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An angiokeratoma is a benign vascular lesion that appears as one or more red to black papules with a verrucous surface. Histologically, it is defined by ectatic, thin-walled vessels in the papillary dermis, acanthosis with elongated rete ridges, and compact hyperkeratosis. Solitary angiokeratoma is one of five defined subtypes of angiokeratoma. We report the case of an 18-year-old woman with a “wart” that had been present for many years. After treatment with several over-the-counter wart therapies, several rounds of paring plus cryotherapy, and Candida antigen injections failed, a shave biopsy was taken to remove the lesion, and histopathologic examination was consistent with an angiokeratoma. This case demonstrates the importance of considering angiokeratoma in the differential diagnosis of a wart, particularly one recalcitrant to treatment.

Introduction Efforts are increasingly being made to implement pharmacists working in General Practice to support General Practitioners and alleviate pressure, mainly by providing pharmacotherapy services such as medication reviews and authorising prescribing requests (1). While there is wide interest in the contributions pharmacists can make within primary care, there is limited research exploring the competencies pharmacists need to safely and effectively provide care in this area. Aim The aim of this project was to identify competencies required for pharmacists providing pharmacotherapy services in General Practice. Methods Modified eDelphi study (2), comprising a series of online questionnaires conducted between July 2019 and January 2020. Participants were pharmacists working in General Practice in Scotland. The first questionnaire consisted of open-ended questions aimed at generating a list of competencies; competency categories and individual competency items relating to pharmacotherapy service tasks were identified based on the free text responses using content analysis. Subsequently, the second questionnaire aimed to establish consensus regarding the importance of the collected competencies, using a rating scale from 1 (“not important”) to 10 (“very important”); participants’ scores were aggregated using modes and medians, and the level of agreement among participants with regards to the importance of competencies was evaluated by calculating the percentage of scores between 8 and 10. Due to the novelty of this work and the resultant uncertainty surrounding participants’ responses, no cut-off point for agreement was pre-specified. Results Overall, 10 pharmacists completed the first questionnaire, and 11 completed the second. Building on the findings from the first questionnaire, a framework of competencies necessary to provide pharmacotherapy services in General Practice was developed, comprising eight competency categories, with a total of 31 individual competency items: General Skills (e.g. ability to record patient information); IT Skills (e.g. ability to use GP computer system to update documentation); Legal & Professional Frameworks (e.g. understanding of clinical guidelines); Procedural Skills (e.g. ability to arrange follow-up); Multidisciplinary Team Communication Skills (e.g. ability to communicate with others within the GP practice); Consultation Skills (e.g. ability to take a complete history); Clinical Knowledge (e.g. knowledge related to conditions being treated); and Clinical Skills (e.g. ability to interpret clinical information). All eight competency categories were considered important across the pharmacotherapy service, with high agreement (between 71 and 85%) among participants. Conclusion Using a bottom-up, exploratory approach, this study confirmed that practicing within the General Practice setting requires a wide set of competencies, including – but not limited to – advanced clinical and consultation skills. Nevertheless, findings should be interpreted cautiously due to the limited sample size; although results have tentatively been validated using a paper-based version of the second online questionnaire during an in-person event with General Practice pharmacists, results might not be reflective of all pharmacists working in this setting. References (1) Scottish Government. (2017). The 2018 General Medical Services Contract in Scotland. Retrieved from https://www.glasgowlmc.co.uk/download/contract%20and%20contractural%20Issues/The-2018-General-Medical-Services-Contract-in-Scotland.pdf (2) Hsu, C. C., & Sandford, B. A. (2007). The Delphi technique: Making sense of consensus. Practical Assessment, Research & Evaluation, 12, Article10. https://doi.org/10.7275/pdz9-th90

