text:
Peribiliary cysts: a systematic review and proposal of a classification framework
Fateh Bazerbachi1,
Samir Haffar2,
Takaaki Sugihara3,
Taofic M Mounajjed4,
Naoki Takahashi5,
Mohammad Hassan Murad6,
Barham K Abu Dayyeh1
1 Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
2 Digestive Center for Diagnosis and Treatment, Damascus, Syria
3 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
4 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
5 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
6 Evidence-based Practice Center, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
Correspondence to Dr Barham K Abu Dayyeh; AbuDayyeh.Barham{at}mayo.edu
Objective Peribiliary cysts are usually benign, although severe complications and mortality may occur, and they may be confounded with other diseases. No classification delineating their different characteristics exists.
Design We performed a systematic review of the frequency and clinical manifestations of peribiliary cysts. Two reviewers identified studies after searching multiple databases on 2 August 2017.
Results These cysts were prevalent in cirrhosis (9%). A total of 135 patients were reported in 72 papers with sufficient clinical data (10 countries, 65% from Japan, median age 63 years (range: 4–88), and 80% were males). Symptoms were present in 70%. Misdiagnosis occurred in 40%, and 33% underwent therapeutic misadventures. Cysts were solitary in 10%. Obstructive features and cholangitis were observed in 36% and 12.5%, respectively. Cysts progression was observed in 37.5% over a median of 18 months. Mortality was 24%, mostly due to cirrhosis. A classification framework is proposed, wherein type I includes hepatic, type II extrahepatic and type III mixed hepatic and extrahepatic cysts, each having distinct features. Specifically, type II was more frequent in females, solitary, without cirrhosis, presenting with obstructive jaundice, more difficult to diagnose and required more surgical interventions (all p<0.05).
Conclusion Although rarely studied in the literature, peribiliary cysts were frequent in studies designed to evaluate their prevalence, and were mostly asymptomatic. Inaccurate diagnosis, therapeutic misadventures, cysts progression and cysts-related complications are frequent. In a novel classification framework based on location, extrahepatic peribiliary cysts have distinct characteristics and require a special approach for diagnosis and management.
bile duct surgery
Peribiliary cysts are one of the most recent discoveries in the domain of liver cystic abnormalities. These lesions are usually found up the liver hilum, tracking the fourth-order biliary duct branches. Although they are usually diminutive, measuring <20 mm in diameter and lacking communication with the adjoining large bile ducts, they can at times cluster together resembling a multilocular malignancy, mimic biliary dilation (taking the appearance of periportal fluid-filled cylinders), or grow to compress the neighbouring structures, resulting in obstruction and cholestasis. These structures do not communicate with the biliary lumen, and are external to the duct walls. Although these cysts are usually benign, and typically found in patients with liver cirrhosis, they can occasionally cause biliary obstruction or cholangitis. The clinical importance of these structures arises from the fact that they may mimic other diseases (eg, cholangiocarcinoma, choledochal cyst), or may represent a harbinger of an important underlying illness (eg, portal hypertension), which may lead the clinician to unneeded investigations.1 2 Our aim was to systematically review the characteristics of these anatomical variants, and propose a clinical classification based on their location.
This systematic review is reported in line with the guidelines of the preferred reporting items for systematic reviews and meta-analyses with an a priori study protocol (see online supplement 1).
[bmjgast-2018-000204-SP1.docx]
Data sources and search strategies
A comprehensive search of several databases from each database's inception to 2 August 2017, any language was conducted. The actual strategy is provided in online supplements 2 and 3. In addition, the first 300 entries of Google Scholar were searched using the terms 'peribiliary cysts' to look for studies not included in major databases. Reference lists were manually reviewed for additional publications.
Inclusions criteria
Inclusion criteria was based on a priori definitions of the frequency, diagnostic modality and clinical manifestations of peribiliary cysts (see online supplement 3).
We excluded duplicated studies and studies with insufficient clinical data.
Data extraction and assessment
Two independent reviewers (SH, FB) evaluated the included studies based on a priori criteria, and extracted the relevant data. Publications in languages other than English were translated to English through Google Translate website (https://translate.google.com). Japanese language articles data were reviewed by a native speaker (TS). Korean language articles were also reviewed by a native speaker. The data included are shown in online supplement 3.
Assessment of methodological qualities of case reports and case series
We applied a previously described tool, used in several systematic reviews with consistency among reviewers, to assess the methodological quality of case reports and case series3–7 (see online supplements 3 and 4).
We compared patient characteristics, cyst type, surgical interventions and outcomes between cysts location (hepatic/extrahepatic/combined) and in multiple versus solitary cysts. Comparison was done using Pearson's Χ2 test. When the number of patients in any cell in a contingency table was under 5, we used Fisher's exact test. Two-tailed p values were considered to be statistically significant when they were below 0.05. Analysis was performed using Stata V.15 software (StataCorp, College Station, Texas, USA).
The flow diagram through the different phases of this systematic review is shown in online supplement 5. We identified 9 studies that assessed the frequency and 72 case reports and case series with sufficient clinical data. Online supplements 3 and 7 show individual studies and granular information identified in this systematic review.
Frequency of peribiliary cysts
Online supplement 8 shows the frequency of peribiliary cysts in nine studies, and it ranged from 1% (liver transplant patients explant) to 100% (autopsy of patients with autosomal dominant polycystic liver disease (ADPLD)). In patients with autosomal dominant polycystic kidney disease (ADPKD), the disease was identified by contrast-enhanced CT (CECT) and magnetic resonance cholangiopancreatography (MRCP) in 54% and 66%, respectively. In a Japanese study assessing the frequency of these structures, 20% of 1000 autopsies showed mostly microscopic peribliary cysts.8
Clinical characteristics of peribiliary cysts
Studies characteristics
Most studies were reported from Japan (Japanese studies: 54/72 (75%) —Japanese cases: 88/135 (65%)). Online supplements 3 and 7 demonstrate individuals study characteristics. References of excluded studies and reasons for exclusion are found in online supplement 6.
Patient's characteristics
Table 1 shows the main clinical characteristics of the identified 135 patients (80% males, median age 63 years, range (9–88)).
Main characteristics of patients with peribiliary cysts
Cirrhosis was the most frequent associated disease (52/135 patients—38%), with alcohol being the most frequent aetiology (24/52 patients—46%). Other associated conditions were reported such as portal hypertension, portal vein thrombosis, history of neoplasms, ADPKD, liver transplantation and primary sclerosing cholangitis (table 1). Hepatic, biliary or pancreatic neoplasms were reported in 23 patients (17%) and were observed exclusively in patients with cirrhosis or in patients with multiple intrahepatic cysts (see online supplement 9). Hepatocellular carcinoma was the most frequent neoplasm (16 patients) followed by intraductal papillary neoplasm of the bile tract (4 patients). Other neoplasms such as gastric cancer or colon cancer were reported in 14 patients. No comorbid conditions were identified in 21/135 (15%) of cases.
They were present in 70% of patients (73/104), and were related to the associated disease (eg, symptoms of cirrhosis), to peribiliary cysts per se (eg, clinical manifestations of obstructive jaundice or cholangitis) or to both in 52%, 29% and 19%, respectively. Asymptomatic incidental discovery characterised 30% (31/104) of patients.
Diagnostic modalities of peribiliary cysts
Online supplement 10 shows the diagnostic modalities of peribiliary cysts. CECT was diagnostic in 51 of 105 patients (48%), drip infusion cholangiographic CT (DIC-CT) in 15 of 19 patients (79%) and MRCP in 25 of 39 patients (64%). Among 14 patients who were inaccurately diagnosed by MRCP, dilatation of the biliary tract was present in 11 patients and 3 of them had solitary cysts. Cholangioscopy performed in 12 patients demonstrated submucosal lesions in 7 of them (58%), and intraductal ultrasound demonstrated cystic cavities in 3 of 4 of these cases (75%). The central dot sign was reported in three patients on CECT.
Initial misdiagnosis
An alternative diagnosis was initially considered in 34 patients (cholangiocarcinoma in 25 patients). Other suspected diseases were: hepatocellular carcinoma (one patient), liver metastasis (one patient), intraductal papillary mucinous neoplasm of the biliary tract (two patients), mucinous biliary cystadenoma (one patient), primary sclerosing cholangitis (two patients), Caroli disease (one patient) and choledochal cyst (one patient).
Surgical intervention
Surgical interventions were performed in 61 for different indications, 20 of which (33%) were therapeutic misadventures for inaccurate diagnosis (left lateral segmentectomy (four patients), left lobectomy (eight patients), left lobectomy including the caudate lobe (two patients), left hepatectomy (two patients), extended left lobectomy (one patient), resection of hepatic segment VI (one patient), right hemihepatectomy (one patient) and duodenopancreatectomy (one patient)).
Cysts characteristics
Intrahepatic peribiliary cysts were found in 87%, extrahepatic in 7% and both in 6% (table 2). The cysts were multiple in 90% and solitary in 10% of patients. The size of the cysts ranged from 1 to 55 mm in 92 patients with available data. In one patient, the cysts were microscopic and were associated with intraductal papillary neoplasm of the biliary tract.9
Classification of peribiliary cysts based on their location along the biliary tract
Complications related to peribiliary cysts were observed in 58 of 106 patients (55%), and biliary tract dilatation, obstructive jaundice and cholangitis were the most reported ones (table 1). Other less frequent complications were noted in seven patients: hepatolithiasis (five patients),10–14 acute pancreatitis (one patient)15 and febrile peribiliary cysts infection (one patient).14 Some patients had more than one complication such as obstructive jaundice and cholangitis.
Follow-up changes
Data for 40 patients followed for a median period of 18 months (range: 1–92) were available, and an increase in size and/or number of cysts was reported in 40%. Ten of these patients had cirrhosis, two had alcoholic hepatopathy, one had pancreatic cancer and two were without associated disease.
Death was reported in 29 of 122 patients (mortality rate 24%), and postmortem exam was performed in 27 patients. Among patients with reported cause of death (21 patients), decompensated cirrhosis was the most frequent culprit (17/21%–81%). The other causes of mortality were: acute respiratory distress syndrome in a patient with cirrhosis16; recurrent cholangitis after duodenopancreatectomy for intraductal papillary mucinous neoplasm of the pancreas in one patient17 and pneumonia in a kidney transplant patient18 and in a patient with acute myeloid leukaemia.19
Assessment of methodological qualities of included studies
As shown in online supplement 11, 67% studies had good, 23% had moderate and 10% had ow methodological quality. Agreement between the two reviewers in assessing the methodological quality was evaluated with inter-rater reliability of 93%.
Proposal of a classification framework for peribiliary cysts
When the hepatic bile duct bifurcation delineates two hepatobiliary segments: hepatic and extrahepatic, we identify the following types: type I: hepatic, type II: extrahepatic, type III: mixed hepatic and extrahepatic (table 2 and figure 1). Characteristics and implications of the lesions, as they relate to the anatomic location are shown in online supplement 12. Extrahepatic cysts, compared with other cysts, were more frequent in females, solitary with no associated cirrhosis or portal hypertension, presenting frequently with obstructive jaundice, more difficult to diagnose by imaging modalities and required more surgical interventions (all p<0.05) (table 3). There was a trend of better prognosis in extrahepatic cysts compared with other cysts (mortality rate: 11% vs 25%, p=0.68). The comparison between multiple and solitary cysts is shown in online supplement 13. Solitary cysts share some of the extrahepatic cysts characteristics: more frequent in females, less association with cirrhosis and portal hypertension and more difficult to diagnose by imaging modalities (all p<0.05). There was a trend of better prognosis in solitary cysts compared with multiple cysts (mortality rate: 8% vs 26%, p=0.19).
Comparison between hepatic and hepatic/extrahepatic cysts vs extrahepatic cysts
Proposal of a classification framework for peribiliary cysts. When the hepatic bile duct bifurcation delineates two hepatobiliary segments: hepatic and extrahepatic, we identify the following types: type I: hepatic, type II: extrahepatic, type III: mixed hepatic and extrahepatic.
Generalisability of the results
The presence of selection bias favouring the report of more severe cases limits the generalisability of all results of this review to patients with peribiliary cysts. However, the majority of included studies had a good methodological quality, making their results applicable in the appropriate context, and they were not restricted to a certain ethnicity.
Peribiliary cysts result from cystic dilatation of the extramural peribiliary glands located on both sides of the intrahepatic and extrahepatic bile ducts.20 The disease was first described in Japan by Nakanuma et al 21 in 1984 as an incidental finding in eight autopsy cases. Grossly, they are often multiple, featuring thin transparent walls and serous contents (figure 2). Histologically, the cysts are associated with dilated peribiliary glands, suggesting variable developmental stages of the process.22 The epithelial lining is most often flat and attenuated, but resembles the epithelial lining of peribiliary glands.23
(A) Schematic representation of peribiliary glands, and histology. (B) Histology of a peribiliary cyst.
