Through the seismo-stratigraphic analysis of new high- resolution seismic data acquired along the southwestern offshore of the Hyblean Plateau, this work aims to improve the knowledge about the stratigraphic and structural setting in the marine area connecting the Hyblean Plateau Foreland to the Gela-Catania Foredeep.Two main goals have motivated the acquisition of new seismic profiles along the southern coastline of Sicily, in the Marina di Ragusa offshore:(i) to obtain a better comprehension of the Cenozoic stratigraphic and structural setting of the area, with a particular attention to the characterization of the Pliocene-Holocene sedimentary deposits and their areal distribution;(ii) to identify, in the offshore area, the possible prolongation of the main structural lineaments outcropping in the hinterland (Scicli-Ragusa-Irminio Line), and verify the presence of structures, responsible for the tectonic activity affecting the area.Our model shows that an extensional fault system, characterized by a main NE-SW orientation, affects the highly deformed Oligo-Miocene, or older, substratum, originating structural highs and down-faulted sectors. These faults are inferred to record the early history of the Scicli Line and of the polyphase kinematic evolution of the N50° oriented regional fault systems.The Gessoso-Solfifera deposits (Messinian, Late Miocene) have been recognized in several sectors of the study area, showing a very peculiar seismic facies, and occupying deep erosional channels probably resting within down-faulted sectors. This feature is in good agreement with isolated onshore areas of the Hyblean Plateau (Licodia Eubea and south Vittoria villages) where the Gessoso-Solfifera deposits are associated to normal faults, thus documenting that Messinian evaporites are not restricted to compressive tectonic setting, such as the marginal sub-basins and the thrust top mini-basins of the Appennine-Maghrebian belt.A peculiar seismic facies has been associated to the Trubi Fm., unconformably lying upon the older succession.The undeformed seismic units, onlapping the older substratum, has been associated to the post-Trubi-Holocene deposits, arranged into seven seismic units that reflect the youngest depositional evolution of the nearby Catania-Gela Foredeep. These deposits, generally represented by plane-parallel seismic facies, are in turn separated by an unconformity highlighted by an onlap termination of the yougermost terms upon the older. In some cases they are interrupted by gas rising from the deeper succession that reaches, at times, also the seafloor.


The improper use of drugs can leads to patient morbidity and even mortality. Drug therapy problems are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying drug therapy problems help patients to achieve their goals of therapy and understand the best possible outcomes from drug therapy. To identify, resolve and prevention of drug therapy problems, the practitioner must understand how patients with drug therapy problems present in the clinical setting. Stating the problem and identifying the cause requires involves clinical judgment by the practitioner. All patient problems involving medications can be categorized into seven types. These include all side effects, toxic reactions, treatment failures, or the need for additive, synergistic, or preventive medications, as well as noncompliance. During 2002, there were 3.3 billion prescriptions dispensed from community pharmacies throughout the United States and over 44,000 hospitalized patients die each year resulting from medical errors. Recent research, on drug-related problems and adverse drug reactions has identified several categories of risk factors that may be used to identify patients who are susceptible to drug related problems and adverse drug reactions. It is essential that practitioners who intend to provide pharmaceutical care understand the descriptions and identification of each type of drug therapy problem as well as their common causes. Continuous referral to the seven categories of drug therapy problems ensures that a consistent, rational, comprehensive, and effective care plan can be established for even the most complicated patient.


Introduction Interpretation of perimetric findings, particularly in children, relies on accurate assessment of test reliability, yet no objective measures of reliability exist for kinetic perimetry. We developed the kinetic perimetry reliability measure (KPRM), a quantitative measure of perimetric test reproducibility/reliability and report here its feasibility and association with subjective assessment of reliability. Methods Children aged 5–15 years, without an ophthalmic condition that affects the visual field, were recruited from Moorfields Eye Hospital and underwent Goldmann perimetry as part of a wider research programme on perimetry in children. Subjects were tested with two isopters and the blind spot was plotted, followed by a KPRM. Test reliability was also scored qualitatively using our examiner-based assessment of reliability (EBAR) scoring system, which standardises the conventional clinical approach to assessing test quality. The relationship between KPRM and EBAR was examined to explore the use of KPRM in assessing reliability of kinetic fields. Results A total of 103 children (median age 8.9 years; IQR: 7.1 to 11.8 years) underwent Goldmann perimetry with KPRM and EBAR scoring. A KPRM was achieved by all children. KPRM values increased with reducing test quality (Kruskal-Wallis, p=0.005), indicating greater test-retest variability, and reduced with age (linear regression, p=0.015). One of 103 children (0.97%) demonstrated discordance between EBAR and KPRM. Conclusion KPRM and EBAR are distinct but complementary approaches. Though scores show excellent agreement, KPRM is able to quantify within-test variability, providing data not captured by subjective assessment. Thus, we suggest combining KPRM with EBAR to aid interpretation of kinetic perimetry test reliability in children.


International development's preoccupation with growth-oriented strategies has abated in response to the inadequacies of Gross Domestic Product (GDP) as a measure of societal progress. The broader framing of a wellbeing agenda promises a departure from the policymaking status quo, yet its measures have not kept pace. Efforts to operationalise wellbeing have relied on familiar statistical tools and linear models that limit the information considered relevant for human flourishing. The resulting loss of complexity and diversity distorts policy messages and systematically perpetuates the structural conditions that generate wellbeing inequities. In New Zealand, the re-emergence of wellbeing as a political focal point, coupled with a commitment to the Sustainable Development Goals' (SDGs) call to 'leave no-one behind', places pressure on wellbeing frameworks to improve outcomes for people experiencing hardship. This research explores wellbeing from the perspective of those experiencing hardship in Cannons Creek, Porirua, and analyses how holistic approaches to wellbeing might enable more targeted policies that address wellbeing inequities. Critical theory guided this research and was complemented by the methodologies of participatory action research and the capability approach. Participatory mixed methods enabled an exploration of participants' perspectives via focus group discussions, diagramming activities, and free-list surveys. The results revealed a disconnect between New Zealand's macro level wellbeing framework and community level realities, primarily in what was measured and why it was considered relevant for wellbeing. Participants conceptualised wellbeing as a balance of domains in a non-hierarchical system, and an analysis of wellbeing inter-relationships indicated that some domains acted as catalysts of change or as bridges between seemingly unrelated wellbeing processes. The conclusion can be drawn that for the operationalisation of wellbeing to reach fuller potential, policymakers should make use of alternative framings that shift emphasis from static linear thresholds to a continuum of dynamic, inter-related processes embedded in time, place, and context. As New Zealand's transition to a wellbeing agenda marks new opportunities to pioneer discussions on how best to 'leave no-one behind', this research makes a strong case for measures of progress to reflect the intrinsic and inescapably complex nature of wellbeing as it is experienced in people's daily lives.


These days, Thin-client devices are continuously accessing the Internet to perform/receive diversity of services in the cloud. However these devices might either has lack in their capacity (e.g. processing, CPU, memory, storage, battery, resource allocation, etc) or in their network resources which is not sufficient to meet users satisfaction in using Thin-client services. Furthermore, transferring big size of Big Data over the network to centralized server might burden the network, cause poor quality of services, cause long respond delay, and inefficient use of network resources. To solve this issue, Thinclient devices such as smart mobile device should be connected to Edge computing which is a localized near to user location and more powerful to perform computing or network resources. In this paper, we introduce a new method that constructs its architecture on Thin-client -Edge computing collaboration. Furthermore, present our new strategy for optimizing big data distribution in cloud computing. Moreover, we propose algorithm to allocate resources to meet service level agreement (SLA) and QoS requirements. Our simulation result shows that our proposed approach can improve resource allocation efficiently and shows better performance than other existing methods.


The Authors refer about two cases of retained rectal foreign bodies by trans-anal introduction as consequence of anal eroticism: a deodorant aerosol-can cap and a sizeable phallic object. These reports represent an occasion to talk about the etiology (the wide variety of foreign bodies) and the motivations (eroticism or sadism, clumsy diagnostic and therapeutic procedures, true or presume accidents) responsible for this pathological condition and to consider every therapeutic options employed during the past years, without forgetting that, despite difficulties, non-surgical extraction is to prefer, if possible, because of the negative prognostic implications often related to the surgical treatment. The Authors finally confirm, because of the severity of this pathological condition - with negative outcomes especially in that cases with complete or incomplete perforative complications (produced during introduction through the anus or during several attempts of extraction of the object or caused by its long staying in the rectum because of the patient's denial of medical care) - the surgeons can't put aside possible indication for surgical treatment.


