dam from 1929-31. The changes included a plank ceiling, electrical wiring and plumbing, and dividing the building into three rooms. An adobe curing room was also added to the north end of the old fort.
It was not until 1937 that the Daughters of the Utah Pioneers began a campaign to save what remained of the old fort. In 1944 they obtained a lease from the railroad on the adobe fort building to preserve it as a museum. The Union Pacific divided the property selling the portions of the old ranch to the Mormon Church, the city of Las Vegas, and the Elks Club in 1955. The land sold to the Elks actually contained the ranch house and old fort. The Stewart House was moved in the 1960s to a site in North Las Vegas and used as a restaurant, but was later demolished. The city of Las Vegas purchased the property that contained what remained of the Old Las Vegas Mormon Fort and the historic Stewart Ranch in 1971.
The site of the Old Las Vegas Mormon Fort and ranch played a significant role in the development of southern Nevada and the city of Las Vegas. The pioneer agricultural and ranching activities also contributed to the economic development of the region. While the Mormon missionaries' agricultural efforts were limited and less successful, the later ranch occupants expanded the irrigated area which led to a successful ranching operation. This helped lead the way toward the development of desert agriculture in the Southern Nevada.
Today there are remnants of the many different uses of the Old Las Vegas Mormon Fort--as a Mormon settlement, ranch, and cement testing facility. Of the original structure there is a section of the fort wall, and part of the bastion. The walls of the fort, the bastion, a corral, and garden were reconstructed and opened to the public in 2000. The foundation of the Stewart house is underground and there are future plans to unearth the foundation. There are also remnants of the testing facility which house museum exhibits with contributions by the Daughters of the Utah Pioneers. A historical marker shows the site of the first post office. On June 11, 2005 Nevada State Parks opened an education facility that reflects the story of the fort and its many uses as a ranch, testing site, and resort. The interpretation also covers all aspects of the American Indian history of the area until 1905. There is also a library for research and a visitor's center.
The Mormon Mission although only lasting two years was successful in placing Las Vegas on the map, establishing new crops planted in the Southwest, serving as a way station for travelers, promoting the legacy of a faithful people, and paving the way for the birth of Las Vegas, Nevada.
Questions for Reading 3
1. How would you describe the changes made to the fort after the railroad purchased the land?
2. What preservation efforts took place to salvage the remains of the fort?
3. Why do you think the Old Las Vegas Mormon Fort is credited with giving birth to the city of Las Vegas?
4. What remains of the Old Las Vegas Mormon Fort? How is the fort being used today? Is this the best way to preserve the story of the fort? Why or why not?
Reading 3 was compiled from Robert Elson and Alvin McLane, Old Las Vegas Mormon Fort: Historical and Archeological Perspectives (Silver City, Nevada: Intermountain Research, 1993) and site visits of exhibits.


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The stylish victory by Reddam Racing's I'll Have Another in the Kentucky Derby Presented by Yum! Brands was impressive but has failed chase opponents from the Preakness, the middle jewel of racing's Triple Crown that will be run Saturday at Baltimore's Pimlico Race Course.
As this column was written Tuesday morning, it appeared that around a dozen 3-year-olds would break from the Preakness starting gate, including the Derby winner and five horses that finished behind him on the first Saturday in May.
The most prominent potential roadblocks to I'll Have Another's bid to take a successful second step toward becoming the first horse in 34 years to win the elusive Triple Crown all come from the Derby. They include runner-up Bodemeister, fourth-place finisher Went the Day Well and fifth-place runner Creative Cause.
Daddy Nose Best, 10th in the Derby after popularity as a handicapper's longshot during Derby Week, will also travel to Pimlico to take a shot at winning the middle classic of the America 3-year-old season. And five-time Preakness winner D. Wayne Lukas will give another chance to Optimizer, who was 11th in the Derby.
The Kentucky Derby winner usually earns the role of Preakness favorite off his (or her) exploits in Louisville, but it will be a Preakness surprise if the runner-up is not the people's choice at post time. Bodemeister's second-place run for trainer Bob Baffert was a front-running dazzler as he reeled off some of the fastest fractions in Derby history. But the pace took its toll and I'll Have Another, benefiting from a trouble-free trip under rookie Derby jockey Mario Gutierrez, made a successful first-run at the leader.
While this column was penned before entry-time for the Preakness, a look at its prospective field leaves a strong impression that Bodemeister could well be the race's lone speed. Absent is a speedy type like Trinniberg, who applied pressure to Bodemeister through the Derby's opening mile, and that is a significant tactical advantage for Bodemeister in the Triple Crown's middle jewel.
In that scenario, it could be up to I'll Have Another, a natural stalker, to take the early fight to Bodemeister rather than allow him to gallop on an easy lead.
