the-french-artist/wikipedia_20220301.simple_sentence_split huggingface dataset:
Together the two houses form the government and parliament of the UK.
2 people are members because of their job (The Duke of Norfolk, who is the Earl Marshal, and the Marquess of Cholmondeley, the Lord Great Chamberlain, who both help to organise royal events).
90 people are hereditary peers.
These are members of the House of Lords because one of their ancestors was made a member and (since 1999) have been elected from among other such people.
The other members were made members for life, either life peers, who have existed since 1958 or as law lords.
Law lords were senior judges made members of the House to help when the House of Lords was also the highest court in England and Wales (before the foundation of the Supreme Court in 2009).
The twenty-six most senior Bishops of the Church of England also sit in the House of Lords, they are called the Lords Spiritual.
Crossbenchers
Many members of the House of Lords sit as Crossbenchers.
This means they do not support either the government or opposition parties, but instead are independent of party politics.
They got their name because the benches where they sit are placed across the aisle which separates the government and opposition supporters.
Parliament UK
Acapulco is a town and sea port on the Pacific coast of Mexico, 300 km (190 miles) southwest from Mexico City.
Acapulco is on a deep, semi-circular bay.
It is a stop for shipping and cruising lines running between Panama, and San Francisco, California, USA.
In 2005, about 722,499 people lived there.
Its name is a Nahuatl word, meaning "plain of dense reeds".
The city has been a port since the 16th century.
Playones de San Isidro
Playones de San Isidro de Isidro is a community belonging to the Flavio Alfaro canton.
The village has a population of approximately 200 people.
Deutsche Bahn AG (short DB AG or often only DB) is Europe's largest railway company.
It runs over 30,000 trains a day and owns more than 5,000 stations.
The company headquarters are in Berlin, Germany.
Deutsche Bahn is also active in the field of logistics and owns companies like Schenker.
DB claim they are the second largest logistics company in the world.
DB corporate home page
DB travel portal
DB timetable information
Rail transport in Germany
Transport companies of Germany
1994 establishments in Germany
The Vienna Convention on the Law of Treaties is a contract of International law.
It was signed in the 1960s.
It codified earlier customs that were there.
105 states signed the convention.
Full text of the treaty: html, pdf
Easy-to-read version of the text
Damrosch, Henkin, et al.,
International Law, West Group 2001.
The Lost World is a book written by Sir Arthur Conan Doyle in the year 1912.
After a long journey they find the plateau, and witness not only dinosaurs, but two tribes - an ancient Native American people and ape-men who resemble the missing link.
Books by Arthur Conan Doyle
Amnesty International (also called AI or Amnesty) is an international organization founded in London in 1961.
They promote human rights in accordance with Universal Declaration of Human Rights and international human rights law.
This organization was the recipient of the Nobel Peace Prize in 1977 for its defense of human dignity against torture.
It is one of the most widely-known human rights groups in the world.
The six key areas that Amnesty International focuses on are refugee rights, the rights of women, children, and of minorities, ending torture, stopping the death penalty, the rights of people imprisoned because of what they believe, and protection of human dignity.
What they believe in
Every person has human rights.
Human rights cannot be taken away from a person.
They are natural laws that are the right of all human beings from their birth on.
Human rights cannot be divided.
When one right is taken away, this is also bad for other rights.
When one right is protected, other rights are in a better position as well.
Human rights will not be protected by governments alone.
Governments have said they will protect human rights, and then not acted upon it.
Human rights organisations have to influence the governments.
To protect human rights, people must help other people.
Danger for human rights starts at the level of single persons.
To help one person means to stop the danger from growing.
One person alone can do this.
To defend human rights, an organization must be independent and impartial.
It should not be for or against any one ideology.
An ideology is a certain point of view.
It can be political, economic, or religious.
Also, the organization should not say one country is the "worst".
It should focus on the individual and all individuals.
Jürgen Wüst: «Imperialistisches Menschenrechtsgeschrei».
Der Kampf des MfS gegen die Internationale Gesellschaft für Menschenrechte (IGFM) und Amnesty International (AI), in: Deutschland Archiv, Nr.
3/1998, S. 418—427
Amnesty International website
Human rights organisations in the United Kingdom
It was a show made from 31 March 1997 to 16 February 2001.
It was developed by Ragdoll Productions and created by director Anne Wood CBE and Andrew Davenport whom wrote all 365 episodes of the original series and all 120 episodes of the revival series, this time with Darrall Macqueen developing the show.
The show had two narrators; Tim Whitnall (for the international versions) and Rolf Saxon (for the PBS version).
Teletubbies was also shown on televisions in the United States on the Public Broadcasting Service (PBS).
Public television used the show on their television network until 29 August, 2008, when it was removed from the television schedule and return on the PBS Kids Pluto TV on May 1, 2019.
The show made new episodes until on 16 February 2001.
Years later, a new series aired in 2015.
The show takes place in a grassy, floral landscape populated by rabbits with bird calls heard in the background.
The four Teletubbies live in a house in a hill, known as the "Tubbytronic Superdome."
Located in the ground, it has two entrances: a hole at the top, and a large semicircular (shaped like the half of a circle) door at the dome's foot.
The Teletubbies are four colourful monkey-like and lemur-like puppets acting like four multicolored creatures.