Introduction Treatment of severe chronic constipation (CC) is suboptimal. This study evaluates the combined efficacy results of prucalopride (PRU) in three identical pivotal, randomised, placebo (PLA)-controlled trials. The objective of each trial was to compare the efficacy and safety of a 12 week once daily treatment of 2 mg or 4 mg PRU with PLA in CC. Methods All three trials were of identical design with three parallel treatment groups: PLA, PRU 2 mg and PRU 4 mg. Treatment phase followed a 2-week run-in. Two trials were executed in the US and one in Europe, Canada, Australia and South Africa. The main inclusion criterion was ≤2 spontaneous complete bowel movements (SCBM) per week in combination with straining, sensation of incomplete evacuation or hard stools, at least 25% of the time. The primary efficacy parameter was the percentage of patients with an average of ≥3 SCBM/week over the 12-week treatment period. The two main secondary endpoints were the percentage of patients with an average increase of ≥1 SCBM/week and the percentage of patients with an improvement ≥1 on the satisfaction subscale of the validated quality of life instrument, PAC-QOL. Other endpoints were based on number of (S) BM, time to first BM, stool consistency, straining and patient-reported global evaluation of severity of constipation. Data analysis followed intent-to-treat (ITT) principles. Results Total 1924 ITT patients, 89% female, average age 47 years, average duration of constipation ∼20 years, prior treatments rated inadequate for 83%. Main Complaints: Infrequent defecation (30%), abdominal bloating (24%), abdominal pain (14%), during 2-week run-in ∼57% of the patients had no SCBM, and average weekly number of SCBM was 0.47. In each individual trial the results for the primary endpoint and secondary endpoints were significantly better for both PRU groups compared to PLA. For the three trials combined, the percentage of patients with an average of ≥3 SCBM per week over the 12 week treatment period (primary endpoint) were 11.3%, 23.6% end 24.7% for PLA, PRU 2 mg and PRU 4 mg, respectively (both p<0.001 PRU vs PLA); similar for subjects who rated their previous therapy as inadequate. Response was highest in week 1 of treatment and stable over the remaining 11 weeks. PRU 2 mg and 4 mg consistently showed significant differences with PLA on all other secondary endpoints. Except for higher incidences of diarrhoea, nausea and headache on first day of treatment, PRU was well tolerated. Conclusion Both 2 and 4 mg PRU significantly improve bowel function and associated symptoms in CC compared to PLA. Results are reflected consistently in all observed efficacy parameters, including QOL.


Digital impressions of teeth, obtained through intra-oral scanning, allow for more efficient and cost effective treatments of many dental indications. Current state-of-the-art intra-oral impression acquisition systems make use of a separate monitor to show the scanning progress, forcing the dentist to divert attention away from the scanner and the patient. In this paper, we present an augmented reality based solution to this problem. During the scanning process, an optical see-through head-mounted display is used to show an online overlay of the dynamic dental model onto the patient's teeth. The dentist can then fully focus on the patient and the scanner, while still being able to keep track of the current state of the model. This type of novel application, which fundamentally changes the humancomputer interaction of intra-oral scanning systems, requires a fast and accurate registration of a dynamically growing model onto a glossy, partially occluded surface at a very small scale. To meet this demand, we propose application tailored algorithms for indirect high accuracy online 3D teeth tracking and optical see-through head-mounted display calibration. Experimental results indicate that our system does have a potential to noticeably facilitate intraoral scanning in the future.


While DSS development methodologies and implementation research are abound in the DSS literature, a gap still exists in terms of the ability to provide a holistic conceptual structure for improving the management and development of decision support systems, the ability to capture and share understanding of key DSS development processes, and most notably, the ability to provide guidance for DSS development and process improvements. This paper proposes a Decision Support System Capability Maturity Model DSS-CMM. The model leverages related DSS literature and input from DSS researchers and practitioners to identify pertinent DSS development processes and capability levels. From a theoretical perspective, DSS-CMM provides a meta-model for DSS development processes and represents the first maturity model specifically targeting DSS development. From a practical perspective, the model provides a framework for organizations to assess the capability level of their DSS development processes and devise process improvement initiatives to address any limitations with existing practices.


Colorectal cancer has provided an excellent model for studying the genetic basis of cancer and is one of the better-understood malignancies in this regard. The orderly progression of the disease, with distinct genetic alterations at each step, is a useful framework for deciphering the molecular basis of neoplasia. Epigenetics, the study of clonal changes in gene expression without associated genetic lesions, has raised increased interest recently, in part because of the identification of DNA methylation as a potential molecular mediator of the process. Several tumor-suppressor genes are silenced in various neoplasms in association with aberrant promoter methylation, and in the absence of coding region mutations. The study of DNA methylation changes in colorectal cancer has now provided additional clues into the pathogenesis of the disease. This review presents evidence for a model whereby DNA methylation changes play two distinct roles in the molecular evolution of colorectal cancer. Initially, progressive methylation and silencing of a subset of genes takes place in normal tissues as a function of age or time-dependent events and predisposes these normal cells to neoplastic transformation. At a later stage of disease progression, DNA methylation plays an important role in a subset of tumors affected by the CpG island methylator phenotype (CIMP), a recently identified pathway that results in a form of epigenetic instability through the simultaneous silencing of multiple genes. DNA methylation changes have important interactions with genetic lesions in this cancer type. CIMP+ cancers include the majority of tumors with sporadic mismatch repair deficiency through hypermethylation of the hMLH1 promoter, and also account for the majority of tumors with Ki-ras mutations through an unknown mechanism. By contrast, CIMP- cases evolve along a more classic genetic instability pathway, with a high rate of p53 mutations and chromosomal changes. Thus, the integration of epigenetic and genetic information provides a more complete molecular understanding of colorectal cancer and may have implications for the diagnosis, prognosis, and treatment of patients affected by this disease.


The hallways of intergovernmental organizations (IGOs) are no longer just occupied by state delegations, but instead, a majority of IGOs in existence today grant access or participatory rights to non-governmental organizations (NGOs) too. Many NGOs can therefore attend IGO conferences, participate in day-to-day IGO working groups, implement the projects sponsored by IGOs, push items onto the agendas of IGO meetings, and provide background research for contentious topics. Existing explanations privilege the idea that NGOs help IGOs accommodate a growing democratic deficit or the legitimacy of the IGO, ignoring states as the central actors in international politics. But why would states want to bring NGOs into the already complex coordination problems that exist within IGOs? I argue that states primarily employ NGOs to help monitor and enforce their own positions in international politics. This chapter looks specifically at one IGO - the UN ECOSOC - to test this theory. I analyze the rotating 19 member ECOSOC NGO committee which helps to eliminate some of the predominant research challenges in IGO-NGO research. I show that (1) when a state is represented in the ECOSOC NGO committee, they are more likely to grant access to NGOs whose preferences align with the state's and (2) the more pro-US the ECOSOC NGO committee, the more likely it is that pro-US NGOs are granted access. These relationships emphasize that state-level motivations and benefits are at the heart of explaining IGO-NGO access.


4D treatment plans are optimized to compensates for a patient's individual respiratory motion. However, changes in the time spent in the each respiratory state may render a 4D plan invalid. We introduced and evaluate two robust treatment planning approaches to compensate for respiratory motion variations. Robust 4D plans can be designed either using an average pdf approach or a worst case pdf approach. We tested these approaches on two motion variation scenarios and compared them with nominal 4D optimization and ITV plans. The nominal 4D plans were very sensitive to the variation in respiration pattern while the average pdf and worst case pdf plans were less sensitive under the similar variations. The average and worst case pdf plans were not as robust as the ITV plans but had better healthy tissue sparing. The worst case pdf approach was found to be the most promising for robust 4D plan optimization.


This paper argues that the theoretical contributions of Karl Polanyi can provide a compelling foundation for the analysis of community development (CD) processes and cases. Through a review of the international theoretical and empirical literature in CD the paper demonstrates that CD scholars work with concepts such as social solidarity, agency, self-help and mutual help, social capital, and reciprocity, that can be effectively understood in Polanyian terms. CD scholars explain the emergence of CD as a response to "modernization" where communities seek to mitigate the impacts of modernization while also taking advantage of its promises to improve communities and livelihoods. Also CD normative actions are explained in terms of building – and rebuilding – social capital in response to the erosion of communities caused by modern forces such as the nation-state and industrial capitalism. CD scholars borrow from social analysts such as Jurgen Habermas, Paulo Freire, and Anthony Giddens to structure their explanatory and normative writing. But Polanyi is notably absent as a conceptual source in the CD literature. We argue that Polanyian concepts of the double movement, social disembeddedness, reciprocity institutions, and fictitious commodities can offer conceptual benefits to CD studies. For instance, Polanyi's faculty for coherently defending the social and cultural spheres by using the language of institutional economics provides new perspectives that can induce new analyses of CD processes.


This article investigates how organizational features of high schools interact with students' ascriptive characteristics to shape opportunities to learn. It advances previous research by examining the intersection of students' gender-by-race cohort with their high schools' racial composition on their Grade 12 English track placement in the Charlotte-Mecklenburg Schools. Using HLM with a sample of seniors, we find that school racial composition has significant effects on the track placement of different race-gender cohorts, and that schools' racial compositions interact with students' ascriptive characteristics in these processes. Net of prior achievement, track placements are influenced by individual and family characteristics, as well as school racial composition. Attending a racially imbalanced school affects students' chances of enrolling in college-prep tracks. Racially balanced high schools offer all students the greatest equality of access to college prep tracks.


