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Healthy Community Initiatives is a means of directly impacting the health and well-being of the cities and communities served by the Cleveland Clinic. The Health Challenge is the signature program of the Cleveland Clinic Healthy Community Initiatives. It is a collaborative effort between Cleveland Clinic and community partners to engage individuals in the community to help manage chronic conditions and promote a healthier lifestyle. The population is the Cleveland Clinic Central region and other nearby neighborhoods impacting 59 zip codes. Each Health Challenge lasted 8 weeks. Neighborhood participants representing each area acquired points by attending health and wellness classes and events held at the Cleveland Clinic community center and partner locations. Individuals are awarded points for participation and improvement in biometric results and/or completion of a clinical appointment. Data was collected by summing up scores received from the different events in the health challenges as noted : Pre-Program Health Screening (1 point), Post-Program Health Screening (1 point), Decrease in BMI at End of Program (1 Point), Decrease in Blood Pressure at End of Program (1 point), Attend classes, programs, or exercise sessions at partner organizations (1 point), Attend classes, programs, or exercise sessions (2 points), mammography (5 points) and Women's Clinic Appointment (5 points) at the Cleveland Clinic Community Center. The winner of individual health challenge was determined by a point system based on participation and completion percentage. There were 17 eight week Health Challenges held in 2018 and 2019 in which a total of 1889 participants enrolled. Average age was 60 years. Average participant attended 9.4 classes/programs or exercise sessions during the 8 week program - total number attended by all the participants was 7,433. The completion percentage was 47.6%. From 2018 to 2019, enrollment increased by 24.9%, weight (by pounds) decreased by 27.7% (a net total of 2,133.7 pounds lost). However, completion rate decreased by 6.6%. Blood pressure abnormality (number of participants with stage 2 blood pressure abnormality decreased from 33% to 23% (national average 28.3%) ; initial lack of physical activity decreased from 51.2% to 32.2% (national average 25.4%) , initial lack of sleep decreased from 50.2% to 41% (national average 29.2%). The main objective of this report is to show how community health interventions such as these have positive impact on the health and well-being of both individuals and community at large. It is anticipated that dissemination of the positive outcomes of these community health interventions will encourage and consolidate healthy behaviors. It may also create incentives for both community and institutional investment and support in such beneficial health focused activities at the grassroots level.

A diverse charophyte assemblage from the Middle Miocene of the Vallès‒Penedès and Vilanova basins (Catalonia, NE Spain) is here described and illustrated for the first time. This flora has been recovered from three localities: els Casots (Subirats), Vilobí del Penedès, and Mas de l'Alonso‒el Pi Gros (Vilanova i La Geltrú). The charophyte assemblages comprise ten different species distributed among three distinctive aquatic environments, and are approximately simultaneous to major fossil vertebrate sites of these basins. Sphaerochara ulmensis, Chara cf. vulgaris, Chara molassica var. notata, Lychnothamnus barbatus var. antiquus, Lychnothamnus sp., Nitellopsis (Tectochara) merianii, and Nitellopsis sp. occur associated to abraded benthic foraminifera in organic-rich claystones related to palustrine and shallow freshwater coastal lakes. Lamprothamnium papulosum forms monospecific assemblages in gypsum-claystone alternations attributed to a coastal brackish water salina. Chara cf. hispida and Chara sp. are found to be associated with ostracods in marls and limestones related to a permanent oligohaline and alkaline lake. The discovery of this aquatic flora sheds new light on the palaeoenvironmental conditions that prevailed in the Vallès‒Penedès Basin during the Langhian in the context of the Mid-Miocene Climatic Optimum and in the Vilanova Basin during the Serravallian.

