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The developed method was a simple, accurate, precise, specific and robust method for the validation of Sofosbuvir and Velpatasvir Tablets by reverse phase high pressure liquid chromatography. For Sofosbuvir and Velpatasvir Tablets Chromatography was performed on Agilent 1200 series, UV and PDA Detector, Waters X-bridge C18 (150 mm x 4.6 mm, 3.5 µm) by using Mobile Phase A contains Buffer solution (0.6% Trifluroacetic acid in water adjusted pH to 2.2±0.05) : Acetonitrile (95:5)%v/v and Mobile Phase B contains mixture of purified water, methanol and acetonitrile in the ratio of (20: 30: 50) % v/v/v. at a flow rate of 1.0 mL/min and at 263 nm for Sofosbuvir and 320 nm for Velpatasvir wavelength. The retention times of About 48.0 minutes for Sofosbuvir and About 78.8 minutes for Velpatasvir respectively. Methyl Uridine and Impurity at RRT 0.39 found linear over the range of LOQ - 150 % of target concentration. Method also found precise by spiking impurities at specification level. Accuracy was demonstrate at LOQ - 150 % level by preparing sample in triplicate for each level and found accurate. Hence, the method could be successfully used for the analysis Impurities in Sofosbuvir and Velpatasvir Tablets Tablet.

Recently published national data demonstrate inadequate and worsening control of high blood pressure (HBP) in the United States, outcomes that likely have been made even worse by the coronavirus disease 2019 (COVID-19) pandemic. This major public health crisis exposes shortcomings of the US health care delivery system and creates an urgent opportunity to reduce mortality, major cardiovascular events, and costs for 115 million Americans. Ending this crisis will require a more coherent and systemic change to traditional patterns of care. The authors present an evidence-based Blueprint for Change for comprehensive health delivery system redesign based on current national clinical practice guidelines and quality measures. This innovative model includes a systems-based approach to ensuring proper BP measurement, assessment of cardiovascular risk, effective patient-centered team-based care, addressing social determinants of health, and shared decision-making. The authors also propose building on current national quality improvement initiatives designed to better control HBP.

Hospitals must strategically build organizational capacities to succeed in bundled payment arrangements. Given differences between Medicare and commercial arrangements, capacities may vary between hospitals in Medicare vs both Medicare and commercial bundled payment programs. This study compared organizational capacities between these 2 hospital groups.National survey of American Hospital Association (AHA) member hospitals with experience in bundled payment programs.We analyzed data from October 31, 2017, to April 30, 2018, collected from AHA member hospitals with bundled payment experience in only Medicare (Medicare-only hospitals) or in both Medicare and commercial insurers (multipayer hospitals). Survey questions examined capacity in 4 areas: (1) physician performance feedback, (2) care management, (3) postacute care provider utilization, and (4) health information technology.Our sample included 114 hospitals reporting experience in Medicare or commercial bundled payment programs. Both Medicare-only and multipayer hospitals reported high organizational capacities in performance measurement of physician-level quality and cost feedback and in incorporation of health information technology. More multipayer hospitals reported high capacity for coordinating hospital to postacute care settings (88% vs 52%). Although nearly all hospitals in both groups reported formalized relationships with skilled nursing facilities (98%), fewer hospitals reported such relationships with long-term acute care hospitals (83%) and inpatient rehabilitation facilities (80%).Although they have similar capacity in a number of areas, Medicare-only and multipayer hospitals differed with respect to other aspects of organizational capacity.

Outreach, including patient navigation, has been shown to increase the uptake of colorectal cancer (CRC) screening in underserved populations. This analysis evaluates the cost-effectiveness of triennial multi-target stool DNA (mt-sDNA) versus outreach, with or without a mailed annual fecal immunochemical test (FIT), in a Medicaid population. A microsimulation model estimated the incremental cost-effectiveness ratio using quality-adjusted life years (QALY), direct costs, and clinical outcomes in a cohort of Medicaid beneficiaries aged 50-64 years, over a lifetime time horizon. The base case model explored scenarios of either 100% adherence or real-world reported adherence (51.3% for mt-sDNA, 21.1% for outreach with FIT and 12.3% for outreach without FIT) with or without real-world adherence for follow-up colonoscopy (66.7% for all). Costs and outcomes were discounted at 3.0%. At 100% adherence to both screening tests and follow-up colonoscopy, mt-sDNA costed more and was less effective compared with outreach with or without FIT. When real-world adherence rates were considered for screening strategies (with 100% adherence for follow-up colonoscopy), mt-sDNA resulted in the greatest reduction in incidence and mortality from CRC (41.5% and 45.8%, respectively) compared with outreach with or without FIT; mt-sDNA also was cost-effective versus outreach with and without FIT ($32,150/QALY and $22,707/QALY, respectively). mt-sDNA remained cost-effective versus FIT, with or without outreach, under real-world adherence rates for follow-up colonoscopy. Outreach or navigation interventions, with associated real-world adherence rates to screening tests, should be considered when evaluating the cost-effectiveness of CRC screening strategies in underserved populations.