An early engagement between the Derby's top two could set the race up for Creative Cause, whose Derby run might have been a bit better than it looked, and Went the Day Well, who was 17th before launching a furious late rally in the Derby. The latter should be much closer in Saturday's early going.
The Preakness clearly revolves around Bodemeister, who has been spectacular in back-to-back efforts at the Arkansas Derby and the Kentucky Derby. It could be up to the Derby winner to take the early fight to Bodemeister, a move that would be outside of their respective comfort zones.
So make my Baltimore top four: Went the Day Well, Creative Cause, Bodemeister, I'll Have Another.
While the focus of Derby and Oaks Days is justifiably on the main events, there were plenty of performances other than the Derby win by I'll Have Another and the Oaks victory by Believe You Can that deserve praises. They include:
Best Performance
Groupie Doll set a seven-furlong track record of 1:20.44 in her runaway victory in the Humana Distaff on Derby Day. She's the latest star from the Frankfort, Ky.-based team headed by owner-breeder Fred Bradley and son Buff, the 4-year-old filly's co-owner and trainer, that brought us the beloved millionaire gelding Brass Hat. She finished 7 ¼ lengths in front of Musical Romance, the Eclipse Award filly and mare sprint champion of 2011, and is improving with every start.
Best Comeback
Morton Fink's Successful Dan won the Grade III Alysheba on Oaks Day, setting a track record for 1 1/16 miles and capping a marvelous training job by Charlie Lopresti.
Successful Dan looked like one of the best older horses in America when he finished first in the 2010 Clark Handicap at Churchill Downs, and that impression was not diminished when he was disqualified for a bumping incident in the upper stretch. But it would be 16 months before Successful Dan would return to racing after he suffered an injury to his suspensory ligament.
Lopresti, with guidance from internationally-renowned veterinarian Dr. Larry Bramlage, patiently waited for Successul Dan to come around. He finally returned to racing with an impressive allowance victory on April 6 at Keeneland.
Successful Dan must share the 2012 spotlight in Lopresti's talent-laden barn with stablemates Wise Dan, who looked like the best horse in America in his victory in Keeneland's Ben Ali, and grass star Turallure. But the 6-year-old gelding is a special horse and the careful handling by Lopresti and Bramlage has made the 2012 campaign by Successful Dan something to appreciate and savor.
Get Your Top Hat Ready
A win in the Edgewood on Oaks Day by Stephanie's Kitten – a course record for a mile on turf – should have Ken and Sarah Ramsey's homebred filly ready for a planned trip to England's famed Royal Ascot in June for a run in the Group I Coronation Stakes. One of Ken Ramsey's dreams is to win at that 300-year-old meet, and his traditional Ascot top hat is packed and ready to travel.


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Kevin Hart: A Day In The Life
Some people think just cause my tour is over that i have time to sit down and relax...So I decided to show you just what a day in the life of Kevin Hart consist of
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I'm having some issues with my Tritton Ax Pro headsets and tired of beating my head against walls am seeking outside help. I originally purchased my Ax Pros for use with my Playstation, but have since moved more into PC gaming and would desperately like to continue using my 5.1 Dolby Digital headset. The issue that I am having is that I cannot get anything other than stereo sound out of them. I have a Creative X-Fi Sound Blaster sound card which has the Dolby Digital Live codec and am using an Optical cable. The optical cable is connected to the Dolby Digital Decoder box. In my Volume Control options, S/PDIF Out shows connectivity to the X-Fi optical jack but within the Properties, under the Advanced tab I am only offered 2 Channel, 24 Bit sound options. I have enabled DDLive within the Creative Audio Control Panel and the Dolby Digital light is illuminated on the decoder box. If I "Test" the sound I am able to hear it though the headset, but no other applications produce any sound.
I am at a loss and don't know where to go from here.


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INVESTIGATION… Inside Benue where quack doctors perform surgeries, remove uterus for abdominal pains
FACT-CHECK: Truths, half-truths and lies of FG's ongoing projects in S'East
INVESTIGATION… Despite billions budgeted, Ebonyi students sit on stones under thatched roofs to learn
INVESTIGATION… Enugu public libraries in ruins despite huge budgetary allocations –Part 2
Kajuru attack a setback at efforts to promote tourism in the country, Lai Mohammed laments
Reps protest as Speaker passes bill for 2nd reading despite 'nay' vote
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Wooden Beds
We offer a large range of fantastic wooden beds for sale from Birlea, Serene and Kaydian, at low prices. Available in single, double and king size, there is a size to suit everyone. Free delivery is available by our friendly and efficient 2 man delivery service.
