Calcification repsonse of m,arione bivalves to changed carbonate chemistry

Bivalve calcification, particularly of the early larval stages, is highly sensitive to the change in ocean carbonate chemistry resulting from atmospheric CO2 uptake. Earlier studies suggested that declining seawater [CO32-] and thereby lowered carbonate saturation affect shell production. However, disturbances of physiological processes such as acid-base regulation by adverse seawater pCO2 and pH can affect calcification in a secondary fashion. In order to determine the exact carbonate system component by which growth and calcification are affected it is necessary to utilize more complex carbonate chemistry manipulations. As single factors, pCO2 had no effects and [HCO3-] and pH had only limited effects on shell growth, while lowered [CO32-] strongly impacted calcification. Dissolved inorganic carbon (CT) limiting conditions led to strong reductions in calcification, despite high [CO32-], indicating that [HCO3-] rather than [CO32-] is the inorganic carbon source utilized for calcification by mytilid mussels. However, as the ratio [HCO3-] / [H+] is linearly correlated with [CO32-] it is not possible to differentiate between these under natural seawater conditions. An equivalent of about 80 µmol kg-1 [CO32-] is required to saturate inorganic carbon supply for calcification in bivalves. Below this threshold biomineralization rates rapidly decline. A comparison of literature data available for larvae and juvenile mussels and oysters originating from habitats differing substantially with respect to prevailing carbonate chemistry conditions revealed similar response curves. This suggests that the mechanisms which determine sensitivity of calcification in this group are highly conserved. The higher sensitivity of larval calcification seems to primarily result from the much higher relative calcification rates in early life stages. In order to reveal and understand the mechanisms that limit or facilitate adaptation to future ocean acidification, it is necessary to better understand the physiological processes and their underlying genetics that govern inorganic carbon assimilation for calcification.

Teaching Empowerment Through Sport: An Analysis of Fast and Female

This project is about Fast and Female, a community-based girls’ sport organization, that focuses on empowering girls through sport. In this thesis I produce a discourse analysis from interviews with six expert sportswomen and a textual analysis of the organization’s online content – including its social media pages. I ground my analysis in poststructural theory as explained by Chris Weedon (1997) and in literature that helps contextualize and better define empowerment (Collins, 2000; Cruikshank, 1999; Hains, 2012; Sharma, 2008; Simon, 1994) and neoliberalism (Silk & Andrews, 2012). My analysis in this project suggests that Fast and Female develops a community through online and in-person interaction. This community is focused on girls’ sport and empowerment, but, as the organization is situated in a neoliberal context, organizers must take extra consideration in order for the organization to develop a girls’ sport culture that is truly representative of the desires and needs of the participants rather than implicit neoliberal values. It is important to note that Fast and Female does not identify as a feminist organization. Through this thesis I argue that Fast and Female teaches girls that sport is empowering – but, while the organization draws on “empowerment,” a term often used by feminists, it promotes a notion of empowerment that teaches female athletes how to exist within current mainstream and sporting cultures, rather than encouraging them to be empowered female citizens who learn to question and challenge social inequity. I conclude my thesis with suggestions for Fast and Female to encourage empowerment in spite of the current neoliberal situation. I also offer a goal-setting workbook that I developed to encourage girls to set goals while thinking about their communities rather than just themselves.

Argaric Sociology: Sex and Death

The detailed, rich and diverse Argaric funerary record offers an opportunity to explore social dimensions that usually remain elusive for prehistoric research, such us social rules on kinship rights and obligations, sexual tolerance and the role of funerary practices in preserving the economic and political organization. This paper addresses these topics through an analysis of the social meaning of Argaric double tombs by looking at body treatment and composition of grave goods assemblages according to gender and class affiliation. The Argaric seems to have been a conservative society, scarcely tolerant regarding homosexuality, and willing to celebrate ancestry associated to certain places as a means of asserting residence and property rights.

"Sub Tiberio quies"? Judaea’s Political Situation under the Prefects (6-41 c.e.), between Reality and Ideology

Deeply conflicting views on the political situation of Judaea under the Roman prefects (6-41 c.e.) have been offered. According to some scholars, this was a period of persistent political unrest and agitation, whilst according to a widespread view it was a quiescent period of political calm (reflected in Tacitus’ phrase sub Tiberio quies). The present article critically examines again the main available sources –particularly Josephus, the canonical Gospels and Tacitus– in order to offer a more reliable historical reconstruction. The conclusions drawn by this survey calls into question some widespread and insufficiently nuanced views on the period. This, in turn, allows a reflection on the non-epistemic factors which might contribute to explain the origin of such views.

