Stagnation Of Progress Research Articles

Reasons for stagnation in river transport in Poland at the turn of the 20th and 21st centuries

The aim of the study was to identify the causes of the progressive stagnation in Polish river shipping (Polish inland navigation) since the middle of the 20th century. The methodology used, due to the type of research, was of a complex, eclectic nature. It was based on the analysis of empirical data, desktop research studies, a systemic analysis of relations and cause-and-effect relationships in the sphere of river transportation, and a critical interpretation of the goals contained in program documents on the development of river shipping. The studies focused on the macroeconomic level. The results obtained not only identified the causes of stagnation, but also indicated the most urgent directions for research in this area. Their implementation may allow to design such a strategy for the development of river shipping in Poland, thanks to which it will become an important part of the economy and sustainable transport. The research is original and unknown in this form in the Polish literature.

Rethinking malaria: Governance lessons from other disease programs.

The global disruptions brought about by the COVID-19 pandemic as well as the stagnation of progress of global malaria elimination efforts have provided an opportunity to rethink several aspects of the global malaria program, including its governance at all levels, from the community to the nation and to the world. Approaching this issue requires an examination of the critical governance factors that affect malaria elimination as well as lessons that could be learned from the governance of other global health programs. The paper, therefore, first reviews malaria program governance challenges at the global, national, and sub-national levels. We then conducted a literature review of governance factors that affected four major global disease elimination programs; (1) the global smallpox eradication program; (2) polio eradication efforts (focus on Latin America); (3) the onchocerciasis eradication program; and (4) global COVID-19 pandemic control efforts. Based on this review, we identified eight comment governance themes that impact disease elimination programs. These include 1) International support and coordination; 2) Financing; 3) Data use for engagement and decision making, 4) Country ownership; 5) National program structure and management, 6) Community support/engagement; 7) Multisectoral engagement; and 8) Technology and innovation The paper then illustrates how these eight governance themes were factored in the four disease control programs, draws lessons and insights about the role of governance from these programs and outlines the implications for governance of malaria elimination efforts. The paper concludes by making recommendations for improving governance of malaria elimination programs and how the analyses of other global disease control programs can provide new ideas and inspiration for a more robust push towards malaria eradication.

Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension.

Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as <140/90 mm Hg, improved from 31.8% in 1999–2000 to 48.5% in 2007–2008, it remained stable through 2013–2014 and declined to 43.7% in 2017–2018. To address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. Also, the group sought to identify opportunities to reverse the adverse trend and further improve hypertension control. The workshop immediately preceded the Surgeon General’s Call to Action to Control Hypertension, which recognized a stagnation in progress with hypertension control. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible “big ideas,” and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities. The broad set of “big ideas” was comprised of various activities that may improve hypertension control, including: interventions to engage patients, promotion of self-measured BP monitoring with clinical support, supporting team-based care, implementing telehealth, enhancing community–clinical linkages, advancing precision population health, developing tailored public health messaging, simplifying hypertension treatment, using process and outcomes quality metrics to foster accountability and efficiency, improving access to high-quality health care, addressing social determinants of health, supporting cardiovascular public health and research, and lowering financial barriers to hypertension control.

An Introduction to the Orthopaedic Diversity Leadership Consortium: Advancement of Our Orthopaedic Leaders of Diversity, Equity, and Inclusion Through Networking, Strategy, and Innovation.

Achievement of diversity, equity, and inclusion (DEI) is an ongoing discussion that has evolved over time in the field of orthopaedic surgery. To enhance and highlight commitments to diversity, many academic department and health organizations have designated individuals to serve as their DEI leader. However, suboptimal structure and support of this specific leadership position have limited its potential and have led to increased position turnover and stagnation in progress. To mitigate these challenges, the Orthopaedic Diversity Leadership Consortium (ODLC) was formed as a growing network of orthopaedic diversity leaders from around the United States as well as international members and industry affiliates. The mission of ODLC is to optimize the sustainability of DEI efforts by providing professional development support and best-practice solutions to leaders serving in this capacity. The efforts of the organization are guided by 3 key objectives: leadership development, design of strategic plan models for diversity, and interprofessional education for perioperative care teams on inclusion. Through this powerful network and its educational offerings, ODLC works to increase role efficacy and to encourage sustainable creation of diverse, equitable, and inclusive environments for our patients, colleagues, and team members.

