Disparate Representations Research Articles

Crossed by the border: children’s lived experiences with flooding in an urbanized transborder watershed

ABSTRACT This article analyzes the differential effect of the US-Mexico border on the lived experience of children exposed to flooding risk in an urbanized transborder watershed. The central argument is that this geopolitical border is an institution generative of social and spatial processes that create and thrive on differences and expose children on both sides of the border to high but unequal hazard levels. We pose that children’s bifurcated experiences with rain evince the border’s structuring power as a supra institution producing a socio-spatial regime that enables environmental inequities producing disparate representations of place. Understanding children’s lived experiences is critical to reducing their vulnerability in a highly integrated cross-border urbanization. Framed as a case study based on qualitative data obtained through narratives and visual elicitation techniques, the analysis reveals children’s experiences with flooding and associated hazards that have not been exposed in prior border research and have important implications for integrated disaster management, environmental justice, and resilience in border regions and cities.

Bridging 20 Years of Soil Organic Matter Frameworks: Empirical Support, Model Representation, and Next Steps

AbstractIn the past few decades, there has been an evolution in our understanding of soil organic matter (SOM) dynamics from one of inherent biochemical recalcitrance to one deriving from plant‐microbe‐mineral interactions. This shift in understanding has been driven, in part, by influential conceptual frameworks which put forth hypotheses about SOM dynamics. Here, we summarize several focal conceptual frameworks and derive from them six controls related to SOM formation, (de)stabilization, and loss. These include: (a) physical inaccessibility; (b) organo‐mineral and ‐metal stabilization; (c) biodegradability of plant inputs; (d) abiotic environmental factors; (e) biochemical reactivity and diversity; and (f) microbial physiology and morphology. We then review the empirical evidence for these controls, their model representation, and outstanding knowledge gaps. We find relatively strong empirical support and model representation of abiotic environmental factors but disparities between data and models for biochemical reactivity and diversity, organo‐mineral and ‐metal stabilization, and biodegradability of plant inputs, particularly with respect to SOM destabilization for the latter two controls. More empirical research on physical inaccessibility and microbial physiology and morphology is needed to deepen our understanding of these critical SOM controls and improve their model representation. The SOM controls are highly interactive and also present some inconsistencies which may be reconciled by considering methodological limitations or temporal and spatial variation. Future conceptual frameworks must simultaneously refine our understanding of these six SOM controls at various spatial and temporal scales and within a hierarchical structure, while incorporating emerging insights. This will advance our ability to accurately predict SOM dynamics.

Representation of Racial Disparity in Angie Thomas's The Hate U Give

Racism has become the biggest social issue in the world because of its constant unjust treatment that affects people from minority races, ethnicities, and religions. Related to this issue, The Hate U Give conveys the social condition where racial disparity towards black people is profoundly represented in the narrative. This study focuses on identifying the ideational metafunction elements, including transitivity and ergativity patterns found in the narrative. It reveals how the racial disparity is performed by the use of the meta function. Mixed method research was employed to collect and analyze the data to yield more insightful information that complements both methodologies’ findings. The theory of Systemic Functional Grammar was used to identify and classify the ideational metafunction elements from the collected narrative, and the Discourse Analysis approach was applied as a theoretical approach to support the observation. The result concluded that in the analysis of transitivity patterns, material and relational processes dominate the narrative by approximately 25% to 33% of the entire collected narrative. The findings show that racial disparity in analyzing black people that was performed by law enforcement in the collected narrative is manifested in three forms: police brutality, racial profiling, and sentencing policy.