Oxygen-isotope ratios can be measured on a range of materials (e.g. ostracods, bulk carbonates, diatom silica) and this, alongside their sensitivity to changes in temperature and precipitation has resulted in oxygen-isotope analyses becoming a well-established tool for investigating palaeoclimatic change. We use δ18O of calcite from ostracod shells to reconstruct palaeotemperature and palaeo-precipitation variability during an early Holocene abrupt climatic event in Crudale Meadow, SW Orkney Mainland, Scotland, UK. The research ultimately aims to further our understanding of the driving mechanisms of palaeoclimatic change during the early Holocene by producing a high-resolution palaeoclimate record from Crudale Meadow and comparing this to the existing data of NW Europe. Crudale Meadow is an ideal study site for this research. Spatially, it completes a transect of published early Holocene δ18O records that span Western Ireland1, NW England2 and into Scandinavia3. It has a ~3m thick early Holocene carbonate sequence which offers a multi-decadal or multi-centennial scale study resolution and its proximity to the N. Atlantic makes it highly likely to have been influenced by any climatic changes in the region. A previous study4 presented a bulk carbonate δ18O record for Crudale Meadow but the skeletal chronology limits its usefulness for comparing with regional trends. Here, we present an improved chronology using tephra and pollen stratigraphy, in addition to the ostracod-derived δ18O record. The studied sequence is anchored by the previously identified Saksunarvatn visible tephra layer dated to 10,210 ± 70 cal. years BP5.Ostracods are micro-crustaceans with low-Mg calcite shells which take on the isotopic signal of the water body they are in, at the time of shell calcification. In this study, we use winter calcifying Candona spp. for isotopic analysis. These were abundant and well preserved throughout the sequence. Members of this genus have a well-characterised vital offset6 so the δ18O curve can be reliably corrected for vital effects. Moreover, the species analysed are probable winter calcifers, thus reducing the impact of isotopic enrichment through lake water evaporation during summer months. The high-resolution study allows us to identify structure within the identified isotopic excursion and suggest palaeotemperature estimates from the ostracod- and chironomid-inferred temperatures.The new data presents a clear climatic event with internal structure, which with the current chronology, we hypothesise to be the 9.3ka event. The 9.3ka event has fewer detailed records in comparison to other early Holocene abrupt climatic events (e.g. 8.2ka). Consequently, to identify a structured isotopic signal of the 9.3ka event in NW Europe is an important contribution to our early Holocene records. It emphasises the need for high-resolution δ18O studies during the early Holocene across NW Europe in order to be able to fully identify subtle abrupt climatic events. References: 1Holmes, J.H. et al. (2016) QSR, p.341-349; 2Marshall, J.D. et al. (2007) Geology, 35, p.639–642; 3Hammarlund, D. et al. (2002) The Holocene, 12, p.339–351; 4Whittington, G. et al. (2015) QSR, 122, p.112–130; 5Timms, R.G.O. et al. (2018) Quat. Geochron. 46, p.28–44; 6Holmes, J.H & Chivas, A. (2002) AGU Geophysical Monograph, p.118-204.

Transient loss of consciousness (TLOC) is a common presentation to the emergency department and has a multitude of causes from benign to potentially fatal. We describe the case of a young female presenting with TLOC during sexual activity that was subsequently diagnosed with subarachnoid haemorrhage. She had normal neurology and only moderate headache. She was subsequently transferred to a neurosurgical unit and underwent endovascular coiling of a small anterior communicating artery aneurysm. She was discharged 15 days later without sequelae.

Purpose The purpose of this study was to evaluate the quality of reporting in the abstracts of oncology systematic reviews using PRISMA guidelines for abstract writing. Methods Oncology systematic reviews and meta-analyses from four journals - The Lancet Oncology , Clinical Cancer Research , Cancer Research , and the Journal of Clinical Oncology - were selected using a PubMed search. The resulting 337 abstracts were sorted for eligibility and 182 were coded based on a standardized abstraction manual constructed from the PRISMA criteria. Eligible systematic reviews were coded independently and later verified by a second coder, with disagreements handled by consensus. One hundred eighty-two abstracts comprised the final sample. Results The number of included studies, information regarding main outcomes, and general interpretation of results were described in the majority of abstracts. In contrast, risk of bias or methodological quality appraisals, the strengths and limitations of evidence, funding sources, and registration information were rarely reported. By journal, the most notable difference was a higher percentage of funding sources reported in Lancet Oncology . No detectable upward trend was observed on mean abstract scores after publication of the PRISMA extension for abstracts. Conclusion Overall, the reporting of essential information in oncology systematic review and meta-analysis abstracts is suboptimal and could be greatly improved.