Several names has been given to the disease in the literature such as 'multiple cysts in the hepatic hilum', 'hepatic cysts of periductal gland origin', 'mucinous hamartoma of the biliary system', 'multiple hilar cysts', 'Nakanuma disease', 'hepatic peribiliary cysts' and 'peribiliary cysts'.23 The last two names are preferred by most authors, and are the most widely used.
The disease was prevalent in studies designed to examine its frequency especially in patients with cirrhosis, ADPKD and ADPLD, and cysts were mostly microscopic and asymptomatic. In this systematic review, we identified 72 reports with 135 cases from 10 countries, spanning a period of 33 years.
Almost two-thirds of cases emanate from Japan. An awareness publication bias could be behind this observation, since the disease was first described in Japan, and under-reporting due to clinical unawareness in other parts of the world may account for this trend. For example, the two French reports in this systematic review24 25 have been published by the same group from Clermont-Ferrand, while no reports have been published from other parts of France. Other factors, such as ethnic and environmental determinants, might be in play.
We found higher male gender predilection, which may be partially related to higher alcohol consumption.26 Of the 33 patients with alcoholic liver disease, identified in this review, 88% were male. Other possible hormonal, genetic or acquired factors may be in play.
Although the pathogenesis remains unclear, two scenarios are considered.27 One is congenital or developmental, and is associated with fibrocystic diseases such as ADPKD or ADPLD. The other is secondary to alcohol use, cirrhosis, portal hypertension and portal vein thrombosis.28 29 In this systematic review, 15% of the cases were idiopathic without any recognised associated condition.
Chronic alcohol may injure the peribiliary glands, and among consecutive autopsy cases of chronic alcoholics in a Japanese study, cysts were found in 14%, and their frequency correlated with the degree of alcohol-related hepatic fibrosis.30 In this systematic review, alcoholic liver disease with or without cirrhosis was reported in 28%.31 32
Another interesting observation is the neoplastic associations, with 20% of patients in this review harbouring hepatic, biliary or pancreatic neoplasms. Hepatocellular carcinoma was the most reported neoplasm and occurred in patients with cirrhosis. Peribiliary cysts may have been the origin of the biliary neoplasms encountered in this review.33 Sato et al reported peribiliary glands epithelial changes in almost 10% of cases in an autopsy study,34 and such changes may be precursors of intraductal papillary neoplasm of the bile duct, as well as cholangiocarcinoma, although their clinical significance remains unclear.35
This systematic review reveals that establishing a correct diagnosis of peribiliary cysts is essential to avoid therapeutic misadventures which were observed in one-third of patients. Cholangiocarcinoma was the most frequent suspected disease in difficult-to-diagnose cases. Considering the prevalence of these lesions in patients with cirrhosis, it is critical to accurately establish the diagnosis to prevent delisting of an otherwise appropriate liver transplantation candidate.36 In addition, it is important to differentiate peribiliary cysts from other conditions such as dilated bile ducts, intraductal papillary mucinous neoplasm of the bile duct, cystic metastasis of a malignancy, primary sclerosing cholangitis and Caroli disease.
Awareness of the disease, especially in patients with cirrhosis, is the first step towards the accurate diagnosis. CECT and MRCP are good imaging modalities for identifying the cysts. DIC-CT, MRI with administration of gadoxetic acid (Eovist in the USA and Primovist in Canada, Europe and Asia, Bayer Healthcare Pharmaceuticals, Wayne, New Jersey, USA), or ERCP when indicated, are useful to establish presence or absence of biliary luminal communication. DIC-CT may have a limited role in patients with decompensated cirrhosis since it requires normal hepatic function to clearly delineate the bile ducts and is not available in some countries. MRCP was less accurate than DIC-CT for the diagnosis of peribiliary cysts in this review (64% vs 79%, respectively; p=0.37). Cholangioscopy may raise suspicion of the disease by visualising submucosal lesions when other imaging modalities were not diagnostic, and intraductal ultrasound could be helpful. We propose an algorithm of different imaging modalities for the diagnosis of peribiliary cysts (figure 3). Further studies are needed to determine the diagnostic accuracy of combined imaging modalities in challenging cases.
Proposal of algorithm to approach and evaluate peribiliary cysts. *DIC-CT is not available in some countries and could be replaced by MRI gadoxetic acid. CECT, contrast-enhanced CT; DIC-CT, drip infusion cholangiographic CT; IDUS, intraductal ultrasound; MRCP, magnetic resonance cholangiopancreatography.
Interestingly, progression of size and/or number of these structures may serve as a marker for worsening liver disease,28 and this was observed in a third of patients with available data.
We found that peribiliary cysts were solitary in 10% of cases and located along the extrahepatic biliary tract (either alone or in association with intrahepatic location) in 13% of cases. We propose a novel classification of peribiliary cysts, based on biliary distribution, in order to emphasise these two aspects of the disease, and to study their different characteristics according to their anatomic location. We observed that solitary cysts, mostly extrahepatic, have special characteristics, and warrant a distinct approach.
This review has several inherent and unavoidable limitations. First, it is based on case reports and case series with high likelihood of associated bias. However, evidence from case report and case series become more significant when higher evidence is absent.5 Second, we were not able to reflect the natural history, and a publication bias favouring the report of most severe cases is certain. Indeed, the disease was frequent in the studies incepted to assess its frequency, and most cysts were asymptomatic and microscopic. Third, missing data in some reports precluded obtaining complete clinical and prognostic information. However, we were able to reveal some of the epidemiological, clinical, diagnostic and prognostic aspects that have been identified in this disease. Fourth, the diagnostic accuracy of different imaging modalities was not stated in all studies. However, two reviewers evaluated this accuracy, when needed, based on reported results, and disagreements were resolved by discussion. Lastly, our proposed tool for quality assessment of case reports and case series has not been validated, although it was derived from a commonly used instrument and was previously applied with good consistency.
To our knowledge, this is the first systematic review that attempts to synthesise the evidence about peribiliary cysts. This synthesis followed a priori developed protocol and included evaluation of multiple databases by pairs of independent reviewers. More studies are needed to further delineate the pathogenesis of the disease, its relationship with biliary neoplasia, the diagnostic accuracy of combined imaging modalities in challenging cases and to evaluate the utility of the proposed classification.
Although rarely studied in the literature, pribiliary cysts were frequent in studies designed to evaluate their prevalence, and were mostly asymptomatic. Inaccurate diagnosis, therapeutic misadventures, cysts progression and cysts-related complications are frequent. In a novel classification framework based on location, extrahepatic peribiliary cysts appear to have distinct characteristics and require a special approach for diagnosis and management.
The authors would like to thank Dr Chul Kim (Division of Hematology and Oncology, Department of Medicine, Georgetown University, Washington, DC) for revising the translation of the Korean papers included in this review, to Dr Kotaro Yoshida (Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan) for his valuable information on the actual status of DIC-CT in Japan and to Mr. Larry Prokop for excellent librarian assistance.
Tamilarasan AG ,
Yang J ,
Lee AU
. Peribiliary cysts presenting as primary sclerosing cholangitis. Clin Gastroenterol Hepatol 2018.doi:10.1016/j.cgh.2018.02.005
Díaz Alcázar MDM ,
Martín-Lagos Maldonado A ,
Ruiz Escolano E
. Complicated peribiliary cysts in patient without any prior liver disease. Rev Esp Enferm Dig 2018;110:128.doi:10.17235/reed.2017.5350/2017
Bazerbachi F ,
Sawas T ,
Vargas EJ , et al
. Metal stents versus plastic stents for the management of pancreatic walled-off necrosis: a systematic review and meta-analysis. Gastrointest Endosc 2018;87:30–42.doi:10.1016/j.gie.2017.08.025
Haffar S ,
Hussain MT , et al
. Systematic review of acute pancreatitis associated with interferon-α or pegylated interferon-α: Possible or definitive causation? Pancreatology 2017.doi:10.1016/j.pan.2017.08.012
Murad MH ,
Sultan S ,
Haffar S , et al
. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018;23:60–3.doi:10.1136/bmjebm-2017-110853
Szarka LA , et al
. Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature. Neurogastroenterol Motil 2017;29:e13120.doi:10.1111/nmo.13120
Prokop L , et al
. Frequency and prognosis of acute pancreatitis associated with fulminant or non-fulminant acute hepatitis A: A systematic review. Pancreatology 2017;17:166–75.doi:10.1016/j.pan.2017.02.008
Terada T ,
Nakanuma Y
. Pathological observations of intrahepatic peribiliary glands in 1,000 consecutive autopsy livers. III. Survey of necroinflammation and cystic dilatation. Hepatology 1990;12:1229–33.doi:10.1002/hep.1840120525
Nakanishi Y ,
Nakanuma Y ,
Ohara M , et al
. Intraductal papillary neoplasm arising from peribiliary glands connecting with the inferior branch of the bile duct of the anterior segment of the liver. Pathol Int 2011;61:773–7.doi:10.1111/j.1440-1827.2011.02738.x
Kai K ,
Eguchi Y ,
Kumagai T , et al
. An autopsy case of obstructive jaundice due to hepatic multiple peribiliary cysts accompanying hepatolithiasis. Hepatol Res 2008;38:211–6.doi:10.1111/j.1872-034X.2007.00211.x
Kolodziejski TR ,
Safadi BY ,
Nakanuma Y , et al
. Bile duct cysts in a patient with autosomal dominant polycystic kidney disease. Gastrointest Endosc 2004;59:140–2.doi:10.1016/S0016-5107(03)02359-9
Matsukura M ,
Chida T ,
Kageyama F , et al
. A case of intrahepatic choledochal stone and peribiliary cysts with bile duct stricture. Journal of Hamamatsu Medical Center 2010;4.
Matsushita H ,
Tashiro J , et al
. Cholesterol hepatolithiasis with peribiliary cysts. Pathol Int 2003;53:716–20.doi:10.1046/j.1440-1827.2003.01538.x
Teramoto A ,
Nakamatsu G ,
Shimizu S , et al
. A case of peribiliary cyst infection due to hepatolithiasis. Am J Gastroenterol 2015;110:S51–S2.
Ueki Y ,
Mori T ,
Tominaga Y , et al
. [A case of simple cyst derived from the common bile duct; undiscriminated from malignant lesion]. Nihon Naika Gakkai Zasshi 1987;76:76.
Stevens W ,
Harford W ,
. Obstructive jaundice due to multiple hepatic peribiliary cysts. Am J Gastroenterol 1996;91:155–7.
Sato Y ,
Mukai M ,
Sasaki M , et al
. Intraductal papillary-mucinous neoplasm of the pancreas associated with polycystic liver and kidney disease. Pathol Int 2009;59:201–4.doi:10.1111/j.1440-1827.2009.02352.x
Wanless IR ,
Zahradnik J ,
Heathcote EJ
. Hepatic cysts of periductal gland origin presenting as obstructive jaundice. Gastroenterology 1987;93:894–8.doi:10.1016/0016-5085(87)90455-0
Takahashi H ,
Miwa S ,
Nomoto K , et al
. Peribiliary cyst of common bile duct: possible cause of refractory jaundice. Pathol Int 2009;59:692–3.doi:10.1111/j.1440-1827.2009.02430.x
Kudo M
. Hepatic peribiliary cysts: clinically harmless disease with potential risk due to gradual increase in size and number. J Gastroenterol 2001;36:286–8.doi:10.1007/s005350170119
Kurumaya H ,
Ohta G
. Multiple cysts in the hepatic hilum and their pathogenesis. Virchows Arch A Pathol Anat Histopathol 1984;404:341–50.doi:10.1007/BF00695218
Hubscher SG ,
Burt AD ,
Portmann BC , et al
. MacSween's pathology of the liver E-Book: Elsevier Health Sciences, 2011.
Fujioka Y ,
Kawamura N ,
Tanaka S , et al
. Multiple hilar cysts of the liver in patients with alcoholic cirrhosis: report of three cases. J Gastroenterol Hepatol 1997;12:137–43.doi:10.1111/j.1440-1746.1997.tb00396.x
Da Ines D ,
Essamet W ,
Montoriol PF
. Peribiliary cysts. Hepatology 2011;54:2272–3.doi:10.1002/hep.24715
Montoriol PF ,
Poincloux L ,
Petitcolin V , et al
. Peribiliary cysts mistaken for a biliary dilatation in a cirrhosis patient. Clin Res Hepatol Gastroenterol 2012;36:e93–e95.doi:10.1016/j.clinre.2012.03.005
Shimizu I ,
Kamochi M ,
Yoshikawa H , et al
. Gender difference in alcoholic liver disease. InTech: Trends in Alcoholic Liver Disease Research-Clinical and Scientific Aspects, 2012.
. Pathology of the bile duct: Springer, 2017.
. Peribiliary cysts have at least two different pathogeneses. J Gastroenterol 2004;39:407–8.doi:10.1007/s00535-004-1333-x
Kozaka K ,
. Radiological approaches to biliary diseases with pancreatic counterparts. Biliary diseases with pancreatic counterparts: a new disease concept: Nova Science Publishers, Inc, 2017:217–33.
Matsubara T ,
Igarashi S , et al
. Alcohol-related injury to peribiliary glands is a cause of peribiliary cysts: based on analysis of clinical and autopsy cases. J Clin Gastroenterol 2014;48:153–9.doi:10.1097/MCG.0b013e318299c8c1
Ohta H ,
Baba Y ,
Ishikawa T , et al
. A clinical evaluation of hepatic peribiliary cysts. Kanzo 2003;44:58–65.doi:10.2957/kanzo.44.58
Kozuki A ,
Shima Y ,
Sumiyoshi T
. A resected case of hepatic peribiliary cysts difficult to distinguish from intrahepatic cholangiocarcinoma. Tan to Sui 2012;26:604–9.
Zen Y ,
Amarapurkar AD ,
Portmann BC
. Intraductal tubulopapillary neoplasm of the bile duct: potential origin from peribiliary cysts. Hum Pathol 2012;43:440–5.doi:10.1016/j.humpath.2011.03.013
Harada K ,
. Cystic and micropapillary epithelial changes of peribiliary glands might represent a precursor lesion of biliary epithelial neoplasms. Virchows Arch 2014;464:157–63.doi:10.1007/s00428-014-1537-2
Sato Y
. Cystic and micropapillary neoplasm of peribiliary glands: its perspective to cholangiocarcinogenesis. Springer: Pathology of the Bile Duct, 2017:177–88.
Lim J ,
Nissen NN ,
McPhaul C , et al
. Peribiliary hepatic cysts presenting as hilar cholangiocarcinoma in a patient with end-stage liver disease. J Surg Case Rep 2016;8:10.
FB and SH contributed equally.
Contributors All authors contributed to the study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and statistical analysis. All authors approved the final manuscript.
Ethics approval The IRB exempted this systematic review and pooled anaylsis from IRB approval as it did not involve new research on new human subjects.
Data sharing statement Additional data are available in the online supplements.