Intersectional fair ranking via subgroup divergence

Societal biases encoded in real-world data can contaminate algorithmic decisions, perpetuating preexisting inequalities in domains such as employment and education. In the fair ranking literature, following the doctrine of affirmative action, fairness is enforced by means of a group-fairness constraint requiring “enough” individuals from protected groups in the top-k positions, for a ranking to be considered valid. However, which are the groups that need to be protected? And how much representation is “enough”? As the biases affecting the process may not always be directly observable nor measurable, these questions might be hard to answer in a principled way, especially when many different potentially discriminated subgroups exist. This paper addresses this issue by automatically identifying the disadvantaged groups in the data and mitigating their disparate representation in the final ranking. Our proposal leverages the notion of divergence to automatically identify which subgroups, defined as combination of sensitive attributes, show a statistically significant deviation, in terms of ranking utility, compared to the overall population. Subgroups with negative divergence experience a disadvantage. We formulate the problem of re-ranking instances to maximize the minimum subgroup divergence, while maintaining the new ranking as close as possible to the original one. We develop a method which is based on identifying the divergent subgroups and applying a re-ranking procedure which is monotonic w.r.t. the goal of maximizing the minimum divergence. Our experimental results show that our method effectively eliminates the existence of disadvantaged subgroups while producing rankings which are very close to the original ones.

Deciphering the chemical language of inbred and wild mouse conspecific scents.

In most mammals, conspecific chemosensory communication relies on semiochemical release within complex bodily secretions and subsequent stimulus detection by the vomeronasal organ (VNO). Urine, a rich source of ethologically relevant chemosignals, conveys detailed information about sex, social hierarchy, health, and reproductive state, which becomes accessible to a conspecific via vomeronasal sampling. So far, however, numerous aspects of social chemosignaling along the vomeronasal pathway remain unclear. Moreover, since virtually all research on vomeronasal physiology is based on secretions derived from inbred laboratory mice, it remains uncertain whether such stimuli provide a true representation of potentially more relevant cues found in the wild. Here, we combine a robust low-noise VNO activity assay with comparative molecular profiling of sex- and strain-specific mouse urine samples from two inbred laboratory strains as well as from wild mice. With comprehensive molecular portraits of these secretions, VNO activity analysis now enables us to (i) assess whether and, if so, how much sex/strain-selective 'raw' chemical information in urine is accessible via vomeronasal sampling; (ii) identify which chemicals exhibit sufficient discriminatory power to signal an animal's sex, strain, or both; (iii) determine the extent to which wild mouse secretions are unique; and (iv) analyze whether vomeronasal response profiles differ between strains. We report both sex- and, in particular, strain-selective VNO representations of chemical information. Within the urinary 'secretome', both volatile compounds and proteins exhibit sufficient discriminative power to provide sex- and strain-specific molecular fingerprints. While total protein amount is substantially enriched in male urine, females secrete a larger variety at overall comparatively low concentrations. Surprisingly, the molecular spectrum of wild mouse urine does not dramatically exceed that of inbred strains. Finally, vomeronasal response profiles differ between C57BL/6 and BALB/c animals, with particularly disparate representations of female semiochemicals.

Deciphering the chemical language of inbred and wild mouse conspecific scents

In most mammals, conspecific chemosensory communication relies on semiochemical release within complex bodily secretions and subsequent stimulus detection by the vomeronasal organ (VNO). Urine, a rich source of ethologically relevant chemosignals, conveys detailed information about sex, social hierarchy, health, and reproductive state, which becomes accessible to a conspecific via vomeronasal sampling. So far, however, numerous aspects of social chemosignaling along the vomeronasal pathway remain unclear. Moreover, since virtually all research on vomeronasal physiology is based on secretions derived from inbred laboratory mice, it remains uncertain whether such stimuli provide a true representation of potentially more relevant cues found in the wild. Here, we combine a robust low-noise VNO activity assay with comparative molecular profiling of sex- and strain-specific mouse urine samples from two inbred laboratory strains as well as from wild mice. With comprehensive molecular portraits of these secretions, VNO activity analysis now enables us to (i) assess whether and, if so, how much sex/strain-selective ‘raw’ chemical information in urine is accessible via vomeronasal sampling; (ii) identify which chemicals exhibit sufficient discriminatory power to signal an animal’s sex, strain, or both; (iii) determine the extent to which wild mouse secretions are unique; and (iv) analyze whether vomeronasal response profiles differ between strains. We report both sex- and, in particular, strain-selective VNO representations of chemical information. Within the urinary ‘secretome’, both volatile compounds and proteins exhibit sufficient discriminative power to provide sex- and strain-specific molecular fingerprints. While total protein amount is substantially enriched in male urine, females secrete a larger variety at overall comparatively low concentrations. Surprisingly, the molecular spectrum of wild mouse urine does not dramatically exceed that of inbred strains. Finally, vomeronasal response profiles differ between C57BL/6 and BALB/c animals, with particularly disparate representations of female semiochemicals.