Background The Joint Commission's hospital antimicrobial stewardship (AS) standards became effective in January 2017. Surveyors' experience to date suggests that almost all hospitals have established AS leadership commitment and organized structures. Thus, The Joint Commission sought to examine advances in AS interventions and measures that hospitals could implement to strengthen their existing AS programs. Methods The Joint Commission and Pew Charitable Trusts sponsored a meeting to bring together experts and key stakeholder organizations from around the country to identify leading practices for AS interventions and measurement. Presenters were asked to summarize the AS activities they thought were most important for the success of their own AS program and leading practices that all hospitals should be able to implement. Results The panel highlighted two interventions as leading practices that go beyond current guidelines and established practices (that is, preauthorization and prospective audit and feedback). The first is diagnostic stewardship. This type of intervention addresses errors in diagnostic decision making that lead to inappropriate antibiotic prescribing. The second is handshake stewardship, a method of engaging frontline providers on a regular basis for education and discussions about barriers to AS from the clinician's perspective. The panel identified days of therapy (or defined daily dose, when days of therapy is not possible), Clostridioides difficile rates, and adherence to facility-specific guidelines as the preferred measures for assessing stewardship activities. Conclusion The practices highlighted should be given greater emphasis by The Joint Commission in their efforts to improve hospital AS, and the Centers for Disease Control and Prevention will be updating the Core Elements of Hospital Antibiotic Stewardship Programs.

e18827 Background: Despite proven effectiveness in reducing colorectal cancer (CRC) cases, screening for CRC remains underutilized, including those enrolled in Medicare Advantage. A mailed fecal immunochemical test (FIT) outreach program may increase CRC screening adherence. This study examined the cost-effectiveness of stool-based tests (FIT and multi-target stool DNA [mt-sDNA]), with FIT offered via a mailed outreach program, in a Medicare Advantage population. Methods: The validated CRC-AIM microsimulation model was used to simulate the costs and clinical outcomes of 2 million average-risk individuals, free of diagnosed CRC at age 40, who initiated CRC screening at age 65. Annual mailed FIT outreach and triennial mt-sDNA were assessed. Test sensitivity and specificity inputs were based on the 2021 United States Preventative Services Task Force modeling study. FIT outreach program cost ($25.92) and direct costs for screening tests, colonoscopies (COLs), complications, and CRC care were included. The model employed a lifetime horizon, 3% discount rates, and a Medicare Advantage perspective. The primary analysis used published real-world adherence rates for stool-based tests and follow-up COLs (FIT/COL: 29%/53%; mt-sDNA/COL: 69.8%/71.5%). Secondary analyses assumed 100% adherence for stool-based tests and/or follow-up COLs and 20% higher than primary analysis for FIT and the corresponding follow-up COLs. Results: In the primary analysis, mt-sDNA had the greatest life-years gained (LYG), incidence reduction (IR), and mortality reduction (MR) and was cost-effective at a willingness-to-pay threshold of $50,000/QALY compared to mailed FIT outreach (Table). This was true when 100% adherence was assumed for follow-up COL and when FIT had 20% higher adherence than the primary analysis. mt-sDNA had 64-129% greater LYG, 79-150% greater IR, and 68-146% greater MR than mailed FIT outreach. When assuming 100% adherence for both screening test and follow-up COL, mt-sDNA was dominated by mailed FIT outreach. Conclusions: Adherence to CRC screening modality and follow-up COL greatly impacts clinical and cost-effectiveness outcomes. Future analysis should consider evidence-based, health plan-specific data to accurately reflect outcomes that aid in payer decision making.[Table: see text]

