Method for computing variances of estimates derived from the Health Interview Survey

A method for computing variances of estimates derived from the health interview survey[by Judy A. Bean].Public Health Service publication no. 1000, ser. 2, no. 38.Includes bibliographical references.1970500686

Cholesterol Levels and Activity of Membrane Bound Proteins: Characterization by Thermal and Electrochemical Methods

The long-term goal of this investigation is to study the effects of increased cholesterol levels on the molecular activity of membrane-bound enzymes such as nitric oxide synthase, that are critical in the functioning of the cardiovascular system. In this particular investigation, we used differential scanning calorimetry (DSC) and dielectric thermal analysis (DETA) to study the effect of added cholesterol on melting/recrystallization and dielectric behavior, respectively, of phosphatidylcholine (PC) bilayered thin films. We also used electrochemical methods to investigate the effect of added cholesterol on the redox behavior of the oxygenase domain of nitric oxide synthase as a probe embedded in the PC films. The results show that added cholesterol in the PC films seems to depress the molecular dynamics as indicated by lowered current responses in the presence of cholesterol as well as a slight increase of the transition temperature in the overall two-phase regime behavior observed in PC–cholesterol films. These results are rationalized in the context of the general DSC and DETA behaviors of the PC–chol films

Epidemiological study of gastroenteritis cases at the medical-social centre of Megara

Pnrpose: Epidemiological study of the possible causes and characteristics of gastroenteritis cases, recorded at the area of concern of the medical- social centre of Megara. Material- Method: The material of the study consisted of adults who came to the centre during the period January 2007 until December 2008 and were diagnosed with gastroenteritis. All patients with chronic inflamational bowel disease as well as patients having taken recently antibiotics were excluded. All patients came with symptoms of gastroenteritis i.e. vomits, diarrhea, abdominal pain, fever, debilitation

Exploring directional and fluctuating asymmetry in the human palate during growth

open24siObjectives: Palate morphology is constantly changing throughout an individual's lifespan, yet its asymmetry during growth is still little understood. In this research, we focus on the study of palate morphology by using 3D geometric morphometric approaches to observe changes at different stages of life, and to quantify the impact of directional and fluctuating asymmetry on different areas at different growth stages. Materials and Methods: The sample consists of 183 individuals (1–72 years) from two identified human skeletal collections of 19th and early 20th Century Italian contexts. A 3D-template of 41 (semi)landmarks was applied on digital palate models to observe morphological variation during growth. Results: Asymmetrical components of the morphological structure appears multidirectional on the entire palate surface in individuals <2 years old and become oriented (opposite bilateral direction) between 2 and 6 years of age. Specifically, directional asymmetry differentially impacts palate morphology at different stages of growth. Both the anterior and posterior palate are affected by mild alterations in the first year of life, while between 2 and 6 years asymmetry is segregated in the anterior area, and moderate asymmetry affects the entire palatal surface up to 12 years of age. Our results show that stability of the masticatory system seems to be reached around 13–35 years first by females and then males. From 36 years on both sexes show similar asymmetry on the anterior area. Regarding fluctuating asymmetry, inter-individual variability is mostly visible up to 12 years of age, after which only directional trends can be clearly observed at a group level. Discussion: Morphological structure appears instable during the first year of life and acquires an opposite asymmetric bilateral direction between 2 and 6 years of age. This condition has been also documented in adults; when paired with vertical alteration, anterior/posterior asymmetry seems to characterize palate morphology, which is probably due to mechanical factors during the lifespan. Fluctuating asymmetry is predominant in the first period of life due to a plausible relationship with the strength of morphological instability of the masticatory system. Directional asymmetry, on the other hand, shows that the patterning of group-level morphological change might be explained as a functional response to differential inputs (physiological forces, nutritive and non-nutritive habits, para-masticatory activity as well as the development of speech) in different growth stages. This research has implications with respect to medical and evolutionary fields. In medicine, palate morphology should be considered when planning orthodontic and surgical procedures as it could affect the outcome. As far as an evolutionary perspective is concerned the dominance of directional asymmetries in the masticatory system could provide information on dietary and cultural habits as well as pathological conditions in our ancestors.embargoed_20220511Oxilia G.; Menghi Sartorio J.C.; Bortolini E.; Zampirolo G.; Papini A.; Boggioni M.; Martini S.; Marciani F.; Arrighi S.; Figus C.; Marciani G.; Romandini M.; Silvestrini S.; Pedrosi M.E.; Mori T.; Riga A.; Kullmer O.; Sarig R.; Fiorenza L.; Giganti M.; Sorrentino R.; Belcastro M.G.; Cecchi J.M.; Benazzi S.Oxilia G.; Menghi Sartorio J.C.; Bortolini E.; Zampirolo G.; Papini A.; Boggioni M.; Martini S.; Marciani F.; Arrighi S.; Figus C.; Marciani G.; Romandini M.; Silvestrini S.; Pedrosi M.E.; Mori T.; Riga A.; Kullmer O.; Sarig R.; Fiorenza L.; Giganti M.; Sorrentino R.; Belcastro M.G.; Cecchi J.M.; Benazzi S