About a third of current inmates in the United States prisons and jails suffer from severe mental illness (Collier, 2014). For most of these inmates, their untreated mental health needs contribute to their return to custody within the criminal justice system. A 2011 study reported that approximately 68% of inmates with an untreated mental illness and substance abuse diagnoses return to custody at least once within 4 years of the initial release, compared to 60% of those who do not suffer from either mental illness or substance abuse diagnoses (Bronson et al., 2017). This project extends over a decade of prior research examining current mental health services available to those released from the Albemarle-Charlottesville Regional Jail (ACRJ). The primary objective of this project was to identify individuals within the ACRJ, which serves jurisdictions in Charlottesville, Albemarle, and Nelson County who were recommended for services following screening through the Brief Jail Mental Health Screener (BJMHS) to answer questions surrounding the return to custody rate of those linked vs not linked to services.To examine the demographics of inmates screened, types of charges, and length of stay in the criminal justice system, data sets were obtained from Region Ten Community Services Board (R10), ACRJ, Offender Aid and Restoration (OAR), and the Thomas Jefferson Area Coalition for the Homeless (TJACH) after each member of the team completed a training on protecting personally identifiable information (PII) and signing a nondisclosure agreement (NDA). The research team analyzed 60 months of data spanning from July 2015 through June 2020. The data include individuals booked into ACRJ and individuals who received mental health, substance abuse, and intake/access/emergency services from R10. The data from ACRJ, the BJMHS, and R10 were merged to form a single data set compiling relevant information for each individual in ACRJ, such as booking details, BJMHS screener scores, and services received from R10.According to the merged data, of the individuals who took the BJMHS when they were booked into ACRJ, 26% screened in, meaning their BJMHS results indicated they should be referred for further mental health evaluation. The team analyzed the cohort of individuals who screened-in and were available to receive services from R10 following their release from custody. The key findings and outcomes of the study included:•From the ACRJ dataset from 2015 to 2019, 913 individuals screened-in for referral to mental health services. This is 26% of the total inmates who were screened at ACRJ.•Individuals who received services from R10 were more likely to return to custody (19%) within 12 months than screened-in individuals who did not receive these services (11%).

Introduction There is growing pressure on primary care, which has resulted in an increased number of clinical pharmacists working within the setting. To help support this growing workforce in their role and with their development, several countries have created educational resources. Within Scotland, an educational resource package was created for pharmacists working in General Practice, containing a Competency and Capability Framework, an online platform and educational and clinical supervision. The implementation of these resources in Scotland has not been evaluated thus far, therefore it is unclear to what extent they may support and facilitate pharmacists in their professional role. Aim The aim of this project was to assess pharmacists’ perceptions of the educational resource package available to General Practice pharmacists in Scotland. Methods A mixed-methods study comprising an online questionnaire and semi-structured telephone interviews was undertaken between July and October 2019. The questionnaire sought to provide a more representative overview, with the interviews designed to gain an in-depth understanding, to support the development of recommendations to improve the educational resource package. A previously validated, online questionnaire (1) was used to explore pharmacists’ view on the adoption, acceptability, appropriateness, and feasibility of the educational resources based on Proctor’s model of implementation outcomes (2); similarly, the semi-structured telephone interviews explored pharmacists’ experiences with the resources, in addition to inquiring about its adoption, acceptability, appropriateness, and feasibility. The questionnaire included a Likert scale and free-text questions; quantitative responses were summarised, whereas the qualitative answers underwent a content analysis directed by Proctor’s implementation outcomes. The interview results were structured using the framework approach, with the data undergoing a thematic or summative content analysis. Results Overall, 52 pharmacists completed the questionnaire and 12 participated in the interviews. The results indicated widespread adoption and acceptance of the educational resource package. The level of acceptance was influenced by the perceived purpose of completing the resources, such as if they believed it provided development opportunities. Its appropriateness depended on the pharmacist’s individual situation since previous experiences and current job role differed. Additionally, several barriers complicated the feasibility of the resources, such as insufficient support and guidance. Conclusion The adoption and acceptance of the educational resource package for General Practice pharmacists in Scotland indicated its suitability for supporting their role; however, further facilitation would enhance their engagement with the resources, and potentially improve their perception of its appropriateness and feasibility. Despite the limited sample size, the study provided an in-depth understanding of general practice pharmacists perceptions of the educational recourse package, based on an established model. References (1) Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65-76. (2) Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017; 12(1): 108.

Risankizumab, a fully human IgG monoclonal antibody inhibitor of IL-23, is a therapeutic agent currently in late stage development for use in the treatment of moderate-to-severe plaque psoriasis. It is a biologic agent similar to guselkumab and tildrakizumab which targets IL-23 specifically, and has been primarily developed for use in moderate-to-severe psoriasis. USA-based pharmaceutical company Abbvie submitted it for a Biologics License Application to the US Food and Drug Administration (FDA) in April 2018. Risankizumab is the result of a collaboration between the German company Boehringer Ingelheim and Abbvie, which together are leading the future development and commercialization of risankizumab globally. The results from Phase I to Phase III clinical trials of risankizumab show it is highly effective and its FDA-approval in 2018 is likely. In this article we provide an independent expert opinion on the efficacy and safety of risankizumab in psoriasis based on a full review of the literature.

Simulation is experimentation with a model. The behavior of the model imitates some salient aspect of the behavior of the system under study and the user experiments with the model to infer this behavior. This general framework has proven a powerful adjunct to learning, problem solving, design, and control. In this tutorial, we focus principally on discrete-event simulation – its underlying concepts, structure, and application.