Mobile Device Security is an important factor as all the user's sensitive information is stored on the mobile device. The problem of mobile devices getting lost or stolen has only been increasing. There are various systems which provide Online Mobile Device Security which require internet to perform their required functions. Our proposed system SMS Based Offline Mobile Device Security System provides mobile device users with a wide range of security features that help protect the mobile device from theft and also acts as an assistant that helps the users in any problems they may face in their day-to-day lives. The project aims to develop a mobile security system that will allow the user to manipulate his mobile device from any other device through SMS which can be used to get contact information from the user's mobile device remotely, help find the phone by maximizing the volume and playing a tone, trace the current location of the mobile device, get the IMEI No of the device, lock the device, send a message that will be converted to speech and played on the user's mobile device, call forwarding, message forwarding and various other features. It also has an additional security feature that will detect a sim card change and send the new SIM card mobile no to the recovery mobile numbers specified during initial setup automatically. Hence, the user will be able to manipulate his phone even after the SIM card has been changed. Therefore, the SMS-Based Offline Mobile Device Security System provides much more security for the mobile device than the existing online device security methods.

Quantum key distribution (QKD) is a revolutionary communication technology that promises ultimate security assurance by exploiting the fundamental principles of quantum mechanics. In this work, we report design and development of a fully automated inter-building QKD framework for generation and distribution of cryptographic keys, securely and seamlessly, by executing weak coherent pulse based BB84 protocol. This framework is experimentally validated by establishing a quantum communication link between two buildings separated by ~300m of free-space atmospheric channel. A novel synchronization technique enabled with indigenous NavIC (IRNSS) constellation is developed and implemented. This QKD system demonstrates generation of secure key rate as high as 300 Kbps with QBER< 3% for mean photon no. per pulse (${\mu}$) of 0.15. The intercept-resend eavesdropping attack has been emulated within the system and evaluated during experiment. A novel quantum secured end-to-end encrypted video calling app (QuViC) is also developed and integrated with QKD framework to demonstrate unconditionally secure two-way communication over Ethernet, functioning alongside with quantum communication.

For millions of Americans living in vulnerable rural and urban communities, their hospital is an important, and often their only, source of health care. As transformation in the hospital and health care field continues, some communities may be at risk of losing access to health care services and the opportunities and resources they need to improve and maintain their health. Integrated, comprehensive strategies to reform health care delivery and payment, within which vulnerable communities can make individual choices based on their needs, support structures, and preferences, are needed. In this Invited Commentary, the authors outline characteristics and parameters of vulnerable communities as well as the essential health care services that hospitals should strive to maintain locally identified by the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities. They also describe four of nine emerging strategies—recommended by the task force—to reform health care delivery and payment and allow hospitals to provide the essential health care services, along with implementation barriers and how to address them. While this Invited Commentary focuses on vulnerable communities, the four highlighted strategies (addressing the social determinants of health, adopting new and innovative virtual care strategies, designing global budgets, and using inpatient/outpatient transformation strategy), as well as the other five strategies, may have broader applicability for all communities.

In 2016, Keyes and Galea issued 9 foundational principles of population health science and invited further deliberations by specialists to advance the field. This article presents 7 foundational principles of population health policy whose intersection with health care, public health, preventive medicine, and now population health, presents unique challenges. These principles are in response to a number of overarching questions that have arisen in over a decade of the authors' collective practice in the public and private sectors, and having taught policy within programs of medicine, law, nursing, and public health at the graduate and executive levels. The principles address an audience of practitioners and policy makers, mindful of the pressing health care challenges of our time, including: rising health-related expenditures, an aging population, workforce shortages, health disparities, and a backdrop of inequities rooted in social determinants that have not been adequately translated into formal policies or practices among the key stakeholders in population health. These principles are meant to empower stakeholders—whether it is the planner or the practitioner, the decision maker or the dedicated caregiver—and inform the development of practical tools, research, and education.