English secondary students’ thinking about the status of scientific theories: consistent, comprehensive, coherent and extensively evidenced explanations of aspects of the natural world – or just ‘an idea someone has’

Teaching about the nature of science (NOS) is seen as a priority for science education in many national contexts. The present paper focuses on one central issue in learning about NOS: understanding the nature and status of scientific theories. A key challenge in teaching about NOS is to persuade students that scientific knowledge is generally robust and reliable, yet also in principle always open to challenge and modification. Theories play a central role, as they are a form of conjectural knowledge that over time may be abandoned, replaced, modified, yet sometimes become well established as current best scientific understanding. The present paper reports on findings from interviews with 13–14 year olds in England where target knowledge presents theories as ‘consistent, comprehensive, coherent and extensively evidenced explanations of aspects of the natural world’. Student thinking reflected a two-tier typology of scientific knowledge in which largely unsupported imaginative ideas (‘theories’) became transformed into fairly definitive knowledge (such as laws) through relatively straightforward testing. These results are considered in relation to research into intellectual development which indicates that effective teaching in this area requires careful scaffolding of student learning, but has potential to contribute to supporting intellectual development across the curriculum.This is the author accepted manuscript. The final version is available from Taylor & Francis via http://dx.doi.org/10.1080/09585176.2015.104392