ObjectivesInforming research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.DesignIn the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.SettingUK stroke services.Participants3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.ResultsOf those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.ConclusionIt is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration numberISRCTN83290762; Post-results.

Bristow’s stature in New York as a composer, conductor, and organist was unrivaled during the 1870s. He continued to perform with the two orchestras and to conduct several society choirs. The number of new compositions slowed during the 1870s, but his significant works included Great Republic: Ode to the American Union (1870-1876), Pioneer: A Grand Cantata (1872), and his programmatic Arcadian Symphony (1872). An increasingly number of his compositions were performed during the decade, including a revival (unsuccessful) of Rip Van Winkle. He enjoyed a third Grand Testimonial Concert and the performance of his Arcadian Symphony in a Baltimore concert of American music (both 1875).

Bristow married Harriet Crane (1853) and began to teach in the New York Public Schools (1854). He was conductor of the New York Harmonic Society (1851-1863) and organist for several churches. Three major works were premiered: his opera Rip Van Winkle (1855, by the Pyne and Harrison Company) and his symphonies nos. 2 and 3 (1856 and 1859, both by the Philharmonic Society). He also wrote the Winter’s Tale Overture (1855). During the 1850s Bristow’s activities as a teacher, performer, and composer grew apace, as did his reputation. He was awarded an honorary Doctor of Music degree (1858) and enjoyed a testimonial concert (1859).

The conclusion suggests a more rounded perception of Bristow. Letters he wrote to his daughter (1898) and condolence letters to his widow suggest a quirky sense of humor, love for his daughter, and utter devotion to his grandson. Obituaries mostly focus on his professional accomplishments, but several describe him as a lovable, genuine, considerate individual who was “modest and unassuming to a fault” and a man who despised self-promotion. These themes are echoed in condolence letters, where he is described as a warm and genial gentleman and someone who was always quick to discover the good in others. It is fitting to end the book with these observations.

Bristow taught music in the New York Public Schools (1854-1898), even after relocating to Morrisania. He taught simultaneously in as many as six different schools and was known as an effective teacher. Most of his students (boys and girls) were foreign-born. The inclusion of music pedagogy in the public school system was a long and gradual process. Students in the schools with music teachers learned and performed fairly difficult choral repertory at commencements, in special concerts, and as fund-raising activities. In 1870 Bristow oversaw a “Grand Juvenile Beethoven Festival.” He also taught in private conservatories and institutions, including the New York Conservatory, where he was director for several years.

George Frederick Bristow (1825-1898), a pillar of the nineteenth-century New York musical community, was educated, lived, and worked in New York for his entire life. A skilled performer (piano, organ, violin, conducting), he was a decades-long member of the Philharmonic Societies of New York and Brooklyn, and conducted the Harmonic Society, Mendelssohn Union, numerous church choirs, and pickup choral and instrumental ensembles organized for special events. He taught music privately and in the public school system. Bristow’s professional activities were those of a highly skilled urban journeyman musician--typical of many who worked in America during the period. Bristow was a steadfast and outspoken supporter of American composers throughout his career. This started in 1854 with his participation--along with William Henry Fry and editor Richard Storrs Willis--in a months-long journalistic battle that centered on the Philharmonic Society’s lack of support for American composers, an activity that has dominated his historical reputation. But he was also a prolific composer: of five symphonies, two oratorios, an opera, many secular and sacred choral pieces, chamber music, songs, and works for piano and organ. As a quiet and self-effacing individual, Bristow was not a self-promoter. But many of his contemporaries regarded him as a skilled performer, a generous colleague, and the most important American classical composer during much of the mid-century period.

New York grew dramatically in population and musical activity in the 1880s and 1890s. Bristow was still respected and admired but now as a venerable musician who was out-of-step with current developments (he was never a Wagnerian). His performing activity diminished; he resigned from the Philharmonic Society in 1882. He joined the New York Manuscript Society, suggesting continued support for American musicians. He resumed writing songs and character pieces for piano (including “Plantation Melodies,” perhaps in response to Antonin Dvořák). He revised Rip Van Winkle and wrote the overture Jibbenainosay (1886) as well as the Mass in C (1885) and his choral symphony, Niagara (1893).

George Bristow’s passionate support for American musicians in an 1854 journalistic battle with two critics (Richard Storrs Willis and John Sullivan Dwight) has unduly colored his historical reputation as an old-fashioned hothead who was hostile to German music and musicians; some have even called him a Know-Nothing. Commentary and descriptions from letters and print media, however, suggest that his contemporaries considered him to be not only a highly esteemed composer, performer, and educator, but also one of the most important classical-music composers active in America during most of the second half of the nineteenth century.

