Outer Banks Tourists' Preferences, Sensitivities, and Environmental Perceptions: A Case Study of Cape Hatteras National Seashore

Tourism is the driving economic force for North Carolina's Outer Banks, attracting millions of visitors every year. However, through the combined effects of increased human activity and development, storms, sea level rise, and climate change, portions of the island chain are disappearing. This study seeks to better understand why visitors choose the Outer Banks, how aware and concerned they are about environmental changes occurring there, and how that may affect their beach destination choice in the future. To address these questions, a survey of 137 visitors at Cape Hatteras National Seashore was undertaken. The relative sensitivity to seven environmental variables is considered and differences in perception among local and non-local beachgoers are compared. Analyses of scores and responses to survey questions show that scenery and uncrowded beaches are the primary reasons for choosing the Outer Banks, followed closely by location and accessibility. Visitors appear to be generally conscious of the changing environment there, with a majority of respondents saying they were aware of environmental changes at the Outer Banks prior to being surveyed. However, only half of respondents indicate experiencing effects from these changes during their visit. As such, respondents expressed environmental changes as having little to no effect on their decision to return, with over 95% claiming they will still recommend the Outer Banks and revisit in the future. For many, the fact that the Outer Banks remains relatively undeveloped compared to other East Coast beaches constitutes enough reason to return in spite of other changes

Tight junctions: a barrier to the initiation and progression of breast cancer?

Breast cancer is a complex and heterogeneous disease that arises from epithelial cells lining the breast ducts and lobules. Correct adhesion between adjacent epithelial cells is important in determining the normal structure and function of epithelial tissues, and there is accumulating evidence that dysregulated cell-cell adhesion is associated with many cancers. This review will focus on one cell-cell adhesion complex, the tight junction (TJ), and summarize recent evidence that TJs may participate in breast cancer development or progression. We will first outline the protein composition of TJs and discuss the functions of the TJ complex. Secondly we will examine how alterations in these functions might facilitate breast cancer initiation or progression; by focussing on the regulatory influence of TJs on cell polarity, cell fate and cell migration. Finally we will outline how pharmacological targeting of TJ proteins may be useful in limiting breast cancer progression. Overall we hope to illustrate that the relationship between TJ alterations and breast cancer is a complex one; but that this area offers promise in uncovering fundamental mechanisms linked to breast cancer progression

LINVIEW: Incremental View Maintenance for Complex Analytical Queries

Many analytics tasks and machine learning problems can be naturally expressed by iterative linear algebra programs. In this paper, we study the incremental view maintenance problem for such complex analytical queries. We develop a framework, called LINVIEW, for capturing deltas of linear algebra programs and understanding their computational cost. Linear algebra operations tend to cause an avalanche effect where even very local changes to the input matrices spread out and infect all of the intermediate results and the final view, causing incremental view maintenance to lose its performance benefit over re-evaluation. We develop techniques based on matrix factorizations to contain such epidemics of change. As a consequence, our techniques make incremental view maintenance of linear algebra practical and usually substantially cheaper than re-evaluation. We show, both analytically and experimentally, the usefulness of these techniques when applied to standard analytics tasks. Our evaluation demonstrates the efficiency of LINVIEW in generating parallel incremental programs that outperform re-evaluation techniques by more than an order of magnitude.Comment: 14 pages, SIGMO

Mirizzi syndrome associated with hepatic artery pseudoaneurysm: a case report.

INTRODUCTION: This is the first case report of Mirizzi syndrome associated with hepatic artery pseudoaneurysm. CASE PRESENTATION: A 54-year-old man presented with painful obstructive jaundice and weight loss. Computed tomography showed a hilar mass in the liver. Following an episode of haemobilia, angiography demonstrated a pseudoaneurysm of a branch of the right hepatic artery that was embolised. At surgery, a gallstone causing Mirizzi type II syndrome was found to be responsible for the biliary obstruction and a necrotic inflammatory mass and haematoma were found to be extending into the liver. The mass was debrided and drained, the obstructing stones removed and the bile duct drained with a t-tube. The patient made a full recovery. CONCLUSION: This case highlights another situation where there may be difficulty in differentiating Mirizzi syndrome from biliary tract cancer.Published versio

Which primary care practitioners have poor human papillomavirus (HPV) knowledge? A step towards informing the development of professional education initiatives

Background: Primary care practitioners (PCP) play key roles in cervical cancer prevention. Human papillomavirus (HPV) knowledge is an important influence on PCPs’ cervical cancer prevention-related behaviours. We investigated HPV knowledge, and associated factors, among general practitioners (GPs) and practice nurses. Methods: A survey, including factual questions about HPV infection and vaccination, was mailed to GPs and practice nurses in Ireland. Multivariable logistic regression was used to determine which PCPs had low knowledge (questions correctly answered: infection ≤5/11; vaccination: ≤4/10). Questions least often answered correctly were identified. Results: 697 PCPs participated. For HPV infection, GPs and practice nurses answered a median of nine and seven questions correctly, respectively (p⅓ of PCPs. Conclusions: There are important limitations in HPV infection and vaccination knowledge among PCPs. By identifying factors associated with poor knowledge, and areas of particular uncertainty, these results can inform development of professional education initiatives thereby ensuring women have access to uniformly high-quality HPV-related information and advice

Breast cancer cell migration is regulated through junctional adhesion molecule-A-mediated activation of Rap1 GTPase