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text: Marketing was never my strongest or most favorite part of the business. My son has his own marketing company and pretty much told me if I don't listen to his advice then business is going to decline. I listened to him and had him set up my mobile website and also a crm to manage my customers. I'm now one of the highest ranked plumbing companies on Angies, HomeAdvisor and Yelp in my area. I have people waiting weeks for me to make a repair and I'm charging more for drain cleanings. He asked me to share my experience with my contracting network and to let them know that if you don't have a system in place to collect reviews then it's going to be really tough to catch up to the competition in the near future. Now that I see how important it is I have to agree. Never would have listened to a random marketer who calls every day so I kind of lucked out my son does this for a living. If anyone is looking for some help in the website and marketing area I'd recommend reaching out to him. Feel free to send me a message on here or look up his company directly, Motivo Media.


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Over the last ten years we've watched interior color schemes change from deep earth tones to bright, bold colors and prints contrasted with crisp black and white spaces completely void of color. 2012 marked the start of a transition from … Continue reading
Bathroom Spas
Spa Bathrooms – A New Trend in Modern Bathrooms Purely utilitarian bathrooms are a thing of the past. Today's trend of bathroom renovations can add space, style, and comfort to what was once a small, cramped room, turning a bath … Continue reading
Functional Kitchen Spaces
A kitchen can be a family gathering place, a foodie's refuge, an office, and a spot for homework. The kitchen remodeling trend makes kitchens efficient and attractive with a perfect blend of great use of space and complementary accessories that … Continue reading
Smart Kitchen Remodeling Pays Off
These days everyone is concerned about resale value when they think about home renovations. Kitchens are the hub of everyday life and they go out of style faster than other parts of the house, so they are one of the most common places to put your remodeling dollars. Even in today's uncertain economy, a good kitchen renovation can add significant value to your home. However, I warn my clients is that it's more important to have a smart kitchen remodeling project than one that is luxurious or has the latest cutting edge features.
Remodeling for the Family Pet
Every once in a while I get a request to remodel a home so that it's pet-friendly. That shouldn't be surprising; after all, it's estimated that 73 million dogs and 90 million cats live in U.S. households. Doing renovations for your pet may sound like some pet owners are being overly indulgent, but remember that taking your pets' needs into account can also makes life easier for you. If you can put the litter box in an out-of-the-way location or find a convenient way to bathe the dog, your house will be better suited to your lifestyle.


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About the Cricket Match - A fabulous day though, thoroughly enjoyed from beginning to end, thanks for letting us be a part of it.
Jamie Finlinson - Southend
I read your website the other day. What a terribly sad story, but an excellent cause. Well done for your good work!
Mark Balcombe - Southend
I think Katie would be extremely proud of how much money has been raised by you and all her family and friends and school friends too, for such a....
Jenny Abrahams - Witham
Well what can I say – other than massive congratulations for a brilliant afternoon yesterday smashing the 100k milestone in Katie's memory.
Peter Hall - Little Havens
On reaching £100,000 - Fantastic effort on your part to have raised so much money - a massive well done to you and all of your family, frie....
Martin Sanderson -
On reaching £100,000 - Just a quick email to congratulate you on yesterday. Beautifully organised and hosted, good win and of course getti....
Richard Brown - King's Lynn
Article last updated : 08/05/2012
We have now taken delivery of 250 of the beautiful Katie wristbands, selling them at £1 each.
The wristbands come in small, medium and large. We also now have our 2009 & 2012 badges at £2.50 each so please contact us if you wish to make a purchase.


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PrimaX® P Gas Transmitter
Designed to detect gases indoors or outdoors, our PrimaX P Gas Transmitter measures oxygen and toxic and combustible gases. The flameproof transmitter is housed in a powder-coated aluminum enclosure that will protect it in extremely dangerous conditions. The unit also features a large, easy-to-read LCD screen and three LED status indicators for up-to-the-second reporting. The transmitter attaches to an integral mounting plate for easy installation, and it can be easily calibrated using the built-in keypad. It uses a 4-20 mA output signal to transmit its data, and it can also be configured to use HART digital communication. With easily replaced plug-in sensors, the PrimaX P transmitter is suitable for laboratories, chemical plants, power plants and several other industry settings.
PrimaX® I Gas Transmitter
Indoors or outdoors, our PrimaX I Gas Transmitter provides dependable, accurate gas detection. The transmitter detects toxic gases and oxygen and is housed in an antistatic, reinforced nylon enclosure. It also has a large, easy-to-read LCD screen and attaches to an integral mounting plate for easy installation, while the built-in keypad makes for quick, simple calibration. To transmit data, the unit uses a 4-20 mA output signal and can also be configured to use HART digital communication. With easily replaced plug-in sensors, the PrimaX I transmitter is suitable for laboratories, chemical plants, power plants and several other industry settings.
