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Conditionals are of two basic kinds, often called ‘indicative’ and ‘subjunctive’. This book expounds and evaluates the main literature about each kind. It eventually defends the view of Adams and Edgington that indicatives are devices for expressing subjective probabilities, and the view of Stalnaker and Lewis that subjunctives are statements about close possible worlds. But it also discusses other views, e.g. that indicatives are really material conditionals, and Goodman's approach to subjunctives.

ObjectivesUtility of CT coronary angiography (CTA) and coronary artery calcium (CAC) scoring in risk stratification prior to non-cardiac surgery is unclear. Although current guidelines recommend stress testing in intermediate-high risk individuals, over one-third of perioperative major adverse cardiovascular events (MACE) occur in patients with a negative study. This systematic review and meta-analysis evaluates the value of CTA and CAC score in preoperative risk prognostication prior to non-cardiac surgery.MethodsMEDLINE, PubMed and EMBASE databases were searched for articles published up to June 2018. Summary ORs for degree of coronary artery disease (CAD) and perioperative MACE were pooled using a random-effects model.ResultsEleven studies were included. Two hundred and fifty-two (7.2%) MACE occurred in 3480 patients. Risk of perioperative MACE rose with the severity and extent of CAD on CTA (no CAD 2.0%; non-obstructive 4.1%; obstructive single-vessel 7.1%; obstructive multivessel 23.1%, p<0.001). Multivessel disease (MVD) demonstrated the greatest risk (OR 8.9, 95% CI 5.1 to 15.3, p<0.001). Increasing CAC score was associated with higher perioperative MACE (CAC score: ≥100 OR 5.1, ≥1000 OR 10.4, both p<0.01). In a cohort deemed high risk by established clinical indices, absence of MVD on CTA demonstrated a negative predictive value of 96% (95% CI 92.8 to 98.4) for predicting freedom from MACE.ConclusionsSeverity and extent of CAD on CTA conferred incremental risk for perioperative MACE in patients undergoing non-cardiac surgery. The ‘rule-out’ capability of CTA is comparable to other non-invasive imaging modalities and offers a viable alternative for risk stratification of patients undergoing non-cardiac surgery.Trial registration numberCRD42018100883

INTRODUCTION:Ischemic Colitis (IC) is the most common form of intestinal ischemic disorders. This disease process typically affects older adults and is the result of non-occlusive hypoperfusion, which can be precipitated by a multitude of risk factors. Patients usually present with lower abdominal pain and hematochezia. A colonoscopy with biopsies is the gold standard for diagnosis. Increasingly, medications have been associated with contributing to this disease process. Here, we report a unique case of IC attributed to Docetaxel, a taxane class chemotherapeutic agent.CASE DESCRIPTION/METHODS:A 76-year-old Caucasian female with a history of multi-focal intraductal carcinoma (Stage IIA), hypertension, and diverticulosis presented to the emergency room (ER) with complaints of lower back and abdominal pain. She had begun therapy with Docetaxel and Cyclophosphamide 8 days prior to presentation. In the ER, she was afebrile, neutropenic (ANC 400), and hypotensive requiring supportive care including antibiotics, fluids and a very brief course of norepinephrine. She was subsequently admitted to the intensive care unit where her neutropenia was noted to have resolved and antibiotics were discontinued in setting of negative cultures. On hospital day 3, she complained of continued abdominal pain and hematochezia with CT imaging that demonstrated bowel wall thickening and mild inflammatory changes in the sigmoid/descending colon. Subsequently, a colonoscopy was performed and showed circumferential, violaceous mucosa consistent with IC. Antibiotics were restarted and the patient was treated supportively with complete resolution of symptoms. Following hospital discharge, she was evaluated by her oncologist who discontinued her Docetaxel and initiated therapy with Paclitaxel. No recurrence of her symptoms have been noted and repeat cross sectional imaging demonstrated resolution of colonic thickening in the previously noted watershed distribution.DISCUSSION:IC is a rare but serious complication that has been described in patients receiving Docetaxel. Among the 6 reported cases, symptoms occur within 10 days of Docetaxel administration. Patients present with abdominal pain and hematochezia in the setting of neutropenia with or without fever. This type of IC is often severe, with spontaneous perforation, bowel necrosis, and a reported mortality rate of 40-50%. Although underreported, Docetaxel use is a risk factor for developing IC, one deserving of more clinical awareness.