… but with the help of Halo Bail Bonds you can be sure to minimize it to the greatest extent.
You're not even convicted yet, so why should you spend time in jail waiting around? If you even did something that's punishable by incarceration, that is. Unfortunately the California prison system isn't about efficiency, even as it makes claims to the contrary. Most prisons in the state are overcrowded, understaffed and underfunded, which leads to inefficiency and poor conditions for the inmates, even pre-trial persons … At Halo Bail Bonds we understand your pain from seeing thousands of persons locked up for too long over small offenses. Click the button below now to fill out our quick app and hear from a bail agent within 10 minutes in most cases.
The population of rural county San Bernardino in 2012 was 2,081,313; with a size of just over 20,000 square miles, the county is easily one of the largest in the entire state. The population density, however, remains average due to the relatively high number of persons -- 103 to be exactly -- per square mile.
44% of the county's population is employed by private businesses, while 19% derives income from the government, 35% are self-employed and 2% receives no income from family work, usually in the agriculture industry.
What's there to do in San Bernardino County? Frankly, too much to name here. Whether you're an outdoor enthusiast, shopaholic or connoisseur of fine foods, you'll find something to your liking. For example, the mountains which bear the county's name are a big draw because they offer resort-grade getaways like Lake Arrowhead and Big Bear Lake. Joshua Tree National Park is another outdoor marvel perfect for hiking and exploration. And the Mojave National Preserve provides an entirely different terrain for outdoor enthusiasts.
High Desert Detention Center: Opened in 2006; first detention center in the high desert; relieved other county jails which were overcrowded; houses as many as 700 inmates.
Central Detention Center: Main county jail from 1971 to 1991; closed for a time due to lack of use and overcrowding, but reopened to house federal inmates.
West Valley Detention Center: In operation since 1991; 3,347 inmate capacity, making it one of the largest California county jails.