Senscient ELDS™ Open Path Gas Detector
The Senscient ELDS laser-based open path gas detector is available for a wide range of toxic and flammable gases. The Senscient ELDS uses 'SimuGas' self-testing to eliminate employees entering hazardous areas for gas checks. Nuisance false alarms are virtually eliminated with its breakthrough Harmonic Fingerprint processing.
Observer-i Ultrasonic Gas Leak Detector
Instantly detect pressurized gas leaks with this high-precision, omni-direction acoustic detector utilizing Gassonic ultrasonic technology. Works even when traditional methods of gas detection are unsuitable or dependent on ventilation. Features Artificial Neural Network (ANN) technology that distinguishes between real gas leaks and false alarm sources without requiring any in-field training. The Observer-i UGLD provides an industry-leading detection range (up to 28 m) reducing the number of detectors required. Ideal for use in complex, outdoor pipeline systems.
Ultima® X Series Gas Monitors
Designed to provide thorough, continuous monitoring of many hazardous gases, the indoor/outdoor Ultima X Series Gas Monitors offer excellent performance and MSA quality craftsmanship. DuraSource™ Technology offers extended sensor life, while HART provides convenient setup, calibration and diagnostics. HART also allows for existing component install and wiring to be used. A single circuit board increases reliability, while our patented sensor disconnect-underpower feature allows all sensors to be replaced in hazardous areas without area declassification. The units are crafted from either stainless steel or polycarbonate, and the interchangeable smart sensors eliminate the need for reconfiguration. Our scrolling LCD screen display sensor reading and gas type, while the calibration process includes date stamping and the ability to calibrate locally or remotely.
H2S Gas Sensors and Accessories
General Monitors' hydrogen sulfide (H2S) sensors are solid state devices, designed and manufactured for long life and fast response. They are selective to H2S and remain unaffected by high concentrations of other substances like hydrogen, sulfur dioxide, and gasoline vapors, which are often present in facilities that process sour gas and crude oil. A high tolerance to a broad range of temperatures and humidity enable these sensors to operate in rugged environments, as does their capacity to withstand exposure to high H2S concentrations over short periods.
S4100T H2S Gas Detector
The S4100T Intelligent Sensor is a highly reliable, self-contained, microprocessor-controlled hydrogen sulphide transmitter with integral 3 digit readout. It is designed to measure and display concentrations of H2S in the 0-20 ppm, 0-50 ppm or 0-100 ppm range, but will continue to display concentrations up to 120% FSD. The gas sensor may be incorporated in the transmitter housing or remotely mounted at distances of 600 meters. The sensor employs thin film metal oxide semiconductor (TFMOS) technology as the measuring principle.
TS4000H - H2S Electrochemical Gas Detector
The TS4000H Intelligent Toxic Gas Detector continuously monitors hydrogen sulfide (H2S) in several ppm ranges, delivering highly accurate detection and protection. The unit features one person calibration and can virtually self-calibrate by simply activating a magnetic switch and applying gas. It provides status indication and alarm outputs. Configurations with relays, Modbus, and HART are available to meet many needs.
S4000TH H2S Gas Detector
The S4000TH Intelligent Gas Sensor is a microprocessor-based transmitter designed for use with General Monitors' thin film metal oxide semiconductor (TFMOS) sensors to detect H2S gas. The unit features one person calibration and can virtually self-calibrate by simply activating a magnetic switch and applying gas. It detects hydrogen sulfide in 0-20 ppm, 0-50 ppm or 0-100 parts per million (ppm) levels over a wide temperature range.


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Non Hodgkin Lymphoma in ChildrenHodgkin Lymphoma - Causes, Symptoms, Diagnosis and Treatment
What is non-Hodgkin lymphoma (NHL)?
Non-Hodgkin lymphoma is cancer in the lymphatic system. The lymphatic system is part of the immune system and functions to fight disease and infections.
The lymphatic system includes the following:
lymph fluid - fluid containing lymphocyte cells.
lymph vessels - thin tubes that carry lymph fluid throughout the body.
lymphocytes - specific white blood cells that fight infections and disease.
lymph nodes - bean-shaped organs, found in the underarm, groin, neck, chest, abdomen, and other parts of the body, that act as filters for the lymph fluid as it circulates through the body.
Non-Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually causing tumors to grow. The cells can also spread to other organs and tissues in the body.
Non-Hodgkin lymphomas are the third most common childhood cancer in the U.S. About 500 cases are diagnosed in children in the U.S. each year. They can occur at any age from infancy to adulthood.
Non-Hodgkin lymphoma affects males more often than females, and is more common among Caucasian children than among African-American children and children of other races.
Staging and classification of non-Hodgkin lymphoma is based on the extent of the disease and the specific cells involved.
What are the different types of non-Hodgkin lymphoma?