Gender trends at the annual Spanish Urologic Association (AEU) meeting: A review of AEU programmes over a 10-year period (2012–2022)

IntroductionGender equity in urological meetings is pivotal for fostering diversity and inclusivity in the field. This study aims to evaluate the representation of Spanish urologist and regional disparities, and to assess its alignment with the demographic composition of the urological community. Materials and methodsAll urology meetings organized by the AEU between January 2012 and December 2022 were reviewed, including meeting information and details of the faculty. Additionally, we analysed geographic distribution of speakers across 17 different regions. Gender demographics were obtained disaggregating data by sex and year from the Organización Médica Colegial de España (OMC) and from those urologists affiliated to the AEU. ResultsAnalysing 52 AEU congresses held from 2012 to 2022, encompassing 3,407 speakers, the study found that 95.25% of speakers were from Spain and 89.6% were male speakers. Over the years, there was a positive trend in female speaker representation, increasing by 1.1% annually, slightly lagging the 1.8% annual rise in the number of female urologists in Spain. In specific subfields like functional, transplantation, and oncology sessions, the study revealed a higher representation of women, indicating focused efforts in these areas. Geographically, Madrid, Catalonia and Andalusia exhibited the highest representation. ConclusionsAlthough there was a positive trend towards an increased participation of female urologists in Spanish urological meetings, it fails to accurately reflect the proportional increase in the number of women entering the urology profession in recent years. This study underscores the importance of ongoing efforts to ensure diverse and balanced representation in urological forum.

Digital remix as a pedagogical platform intervention

ABSTRACT An emerging body of scholarship on digital platforms in education has offered critical insights into the influence of platform technologies within traditional school contexts. This study, however, examines platforms’ broader cultural impact on teacher identity and the thinking teachers do around school(ing) writ large (i.e., the ways platforms enable or constrain teachers’ imaginations with regards to teaching, student possibilities, standardization, etc.). Mobilizing digital remix as a platform intervention, the article considers how preservice teachers’ conceptions of the teaching profession were shaped by a course project asking them to navigate and splice together an array of disparate representations of school(ing) on YouTube. The study thus explores how preservice teachers dissected these representations by animating digital remix as a means to initiate dialogue across differences and limn the interstitial spaces between representations through which new lines of thinking might emerge.

The Cost of Being a Woman in Academic Cardiothoracic Surgery: Joint Collaboration of The Society of Thoracic Surgeons Workforces on Diversity, Equity, and Inclusion and Cardiothoracic Surgery Practice Models

BackgroundGender disparity in the cardiothoracic surgery workforce is challenging to enumerate and quantify. The purpose of our work is to use the most current data to quantify the percentage of women in academic cardiothoracic surgery and salary disparity between women and men. MethodsWe performed a cross-sectional analysis of data collected by the Accreditation Council for Graduate Medical Education Data Resource Book 2021 and Association of American Medical Colleges Faculty Data for U.S. Medical School Faculty 2019, 2020, and 2021. We used descriptive analysis of the number of faculty and mean salaries of academic cardiothoracic surgeons according to academic rank and gender. Salary disparity in cardiothoracic surgery was compared with salary disparities seen among surgical specialties and academic clinicians. ResultsOver the past 3 years, women comprised 11.5% of the cardiothoracic workforce. In 2021, cardiothoracic surgeons who were women earned $0.71 to $0.86 for every $1.00 earned by cardiothoracic surgeons who were men. Ascending academic rank correlated with greater gender salary disparity; women professors earned less than men of equal and lower academic rank. From 2019 to 2021, women of the academic ranks of associate professor, professor, and chief of cardiothoracic surgery experienced a decrease in mean salaries, whereas men of equivalent academic ranks experienced an increase in mean salaries. ConclusionsGender disparity in cardiothoracic surgery persists, with low representation of women and salary disparity at every academic rank.