Bristow’s first teacher was his father, William Richard Bristow; he later studied with George Macfarren, Ole Bull, and others. During the 1840s he performed professionally in theater orchestras (Park, National, and Olympic), joined the Philharmonic Society (1842), and soon began performing in the orchestra (1843). Important mentors included William Musgrif and George Loder. In the same decade he wrote songs, piano pieces, and chamber works, as well the Concert Overture (1845) and Sinfonia No. 1 (1847). By mid-decade he was thoroughly immersed in the thriving performance scene of the city: as an ensemble member, conductor, and solo violinist or pianist.

The early 1860s were tumultuous for the country and Bristow. Exempt from military service, he organized patriotic concerts and composed overtly nationalistic works, including Keep Step with the Music of Union and Columbus Overture (both 1861). He divorced Crane (1863) and married Louise Holder (1864), a widow with a young daughter, Nina. They moved to Morrisania (now in the Bronx) and added daughter Estelle Viola (1868). Bristow’s gigging activities diminished, but he commuted daily to Manhattan to teach and to perform with the two philharmonic societies, the Harmonic Society and the Mendelssohn Union (1867-1871), and in various churches. He wrote two oratorios: Praise to God (1861) and Daniel (1867).

Bristow was a music educator for most of his professional life. Teaching was a reliable source of income, but also helped to fulfill his goal “to do all that he could for art,” for he believed strongly in the power of music. His first teaching job was at the American Musical Institute (1847), after which he began to teach piano privately. He fell in love with a succession of his female students, which inspired him to write a series of nocturnes. He created several pedagogical publications, including vocal textbooks Cantara I and Cantara II, and a method book for organ.

Bristow served as a church organist and choir director for most of his professional life, in almost a dozen different churches (1840s-1890s). The type of music performed in churches on holy days is readily available; what was heard on regular Sundays is mostly unknown. A 1906 publication about music at Manhattan’s Trinity Church, however, is instructive about both types of services. Bristow programmed compositions by both European and American composers, especially on holy days; this indicates his continued support for fellow composers. He wrote numerous sacred works for organ (interludes, voluntaries, various pieces) and voice (anthems, sentences, services, hymns, songs, offertories, and oratorios).

In the 1850s Bristow was strongly influenced by William Henry Fry and Louis Jullien. Fry inspired Bristow with his 1853 challenge to American composers to create a nationalistic style; the visiting conductor Jullien both led an orchestra (which included Bristow) that was superior to any yet heard in America and overtly supported American composers by commissioning and performing their works, including Bristow’s Symphony No. 2. The activities of both mentors contributed to Bristow’s participation (1854) in the journalistic “musical battle of the century,” in which he accused the Philharmonic Society of not supporting American composers. Bristow continued to be busy as a performer.

Bristow organized two piano and melodeon businesses--the first a disaster, the second more successful. He provided testimonials to many instrument manufacturers (Steinway, Chickering, Bradbury, and Weber pianos) and other music-related endeavors. He was also associated with the United States Mutual Pianoforte Association (1867), a nonprofit that made pianos available to the general public at low prices. Bristow also served as a musical-instrument judge at the 1876 Centennial Exposition and became swept up in a controversy about the judging process. He was defended by some New York critics but was deemed guilty by association by many and must have rued the day he agreed to take on the task.

The aim of the study was to determine if the additional surgical complexity of Lefort II distraction with zygomatic repositioning (LF2ZR) results in increased complications compared to Lefort III distraction (LF3). A retrospective review was performed of all LF3 and LF2ZR advancements performed by the senior author over 15 years. Demographic, operative, postoperative, and cephalometric data were collected from initial procedure through greater than 1 year postoperatively. Univariate and multivariate analyses were performed to compare procedures. 19 LF2ZR and 39 LF3 in 53 patients met inclusion criteria. Diagnoses differed between procedures, with more Crouzon Syndrome in LF3 and more Apert Syndrome in LF2ZR. Complication rate was 7/19 for LF2ZR and 12/39 for LF3 with no severe morbidity or mortality, and no difference between procedures (p = 0.56). The types of complications encountered differed between procedures. LF2ZR had a significantly longer operative time (506 ± 18 vs. 358 ± 24 min, p0.001). However, a greater number of LF2ZR patients underwent concomitant procedures (15/19 vs. 13/39, p0.001). Multivariate analysis revealed that Apert Syndrome and reoperative midface advancement were the most significant predictors of increased blood loss. LF2ZR has an equivalent complication rate to LF3. Therefore, it is our treatment of choice for cases requiring differential sagittal and vertical distraction of the central midface.