Non-Hodgkin lymphoma in children is almost always one of three types:
lymphoblastic non-Hodgkin lymphoma
Lymphoblastic non-Hodgkin lymphoma accounts for about 30 percent of the cases, usually involves the T-cells (T-lymphocytes), and typically presents with a mass in the chest, swollen lymph node(s), with or without bone marrow and central nervous system involvement.
Burkitt's or non-Burkitt's lymphoma
Burkitt's or non-Burkitt's lymphoma is a non-Hodgkin disease in which the cells are undifferentiated and diffuse. This has also been referred to as small non-cleaved cells. Burkitt's and non-Burkitt's lymphoma accounts for about 40 to 50 percent of the cases and is usually characterized by a large abdominal tumor and may have bone marrow and central nervous system involvement.
large cell or diffuse histiocytic non-Hodgkin lymphoma
Large cell or diffuse histiocytic non-Hodgkin involves the B-cells or T-cells and accounts for about 25 percent of the cases. Children with this type of non-Hodgkin lymphoma usually have lymphatic system involvement, as well as a non-lymph structure (such as lung, jaw, brain, skin, and bone) involvement.
Large cell anaplastic lymphoma is a less common type of lymphoma in children. Treatment for this type is the same as for large cell lymphoma.
How is non-Hodgkin lymphoma staged?
Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging symptoms that are used for non-Hodgkin lymphoma. Always consult your child's physician for information on staging. One method of staging non-Hodgkin lymphoma is the following:
stage I - the lymphoma is at one site, either nodal or elsewhere in the body, but not in the chest or abdomen.
stage II - the lymphoma is at two or more sites on the same side of the body (above or below the diaphragm), but not in the chest.
stage III - the lymphoma is in the chest or spine, or it has spread widely in the abdomen, or it is both above and below the diaphragm, but it does not involve bone marrow or the central nervous system.
stage IV - any stage of tumor that also has bone marrow and/or central nervous system involvement. Stage IV is also subdivided depending on the amount of blasts (cancer cells) present in the bone marrow.
What causes non-Hodgkin lymphoma?
The specific cause of non-Hodgkin lymphoma is unclear. It is possible that genetics and exposure to viral infections may increase the risk for developing this malignancy. Non-Hodgkin lymphoma has also been linked to chemotherapy and radiation therapy. Non-Hodgkin may be a second malignancy as a result of the treatment for certain cancers.
There has been much investigation into the association of the Epstein-Barr virus (EBV) that causes the mononucleosis infection; as well as the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS). Both of these infectious viruses have been linked to the development of Burkitt's lymphoma.
Children and adults with other hereditary abnormalities have an increased risk of developing non-Hodgkin lymphoma, including patients with ataxia telangiectasia, X-linked lymphoproliferative disease, or Wiskott-Aldrich syndrome.
What are the symptoms of non-Hodgkin lymphoma?
In many cases, non-Hodgkin lymphoma in children may not cause symptoms until it has grown or spread. Most children have stage III or IV disease at the time of diagnosis because of the sudden onset of symptoms. The disease can sometimes progress quickly from a few days to a few weeks. A child can go from otherwise healthy to having multi-system involvement in a short time period.
Some children with non-Hodgkin lymphoma have symptoms of an abdominal mass and have complaints of abdominal pain, fever, constipation, and decreased appetite due to the pressure and obstruction a large tumor in this area can cause.
Some children with non-Hodgkin lymphoma have symptoms of a mass in their chest and have complaints of respiratory problems, pain with deep breaths (dyspnea), cough, and/or wheezing. Lymphomas in the chest can also press on a main blood vessel (the superior vena cava), which can cause swelling and a bluish coloration in the head and arms. If left unchecked, it can also affect the brain and may even be life-threatening.
The following are the most common symptoms of non-Hodgkin lymphoma. However, each child may experience the symptoms differently. Symptoms may include:
painless swelling of the lymph nodes in neck, chest, abdomen, underarm, or groin
sore throat
fullness in groin area from node involvement
bone and joint pain
night sweats
tiring easily (fatigue)
weight loss/decreased appetite
itching of the skin
recurring infections
The symptoms of non-Hodgkin lymphoma may resemble other blood disorders or medical problems. Always consult your child's physician for a diagnosis.