They have TV screens in their stomachs and antennas on their heads.
They live with a number of  monkey-like objects (objects with lemur-like characteristics) such as the Noo-noo, a blue vacuum cleaner, and the Voice Trumpets, a set of speakers shaped like shower heads.
On every episode, the Teletubbies do similar activities, like playing with the Voice Trumpets, or the mishaps caused by the Noo-noo.
That also includes the footage of live children displayed on the screens in the Teletubbies' stomachs, and a magical event that happens once per episode.
The activities are different from each episode but still very similar.
Danish Person Cast
Hans Henrik Bærentsen (Tinky Winky)
Louise Engell (Laa-Laa)
Anne Lorentzen
Timm Mehrens (Dipsy)
Marie Schjeldal (Po)
Torben Sekov
Peter Zhelder
Laura Aller Jonasdottir
Johannes Bjergfelt
The Teletubbies
Tinky Winky
Tinky Winky, (played by Dave Thompson, Mark Heenehan, and Simon Shelton), is the first Teletubby.
He is the largest Teletubby, he is Purple, and has a triangular antenna on his head.
He is notable for a red magic bag he always carries.
He is also found dancing in a ballet-style skirt from time to time, which is also often worn by Laa-Laa.
Dipsy
Dipsy (played by John Simmit) is the second Teletubby.
He is lime green and is called "Dipsy" because his straight antenna looks like a dipstick.
He has a black and white furry top hat that he likes a lot.
Dipsy is the most stubborn of the Teletubbies, and will sometimes refuse to go along with the other Teletubbies' opinion.
His face and ears are notably dark
Laa-Laa
Laa-Laa (played by Nikky Smedley) is the third Teletubby.
She is yellow, has a swirly antenna and is concerned with the welfare of all.
She is the best singer of all the Teletubbies, and is a "drama queen", party-girl, and motherly type.
Her favorite thing is a bouncy, orange ball, which is almost as big as she is.
She likes to sing and dance.
Laa-Laa is one of the two girls in the teletubbies show.
Po (played by Pui Fan Lee) is the red Teletubby.
She is the fourth of the Teletubbbies, and has an antenna that is round.
Po is the smallest of the Teletubbies and gets into trouble the most.
She also says the word "Eh-oh" (hello), a word used by herself and the other three Teletubbies.
Po's favorite object is her blue and pink scooter, which she calls "'cootuh"(, but also "'cooter" or "scootuh").
Po often wants attention and can sometimes be mischievous and naughty when she disobeys the commands of the "Voice Trumpets."
Po can speak two languages.
Those languages are English (or the broadcasting country's language) and, for counting, Cantonese.
For example, she says "Yat, yi, sam," which means "One, two, three."
She is a problem solver and the best "spider-fighter".
Po is also a Tomboy type.
In the Teletubbies' house, she sleeps at the side of all the other Teletubbies and sometimes eats Tubby Toast while the others are sleeping.
She is voiced by Pui Fan Lee, who can speak Cantonese as well.
Character Names
Triangle: Tinky Winky
Dipstick: Dipsy
Loop: Laa-Laa
"O" shape: Po
Color Skin
~~Tinky Winky~~:
'Dipsy~~     :
~~Laa-Laa~~    :
~~Po~~         :
Other Characters
Noo-Noo
Noo-Noo (played by Mark Dean) is the Teletubbies' sentient automated blue vacuum cleaner, and then he turns orange.
He cleans up after the Teletubbies ("Noo-Noo tidy up!").
It has been shown that Noo-Noo has extraordinarily large storage capacity.
He also has the ability to spit out any contents, often things that it should not have consumed in the first place such as the Teletubbies' blankets, foods, or favorite things.
Then he is called "Naughty Noo-Noo!"
Noo-Noo does not share the Teletubbies' enthusiasm for big hugs, resulting in Benny Hill style chase scenes around the dome when the Tubbies try to express their thankfulness, during which Noo-Noo does an impression of a Formula 1 car engine in full flight.
The Teletubbies always win and give Noo-Noo a 'big-hug'.
The Voice Trumpets are devices resembling periscopes.
They are also guardians of the Teletubbies.
They live outside in the fields.
They sometimes come out of the ground to talk to the Teletubbies.
They can play games with the Teletubbies, usually games such as hide-and-seek.
The Sun Baby (played and voiced by Jess Smith) appears at the beginning and the end of each episode.
Her job is to wake up the Teletubbies.
The Tubby Toaster is very unreliable, and often either leaves a Tubby without their toast or buries them under heaps of toast.
The dome's central console has a battery of knobs and levers with which a Tubby often chooses to amuse themselves ("Adjustments!"),
although the outcome is normally limited to a variety of loud and surprising noises being generated.
The central console is also home to the Tubby Sponges ("Wash, wash, wash.
Wash, wash, wash.
Tubby, Tubby, Tubby, Tubby.
Wash wash wash").
Outside the Superdome, the Magic Windmill gives the signal to the Teletubbies that it is time to watch the Earth's children on either one of their TV screens, as well as announcing Magical Events, the Lion and the Bear or Tubby Bye-Bye.
The show also features the Little Lambs, the Dog, the Butterfly, the Pink Spider, the Magic Crown, the Socks, the Vest, the Pants, the Blue Mittens and the Pink Boots and occasionally, the Trees, the Clouds and the Rabbits.