Trends in the burden of stroke in Mexico: A national and subnational analysis of the global burden of disease 1990–2019

Scarce epidemiological information on stroke in Mexico impedes evidence-based decisions and debilitates the design of effective prevention programmes at the local level. Ecological and secondary analysis of Global Burden of Disease national and subnational data for Mexico, from 1990 to 2019. We analysed the incidence, prevalence, deaths, premature mortality, disability, and DALYs due to cerebrovascular disease included to identify the differences in the burden of stroke in Mexico by type of stroke (ischaemic [IS], intracerebral haemorrhage [ICH] and subarachnoid haemorrhage [SAH]), sex, age groups, and state levels ordered by quartiles of Sociodemographic Index (SDI). Means and 95% uncertainty intervals are reported. Reductions in all metrics of total stroke occurred during the 1990 to 2005 period; however, this declining trend was followed up by stagnation of progress from 2006 to 2019, except for premature mortality. This pattern of the declining trend was observed also for IS and to a lesser extent for ICH, while SAH showed no major changes during the 1990-2019 period. The magnitude of decline was higher in females for total stroke for incidence, prevalence and YLDs rates. The less developed states by SDI exhibited the lowest improvements during the period, particularly for ICH metrics. The reduction in stroke burden in Mexico did not follow the same pace for all types of stroke, with regional differences by SDI and by sex. Study findings reveal the need for strengthening prevention policies to address health disparities in the burden of stroke by sex and states, within the fragmented Mexican Healthcare System. Bill & Melinda Gates Foundation.

The Role of Sustainable HRM in Sustainable Development

Achieving sustainability is becoming a primary agenda for many societies throughout the world. However, we are currently witnessing a surprising stagnation in progress toward this goal. Neoliberal values of individualism, privatization and competitive advantage are proving to be hard to breach. Hence, there is a pressing need for change. Through an extensive literature overview, the present paper identifies existing misconceptions and differences in the comprehension of concepts such as sustainable development, corporate social responsibility and the relationship between strategic human resource management (HRM) and sustainable HRM. It describes and acknowledges the hindrances that sustainable HRM faces in practice, with a particular focus on the predominant schema of strategic HRM and the misconception of corporate social responsibility. The aspiration of the paper is to pose a new model of sustainability by implementing sustainable HRM at the center of sustainable development and corporate accountability. The proposed model is intended as a measurement of the levels of sustainable development in which organizations find themselves and report on, and as a more comprehensive model of sustainable HRM, which has the potential to be applied in practice.

The Implications of Closing Civic Space for Hunger and Poverty in the Global South

AbstractConcerns about closing civic space have focused on human rights, and little to date has been known of the impacts on development. This article traces impacts of closing civic space on civil society and social movements addressing poverty and hunger in Brazil, Ethiopia, Pakistan and Zimbabwe. Countries that clamped down on civil society and social movements have not all fared badly in terms of poverty and hunger, as the ‘developmental states’ of China and Vietnam demonstrate. This article proposes that how closures of civic space affect development outcomes will depend on the role civil society plays in development, and specifically on the ‘fit’ between civil society and the state with respect to development policy and programming. Despite diversity in political and economic context, restrictions on civic space commonly prevent broad civic engagement in policy processes, in particular critique or scrutiny of government policy and practice, and hamper non‐governmental organizations’ service delivery. Because civic engagement matters most for marginalized and disempowered people, their exclusion from policy processes and services will deepen. Reversals or stagnation in progress towards addressing poverty and hunger indicate that as civic space narrows, the most marginalized and disempowered groups face a growing risk of being left behind.

US women in thoracic surgery: reflections on the past and opportunities for the future.