To discuss technical modifications specific to the cleft Le Fort I osteotomy that improve mobilization and demonstrate the stability of the maxilla at the Le Fort I level in a cohort of patients with cleft palate (with or without cleft lip) who underwent traditional maxillary advancement.This was a retrospective evaluation of patients with cleft palate (+/- cleft lip) who underwent orthognathic surgery for management of skeletal malocclusions. All study subjects had a Le Fort I osteotomy +/- bilateral mandibular sagittal split osteotomies. The cleft Le Fort I osteotomy technique is modified to extensively release fibrous tissue and scar from the posterior maxilla, including around the tuberosity, along the posterior maxillary sinus wall, and circumferentially around the descending palatine canal. Maxillary position was assessed using angular and linear measurements pre-operatively (T0), immediately post-operatively (T1), and at 1-year post-operatively (T2). Descriptive and bivariate statistics were computed; a P 0.05 was considered significant.Twenty-eight patients with cleft palate (with or without cleft lip) were included. The sample's mean age was 18.9 ± 1.4 years and included 11 females. The majority of subjects (64.3%) underwent bimaxillary surgery; eight subjects (28.6%) had segmental maxillary surgery and 14 subjects (50%) had simultaneous maxillary interpositional bone grafting. The mean maxillary sagittal advancement was 6.1 mm (range: 0-10 mm). At 1-year post-operatively, the absolute change in SNA was 0.7 ± 0.9 degrees; the absolute change in maxillary sagittal position was 0.8 ± 0.6 mm. There was no association between the magnitude of advancement and the magnitude of position change (P = 0.86). Stability was not influenced by segmental surgery, bone grafting, or bimaxillary surgery (P 0.33).Using a modified technique with extensive release of posterior scar and graduated intra-operative traction, maxillary advancement of up to 10 mm can be performed in patients with cleft palate (± cleft lip) with sagittal relapse of1 mm at 1-year post-operatively.

Closure of psychiatric hospitals in favor of community-based treatment methods (Torrey, 1997), resulted in jails and prisons becoming the “new asylums” of the United States (National Institute of Corrections, 2014). Over the past decade, research teams in Charlottesville, Virginia, have studied data from the region to better understand the nature and extent of the individuals in the criminal justice system who suffer from severe mental illnesses (Boland et al., 2019). The work presented here extends this prior research by enlarging the study population to cover a longer time period, by characterizing the dynamic paths individuals follow through various periods of incarceration, mental health services, homelessness, and probation/supervision, and by incorporating geocoding to explore whether proximity to treatment centers has an impact on linkage to mental health services.Under an approved Institutional Review Board (IRB) protocol, the research team partnered with multiple local criminal justice agencies and community service providers (CSPs) to share data. These agencies interact through the Albemarle-Charlottesville Evidence Based Decision Making (EBDM) Policy Team, where regular monthly meetings are held to discuss issues in the criminal justice system. The research team analyzed data across 48 months from July 2015 to June 2019. These data comprise 8,332 individuals booked into Albemarle/Charlottesville Regional Jail (ACRJ), 13,340 individuals who received Region Ten Community Services Board (R10) mental health or substance abuse services, 2,117 individuals in a locally maintained database of homeless individuals, and 4,345 individuals who received services from Offender Aid and Restoration (OAR), which supervises individuals on local probation. Of the individuals booked into ACRJ, 18 percent “screened in” for referral for mental health services according to the Brief Jail Mental Health Screener (BJMHS). Key findings and outcomes of this study include:•Of the 8,332 individuals booked into ACRJ, 5,499 individuals (67%;) were administered the BJMHS.•Of those 5,499 individuals administered the BJMHS, 1,534 screened in for referral to mental health services, which is 28%; of individuals who received the screener and 18%; of all individuals at ACRJ.These findings support the results of prior research with greater statistical confidence. New findings include:•Individuals who associate their current legal trouble with drugs and alcohol have a 12%; higher screening-in rate than those who do not.•63%; of individuals in ACRJ who screened in and were available to be treated once released ultimately were linked to R10 services.In previous years, BJMHS results showed that there were nearly three times as many people with severe mental illness in jail than previously estimated by the state, and that linkage to mental health services could be improved. These findings led to the development of the Therapeutic Docket, an alternative to the standard judicial process for individuals with severe mental illness (Jefferson Area Community Corrections, 2018). New findings continue to help members of the Thomas Jefferson Area Community Criminal Justice Board and the EBDM Policy Team gain insight into the needs of the region’s mentally ill inmate population, ultimately leading to more evidence-based decision-making regarding the treatment of these individuals within and beyond their periods of incarceration.