How is non-Hodgkin lymphoma diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for non-Hodgkin lymphoma may include:
blood and urine tests
x-rays of the chest - use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
computed tomography scan of the abdomen, chest, and pelvis (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
positron emission tomography (PET) scan - radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) can be detected by a scanning machine. PET scans can be used to find small tumors or to check if treatment for a known tumor is working.
magnetic resonance imaging (also called an MRI scan) - MRIs use radio waves and magnets. The energy from the radio waves creates patterns formed by different types of tissue and diseases. This produces detailed cross-sectional pictures that look like slices of the body. This test is helpful in examining the brain and spinal cord. Or it may be used if the results of an X-ray or CT scan aren't entirely clear.
ultrasound (also called sonography) - a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
lymph node biopsy - a sample of tissue is removed from the lymph node and examined under a microscope.
bone marrow aspiration and/or biopsy - a procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.
lumbar puncture (to evaluate central nervous system disease for cancer cells ) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing. CSF is the fluid which bathes the brain and spinal cord.
removal of fluids from the chest or abdomen
Treatment of non-Hodgkin lymphoma
Specific treatment for non-Hodgkin lymphoma will be determined by your child's physician based on:
your child's age, overall health, and medical history
the type and extent of the disease
your child's tolerance for specific medications, procedures, or therapies
the expectations for the course of the disease
your opinion or preference
Treatment may include (alone or in combination):
radiation therapy
close monitoring of blood work
bone marrow transplant
bone marrow examinations
lumbar punctures/spinal taps
antibiotics (to prevent or treat infections)
supportive care (for side effects of treatment)
long-term follow-up care (to determine response to treatment, detect recurrent disease, and manage late effects of treatment)
Long-term outlook for a child with non-Hodgkin lymphoma
Prognosis greatly depends on:
the extent of the disease.
the presence or absence of metastasis.
the response to therapy.
age and overall health of the child.
your child's tolerance of specific medications, procedures, or therapies.
new developments in treatment.
As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with non-Hodgkin lymphoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of non-Hodgkin lymphoma. New methods are continually being discovered to improve treatment and to decrease side effects.


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Postmortem: Stardock Entertainment and Ironclad Games' Sins of a Solar Empire: Rebellion
October 9, 2012 Page 1 of 3
The original Sins of a Solar Empire released in 2008 to critical and commercial success. Development responsibilities for the game and its two subsequent expansion packs were shared between Ironclad Games and published by Stardock Entertainment.
Staffing breakdown for Stardock developers on Sins: Rebellion
Even after two expansions, the teams felt the definitive version of the game had not yet been realized. With Ironclad Games working on the forthcoming Sins of a Dark Age, Stardock took a greater role in the development of the stand-alone expansion Sins of a Solar Empire: Rebellion to do just that.
Sins: Rebellion was developed with a small team over 13 months, including about a week of crunch (mostly individual late nights clustered around the various beta and final releases). Stardock's staffing peaked at 11 developers, as shown below.
What Went Right
1. Focused Design
The original Sins of a Solar Empire was a game of considerable scope and depth when it was initially released. After two additional expansions, simply adding more ship variants or weapon buff technologies would have been adding content without purpose.
We also had logistical constraints. Stardock's other internal projects limited the number of art staff that would be available to us. Additionally, engine memory constraints limited the number of assets that could be added. We ended up taking a quality over quantity approach, both as an intentional design choice and out of necessity.
Concept for one of the six new Titan warships (click for full size)
Careful gameplay balance was needed to make these units game-changers, without overpowering other strategic options. Click for larger version.
With this in mind, the design of the game followed the approach of adding unique and game-changing technology, ships, and victory conditions. With that approach came additional risk. Features like destroying entire planets or players abandoning their homeworld and "going mobile" added new strategies, but also could have upset the balance of the entire game if implemented poorly.
Gameplay balancing to avoid these risks quickly becomes a time sink when a complete match lasts 5-plus hours. We also needed to balance the needs of hardcore competitive multiplayer fans with our larger single-player focused audience. Since the development of the original Sins, an "MVP" program was used to mitigate these problems. Through this program we invite some of our most active community members to receive regular builds throughout development and give feedback on the balance of new gameplay features.
The MVP program combined with our team's strategy design expertise and long experience with the franchise allowed us to walk that fine line of making big new changes without breaking the core of what fans had grown to love. This paid dividends in reinvigorating the gameplay and was the high point of many reviews.
2. Cutting Scenarios
One of the complaints that showed up consistently in reviews of the original game was its lack of a campaign. We'd always felt that a campaign wasn't a good fit for the type of gameplay that Sins of a Solar Empire offered. Our sandbox style games also tend to last as long as most single player campaigns. Though a traditional campaign was off the table, we did design a "Scenarios" feature to address a player's desire for more controlled and deliberately paced gameplay challenges.
About eight months into development, we took a hard look at the work remaining on the project and realized that moving forward on the Scenarios feature would likely result in:
- Pulling design resources and attention from core features
- Significant crunch or delays
- Still falling short of user's desire for a story-driven Sins experience
- All of the above
We decided to cut the feature, while leaving in the underlying tech for modders to experiment with post-release. It may be odd to have a complaint from reviewers and fans alike in the "What Went Right" section of a postmortem, but we feel we made the right decision to ensure what we did deliver fans was of the highest quality.