text:
Illusion Theater Presents New Stage Adaptation by Michael Egan
On September 26 and 27, 2020, Illusion Theater in Minneapolis will present a virtual performance of a new stage adaptation of Five Minutes in Heaven, a play about violence and reconciliation set during the "Troubles" in Northern Ireland. The original film starred Liam Neeson and James Nesbitt and won multiple awards at the Sundance Film Festival.
This new stage adaptation was created by Michael Egan, who is an acupuncturist and teaches tai chi and qi gong at the Penny George Institute for Health and Healing at Allina Health. Michael is a dear friend of the George Family Foundation, and we are excited to see his adaptation of this powerful story.
Visit this blog to learn about Michael's work at the Penny George Institute.
And visit Illusion Theater's website to learn more about the virtual performance of Five Minutes in Heaven.

redpajama_set_name: RedPajamaCommonCrawl


text:
package com.google.zxing.client.android.result;

import com.google.zxing.Result;
import com.google.zxing.client.android.R;
import com.google.zxing.client.result.ISBNParsedResult;
import com.google.zxing.client.result.ParsedResult;

import android.app.Activity;
import android.view.View;

/**
 * Handles books encoded by their ISBN values.
 *
 * @author dswitkin@google.com (Daniel Switkin)
 */
public final class ISBNResultHandler extends ResultHandler {
  private static int[] buttons;

  public ISBNResultHandler(Activity activity, ParsedResult result, Result rawResult) {
    super(activity, result, rawResult);
	buttons = new int[]{
		fakeR.getId("string", "button_product_search"),
		fakeR.getId("string", "button_book_search"),
		fakeR.getId("string", "button_search_book_contents"),
		fakeR.getId("string", "button_custom_product_search")
	};
    showGoogleShopperButton(new View.OnClickListener() {
      @Override
      public void onClick(View view) {
        ISBNParsedResult isbnResult = (ISBNParsedResult) getResult();
        openGoogleShopper(isbnResult.getISBN());
      }
    });
  }

  @Override
  public int getButtonCount() {
    return hasCustomProductSearch() ? buttons.length : buttons.length - 1;
  }

  @Override
  public int getButtonText(int index) {
    return buttons[index];
  }

  @Override
  public void handleButtonPress(int index) {
    ISBNParsedResult isbnResult = (ISBNParsedResult) getResult();
    switch (index) {
      case 0:
        openProductSearch(isbnResult.getISBN());
        break;
      case 1:
        openBookSearch(isbnResult.getISBN());
        break;
      case 2:
        searchBookContents(isbnResult.getISBN());
        break;
      case 3:
        openURL(fillInCustomSearchURL(isbnResult.getISBN()));
        break;
    }
  }

  @Override
  public int getDisplayTitle() {
    return fakeR.getId("string", "result_isbn");
  }
}

redpajama_set_name: RedPajamaGithub


New Listing Polaroid PLD 3012/S Polarized 29J/C3 Occhiali da sole Crystal Dark Blue | Uomo Occhiali da sole - eHcOdG7X8f2m, Up to 63% Off Sale!
UV Protection Category: 3. Base Curve: 6. Polyamide: Polyamide is hypoallergenic and can be moulded to create very thin, lightweight frames.It's scratch and chemical resistant.
Made from Polyamide and Plastic , this particular pair of PLD 3012/S Polarized are tough and trendy. The Grey/Category:3 Polarized lenses partner well with the Crystal Dark Blue frames, a great combination. The 24 month warranty ensures your Occhiali da sole remain in great condition for longer.


text:
How Our Program Is Different
The Pet Partners Story
Pet Partners in the News
Animal-Assisted Crisis Response
National Therapy Animal Day
Pet Partners at Your Facility
Organize in Your Community
World's Largest Pet Walk
Benefits of the Human-Animal Bond
AAI for Professionals
Pet Partners Magazine
Take The Lead: The Pet Partners Blog
Volunteer with Pet Partners
Community Partners & Chapters
Our Therapy Animal Program
Outside the U.S. and Canada
Honoring Our Therapy Animals
Give in Honor or Memory
Fundraise for Pet Partners
Caring Companies
Volunteer Home
Log A Visit
Home / Learn / Terminology
Animal-Assisted Intervention (AAI)
Animal-assisted interventions are goal-oriented and structured interventions that intentionally incorporate animals in health, education, and human service for the purpose of therapeutic gains and improved health and wellness. Animal-assisted therapy (AAT), animal-assisted education (AAE), and animal-assisted activities (AAA) are all forms of animal-assisted interventions. In all these interventions, the animal may be part of a volunteer therapy animal team working under the direction of a professional or an animal that belongs to the professional.
Animal-Assisted Therapy (AAT)
Animal-assisted therapy is a goal-oriented, planned, structured, and documented therapeutic intervention directed by health and human service providers as part of their profession. A wide variety of disciplines may incorporate AAT. Possible practitioners could include physicians, occupational therapists, physical therapists, certified therapeutic recreation specialists, nurses, social workers, speech therapists, or mental health professionals.
Animal-Assisted Education (AAE)
Animal-assisted education is a goal-oriented, planned, and structured intervention directed by a general education or special education professional. The focus of the activities is on academic goals, prosocial skills, and cognitive functioning with student progress being both measured and documented.
Animal-Assisted Activities (AAA)
Animal-assisted activities provide opportunities for motivational, educational, and/or recreational benefits to enhance quality of life. While more informal in nature, these activities are delivered by a specially trained professional, paraprofessional, and/or volunteer, in partnership with an animal that meets specific criteria for suitability.
*The terms AAI, AAT, AAE, and AAA are the preferred industry terms. The term 'pet therapy' should be avoided because it is inaccurate and misleading. The term was widely used several decades ago to refer to animal training programs. By contrast, the currently preferred terms imply that the animal is acting as a motivating force to enhance the treatment provided by a well-trained person.
We have a chart that breaks down the different types of animal-assisted interventions. View or download
Animal-Assisted Crisis Response (AACR)
Animal-assisted crisis response is a form of animal-assisted activities which provides comfort to those who have been affected by natural, human-caused, or technological disasters. AACR is effective because the safety, familiarity, novelty, and interest in the animal have been found to be impactful when building rapport with a person affected by crisis. Learn more…
Animal-Assisted Workplace Well-being (AAWW)
When Pet Partners therapy animal teams make workplace well-being visits, they boost employee morale and satisfaction, and increase productivity. Numerous studies have shown that when people take just a few moments to pet an animal, their stress is reduced. Research also shows that animals in the workplace often lead to more productive coworker interaction, increased trust levels between colleagues, and more effective collaboration.
Therapy Animal
Therapy animals can provide physical, psychological, and emotional benefits to those they interact with, typically in facility settings such as healthcare, assisted living, and schools. While most frequently dogs, therapy animals can include other domesticated species such as cats, equines, and rabbits, to name a few. These pets are evaluated on their ability to safely interact with a wide range of populations, and their handlers are trained in best practices to ensure effective interactions that support animal welfare. Therapy animal handlers may volunteer their time to visit with their animals in the community, or they may be practitioners who utilize the power of the human-animal bond in professional settings.
A therapy animal has no special rights of access, except in those facilities where they are welcomed. They may not enter businesses with "no pets" policies or accompany their handler in the cabin of an airplane regardless of their therapy animal designation.
Assistance Animal (also commonly called Service Animal)
Assistance animals are defined as dogs and in some cases miniature horses that are individually trained to do work or perform tasks for people with disabilities. Examples include guide dogs for people who are blind, hearing dogs for people who are deaf, or dogs trained to provide mobility assistance or communicate medical alerts.
Assistance dogs are considered working animals, not pets. The work or task a dog has been trained to provide must be directly related to the person's disability. Guide, hearing, and service dogs are permitted, in accordance with the Americans with Disabilities Act (ADA), to accompany a person with a disability almost anywhere the general public is allowed. This includes restaurants, businesses, and on airplanes.
An emotional support animal, sometimes also referred to as a comfort animal, is a pet that provides therapeutic support to a person with a mental illness. To be designated as an emotional support animal, the pet must be prescribed by a licensed mental health professional for a person with a mental illness. The prescription must state that the individual has an impairment that substantially limits one or more major life activities, and that the presence of the animal is necessary for the individual's mental health.
Per the ADA, individuals with emotional support animals do not have the same rights to public access as individuals with a service dog. Emotional support animals may only accompany their owners in public areas with the express permission of each individual venue and/or facility management. Emotional support animals may live with their owners in locations covered by the Fair Housing Amendments Act (FHAA) regardless of a "no pets" policy, and may travel with their owners on airplanes if they meet airline requirements. Although most frequently dogs, other species may be prescribed as emotional support animals.
We have a useful chart that gives a general overview of the differences between therapy, service/assistance, and emotional support animals. View or download
Facility Animal
A facility animal is an animal who is regularly present in a residential or clinical setting. These animals may be a variety of species from dogs and cats to birds or fish. They might live with a handler who is an employee of the facility and come to work each day, or they might live at the facility full-time under the care of a primary staff person. Facility animals should be specially trained for extended interactions with clients or residents of the facility, which may include AAA, AAE, or AAT. These animals do not have special rights of access in public unless they are accompanying and directly supporting a client with a disability.
Pet Partners Terms
The process through which a therapy animal team becomes part of the Pet Partners Therapy Animal Program. This process confirms that the team meets the requirements of our program and is suitable to participate in AAI. There is a distinction between registration and certification. Therapy animal teams are registered, not certified. Certification implies that an independent third party has assessed an individual's mastery of knowledge and skills. For example, a doctor is certified by a Board of Medicine, not by the medical school where they completed their education. At this time, no independent certifying bodies for therapy animals exist.
Therapy Animal Team
A unique combination of one handler and one animal working together that registers through Pet Partners to participate in volunteer AAI in their community. Because Pet Partners believes in the importance of proactive handling for both animal welfare and client safety reasons, we emphasize the importance of balance between a skilled handler, an appropriate animal, and a positive, communicative relationship between the two. Our registration process is designed to assess this through a combination of coursework and evaluation.
The human end of the leash in a therapy animal team, facilitating interactions between their animal and clients with skill and knowledge acquired through the Pet Partners Handler Course.
Team Evaluator (TE)
A valued member of the Pet Partners family and a volunteer leader, who completes required prerequisite volunteer hours, coursework, discussion, and an in-person practicum to verify their suitability to conduct evaluations (in-person assessments) of prospective and renewing Pet Partners therapy animal teams.
Volunteer Instructor (VI)
A valued member of the Pet Partners family and a volunteer leader, who completes required training to lead an in-person workshop version of the Pet Partners Handler Course in their local community.
345 118th Ave SE #200, Bellevue, WA 98005
Copyright © 2020 Pet Partners.
Designed & Developed by Firefly Partners