INTRODUCTION:Anorectal sources account for 15–20% of hospital admissions for acute lower gastrointestinal bleeding (LGIB). Rectal varices are common in patients with portal hypertension, however, clinically significant bleeding occurs in only 0.5–5%. Management of rectal varices is described in several case reports but no standardized therapy exists due to the low incidence. Here we describe a case rectal varices treated by collateral vein embolization during an initial presentation for noncirrhotic hepatocellular carcinoma.CASE DESCRIPTION/METHODS:A 69-year-old African American male presented for weakness in the setting of 3 days of hematochezia. Medical history was notable for prostate cancer status post radiation therapy, prior hepatitis B exposure and hepatitis C status post Harvoni with sustained virologic response. Physical examination was notable for normal vital signs and gross blood on glove during rectal exam. Labs revealed a hemoglobin of 11.6 g/dl, and BUN of 18.0 mg/dl. CT abdomen was performed and notable for asymmetric rectal wall thickening, an ill-defined mass at the hepatic dome and expansion of the portal veins. He was admitted for colonoscopy in the setting of hematochezia. Liver MRI was completed, showing an abnormal heterogeneous right hepatic lobe with extensive portal vein thrombus and a 1.1 cm exophytic nodular LI-RADS 5 lesion. Tumor markers were notable for a normal CEA, and an Alpha-1-fetoprotein of >55,000 ng/ml. Colonoscopy was performed to evaluate the rectal findings on CT, revealing large rectal varices with a prominent nipple sign. Interventional radiology (IR) was consulted for embolization of a venous shunt draining bilateral hemorrhoidal veins and obtained a liver biopsy, resulting in grade II-III Hepatocellular carcinoma (HCC). Patient would ultimately fail sorafenib and lenvatinib therapy due to liver toxicity and continued tumor growth without recurrence of LGIB.DISCUSSION:HCC in the absence of cirrhosis has been documented in several patient populations to include chronic hepatitis B and more recently NASH. Portal vein thrombosis (PVT) is common in HCC with an incidence of 34–50%, and frequently leads to varix formation. Rectal varices are less common than esophageal and gastric varices, however can still result in life threatening hemorrhage. Given the low incidence, there are no established guidelines to define management strategies for bleeding rectal varices. Currently long term management is directed by physician expertise and available services.

Detonation, a combustion phenomenon is a supersonic combustion wave which plays critical role in the theory and application of combustion. This work presents numerical investigation into indirect initiation of detonation using direct numerical simulations (DNS). The Adaptive Mesh Refinement in object–oriented C++ (AMROC) tool for parallel computations is applied in DNS. The combustion reactions take place in a shock tube and an enclosure with a tube respectively and are controlled by detailed chemical kinetics. The database produced by DNS accurately simulates the process of transition of deflagration to detonation (DDT), and investigates the influence of overpressure and kinetics on flame propagations during combustion processes. The numerical simulations showed the influence of pressure and kinetics to the transition of slow and fast flames and DDT during flame propagations. When the reaction rate is fast, DDT is achieved, but when slow, DDT will not occur and therefore, there will be no detonation and consequently no strong explosion. Exploring the influence of free radical H on flame propagation showed that the concentration of the reacting species decreased with flame speed increase for each propagation. Hence, the heat generated was very fast with a greater chance of DDT beingtriggered because flame speed increased.

