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We present the complete sample of protoplanetary disks from the Gemini- Large Imaging with GPI Herbig/T-tauri Survey (Gemini-LIGHTS) which observed bright Herbig Ae/Be stars and T-Tauri stars in near-infrared polarized light to search for signatures of disk evolution and ongoing planet formation. The 44 targets were chosen based on their near- and mid-infrared colors, with roughly equal numbers of transitional, pre-transitional, and full disks. Our approach explicitly did not favor well-known, "famous" disks or those observed by ALMA, resulting in a less-biased sample suitable to probe the major stages of disk evolution during planet formation. Our optimized data reduction allowed polarized flux as low as 0.002% of the stellar light to be detected, and we report polarized scattered light around 80% of our targets. We detected point-like companions for 47% of the targets, including 3 brown dwarfs (2 confirmed, 1 new), and a new super-Jupiter mass candidate around V1295 Aql. We searched for correlations between the polarized flux and system parameters, finding a few clear trends: presence of a companion drastically reduces the polarized flux levels, far-IR excess correlates with polarized flux for non-binary systems, and systems hosting disks with ring structures have stellar masses $100$ au) scattered light around each, signs of extreme youth for these enigmatic systems. Science-ready images are publicly available through multiple distribution channels using a new FITS file standard jointly developed with members of the VLT/SPHERE team., 51 pages, 31 figures, 7 tables, accepted to AJ

Introduction It is widely acknowledged that older adults with hearing or visual impairment are at higher risk of developing delirium. The National Institute for Clinical Excellence (NICE) guideline for delirium prevention in the hospital setting emphasises the importance of considering sensory impairment in the clinical assessment of patients at risk of delirium, yet it is often overlooked. This audit aimed to determine doctors’ documentation of sensory needs in a geriatrics department and the effect of bedside signs on this documentation. Method This study analysed documentation for all patients on three elderly care wards. Pre-defined search terms relating to hearing, visual and cognitive impairment were used to analyse whether sensory needs were mentioned during the patients’ hospital stay to study date. After the first round of data collection, bedside signs to indicate whether patients have hearing aids or glasses were installed, complemented by ward teaching on sensory impairment and delirium. Documentation was re-audited using the same pre-defined search terms as in the first round. Results The first round of data collection included 71 patients with an average age of 79 years. Only 30% of patients had documentation regarding sensory needs (hearing and/or vision) and 49% were documented as having delirium and/or dementia. The second round of data collection was completed one month after intervention and included 71 patients with an average age of 82 years. After intervention of bedside signs and ward teaching, doctors’ documentation of sensory impairment increased by 81%. Conclusion Installing bedside signs to indicate whether patients have hearing aids or glasses has improved documentation of sensory impairment, in turn prompting its consideration in assessment and care of patients at risk of delirium.

BACKGROUND Dupilumab is an antibody against interleukin-4 receptor α, used in the treatment of atopic dermatitis (AD). OBJECTIVES To evaluate the efficacy and safety of dupilumab in adult Chinese patients with moderate-to-severe AD. METHODS In this randomized, double-blind, placebo-controlled, parallel-group, phase III study, conducted between December 2018 and February 2020, patients with AD received dupilumab (300 mg) or placebo once every 2 weeks for 16 weeks, and were followed up for 12 weeks. The primary efficacy endpoint was the proportion of patients with both an Investigator's Global Assessment score of 0-1 and a reduction from baseline of ≥ 2 points at week 16. RESULTS Overall, 165 patients (mean age 30·6 years; 71·5% male patients) were randomized; 82 patients were randomized to dupilumab and 83 patients were randomized to placebo. At week 16, 26·8% of patients in the dupilumab group and 4·8% of patients in the placebo group achieved the primary endpoint [difference 22·0%, 95% confidence interval (CI) 11·37-32·65; P

Pituitary adenomas are relatively common intracranial neoplasms that are frequently treated with surgical resection. Rapid visualization of pituitary tissue remains a challenge as current techniques either produce little to no information on hormone-secreting function or are too slow to practically aid in intraoperative or even perioperative decision-making. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) represents a powerful method by which molecular maps of tissue samples can be created, yielding a two-dimensional representation of the expression patterns of small molecules and proteins from biologic samples. In this chapter, we review the use of MALDI MSI, its application to the characterization of the pituitary gland, and its potential applications for guiding the management of pituitary adenomas.