I am grateful for the comments to the recent entry "Generalized Worldsheets?", but I feel they indicate that I did not manage to get my main point across. I now tried again, providing more details, in the latest comment to that entry (→), which, for that reason, I thought I should lift to blog top-level. It is reproduced below.
What IS 2-dimensional conformal field theory, really?
A full rational conformal field theory (RCFT) (where "full RCFT" means a consistent assignment of n-point correlators to all kinds of Riemann surfaces) is specified by two pieces of data.
1) There is the complex-analytic content of the RCFT. This is specified by the local symmetries of the RCFT, encoded in the operator algebra of the Virasoro current and possibly other symmetry currents (like affine current algebras in WZW models).
This "chiral" component of the RCFT gives us, for every Riemann surface, a vector space of potential correlation functions (called "conformal blocks"), namely a vector space of all those would-be correlation functions that are consistent with the local symmetries of the RCFT (with the chiral Ward identities).
In order to get a full CFT, we need to pick from these potential correlation functions the actual correlation functions, such that our choice is consistent with the sewing and cutting of Riemann surfaces. This choice is additional information not contained in the Virasoro and other chiral operators.
2) Hence there is also topological content to an RCFT. This turns out to be encoded in a (special, symmetric) Frobenius algebra object A in the representation category of the chiral algebra (namely the algebra of open string states for any one boundary condition in our RCFT). In practice this means, that the way to pick a consistent set of correlation functions from the spaces of conformal blocks obtained in 1) is to choose a dual triangulation for every Riemann surface and, roughly, interpret it as a "flow chart" for some algebraic computation using that algebra A. The result of that computation is a vector, and interpreted as a vector in the space of conformal blocks, this yields the correlation function.
The above construction has nicely abstracted away from any details of an RCFT to the crucial structure.
Given this alone, we can assign consistent n-point correlators to all Riemann surfaces.
We don't even need to know that our chiral data is obtained from Virasoro currents, all we need is that it behaves like chiral data. Technically, all we need is a modular tensor category C and and a certain algebra object in C.
My question is: Can we also abstract away from the nature of Riemann surfaces? I.e., can we use the data given by a symmetric special Frobenius algebra in a modular tensor category and assign vectors to something else than ordinary Riemann surfaces, such that some analog of the sewing constraints holds??
If that "something else" is a Moyal-deformed Riemann surface that's fine. But since I don't see how restricting attention to technical details of Moyal star NCG helps to adresss the general question, I would rather like to ignore this for a moment!
Let me sketch how one could imagine performing the generalization that I am talking about to a setup where Riemann surfaces are replaced by Diamond complexes (→).
As you may have seen, I am in the process (→) of showing that the above mentioned "flow chart computation" on dual triangulations of Riemann surfaces is secretly the result of applying a locally trivialized 2-functor to our Riemann surface. This way of looking at things has the advantage that one sees what structure of the Riemann surface we really need: what we need is some 2-category whose composition of 2-morphisms behaves like gluing of little pieces of Riemann surface!
It is easy to construct such a 2-category P 2 for instance from any 2-dimensional diamond graph.
Let the objects of P 2 be the points of the diamond complex, let the 1-morphisms be the edges and those freely generated by composing these, and let the 2-morphisms be the diamonds in between four edges, and all those obtained by freely composing these. Finally, allow for a means to identify edges in order to obtain topologically nontrivially situations (as sketched in section 1.3 of these notes).
There is nothing much which can stop you from applying the whole construction of RCFTs as outlined above to a situation where instead of 2-categories of faces in Riemann surfaces we use such 2-categories obtained from diamond complexes.
In fact, somebody should seriously think about this, the diamond complex setup might even allow to carry through the full program without any serious modification. After all, the light-cone structure implicit in the diamond structure defines a conformal structure. Furthermore, restriction to diamonds may not be a restriction at all as far as Riemann surfaces go. We know (→) that every Riemann surface may be decomposed into a collection of conformal rectangles with appropriately identified boundaries.
How much can we generalize the 2-category of 2-paths in Riemann surfaces and still be able to define (R)CFTs on it?
I would not be surprised if it turns out that there is a 2-category whose 2-morphisms are to be regarded as Moyal-deformed disks and that, with due care, we can define an RCFT 2-transport on this 2-category. But fiddling around with the details of the Moyal star may not be the best way to see if and how this can work. Instead, I believe we would first need to understand which general properties of a 2-category we need in order to be able to define an (R)CFT on it.
Hi Urs, interesting topic in my opinion, but I'm mostly confused about what it precisely means so I'll scatter some comments and questions. They may be stupid, however, owing to my present confusion.
First though, let me just say that I find the idea interesting partly because it looks like an alternative to the deformation of RCFT that one usually considers, i.e. something like relaxing the conditions on the category C, and also consequently generalising the modular functor. I would expect in that case, though, that the domain category can still be thought of as some category of decorated surfaces. At least that's the basic idea I have of deforming RCFT to the non-rational case.
Anyway, as I understand your idea, it would mean that one should generalise the modular functor such that the domain category might possibly be thought of as C-decorated somethings, where C is still modular, but the somethings are no longer surfaces. Do you agree with this?
What confuses me about this is that I have no clue what one would mean by "sewing" of things which are not geometrical. In the RCFT case it is possible to define a RCFT quite abstractly, in purely categorical language, such that, essentially, the only reference to the geometrical notion of sewing is in the axioms of a modular functor. I would certainly guess that this could easily be generalised in many ways which would have absolutely nothing to do with CFT if one does not have some good characterisation of sewing that can be applied to more general categories. So, this is my main confusion, how does one characterise sewing abstractly? Maybe this is in fact what you're trying to say with your example, that it's contained in the structure of some 2-category, or 2-functor?
Hi Jens, great to hear from you!
as I understand your idea, it would mean that one should generalise the modular functor such that the domain category might possibly be thought of as C-decorated somethings, where C is still modular, but the somethings are no longer surfaces. Do you agree with this?
Yes, exactly, that's what I was thinking of! I don't know if it can be done (though I hope it could), but this seems to be the issue which people like Fedele Lizzi should eventually address in the context of their work, which I mentioned (→).
So, this is my main confusion, how does one characterise sewing abstractly? Maybe this is in fact what you're trying to say with your example, that it's contained in the structure of some 2-category, or 2-functor?
1) First of all, indeed, as you indicate, the mere fact that we characterize our domain by a 2-category and our correlators by 2-functors does implement at least some notion of sewing. It's nothing but (2-)functoriality, saying that it does not matter if I first compute correlators on a surface Σ 1, then on a surface Σ 2, then somehow compose these results, or if I first "sew" both surfaces to obtain Σ 1∘Σ 2 and then compute correlators on that.
That's just what functoriality is about, and it is, at least morally, the very reason why it makes sense to go ahead and define a local QFT to be some sort of fucntor.
2) On the other hand, I have not yet managed to understand if the mere fact that we can identify a 2-functor behind the scenes of FFRS ("Fjelstad-Fuchs-Runkel-Schweigert" :-) (as I think we can) tells us something about the main result in FFRS V. I am hoping it does, but somehow seeing this is still beyond me.
In fact, maybe you can help me understanding this better. Ingo once told me something about how it should be possible to regard an A-ribbon "ending" on a boundary somehow in terms of a couple of U i-field insertions, namely those appearing in A=⊕ i∈SU i. I can see how this must be true on heuristic grounds, but within FFRS formalism I am having trouble giving this idea a precise meaning.
So, as I understand it, your idea of generalising RCFT would mean generalising a modular functor to some non-geometric category. This would btw be the type of MF that includes sewing in the axioms. If that's corectly understood, I just now came to think of something that I have no idea whether it a) has been done, b) is completely trivial, or c) would be interesting. The fact that the idea is so straightforward I guess points towards b). Anyway, the idea would be to formulate the notion of a topological modular functor (in the language of Bakalov & Kirillov in terms of continuous functions (or something similar taking into account C-decorations). That would be something like a commutative C * modular functor. Have you encountered, or thought, something along these lines? I've never, that's for sure, but unless a) or b) applies, it certainly looks very interesting to me. And it would (presumably) be a suitable avenue for non-commutative generalisations.
the idea would be to formulate the notion of a topological modular functor (in the language of Bakalov & Kirillov in terms of continuous functions (or something similar taking into account C-decorations). That would be something like a commutative C * modular functor.
The idea would be to replace any mentioning of topological spaces S in the definition of the 3DTFT that the modular functor gives rise to, by the corresponding C * algebra A(S)=C ∞(S) of continuous functions on these spaces. There must be a way to read off from a commutative C *-algebra the boundary of the corresponding topological space A(S)↦A(∂S) and to determine an operation on two C *-algebras A(S)⊗A(S′)↦A(S∪S′) whenever the boundaries of S and S′ match.
In short, there should be a category structure on commutative C *-algebras which implements the gluing of d-dimensional topological spaces. The idea is to replace the category dCob of d-dimensional cobordisms by this algebraic category and define a modular functor in terms of that.
Once this is done, we would hope to simply be able to drop the reqirement that our C *-algebras be commutative. Voila, a modular functor on a "generalized space".
That's the idea that I had in mind. I don't know if anyone has looked into this. The idea itself may be trivial, but I guess working out the consequences is hardly trivial and I bet it has not been done yet.
Yes, that's the basic idea I had in mind, although when I wrote it I had more precisely the 2D modular functor in mind, and not 3D TFT. They are essentially the same, but I just thought it might be easier to generalise a setting where there is only one type of geometrical objects (extended surfaces) instead of two (ext. surfaces + cobordisms).
Also, I have a personal preference, which may very well be misguided, to stay in 2D unless it's necessary to use the 3DTFT.
Re: A-ribbons and boundary field insertions. Am I right in asuming that you're wondering about the precise relation between the formalisms of FFRS V and Ingo's Streetfest procedings?
If so, then I can tell you how I understand it, although it will have to wait until I have more time…must first gather my thoughts on this again. If that's not what you're refering to, could you maybe be a little more specific?
Am I right in asuming that you're wondering about the precise relation between the formalisms of FFRS V and Ingo's Streetfest procedings?
Yes, essentially. All comments you have will be highly appreciated.
Well, I hope the following can be to some help, if it's not enough then just bombard me with specific questions…hopefully I'll be able to shed some light on it.
In the original formalism (with small variations through parts I-V), a boundary field insertion is basically labeled by two left A-modules, M and N, an object U, and an element ψ∈Hom A(M⊗U,N). If we only allow for one left A-module, namely A itself (which is the situation in the Streetfest proceedings), then the intertwiner ψ lies in the space Hom A(A⊗U,A)∈Hom A(A⊗U,A.
Now, the reciprocity (see part I, and originally one of Ostrik's papers) tells you that there is a canonical isomorphism Hom A(A⊗U,A)≅Hom(U,A), so boundary field insertions in this case correspond to subobjects of A. The isomorphism acts as ϕ∈Hom(U,A)↦m∘(id A⊗ϕ)∈Hom A(A⊗U,A), where m is the multiplication of A. So, what one does now is to disregard individual boundary insertions (all the information of those can be found in the algebra A), and simply replace every boundary insertion by the object A and the intertwiner m (really m if the boundary is ingoing, Δ if it is outgoing). If you want to retain a correlator with a specific boundary field insertion given by an object f:U↪A, you can basically take the connecting manifold, glue it to a cylinder over the double with straight ribbons and one coupon labeled by f. This gives you the original construction, using that reciprocity tells you how the intertwiner looks.
Anyway, this only works for the boundary condition A. To generalise this, I guess one should label boundary insertions with algebras and bimodules according to your post about RCFT and Quiver Reps. I haven't thought too much about this though.
Yes, very much so. Thanks!
I knew about the reciprocity theorem, but I had not realized that this implies that open A−A string insertions are necessarily just subobjects of A. Of course that's precisely as one would expect.
Now, using this insight, doesn't that alone pretty much solve the sewing problem for open worldsheets already?
Maybe another question: Intuitively it seems that closed string sewing should be a direct consequence of open string sewing. But apparently there is no way to just demonstrate open string sewing and then lean back and claim that this deals with closed string sewing automatically?