8.1 Introduction The most frequently occurring malignancy in women is breast cancer,
and its mortality rate is high. Predictions of new cases from the United States National Cancer Institute continue to rise. There are many breast imaging systems available on the market to facilitate the diagnosis of breast cancer. Some of them are used for screening, some for diagnosis, and most others are used for adjunctive evaluation. The most commonly used diagnostic modalities for breast cancer detection are mammography, ultrasound, and clinical breast examination (CBE). Mammography is currently the most widely used technique due to its effectiveness in detecting microcalcifications; however, in spite of its current popularity, mammography has its own limitations. In a study conducted by Carney et al., mammography recorded a sensitivity of 87% and specificity of 96.9% for women with fatty breasts. However, for younger women with extremely dense breasts, the sensitivity of mammography was only 62.9%, and the specificity was 89.1%. This indicates that mammographic
sensitivity increases with age and decreases with breast density. Other limitations of mammography include risks of increased radiation exposure, possible inter-observer variability, and patient discomfort due to breast compression. Though there are a number of other methods used for breast cancer
detection in addition mammography, they also have their own limitations. By the time CBE detects a cancer, the disease is usually at an advanced stage. Breast ultrasound is frequently used to evaluate breast abnormalities that are found with screening or diagnostic mammography or CBE. In spite of ultrasound being less expensive, more comfortable for the patient, and radiation-free, it is not as efficient in imaging microcalcifications as mammography. Microcalcifications are often the first indication of breast cancer. Breast MRI is also radiation-free and has been found to be more sensitive than other modalities in detecting breast cancer in young women. However, it is more expensive, does not detect microcalcifications well, and is not suitable for evaluating patients
with implants or metallic pieces embedded in their bodies. Computed
tomography (CT) can effectively locate an abnormal mass but is not
efficient in differentiating benign from malignant masses, or scar tissue from cancerous tissue. Positron emission tomography (PET) is effective in detecting metabolically active large tumors but is not capable of picking up microscopic metastatic foci, and is more expensive and time consuming. Other modalities include optical mammography, electrical impedance tomography, electrical impedance scanning, and thermography. These techniques have their own drawbacks as well.


Introduction Miniscrew-assisted rapid palatal expansion (MARPE) appliances utilize the skeletal anchorage to expand the maxilla. One type of MARPE device is the Maxillary Skeletal Expander (MSE), which presents four micro-implants with bicortical engagement of the palatal vault and nasal floor. MSE positioning is traditionally planned using dental stone models and 2D headfilms. This approach presents some critical issues, such as the inability to identify the MSE position relative to skeletal structures, and the potential risk of damaging anatomical structures. Methods A novel methodology has been developed to plan MSE position using the digital model of dental arches and cone-beam computed tomography (CBCT). A virtual model of MSE appliance with the four micro-implants was created. After virtual planning, a positioning guide is virtually designed, 3D printed, and utilized to model and weld the MSE supporting arms to the molar bands. The expansion device is then cemented in the patient oral cavity and micro-implants inserted. A clinical case of a 12.9-year-old female patient presenting a Class III malocclusion with transverse and sagittal maxillary deficiency is reported. Results The midpalatal suture was opened with a split of 3.06 mm and 2.8 mm at the anterior and posterior nasal spine, respectively. After facemask therapy, the sagittal skeletal relationship was improved, as shown by the increase in ANB, A-Na perpendicular and Wits cephalometric parameters, and the mandibular plane rotated 1.6° clockwise. Conclusion The proposed digital methodology represents an advancement in the planning of MSE positioning, compared to the traditional approach. By evaluating the bone morphology of the palate and midface on patient CBCT, the placement of MSE is improved regarding the biomechanics of maxillary expansion and the bone thickness at micro-implants insertion sites. In the present case report, the digital planning was associated with a positive outcome of maxillary expansion and protraction in safety conditions.


The proliferation of networked embedded devices such as wireless sensors ushers in an entirely new class of computing platforms. We need new ways to organize and program them. Unlike existing platforms, systems such as sensor networks are decentralized, embedded in physical world, and interact with people. In addition to computing, energy and bandwidth resources are constrained and must be negotiated. Uncertainty, both in systems and about the environment, is a given. Many tasks require collaboration among devices, and the entire network may have to be regarded as a processor. The networked embedded computing group at Microsoft Research is developing new architectures, models, and tools for organizing and programming these systems, and innovative applications in areas such as security, transportation, and healthcare. Our goal is to build systems that are easy to use, manage, and program, robust to failures, and secure. We argue that the traditional node-centric programming of embedded devices is inadequate and unable to scale up. We need new service architectures, inter-operation protocols, programming models that are resource-aware and resource-efficient across heterogeneous devices that can range from extremely limited sensor motes to more powerful servers. In this talk, I will describe our on-going work in developing a lightweight, multi-tier architecture that seamlessly mediates information flows between wireless sensors, micro-servers, and PCs, and discuss challenges in resource discovery, sensor tasking, load balancing, and uncertainty management.


An alternating-current bolometer system has been developed for detecting and recording radiant energy in infra-red spectroscopy. Almost constant use over a ten-months' period dictates certain improvements which are pointed out. The useful sensitivity is limited now by fluctuations originating in the power supply to the bolometer bridge.


The iconic koala (Phascolarctos cinereus) is host to two divergent gammaherpesviruses, phascolarctid gammaherpesviruses 1 and 2 (PhaHV-1 and -2), but the clinical significance of the individual viruses is unknown and current diagnostic methods are unsuitable for differentiating between the viruses in large-scale studies. To address this, we modified a pan-herpesvirus nested PCR to incorporate high-resolution melt analysis. ABSTRACT The iconic koala (Phascolarctos cinereus) is host to two divergent gammaherpesviruses, phascolarctid gammaherpesviruses 1 and 2 (PhaHV-1 and -2), but the clinical significance of the individual viruses is unknown and current diagnostic methods are unsuitable for differentiating between the viruses in large-scale studies. To address this, we modified a pan-herpesvirus nested PCR to incorporate high-resolution melt analysis. We applied this assay in a molecular epidemiological study of 810 koalas from disparate populations across Victoria, Australia, including isolated island populations. Animal and clinical data recorded at sampling were analyzed and compared to infection status. Between populations, the prevalence of PhaHV-1 and -2 varied significantly, ranging from 1% to 55%. Adult and older animals were 5 to 13 times more likely to be positive for PhaHV-1 than juveniles (P < 0.001), whereas PhaHV-2 detection did not change with age, suggesting differences in how these two viruses are acquired over the life of the animal. PhaHV-1 detection was uniquely associated with the detection of koala retrovirus, particularly in females (P = 0.008). Both viruses were significantly associated (P < 0.05) with the presence of genital tract abnormalities (uterine/ovarian cysts and testicular malformation), reduced fertility in females, urinary incontinence, and detection of Chlamydia pecorum, although the strength of these associations varied by sex and virus. Understanding the clinical significance of these viruses and how they interact with other pathogens will inform future management of threatened koala populations.


This study applies a sensitivity analysis (SA) technique (the Morris method, MM) to an automated Lagrangian tropical cyclone (TC) tracking algorithm used on gridded climate data. MM demonstrates the ability to screen for input parameters defining TCs (such as minimum intensity and lifetime) that contribute significantly to sensitivity in output metrics (such as storm count). The SA is performed by tracking TCs in four different reanalyses. Tracked TC trajectories are compared to a pointwise observational record. Results show that using thermally integrated metrics for isolating TC warm cores is superior to single‐temperature levels. Input thresholds defining TC vortex strength during tracking contribute the most variance in all output metrics. Integrated output metrics (such as accumulated cyclone energy) are less variable than "counting" metrics such as TC frequency. MM greatly reduces the computational requirements for tracker optimization, with tracked TCs demonstrating better hit and false alarm rates than previous studies.


Bid-ask spreads, which measure trade execution costs, and reflect the price concessions necessary to complete transactions quickly, are important as indicators of market quality and in determining traders' actual investment results. Execution costs arise because it is costly to provide liquidity, and can be estimated on the basis of comparisons of trade prices with proxies for underlying security value, with the most common proxy being the quote midpoint. Comparisons can be of trade prices to midpoints at or before the time of the trade, as in effective spread measures, or to midpoints after the trade, as in realized spread measures. Recent research indicates that trade execution costs have declined in US markets in recent years, and documents substantial variation in average trading costs across international equity markets.

Keywords:

bid-ask spread;
trading cost;
quoted spread;
effective spread;
price impact of trade;
realized spread;
benchmark price;
stock exchange;
liquidity cost


IN 1985, Leslie et al1described a series of 168 cases of injuries and deaths related to fraternity hazing activities occurring in the United States between 1923 and 1982. This was the first article in the literature to address the medical hazards of fraternity hazing. Hazing has reportedly existed on the campuses of American universities since the mid-19th century, but documentation of a specific incident was unavailable at the time of the original research. The extent of hazing-related injuries and deaths is still unknown because of concealment of the activity by student participants and lack of recognition by professionals who treat students for a variety of injuries of undetermined origin. The types of injuries previously reported included those from blunt force (beatings, paddling, motor vehicle crashes, pedestrian accidents, and falls from height), burns (including chemical burns, branding, and immolation), cold exposure, heat exhaustion, acute ethanol intoxication, food and laxative


The behavior of deep neural networks (DNNs) is hard to understand. This makes it necessary to explore post hoc explanation methods. We conduct the first comprehensive evaluation of explanation methods for NLP. To this end, we design two novel evaluation paradigms that cover two important classes of NLP problems: small context and large context problems. Both paradigms require no manual annotation and are therefore broadly applicable. We also introduce LIMSSE, an explanation method inspired by LIME that is designed for NLP. We show empirically that LIMSSE, LRP and DeepLIFT are the most effective explanation methods and recommend them for explaining DNNs in NLP.