Cost cutting measures implemented to the Oregon Health Plan (OHP) in 2003 included the elimination of the chemical dependency treatment benefit for the Medicaid expansion population. Study results indicate that removal of this benefit decreased methadone treatment providers' capacity to provide treatment and retain OHP patients and dramatically impacted patients' quality of life. In contrast, Washington's Medicaid cost containment measures had little impact on the financing of publicly funded methadone treatment. Due to a variety of measures, methadone maintenance treatment increased in Washington. Results have important implications for those advocating for greater access to publicly funded methadone treatment and for state policymakers considering Medicaid cuts to chemical dependency treatment services.

The Oregon Practice Improvement Collaborative (OPIC) facilitated the implementation of motivational interviewing (MI) in two community-based substance abuse treatment agencies. The Change Book: A Blueprint for Technology Transfer was used to structure and support the implementation of motivational interviewing. As part of the implementation process, the agencies' organizational readiness for change was assessed using standardized instruments developed by Simpson and colleagues. Results from the implementation effort suggest that an MI approach may be just as applicable to facilitating organizational change as it is to facilitating individual behavioral change. When integrated with The Change Book framework, MI may provide core strategies for assisting treatment agencies in adopting evidence-based practices and navigating organizational change.

This study assessed the impact of managed care on publicly funded adolescent substance abuse treatment by comparing differences in service utilization and outcomes across prospective samples from two states: Oregon, which uses managed care practices in service financing and delivery, and Washington, which does not. One hundred and six adolescents from Washington and 94 from Oregon, who entered outpatient substance abuse treatment in 1998 and 1999, completed self-report surveys about their substance use before and after receiving treatment (follow-up rate = 75 percent). In addition, clinical chart reviews conducted at the 6-month follow-up assessed the type and amount of treatment these adolescents received during the study period. It was found that service utilization and treatment outcomes were comparable across the two state samples. The evidence presented here suggests that managed care is capable of delivering substance abuse treatment services of comparable quality to state-administered substance abuse treatment services.

In 1993 Oregon became one of the first states to apply for and receive a Health Care Financing Administration (HCFA; now called Centers for Medicare and Medicaid Services) 1115 Medicaid waiver from the U. S. Department of Health and Human Services. Policymakers in Oregon, after the passage of a series of legislative bills (Rutledge, 1997), restructured the state's publicly funded health care services and implemented the landmark Oregon Health Plan (OHP) in February 1994, which included outpatient substance abuse treatment as a benefit. Before OHP, only a minority of clients seeking publicly funded substance abuse treatment services were eligible for Medicaid. Treatment services delivered to Medicaid clients were paid for by the state using a fee-for-service model. Substance abuse treatment for low-income people not eligible for Medicaid, who accounted for the majority of clients obtaining publicly funded substance abuse treatment, was provided through a "slot" model funded through Oregon's general fund. These outpatient treatment slots were akin to "beds," in that a single person filled each slot. This service delivery model had pervaded the publicly funded outpatient substance abuse treatment system for more than 50 years, influencing the philosophy and the delivery of publicly funded treatment. The 1115 Medicaid waiver expanded the eligibility criteria for Medicaid, which almost doubled the Medicaid population in the state (Deck, McFarland, Titus, Laws, & Gabriel, 2000). The result of this was that the majority of clients seeking or in publicly funded substance abuse treatment were transferred from the state slot model with a capped capacity to the Medicaid fee-for-service model. The Medicaid model placed no limit on the number of clients providers could serve and reimbursed them for each service provided regardless of the number of clients treated at any one time. The transfer of the majority of state-funded clients to the Medicaid fee-for-service model allowed providers to increase the number of clients they served without adding new treatment agencies or counselors--at least to the extent that treatment providers were willing and able to increase their client load at the individual agency level. The Oregon Department of Human Services (DHS) allocated most of the general funds it had used to pay for outpatient treatment slots as matching dollars for the federal Medicaid funds. DHS retained some of those general funds (called "directed purpose" funds) to pay for outpatient treatment slots for people ineligible for OHP whose incomes were between 100 percent and 200 percent of the federal poverty level. These people, referred to as the "working poor," had no health insurance and could not pay for treatment. Thus, in 1994 the publicly funded outpatient substance abuse treatment system was primarily funded by Medicaid's fee-for-service system, with some state-funded slots available for clients ineligible for OHP. In spring 1995 OHP changed the administrative system for outpatient substance abuse treatment services, including methadone maintenance, from a fee-for-service model to a managed care model. The state legislature believed that the integration of substance abuse treatment into the OHP physical health benefit would reduce the inappropriate use and cost of medical and surgical services (Office of Medical Assistance Programs, 1997). Funds continued to be available to certain low-income populations through a limited directed-purpose outpatient treatment (DPOT) slot model, and the distribution of these slots was based on historical use--that is, DHS only allocated these DPOT slots to certain established treatment providers. Despite preparation at the state and provider levels, the transition to a managed care service delivery model created more chaos and problems in a three-year period than had occurred in Oregon's substance abuse treatment system in decades. As one treatment provider remarked, "It was like steamr olling the glass menagerie. …