I will need to think more about this sewing stuff, and in particular have another close look at FFRS V before I can say/ask anything else of substance.
That is also my intuition in fact. I still think that is true, but may require some better understanding of the bulk algebra for a RCFT. My ideas are rather vague, but if you allow vagueness, I expect that there is some more natural way to define the bulk algebra than the present, which might make it obvious why closed string sewing follows immediately from open string sewing.
What do you mean by "bulk algebra" here? Do you mean the prescription for how to choose the C-decoration of the bulk triangulation?
Sorry, I didn't explain what I meant by this. What I'm refering to is the (commutative Frobenius) algebra object in 풞×풞¯ that is assigned to a closed string boundary. The algebra of closed string states so to speak. In math.CT/0512076 it's defined to be C l(A×1⊗T 풞) for a ssFa A in 풞, and with the algebra T 풞=⊕ i,jU i×U¯ j as an object.
Ah, I see, I should have guessed that this is what you were referring to.
This way of looking at things is for instance emphasized by Lauda&Pfeiffer (→).
Hm, on the other hand I recall I wanted to check what happens to this projector in the presence of a nontrivial twist (in the sense of twist in ribbon categories) and never did. Does it project on either the left or right center C ℓ(A), C r(A) as in section 5.5 of FRS I? I'd hope it does, but now I am not sure what happens to the twist and how left and right center are distinguished by the cylinder projector.
It's good that we talk about this stuff. I wanted to work this projection stuff out a while ago and never got around to doing it. Now I should!
Quick reply before leaving for today: I agree that's the elegant way of defining it, but as far as I can see one needs to work out a few things before it is even possible to define it this way. Maybe possible via 2-transport? Anyway, I've been trying to figure this out as well, and I think I have some idea at least, but I need to sit down and work it out thoroughly.
Hmm, I'm not exactly sure which setting you are looking at, a genuinely braided category? That's the difficult part right, because the algebra should no longer lie in 풞, but in 풞×풞¯. For a symmetric category I believe it does (haven't checked in detailed, but have checked similar stuff), but there of course the left and right centers coincide.
Hmm, I'm not exactly sure which setting you are looking at, a genuinely braided category?
Sorry, I should have been more precise. I was thinking about the move depicted for instance on page 3 of these slides (by Jeffrey Morton). This indicates how that cylinder I mentioned gives rise to the projector onto the center of an algebra internal to Vect.
Unless I am mixed up, when you try to perform this move not in Vect but in a ribbon category, you'll see that you get the diagram on the very right, but with in addtion a ribbon twist inserted at one point (which is invisble in the case of Vect, of course).
I'll try to think about it.
I was thinking about the move depicted for instance on page 3 of these slides (by Jeffrey Morton). This indicates how that cylinder I mentioned gives rise to the projector onto the center of an algebra internal to Vect.
Ahh, I see. Well, I agree that if you tried to interpret the same move in a ribbon category then you would get an additional twist. Still, I don't think that's what one would like to do.
I don't think that's what one would like to do.
Ok, I need to think about this when I am less tired. It just seems that in part this cylinder projector is forced upon us, since it necessarily is at work when you have an open string coming in and a closed coming out (the "zipper" move in Lauda/Pfeiffer language, which there precisely defines the map to the closed string algebra).
Well, as far as I can see it's not clear how to translate this from TFT to CFT. Would like to discuss this further, but that'll have to wait.
This way of looking at things is for instance emphasized by Lauda+Pfeiffer.
I should mention, BTW, that I saw a copy (from a distance) of an actual manuscript by Moore and Segal today. I don't know how complete it was, but perhaps their paper may be forthcoming.
I'm not exactly sure what you're referring to here (I'm just dropping into the comment thread), but I learned today (from Dan Freed) that the image of the map from the closed string algebra to the center of the open string algebra can be thought of as living in the endomorphisms of the identity functor. This is related to Costello's work because the Hochschild (co?)homology is just the derived version of this.
the image of the map from the closed string algebra to the center of the open string algebra can be thought of as living in the endomorphisms of the identity functor. This is related to Costello's work because the Hochschild (co?)homology is just the derived version of this.
Sounds very interesting. Right now I am not sure how to decode this, though. The identity functor on which category are you refering to? That of Frob algebras?
The category where the objects are boundary conditions and the Homs are the vector spaces of string states.
(and similarly for diagrams where we have a different branes a and b in the top and bottom line), where composition of arrows is the operator product of the corresponding vertex operators.
Well, mainly because, in a (non-topological) CFT, I don't wan't to assign an object in the "chiral" category to a closed string. I don't see how that could even give something consistent, given that the geometric category is symmetric, or do you not agree?
thought of as living in the endomorphisms of the identity functor.
Robin Houston mentions something closely related over on his bosker blog.
This is related to Costello's work because the Hochschild (co?)homology is just the derived version of this.
If you could point me directly to the point in his papers related to this particular statement that would be a real treat.
I just heard a talk by Daniel Huybrechts on stability conditions for derived categories D b(X) of coherent sheaves on X=K3 surfaces (based on the work by Bridgeland).
This reminded me, that the collection of "physical" B-branes, i.e. the stable BPS branes, is actually still a subcategory of D b(X), i.e. still a derived category.
This again means that if we could correctly analyze the brane content of the physical theory in the first place, this, too, should involve derived categories.
Now, as I went on about in a recent entry (→), using FRS we completely understand the abstract nature of the "landscape" of rational CFT string backgrounds. It is something like the collection of bimodule subcategories internal to modular tensor categories.
As I tried to point out, we can think of this as a collection of lax "quiver representations" with values in the modular category. But this suggests a natural category structure on this collection, which, in fact, should be abelian.
Hence it is sort of tempting to consider the derived category of that category of RCFT backgrounds.
While interesting, this leads me into completely unknown territory. Maybe its misguided altogether.
I learned it from David Ben-Zvi, so I'm not sure of a reference. Maybe something by Caldararu might talk about it?
I can talk a little more now about Hochschild cohomology. It is true (only on the level of the dg-category, I think), that HH n is equal to natural transformations from Id→[n]. If you want to phrase this in terms of the usual derived category of sheaves, say, you get something like HH n=Ext XtimesX n(O Δ,O Δ) where Δ is the diagonal. It follows from a generalization of a theorem of Hochschild-Kostant-Rosenberg that, for the derived category of coherent sheaves, we have HH n(D(X))=⨁ i+j=nH i(X,∧ jTX) which you'll recognize as the right answer from the B-model.
For the relation of HH to the dg-category, there is this paper by Toen. Caldararu has a nice discussion of the definition just in terms of sheaves in this paper. There's more on the HKR isomorphism (and the relation to K-theory) here.
I can talk a little more now about Hochschild cohomology.
Great, thanks a lot for the information.
I'll take a look at this as soon as time permits.
In fact, somebody should seriously think about this, the diamond complex setup might even allow to carry through the full program without any serious modification.
If you were walk down this path, I would be excited to sit on the sidelines and comment as the journey evolves. I can almost guarantee you that formulating things using diamond complexes will lead to significant simplification and conceptual transparency. That is the pattern we saw emerge from our adventures and I completely expect it to continue the deeper you go.
Anyway, I just thought I would make a totally naive comment regarding something you said.
So, as I understand it, your idea of generalising RCFT would mean generalising a modular functor to some non-geometric category.
I'm guessing that the term "geometric category" probably has some really specific mathematical definition (one that would give me a nose bleed if I heard it). However, in the case of a diamond complex, I just thought I would point out that some things that might not seem "geometric" in the tradition sense of Riemannian manifolds may deserve the right to be thought of as geometric. A diamond complex is kind of like a "discrete" or "finitary" or "combinatorial" manifold although there is no notion of a underlying continuum (Hausdorf space) in sight.
You are probably too busy and/or not interested enough, but I would be really thrilled to hear if you had any opinion about the paper Urs and I wrote on discrete differential geometry on diamond complexes (→)(which I changed the name at the last minute to "causal graph" in an apparent failed attempt to avoid the possible misconception that what we did was limited to cubic lattices and also to draw attention to the parallels with Sorkin's poset stuff).
Personally, and I think I can speak for Urs to a certain extent, I (we?) think that there is something fundamental in all that discrete differential geometry stuff. One of the fascinating aspects of it that I have made use of in mathematical finance is that discrete calculus on a diamond graph leads naturally to a discrete version of stochastic calculus.
Anyway, I am pretty sure that noone who reads this will find any of those interesting :) The real point is just to demonstrate that there is some neat (and deep?) mathematics involved with diamond complexes.
Anyway, I know nothing about RCFTs, but I am just really happy to see Urs thinking about constructing them within the framework of discrete differential geometry on diamond complexes and I look forward to trying to follow along.
Hi Eric! :) I'm quite sure you're not completely clueless, seeing that you wrote a paper with Urs and all.
Nope, at least not the way I was using the term. I simply meant some category where the objects are in some loose sense geometric, like some type of manifolds for instance, or (as is relevant for RCFT) extended surfaces.
I guess (as is maybe clear from the discussion above) that something like what you describe, things that are not obviously geometric but for some reason deserve to be called geometric (or maybe, things that share certain properties with geometric structures), is needed to define a sensible generalisation of RCFT along the lines Urs has been talking about here. Personally I don't really have a clue as to what precise properties one should require. It looks probable to me that, as Urs comments above, the relevant properties are abstracted in terms of "2-structures", but I've no idea about any details. Maybe I should better shut up and try to understand Urs' work on understanding FRS as a locally trivialised 2-functor first.
Well, I have to admit that I haven't read it…although there may be motivation for me to do so. Also, I'm completely clueless regarding those ideas (i.e. discrete diff. geometry), and any comments from me would most likely be worthless I'm afraid.
Similarly for n-transport. For me, n-transport is just any n-functor on a geometric n-category. Hence it just any old n-functor, but with the difference that I happen to interpret its domain in a special way.
(If you like, compare my remarks on precisely this issue in the very begining of my notes →).
It's exactly this fact which suggests that we consider domain n-categories for n-transport whose p-morphisms are not at all like ordinary p+x-dimensional "spaces".
When showing that locally trivialized n-transport gives rise to lots of structures which are encountered in gerbes and QFT, the only property of the domain n-category that one really needs to require is that there is some sort of a site structure around, which allows to say what it means to restrict the n-functor to "local patches" of its domain n-category.
For any integer n, we define the category nCob to be that whose objects are diffeomorphism classes of (n−1) dimensional manifolds, and whose morphisms are diffeo classes of n-dimensional manifolds cobording their source and target objects. Composition is gluing of manifolds at their boundaries.
I would like to understand the construction of this category in terms not of the manifolds themselves, but in terms of their algebras of smooth functions.
There should be a nice way to read off the algebra of functions supported on the boundary from the algebra of functions on the entire manifold with boundary; and to encode the gluing of manifolds in terms of a certain gluing operation on their algebras of functions.
Of course the motivation behind all this is that I would like to understand if there is something like a noncommutative version of nCob.
It feels like these questions should have basic, well-known answers, but I am probably not familiar enough with the relevant literature in order to know.
I'd be grateful for any comments and pointers to relevant literature.
Would it be misguided to try to construct something like this on diamonds?
Right, in that case we can easily see what we need to do.
So say our algebra is that of functions on finite sets and say it comes to us enhanced to a full differential graded algebra, i.e. as the grade 0-component.
Then this is the same as encoding a directed graph structure with the set of vertices being our finite set. We can read off the "boundary" from that graph.
To formulate that more algebraically, let's assume our graph looks well behaved 2-dimensional, in that our dg algebra has well-behaved elements up to degree 2 and is empty in higher degree. We know this means that at least locally the graph is of diamond form (square lattice, two incoming, two outgoing edges at every bulk vertex).
We can now easily capture the boundary vertices algebraically. They correspond to those functions (grade 0 elements) whose differential lives in a smaller space than those of bulk points (since the differential is the weighted sum of the outgoing and incoming edges, some of which are not present at the boundary).
Hm, right, so perhaps what we need is a catgeory not just of algebras, but of dg-algebras.
Turns out there is indeed a theory of algebraic cobordisms.