: In the current health care environment, many customary procedures, developed in an era when cost containment and market competition were not major concerns are no longer compatible with the operation of a successful surgery service. This article outlines a perioperative system that accomplishes the goals of cost containment and patient and surgeon satisfaction without sacrificing quality of care. This system entails streamlining the entire perioperative process, from the initial interface with the surgeon's office to discharge from the facility. In addition, the system eliminates unnecessary waste that remains rampant in most surgery departments, and addresses scheduling problems that limit efficiency.


The phase behavior of solutions of the acid form of lightly sulfonated polystyrene in Decalin was affected by the total acid group concentration and by the number of acid groups per molecule. The upper critical solution temperatures (UCST) increased with total acid group content as a consequence of poorer solvent quality. The UCST also increased with increasing number of acid groups per molecule, which was attributed to a loss of configurational entropy due to the aggregation of the acid groups by hydrogen bonding.


During the last decades, large-scale land use changes took place in the Hailiutu River catchment, a semi-arid area in northwest China. These changes had significant impacts on the water resources in the area. Insights into groundwater and surface water interactions and vegetation-water dependencies help to understand these impacts and formulate sustainable water resources management policies. In this study, groundwater and surface water interactions were identified using the baseflow index at the catchment scale, and hydraulic and water temperature methods as well as event hydrograph separation techniques at the sub-catchment scale. The results show that almost 90% of the river discharge consists of groundwater. Vegetation dependencies on groundwater were analysed from the relationship between the Normalized Difference Vegetation Index (NDVI) and groundwater depth at the catchment scale and along an ecohydrogeological cross-section, and by measuring the sap flow of different plants, soil water contents and groundwater levels at different research sites. The results show that all vegetation types, i.e. trees (willow (Salix matsudana) and poplar (Populus simonii), bushes (salix – Salix psammophila), and agricultural crops (maize – Zea mays)), depend largely on groundwater as the source for transpiration. The comparative analysis indicates that maize crops use the largest amount of water, followed by poplar trees, salix bushes, and willow trees. For sustainable water use with the objective of satisfying the water demand for socio-economical development and to prevent desertification and ecological impacts on streams, more water-use-efficient crops such as sorghum, barley or millet should be promoted to reduce the consumptive water use. Willow trees should be used as wind-breaks in croplands and along roads, and drought-resistant and less water-use intensive plants (for instance native bushes) should be used to vegetate sand dunes.


Abstract Background Improving Access to Psychological Therapies (IAPT) services treat most patients in England who present to primary care with major depression. Psychodynamic psychotherapy is one of the psychotherapies offered. Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression. 16 sessions are delivered over approximately 5 months. Neither DIT's effectiveness relative to low-intensity treatment (LIT), nor the feasibility of randomizing patients to psychodynamic or cognitive-behavioural treatments (CBT) in an IAPT setting has been demonstrated. Methods 147 patients were randomized in a 3:2:1 ratio to DIT (n = 73), LIT (control intervention; n = 54) or CBT (n = 20) in four IAPT treatment services in a combined superiority and feasibility design. Patients meeting criteria for major depressive disorder were assessed at baseline, mid-treatment (3 months) and post-treatment (6 months) using the Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory-II (BDI-II) and other self-rated questionnaire measures. Patients receiving DIT were also followed up 6 months post-completion. Results The DIT arm showed significantly lower HRSD-17 scores at the 6-month primary end-point compared with LIT (d = 0.70). Significantly more DIT patients (51%) showed clinically significant change on the HRSD-17 compared with LIT (9%). The DIT and CBT arms showed equivalence on most outcomes. Results were similar with the BDI-II. DIT showed benefit across a range of secondary outcomes. Conclusions DIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs.


The Supreme Court of Appeal (hereinafter "the SCA") was recently tasked with resolving the elusive answer to an unsettled question: may employees in the public service challenge dismissals and other forms of alleged unlawful practices in the High Court as infringements of their right to lawful, rational and procedurally fair administrative action? The High Court and the Labour Court have been divided on the issue to such an extent that neither forum has managed to follow a consistent approach. The uncertainty has arisen, in essence, from two irreconcilable bases: the first, that dismissals and other employment practices in the public sector do not constitute administrative action, and so cannot be subjected to scrutiny under the common law, the PAJA or the Constitution; the second, that public sector employees have always been regarded as administrative law subjects under the common law, and as the PAJA does not expressly alter the position, they retain the protection. Amid this legal setting of uncertainty emerged Ms Chirwa. She was dismissed for alleged incompetence following an enquiry in which she refused to participate as she was adamant that the presiding manager was biased or could reasonably be seen to be biased against her. She challenged her dismissal in the High Court as an infringement of her right to lawful, reasonable and procedurally fair administrative action in terms of the PAJA, alternatively the Constitution. (S 33(1) of the Constitution reads: "Everyone has the right to administrative action that is lawful, reasonable and procedurally fair.") The court agreed with Ms Chirwa's contentions, declared her dismissal a nullity, and reinstated her with retrospective effect. (Brassey AJ found that Transnet had breached the audi alteram partem rule, a principle of natural justice applicable to pubic sector dismissals. This case note does not offer a critique of the court a quo's decision.) On appeal, Transnet contended that Ms Chirwa's dispute was one over which the Labour Court had exclusive jurisdiction in terms of section 157(1)  of the LRA, (s 157(1) of the LRA which reads: "Subject to the Constitution and section 173, and except where this Act provides otherwise, the Labour Court has exclusive jurisdiction in respect of all matters that elsewhere in terms of this Act or in terms of any other law are to be determined by the Labour Court."); alternatively, that her dismissal did not constitute administrative action as defined in section 1 of the PAJA. Put simply, the issue on appeal was whether Ms Chirwa had an administrative justice cause of action justiciable in the High Court. Of the five judges who heard the appeal, three held that the High Court could not assist her. On the face of it, Chirwa therefore appears to have resolved the jurisdictional dispute in favour of the exclusive jurisdiction of the Labour Court in employment disputes. However, scratching the surface of the judgment, the worth of its appearance quickly fades. This case note offers a critique and attempts to determine the real worth of Chirwa, a judgment by what, as will be explained, was actually a divided bench of the SCA.


Carol Gilligan is associate professor of education at the Harvard Graduate School of Education. Her 1982 book, In a Different Voice, presents a theory of moral development which claims that women tend to think and speak in a different way than men when they confront ethical dilemmas. Gilligan contrasts a feminine ethic of care with a masculine ethic ofjmtice. She believes that these gender differences in moral perspective are due to contrasting images of self.


Learning to leverage the relationship among diverse image restoration tasks is quite beneficial for unraveling the intrinsicingredients behind the degradation. Recent years have witnessed the flourish of various All-in-one methods, which handle multiple image degradations within a single model. In practice, however, few attempts have been made to excavate task correlations in that exploring the underlying fundamentalingredients of various image degradations, resulting in poor scalability as more tasks are involved. In this paper, we propose a novel perspective to delve into the degradation via aningredients-oriented rather than previous task-oriented manner for scalable learning. Specifically, our method, named Ingredients-oriented Degradation Reformulation framework (IDR), consists of two stages, namely task-oriented knowledge collection and ingredients-oriented knowledge integration. In the first stage, we conduct ad hoc operations on different degradations according to the underlying physics principles, and establish the corresponding prior hubs for each type of degradation. While the second stage progressively reformulates the preceding task-oriented hubs into single ingredients-oriented hub via learnable Principal Component Analysis (PCA), and employs a dynamic routing mechanism for probabilistic unknown degradation removal. Extensive experiments on various image restoration tasks demonstrate the effectiveness and scalability of our method. More importantly, our IDR exhibits the favorable generalization ability to unknown downstream tasks.


Vascular smooth muscle cell (VSMC) proliferation after arterial injury is important in the pathogenesis of a number of vascular proliferative disorders, including atherosclerosis and restenosis after balloon angioplasty. Thus, a better understanding of the molecular mechanisms underlying VSMC proliferation in response to arterial injury would have important therapeutic implications for patients with atherosclerotic vascular disease. The p21 protein is a negative regulator of mammalian cell cycle progression that functions both by inhibiting cyclin dependent kinases (CDKs) required for the initiation of S phase, and by binding to and inhibiting the DNA polymerase delta co-factor, proliferating cell nuclear antigen (PCNA). In this report, we show that adenovirus-mediated over-expression of human p21 inhibits growth factor-stimulated VSMC proliferation in vitro by efficiently arresting VSMCs in the G1 phase of the cell cycle. This p21-associated cell cycle arrest is associated both with significant inhibition of the phosphorylation of the retinoblastoma gene product (Rb) and with the formation of complexes between p21 and PCNA in VSMCs. In addition, we demonstrate that localized arterial infection with a p21-encoding adenovirus at the time of balloon angioplasty significantly reduced neointimal hyperplasia in the rat carotid artery model of restenosis. Taken together, these studies demonstrate the important role of p21 in regulating Rb phosphorylation and cell cycle progression in VSMC, and suggest a novel cytostatic gene therapy approach for restenosis and related vascular proliferative disorders.