The "Birds" are planned to be in the TV series, but only heard off-screen.
Physical Cast
The only physical cast members are John Schwab and Sandra Dickson, who play the Voice Trumpets, Penelope Keith, who plays the Bear with Brown, Fuzzy Hair, Eric Sykes, who plays the Scary Lion with Big, Scary Teeth and Jess Smith who plays the Baby Sun, who is believed to have been around seven months old at the time of filming.
Her giggle was included in the single Teletubbies Say Eh-Oh!.
Although not credited, this makes her technically the youngest person ever whose vocal appeared on a number one song.
The Teletubbies' instruments
Tinky Winky: saxophone, flute, bassoon, clarinet, piccolo, oboe, recorder, English horn, and contrabassoon
Dipsy: French horn, trombone, tuba, cornet, sousaphone, and euphonium
Laa-Laa: xylophone, triangle, bass drum, snare drum, cymbals, timpani, castanets, maracas, tambourine, and glockenspiel
Po: trumpet, violin, viola, cello, double bass, guitar, banjo, and mandolin
He was first called gay by the academic and cultural critic Andy Medhurst in a letter of July 1997 to The Face, and gained the interest of Jerry Falwell in 1997 when Fallwell said that the character was a "gay role model."
Falwell wrote about it in his National Liberty Journal.
He said that in the Washington Post "In/Out" column someone had written that lesbian comedian Ellen DeGeneres was "out", or uncloseted, as the main gay model, while the Tinky Winky was "in", or closeted.
Falwell said it was because of the Teletubby's purple color, the "purse" (British for Handbag), and the triangle antenna which all represented homosexuality.
Also, Tinky Winky dances in a tu-tu, which supporters of the theory may take as evidence.
This caused many Christians to boycott Teletubbies because it made them think that Teletubbies support homosexuality.
A February 1999 article in the National Liberty Journal'', published by evangelical pastor Jerry Falwell, warned parents that Tinky Winky could be a hidden homosexual symbol, because "he is purple, the gay pride colour, and his antenna is shaped like a triangle, the gay pride symbol".
A spokesman for The itsy bitsy Entertainment Company, who licenses the characters in the United States, said that it was just a magic bag. "
The fact that he carries a magic bag doesn't make him a homosexual.
It's a children's show, folks.
To think we would be putting sexual innuendo in a children's show is kind of outlandish", he added.
In an unrelated incident reported in 2000, a girl's Tinky Winky toy reportedly said "I got a gun".
Kenn Viselman, then chairman of The itsy bitsy Entertainment Company, said the toy was actually saying "Again, again!",
a catchphrase from the show.
A girl's talking Po doll was thought to be saying "faggot, faggot" as well as "fatty, fatty".
Supporters of the interpretation of Tinky Winky as gay pride symbol might take this as evidence as well.
The toy was recalled and it was revealed to have said "fidit, fidit," inspired by the Cantonese for "faster, faster."
The Lion and The Bear
In the episode "See-Saw" from (season 1) The Lion and The Bear came to Teletubbyland.
The Lion is voiced by Eric Sykes and The Bear is voiced by Penelope Keith.
In the original, many kids thought The Lion and The Bear was very scary and parents reported to the BBC that The Lion and The Bear was too scary.
In the next season, they will do The Lion and The Bear again but this time with more careful Music and happier voices.
Nickelodeon Home Entertainment (1998-2008)
Official UK website
Official USA website
Official BBC/ CBeebies website
1997 television series debuts
1990s children's television series
2000s children's television series
2010s children's television series
British children's television series
1997 establishments in the United Kingdom
FLAC (which stands for Free Lossless Audio Codec) is a way to code audio files.
It makes those audio files smaller, without affecting the sound quality.
It is unlike MP3, because when encoding audio using an MP3 encoder, information is lost and cannot be recovered.
When a FLAC file is decoded, it will be identical to the original raw audio.
FLAC is the most common lossless audio codec.
The Enabling Act (Ermächtigungsgesetz in German) was passed by Germany's parliament (the Reichstag) on 23 March 1933.
It was the second major step after the Reichstag Fire Decree through which the Nazis obtained dictatorial powers using largely legal means.
The Act enabled Chancellor Adolf Hitler and his cabinet to enact laws without the participation of the Reichstag.
The formal name of the Enabling Act was Gesetz zur Behebung der Not von Volk und Reich ("Law to Remedy the Distress of the People and the Empire").
Enabling Act text
As with most of the laws passed in the process of Gleichschaltung, the Enabling Act is quite short, considering its consequences.
It is therefore reproduced in full in German and English:
The Enabling Act was passed by the Reichstag on March 23 and proclaimed by the government the following day.
Following constitutional procedure for legislation, the law was countersigned by President von Hindenburg, Chancellor Hitler, Minister of Interior Frick, Foreign Minister von Neurath, and Minister of Finance von Krosigk.
Passage of the Enabling Act
Now it will be easy to carry on the fight, for we can call on all the resources of the State.
Radio and press are at our disposal.
We shall stage a masterpiece of propaganda.
In the days leading up to the elections, the Nazis organized street violence to intimidate the opposition and to build fear of communism.
The burning of the Reichstag six days before the election was the pivotal event of the campaign.