The Life Sciences Minister George Freeman MP, who told the audience that he's looking forward to being hounded by Empower: Data4Health in the campaign for the better use of data in healthcare.
For more coverage of the Data4Health launch, including pictures and comments from the attendees, speakers and supporters, please take a look at our Storify here.
The campaign has only just started, but we need to demonstrate how important our mission is to politicians, the media and the public. If you, or anyone you know, has a personal experience of how data saves lives please get in touch with William Pender (william.pender@jbp.co.uk).
You can also find below the press release issued after the launch of Empower: Data4Health.
This week saw the launch of a new health data campaign, Empower: Data4Health, in the House of Commons. The event brought together politicians, including the Life Sciences Minister George Freeman MP, cancer survivor Jo Churchill MP, and host Geoffrey Clinton-Brown MP, with clinicians and patients from across the country.
Empower: Data4Health is calling on the government to rollout electronic health records nationally, and bring together the data for medical research. The Science and Technology Select Committee has recently reported that healthcare data could contribute £14.4bn to the British economy by 2017, whilst centralised data would also help to advance treatments for terminal illnesses.
The Care.Data pathfinders are in progress in areas across the country, the Accelerated Access Review is due to report in the Spring, and there are a number of reports due imminently on how to safeguard patient data. Empower: Data4Health sees this work as vital and wants to ensure the system delivers for patients this time following the withdrawal of the Care.Data provisions in the Health and Social Care Act.
A number of key guests made speeches over the course of the event, highlighting the need for better use of vitally important data across the NHS.
"I believe in patient data being the power behind the science. Every patient holds an answer. With the support of clinicians and charities, and a strong sense of government purpose, I want to see data used for the benefit of patients.
You can read Jo's story in full here.
For more information or to arrange interviews, please contact James Hargrave on 0203 267 0074, 07900 904 707, james.hargrave@jbp.co.uk or Will Pett on 0203 267 0074, 07540 124 226, william.pett@jbp.co.uk.
Empower: Data4Health is now taking on a new important challenge in the health debate – using the data at the disposal of the NHS to produce more effective medicines and better outcomes for patients at all levels of the NHS from Primary to Acute care.
Empower: Access to Medicine was founded in 2012 by Les Halpin who lost his battle with Motor Neurone Disease in 2013.
Empower's central aim was to campaign for accelerated and earlier access to medicines for patients with rare and life-threatening diseases.
Empower has now teamed up with Graham Silk, Co-Founder of Cure Leukaemia, to form Empower: Data4Health. Graham Silk, a Birmingham based businessman, was diagnosed with Leukaemia in 2001, and was saved by an experimental medicine through a clinical trial. Graham is a passionate advocate of the potential of patient data to accelerate medical research, and has joined Empower: Data4Health as its lead spokesman.
Empower is convening likeminded patients groups, charities, politicians and clinicians to make a positive case for change. If you would like to talk to one of the Data Saves Lives case studies please contact James Hargrave or William Pett on 0203 267 0074.
Empower: Data4Health had its official launch in Dining Room B of the House of Commons, 13:00-15:00, 23 February 2016. The event featured an introduction from Geoffrey Clifton-Brown MP; the story of Jo Churchill MP and her plans to champion this issue in Parliament; an introduction to the Empower: Data4Health campaign by Graham Silk; the story of Amanda Walburn-Green and how her daughter's rare genetic disorder was identified; the view of clinicians from Professor Charlie Craddock; and a closing speech from the Life Sciences Minister, George Freeman MP.