: Full-field reversed 1.3X telescopes were used in the treatment of a 63-year-old male retinitis pigmentosa (R.P.) patient with a 5 degree central field. The patient was highly motivated to "expand" his visual field. He was trained intensively with 1.3X, 1.7X, and 2,2X reversed telescopes prior to prescribing. Evaluations by the Orientation and Mobility staff indicated significant improvements in his functioning with the devices. The reversed telescopes expanded his field to approximately 14 degrees. Patient has been reevaluated after using the aid at home and remains enthusiastic about his successful use of the aid. This case is notable in that binocular, low-power, full-field, reversed telescopes are being used successfully for mobility, eating, and other tasks.


Convergence introduces several transformations into Cultural Industries' structures and dynamics. The option to receive television signal into mobile devices with 3G technologies is one of these changes. This article analyzes new phenomenon from Political Economy of Communication focus. As a consequence, all 3G mobile television technologic, economic and political dimensions will be studied. The results show that new method of television broadcasting is more positioned to potentiate economic factors than media integration based on convergence logics. This new system is contributing to reinforce the commodification of cultural industries. In this way, it moves television away from public services logics, setting it as a mere complement of media companies' commercial strategies. In conclusion, 3G mobile TV assumes decisive importance since besides placing as the forth screen it is helping to re-define classic concept of television.


We describe the geographical variation of corolla and nectar guide size in seven populations of Mimulus luteus (Phrymaceae) in central Chile, and examine whether flower phenotypes associate with taxonomic composition and flower visit patterns of pollinators across populations. Flowers showed higher variation in nectar guide size than corolla size. Mean corolla size increased with the proportion of bees and decreased with the proportion of lepidopterans in the pollinator assemblages. Nectar guide size increased with the proportion of hummingbirds in the pollinator assemblages. When the frequency of flower visits rather than taxonomic composition was considered, the results revealed similar patterns. Because these traits previously have been described as targets of bee- and hummingbird-mediated selection in M. luteus, our results have implications for understanding the processes that determine flower diversification in Chilean Mimulus. Although we cannot rule out ecological sorting as an explanation for the geographical association between pollinators and flower phenotypes, changes in the prevalence and importance of bees and hummingbirds across populations appear to account, at least in part, for the flower phenotypic variation across populations. The extent to which insect and hummingbird pollination in M. luteus produces pollinator-mediated divergence among populations needs to be examined in future studies.


An 82-year-old woman presented with neck pain and bilateral upper limb paraesthesia after sustaining an unwitnessed fall at home the day before. Physical examination revealed tenderness over the C4–6 region but no evidence of step deformity or neurological deficit. Magnetic resonance imaging of the cervical spine revealed multiple small fractures at the anteroinferior endplate corners of the C3, C5 and C6 vertebrae with focal kyphosis and marrow oedema at these levels, as well as associated disruption of the anterior longitudinal ligament and central spinal canal stenosis. The diagnosis of multiple flexion teardrop fractures was made based on these imaging findings, and the patient subsequently received conservative management. This paper illustrates the radiological features of flexion teardrop fractures and highlights the importance of prompt diagnosis and management of such cases.


Abstract.The high compression of 600 times liquid density and the recent fast heating of a compressed core to 1-keV temperature have provided proof-of-principle of the fast ignition concept, and these results have significantly contributed to approve first phase of the Fast Ignition Realization EXperiment (FIREX) project. The goal of FIREX-I is to demonstrate fast heating of a fusion fuel up to the ignition temperature of 5–10 keV. Although the fuel size of FIREX-I is too small to ignite, sufficient heating will provide the scientific viability of ignition-and-burn by increasing the laser energy thereby the fuel size. Based on the result of FIREX-I, the decision of the start of FIREX-II to achieve ignition-and-burn can be made. The FIREX program is under the collaboration of the Institute of Laser Engineering and the National Institute for Fusion Science.


The workshop on Parton Distributions and Lattice Calculations in the LHC era (PDFLattice2017) was hosted at Balliol College, Oxford (UK), from 22$^{\rm nd}$ to 24$^{\rm th}$ March 2017. The workshop brought together the lattice-QCD and the global-fit physicists who devote their efforts to determine the parton distribution functions (PDFs) of the proton. The goals were to make the two communities more familiar between each other, review developments from both sides, and set precision targets for lattice calculations so that they can contribute, together with the forthcoming experimental input, to the next generation of PDF determinations. This contribution summarises the relevant outcome of the workshop, in anticipation of a thorough white paper.


Previous studies have shown that anti-γ-interferon (IFN-γ) antibody reduces the frequency of autoimmune IDDM in the DP-BB rat. We tested the effects of systemically administered recombinant rat IFN-γ in both DP-BB and DR-BB rats. Unexpectedly, IFN-γ markedly reduced the incidence of IDDM as compared with control rats when administered six times per week at a dosage of 280,000 U between ages 30-35 to 105 days or ages 60-64 to 105 days. A lower dosage (28,000 U on alternate days) was also protective when administered to DP-BB rats between birth and age 60 days. However, long-lasting protection against IDDM development over the 1-year study period was achieved only by the highest dosage of IFN-γ administered from age 30 to 105 days. Ex vivo production of tumor necrosis factor-a from splenic lymphoid cells (SLCs) and peritoneal macrophages of the rats treated with IFN-γ was comparable with that of controls; however, SLCs from the IFN-γ-treated animals secreted lower amounts of IFN-γ after stimulation with concanavalin A. IFN-γ treatment also markedly reduced the frequency of phenotypically activated SLC-expressing class II antigens and interleukin-2 receptor. Finally, in agreement with the observed antidiabetogenic effects, exogenously administered IFN-γ induced neither insulitis nor IDDM development in DR-BB rats, a subline of DP-BB rats in which autoimmune diabetes rarely occurs spontaneously but can be induced by administration of polyinosinic-polycytidilic acid.


Abstract Background: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model. Objective: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective. Research Design: A cross-sectional survey design was used. Study Sample: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus. Data Collection and Analysis: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions. Results: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with—receiving—spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor. Conclusions: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected.


The role of mechanical properties is essential to understand molecular, biological materials and nanostructures dynamics and interaction processes. Atomic force microscopy (AFM), due to its sensitivity is the most commonly used method of direct force evaluation. Yet because of its technical limitations this single probe technique is unable to detect forces with femtonewton resolution. In this paper, we present the development of a combined atomic force microscopy and optical tweezers (AFM/OT) instrument. The system is based on a commercial AFM and confocal microscope. The addition of three lasers along with beam shaping and steering optics, on which the optical tweezer is based upon, provide us with the ability to manipulate small dielectric objects suspended in a fluid. Additionally, this same device allows for direct displacement and force measurement with very high resolution and accuracy in the same AFM scanning zone. We have also fitted a laser and a set of filters to observe fluorescent samples appropriately exited. We show that this is a great improvement of a standalone AFM force resolution and more so opens a way to conduct experiments using a hybrid double probe technique with high potential in nanomechanics, molecules manipulation and biological studies. This paper describes in detail the construction of all the modules such as the trapping laser optics, detection laser optics and the fluorescence module. Also, due to its importance on the performance of the equipment, the electronics part of the detection system is described. In the following chapters the whole adjustment and calibration is explained. The performance of the apparatus is fully characterized by studying the ability to trap dielectric objects and quantifying the detectable and applicable forces. The setting and sensitivity of the particle position detector and force sensor is shown. We additionally describe and compare different optical tweezer calibration methods. In the last part we show the ability of our instrument to conduct experiments using the proposed double-probe technique, in this case to study interaction forces between two particles. Development of a hybrid Atomic Force Microscope and Optical Tweezers apparatus Krzysztof Zembrzycki, Sylwia Pawłowska Paweł Nakielski, Filippo Pierini Instytut Podstawowych Problemów Techniki Polskiej Akademii Nauk


A stable HepG2 cell line harboring a human cholesterol 7 alpha-hydroxylase (CYP7A) minigene/luciferase reporter gene construct was selected for studying transcriptional regulation of CYP7A gene promoter. Insulin and phorbol 12-myristate-13-acetate (PMA) strongly repressed the promoter activity as measured with luciferase activity expressed in the cells. The promoter activity of the 5' progressive deletion/luciferase reporter gene constructs was studied in a transient transfection assay in HepG2 cells. PMA represses the promoter activity and the response elements were localized in the -184/-151 and -134/-81 regions. Insulin also represses the promoter activity and response element was mapped in the -298/-81 region. Surprisingly, glucocorticoid receptor (GR) strongly inhibited promoter activity in the presence of dexamethasone, and response elements were localized in the -298/-151 and the -150/+24 regions. Thyroid hormone receptor also repressed promoter activity and response elements were localized in the -150/+24 and upstream regions. Cotransfection of CYP7A chimeric constructs with an expression vector carrying liver-enriched transcription factor HNF3 alpha stimulated the reporter gene activity, but cotransfection with GR plasmid interfered with the HNF3 alpha-stimulated activity possibly through competition for binding to overlapping GR/HNF3 binding sites. Thus, human cholesterol 7 alpha-hydroxylase gene promoter is strongly repressed by insulin, PMA, and steroid/thyroid hormones and results in the low level of cholesterol 7 alpha-hydroxylase expression in the human liver.