In this research work in progress paper, we discuss the possible benefits of separating syntax practice from problem-solving learning in an Introductory Computer Programming course. We propose a curriculum and associated development tool called Phanon that teach the rudiments of programming language through exercises done online outside of class. Having students complete exercises before class frees up classroom time and instructor face time for the higher-order learning tasks of problem decomposition and solving. We report results from a pilot study that are consistent with our hypothesis that these techniques result in improved student outcomes and attitudes and we discuss a future follow-up study.

This paper states 16 principles for the long term retention and preservation of digital geographic information. The paper is mainly aimed at public sector geographic information providers in Europe (particularly those involved in mapping and cadastre) with the intention of highlighting the significance of fundamental concepts for digital geographic data archiving. Geographic information providers are mainly mapping agencies, but also archives preserving geographic data among a wider range of digital information. A supplementary objective is that the paper may provide useful information for providers of all types of geographic information right around the world. This paper states 16 principles for the long term retention and preservation of digital geographic information. The paper is mainly aimed at public sector geographic information providers in Europe (particularly those involved in mapping and cadastre) with the intention of highlighting the significance of fundamental concepts for digital geographic data archiving. Geographic information providers are mainly mapping agencies, but also archives preserving geographic data among a wider range of digital information. A supplementary objective is that the paper may provide useful information for providers of all types of geographic information right around the world. There are many reasons why people wish to retain access to information, though the main drivers for archiving digital geographic information are meeting legislative requirements, the short and long term exploitation (re-use not only access) of archived data for analyzing social, environmental (e.g. global climate changes) and economic changes over time as well as efficiency savings in managing superseded datasets. This paper sets out the path and describes what needs to be done now to future-proof the investment government agencies around the world have made in creating digital Geographic Data.

Systematic reviews synthesize data across multiple studies to answer a research question, and an important component of the review process is to evaluate the heterogeneity of primary studies considered for inclusion. Little is known, however, about the ways that systematic reviewers evaluate heterogeneity, especially in clinical specialties like oncology. We examined a sample of systematic reviews from this body of literature to determine how meta-analysts assessed and reported heterogeneity. A PubMed search of 6 oncology journals was conducted to locate systematic reviews and meta-analyses. Two coders then independently evaluated the manuscripts for 10 different elements based on an abstraction manual. The initial PubMed search yielded 337 systematic reviews from 6 journals. Screening for exclusion criteria (nonsystematic reviews, genetic studies, individual patient data, etc.) found 155 articles that did not meet the definition of a systematic review. This left a final sample of 182 systematic reviews across 4 journals. Of these reviews, 50% (91/182) used varying combinations of heterogeneity tests, and of those, 16% (15/91) of review authors noted excessive heterogeneity and opted to not perform a meta-analysis. Of the studies that measured heterogeneity, 51% (46/91) used a random-effects model, 7% (8/91) used a fixed-effects model, and 43% (39/91) used both. We conclude that use of quantitative and qualitative heterogeneity measurement tools are underused in the 4 oncology journals evaluated. Such assessments should be routinely applied in meta-analyses.