Sherman Alexie’s "The Toughest Indian in the World": Amalgamating the Oral and the Written Traditions

This article argues that The Toughest Indian in the World (2000) by Native-American author Sherman Alexie combines elements of his tribal (oral) tradition with others coming from the Western (literary) short-story form. Like other Native writers — such as Momaday, Silko or Vizenor — , Alexie is seen to bring into his short fiction characteristics of his people’s oral storytelling that make it much more dialogical and participatory. Among the author’s narrative techniques reminiscent of the oral tradition, aggregative repetitions of patterned thoughts and strategically-placed indeterminacies play a major role in encouraging his readers to engage in intellectual and emotional exchanges with the stories. Assisted by the ideas of theorists such as Ong (1988), Evers and Toelken (2001), and Teuton (2008), this article shows how Alexie’s short fiction is enriched and revitalized by the incorporation of oral elements. The essay also claims that new methods of analysis and assessment may be needed for this type of bicultural artistic forms. Despite the differences between the two modes of communication, Alexie succeeds in blending features and techniques from both traditions, thus creating a new hybrid short-story form that suitably conveys the trying experiences faced by his characters.

Fiducial Marker Guided Prostate Radiotherapy: A Review

Image guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogenous whole pelvic radiotherapy dose but these are not reliable when using reduced margins, dose escalation or hypo-fractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990's. They require surgical implantation and provide a surrogate for the position of the prostate gland. A variety of FMs are available and they can be used in a number of ways. This review aims to establish the evidence for using prostate FMs in terms of feasibility, implantation procedures, types of FMs used, FM migration, imaging modalities used and the clinical impact of FMs. A search strategy was defined and a literature search was carried out in Medline. Inclusion and exclusion criteria were applied which resulted in 50 papers being included in this review. The evidence demonstrates that FMs provide a more accurate surrogate for the position of the prostate than either external skin marks or bony anatomy. A combination of FM alignment and soft tissue analysis is currently the most effective and widely available approach to ensuring accuracy in prostate IGRT. FM implantation is safe and well tolerated. FM migration is possible but minimal. Standardisation of all techniques and procedures in relation to the use of prostate FMs is required. Finally a clinical trial investigating a non-surgical alternative to prostate FMS is introduced.

Non-pharmacological interventions for cognitive impairment due to systemic cancer treatment (Review)

Background

It is estimated that up to 75% of cancer survivors may experience cognitive impairment as a result of cancer treatment and given the increasing size of the cancer survivor population, the number of affected people is set to rise considerably in coming years. There is a need, therefore, to identify effective, non-pharmacological interventions for maintaining cognitive function or ameliorating cognitive impairment among people with a previous cancer diagnosis.
Objectives

To evaluate the cognitive effects, non-cognitive effects, duration and safety of non-pharmacological interventions among cancer patients targeted at maintaining cognitive function or ameliorating cognitive impairment as a result of cancer or receipt of systemic cancer treatment (i.e. chemotherapy or hormonal therapies in isolation or combination with other treatments).
Search methods

We searched the Cochrane Centre Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PUBMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PsycINFO databases. We also searched registries of ongoing trials and grey literature including theses, dissertations and conference proceedings. Searches were conducted for articles published from 1980 to 29 September 2015.
Selection criteria

Randomised controlled trials (RCTs) of non-pharmacological interventions to improve cognitive impairment or to maintain cognitive functioning among survivors of adult-onset cancers who have completed systemic cancer therapy (in isolation or combination with other treatments) were eligible. Studies among individuals continuing to receive hormonal therapy were included. We excluded interventions targeted at cancer survivors with central nervous system (CNS) tumours or metastases, non-melanoma skin cancer or those who had received cranial radiation or, were from nursing or care home settings. Language restrictions were not applied.
Data collection and analysis

Author pairs independently screened, selected, extracted data and rated the risk of bias of studies. We were unable to conduct planned meta-analyses due to heterogeneity in the type of interventions and outcomes, with the exception of compensatory strategy training interventions for which we pooled data for mental and physical well-being outcomes. We report a narrative synthesis of intervention effectiveness for other outcomes.
Main results