Passivity and exclusion: media power in the construction of the aged-care debate in Australia and Malaysia

ABSTRACT This article explores relationships between media power and older people in Western and non-Western settings, utilising the examples of Australia and Malaysia. Drawing on Fairclough’s three-dimensional critical discourse analysis and a dataset of articles from Australian and Malaysian newspapers, it reveals that despite differences in journalistic practices in the two countries there is a common thread of disparate representation of voices of older people and elites in news about older people. This demonstrates the exercise of power by journalists – and the influence of broader media and socio-political environments – in sustaining and reproducing social inequalities, including opportunities for people to have their stories and issues portrayed fairly and accurately. While the lack of critical engagement by Malaysian journalists can be linked to social norms and ideas of Asian-based development journalism, the absence of critical engagement from the Australian news media can be seen as conflicting with their Fourth Estate watchdog role.

Experiments in history: the voice of Bondi

ABSTRACT How might we distil the meaning of a place amid a myriad of competing representations, perspectives and narratives? In this article, I address this question with a case study of Bondi Beach, Australia. Bondi is a synecdoche for an Australian beach lifestyle, and for urban congestion, dysfunction and the destruction of the natural world. I argue that appeals to historical facts, which are invariably contested, can never reconcile disparate representations into a single truth. All representations are mediated by contextually laden perspectives. Here I explore the issue of representational histories of places by presenting a case study of Bondi Beach. The article comprises two sections. In the first I highlight the problem of competing evidence and representations that emerge from traditional empirical-analytical research into three subjects relevant to Australian beaches including Bondi: Aboriginal custodianship, colonization, and coastal management. In the second section, I propose a biographical/autobiographical form of representation using Bondi’s voice. I advocate Bondi’s voice as an approach to mediating competing representations of place. Bondi’s voice – in the form of a biographical/autobiographical narrative – is not an attempt to produce a single truth but to tell a story from the perspective of a natural environment under siege from destructive human cultures.

Gait analysis using physical examination and digital techniques

Gait examination is an important component of the patient assessment prior to movement therapy. With the advancement of video technology and computer science, digital analysis of gait has become possible. This research aims to physically examine gait and analyze video recordings using dedicated software. A voluntary group of 10 individuals diagnosed with coxarthrosis or gonarthrosis constituted the study group, while the control group comprised 10 individuals without lower limb musculoskeletal disorders. The mean age of the study group was 57 ±4.03 years, and the mean age of the control group was 54.2 ±3.16 years. The research involved conducting physical examinations of gait and recording walking sessions with body markers. The software facilitated the presentation of marker displacements on diagrams in both vertical and horizontal planes. Visual analysis and a two-sample t-test were employed. The physical musculoskeletal examination successfully identified causes of claudication. Significant differences were observed between the two groups across all kinematic gait indicators. The mean stance width in the test group was 17.65 ±3.09 cm, while the control group averaged 8.75 ±1.23 cm (p < 0.001). The walking speed, assessed using a two-sample t-test, also yielded a significant difference (p < 0.001). Key diagrams representing the groups during functional analysis were presented. Visual analysis revealed distinct variations in marker frequency and vertical and horizontal displacements between the groups. The study group exhibited notable deviations in the displacement diagrams on the affected side of the body. The average of the maximum and minimum points on the charts demonstrated a significant difference between the groups in terms of body displacement. The identified differences in gait between the two groups align with the results of the physical examination. The graphical representation of disparities in body displacement between the two halves of the body in the study group indicates the future potential of digital gait analysis for practical applications and monitoring the effectiveness of physiotherapy.