The phenomenon of teenage campus suicide has become the focus of attention of parents, schools and the society. The causes behind it are extremely complicated, and the root cause is psychological and spiritual problems. However, one's negative psychology is often hidden, and it is difficult to detect and effectively intervene before the tragedy. How to effectively identify students with suicidal tendencies in order to prevent tragedies has aroused extensive research and discussion among the government, academia and the public. Through investigation and research, it is found that the current popular computer cutting-edge technologies such as artificial intelligence and computer vision can be well used for human emotion recognition and behavior prediction, and put into use in schools as a mental health auxiliary diagnosis and treatment system, thus effectively reducing the suicide rate on campus. The scenario assumes that machine learning can be used to deduce the risk of psychological problems in human samples by analyzing the frequency of negative emotions in facial expressions. Based on this, this paper proposes an effective solution for campus suicide prediction, and designs a set of auxiliary diagnosis and treatment system based on campus monitoring network system for suicide behavior prediction and student mental health analysis. Through preliminary experimental analysis and verification, the suicide psychological auxiliary diagnosis and treatment system has achieved good results in face recognition success rate, emotion recognition success rate and behavior prediction success rate. With the input of more experimental data and the increase of self-training time, the prediction system will perform better.


Abstract Objective An increasing focus on legislation, policy and guidance on the nutritional content of school food has in part been in response to the limited impact of more behavioural or educational approaches. However, there is a risk that a sole focus on policy-level action may lead to neglect of the important contribution that more behavioural approaches can make as components of effective, coordinated, multilevel action to improve the dietary intake of schoolchildren. The current paper aims to highlight the potential importance of viewing alternative approaches as complementary or synergistic, rather than competing. Design The socio-ecological and RE-AIM frameworks are used to provide a theoretical rationale and demonstrate the importance of explicitly identifying the interdependence of policies, interventions and contextual structures and processes. School food case study evidence is used to exemplify how understanding and exploiting these interdependencies can maximise impact on dietary outcomes. Setting Case studies of trials in schools in the UK (South West England and Wales) and Australia (Victoria). Subjects Schoolchildren. Results The case studies provide examples to support the hypothesis that the reach, effectiveness, adoption, implementation and maintenance of school food policies and interventions can be maximised by understanding and exploiting the interdependence between levels in the socio-ecological framework. Conclusions Rather than being seen as competing alternatives, diverse approaches to improving the diets of schoolchildren should be considered in terms of their potential to be complementary and synergistic, acting at multiple levels to improve acceptability, fidelity, effectiveness and sustainability.


Biodiversity is a complex and multidimensional concept that characterizes variation of life on Earth. Nonetheless, most studies have examined only a few, if not just one, dimension in isolation. Herein we conduct analyses that explicitly incorporate correlations among multiple dimensions of biodiversity by characterizing morphological, phylogenetic, and functional structure of bat communities from Atlantic Forest of South America and examine degree of redundancy among these sets of descriptors. Second, we examine dimensionality (i.e. number of orthogonal dimensions) of community structure by quantitatively determining if these different sets of descriptors correspond to unique dimensions. We assess if dimensionality measured from empirical communities differs from that based on communities randomly assembled from a regional species pool. Finally, we examine whether different indices of community structure respond differently to environmental gradients spanning Atlantic Forest. We find that Atlantic Forest bat communities are highly variable in terms of morphological, phylogenetic, and functional structure. Different sets of community structure indices exhibited substantive correlations. Accordingly, dimensionality was lower than the set of six different descriptors or even the three different biological dimensions represented. Nonetheless, observed dimensionality was greater than that expected from a null model of assembly. Only abundance-based indices of phylogenetic structure exhibited significant environmental gradients. Temperature seasonality was the strongest predictor of phylogenetic structure, with overdispersed communities characterizing more seasonal environments and underdispersed communities occurring in areas of lower variation in temperature. Dimensionality of community structure is low with phylogenetic structure exhibiting the strongest patterns, probably because phylogeny reflects many different ecological aspects of the phenotype that are not restricted to just one index of structure. Temperature seasonality is an important determinant of phylogenetic structure of bat communities in Atlantic Forest. This research helps us to better understand the factors underlying the distribution of biodiversity, which is increasingly important for endangered ecoregions such as Atlantic Forest.


Absii-act--In this paper we report the fabrication of a robust, tunable single-longitudinal-mode compound-ring Er3+-doped fiber laser. The laser is fundamentally structured on an all-fiber compound-ring resonator in which a dual-coupler fiber kg is inserted into the main cavity. When combined in tandem with a mode-restricting intracavity tunable bandpass filter, the compound-ring resonator ensures single-longitudinal-mode laser oscillation. The laser can provide up to 20 mW output power over much of its 1525 to 1570 nm wavelength tuning range. The short-term linewidth of the laser output measured is less than 5 kHz. The laser frequency is actively stabilized for a long time by exploiting the inherent filter nature of the compound-ring resonator. The reduction of an associated frequency modulation is also discussed in detail.


This work seeks to assess the outsourcing process adopted by Philips for producing LCD televisions. The authors used the Resource-based Theory and the Transaction Cost Theory for analyzing the case. Based on industry data and interviews with ten of the company's senior executives, this study sought to understand how the decision making process was carried out and how it affected the company's activities in the field of LCD televisions. Philips has lost its competitiveness in the Brazilian market – it went from being the leader in 2006 to fourth place in 2009, both as far as regards its sales volume and value. The executives pointed out that the LCD panel is an important resource and that its supply by third parties represented a high transaction cost. The results illustrate the complementarity that exists between the RBT and TCT theories in a competitive environment that has few players.


Existing literature suggests that numerous factors influence cancer survivors' physical activity (PA) levels, for example receiving specific PA information from health care professionals. Interestingly. research also suggests that health care professionals fail to promote PA to cancer patients due to a variety of reasons. However, qualitative research exploring how these factors impact or influence PA levels amongst cancer survivors and PA promotion amongst health care professionals is sparse. In addition to this, no known research has utilised an interpretative phenomenological approach which includes both breast cancer survivors and breast cancer nurses. This research study utilises an interpretative phenomenological approach to explore breast cancer survivors' lived experiences of physical activity (PA) and breast cancer nurses' perspectives and experiences of promoting PA. By utilising a phenomenological approach and involving both groups, I aim to illuminate the multiple perspectives of PA and understand the meanings of the participants' experiences of either participating in PA or promoting PA.

This research involved two separate phases. During Phase One, I interviewed ten breast cancer survivors individually, using semi-structured interviews; exploring their individual lived experiences of PA. The findings were analysed using interpretative phenomenological analysis (IPA) approach; the aim here was to illuminate the participants' individual experiences and meanings of PA. The themes identified were: 'losing and regaining control of the body', 'experiences and perceptions of support', 'the meaning of PA' and 'the importance of being with other people who were in the same boat'.

During Phase Two, I interviewed five breast cancer nurses individually, using semi-structured interviews; exploring their perspectives and experiences of promoting PA. Template analysis was the method chosen to analyse the findings, the main themes identified were: 'Perceived responsibility for promoting PA', 'External services and resources', 'Nurse-survivor relationship' and 'Perceptions of breast cancer survivors' characteristics'.

In Phase One: Varied experiences and meanings of PA amongst the breast cancer survivors are illuminated; however, it appeared that they utilised PA as a tool to help make sense of and adapt to their 'new normal'. In Phase Two: Differences amongst the breast cancer nurses with regards to their attitudes and perceptions of their roles and PA promotion were identified; it appeared that these differences caused inconsistencies with PA promotion. The findings from both phases of the research study were synthesised and explored further. The key findings which emerged across the two phases were: utilising PA as a tool to make sense of and adapt to a 'new normal', the importance of relationships and limited PA advice. The key findings illuminate the differences between the breast cancer survivors' and the breast cancer nurses' perceptions and attitudes. For example, the breast cancer survivors' meanings of PA were related to gaining a sense of 'normality' and control over their overall health and well-being. Whereas, the majority of the breast cancer nurses' focused on the medical benefits of PA, rather than focusing on the benefits of PA holistically.

The unique insight into both sample groups, provides a deeper understanding of their experiences and meanings of PA and promoting PA. These findings may support and improve future research and PA promotion within oncology. It is recommended that more research is needed to develop further understanding of this phenomena which a) utilises interpretative phenomenological methods b) includes both sample groups, c) involves diverse sample groups such as; age, ethnicity, job roles etc. Further, it is suggested that specific education and training for breast cancer nurses with regards to their role and responsibility to promote PA, should be available as it may overcome specific issues relating to perception of their roles and PA promotion.


Event-driven architectures (EDA) have been proposed as a new architectural paradigm for event-based systems to process complex event streams. However, EDA have not yet reached the maturity of wellestablished software architectures because methodologies, models and standards are still missing. Despite the fact that EDA-based systems are essentially built on events, there is a lack of a general event modelling approach. In this paper we put forward a semantic approach to event modelling that is expressive enough to cover a broad variety of domains. Our approach is based on semantically rich event models using ontologies that allow the representation of structural properties of event types and constraints between them. Then, we argue in favour of a declarative approach to complex event processing that draws upon well established rule languages such as JESS and integrates the structural event model. We illustrate the adequacy of our approach with relation to a prototype for an event-based road traffic management system.