Five RCTs describing six interventions (comprising a total of 235 participants) met the eligibility criteria for the review. Two trials of computer-assisted cognitive training interventions (n = 100), two of compensatory strategy training interventions (n = 95), one of meditation (n = 47) and one of physical activity intervention (n = 19) were identified. Each study focused on breast cancer survivors. All five studies were rated as having a high risk of bias. Data for our primary outcome of interest, cognitive function were not amenable to being pooled statistically. Cognitive training demonstrated beneficial effects on objectively assessed cognitive function (including processing speed, executive functions, cognitive flexibility, language, delayed- and immediate- memory), subjectively reported cognitive function and mental well-being. Compensatory strategy training demonstrated improvements on objectively assessed delayed-, immediate- and verbal-memory, self-reported cognitive function and spiritual quality of life (QoL). The meta-analyses of two RCTs (95 participants) did not show a beneficial effect from compensatory strategy training on physical well-being immediately (standardised mean difference (SMD) 0.12, 95% confidence interval (CI) -0.59 to 0.83; I2= 67%) or two months post-intervention (SMD - 0.21, 95% CI -0.89 to 0.47; I2 = 63%) or on mental well-being two months post-intervention (SMD -0.38, 95% CI -1.10 to 0.34; I2 = 67%). Lower mental well-being immediately post-intervention appeared to be observed in patients who received compensatory strategy training compared to wait-list controls (SMD -0.57, 95% CI -0.98 to -0.16; I2 = 0%). We assessed the assembled studies using GRADE for physical and mental health outcomes and this evidence was rated to be low quality and, therefore findings should be interpreted with caution. Evidence for physical activity and meditation interventions on cognitive outcomes is unclear.
Authors' conclusions

Overall, the, albeit low-quality evidence may be interpreted to suggest that non-pharmacological interventions may have the potential to reduce the risk of, or ameliorate, cognitive impairment following systemic cancer treatment. Larger, multi-site studies including an appropriate, active attentional control group, as well as consideration of functional outcomes (e.g. activities of daily living) are required in order to come to firmer conclusions about the benefits or otherwise of this intervention approach. There is also a need to conduct research into cognitive impairment among cancer patient groups other than women with breast cancer.

Paramilitary punishments in Belfast: policing beneath the peace

As an enduring legacy of the conflict, paramilitary policing remains an unpalatable but indisputable fact within Belfast's working-class, Republican communities. Historically, while much attention has been devoted to the causes and consequences of paramilitarism along with the terrorist threat posed by such organizations, little attention has been paid to the influence upon, or relations between, such nonstate policing actors, the communities in which they exist and the delivery of policing by the Police Service of Northern Ireland. While local and international literature surrounding paramilitary violence has tended towards political axiom or physical impact of such activity, the current paper presents an empirical study of the relations between communities and Republican paramilitary organizations who seek to exploit a perceived dearth of state-based policing at the community level within Belfast. Framing the ontology of paramilitary policing and its support from a community, rather than political or security perspective, the paper argues that continuing grass-roots support for this ‘new’ paramilitary policing within Republican communities of Belfast is more complex and nuanced than the political antecedents of the conflict from which such activity emerged – especially in terms of such support surviving successive political negotiations and police reforms since the ‘Good Friday’ Agreement of 1998.

Characteristics of aerosols over the Indian region and their variability associated with atmospheric conditions

The aerosols in the atmosphere play major role in the radiation balance of the Earthatmosphere system. Direct and indirect impact of aerosols on the weather and climate still remains as a topic to be investigated in detail. The effect of aerosols on the radiation budget and thereby circulation pattern is important and requires further study. A detailed analysis of the aerosol properties, their variability and meteorological processes that affect the aerosol properties and distribution over the Indian region is performed in the thesis. The doctoral thesis entitled “Characteristics of aerosols over the Indian region and their variability associated with atmospheric conditions” contains 7 chapters. This thesis presents results on the analysis on the distribution (spatial and temporal) and characteristics of the aerosols over the Indian region and adjoining seas. Regional and stationwise data were analysed and methods such as modeling and statistical analysis are implemented to understand the aerosol properties, classification and transportation. Chapter-1 presents a brief introduction on the aerosols, their measurement techniques, impact of aerosols on the atmospheric radiation budget, climatic and geographic features of the study area and the literature review on the previous studies. It provides a basic understanding in the field of study and objective of the thesis. Definition of the aerosols, their sources/sinks and classification of the particles according to optical and microphysical properties are described. Different measurement techniques such as sampling and remote sensing methods are explained in detail. Physical parameters used to describe aerosol properties and effect of aerosols on the radiation distribution are also discussed. The chapter also explains the objectives of the thesis and description of climatic features of the study area.