Shifting terminology and confusing representations

In order to gain a better understanding of the debates surrounding language preferences, the shifts in intellectual disability terminology in Dutch newspapers were analysed. Using quantitative and qualitative content analysis, this study examined newspaper articles between 1950 and 2020. The results indicated shifts in intellectual disability terminology in newspapers in the direction of organisations of people with disabilities, scholars’, and the government’s preferred terminology. The use of outmoded terms such as “feebleminded” and “mongol” decreased. However, newspapers continued to use outdated and pejorative terminology and traditional narratives. Intellectual disability terminology, particularly the terms “idiot” and “backward,” is frequently employed in non-disability-related contexts to emphasise negative viewpoints. Consequently, newspaper readers are confronted with a confusing array of terms associated with disparate representations of people with intellectual disabilities, ranging from antiquated and negative to positive and inclusive.

Geographical Analysis of Regional Disparities in Level of Women Education: A Case Study of Hadoti Region, Rajasthan

This paper presents a spatial and temporal analysis of women education in geographical unit of Hadoti region. For the representation of spatial disparities in women education composite quotient index has been calculated at the tehsil level. The findings reveal’s that the level of education among women at tehsil level is highly dispersed despite all the tehsils belong to same geographical unit. Paper shows the importance of regional geography in the women education, every region has uniqueness and, in that line, it requires a target-oriented solution. Conclusively, to achieve the aim of sustainable development in all aspects there is need to have synergy among all stakeholders involved in formulating, implementing and evaluating educational policies.

Dynamics of Hierarchical Task Representations.

Task representations are critical for cognitive control and adaptive behavior. The hierarchical organization of task representations allows humans to maintain goals, integrate information across varying contexts, and select potential responses. In this study we characterized the structure and interactive dynamics of task representations that facilitate cognitive control. Human participants (both males and females) performed a hierarchical task that required them to select a response rule while considering the contingencies from different contextual inputs. By applying time- and frequency-resolved representational similarity analysis to human electroencephalography data, we characterized properties of task representations that are otherwise difficult to observe. We found that participants formed multiple representations of task-relevant contexts and features from the presented stimuli, beyond simple stimulus-response mappings. These disparate representations were hierarchically structured, with higher-order contextual representations dominantly influencing subordinate representations of task features and response rules. Furthermore, this cascade of top-down interactions facilitated faster responses. Our results describe key properties of task representations that support hierarchical cognitive control.SIGNIFICANCE STATEMENT Humans can adjust their actions in response to contingencies imposed by the environment. Although it has long been hypothesized that this ability depends on mental representations of tasks, the neural dynamics of task representations have been difficult to characterize. Our study used electroencephalography data from human participants to demonstrate the neural organization and interactive dynamics of task representations. Our results revealed a top-down, hierarchically organized representational structure that encoded multiple contexts and features from the environment. To support cognitive control, higher-level contextual representations influenced subordinate representations of task-relevant features and potential responses, facilitating response selection in a context-dependent manner. Our results provide direct evidence of organizational properties of task representations, which are cornerstones of cognitive control theories.

The colour-line of journalism

This article argues that Danish journalistic boundary producing practices and principles uphold a representation of racial disparity. Based on critical theories of race and racism in journalism and a boundary work framework, we conduct a discursive analysis of two collective case studies that encompass 56 articles and 23 Facebook posts. Focusing mainly on 1) the construction of knowledge about potential racism, 2) who are positioned as authorities on the topic of racism, and 3) who are missing among the potential actors in the stories, we identify meta-journalistic discourses and the (re)establishment of journalistic principles and practices. We conclude that journalistic norms and practices, for now, withstand the challenges posed by minority media’s call for the recognition of race as structure by applying discursive strategies of firstly rejecting racism as structure and secondly asserting principles and practices of specific kinds of objectivity, utilising, for instance, elite sources.