Mobile health (mHealth) is being recognized as an innovative approach to deliver health care in an accessible, portable and cost effective manner. Despite the numerous benefits associated with the use of mobile devices, there are major concerns with mhealth in the area of privacy and security. These aspects need to be considered at every stage of design and development of mHealth devices and applications which need to be developed by security-trained, trusted manufacturers who should be accountable to minimize damages in the healthcare industry. It is also crucial for users and/or organizations to be more cautious and responsible to use mobile devices. Major stakeholders, including those in the user׳s community (patients and providers), vendors and developers, and policy makers need to come together to survey the landscape, identify the issues, and develop policies, regulations, safeguards and industry standards.

In this study, a comparison is made between Artificial Neural Network Algorithm and Machine Learning Algorithm of Support Vector Machine by considering pre-release and pre plus post release features of a movie for predicting a movie to a particular success class. These success classes includes Flop/Disaster, Average, Hit, Super-Hit and Block-Buster of a movie. Our best performing model from Artificial Neural Network and Support Vector Machine is able to give better performance in order to predict any particular movie to specific success class of a movie for both the cases of prerelease as well as pre plus post release features of a movie.

Every day in the United States, health professionals confront the effects of firearm injury. In emergency rooms, trauma centers, ambulatory offices, and acute care and rehabilitation facilities, health professionals and the health systems they work within attempt to heal the wounds that firearms can inflict on individuals and their families. Thus, hospitals and health systems are in a position to grasp the scope of the issue and find opportunities to prevent firearm injury and death. In 2016 and 2017, the physicians and nurses at Kaiser Permanente treated more than 3,400 gunshot victims. These patients—from a single health system among the hundreds that operate across the United States—are a sobering reminder of the toll of firearm injury. Firearm injury—including other-directed, self-directed, and unintentional injury and death—is a broad-based public health issue. In 2016, more than 38,000 people were killed by firearms.1 In the same year, half of those who died by suicide used a firearm, and three quarters of homicides involved a firearm.1 Firearm death is the third leading cause of death for children under age 17 in the United States. A social network analysis by Kalesan and colleagues2 showed that almost everyone in the United States, at some point, will know someone injured or killed by a firearm. The nature of the injury varies—homicide is the more likely cause of a firearm death in an urban area, whereas suicide is more likely in a rural area—but every community in every geographic region and every socioeconomic stratum is … Address correspondence to: Questions or comments should be directed to Melissa French at mfrench{at}nas.edu.

The overuse and misuse of antibiotics affect patients in many ways, including by driving antibiotic resistance, a serious public health threat in the United States and around the world. To improve patient safety and address rising rates of resistance, an increasing number of health care facilities have created antibiotic stewardship programs (ASPs). ASPs have been successful in slowing the emergence of resistance and improving patient outcomes. However, there are serious geographic and resource barriers to ASP adoption in small community hospitals and critical access hospitals. Fortunately, many barriers can be overcome by using collaborative models to bring together key stakeholders, including large hospitals and health systems and academic medical centers; hospital associations; federal, state, and local public health organizations; and federal and state offices of rural health. These stakeholders are ideally positioned to assist with stewardship efforts in small community and critical access hospitals and, in doing so, can improve patient safety while stemming the spread of resistant bacteria.

Background & Aims: Opioid substitution treatment is used in many countries as an effective\ud harm minimization strategy. There is a need for more information about patient safety\ud incidents and resulting harm relating to this treatment. We aimed to characterise patient\ud safety incidents involving opioid-substitution treatment with methadone or buprenorphine in\ud community-based care by: (i) identifying the sources and nature of harm, and (ii) describing\ud and interpreting themes to identify priorities to focus future improvement work.\ud Design: Mixed-methods study examining patient safety incident reports involving opioid\ud substitution treatment with either methadone or buprenorphine in community-based care.\ud Setting: Data submitted between 2005 and 2015 from the National Reporting and Learning\ud System (NRLS), a national repository of patient safety incident reports from across England\ud and Wales.\ud Participants: 2,284 reports were identified involving patients receiving community-based\ud opioid substitution treatment.\ud Measurements: Incident type, contributory factors, incident outcome and severity of harm.\ud Analysis involved data coding, processing and iterative generation of data summaries using\ud descriptive statistical and thematic analysis.\ud Findings: Most risks of harm from opioid substitution treatment came from failure in one of\ud four processes of care delivery: prescribing opioid-substitution (n=151); supervised\ud dispensing (n=248); non-supervised dispensing (n=318); and monitoring and communication\ud (n=1544). Most incidents resulting in harm involved supervised or non-supervised dispensing\ud (n=91/127, 72%). Staff- (e.g. slips during task execution, not following protocols) and\ud organisation-related (e.g. poor working conditions or poor continuity of care between\ud services) contributory factors were identified for over half of incidents.\ud 3\ud Conclusions: Risks of harm in delivering opioid-substitute treatment in England and Wales appear to arise out of failures in four processes: prescribing opioid-substitution, supervised dispensing, non-supervised dispensing, and monitoring and communication.