Analysis of the Market Potential of Syrian Organic Fruit and Vegetables for Exports to Germany

Syria has been a major producer and exporter of fresh fruit and vegetables (FFV) in the Arabic region. Prior to 2011, Syrian FFV were mainly exported to the neighbouring countries, the Gulf States and Northern Africa as well as to Eastern European countries. Although the EU is potentially one of the most profitable markets of high quality FFV (such as organic ones) in the world, Syrian exports of FFV to Western European countries like Germany have been small. It could be a lucrative opportunity for Syrian growers and exporters of FFV to export organic products to markets such as Germany, where national production is limited to a few months due to climatic conditions. Yet, the organic sector in Syria is comparatively young and only a very small area of FFV is certified according to EU organic regulations. Up to the author’s knowledge, little was known about Syrian farmers’ attitudes towards organic FFV production. There was also no study so far that explored and analysed the determining factors for organic FFV adoption among Syrian farmers as well as the exports of these products to the EU markets. The overarching aim of the present dissertation focused on exploring and identifying the market potential of Syrian exports of organic FFV to Germany. The dissertation was therefore concerned with three main objectives: (i) to explore if German importers and wholesalers of organic FFV see market opportunities for Syrian organic products and what requirements in terms of quality and quantity they have, (ii) to determine the obstacles Syrian producers and exporters face when exporting agricultural products to Germany, and (iii) to investigate whether Syrian farmers of FFV can imagine converting their farms to organic production as well as the underlying reasons why they do so or not. A twofold methodological approach with expert interviews and a farmer survey were used in this dissertation to address the abovementioned objectives. While expert interviews were conducted with German and Syrian wholesalers of (organic) FFV in 2011 (9 interviews each), the farmer survey was administrated with 266 Syrian farmers of FFV in the main region for the production of FFV (i.e. the coastal region) from November 2012 till May 2013. For modelling farmers’ decisions to adopt organic farming, the Theory of Planned Behaviour as theoretical framework and Partial Least Squares Structural Equation Modelling as the main method for data analysis were used in this study. The findings of this dissertation yield implications for the different stakeholders (governmental institutions and NGOs, farmers, exporters, wholesalers, etc.) who are interested in prompting the Syrian export of organic products. Based on the empirical results and a literature review, an action plan to promote Syrian production and export of organic products was developed which can help in the post-war period in Syria at improving the organic sector.

Do Psychosocial Interventions Improve Quality of Life and Wellbeing in Adults with Neuromuscular Disorders? A Systematic Review and Narrative Synthesis

Background: Quality of life and well-being are frequently restricted in adults with neuromuscular disorders. As such, identification of appropriate interventions is imperative. Objective: The objective of this paper was to systematically review and critically appraise quantitative studies (RCTs, controlled trials and cohort studies) of psychosocial interventions designed to improve quality of life and well-being in adults with neuromuscular disorders. Method: A systematic review of the published and unpublished literature was conducted. Studies meeting inclusion criteria were appraised using a validated quality assessment tool and results presented in a narrative synthesis. Results: Out of 3,136 studies identified, ten studies met criteria for inclusion within the review. Included studies comprised a range of interventions including: cognitive behavioural therapy, dignity therapy, hypnosis, expressive disclosure, gratitude lists, group psychoeducation and psychologically informed rehabilitation. Five of the interventions were for patients with Amyotrophic Lateral Sclerosis (ALS). The remainder were for patients with post-polio syndrome, muscular dystrophies and mixed disorders, such as Charcot-Marie-Tooth disease, myasthenia gravis and myotonic dystrophy. Across varied interventions and neuromuscular disorders, seven studies reported a short-term beneficial effect of intervention on quality of life and well-being. Whilst such findings are encouraging, widespread issues with the methodological quality of these studies significantly compromised the results. Conclusion: There is no strong evidence that psychosocial interventions improve quality of life and well-being in adults with neuromuscular disorders, due to a paucity of high quality research in this field. Multi-site, randomised controlled trials with active controls, standardised outcome measurement and longer term follow-ups are urgently required.