Herein, we examine the state of women in thoracic surgery from the United States (US) perspective in terms of our past, present, and opportunities for the future. We explore the achievements of the first three women certified in thoracic surgery in 1961 and describe the progress made resulting in the current state. Women constitute slightly more than 50% of all medical students in the US, yet women remain underrepresented in thoracic surgery. The disparity is most notable for female representation in senior academic leadership positions, reflecting stagnation in progress. The lack of gender equity has important implications for projected workforce shortages and patient safety in cardiothoracic surgery. Recent organized efforts in scholarships and leadership training, as well as increasing awareness and mentorship, may herald progress on the horizon. Ultimately, however, engagement of leadership and top-down change are needed to achieve equity and, thereby, to improve patient health and satisfaction.

Toward a global conceptual model for metal enrichment in felsic, mafic-ultramafic, and alkaline-carbonatitic magmas

The formation of intrusion-related metal ore deposits commences with a combination of sequential metal and melt interactions in the magma reservoir: (i) metal diffusion within the melt; (ii) melt motion; (iii) metal partitioning between silicate melts and a magmatic immiscible phase (MIP, including immiscible melts and/or immiscible vapor phases, and crystalized solids; (iv) metal advection in the melt; (v) chemical interactions between the MIP and the mush; and (vi) finally metal deposition. Occasionally, these processes may also develop simultaneously, and lead to formation of multiple depositional centers. During those events, the presence of the MIP seems preponderant and a prerequisite to metal segregation and transport with the interactive mush. Based on forward and inverse modeling, novel diffusion-partitioning-advection models are proposed to account for economic metal enrichment (three to five orders of magnitude relative to initial concentrations in parental melts). For felsic to intermediate magmas, metals (Cu, Mo, W, Sn) are enriched in a saline aqueous phase by diffusion and metal partitioning. Progressive stagnation of melt motion enhances metal diffusion according to the tortuosity of a developing mush and destabilization of plagioclases. The metal-rich liquids separate from the magma reservoir by advection and transfer the metals to the country rocks. For mafic/ultramafic magmas, the MIP is a dense, sulfide melt, which preferentially sequesters metals (Ni, Cu, platinum group elements). The sulfide droplets interact with olivine to scavenge more Ni before they sink toward the bottom of the magma chamber due to negative buoyance. The down-going flow may even become turbulent according to the melt viscosity, leading to disperse and chaotic ore. In peralkaline magmas, CO2-rich carbonatitic melts are the MIPs formed by segregation of CO2-poor feldspathoid syenite melts, and attracting rare earth elements. Those are selectively partitioned by fenitization. In all the three different types of magmatic system, metals diffuse from viscous evolved parental melts toward a MIP, which is responsible for metal partitioning, segregation and transports. This global conceptual model for metal enrichment focuses on the competition between metal diffusion within the melt, melt viscosity and metal partitioning between the parental melt and MIP. However, a second stage of metal enrichment occurs during interaction of the already enriched melt and the mush. Such conceptual model is a first order model that could suggests newer ideas to ore formation.

Abstract 14212: Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among Us Adults; Trends From 2008-2017, the Medical Expenditure Panel Survey

Introduction: Although data up to 2016 suggests that mortality from cardiovascular disease (CVD) in the US appears to be on a decreasing trend, there is evidence of stagnation in progress among young adults, especially women. Sex differences in the trends for control of CVD risk factors have been described, but the temporal trends in the age at which CVD and its risk factors are diagnosed in the US, and whether there are sex-specific differences in these trends is unknown. Methods: We used the Medical Expenditure Panel Survey (MEPS) 2008-2017, a nationally representative sample of the US population. Individuals ≥18 years, with a diagnosis of hypercholesterolemia, hypertension, coronary heart disease (CHD) or stroke and reported the age at which these conditions were diagnosed were included. The trend in the age at diagnosis was calculated from the annual change overall and by sex, using a linear regression model. Results: There were 100,709 participants (50.2% women), representing 91.9 million US adults with the above disease conditions. The mean age at diagnosis of CVD risk factors has decreased over time, with steeper declines among women [(Hypercholesterolemia: women - annual decrease of 0.31 years, men-annual decrease of 0.24 years, all Ps&lt;0.001); (Hypertension: women - annual decrease of 0.23 years, men - annual decrease of 0.20 years, all Ps&lt;0.001); the annual decrease in the age at diagnosis for CHD was not statistically significant. For stroke, while the age at diagnosis decreased by 0.19 years annually for women (p=0.03), it increased by 0.22 years annually for men (p=0.02) Conclusion: The decreasing trend in the age at diagnosis for CVD and its risk factors in the US appears to be more pronounced among women. While earlier identification of CVD risk factors may provide an opportunity to initiate preventive treatment, younger age at diagnosis of CVD highlights the need for the prevention of CVD at the earliest opportunity and sex-specific interventions may be needed.