A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study

[EN] Performance evaluation is relevant for supporting managerial decisions related to the improvement of public emergency departments (EDs). As different criteria from ED context and several alternatives need to be considered, selecting a suitable Multicriteria Decision-Making (MCDM) approach has become a crucial step for ED performance evaluation. Although some methodologies have been proposed to address this challenge, a more complete approach is still lacking. This paper bridges this gap by integrating three potent MCDM methods. First, the Fuzzy Analytic Hierarchy Process (FAHP) is used to determine the criteria and sub-criteria weights under uncertainty, followed by the interdependence evaluation via fuzzy Decision-Making Trial and Evaluation Laboratory(FDEMATEL). The fuzzy logic is merged with AHP and DEMATEL to illustrate vague judgments. Finally, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) is used for ranking EDs. This approach is validated in a real 3-ED cluster. The results revealed the critical role of Infrastructure (21.5%) in ED performance and the interactive nature of Patient safety (C+R =12.771). Furthermore, this paper evidences the weaknesses to be tackled for upgrading the performance of each ED.Ortiz-Barrios, M.; Alfaro Saiz, JJ. (2020). A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study. International Journal of Information Technology & Decision Making. 19(6):1485-1548. https://doi.org/10.1142/S0219622020500364S14851548196Lord, K., Parwani, V., Ulrich, A., Finn, E. B., Rothenberg, C., Emerson, B., … Venkatesh, A. K. (2018). Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. The American Journal of Emergency Medicine, 36(7), 1246-1248. doi:10.1016/j.ajem.2018.03.043Sørup, C. M., Jacobsen, P., & Forberg, J. L. (2013). 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Performance Management in Healthcare. doi:10.4324/9781315102214Santos, S. P., Belton, V., Howick, S., & Pilkington, M. (2018). Measuring organisational performance using a mix of OR methods. Technological Forecasting and Social Change, 131, 18-30. doi:10.1016/j.techfore.2017.07.028Ho, W., & Ma, X. (2018). The state-of-the-art integrations and applications of the analytic hierarchy process. European Journal of Operational Research, 267(2), 399-414. doi:10.1016/j.ejor.2017.09.007Dargi, A., Anjomshoae, A., Galankashi, M. R., Memari, A., & Tap, M. B. M. (2014). Supplier Selection: A Fuzzy-ANP Approach. Procedia Computer Science, 31, 691-700. doi:10.1016/j.procs.2014.05.317Jing, M., Jie, Y., Shou-yi, L., & Lu, W. (2015). Application of fuzzy analytic hierarchy process in the risk assessment of dangerous small-sized reservoirs. International Journal of Machine Learning and Cybernetics, 9(1), 113-123. doi:10.1007/s13042-015-0363-4Samanlioglu, F., Taskaya, Y. E., Gulen, U. C., & Cokcan, O. (2018). A Fuzzy AHP–TOPSIS-Based Group Decision-Making Approach to IT Personnel Selection. International Journal of Fuzzy Systems, 20(5), 1576-1591. doi:10.1007/s40815-018-0474-7CHEN, M.-F., TZENG, G.-H., & TANG, T.-I. (2005). FUZZY MCDM APPROACH FOR EVALUATION OF EXPATRIATE ASSIGNMENTS. International Journal of Information Technology & Decision Making, 04(02), 277-296. doi:10.1142/s0219622005001520Gul, M., Celik, E., Gumus, A. T., & Guneri, A. F. (2016). Emergency department performance evaluation by an integrated simulation and interval type-2 fuzzy MCDM-based scenario analysis. European J. of Industrial Engineering, 10(2), 196. doi:10.1504/ejie.2016.075846Jovčić, Průša, Dobrodolac, & Švadlenka. (2019). A Proposal for a Decision-Making Tool in Third-Party Logistics (3PL) Provider Selection Based on Multi-Criteria Analysis and the Fuzzy Approach. Sustainability, 11(15), 4236. doi:10.3390/su11154236Saaty, T. L., & Vargas, L. G. (2012). Models, Methods, Concepts & Applications of the Analytic Hierarchy Process. International Series in Operations Research & Management Science. doi:10.1007/978-1-4614-3597-6Vargas, L. G. (2016). Voting with Intensity of Preferences. International Journal of Information Technology & Decision Making, 15(04), 839-859. doi:10.1142/s0219622016400058Lee, K.-C., Tsai, W.-H., Yang, C.-H., & Lin, Y.