Later that day, the Reichstag assembled under intimidating circumstances, with SA men swarming inside and outside the chamber.
Hitler's speech emphasised the importance of Christianity in German culture.
This was aimed particularly at appeasing the formerly allied Catholic Centre Party.
It partly incorporated the guarantees requested by party chairman Ludwig Kaas.
All parties except the SPD voted in favour of the Enabling Act.
With the Communist delegates removed and 26 of the SPD deputies arrested or in hiding, the final vote was 441 supporting the Enabling Act to 94 (all Social Democrats) opposed.
The Communist Party deputies – and a few Social Democratic deputies as well – were already jailed, and the Communist mandates were declared "dormant" by the government shortly after the elections.
The remaining free members of parliament were intimidated by the SA surrounding the parliament hall.
In the end, only the Social Democrats voted against the bill.
Presidential consequences
President von Hindenburg seemed to be pleased with Hitler's firm hand.
During the cabinet conference on the Enabling Act, von Hindenburg's representative stated that the aged president was withdrawing from day-to-day affairs of government and that presidential collaboration on the laws decreed as a result of the Enabling Act would not be required.
Enabling act (General)
20th century in law
March events
Pulmonary hypertension or PH is a condition where there is high blood pressure in the lungs.
This condition makes it hard to breathe.
Some people with the condition need extra oxygen.
This condition can also make a person dizzy and become easily tired.
Some people with the condition faint easily.
The symptoms get worse when exercising or working hard.
Pulmonary hypertension is a serious condition, and it can be fatal.
The condition makes it harder for the heart to pump blood.
Because the heart has to work harder, it can also become sick.
Some people who are very sick may need a lung transplant or a heart-lung transplant to live.
Pulmonary hypertensions full name is pulmonary arterial hypertension even though most people call it pah, ph or pha.
People with pulmonary hypertension have difficulty breathing.
They also tire easily.
Some of them faint easily too.
They might have chest pain.
Some patients have swelling of the feet and ankles.
These symptoms get worse during exercise or hard work.
Because many diseases can make it hard to breathe, a doctor must learn about the patient's background.
This helps the doctor to treat the patient, even if the patient has another disease.
The doctor also does several tests.
Pulmonary hypertension makes the heart sound different.
One test is to measure the blood pressure inside the pulmonary artery, the blood vessel that goes from the heart to the lungs.
In order to establish the cause, the physician will generally conduct a thorough medical history.
A detailed family history is taken to determine whether the disease might be familial.
A history of exposure to cocaine, methamphetamine, alcohol leading to cirrhosis, and smoking leading to emphysema are considered significant.
Physical examination is performed to look for typical signs of pulmonary hypertension including a loud P2 (pulmonic valve closure sound), (para)sternal heave, jugular venous distension, pedal edema, ascites, hepatojugular reflux, clubbing etc.
What goes wrong with the body
In pulmonary hypertension, the blood vessels in the lungs become too narrow.
The blood pressure in the lungs becomes high.
The heart works very hard to pump blood through the narrow blood vessels.
Later on, the blood vessels in the lungs become hard and thick.
The heart must work harder.
The heart can work so hard that it becomes sick.
This is called heart failure.
The sick heart cannot pump blood well.
Less blood goes to the lungs, so the blood gets less oxygen.
This makes it hard to breathe.
This gets worse when exercising or working hard.
The most common cause of pulmonary hypertension is left heart failure.
This causes pulmonary venous hypertension.
This leads to pulmonary edema, or fluid build-up in the lungs.
Many illnesses can cause pulmonary arterial hypertension (PAH).
Lung diseases that make the blood have less oxygen, such as:
chronic obstructive pulmonary disease or COPD
interstitial lung disease
Pickwickian syndrome
immune system problems, such as:
scleroderma
other autoimmune disorders
liver problems
cirrhosis
other causes
sleep apnea
taking pills to lose weight, such as Fen-Phen, Aminorex, fenfluramine (Pondimin), and phentermine
sickle cell disease,
congenital heart disease
thyroid diseases,
taking drugs like cocaine
possibly Human herpesvirus 8
When a person has pulmonary hypertension without any other cause, this is called idiopathic pulmonary arterial hypertension or IPAH.
When a family history exists, the disease is termed familial pulmonary arterial hypertension, (FPAH).
IPAH and FPAH are now considered to be genetic disorders linked to mutations in the BMPR2 gene, which encodes a receptor for bone morphogenetic proteins, as well as the 5-HT(2B) gene, which codes for a serotonin receptor.
In medicine, pulmonary hypertension (PH) is an increase in blood pressure in the pulmonary artery or lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion.
Depending on the cause, pulmonary hypertension can be a severe disease with a markedly decreased exercise tolerance and right-sided heart failure.
It was first identified by Dr Ernst von Romberg in 1891.
It can be one of five different types, arterial, venous, hypoxic, thromboembolic, or miscellaneous.
Although the terms primary pulmonary hypertension (meaning of unknown cause) and secondary pulmonary hypertension (meaning due to another medical condition) still persist in materials disseminated to patients and the general public, these terms have largely been abandoned in the medical literature.
This change has occurred because the older dichotomous classification did not reflect pathophysiology or outcome.