Background Publication bias is an over-representation of statistically significant results in the published literature and may exaggerate summary effect estimates in oncology systematic reviews. Omitting non-significant results in systematic reviews may therefore affect clinical decision-making. We investigate ways that systematic reviewers attempted to limit publication bias during the search process as well as the statistical methods used to evaluate it. For a subset of reviews not reporting publication bias evaluations, we carried out our own assessments for publication bias to determine its likelihood among these reviews. Design We examined systematic reviews from the top five highest impact factor oncology journals published between 2007 and 2015. Systematic reviews were screened for eligibility and qualifying reviews (n = 182) were coded for relevant publication bias study characteristics by two authors. A re-analysis of reviews not initially evaluating for publication bias was carried out using Egger's regression, trim-and-fill, and selection models. Results Of the 182 systematic reviews, roughly half carried out a hand search to locate additional studies. Conference abstracts were the most commonly reported form of gray literature, followed by clinical trials registries. Fifty-one reviews reported publication bias evaluations. The most common method was the funnel plot (80%, 41/51) followed by Egger's regression (59%, 30/51) and Begg's test (43%, 22/51). Our publication bias evaluations on non-reporting reviews suggest that the degree of publication bias depends on the method employed. Conclusion Our study shows publication bias assessments are not frequently used in oncology systematic reviews. Furthermore, evidence of publication bias was found in a subset of non-reporting reviews. Systematic reviewers in oncology are encouraged to conduct such analyses when appropriate and to employ more robust methods for both mitigating and evaluating publication bias.

Pd(OTf)2(bcope) is shown to react in methanol solution with diphenylacetylene, carbon monoxide and hydrogen to produce the methoxy-carbonylation product methyl 2,3 diphenyl acrylate alongside cis and trans stilbene. In-situ NMR studies harnessing the parahydrogen induced polarization effect reveal substantially enhanced 1H NMR signals in both protic and aprotic solvents for a series of reaction intermediates that play a direct role in this homogeneous transformation. Exchange Spectroscopy (EXSY) measurements reveal that the corresponding CO adducts are less reactive than their methanol counterparts.

During hearings for the inquiry into press regulation, one newspaper proprietor suggested to Ray Finkelstein QC that his journalists were ‘more afraid of Media Watch than of the Press Council’. To counter what he saw as the Australian Press Council's ineffectiveness, Mr Finkelstein recommended a statutory News Media Council to enforce ethical and editorial standards on the print and online media. Although – judging by online comments – such a move might well have proved popular with consumers of news, the mainstream media rancorously opposed it on the grounds that it would threaten freedom of speech. The more cogent objection, however, was that would be unnecessary, and ineffective. Cases of individuals badly maligned, bullied or otherwise damaged by the media are comparatively few in Australia: those cited by Ray Finkelstein, on closer examination, were neither clear-cut nor amenable to regulation. And, while regulating accuracy is possible, regulating ‘fairness' (especially if that means attempting to root out political bias) is well-nigh impossible. The opportunity for the most desirable reform to media regulation – a self-regulatory regime that would cover all media on all platforms – has been lost. But this article argues that the digital revolution might well provide solutions. Over time, it will dilute the dominance of the major news outlets in Australia – especially News Ltd. And for the first time, it affords injured or affronted consumers a means to band together and hit back at Big Media in ways that are both swift and effective. We are all Media Watchers now.