Stridor, a common presenting sign of respiratory distress in a newborn, has many systemic causes. It may arise from the larynx or the tracheobronchial airway. This article presents the most common pathologic conditions in this anatomic region, with highlights on management.

Objective: Under 50% of type 2 diabetic patients achieve the recommended glycemic control. One barrier to glycemic control is patients9 cost-related nonadherence to medications. We hypothesize gender differences in medication nonadherence due to costs among diabetic patients. Methods: US National Health Interview Survey (2011 to 2014) data yielded 5260 males and 6188 females with diabetes for over a year. We applied 2 analytic methods (A and B below) across multiple outcome measures (1 to 4) of medication nonadherence due to cost. The key independent variable was participant9s gender. Results: Across methods and measure, females consistently report significantly higher rates of medication nonadherence due to costs. Pearson9s χ2 showed that female patients were more likely to (1) skip medication (13.5%–10.2%; P Conclusions: A significant gender-based disparity exists on cost-related nonadherence of medication among diabetic patients. Health care providers and policy-makers should pay close attention to find ways to address cost-related nonadherence of medication among patients with chronic illness, especially among female patients.

Purpose Dry eye is known to impact on clinical outcomes after laser vision correction and the use of a newer ‘all femtosecond laser’ surgical approach may be associated with less impact on the ocular surface post-operatively. The purpose of this study was to evaluate the early clinical outcomes and tear instability after the first small incision lenticule extraction (SMILE) cases undertaken by three surgeons at a single site in the UK. Methods Retrospective audit. Seventy-one eyes of 37 patients underwent SMILE surgery using the Zeiss VisuMax laser system (Carl Zeiss Meditec, Germany). Uncorrected and corrected distance visual acuity, spherical equivalent refraction, fluorescein enhanced tear break up time, simulated keratometry and complications were evaluated pre- and post-operatively where applicable. Results The study population consisted of 21 males and 16 females. The mean ± standard deviation age was 33 ± 8 years. The results showed that 100% of eyes achieved 20/40 or better and 88% achieved 20/20 or better uncorrected distance visual acuity. The spherical equivalent refraction after surgery was within ±0.50D in 82% of eyes at three months. There was no significant difference in tear break up time from pre-operative levels at three months. Complications were infrequent. Conclusions This early data from surgeons’ first SMILE procedures suggest SMILE provides good outcomes in terms of refractive predictability and visual acuity with minimal impact on the tear film. Longitudinal research will further improve our understanding of the longer-term impact of SMILE on clinical outcomes, ocular surface metrics and patient reported outcomes.

The aim of our project is to automate the result generation system. We will try to implement the rules as per University norms according to the CBGS system. The necessity of this system is to ease the process of result generation and once the data is fed in the system, could be used to calculate the result and generate it in the desired format. We can analyze this data and generate various reports needed using some data mining techniques. The objective is to generate result that will be semester wise for each student. Analyzing these reports would give various parameters such as students passing or failing, semester wise as well as subject wise. The software will be accessible only to authorized users so that security could be maintained.

This study aims at creating an informatics data tool that enables providers to generate community profiles public health data to understand the social, environmental, and economic context of their patients and support clinical decision making in real time., Big cities continue to be centers for innovative solutions and services. Governments are quickly identifying opportunities to take advantage of this energy and revolutionize the means by which they deliver services to the public. The governmental public health sector is rapidly evolving in this respect, and Chicago is an emerging example of some of the changes to come. Governments are gradually adopting innovative informatics and big data tools and strategies, led by pioneering jurisdictions that are piecing together the standards, policy frameworks, and leadership structures fundamental to effective analytics use. They give an enticing glimpse of the technology's potential and a sense of the challenges that stand in the way. This is a rapidly evolving environment, and cities can work with partners to capitalize on the innovative energies of civic tech communities, health care systems, and emerging markets to introduce new methods to solve old problems.