-Z. (2018). An MCDM approach for selecting green aviation fleet program management strategies under multi-resource limitations. Journal of Air Transport Management, 68, 76-85. doi:10.1016/j.jairtraman.2017.06.011Labib, A., & Read, M. (2015). A hybrid model for learning from failures: The Hurricane Katrina disaster. Expert Systems with Applications, 42(21), 7869-7881. doi:10.1016/j.eswa.2015.06.020Hosseini, S., & Khaled, A. A. (2016). A hybrid ensemble and AHP approach for resilient supplier selection. Journal of Intelligent Manufacturing, 30(1), 207-228. doi:10.1007/s10845-016-1241-yZavadskas, E. K., Govindan, K., Antucheviciene, J., & Turskis, Z. (2016). Hybrid multiple criteria decision-making methods: a review of applications for sustainability issues. Economic Research-Ekonomska Istraživanja, 29(1), 857-887. doi:10.1080/1331677x.2016.1237302Lolli, F., Balugani, E., Ishizaka, A., Gamberini, R., Butturi, M. A., Marinello, S., & Rimini, B. (2019). On the elicitation of criteria weights in PROMETHEE-based ranking methods for a mobile application. Expert Systems with Applications, 120, 217-227. doi:10.1016/j.eswa.2018.11.030De Almeida Filho, A. T., Clemente, T. R. N., Morais, D. C., & de Almeida, A. T. (2018). Preference modeling experiments with surrogate weighting procedures for the PROMETHEE method. European Journal of Operational Research, 264(2), 453-461. doi:10.1016/j.ejor.2017.08.006Sun, G., Guan, X., Yi, X., & Zhou, Z. (2018). An innovative TOPSIS approach based on hesitant fuzzy correlation coefficient and its applications. Applied Soft Computing, 68, 249-267. doi:10.1016/j.asoc.2018.04.004Frazão, T. D. C., Camilo, D. G. G., Cabral, E. L. S., & Souza, R. P. (2018). Multicriteria decision analysis (MCDA) in health care: a systematic review of the main characteristics and methodological steps. BMC Medical Informatics and Decision Making, 18(1). doi:10.1186/s12911-018-0663-1Ortiz-Barrios, M. A., Herrera-Fontalvo, Z., Rúa-Muñoz, J., Ojeda-Gutiérrez, S., De Felice, F., & Petrillo, A. (2018). An integrated approach to evaluate the risk of adverse events in hospital sector. Management Decision, 56(10), 2187-2224. doi:10.1108/md-09-2017-0917Al Salem, A. A., & Awasthi, A. (2018). Investigating rank reversal in reciprocal fuzzy preference relation based on additive consistency: Causes and solutions. Computers & Industrial Engineering, 115, 573-581. doi:10.1016/j.cie.2017.11.027Aires, R. F. de F., & Ferreira, L. (2019). A new approach to avoid rank reversal cases in the TOPSIS method. Computers & Industrial Engineering, 132, 84-97. doi:10.1016/j.cie.2019.04.023Emrouznejad, A., & Yang, G. (2018). A survey and analysis of the first 40 years of scholarly literature in DEA: 1978–2016. Socio-Economic Planning Sciences, 61, 4-8. doi:10.1016/j.seps.2017.01.008Arya, A., & Yadav, S. P. (2017). Development of FDEA Models to Measure the Performance Efficiencies of DMUs. International Journal of Fuzzy Systems, 20(1), 163-173. doi:10.1007/s40815-017-0325-yMufazzal, S., & Muzakkir, S. M. (2018). A new multi-criterion decision making (MCDM) method based on proximity indexed value for minimizing rank reversals. Computers & Industrial Engineering, 119, 427-438. doi:10.1016/j.cie.2018.03.045Kaliszewski, I., & Podkopaev, D. (2016). Simple additive weighting—A metamodel for multiple criteria decision analysis methods. Expert Systems with Applications, 54, 155-161. doi:10.1016/j.eswa.2016.01.042Mousavi-Nasab, S. H., & Sotoudeh-Anvari, A. (2018). A new multi-criteria decision making approach for sustainable material selection problem: A critical study on rank reversal problem. Journal of Cleaner Production, 182, 466-484. doi:10.1016/j.jclepro.2018.02.062Chen, Z., Ming, X., Zhang, X., Yin, D., & Sun, Z. (2019). A rough-fuzzy DEMATEL-ANP method for evaluating sustainable value requirement of product service system. Journal of Cleaner Production, 228, 485-508. doi:10.1016/j.jclepro.2019.04.145Jumaah, F. M., Zadain, A. A., Zaidan, B. B., Hamzah, A. K., & Bahbibi, R. (2018). Decision-making solution based multi-measurement design parameter for optimization of GPS receiver tracking channels in static and dynamic real-time positioning multipath environment. Measurement, 118, 83-95. doi:10.1016/j.measurement.2018.01.011Singh, A., & Prasher, A. (2017). Measuring healthcare service quality from patients’ perspective: using Fuzzy AHP application. Total Quality Management & Business Excellence, 30(3-4), 284-300. doi:10.1080/14783363.2017.1302794Otay, İ., Oztaysi, B., Cevik