A combination of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2 was compared to placebo for relief of symptoms of irritable bowel syndrome (IBS). A total of 113 subjects at 3 clinical sites were randomised in a 2:1 ratio and followed for 12 weeks. Subjects ingested either 2 capsules of active study product, containing 50×109 cfu of live organisms, or 2 placebo capsules daily. Endpoints included improvement in abdominal pain, days of pain, distention, stool consistency and frequency, quality of life (QOL), and adequate relief (AR) of IBS symptoms. IBS subtypes constipation (IBS-C), diarrhoea (IBS-D), and mixed (IBS-M) were evaluated separately; the effect of gender was also examined. For all efficacy endpoints improvement of 30% or more vs placebo was considered clinically significant. With the exception of pain intensity and AR, the endpoints demonstrated a therapeutic advantage of active over placebo for IBS symptoms in at least some subject subgroups. The IBS-D and female subgroups showed the largest and most consistent effects. Stool frequency and consistency were evaluated in the IBS-C and IBS-D subgroups, and improvement of active vs placebo was noted in both. QOL improvement was seen overall and in specific domains. Adverse events (AEs) were limited to 7 subjects; all were of mild or moderate intensity except one, severe cramping. Four AEs in the same subject in the placebo group were judged to be related to study product; these resolved by the end of study. There were no serious AEs.

In large-scale enterprise data centers for big data analytics, long batched jobs and short interactive jobs are usually mixed. Hybrid job schedulers, consisting of one centralized scheduler for long jobs and multiple distributed schedulers for short jobs, have become a promising alternative because they can significantly shorten latencies of short jobs via independent and parallelized assignment of short tasks by distributed schedulers and lower chances of head-of-line blocking via a number of performance optimization techniques.However, short jobs are still facing long job latencies under hybrid job schedulers due to workload fluctuation and straggler task problem. In this paper, we propose Eirene to optimize the latency performance of short jobs via two schemes tightly coupled into the general architecture of hybrid job schedulers. Coordinated Cold Data Migration leverages high task waiting time of short jobs under heavily-loaded periods and migrates cold data from disks to local memory for the initial phase of reading input so as to shorten task runtime and queueing time. On the other hand, Scheduler-Aware Task Cloning exploits spare computing resources under lightly-loaded periods and performs proactive task cloning for short jobs to mitigate the straggler problem.We implement a prototype of Eirene based on Eagle, a state-of-the-art hybrid job scheduler. Experimental results show that, under heavy loads, Eirene is able to improve 50-percentile (P50), 75-percentile (P75), 90-percentile (P90) latency performance of short jobs by up to 44.4%, 80.3%, 84.1% respectively compared with Eagle under the Facebook trace with a cluster of 50000 nodes.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that has a substantial impact on patients’ quality of life. As the exact pathogenesis remains unclear, treatment is complex and not yet standardized. Objectives: The aim of this study was to describe patient characteristics and to broadly examine trends in treatment response of various therapeutic strategies in patients with HS in a single academic referral center in the southern USA. Methods: A retrospective chart review was conducted of a cohort of HS patients seen in a faculty general dermatology practice with academic affiliation to Baylor University Medical Center in Dallas, TX, between February 2015 and February 2018. Patient demographics, clinical features, prescribed treatments, and response to treatment were analyzed using the Pearson χ2 test or Fisher exact test, and by the Mann-Whitney U test for categorical and continuous variables, respectively. Results: A total of 149 patients (113 females, 36 males) were included. Hurley stages I, II, and III were diagnosed in 29.6, 36.5, and 33.9% of patients, respectively. 44.2% of patients had a positive family history of HS, 39.5% of patients were current or former smokers, and 52.8% reported alcohol use. 80.9% of patients were overweight or obese (BMI ≥25), compared to 68.5% in Texas in 2016 (p = 0.0012). The most frequently prescribed treatments were oral antibiotic therapy (83.9%), topical antibiotic therapy (74.5%), metabolic medications such as metformin/zinc (67.1%), intralesional Kenalog (63.1%), and biologic therapies (tumor necrosis factor-α inhibitors; TNF-α inhibitors; 49%). In examining the response rate, patients with disease localized to the buttocks had significantly higher response rates (60.4 vs. 25%, p = 0.043) and approached statistical significance in responders versus nonresponders in treatment with biologics (p = 0.0632) when compared against all other treatments. Conclusions: HS is a complex inflammatory skin condition associated with obesity and smoking. In this cohort, the most frequently prescribed therapies were oral and topical antibiotics. However, the use of biologic agents (TNF-α inhibitors) appears to be associated with the most significant treatment response. Key Points: This is the first study to evaluate trends in treatment response of various therapeutic strategies in HS patients at an academic referral center in Dallas, TX, a unique geographic region of the southern USA. Biologic therapy (TNF-α inhibitor) appears to be associated with the most significant treatment response.