1. Megan H. Tucker, MD* 2. Jonathan Holmes, MD† 3. Susan Harley, MD‡ 4. Maria Roca Garcia, MD§ 5. Haidee Custodio, MD¶ 1. *Pediatrics, Children's Mercy Hospitals and Clinic, Kansas City, MO 2. †Children’s Medical Group, Mobile, AL 3. ‡Division of Pathology 4. §Division of Pediatrics 5. ¶Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine, Mobile, AL A 2-year-old boy with developmental delay and a history of geophagia residing in Mobile, AL, presents to a local emergency department with 3 weeks of intermittent fever and 3 days of irritability, ataxia, and strabismus. He has no history of international travel. Other than a temperature of 101°F (38.3°C), vital signs are within normal limits. On physical examination, the patient is noted to have bilateral cranial nerve 6 palsy, slurred speech, and an ataxic gait. Extreme irritability is observed when sitting the patient upright and with bright lights. Ophthalmologic examination reveals bilateral papilledema. Laboratory analysis reveals C-reactive protein of 0.2 mg/dL (1.90 nmol/L), erythrocyte sedimentation rate of 48 mm/h, and peripheral white blood cell (WBC) count of 9,500/μL (9.50 × 109/L) with an absolute eosinophil count of 32% (0.32). Computed tomography scan of the boy’s head yields unremarkable results; magnetic resonance imaging of the brain reveals nonspecific inflammatory changes. The opening pressure on lumbar puncture (LP) is greater than 20 mm Hg, and the manometer is emptied 3 times before obtaining a normal closing pressure. The cerebrospinal fluid (CSF) shows a white blood cell count of 823 /μL (0.82×109/L), glucose of 41 mg/dL (2.28 μmol/L), and protein of 0.65 g/dL (6.5 g/L). Manual differentiation of the CSF shows the presence of 27% eosinophils (Figure …

Robots are prominent in several industries where high volumes of products are produced and handled; however, certain food processing industries have been slow to adopt robotic work cells due to the high cost of existing systems, difficulties in handling fresh meat products, and inability for robots to survive a corrosive washdown environment. In this paper, we describe the development of a robot specifically designed to address all of these needs with special attention on testing and validation of that machine. The end result of this is the beginning of a design guideline to assist those involved in the design and operation of washdown robots for the food processing industry.

Balanced antenna radiators require a balun feed circuit which provides equal power split and differential phase to each of the two radiator arms. As antenna radiator bandwidths have increased, balun circuits have increasingly wide bandwidth requirements. This paper presents an improved 1–20 GHz printed circuit balun, designed to operate in an electrically small conducting enclosure whose largest dimension is only 10.6% of a wavelength at the lowest frequency. The paper includes a brief presentation of the improved design, details of the prototype hardware, and a comparison between the numerical simulations and measured prototype performance.

Objective To compare 2 hours of daily patching (combined with 1 hour of concurrent near visual activities) with a control group of spectacle wear alone (if needed) for treatment of moderate to severe amblyopia in children 3 to 7 years old. Design Prospective randomized multicenter clinical trial (46 sites). Participants One hundred eighty children 3 to 7 years old with best-corrected amblyopic-eye visual acuity (VA) of 20/40 to 20/400 associated with strabismus, anisometropia, or both who had worn optimal refractive correction (if needed) for at least 16 weeks or for 2 consecutive visits without improvement. Intervention Randomization either to 2 hours of daily patching with 1 hour of near visual activities or to spectacles alone (if needed). Patients were continued on the randomized treatment (or no treatment) until no further improvement was noted. Main Outcome Measure Best-corrected VA in the amblyopic eye after 5 weeks. Results Improvement in VA of the amblyopic eye from baseline to 5 weeks averaged 1.1 lines in the patching group and 0.5 lines in the control group ( P = 0.006), and improvement from baseline to best measured VA at any visit averaged 2.2 lines in the patching group and 1.3 lines in the control group ( P Conclusion After a period of treatment with spectacles, 2 hours of daily patching combined with 1 hour of near visual activities modestly improves moderate to severe amblyopia in children 3 to 7 years old.

There are a number of implications of recent imperatives in the Australian higher education sector to ensure that all institutions offering coursework degrees have clearly defined graduate learning outcomes, mapped against individual units of study. The implications in terms of providing evidence that graduate learning outcomes have been met presents challenges for institutions and disciplines. In this chapter, we consider the consequences of regulations in the broader context for the discipline of music, and report on some of the findings of the Assessment in Music project (AiM), which has explored the constructive alignment between assessment and learning outcomes statements of various kinds at the Bachelor degree program level.