Micro-Foundations of Financialization. Status Anxiety and the Market for Consumer Credit in Chile

This project investigates why people in Chile acquired so much consumer debt in contexts of material prosperity, and asks what the role of inequality and commodification is in this process. The case raises an important challenge to the literature. Insofar as existing accounts assume that the financialization of consumption occurs in contexts marked by wage stagnation and a general deterioration of the middle classes, they engender two contradictory explanations: while political economists argue that people use credit in order to smooth their consumption in the face of market volatility, economists maintain that concentration of wealth at the top pushes middle income consumers to emulate the expenditures of the rich and consume beyond their means. These explanations do not necessarily fit the reality of developing countries. Triangulating in-depth interviews with middle class families, multivariate statistical analysis and secondary literature, the project shows that consumers in Chile use credit to finance “ordinary” forms of consumption that do not aim either at coping with market instability or emulating and signaling status to others. Rather, Chileans use department store credit cards in order to acquire a standard package of “inconspicuous” goods that they feel entitled to have. From this point of view, the systematic indebtedness of consumers originates in a major concern with “rank”, “achievement” and "security" that – following De Botton -- I call “status anxiety”. Status anxiety does not stem from the desire to emulate rich consumers, but from the impossibility of complying with normative expectations about what a middle class family should be (and have) that outweigh wage improvements. The project thus investigates the way in which “status anxiety” is systematically reproduced by means of two broad mechanisms that prompt people to acquire consumer debt. The first mechanism generating debt stems from an increase of real wages and high levels of inequality. It is explained by a general sociological principle known as relative deprivation, which points to the fact that general satisfaction with one´s income, possessions or status, is assessed not in absolute terms such as total income, but in relation with reference groups. In this sense, I explore the mechanisms that operate as catalyzers of relative deprivation, by making explicit social inequalities and distorting the perception of others´ wealth. Despite upward mobility and economic improvement, Chileans share the perception of “falling behind,” which materializes in an “imaginary middle class” against which people compare their status, possessions and economic independence. Finally, I show that the commodification of education, health and pension funds does not directly prompt people to acquire consumer debt, but operate as “income draining” mechanisms that demand higher shares of middle class families’ “discretionary income.” In combination with “relative deprivation,” these “income draining” mechanisms leave families with few options to perform their desired class identities, other than learning how to bring resources from the future into the present with the help of department store credit cards.

Fit in to stand out : An experience perspective on value creation

In order to grow and survive, a firm must create value with consumers in ways that both fit in with consumer demands and stand out from competitors. Focusing on and understanding consumer and firm assessments of value and creation of value has become a central scope in the contemporary strategic management and marketing literature for understanding and explaining firm survival and success. Consequently, the overall aim of this thesis is to provide a conceptually and empirically grounded understanding of consumers’ and managers’ value assessments and behavior in value creation. This thesis draws on a consumer experience perspective and theories on social construction, organizational identity, self-congruence, and the theory of attractive quality, and combines multiple qualitative and quantitative studies. The findings in this thesis shed light on the interplay between consumers, firms, and contextual structures in value creation. Contextual structural, cultural, and political forces are shown to affect and be affected by the shared and individual cognitions of value creation that firms and consumers use in their assessment and creation value. The results of the study enhance the understanding of how firms can adopt various strategic schemas or organizing logics to optimize different types of use value creation when choosing between opposing and contradictive demands in their value creation. Furthermore, the thesis provides a deeper understanding of the hierarchical nature of consumer judgments of value that can be used to enhance the effectiveness of firm prioritizations and as a foundation for future value-creating strategies.

Community in Modern Scottish Literature.

Community in Modern Scottish Literature is the first book to examine representations and theories of community in Scottish writing of the twentieth and twenty-first centuries across a broad range of authors and from various conceptual perspectives. The leading scholars in the field examine work in the novel, poetry, and drama, by key Scottish authors such as MacDiarmid, Kelman, and Galloway, as well as less well known writers. This includes postmodern and postcolonial readings, analysis of writing by gay and Gaelic authors, alongside theorists of community such as Nancy, Bauman, Delanty, Cohen, Blanchot, and Anderson. This book will unsettle and yet broaden traditional conceptions of community in Scotland and Scottish literature, suggesting a more plural idea of what community might be.

Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.