The Situation in the Sphere of Science and Innovation

Two ongoing parallel processes marked the year 2016. The first one had to do with the continuing implementation of previously planned measures, although it clearly fell behind the earlier established schedule. The scientific research community defined it as progressive stagnation. The second process involved the active elaboration, at the government level, of new strategic documents aimed at a fundamental revision of current policies in the sphere of science and innovation. These were the Strategy for Scientific and Technological Development of the Russian Federation, the National Technology Initiative (NTI) Strategy, and the draft federal law On Scientific, Scientific-technological and Innovation Activity in the Russian Federation, to supersede the Federal Law On Science and State Scientific and Technological Policy enacted in 1996. In August, a new RF Minister of Education and Science was appointed, and so it could be expected that the priorities of the government policy in the field of science and related measures would likewise be adjusted. The focus may well be shifted towards the sphere of education, which is also important from the point of view of science: the creation of high quality human resources in the field of scientific research begins in the secondary school education system. In spite of the introduction of a number of comprehensive measures aimed at support and promotion, some aspects of the issues that have to do with lack of personnel in certain key areas have never been resolved. Among other things, it is necessary to alter the hierarchical and age structure of research personnel, create proper conditions for their career growth, and properly adjust the highest-level qualification training system.

Early angiographic signs of acute thrombus formation following cerebral aneurysm treatment with the Pipeline embolization device

Background and objectiveAcute thrombus formation following aneurysm treatment with the Pipeline embolization device (PED) is a potentially devastating complication that may result in significant thromboembolic sequelae if not promptly treated....

Introducing MBSE By using Systems Engineering Principles

AbstractThis paper describes one possible way how to introduce MBSE into an organization. It is based on a real example from a development organisation in aerospace industry. In this example the start of the introduction of MBSE had an innovative enthusiasm, thereafter followed by stagnation of progress. A change in point‐of‐view on why MBSE should be used was made and as a consequence the entire work methodology was considered a Development Enabling system. At this point Systems Engineering principles were applied in order to determine the need and to find a solution. A description of pitfalls and other lessons are included but it will not cover application of SysML or any architectural frameworks. One point in this paper is that introducing MBSE is not a technical task, it is a change process affecting a very complex system where the most important system elements are humans.

A reassessment of the impact of trauma systems consultation on regional trauma system development.

Previous studies have shown that trauma systems decrease morbidity and mortality after injury, but progress in system development has been slow and inconsistent. This study evaluated the progress in 20 state or regional systems following a consultative visit conducted by the Trauma Systems Evaluation and Planning Committee (TSEPC) of the Committee on Trauma, expanding on a previous study published in 2008, which demonstrated significant progress in six systems following consultation. Twenty trauma systems that underwent TSEPC consultation between 2004 and 2010 were studied. Status was assessed using a set of 16 objective indicators. Baseline scores for 14 regions were calculated during the consultation visit and taken from the 2008 study for the remaining six. Postconsultation status was assessed during facilitated teleconferences. Progress was assessed by comparing changes in indicator scores. There was significant improvement in approximately 80% of systems evaluated within 60 months following the consultation. There was no progress in five of six systems reevaluated over 80 months after consultation, and all four systems evaluated over 100 months after consultation showed erosion of progress. Significant improvements were seen in 10 of the 16 individual indicators, with the greatest gains related to system standards, data systems, performance improvement, prehospital triage criteria, and linkages with public health. Consistent with the 2008 study, the two indicators related to financing for the trauma system showed no improvement. The TSEPC consultation process continues to be associated with improvements in trauma system development in approximately 80% of cases, consistent with the 2008 study, but gains are not self-sustaining. There was a stagnation in progress and a deterioration in total score over time, suggesting that a repeat consultation may be beneficial. System funding remains a challenge and was the area most likely to suffer setbacks over during study period. Care management study, level V.