3. Proven Technology
Despite the Iron Engine nearing five years old, it's solid and proven technology that our engineers loved to work with. The ability to update art and design content and see the results on the fly was invaluable, especially in a game where single play sessions can last in the tens of hours.
If we weren't confident in the existing tech, the project would have likely been cancelled before it got off the ground. We knew from the start that switching engines or making major overhauls was out of scope for the time and budget we had to work with (as is usually the case with expansions).
One new ability allows players to destroy whole planets, drastically altering the map
While the core tech worked great, the game was beginning to show its age. Instead of major overhauls, we identified graphics features that would keep us visually competitive with recent releases while staying within the scope of the project. Some examples include dynamic shadows, anisotropic filtering, and improving anti-aliasing quality. These features allowed us to keep using tech we were familiar with without letting down fans and critics with dated visuals.
Page 1 of 3


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Home > Other Stuff > News & Notes> China-Japan air travel recovering
News & Notes
China-Japan air travel recoveringDec 08 (Sat ), 2012
Air travel demand has started to recover on routes between China and Japan after previously being hammered because of the territorial dispute between the two countries.
"Demand from business class passengers is coming back to the level before [the disputes happened]," said Shinichiro Ito, the president and chief executive of All Nippon Airways. "Sooner or later, a full recovery will come, probably next year."
However, leisure travel still had not shown signs of recovery as tourists would rather delay their trips until the tension subsided, Ito said.
"We forecast that December's passenger volume will swing back to as much as 80 per cent of the level in the same period last year," he said.


text: On Fri, 11 Feb 2005, Isaac Dooley wrote: > >True. I always wonder what the low-CPU-usage-advocates want the MPI > >process to do while i.e. an MPI_Send() is executed. > > > They don't want the process to do anything when the call MPI_Send, > however carefully using asynchronous or non-blocking messaging ideally > would not use the CPU. Unless your code is multi-threaded, why do you care what the CPU utilization is during MPI_Send()? Saving on the power bill? When you call MPI_Send() semantically you've said "Hey, send this, and btw I can't do anything else until you are done." Likewise for MPI_Recv(). So the implementation will be built to get things done as quickly as possible. Often the path to lowest latency leads to polling, which leads to the high CPU utilization. Same issue with interrupt mitigation, as mentioned earlier in the thread; you can save CPU by coalescing, or you can get better performance. > Using MPI_ISend() allows programs to not waste CPU cycles waiting on the > completion of a message transaction. No, it allows the programmer to express that it wants to send a message but not wait for it to complete right now. The API doesn't specify the semantics of CPU utilization. It cannot, because the API doesn't have knowledge of the hardware that will be used in the implementation. > This is critical for some tightly coupled fine grained applications. What exactly is critical for tightly coupled, fine grained applications? I would think that extremely low latency communication would be the most important factor, not whether or not we crank on the CPU to get that. > Also it allows for overlapping computation and communication, which is > beneficial. Sure! Rob --- Rob Ross, Mathematics and Computer Science Division, Argonne National Lab


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Posts TaggedBindo POS
The iPad is a fantastic tool for helping you to manage your business. With the wide array of applications available you're often spoilt for choice — this is no exception when looking for an on-the-go mobile inventory management software. But with each iPad inventory management app offering similar features, such as the management of sales and shipping, it's often hard to distinguish between them.
To be the perfect solution for you, iPad inventory management software needs to offer equivalent functionality to its web-based counterpart and be reasonably priced. Below I've looked at six of the best iPad inventory management applications that achieve this. All of these apps are free to download and install, but you'll need a subscription to the cloud service in order to make use of them. Luckily, most have free trials so you can give them a spin and see which one is best for your business.
Read on to find out more!


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One of my favorite movies is Pirate Radio (The Boat that Rocked is the American release title). A quick summary of the plot: Pirate Radio is the high-spirited story of how 8 DJs love affair with Rock n' Roll changed the world forever. In the 1960s this group of rouge DJs, on a boat in the middle of the Northern Atlantic, played rock records and broke the law all for the love of music.
The primary villain in the film is government tight-wad Sir Alistair Dormandy, played magnificently by Kenneth Branagh. In his bid to rid the world of the "filth and pornography" of Pirate Radio he states the following: "You see, that's the whole point of being the government. If you don't like something you simply make up a new law that makes it illegal."
So, why am I bringing this up? Well, the simple fact is we as a species seem to do this all the time. We simply change the rules to suit us, regardless of the consequences that may come to bear from doing so. I think that is where I see my current situation right now. Am I doing this? No. But I see various WoW friends doing it, and perhaps they don't even realize it.