It is common to find a mixture of both long batch jobs and latency-sensitive short jobs in enterprise data centers. Recently hybrid job schedulers emerge as attractive alternatives of conventional centralized job schedulers. In this paper, we conduct trace-driven experiments to study the job-completion-delay performance of two representative hybrid job schedulers (Hawk and Eagle), and find that short jobs still encounter long latency issues due to fluctuating bursty nature of workloads. To this end, we propose Dice, a general performance optimization framework for hybrid job schedulers, to alleviate the high job-completion-delay problem of short jobs. Dice is composed of two simple yet effective techniques: Elastic Sizing and Opportunistic Preemption. Both Elastic Sizing and Opportunistic Preemption keep track of the task waiting times of short jobs. When the mean task waiting time of short jobs is high, Elastic Sizing dynamically and adaptively increases the short partition size to prioritize short jobs over long jobs. On the other hand, Opportunistic Preemption preempts resources from long tasks running in the general partition on demand, so as to mitigate the "head-of-line" blocking problem of short jobs. We enhance the two schedulers with Dice and evaluate Dice performance improvement in our prototype implementation. Experiment results show that Dice achieves 50.9%, 54.5%, and 43.5% improvement on 50th-percentile, 75th-percentile, and 90th-percentile job completion delays of short jobs in Hawk respectively, as well as 33.2%, 74.1%, and 85.3% improvement on those in Eagle respectively under the Google trace, at low performance costs to long jobs.

The purpose of this work was to evaluate the stability of maxillary position in the setting of occlusal plane rotations in bimaxillary surgery with rigid fixation of the mandible and bilateral nasomaxillary fixation at the Le Fort I level. This was a retrospective assessment of patients undergoing bimaxillary surgery for the correction of dentofacial deformities with occlusal plane alterations. Demographic measures assessed included age, sex, history of craniofacial anomaly, segmental maxillary osteotomy, and maxillary bone grafting. Cephalometric measures assessed included occlusal plane rotation (clockwise (CWR) or counterclockwise (CCWR)), angular measurements of maxillary and mandibular position (SNA, SNB, and ANB), and occlusal plane angle (occlusal plane to corrected Frankfort horizontal); these were assessed preoperatively (T0) and immediately (T1), 6 weeks (T2), and 1year postoperative (T3). Descriptive and bivariate statistics were computed; P≤0.05 was considered significant. Thirty-six patients were included as study subjects (mean age 18.6±1.8 years; 17 (47.2%) female); 27 (75%) had a primary diagnosis of craniofacial anomaly. Eleven patients (30.6%) had segmental maxillary osteotomies; 10 patients (27.8%) had simultaneous maxillary bone grafting. Twelve patients underwent CCWR; 24 patients underwent CWR. No patient required repeat surgery for malocclusion or relapse; there were no malunions or non-unions during follow-up. For CCWR patients, the mean occlusal plane change from preoperative to postoperative was 5.8±2.8°, remaining stable at 1 year postoperative (ΔT3-T1 1.6±1.0°, P>0.05). For CWR patients, the mean occlusal plane rotation was 4.5 ± 2.2°, remaining stable at 1 year postoperative (ΔT3-T1 1.1±0.9°, P>0.05). In patients undergoing bimaxillary surgery for occlusal plane rotation, two-point fixation of the Le Fort I osteotomy resulted in a stable maxillary position at 1 year postoperative.

The purpose was to assess maxillary position among patients undergoing Le Fort I maxillary advancement with internal fixation placed only at the nasomaxillary buttresses. This was a retrospective study of patients undergoing a Le Fort I osteotomy for maxillary advancement, with internal fixation placed only at the nasomaxillary buttresses. Demographic and cephalometric measures were recorded. The outcome of interest was the change in maxillary position between immediately postoperative (T1), 6 weeks postoperative (T2), and 1 year postoperative (T3). Fifty-eight patients were included as study subjects (32 male, 26 female; mean age 18.4±1.8 years). Twenty-five subjects (43.1%) had a diagnosis of cleft lip and palate. Forty-three subjects (74.1%) had bimaxillary surgery, 16 (27.6%) had bone grafts, and 18 (31.0%) had segmental maxillary osteotomies. At T3, there were no subjects with non-union, malunion, malocclusion, or relapse requiring repeat surgery. Mean linear changes between T1 and T3 were ≤1mm. Mean angular changes between T1 and T3 were