Even though numerical simulators that use the finite difference approach to model the oil and gas fields and to forecast the field performance are popular in the petroleum industry, they suffer from a very long central processing unit (CPU) time in the complex reservoirs with large number of grids. This issue could be resolved by streamline simulation and it could significantly decrease the runtime. This work explains the the streamline simulation concept and then a real oil field is studied using this technique, the streamline simulation is conducted by a commercial simulator, i.e., FrontSim streamline simulator and then the model was analyzed to find the optimum location of infill wells. In this work, 34 different cases were studied using Streamline simulation method and FrontSim software by considering different arrangement of infill wells. It was concluded that a significant enhancement in the ultimate recovery factor of the oil reservoir could be attained by considering different arrangement of the infill horizontal and vertical wells. It was highlighted that the ultimate recovery factor could be increased significantly, i.e., 13%. Additionally the water cut of the field could be reduced significantly. The novelty of this work is to capture the impact of both vertical and horizontal wells on the ultimate recovery enhancement simultaneously using the concept of streamline simulation and optimization of the field performance using streamline simulation concept.

Purpose There is little research into how teachers think about and teach creative writing and its redrafting and how this might differ depending upon the age of the pupils being taught. This paper aims to compare the creative writing conceptualisations and practices of primary school teachers (5–11-year olds) and secondary school teachers (11–18-year-olds) in England through a qualitative survey. This comparison enables to think about the influence of policy on creative writing in primary and secondary schools as well as what professional development could look like for these teachers to improve the teaching of creative writing. Design/methodology/approach A qualitative survey exploring the creative writing and redrafting pedagogies and conceptualisations was responded to by primary school teachers (n = 18) and secondary school teachers (n = 19). Taking an ecological view of creative writing and teacher identity, the authors undertake a comparative analysis of the survey data using the 5A’s theory of creativity (Glaveanu, 2013) and a view of professional identity existing within “landscapes of practice” (Wenger-Trayner, Wenger-Trayner, 2015). This enables to illuminate how and why creative writing is contextually afforded, or otherwise, in primary and secondary landscapes of practice. Findings This analysis demonstrates how the redrafting of creative writing is marginalised in both landscapes of practice and how redrafting is largely conceptualised as a technical rather than critical or creative action. The authors show how teachers, particularly in primary school, aim for their pupils to produce “products” rather than engaging in the “process” of creative writing. This analysis also shows that whilst creative writing is overall more marginalised in the secondary school landscape, it is often taught through process approaches. In both landscapes of practice, the re-drafting of creative writing is largely taught through product approaches. Research limitations/implications This research is potentially skewed by the fact that we recruited our participants through networks relating the teaching of English, including creative writing. What is worrying about this limitation, however, is that the picture of creative writing in schools in England probably leans more to a product approach than the picture this research has uncovered. Practical implications Professional development for teachers in both landscapes is needed in relation to pedagogical actions for creative writing and its redrafting. Some of the key differences we have outlined in conceptualisations and practices between primary and secondary schools landscapes, notably the overuse of product-based teaching actions in primary landscapes, and some of the differences we have outlined within discrete landscapes of practice, notably how some primary school teachers feel more confident to challenge the product-based approach, with one conceptualising redrafting as “creative”, indicate that professional development should involve teachers working across schools. Social implications Policy needs to be reformed to move away from the technicist view of creative writing held in both landscapes of practice. Linked to this, the way creative writing is assessed as a product in secondary schools needs to change – the re-introduction of portfolio-based coursework (Bishop, 1990) would provide the affordance of redrafting as an action central to creative writing processes. Originality/value To the best of the authors’ knowledge, this is a rare piece of research which compares primary and secondary school teachers’ approaches to teaching creative writing. It shows that primary school teachers can be formulaic in the way they teach creative writing, using product approaches. However, in secondary schools the picture is different: teachers, particularly those, who are writers themselves, give students more agency in redrafting and shaping their writing. This indicates how professional development should involve primary and secondary school teachers in dialogue with one another to cross boundaries of practice.