The World Bank and public sector management: what next?

The new World Bank strategy on Public Sector Management (PSM) has to be judged against the magnitude of the problems it faces. Two of these are what to do about failed and failing states and what to do about the stagnation of progress in ‘flailing’ states. On both of these fronts the gap between what the world of action wants – an implementable action plan to tackle tough problems like Afghanistan – and what the PSM strategy does (and quite probably can) deliver is wide. This article proposes ‘problem-driven iterative analysis’ as one way of bridging the gap.

The Causes of Progressive Stagnation

What accounts for the disconnect between the high end of elite progressive opinion and its other stratums? Why hasn’t there been a greater rejection of judicial review, or a more sustained and broad effort to discredit the courts? To be sure, there have been (and will continue to be) efforts to discredit particular opinions. For instance, many progressives denounced Citizens United v. FEC, with one doing so at the State of the Union. Yet there has been no persistent, general campaign to tear down the courts. Simple reasons account for the failure of the vanguard to convince the rearguard to humble the courts. Habit, identification, preference satisfaction, and the fact that courts remain the most meaningful constitutional game in town all contribute to the continued progressive preference for the courts as the locus of constitutional decision making.

The influence of Christianity on medicine from Graeco-Roman times up to the Renaissance

In this overview of the effect of early Christianity on empirical medicine in Graeco-Roman times, it is shown that the first two centuries represented peaceful cooperation, since the Christians saw secular medicine as a legitimate form of supernatural cure and not as magic. Christianity brought caring communities with indiscriminate personalised care for the ill and aged. This ultimately led to the creation of hospitals as we know them today. Monastic institutions appeared which often had hospitals, and provided a degree of medical scholarship. When Christianity became the state religion in the 4th century, the Church Fathers became increasingly authoritarian regarding the practice of medicine which was to be based on their interpretation of Galen. Progressive stagnation of scientific development and medicine specifically, set in. However, during the 5th century Nestorian Christians, fleeing from persecution by the Church, settled in Persia where they initiated a blossoming of medical science during the Golden Age of Islam (8th to 13th centuries), coexisting with the Dark Ages of Medieval Europe. After this period Jewish and Christian doctors reintroduced Arabic versions of the works of the Greek masters from the teaching hospitals of Islam to the young European medical schools at Palermo and Montpellier. The Church which had in the mean time persisted with antiquated dogmas, resented the new teachings from heathen Islam, and responded with reactionary measures against supposed heretics, inter alia by instituting the Inquisition. But after the Reformation and Henry VIII of England’s break with the Vatican, the hegemony of the Church had come apart and Christianity and medicine gradually became realigned according to the realities of the Age of Enlightenment.

Leveraging primary care in the fight against lung cancer.

In recent years, the decline in youth smoking rates has stopped as the tobacco industry strives to successfully reclaim market areas where it has lost favor. The plateau in lung cancer incidence and stagnation in progress toward smoking abstinence illustrates the necessity for renewed efforts to fight tobacco use. Barriers to fighting tobacco use exist in both the clinical arena and within the general population, but can be overcome. Primary care physicians (PCPs) are uniquely poised to successfully treat nicotine dependence with strategic targeting of these barriers, improved training in smoking cessation techniques, and focused political efforts in tobacco control. Herein, this article describes the landscape of tobacco use in America and provides background, methodology, and resources for PCPs to help achieve the goals of Healthy People 2010 in reducing the illness, disability, and death that occur as a result of tobacco use and exposure to secondhand smoke.

Smoking Cessation Research via the Internet: A Feasibility Study

ABSTRACT To reverse the present stagnation in progress toward reduced smoking rates, new widely accessible treatment methods for smoking cessation must be developed and evaluated with large groups of smokers. We tested the feasibility of conducting a smoking cessation study over the Internet using a brief, self-help educational intervention. Through a direct e-mail sent from a large health information web site (WebMD), and with our presence on the Internet, we recruited 538 adult smokers to the study. Most participants (90.5%) completed all baseline questionnaires. Questionnaires showed acceptable to good reliability and were comparable with studies using paper-and-pencil methods. Participants appeared to be highly dependent on nicotine. Forty-two percent indicated being ready to quit smoking at baseline. At 1-month follow-up, 42.8% of baseline participants returned a complete follow-up questionnaire, 40% of whom indicated having made a serious quit attempt, and 8.3% of whom indicated 7-day abstinence. Most follow-up participants rated the site as at least somewhat helpful to quitting (74.9%) and reported at least a slight increased intention to quit smoking over baseline (67.3%). While Internet-enabled self-help interventions for smoking cessation are able to reach large numbers of smokers interested in quitting smoking, additional procedures are needed to retain these users for treatment and follow-up assessments.