Between December 1996 and October 1998,34 patients with nonischemic dilated cardiomyopathy (DCM) received cardiac volume reduction surgery. The patients' ages ranged from 14 to 67 years (mean = 48 years) and included 28 males and 6 females. Associated mitral regurgitation was present in 31 patients, tricuspid regurgitation in 19 patients, and aortic regurgitation in 4 patients. We performed a partial left ventriculectomy (PLV) using antegrade intermittent warm blood cardioplegia in 15 patients (group A), and in 19 patients (group B) PLV was performed using the on‐pump beating heart technique. In group A, the mean aortic clamping time was 79 ± 33 minutes and the total cardiopulmonary bypass time was 155 ± 58 minutes. In group B the mean cardiopulmonary bypass time was 121 ± 43 minutes. There were eight hospital deaths (five in group A and three in group B). Five of 10 survivors of group A required inotropic support for 13.8 ± 25.3 days after the operation, while 5 of 12 survivors in group B required inotropes for 4.2 ± 3.1 days. Hospital mortality was 86% in 7 emergent cases and 7% in 27 elective cases. Echocar‐diographic study showed that the left ventricular ejection fraction improved from a mean of 18.7% to 30.3% and the left ventricular diameter decreased from a mean of 80.2 mm to 62.3 mm after the operation. All 26 hospital survivors were followed for 1 to 20 months. Three patients died at early follow‐up because of congestive heart failure, thrombosed valve, and hepatic failure, respectively. Nineteen patients were in New York Heart Association (NYHA) Class I or II and four were in NYHA Class III. In conclusion, cardiac volume reduction surgery is effective when the operative technique and proper judgment of patient selection are established, and emergent operation is avoided.


BACKGROUND
The purpose of this study was to examine whether academic primary care physicians recommended appropriate preventive care to their female patients, whether recommendations differed for different types of physicians, and how often these recommendations led to completion of the preventive service.

METHODS
A retrospective chart review was conducted in the family medicine and internal medicine outpatient practices at the Medical Center of Delaware (MCD). A total of 324 women ages 40 and over were selected from the patient panels of nine faculty and 14 residents. Physician recommendation of PAP smears, mammograms, breast exams, and influenza immunizations were measured against the guidelines of the U.S. Preventive Service Task Force. Specifically examined was whether rates of recommendation differed by specialty, gender and faculty/resident status of the physician. Also measured was completion of each preventive service and whether rates of completion differed from rates of physician recommendation.

RESULTS
Physicians recommended appropriate PAPs in 72 percent of patients, mammograms in 83 percent of patients, breast exams in 46 percent of patients and influenza immunizations in 30 percent of patients. Family physicians were more likely to recommend PAP smears (odds ratio 5.53, 95 percent confidence interval 2.26-12.98), but not more likely to recommend other services; female physicians were more likely to recommend breast exams (odds ratio 3.48, 95 percent confidence interval 2.05-5.89), but not other services. There were no significant differences between faculty and residents. Preventive services were completed in 48 percent of patients for PAPs, 68 percent for mammograms, 42 percent for breast exams, and 27 percent for flu shots.

CONCLUSIONS
In academic primary care practices at MCD, physicians perform well in recommending PAPs and mammograms, but not in recommending breast exams or influenza immunizations. There were few differences in performance among different types of physicians. Because many women did not follow through with their physicians' recommendations for preventive care, physician performance is more accurately measured according to their recommendations rather than completion of services. Efforts to improve preventive care in women should differ depending on whether the problem lies in physician performance or patient behavior.


Much research is carried out to determine the relation between socioeconomic status (SES) and health and access to healthcare. Common conclusion of the previous researches done is that lower SES individuals have worse health status, experience worse health and experience reduced access to healthcare. The incidence and prevalence of chronic diseases are higher among lower SES individuals than among higher SES individuals. Since lower SES individuals will have lower health literacy and worse lifestyle, it is important for these individuals to be supervised by their GP in order to manage their disease(s) well. This research will focus on the disease management programs for diabetes mellitus (DM) and cardiovascular risk management (CVRM), since these diseases are more common among lower SES individuals and lifestyle factors play an important role in the development of the diseases. It is not known whether lower SES individuals experience a reduced access in the disease management programs for DM and CVRM and if the higher SES and lower SES patients included in the program differ on patient characteristics as age, age at onset and BMI. Both the enrolment and drop-out of the disease management programs for DM and CVRM and the characteristics of the patients included in this programs will be determined in this study. This knowledge may help better guide the delivery of interventions in the disease management programs for DM and CVRM. In turn, this can lead to a lower burden of these diseases with better self-management. All of this is determined in the light of Almelo, a city which has some postal codes with a very low SES and some postal codes with a high SES. Data is extracted from the database of FEA, a federation for cooperative GPs in Almelo and is analysed with descriptive statistics in SPSS. Mann-Whitney U test is carried out to determine if there is a relation between SES and drop-out of the disease management programs, age, age at onset and BMI. It is shown that there is no significant relation between SES and drop-out of the disease management programs. The rate of enrolment was higher among the lower SES individuals in the DM disease management program, in the CVRM disease management the rate of enrolment was higher among the higher SES individuals, although not significantly. On patient characteristics it appears that lower SES individuals included in the DM program have a significantly higher BMI than higher SES individuals included. In the CVRM program it appeared that lower SES individuals participating because of CVD were significantly younger when included in the program than higher SES individuals. For patients included because they have an increased vascular risk a significant relation between SES and age, age at onset and BMI was found. All in all, these findings correspond with the large body of knowledge that is present. It is recommended for practice to better guide the interventions set up for lower SES individuals and also use other channels to reach these individuals than the GP. For further research it is recommended to further explore on which levels discrepancies between lower and higher SES individuals exists and how this affects the access to healthcare.
Keywords: socioeconomic status (SES), diabetes mellitus (DM), cardiovascular diseases (CVD), enrolment, participation, drop-out, disease management program (DMP)


An algorithm is proposed for 3D object representation using generic 3D features which are transformation and scale invariant. Descriptive 3D features and their relations are used to construct a graphical model for the object which is later trained and then used for detection purposes. Descriptive 3D features are the fundamental structures which are extracted from the surface of the 3D scanner output. This surface is described by mean and Gaussian curvature values at every data point at various scales and a scale-space search is performed in order to extract the fundamental structures and to estimate the location and the scale of each fundamental structure.


Environmental context Heavy metal pollution is a worldwide environmental concern, and the risk depends not only on their total concentration, but also on their chemical speciation. Based on state-of-the-art geochemical modelling, we pinpoint the heavy metal pools approached by the widely used sequential extraction method. The finding of this paper can help users of sequential extraction methods to better interpret their results. Abstract In this study, the metal (Cd, Cu, Zn and Pb) fractionation determined by selective sequential extraction (SSE) was compared with metal speciation calculated using a geochemical model, the Multi-Surface Model (MSM). In addition, the sources of Cd, Cu and Zn extracted in the SSE were identified with the help of the modelling. The results showed that the SSE-based Cd fractionation contradicted the modelled results, with the organic-bound Cd as respectively the least and the most important species. This contradiction was explained by the model and was attributed to the weak specific adsorption of Cd to organic matter; For Cu, a good agreement was found between SSE and model fractionation, both recognising organic-bound Cu as the most dominant fraction. The high affinity of organic matter for Cu reduced the degree of Cu extracted in steps preceding the oxidation step. The SSE measured a larger exchangeable Zn fraction than the model predicted, which could be explained by Zn extracted from organic-bound, oxide-bound forms, and certain rapidly dissolvable Zn-minerals if present. Zinc in the micropores of minerals was probably not extracted in 0.43M HNO3, thus was not included in the modelling for adsorption calculation, which could explain to a certain extent the larger amount of oxide-bound Zn determined in the SSE than calculated in the model. The modelling results for Pb were less reliable than for other metals because of a poor accuracy of Pb concentration in solution predicted. The findings of this paper can help users of the sequential extraction methods to better interpret their results.