Health literacy is critical for cancer patients as they must understand complex procedures or treatment options. Caregivers' health literacy also plays a crucial role in caring for cancer patients. Low health literacy is associated with low adherence to medications, poor health status, and increased health care costs. There is a growing interest in the use of mobile health applications (apps) to improve health literacy. Mobile health apps can empower underserved cancer patients and their caregivers by providing features or functionalities to enhance interactive patient-provider communication and to understand medical information more readily. Despite the potentiality of improving health literacy through mobile health apps, there exist several related concerns: no equal access to mobile technology, no familiarity or knowledge of using mobile health apps, and privacy and security concerns. These elements should be taken into account for health policy making and mobile apps design and development. Importantly, mobile apps should be developed with the goal of achieving a high range of user access by considering all health literacy level and various cultural and linguistic needs.

Key Points Question How do social determinants of health vary across multiple dimensions and geographic space? Findings In this cross-sectional study of 71 901 census tracts with approximately 312 million persons across the continental United States, multivariate social determinants of health measures were reduced to 4 indices reflecting advantage, isolation, opportunity, and mixed immigrant cohesion and accessibility and were clustered into 7 neighborhood typologies that included an extreme poverty group. Social determinants of health indices were associated with premature mortality rates in Chicago, Illinois. Meaning The use of multidimensional geospatial approaches to quantify social determinants of health rather than the use of a singular deprivation index may better capture the complexity and spatial heterogeneity underlying these determinants., Importance An association between social and neighborhood characteristics and health outcomes has been reported but remains poorly understood owing to complex multidimensional factors that vary across geographic space. Objectives To quantify social determinants of health (SDOH) as multiple dimensions across the continental United States (the 48 contiguous states and the District of Columbia) at a small-area resolution and to examine the association of SDOH with premature mortality within Chicago, Illinois. Design, Setting, and Participants In this cross-sectional study, census tracts from the US Census Bureau from 2014 were used to develop multidimensional SDOH indices and a regional typology of the continental United States at a small-area level (n = 71 901 census tracts with approximately 312 million persons) using dimension reduction and clustering machine learning techniques (unsupervised algorithms used to reduce dimensions of multivariate data). The SDOH indices were used to estimate age-adjusted mortality rates in Chicago (n = 789 census tracts with approximately 7.5 million persons) with a spatial regression for the same period, while controlling for violent crime. Main Outcomes and Measures Fifteen variables, measured as a 5-year mean, were selected to characterize SDOH as small-area variations for demographic characteristics of vulnerable groups, economic status, social and neighborhood characteristics, and housing and transportation availability at the census-tract level. This SDOH data matrix was reduced to 4 indices reflecting advantage, isolation, opportunity, and mixed immigrant cohesion and accessibility, which were then clustered into 7 distinct multidimensional neighborhood typologies. The association between SDOH indices and premature mortality (defined as death before age 75 years) in Chicago was measured by years of potential life lost and aggregated to a 5-year mean. Data analyses were conducted between July 1, 2018, and August 30, 2019. Results Among the 71 901 census tracts examined across the continental United States, a median (interquartile range) of 27.2% (47.1%) of residents had minority status, 12.1% (7.5%) had disabilities, 22.9% (7.6%) were 18 years and younger, and 13.6% (8.1%) were 65 years and older. Among the 789 census tracts examined in Chicago, a median (interquartile range) of 80.4% (56.3%) of residents had minority status, 10.2% (8.2%) had disabilities, 23.2% (10.9%) were 18 years and younger, and 9.5% (7.1%) were 65 years and older. Four SDOH indices accounted for 71% of the variance across all census tracts in the continental United States in 2014. The SDOH neighborhood typology of extreme poverty, which is of greatest concern to health care practitioners and policy advocates, comprised only 9.6% of all census tracts across the continental United States but characterized small areas of known public health crises. An association was observed between all SDOH indices and age-adjusted premature mortality rates in Chicago (R2 = 0.63; P, This cross-sectional study uses data from the US Census Bureau and a multidimensional geospatial approach to quantify social determinants of health across the continental United States and to examine the association of social determinants of health with premature mortality in Chicago, Illinois.