Basal till fabric and deposition at Burroughs Glacier, Glacier Bay, Alaska

Research Article| December 01, 1994 Basal till fabric and deposition at Burroughs Glacier, Glacier Bay, Alaska NELSON R. HAM; NELSON R. HAM 1Department of Geology and Geophysics, University of Wisconsin, 1215 West Dayton Street, Madison, Wisconsin 53706 Search for other works by this author on: GSW Google Scholar DAVID M. MICKELSON DAVID M. MICKELSON 1Department of Geology and Geophysics, University of Wisconsin, 1215 West Dayton Street, Madison, Wisconsin 53706 Search for other works by this author on: GSW Google Scholar GSA Bulletin (1994) 106 (12): 1552–1559. https://doi.org/10.1130/0016-7606(1994)106<1552:BTFADA>2.3.CO;2 Article history first online: 01 Jun 2017 Cite View This Citation Add to Citation Manager Share Icon Share MailTo Twitter LinkedIn Tools Icon Tools Get Permissions Search Site Citation NELSON R. HAM, DAVID M. MICKELSON; Basal till fabric and deposition at Burroughs Glacier, Glacier Bay, Alaska. GSA Bulletin 1994;; 106 (12): 1552–1559. doi: https://doi.org/10.1130/0016-7606(1994)106<1552:BTFADA>2.3.CO;2 Download citation file: Ris (Zotero) Refmanager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentBy SocietyGSA Bulletin Search Advanced Search Abstract Basal till and debris-rich ice in the basal transport zone of Burroughs Glacier, southeast Alaska, were studied to develop a model for till deposition and to acquire new pebble fabric measurements from till at a modern glacier. Studies of till deposition and fabric measurements from modern glacial deposits are important for studying the genesis of Pleistocene and pre-Pleistocene glacial sediment.Basal till at Burroughs Glacier is deposited at the ice margin by the melting of basal debris-rich ice that stagnated progressively, from the bottom upward, beneath moving ice during deglaciation. The debris-rich ice is typically ∼1-3 m thick and has very high sediment content ranging from 60% to 70% by volume. The long axes of pebbles in the debris-rich ice, and in other parts of the basal transport zone of the glacier, are typically well oriented parallel to ice flow. The average S1 eigenvalue for nine fabrics measured in the basal transport zone is 0.8092 ± 0.067σ. The basal till is massive, matrix-supported, silty-sandy diamicton. Striated, lodged boulders, and crag and tails are common on the till surface. S1 eigenvalues calculated from 27 pebble fabrics measured in the till range from 0.4930 (no fabric) to 0.8261; the average value is 0.6757 ± 0.092σ. The range of values is nearly identical to that reported for fabrics from "undeformed lodgment till" by Dowdeswell and Sharp (1986).Although the final process of till deposition at Burroughs Glacier is passive melt out from stagnant, debris-rich ice, the nature and pebble fabric of the till are inherited from active ice processes, specifically the progressive stagnation of debris-rich ice beneath active ice. Evidence of differential movement (shear) within the debris-rich ice during deposition is reflected in a change in fabric azimuth with depth in the till, beveled bullet boulders, and shear surfaces. These features are typically thought to be characteristic of lodgment till or brittle deformation of subglacial sediment. The melt-out process is passive because of the very high debris content of the debris-rich ice. If the same sequence of till deposition occurred in older glacial deposits and the debris content of the basal ice was high, the final process of melt-out would not be reflected in properties of the sediment. This content is PDF only. Please click on the PDF icon to access. First Page Preview Close Modal You do not have access to this content, please speak to your institutional administrator if you feel you should have access.