The landscape of data-intensive applications today span the gamut from large-scale Web applications expected to provide persistent, fault-tolerant, high-availability, and low-latency geodistributed services to loosely connected IoT networks comprised of millions of heterogeneous devices streaming and processing realtime data feeds. In both cases, application logic is usually expressed using high-level, often domain-specific, language abstractions, while data management issues are typically relegated to an opaque monolithic data querying and storage service. While this architecture encourages separation of concerns, it provides little opportunity for synergies between the application and database/storage boundary. In particular, applying well-understood programming language principles and verification techniques to ensure data management services enforce application-level invariants becomes difficult, jeopardizing safety and maintainability. To overcome these drawbacks, we propose a radically different view of how applications and databases should interact with one another. Our approach encapsulates data management functionality within transparent libraries written in the same language as the application they support (OCaml in our case). An immediate benefit of our approach is that properties relevant to the application can be now directly interpreted, enforced, and verified by the data management layer. Similarly, database functionality related to consistency, integrity, scalability and faulttolerance can be couched in terms of the data types manipulated by the application. Our ideas can be thought of as a natural extension of unikernels, applied to data (as opposed to computation). We sketch the design of a library-centric data management stack called DaLi, and describe how we unify data representation issues across layers, and exploit language-level data type information to realize scalability and persistence. Digital Object Identifier 10.4230/LIPIcs.SNAPL.2017.23


: Severe ocular surface diseases, such as Stevens-Johnson syndrome, ocular cicatricial pemphigoid or severe ocular burns may result in a significant loss of corneal stem cells, eventually leading to vision impairment or even corneal blindness. In case of unilateral involvement, limbal autografting, by means of transplanting limbal stem cells from the healthy fellow eye, has proved to be an effective procedure for restoring the integrity of the ocular surface. Limbal allografts may be performed in patients with bilateral disease, however, systemic immunosuppression is mandatory in these cases, with a long-term outcome that is frequently reduced compared to limbal autografts due to acute or chronic graft rejection. In recent years, amniotic membrane transplantation has been successfully employed as an additional tool in ocular surface reconstruction. The AlphaCor synthetic cornea, which is made of flexible acrylic may be considered as an alternative in patients with repeated corneal graft failures. Both limbal transplantation and the AlphaCor have been shown to be effective in eyes with an adequate tear film, but are most likely to fail in severe dry eyes or in patients with cicatrising diseases. Such conditions are the domain of keratoprostheses (KPros) with rigid optics, which certainly can be considered as the 'last resort' to restore vision in patients with profound corneal blindness not amenable to conventional corneal and limbal grafting. The osteo-odonto-keratoprosthesis according to Strampelli and modified by Falcinelli makes use of a "biological" support consisting of a longitudinal section of one of the patient's teeth that is also supported by the surrounding alveolar bone tissue. Compared to other devices favourable long-term results have been reported. In patients lacking any usable teeth, implantation of a keratoprosthesis with haptics made of Dacron (Pintucci-KPro) or tibial bone (Temprano-KPro) might be considered.


Abstract. Husnudin UB, Daryono BS, Purnomo. 2019. Genetic variability of Indonesian Eggplant (Solanum melongena) based on ISSR markers. Biodiversitas 20: 3049-3055. Eggplant (Solanum melongena L.) is one of important vegetable in Indonesia and this country has a variety of eggplant germplasm, whereas molecular data of Indonesian eggplant is limited. This study describes an analysis of genetic variation based on ISSR markers to determine the diversity and phenetic relationship of Indonesian eggplants. 23 samples were collected from the Indonesian Center for Agricultural Biotechnology Research and Development (ICABIOGRAD) and some commercial cultivars. Data were analyzed by ISSR analysis using UBC 809, UBC 880, UBC 888, UBC 892 and UBC 895 primers. Similarity index was counted by Jaccard Coefficient formula based on molecular scoring. Cluster analysis was conducted by Unweighted Pair Group Methods using Arithmetic averages (UPGMA) method to create a dendrogram with Multivariate Statistical Program (MVSP) v.3.1 software. The results showed that ISSR markers were effective in the estimation of the genetic variability of eggplant accessions characterized by different level of polymorphism. Five ISSR primers generated 40 polymorphic bands (64.5% of the total). The dendrogram divided 23 eggplant accessions into 2 main clusters and one accession ("terong jawa"/K18) located outside from the main cluster. Results suggested that all accessions were grouped randomly into some clusters not in accordance with the locations of sample collection.


Nurture The Trio mastery over the Akuriyo can also be read in terms of feeding and nurture. The image of the prestation of manioc – the quintessential humanizing food, associated with maternal nurture – constantly recurs in the contact ...


We propose a unified rare-event estimator for the performance evaluation of wireless communication systems. The estimator is derived from the well-known multilevel splitting algorithm. In its original form, the splitting algorithm cannot be applied to the simulation and estimation of time-independent problems, because splitting requires an underlying continuous-time Markov process whose trajectories can be split. We tackle this problem by embedding the static problem of interest within a continuous-time Markov process, so that the target time-independent distribution becomes the distribution of the Markov process at a given time instant. The main feature of the proposed multilevel splitting algorithm is its large scope of applicability. For illustration, we show how the same algorithm can be applied to the problem of estimating the cumulative distribution function (CDF) of sums of random variables (RVs), the CDF of partial sums of ordered RVs, the CDF of ratios of RVs, and the CDF of weighted sums of Poisson RVs. We investigate the computational efficiency of the proposed estimator via a number of simulation studies and find that it compares favorably with existing estimators.


Spectral imaging, the sensing of spatial information as a function of wavelength, is a widely used diagnostic technique in diverse fields such as physics, chemistry, biology, medicine, astronomy, and remote sensing. In this paper, we present a novel computational imaging modality that enables high-resolution spectral imaging by distributing the imaging task between a photon sieve system and a computer. The photon sieve system, coupled with a moving detector, provides measurements from multiple planes. Then an inverse problem is solved in a Bayesian estimation framework to reconstruct the multi-spectral images from these superimposed and blurred measurements. The results illustrate that this technique enables higher spatial and spectral resolution than conventional filtered-based spectral imagers.


Socio-economic development of a country can truly be measured by ensuring social justice. It requires the expansion of development facilities equally in urban and rural areas. In this urbanized society, the rural areas are lagging behind in every field of development, and the rural development has become a challenge for every country like Bangladesh having huge population living in village areas. Islami Bank Bangladesh Limited (IBBL), has been playing an important role in developing social justice by creating economic opportunities for the rural population. The bank established a Shari'ah based Microfinance program named Rural Development Scheme (RDS) in 1995 with the objective of alleviating rural poverty by providing micro-investment to the agricultural and rural sectors. Presently, the scheme is being implemented in around 18,810 villages. Some 940,989 members of around 28,740 centers, of whom 79% are female, are involved in this scheme. For this investment, RDS adds a flat 12.5% profit rate on the purchasing prices and provides a rebate of 2.5% for timely payment, while the CM institutions charge between 15 to 22% interest. The scheme has also been contributing to the moral and ethical development of the rural people. This paper is aimed at assessing the activities of RDS program with a view to analyzing its role in the development of social justice in the economy of Bangladesh. The study has been designed to identify the problems and prospects of the program and thus recommend the ways to improve the program. Key Words: Social Justice, Rural Development, IBBL, RDS, Economy, Bangladesh.


Actively engaging learners in the classroom has been associated with increases in learners' academic and behavioral performance. Multiple empirically supported strategies exist for actively engaging learners, including increasing opportunities for learners to respond and planning highly engaging lessons. In support of these engagement strategies, educators also systematically implement empirically supported classroom management strategies to increase the likelihood of appropriate behaviors and decrease the likelihood of inappropriate behaviors. These classroom management strategies include: (a) maximizing structure, which includes both the physical (e.g., desk arrangement) and embedded (e.g., classroom routines) aspects of structure; (b) establishing, operationally defining, teaching, prompting, and monitoring students' expected classroom behaviors; (c) developing a continuum of acknowledgment strategies to reinforce (i.e., increase the future likelihood of) those expected behaviors; and (d) establishing a continuum of responses for behaviors that do not meet expectations. In addition, educators collect relevant data to evaluate if learners are engaged and meeting academic and behavioral expectations. Finally, to create a classroom environment conducive to engaging all learners, academic and behavioral instruction and support must be: (a) contextually and culturally relevant for learners, and (b) differentiated to meet the diverse learning and behavioral needs within the classroom.
 If educators explicitly and routinely implement empirically supported academic and behavioral instruction and support for all learners, the majority of learners will engage in instruction and demonstrate behaviors that meet expectations, reducing the number of learners who require additional levels of support. Meanwhile, effective educators review academic and behavioral data to determine if learners require more intensive support at a group or individual learner level.


Importance
Patient-perceived barriers to hidradenitis suppurativa (HS) care are poorly understood. Understanding health care barriers is a critical first step toward improving care for this population.

Objective
To characterize the health care experiences of people living with HS, including perceived barriers and facilitators to health care access, and to elucidate potential associations among these barriers and facilitators, health care access, and disease activity.

Design, Setting, and Participants
In this qualitative study, an inductive thematic analysis was conducted on 45 in-depth, 60- to 90-minute semistructured interviews of 45 people with HS from diverse sociodemographic backgrounds that took place between March and April 2020. Individuals were eligible if they could speak English, were 18 years or older, and were diagnosed with HS. A diagnosis of HS was confirmed through physician diagnosis or through self-reported, affirmative response to the validated screening question, "Do you experience boils in your armpits or groin that recur at least every six months?"

Main Outcomes and Measures
Interviews were audio recorded and transcribed verbatim. A modified grounded theory approach was used to develop the codebook, which investigators used for inductive thematic analysis.

Results
Among the 45 participants included, the median (IQR) age was 37 (16) years, 33 (73%) were female, and 22 (49%) were White. There were 6 interrelated themes associated with participant-perceived barriers to accessing HS care: (1) bidirectional associations of disease activity and employment, (2) association of employment with health care coverage, (3) association of health care coverage with costs and perceived access to care, (4) association of costs with access to patient-centered care, (5) health care professional attitudes and knowledge influence patient-centered care and perceived access to care and disease activity, and (6) health system characteristics influence patient-centered care and associated costs, perceived access to care, and disease activity.

Conclusions and Relevance
This qualitative study highlights themes that generate a conceptual model for understanding barriers that may act synergistically to limit health care access and influence disease activity. The disease activity of HS may be reduced when cycle elements are optimized. This study also highlights areas for future investigations and potential systems-level changes to improve access to patient-centered HS care.