Rules are not merely a thing of convenience to be bent or broken when they no longer suit us. They are there to provide order and structure. The rules whatever they may be are to provide a foundation for all to stand upon equally. Everyone knows where they start or begin, where they stand. Is it true that some bend or break the rules for their personal gain? Of course! But then you become THAT guy pictured above. You become Sir Alistair Dormandy. You become the 1%. You become the person who thinks the rules do not apply to them.
Let's be clear, rules are not always presented as rules. Sometimes they are guidelines, recommendations, perhaps just expectations. For example, there are no signs at Starbucks that state no cutting in line. You could walk into Starbucks and merely squeeze yourself right into the front of the line and order your coffee. Bypass that long pesky line and do as you please. When someone complains you can simply state "Hey, there is no rule about no cutting. There is no sign. Its not against the law." But if someone did it to you, you would be PISSED. To say the least. See, these types of rules are rules of convenience. People tend to use them when they are advantageous and benefit them, but want to ignore them when they no longer suit their situation. Now, I know you are wondering…"Q, how does this pertain to WoW!?" Well, let me tell you…
I am a member of Phalanx of Nod on Dalaran. Its a good guild of good people. I've seen some folks come, some folks go. When I joined PoN, I came into it with the understanding that it was a social/casual guild. They put the people first and foremost. Its an inclusive environment that does not exclude anyone for the laundry list of reasons that we all have encountered in WoW: noob, under-geared, not min/maxed, dps too low, hps too low, don't know your class, can't play/raid at least x% per week, etc etc. We have all encountered this in game before. We were weighed and measured to someone else's standards and left wanting, and therefore told that we were not welcome. It sucks. PERIOD END OF STORY. I, you, me, everyone do not pay the same $15 a month to play a video game to have ourselves judged by someone else and left feeling inadequate simply because some DPS meter doesn't add up right, or because you have kids or work and cannot find the time to log-in 6 days a week.
Now, there are times we voluntarily agree to such things. We walk into the environment and agree to the rules and regulations. You cannot join the Military and expect to have unkempt long hair, or wear whatever uniform you choose, its not G.I. Joe. There are agreed upon standards that you accept when you walk through the door. A WoW guild is no different.
When a guild states that it puts the people first, they are unequivocally stating the social aspect is most important. Ultimately this benefits most if not all people. If you opt to gear up your main when raiding, then decide you want to switch mains to an alt, its accepted. No worries, even if you do it 2 or 3 times over the course of an expansion, it will be allowed. Why? Because we all want you to play a toon you are happy playing. Need a break, want to walk away and not long in for 6 months? No worries. You can log back in and no one will bat an eyelash and all will welcome you back with open arms. "We missed you! Where have you been? Everything good? Need help leveling? Need gear or money?" Can't log in for raiding each week consistently due to work, family, schedule changes; no worries. Log in when you can and we will gladly fit you in as best as we can. Left out of raid – let's run LFR or some dungeons together.
The point here is that by putting the people first its an environment of inclusiveness, not exclusivity. No one should be harassed for not min/maxing, not putting out best possible DPS/HPS, essentially: No one is held to YOUR standards and left wanting.
Is this how you run a progression guild? No. Is this the best method for having a world ranked guild? Certainly not. I never joined PoN with that expectation in mind. It was not stated or ever presented that way. In fact, the very opposite. When I needed to take a few weeks off from playing due to home construction, no one ever dropped me from the raiding rank upon returning nearly 6 weeks out of the game. When I get into the competitive soccer season and some times can only make raids once a week, no one has clamored for me to be kicked from the guild. When I choose to not log in one night so I can have a date night with my spouse, I do not find myself being berated for choosing quality time with my wife over the game.
Now, thing is…things can change. Collectively a guild can decide to migrate from a social/casual guild to a progression focused one, and vice-versa. But understand, change is HARD. it encompasses many aspects that are not so easily calculated, and simply stated: humans do not like change. We are bad at it, especially under short time frames. More importantly if you change those expectations, you may find the rules that benefited you previously, now work against you. No you may NOT switch mains. No you can't raid with us you haven't logged in for 6 weeks or 6 months. No you are not welcome in the raid team, your DPS /HPS is too low. You are a noob, learn your class. You constantly stand in the bad, get out of the raid. Why are you not max geared? Is that best in slot? Why aren't you flasking? Why aren't you pre-potting?
I could go on, but I trust you get the idea. The very eye of scrutiny, the very measuring stick your used against someone else, could now be turned upon you. What was once an environment where laughing, relaxing, having fun with whomever showed up, changes to one of constant dissection and derision all for the glory of boss kills.
Don't get me wrong, I want to see digital dragons dead at my hunter's feet too; but never again at the cost of perpetuating an environment of exclusivity. I just don't want to be "that guy".