Onar, S., & Kahraman, C. (2017). Multi-expert performance evaluation of healthcare institutions using an integrated intuitionistic fuzzy AHP&DEA methodology. Knowledge-Based Systems, 133, 90-106. doi:10.1016/j.knosys.2017.06.028Awasthi, A., Govindan, K., & Gold, S. (2018). Multi-tier sustainable global supplier selection using a fuzzy AHP-VIKOR based approach. International Journal of Production Economics, 195, 106-117. doi:10.1016/j.ijpe.2017.10.013Gul, M., Guneri, A. F., & Nasirli, S. M. (2018). A fuzzy-based model for risk assessment of routes in oil transportation. International Journal of Environmental Science and Technology, 16(8), 4671-4686. doi:10.1007/s13762-018-2078-zKazancoglu, Y., Kazancoglu, I., & Sagnak, M. (2018). Fuzzy DEMATEL-based green supply chain management performance. Industrial Management & Data Systems, 118(2), 412-431. doi:10.1108/imds-03-2017-0121Abdullah, L., & Zulkifli, N. (2015). Integration of fuzzy AHP and interval type-2 fuzzy DEMATEL: An application to human resource management. Expert Systems with Applications, 42(9), 4397-4409. doi:10.1016/j.eswa.2015.01.021Ashtiani, M., & Azgomi, M. A. (2016). A hesitant fuzzy model of computational trust considering hesitancy, vagueness and uncertainty. Applied Soft Computing, 42, 18-37. doi:10.1016/j.asoc.2016.01.023Zyoud, S. H., & Fuchs-Hanusch, D. (2017). A bibliometric-based survey on AHP and TOPSIS techniques. Expert Systems with Applications, 78, 158-181. doi:10.1016/j.eswa.2017.02.016Scholz, S., Ngoli, B., & Flessa, S. (2015). Rapid assessment of infrastructure of primary health care facilities – a relevant instrument for health care systems management. BMC Health Services Research, 15(1). doi:10.1186/s12913-015-0838-8Ivlev, I., Vacek, J., & Kneppo, P. (2015). Multi-criteria decision analysis for supporting the selection of medical devices under uncertainty. European Journal of Operational Research, 247(1), 216-228. doi:10.1016/j.ejor.2015.05.075Kovacs, E., Strobl, R., Phillips, A., Stephan, A.-J., Müller, M., Gensichen, J., & Grill, E. (2018). Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care. Journal of General Internal Medicine, 33(7), 1142-1154. doi:10.1007/s11606-018-4435-5Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLOS ONE, 13(8), e0203316. doi:10.1371/journal.pone.0203316Hermann, R. M., Long, E., & Trotta, R. L. (2019). Improving Patients’ Experiences Communicating With Nurses and Providers in the Emergency Department. Journal of Emergency Nursing, 45(5), 523-530. doi:10.1016/j.jen.2018.12.001Hawley, K. L., Mazer-Amirshahi, M., Zocchi, M. S., Fox, E. R., & Pines, J. M. (2015). Longitudinal Trends in U.S. Drug Shortages for Medications Used in Emergency Departments (2001-2014). Academic Emergency Medicine, 23(1), 63-69. doi:10.1111/acem.12838Stang, A. S., Crotts, J., Johnson, D. W., Hartling, L., & Guttmann, A. (2015). Crowding Measures Associated With the Quality of Emergency Department Care: A Systematic Review. Academic Emergency Medicine, 22(6), 643-656. doi:10.1111/acem.12682Chanamool, N., & Naenna, T. (2016). Fuzzy FMEA application to improve decision-making process in an emergency department. Applied Soft Computing, 43, 441-453. doi:10.1016/j.asoc.2016.01.007Farup, P. G. (2015). Are measurements of patient safety culture and adverse events valid and reliable? Results from a cross sectional study. BMC Health Services Research, 15(1). doi:10.1186/s12913-015-0852-xCarter, E. J., Pouch, S. M., & Larson, E. L. (2013). The Relationship Between Emergency Department Crowding and Patient Outcomes: A Systematic Review. Journal of Nursing Scholarship, 46(2), 106-115. doi:10.1111/jnu.12055Ebben, R. H. A., Siqeca, F., Madsen, U. R., Vloet, L. C. M., & van Achterberg, T. (2018). Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review. BMJ Open, 8(11), e017572. doi:10.1136/bmjopen-2017-017572Innes, G. D., Sivilotti, M. L. A., Ovens, H., McLelland, K., Dukelow, A., Kwok, E., … Chochinov, A. (2018). Emergency overcrowding and access block: A smaller problem than we think. CJEM, 21(2), 177-185. doi:10.1017/cem.2018.446Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2014). Overcrowding in emergency department: an international issue. Internal and Emergency Medicine, 10(2), 171-175. doi:10.1007/s11739-014-1154-8Uthman, O. 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Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