L'analyse des mesures en continu a haute precision de vitesse de courant a revele des signatures de nombreux sillages provenant du traffic nautique dans la Baie de San Francisco. Beaucoup des sillages des ferrybots grande vitesse montrent des ondes longues, semblant se propager devant le bateau. Ces ondes ont toutes les proprietes des solitons et sont bien plus longues que celles comprises par le sillage Kelvin. Ceci pourrait les rendre mieux adaptees aux techniques de detection de l'espace. Les mesures discutees ici ont ete prises au Centre Romberg des Etudes environnementales de San Francisco State University, sur la presqu'ile de Tiburon, a l'aide d'un appareil de mesure de la vitesse du courant concu et realise a SFSU. Le mouvement de l'eau est mis en evidence par la mesure du temps de propagation des signaux ultrason, par un porteur 200 MHz module en phase par une sequence binaire pseudo-aleatoire. Le centre se trouve face au bras nord de la Baie, et les paquebots rapides passent souvent. L'etude des sequences en temps montre des paquets de grandes ondes, d'amplitude jusqu'a 30 cm/sec et de periodes de 4 a 6 secondes, correspondant au sillage de Kelvin. De plus, des groupes de vagues de periodes de 30 a 40 secondes sont observees bien avant le sillage de Kelvin, et souvent meme avant le passage du bateau devant le poste experimental. On en deduit des vitesses superieures a √gh. bonne indication des solitons. D'autres proprietes des ondes les separent encore des ondes dispersives du sillage de Kelvin.

Births of drug-affected babies reached an alarmingly high level in Portland, OR in 1989. This study combines qualitative and quantitative data in a retrospective review of neighborhood-based programs and local trends in archival indicators in the most heavily impacted areas of the county since 1989.

Europe's historic cities face many challenges, including those associated with growing pressure from tourist interest. This paper reviews the general issues for historic cities with significant tourist activity, and then examines the background, purposes and future direction of the English city of Canterbury's visitor management initiative. An open, soft systems model is used to clarify the differing significance of the initiative for selected stakeholder groups with interests in the city, its society, economy, environment and ecology. The significance of the Canterbury City Centre Initiative for other European walled and historic cities is considered briefly in the context of wider town centre management initiatives, and the linkages to wider city planning processes that it exemplifies. Copyright © 2000 John Wiley & Sons, Ltd.

Historic buildings are central to the cultural identity of European nations, many are also important tourist attractions, but their internal configurations are idiosyncratic, with steep narrow stairways, many passageways and tiny windows. These conditions present contemporary heritage managers with a range of problems relating to conservation, as well as presentation and visitor management. This paper examines the relationship between service design concepts and the management of visitors' experiences and satisfaction within a heritage setting, applying a modified service blueprinting approach, based on visit diaries and interviews with management, in an exploratory study of Leeds Castle, one of Britain's oldest historic houses. The limitations of the research method are considered, and the paper discusses the need for further research into the management of visitor experiences in the heritage sector of tourism.

This paper is concerned with traditional mass-market resorts and the marketing con straints that are imposed upon them by their innate characteristics and the influence of the distribution channel. As a result of these resorts' reliance upon intermediaries, inclusive tour ( IT) clientele forms the core market of many of the resorts as exempliffied by the patronage of the main Spanish resorts by clients of Northern European tour operators. This has led to the commodification of the resort product by intermediaries and the need for resorts to differentiate their offering in a highly competitive market. In recognition of these issues and the changing tourism marketplace, many resorts are currently setting new objectives for their marketing, and revising their strategies to take into account the wish to seek new ways to target and serve their preferred clients.1 How ever, inclusive holidays are a key element of business for these resorts, and the inclusive holiday industry is characterised by a high degree of differential power, where the initia tive is often vested in the major tour operators. This suggests that many mass-market resorts are unable to put into effect the strategic mar keting and planning approaches that theory often suggests as solutions to the problems faced by resorts in this stage of development. In addition, resorts are often debilitated in their attempts to implement marketing by stakeholder interests and the nature of public sector organisation. It is the aim of this paper to provide a framework for the understanding of the constraints upon the implementation of marketing that are experienced by mass- market resorts.