It led to erroneous therapeutic decisions, i.e. treat "primary" pulmonary hypertension only.
This in turn led to therapeutic nihilism for many patients labeled "secondary" pulmonary hypertension, and could have contributed to their deaths.
The term "primary pulmonary hypertension" has now been replaced with "idiopathic pulmonary arterial hypertension".
The terms "primary" and "secondary" pulmonary hypertension should not be used any longer.
Further details are in the Classification section below.
The most common cause of pulmonary hypertension is left heart failure leading to pulmonary venous hypertension.
This may be due to systolic or diastolic malfunction of the left ventricle or due to valvular dysfunction such as mitral regurgitation or mitral stenosis.
It usually manifests as pulmonary edema.
Common causes of pulmonary arterial hypertension (PAH) include HIV, scleroderma and other autoimmune disorders, cirrhosis and portal hypertension, sickle cell disease, congenital heart disease, thyroid diseases, and others.
Use of weight loss pills such as Fen-Phen, Aminorex, fenfluramine (Pondimin), and phentermine led to the development of PAH in the past.
Pathogenesis
Whatever the initial cause, pulmonary hypertension involves the tightening of blood vessels connected to and within the lungs.
This makes it harder for the heart to pump blood through the lungs, much as it is harder to make water flow through a narrow pipe as opposed to a wide one.
Over time, the affected blood vessels become both stiffer and thicker, further increasing the blood pressure within the lungs and impairing blood flow.
In addition, the increased workload of the heart causes thickening and enlargement of the right ventricle, making the heart less able to pump blood through the lungs, causing right heart failure.
As the blood flowing through the lungs decreases, the left side of the heart receives less blood.
Therefore, it becomes harder and harder for the left side of the heart to pump to supply sufficient oxygen to the rest of the body, especially during physical activity.
Because pulmonary hypertension can be of 5 major types, a series of tests must be performed to distinguish pulmonary arterial hypertension from venous, hypoxic, thomboembolic, or miscellaneous varieties.
A physical examination is performed to look for typical signs of pulmonary hypertension.
These include altered heart sounds, such as a widely split S2 or second heart sound, a loud P2 or pulmonic valve closure sound (part of the second heart sound), (para)sternal heave, possible S3 or third heart sound, and pulmonary regurgitation.
Other signs include jugular venous distension (enlargement of the jugular veins), peripheral edema (swelling of the ankles and feet), ascites (abdominal swelling due to the accumulation of fluid), hepatojugular reflux, and clubbing.
Further procedures are required to confirm the presence of pulmonary hypertension and exclude other possible diagnoses.
These generally include pulmonary function tests, blood tests, electrocardiography (ECG), arterial blood gas measurements, X-rays of the chest (followed by high-resolution CT scanning if interstitial lung disease is suspected), and ventilation-perfusion or V/Q scanning to exclude chronic thromboembolic pulmonary hypertension.
Biopsy of the lung is usually not indicated unless the pulmonary hypertension is thought to be due to an underlying interstitial lung disease.
But lung biopsies are fraught with risks of bleeding due to the high intrapulmonary blood pressure.
Clinical improvement is often measured by a "six-minute walk test", i.e. the distance a patient can walk in six minutes.
Stability and improvement in this measurement correlate with better survival.
Although pulmonary arterial pressure can be estimated on the basis of echocardiography, pressure sampling with a Swan-Ganz catheter provides the most definite measurement.
PAOP and PVR can not be measured directly with echocardiography.
Therefore, diagnosis of PAH requires a cardiac catheterization.
A Swan-Ganz catheter can also measure the cardiac output, which is far more important in measuring disease severity than the pulmonary arterial pressure.
Normal pulmonary arterial pressure in a person living at sea level has a mean value of 12–16 mm Hg (1600–2100 Pa).
Definite pulmonary hypertension is present when mean pressures at rest exceed 25 mm Hg (3300 Pa).
If mean pulmonary artery pressure rises above 30 mm Hg (4000 Pa) with exercise, that is also considered pulmonary hypertension.
Diagnosis of PAH requires the presence of pulmonary hypertension with two other conditions.
Pulmonary artery occlusion pressure (PAOP or PCWP) must be less than 15 mm Hg (2000 Pa) and pulmonary vascular resistance (PVR) must be greater than 3 Wood units (240 dyn•s•cm−5 or 2.4 mN•s•cm−5).
Current classification
In 2003, the 3rd World Symposium on Pulmonary Arterial Hypertension was convened in Venice to modify the classification based on the new understanding of disease mechanisms.
The revised system developed by this group provides the current framework for understanding pulmonary hypertension.
The system includes several improvements over the former 1998 Evian Classification system.
Risk factor descriptions were updated, and the classification of congenital systemic-to pulmonary shunts was revised.
A new classification of genetic factors in PH was recommended, but not implemented because available data were judged to be inadequate.
WHO Group I - Pulmonary arterial hypertension (PAH)
WHO Group II - Pulmonary hypertension associated with left heart disease
WHO Group III - Pulmonary hypertension associated with lung diseases and/or hypoxemia
WHO Group IV - Pulmonary hypertension due to chronic thrombotic and/or embolic disease
WHO Group V - Miscellaneous
Previous terminology
The terms primary and secondary pulmonary hypertension (PPH and SPH) were formerly used to classify the disease.