In the mid-20th century, deinstitutionalization of mental health hospitals in the United States led to a dramatic decline in the availability of centralized institutional services. As a result, a result, a significant portion of the inmate population at correctional facilities consists of individuals with serious mental illness. In Charlottesville, VA and surrounding counties, individuals suffering from serious mental illness often depend on local community service providers (CSPs) for treatment after their release from custody, but limited interagency coordination impedes access to treatment. To better understand the characteristics of the population of incarcerated individuals with serious mental illness, data spanning a 30-month period from July 2015 to December 2017 were obtained through research partnerships with criminal justice agencies and CSPs in the Charlottesville area. In order to evaluate who might benefit from mental health services, this paper characterizes the population of inmates who met screening criteria for further mental health evaluation relative to those who did not. In the Albemarle-Charlottesville Regional Jail (ACRJ) booking data, 5,284 unique individuals were identified, of which 3,064 (48%) were screened for serious mental illness. Of those screened, 32% met the screening criteria for further mental health evaluation. For individuals who met the screening criteria, 21% were linked to a local community service provider for further mental health services. Key findings of this study include: •individuals who met the screening criteria for serious mental illness spent a more time in jail during the study period than those who did not meet the criteria. •individuals who stayed more than 30 days for any given booking event were more likely to have met the criteria for serious mental illness, •individuals who returned to custody due to probation violations were more likely to have met the criteria for serious mental illness, •individuals who were returned to custody most frequently and spent the most time in jail were more likely to meet the criteria for serious mental illness. The paper also analyzes the linkages between the criminal justice system and these individuals who require further mental health evaluation and services. These findings help agencies and community stakeholders develop a better understanding of relationships and interactions and establish best practices for enhancing public safety while addressing the needs of individuals suffering from mental illness.

Due to hardware upgrades and server consolidation, it is not uncommon to witness a few generations of servers deployed in the same datacenters. As a result, variants of fair job schedulers are proposed to enforce fairness for constrained jobs that have hardware or software constraints on task placement. However, the other important characteristics resulted from server heterogeneity, performance variation, is unfortunately overlooked by state-of-art fair job schedulers with placement constraints. In this paper, we propose Eunomia, a performance-variation-aware fair job scheduler, to address the unfairness issue due to performance variation in heterogenous clusters. Eunomia introduces a key metric, called progress share, which is defined as the ratio between the accumulated task progress given the current allocation and the accumulated task progress if the user can monopolize the cluster. Eunomia aims to equalize progress share of jobs as much as possible, so as to achieve the same slowdown of jobs from different users due to resource sharing and placement constraints, regardless of performance variation. Evaluation results show that Eunomia is able to deliver better share fairness compared with state-of-art schedulers without performance loss.

The number of mental health hospital beds in the United States began to decrease dramatically in the mid-20th century, and, since that time, jails and prisons have seen individuals with serious mental illness comprise a significant share of their population. In the region surrounding Charlottesville, VA, these individuals often rely on community service boards for mental health treatment after their release from correctional custody, but limited cross-agency coordination makes receiving this assistance and treatment difficult. To better serve the incarcerated population with serious mental illness and reduce the social and economic burden of re-incarceration, data spanning a 30-month period from July 2015 to December 2017 were obtained through research partnerships with criminal justice agencies and community service boards in the Charlottesville area to track the behavior of individuals with mental illness through every stage of the system. A cohort of individuals with identified serious mental illness from jail data was matched across data from different agencies, and the resulting merged, de-identified data regarding behavior and criminal justice outcomes were analyzed to improve understanding of this system and its service to the population with serious mental illness. 5,584 unique individuals were identified in Albemarle-Charlottesville Regional Jail (ACRJ) booking data, 3,531 were screened for serious mental illness, giving a 63% screening rate, and 1,129 of those screened met the criteria to be referred for serious mental illness, leading to a 32% referral rate of the screened population. Referred individuals were more likely than those not referred or not screened to receive treatment at Region Ten, the local community services provider. Referred individuals were also less likely than those not referred to successfully complete Offender Aid and Restoration probation. These insights help agencies and community stakeholders improve practice in the management of this population.

The original version of this article unfortunately contained a mistake. The name of Matthew Gerber was incorrectly spelled as Mathew Gerber. The correct spelling is now presented correctly in this correction article.

This chapter focuses on the Boston Ideal Opera Company, a comic opera troupe. Its founder, Effie Hinckley Ober, was not a performer, but a businesswoman who owned one of the first musical management firms in the country. Her success in a male-dominated business provides valuable insight into how an ambitious and enterprising woman could navigate a distinctly competitive, virile world in the post-Civil War American social landscape. This chapter covers the Boston Ideals only during the Ober period (1879–1885) and illustrates techniques of management, a hitherto unknown relationship between opera production and the emergence of lyceum bureaus, and performance practice. The company mounted both operettas (Gilbert and Sullivan) and some of the standard works that had been performed by English-language troupes for decades; after Ober’s retirement it continued until 1904 under a new name (the Bostonians) and new management.