Merging familiar and new senses to perceive and act in space

Our experience of the world seems to unfold seamlessly in a unitary 3D space. For this to be possible, the brain has to merge many disparate cognitive representations and sensory inputs. How does it do so? I discuss work on two key combination problems: coordinating multiple frames of reference (e.g. egocentric and allocentric), and coordinating multiple sensory signals (e.g. visual and proprioceptive). I focus on two populations whose spatial processing we can observe at a crucial stage of being configured and optimised: children, whose spatial abilities are still developing significantly, and naïve adults learning new spatial skills, such as sensing distance using auditory cues. The work uses a model-based approach to compare participants’ behaviour with the predictions of alternative information processing models. This lets us see when and how—during development, and with experience—the perceptual-cognitive computations underpinning our experiences in space change. I discuss progress on understanding the limits of effective spatial computation for perception and action, and how lessons from the developing spatial cognitive system can inform approaches to augmenting human abilities with new sensory signals provided by technology.

Diverse Deep Neural Networks All Predict Human Inferior Temporal Cortex Well, After Training and Fitting

Deep neural networks (DNNs) trained on object recognition provide the best current models of high-level visual cortex. What remains unclear is how strongly experimental choices, such as network architecture, training, and fitting to brain data, contribute to the observed similarities. Here, we compare a diverse set of nine DNN architectures on their ability to explain the representational geometry of 62 object images in human inferior temporal cortex (hIT), as measured with fMRI. We compare untrained networks to their task-trained counterparts and assess the effect of cross-validated fitting to hIT, by taking a weighted combination of the principal components of features within each layer and, subsequently, a weighted combination of layers. For each combination of training and fitting, we test all models for their correlation with the hIT representational dissimilarity matrix, using independent images and subjects. Trained models outperform untrained models (accounting for 57% more of the explainable variance), suggesting that structured visual features are important for explaining hIT. Model fitting further improves the alignment of DNN and hIT representations (by 124%), suggesting that the relative prevalence of different features in hIT does not readily emerge from the Imagenet object-recognition task used to train the networks. The same models can also explain the disparate representations in primary visual cortex (V1), where stronger weights are given to earlier layers. In each region, all architectures achieved equivalently high performance once trained and fitted. The models' shared properties-deep feedforward hierarchies of spatially restricted nonlinear filters-seem more important than their differences, when modeling human visual representations.

Human primary visual cortex shows larger population receptive fields for binocular disparity-defined stimuli

The visual perception of 3D depth is underpinned by the brain’s ability to combine signals from the left and right eyes to produce a neural representation of binocular disparity for perception and behaviour. Electrophysiological studies of binocular disparity over the past 2 decades have investigated the computational role of neurons in area V1 for binocular combination, while more recent neuroimaging investigations have focused on identifying specific roles for different extrastriate visual areas in depth perception. Here we investigate the population receptive field properties of neural responses to binocular information in striate and extrastriate cortical visual areas using ultra-high field fMRI. We measured BOLD fMRI responses while participants viewed retinotopic mapping stimuli defined by different visual properties: contrast, luminance, motion, correlated and anti-correlated stereoscopic disparity. By fitting each condition with a population receptive field model, we compared quantitatively the size of the population receptive field for disparity-specific stimulation. We found larger population receptive fields for disparity compared with contrast and luminance in area V1, the first stage of binocular combination, which likely reflects the binocular integration zone, an interpretation supported by modelling of the binocular energy model. A similar pattern was found in region LOC, where it may reflect the role of disparity as a cue for 3D shape. These findings provide insight into the binocular receptive field properties underlying processing for human stereoscopic vision.

Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics.

Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments.Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored.Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures.Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.