This led to the assumption that only the primary disease should be treated, and the secondary variety should be ignored in favor of treating only the underlying illness.
In fact all forms of pulmonary arterial hypertension are treatable.
Unfortunately, this classification system still persists in the minds of many physicians, and probably leads to many patients with being denied treatment.
This nihilistic approach to pulmonary arterial hypertension may also contribute to underdiagnosis.
It is estimated that there are about 100,000 patients with PAH in the US, but only 15-20,000 have been diagnosed.
Many others have been misdiagnosed as COPD, asthma, or congestive heart failure.
The term primary pulmonary hypertension (PPH) has now been replaced with idiopathic pulmonary arterial hypertension (IPAH) in much of the medical literature.
However, some physicians continue to use the older classification inappropriately.
IPAH is a rare disease with an incidence of about 2-3 per million per year and a prevalence of about 15 per million.
Women are almost three times as likely to present with IPAH than men.
Other forms of PAH are far more common.
In scleroderma the incidence has been estimated to be 6 to 60% of all patients, in rheumatoid arthritis up to 21%, in systemic lupus erythematosus 4 to 14%, in portal hypertension between 2 and 5%, in HIV about 0.5%, and in sickle cell disease ranging from 20 to 40%.
Treatment is determined by whether the PH is arterial, venous, hypoxic, thromboembolic, or miscellaneous.
Since pulmonary venous hypertension is synonymous with congestive heart failure, the treatment is to optimize left ventricular function by the use of diuretics, beta blockers, ACE inhibitors, etc.,
or to repair/replace the mitral valve or aortic valve.
In PAH, lifestyle changes, digoxin, diuretics, oral anticoagulants, and oxygen therapy are considered conventional therapy, but have never been proven to be beneficial in a randomized, prospective manner.
High dose calcium channel blockers are useful in only 5% of IPAH patients who are vasoreactive by Swan-Ganz catheter.
Unfortunately, calcium channel blockers have been largely misused, being prescribed to many patients with non-vasoreactive PAH, leading to excess morbidity and mortality.
Vasoactive substances
Three major pathways are involved in abnormal proliferation and contraction of the smooth-muscle cells of the pulmonary artery in patients with pulmonary arterial hypertension.
These pathways correspond to important therapeutic targets in this condition and play a role in determining which of three classes of drugs—endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and prostacyclin derivatives—will be used.
Prostacyclin (prostaglandin I2) is commonly considered the most effective treatment for PAH.
Epoprostenol (synthetic prostacyclin, marketed as Flolan®) is given via continuous infusion that requires a semi-permanent central venous catheter.
This delivery system can cause sepsis and thrombosis.
Flolan® is unstable, and therefore has to be kept on ice during administration.
Since it has a half-life of 3 to 5 minutes, the infusion has to be continuous (24/7), and interruption can be fatal.
Other prostanoids have therefore been developed.
Treprostinil (Remodulin®) can be given intravenously or subcutaneously, but the subcutaneous form can be very painful.
Iloprost (Ilomedin®) is also used in Europe intravenously and has a longer half life.
Iloprost (marketed as Ventavis®) is the only inhaled form of prostacyclin approved for use in the US and Europe.
This form of administration has the advantage of selective deposition in the lungs with less systemic side effects.
The dual (ETA and ETB) endothelin receptor antagonist bosentan (marketed as Tracleer®) was approved in 2001.
Two selective endothelin receptor antagonists (ETA only) are in the final stages of approval: sitaxsentan and ambrisentan.
Sildenafil, a selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5), was approved for the treatment of PAH in 2005.
It is marketed for PAH as Revatio®.
Tadalafil (currently marketed as Cialis® for erectile dysfunction) is currently is Phase III trials.
Vasoactive intestinal peptide by inhalation should enter clinical trials for PAH in 2007.
PRX-08066 is a serotonin antagonist currently being developed for hypoxic pulmonary hypertension.
Atrial septostomy is a surgical procedure that creates a communication between the right and left atria.
It relieves pressure on the right side of the heart, but at the cost of lower oxygen levels in blood (hypoxia).
It is best performed in experienced centers.
Lung transplantation cures pulmonary arterial hypertension, but leaves the patient with the complications of transplantation, and a survival of about 5 years.
Pulmonary thromboendarterectomy (PTE) is a surgical procedure that is used for chronic thromboembolic pulmonary hypertension.
It is the surgical removal of an organized thrombus (clot) along with the lining of the pulmonary artery; it is a large and very difficult procedure that is currently performed in a few select centers.
Case series show remarkable success in most patients.
Treatment for hypoxic and miscellaneous varieties of pulmonary hypertension have not been established.
However, studies of several agents are currently enrolling patients.
Many physicians will treat these diseases with the same medications as for PAH, until better options become available.
The NIH IPAH registry from the 1980s showed an untreated median survival of 2–3 years from time of diagnosis, with the cause of death usually being right ventricular failure (cor pulmonale).
Although this figure is widely quoted, it is probably irrelevant today.
Outcomes have changed dramatically over the last two decades.
This may be because of newer drug therapy, better overall care, and earlier diagnosis (lead time bias).
A recent outcome study of those patients who had started treatment with bosentan (Tracleer®) showed that 86% patients were alive at 3 years.