Abstract Background This study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena. Methods Primary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg. Results A total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p Conclusions In primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH

A general scenario of Hox gene inventory variation among major sarcopterygian lineages

<p>Abstract</p> <p>Background</p> <p><it>H</it>ox genes are known to play a key role in shaping the body plan of metazoans. Evolutionary dynamics of these genes is therefore essential in explaining patterns of evolutionary diversity. Among extant sarcopterygians comprising both lobe-finned fishes and tetrapods, our knowledge of the <it>Hox </it>genes and clusters has largely been restricted in several model organisms such as frogs, birds and mammals. Some evolutionary gaps still exist, especially for those groups with derived body morphology or occupying key positions on the tree of life, hindering our understanding of how <it>Hox </it>gene inventory varied along the sarcopterygian lineage.</p> <p>Results</p> <p>We determined the <it>Hox </it>gene inventory for six sarcopterygian groups: lungfishes, caecilians, salamanders, snakes, turtles and crocodiles by comprehensive PCR survey and genome walking. Variable <it>Hox </it>genes in each of the six sarcopterygian group representatives, compared to the human <it>Hox </it>gene inventory, were further validated for their presence/absence by PCR survey in a number of related species representing a broad evolutionary coverage of the group. Turtles, crocodiles, birds and placental mammals possess the same 39 <it>Hox </it>genes. <it>HoxD12 </it>is absent in snakes, amphibians and probably lungfishes. <it>HoxB13 </it>is lost in frogs and caecilians. Lobe-finned fishes, amphibians and squamate reptiles possess <it>HoxC3</it>. <it>HoxC1 </it>is only present in caecilians and lobe-finned fishes. Similar to coelacanths, lungfishes also possess <it>HoxA14</it>, which is only found in lobe-finned fishes to date. Our <it>Hox </it>gene variation data favor the lungfish-tetrapod, turtle-archosaur and frog-salamander relationships and imply that the loss of <it>HoxD12 </it>is not directly related to digit reduction.</p> <p>Conclusions</p> <p>Our newly determined <it>Hox </it>inventory data provide a more complete scenario for evolutionary dynamics of <it>Hox </it>genes along the sarcopterygian lineage. Limbless, worm-like caecilians and snakes possess similar <it>Hox </it>gene inventories to animals with less derived body morphology, suggesting changes to their body morphology are likely due to other modifications rather than changes to <it>Hox </it>gene numbers. Furthermore, our results provide basis for future sequencing of the entire <it>Hox </it>clusters of these animals.</p