ABSTRACT: INTRODUCTION: The adhesion protein junctional adhesion molecule-A (JAM-A) regulates epithelial cell morphology and migration, and its over-expression has recently been linked with increased risk of metastasis in breast cancer patients. As cell migration is an early requirement for tumor metastasis, we sought to identify the JAM-A signalling events regulating migration in breast cancer cells. METHODS: MCF7 breast cancer cells (which express high endogenous levels of JAM-A) and primary cultures from breast cancer patients were used for this study. JAM-A was knocked down in MCF7 cells using siRNA to determine the consequences for cell adhesion, cell migration and the protein expression of various integrin subunits. As we had previously demonstrated a link between the expression of JAM-A and β1-integrin, we examined activation of the β1-integrin regulator Rap1 GTPase in response to JAM-A knockdown or functional antagonism. To test whether JAM-A, Rap1 and β1-integrin lie in a linear pathway, we tested functional inhibitors of all three proteins separately or together in migration assays. Finally we performed immunoprecipitations in MCF7 cells and primary breast cells to determine the binding partners connecting JAM-A to Rap1 activation. RESULTS: JAM-A knockdown in MCF7 breast cancer cells reduced adhesion to, and migration through, the β1-integrin substrate fibronectin. This was accompanied by reduced protein expression of β1-integrin and its binding partners αV- and α5-integrin. Rap1 activity was reduced in response to JAM-A knockdown or inhibition, and pharmacological inhibition of Rap1 reduced MCF7 cell migration. No additive anti-migratory effect was observed in response to simultaneous inhibition of JAM-A, Rap1 and β1-integrin, suggesting that they lie in a linear migratory pathway. Finally, in an attempt to elucidate the binding partners putatively linking JAM-A to Rap1 activation, we have demonstrated the formation of a complex between JAM-A, AF-6 and the Rap1 activator PDZ-GEF2 in MCF7 cells and in primary cultures from breast cancer patients. CONCLUSIONS: Our findings provide compelling evidence of a novel role for JAM-A in driving breast cancer cell migration via activation of Rap1 GTPase and β1-integrin. We speculate that JAM-A over-expression in some breast cancer patients may represent a novel therapeutic target to reduce the likelihood of metastasis

Video tools in pediatric goals of care communication: A systematic review

Medical advancesmean a growing array of interventions, therapies, and technologies are available to support care for children with chronic and serious conditions. Some of these approaches are supported by robust data drawn from populations that perfectly reflect an individual patient\u27s physiologic, psychologic, and social situation. But much more often, clinicians and families face decisions in the context of some—or much—uncertainty about whether the intervention will do a child more harm than good. This is particularly true for seriously ill children with a limited lifespan— whether the child is a neonate born with a life-threatening brain anomaly or an adolescent with cancer. Because there is no clear right decision in these circumstances, clinical teams review potential benefits and burdens and prioritize the care goals and expectations held by the child\u27s family [1]. Communication about these aspects of care are often referred to as Goals of Care”. This patient- and family-centered approach identifies valued care, avoids unwanted interventions, and fosters holistic family support [2]. In their 2019 paper, Secunda, et al. offer an operational definition of Goals of Care: “…the overarching aims of medical care for a patient that are informed by patients’ underlying values and priorities, established within the existing clinical context, and used to guide decisions about the use of or limitation on specificmedical interventions” [2]. It is fundamental to shared decision-making and relies on bidirectional communication, particularly since care goals are usually discussed in the setting of clinical conflict, poor prognosis, or treatment limitations [3]. Yet while the Goals of Care terminology is often a vernacular phrase for clinical teams, it is, in fact, jargon that can be ambiguous in conversations with families [4]. A clinician\u27s request to discuss Goals of Care may signal unfamiliar, confusing, intimidating, or emotionally laden conversational domains to families. Additional ambiguity arises from the fact that Goals of Care conversations often occur in the context of a changing prognosis and a background of baseline uncertainty. This gap in understanding and communication undermines family support. Families processing their own hopes and goals for a child find a sense of solidarity and support from hearing about the experiences of other families facing similar situations [5-7]. Several studies have identified the value of video modality as a source for Goals of Care education, including readying viewers for discussion, enhancing emotional awareness, and processing information in a safe space [8-11]. Given the emotion-laden nature of Goals of Care conversations, videos have been recognized as helpful preparation for families [12]. Thoughtfully produced video content offers viewers access to insight, emotion, and knowledge in an almost experiential way. This may be particularly important to families of children with serious illness who often feel isolated from other families experiencing similar challenges [13]

Privacy by Design: From Technologies to Architectures (Position Paper)

Existing work on privacy by design mostly focus on technologies rather than methodologies and on components rather than architectures. In this paper, we advocate the idea that privacy by design should also be addressed at the architectural level and be associated with suitable methodologies. Among other benefits, architectural descriptions enable a more systematic exploration of the design space. In addition, because privacy is intrinsically a complex notion that can be in tension with other requirements, we believe that formal methods should play a key role in this area. After presenting our position, we provide some hints on how our approach can turn into practice based on ongoing work on a privacy by design environment

Contextual Influences on Phonetic Categorization in School-Aged Children

Perceptual stability in adult listeners is supported by the ability to process acoustic-phonetic variation categorically and dynamically adjust category boundaries given systematic contextual influences. The current study examined the developmental trajectory of such flexibility. Adults and school-aged children (5–10 years of age) made voicing identification decisions to voice-onset-time (VOT) continua that differed in speaking rate and place of articulation. The results showed that both populations were sensitive to contextual influences; the voicing boundary was located at a longer VOT for the slow compared to the fast speaking rate continuum and for the velar compared to the labial continuum, and the magnitude of the displacement was slighter greater for the adults compared to the children. Moreover, the two populations differed in terms of the absolute location of the voicing boundaries and the categorization slopes, with slopes becoming more categorical as age increased. These results demonstrate that sensitivity to contextual influences on speech perception emerges early in development, but mature perceptual tuning requires extended experience