With multiple agents now available, combination therapy is increasingly used.
Impact of these agents on survival is not known, since many of them have been developed only recently.
It would not be unreasonable to expect median survival to extend past 10 years in the near future.
The Merck Manual of Diagnosis and Therapy: Pulmonary Hypertension
PH Central - the internet resource for Pulmonary Arterial Hypertension
The Pulmonary Hypertension Association Webpage provided by the Pulmonary Hypertension Association
Facts About Primary Pulmonary Hypertension from the National Heart, Lung, and Blood Institute (NHLBI)
Webcast: The Changing World of Pulmonary Arterial Hypertension Therapies - American College of CHEST Physicians
Pulmonary Arterial Hypertension Information for Healthcare professionals
BMPR2-Related Primary Pulmonary Hypertension on GeneReviews
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The Decameron is a collection of 100 short stories.
It was written by the Italian writer Giovanni Boccaccio around 1350.
In the book, ten friends, seven young women and three young men, leave the city of Florence because of the plague and stay in a large house in the countryside.
Each day, they entertain each other by taking turns to tell stories.
The stories are of different types.
Some are romantic, some are erotic, some are comedies and some are tragedies.
Other writers have used the stories for ideas.
Many paintings have been done which illustrate the stories.
The picture to the right shows a scene from the story of "The Pot of Basil" in which Isabella buries the head of her murdered lover Ferdinand inside a potplant.
Decameron Web, from Brown University
The Decameron - Introduction, from the Internet Medieval Sourcebook
A lung transplant is a type of surgery.
People who can not breathe without additional oxygen may need a lung transplant.
In this surgery, the patient's ill lung or lungs are removed.
A healthy lung or lungs are put into the patient.
The healthy lungs may come from a dead or from a living person.
When the person who gives, or donates, the healthy lung is still alive, only one lung is removed.
Sometimes a healthy person can give just part of a lung to a sick person.
A healthy person can normally give a lung or part of a lung without becoming sick.
Commodity is a term with distinct meanings in both business and in Marxian political economy.
For the former, it is a product, that is traded solely on the basis of price.
For Marxian political economy it means wares offered for exchange.
Business usage
In the world of business, a commodity is a product, good or service that is traded based solely on its price, rather than quality and features.
Examples include: electricity (most users of electric power are only concerned with energy consumption; only a minority of users are concerned with the quality and technical details of voltage and frequency deviations), wheat, bulk chemicals such as sulfuric acid, metals, and even orange juice.
In the original and simplified sense, commodities were things of value, of uniform quality, that were produced in large quantities by many different producers; the items from each different producer are considered as of the same value.
Wheat is an example of a soft commodity.
Wheat from many different farms comes together.
Generally, it is all traded at the same price; wheat from farm A has not another price than wheat from farm B.  Some uniform standard of quality is assumed. (
There may be various standards leading to different pools:  one say for genetically modified wheat, and one for unmodified wheat.)
Markets for trading commodities can be very efficient, particularly if the division into pools matches demand segments.
These markets will quickly respond to changes in supply and demand to find a price.
Commodities and Marxism
In classical political economy and especially Karl Marx's critique of political economy, a commodity is simply any good or service offered as a product for sale on the market.
Some items are also seen as being treated as if they were commodities, e.g. human labour or labor power, works of art and natural resources, even though they may not be produced specifically for the market, or be non-reproducible goods.
Marx's analysis of the commodity is intended to help solve the problem of what establishes the economic value of goods, using the labor theory of value.
This problem was extensively debated by Adam Smith, David Ricardo and Karl Rodbertus-Jagetzow among others.
Value and price are not equivalent terms in economics, and theorising the specific relationship of value to market price has been a challenge for both liberal and Marxist economists.
To understand the concept of a commodity, consider a chair.
It is a commodity if the chair is a tradeable product of human work possessing a social use-value.
By contrast, a fallen log of deadwood sat upon in the forest is not a commodity, as it was not produced by human work for the purpose of trade.
A chair created by a hobbyist as a gift to someone is not a commodity.
Nor is a chair a commodity (as a chair) if its only use would be as scrap firewood (unless one purchases a chair specifically to chop it up for fire wood).
A chair that nobody could sit on has no use-value, and cannot be a commodity (unless it has an ornamental value, e.g. in a doll's house).
Commodity markets are markets where raw or primary products are exchanged.
These raw commodities are traded on regulated commodities exchanges, in which they are bought and sold in standardized contracts.
This article focuses on the history and current debates regarding global commodity markets.
It covers physical product (food, metals, electricity) markets but not the ways that services, including those of governments, nor investment, nor debt, can be seen as a commodity.
Articles on reinsurance markets, stock markets, bond markets and currency markets cover those concerns separately and in more depth.
One focus of this article is the relationship between simple commodity money and the more complex instruments offered in the commodity markets.
The modern commodity markets have their roots  in the trading of agricultural products.
While wheat and corn, cattle and pigs, were widely traded using standard instruments in the 19th century in the United States, other basic foodstuffs such as soybeans were only added quite recently in most markets.
For a commodity market to be established, there must be very broad consensus on the variations in the product that make it acceptable for one purpose or another.
The economic impact of the development of commodity markets is hard to over-estimate.
Through the 19th century "the exchanges became effective spokesmen for, and innovators of, improvements in transportation, warehousing, and financing, which paved the way to expanded interstate and international trade."
Early history of commodity markets
Commodity money and commodity markets in a crude early form are believed to have originated in Sumer where small baked clay tokens in the shape of sheep or goats were used in trade.
Sealed in clay vessels with a certain number of such tokens, with that number written on the outside, they represented a promise to deliver that number.
This made them a form of commodity money - more than an "I.O.U." but less than a guarantee by a nation-state or bank.
However, they were also known to contain promises of time and date of delivery - this made them like a modern futures contract.
Regardless of the details, it was only possible to verify the number of tokens inside by shaking the vessel or by breaking it, at which point the number or terms written on the outside became subject to doubt.
Eventually the tokens disappeared, but the contracts remained on flat tablets.
This represented the first system of commodity accounting.
However, the Commodity status of living things is always subject to doubt -  it was hard to validate the health or existence of sheep or goats.
Excuses for non-delivery were not unknown, and there are recovered Sumerian letters that complain of sickly goats, sheep that had already been fleeced, etc.
If a seller's reputation was good, individual "backers" or "bankers" could decide to take the risk of "clearing" a trade.
The observation that trust is always required between market participants later led to credit money.
But until relatively modern times, communication and credit were primitive.
Classical civilizations built complex global markets trading gold or silver for spices, cloth, wood and weapons, most of which had standards of quality and timeliness.
Considering the many hazards of climate, piracy, theft and abuse of military fiat by rulers of kingdoms along the trade routes, it was a major focus of these civilizations to keep markets open and trading in these scarce commodities.
Reputation and clearing became central concerns, and the states which could handle them most effectively became very powerful empires, trusted by many peoples to manage and mediate trade and commerce.
Forward contracts
Commodity and Futures contracts are based on what’s termed "Forward" Contracts.
Early on these "forward" contracts (agreements to buy now, pay and deliver later) were used as a way of getting products from producer to the consumer.
These typically were only for food and agricultural Products.
Forward contracts have evolved and have been standardized into what we know today as futures contracts.
Although more complex today, early “Forward” contracts for example, were used for rice in seventeenth century Japan.
Modern "forward", or futures agreements, began in Chicago in the 1840s, with the appearance of the railroads.
Chicago, being centrally located, emerged as the hub between Midwestern farmers and producers and the east coast consumer population centers.
"Hedging", a common (and sometimes mandatory) practice of farming cooperatives, insures against a poor harvest by purchasing futures contracts in the same commodity.
If the cooperative has significantly less of its product to sell due to weather or insects, it makes up for that loss with a profit on the markets, since the overall supply of the crop is short everywhere that suffered the same conditions.
Whole developing nations may be especially vulnerable, and even their currency tends to be tied to the price of those particular commodity items until it manages to be a fully developed nation.
For example, one could see the nominally fiat money of Cuba as being tied to sugar prices, since a lack of hard currency paying for sugar means less foreign goods per peso in Cuba itself.
In effect, Cuba needs a hedge against a drop in sugar prices, if it wishes to maintain a stable quality of life for its citizens.
Delivery and condition guarantees
In addition, delivery day, method of settlement and delivery point must all be specified.
Typically, trading must end two (or more) business days prior to the delivery day, so that the routing of the shipment (which for soybeans is 30,000 kilograms or 1,102 bushels) can be finalized via ship or rail, and payment can be settled when the contract arrives at any delivery point.
U.S. soybean futures, for example, are of standard grade if they are "GMO or a mixture of GMO and Non-GMO No.
2 yellow soybeans of Indiana, Ohio and Michigan origin produced in the U.S.A. (Non-screened, stored in silo)," and of deliverable grade if they are "GMO or a mixture of GMO and Non-GMO No.
2 yellow soybeans of Iowa, Illinois and Wisconsin origin produced in the U.S.A. (Non-screened, stored in silo)."
Note the distinction between states, and the need to clearly mention their status as "GMO" ("Genetically Modified Organism") which makes them unacceptable to most "organic" food buyers.
The concept of an interchangeable deliverable or guaranteed delivery is always to some degree a fiction.
Trade in commodities is like trade in any other physical product or service.
No magic of the commodity contract itself makes "units" of the product totally uniform nor gets it to the delivery point safely and on time.
Regulation of commodity markets
Cotton, kilowatt-hours of electricity, board feet of wood, long distance minutes, royalty payments due on artists' works, and other products and services have been traded on markets of varying scale, with varying degrees of success.
One issue that presents major difficulty for creators of such instruments is the liability accruing to the purchaser:
Generally, governments must provide a common regulatory or insurance standard and some release of liability, or at least a backing of the insurers, before a commodity market can begin trading.
This is a major source of controversy in for instance the energy market, where desirability of different kinds of power generation varies drastically.
In some markets, e.g. Toronto, Canada, surveys established that customers would pay 10-15% more for energy that was not from coal or nuclear, but strictly from renewable sources such as wind.
Proliferation of contracts, terms, and derivatives
However, if there are two or more standards of risk or quality, as there seem to be for electricity or soybeans, it is relatively easy to establish two different contracts to trade in the more and less desirable deliverable separately.
If the consumer acceptance and liability problems can be solved, the product can be made interchangeable, and trading in such units can begin.