THERE are still long delays after an accident on M62 Eastbound from J11 A574 Birchwood Way (Birchwood) to J12 / M60 (Eccles Interchange).
Congestion is currently back to junction 8 for Warrington West/Burtonwood in the roadworks area.
Travel time is around 45 minutes.
Lane one was cleared around 8.45am but ongoing roadworks are also not helping traffic.


Marvin Gaye's family have confirmed talks are underway with Dr. Dre over a potential biopic about the late soul legend, but insisted any announcement of a deal is ''premature''.
Marvin Gaye's family have confirmed talks are underway with Dr. Dre over a biopic - but denied an agreement is in place.
The life of the 'Ain't No Mountain High Enough' legend - who was just 44 when he was shot dead by his own father in 1984 - is one that many filmmaker's have wanted the rights for, and now his family have spoken out.
His son Marvin Gaye III told The Blast: ''In regards to the announcement that was made in the media on June 18 as it pertains to a biopic about my father, the legendary iconic singer Marvin Gaye, that is being produced by Dr. Dre, I want to say that it was prematurely announced, therefore I denounce these statements.
''I love and highly respect Dr. Dre, and we are currently in talks about his participation in the film. However, the movie rights have not been granted nor secured at this time from me as an heir.
His clarification follows reports that the 53-year-old rapper - who produced the 2015 film 'Straight Outta Compton' about his own early music career - had secured the rights to Gaye's music.
Despite the Motown icon's son's comments on the situation, it appears there are still plans to bring the story to the big screen.
Marvin Gaye III added: ''I'm looking for nothing less than excellence in creating a compelling story of Marvin Gaye's multi-faceted life.


text:
Stranger Things's Charlie Heaton Reportedly Has a Son
And fans are freaking out.
By Allie Gemmill
SAN SEBASTIAN, SPAIN - SEPTEMBER 27: Charlie Heaton attends 'Marrowbone' premiere during 65th San Sebastian Film Festival on September 27, 2017 in San Sebastian, Spain. (Photo by Juan Naharro Gimenez/WireImage)Juan Naharro Gimenez
Stranger Things star Charlie Heaton reportedly has a child with his ex-girlfriend.
According to The Daily Mail, Charlie reportedly shares a three-year-old son with his ex-girlfriend and former Comanechi bandmate, Akiko Matsuura. The outlet also provided an alleged photo of Charlie with his son.
Charlie and Akiko reportedly became parents in late 2014 after Akiko became pregnant in May of that year. An unnamed source told The Daily Mail that while Charlie and Akiko are not together, they remain friendly for the sake of their child and that their child lives in London with Akiko.
"Charlie became a dad when he was just 20. He met Akiko when he was just a teen and fell head over heels in love," the source said. "They're no longer together but they have an amicable relationship for the boy's sake. Right now Charlie's career is his priority but he hopes to see more of his son once filming commitments calm down."
It's a fact that has been kept from the public for years and while it's unclear why exactly this news is coming out now, although it might be due to Charlie's newfound Stranger Things fame. However, this hasn't stopped fans from freaking out about the news online.
That said, neither Charlie nor Akiko have posted any personal statements about the reports, and it's probably best to keep speculation to a minimum until they potentially decide to share their private news with the public.
Related: "Stranger Things" Stars Natalia Dyer and Charlie Heaton Spotted Holding Hands
Keywordscharlie heatonStranger Things


BUT CAN BE READ AS STAND ALONES.
Will Aidan and Summer survive the storm?
The thing is, to love her is easy, but can he trust her?
When Rhett pushes to uncover her agenda, Flo knows she will lose something–the man she loves or what she'd been fighting for years.
At eighteen, DJ had to make a choice–her heart or her dreams. Neither was wrong, yet either would break her heart. She chose the world. Over a decade later, she returns to Crescent Creek and to the one regret she's ever had–Scott. Scott's always been steady as a rocky reef. He'd loved once and when she'd left, his strong heart had crumbled like a sandcastle. Now DJ is back, and Scott wants nothing to do with her. The problem? They share Eva, a close friend of both, and now Eva needs their help. Because of her, he's stuck with DJ and he'd be damned, the woman still gets under his skin. DJ is a free spirit who needs the road under her feet. Scott is a family man who wants to groom his roots. With danger on their doorstep and a baby to keep safe, how much are they willing to compromise for love?
He's impulsive, fearless, and fun loving.
Erik Axelsson, Ax, had it all: talent, fame, money. He'd lived the rock & roll life fully and with gusto until it wasn't fun anymore. Without a second thought, he'd traded the spotlight with the Floridian sun, and the guitar with a surfboard. Rich, and free from anything - what more he could need?
She's innocent, scared, and in trouble.
Andrea Smith escaped the life imposed to her when her parents joined a cult. After years on the run, hunger pushed her to accept a stranger's offer for breakfast. She had no clue her life changed with that simple 'yes'.
But the past catches up with her, forcing Andrea to choose what person she wants to be: the scared cult member that obeyed in silence, or the new woman Erik made blossom.


each plate of white rice eaten in a day – on a regular basis – raises the risk of diabetes by 11 per cent.
adding 20 per cent of brown rice to their white rice. This amount is enough to reduce their risk of diabetes by 16 per cent.


On a pretty regular basis I get asked "How do you find the time to work out?"
I guess on the face of it it is fair question. I am no spring chicken, I work full time and I have two young children. This combination seems to be more than enough to stop most people in their tracks with respect to exercise and other self-care routines.
The answer I always have in my head though when people ask me that question is "How do you not MAKE the time to work out?"
Partly my near-horror in imagining a life without regular exercise is visualizing myself feeling flabby, fidgety and super grumpy (aka me pretty much anytime I miss my work out). I am simply unbearable to be around if I have not done something to MOVE my body in any given day and it is hard for me to appreciate that not everybody feels like they are going to burst out of their skin if they don't get their run in.
1. Make it a Priority. The best article I have read on making fitness a priority this year is quoted here. Bottom line is that we all make choices, big and small, about what we want to prioritize in our lives. I firmly believe that taking care of yourself is one of the least selfish things you can do as it will make you a happier, healthier, more productive contributor to your family, your work and society. As such, I recommend looking hard at each day and each week and seeing where some self-care in the form of fitness can fit in. Maybe it will mean skipping a favorite TV show, eating lunch at your desk, or missing a little more sleep, but on the balance I believe you will be happier for it.
2. Set a Schedule. I have the benefit of having a spouse who is similarly dedicated to maintaining his fitness. We have managed to balance our very full work and life loads by developing and sticking to a consistent schedule. M/W evenings are his solo nights with the kids (i.e., pick up, dinner, bath, bed), T/Th are mine. On our off nights we work late, work out and otherwise have full control of our schedules. Friday morning is my time, Saturday afternoon is his. We put the kids in day care at our gym on Sunday mornings so that we can both work out. Outside of these times we fit in what we can. The beauty of the schedule is that everyone knows the drill and it works pretty seamlessly. You don't always feel like working out on your night, but knowing it is your only chance that week can be a pretty powerful motivator and the second mile is always easier than the first.
3. Get Creative/Be Opportunistic. Don't get boxed in by thinking that a workout has to be a specific activity for a specific length of time. If you have 30 minutes in the morning, after the kids go to bed, or between meetings, use 25 of them to go for a walk or do yoga (minimal clothing change required); Do pushups during your run to incorporate upper body strength without having to make it to a gym to lift weights; Try a new class or activity to keep you motivated; or read or watch TV while you are on a stationary bike or elliptical.
4. Be Accountable. In addition to a set schedule, I have one other major motivator that gets me to the gym at 8PM every M/W - my climbing partner. Having someone or something hold you accountable for all the inconvenient times we have allocated to working out (i.e., in the wee morning hours, at lunch, or late at night) is crucial. There are so many reasons that you can bail on your work out unless you know that someone is expecting you to show up and get it done. If you know that working out will be hard for you - consider recruiting someone to share your pain. They will be grateful.
5. Involve Your Family. There is no better way to have a guilt-free workout than to engage your family in the adventure. I have written several posts about family fitness opportunities including running 5Ks, biking/running, summer adventures, hiking, classes, rock climbing, and yoga. My daughter has fully now internalized the vocabulary of a dedicated exerciser. One of my proudest moments was when she was three years old and we were driving home from work/preschool on what had a been a very rainy day "mom" she chirped from the back seat "can we stop at the track and go for a quick run? I haven't gotten my work out in yet today." That's my girl!
6. Get the Right Equipment. Whether it is the right clothes, shoes, jogging stroller or bike, having the correct equipment can make all the difference in whether you stay committed to something.
7. Make it Convenient. Is your gym out of the way, open for limited hours and lack child care? If the answer is yes, then change gyms. In my experience if your gym is not between work and home the chances of you making it there on a regular basis are slim to none. Due to child care constraints we went one step further and built a gym in our garage and you would still be amazed at how far it can seem to get downstairs at the end of a long day. Also, keep it simple. A run out the front door can be as good as it gets.
8. Do it as Part of Your Commute. There is no better way to kill two birds with one stone than to incorporate your workout into your commute. You will be surprised how little time it actually adds, and those minutes spent running, walking and biking instead of sitting can be a game changer - See my friend's great account of her Runmute to work. Worst case, you can switch to a standing desk or a treadmill desk at work to tick off some miles while you pound away at the keyboard.
9. Set a Goal. Nothing gets me out the door for a run like having a race on the calendar. A friend recently posted a great list of races and events you can sign up for. Check it out, commit and then get it done!
10. Get it Done. It doesn't have to be pretty or perfect or fast or worth telling. It just has to get done.


text:
Lena Dunham Talks Breakup With Jack Antonoff, Her Focus on Staying Single, Sober
Lena Dunham covers the March issue of Cosmopolitan UK, and inside, the Girls creator opens up about her breakup from Bleachers frontman Jack Antonoff.
Looking back, Dunham says she had a lot to learn when they got together. She says: "We fell in love when I was really young. I was 25. I look back and we had a great ride, we cared for each other, but you know what? We were both starting our careers and that was our true passion."
Dunham says their love continues, despite the break up: "The love you have for someone doesn't disappear because you don't have them. It's just logistically it doesn't work any more. I love him so much. He is a dear, dear friend of mine. Has it been easy every second? No, it's not easy to divide life with someone."
During their five years together, they shared homes and pets. When they split, Antonoff kept their Brooklyn apartment, she Dunham kept their two dogs.
Now, they're working on their friendship: "There are definitely moments where I was catty, rude or sassy. But he has been beautifully accepting of those and I've been able to be accepting of his anger too. What's really nice is we don't try to pretend that we don't have this history together, but we're also willing to move forward."
SINGLE LIFE + SOBRIETY
Dunham is also focused on herself following health struggles that include a hysterectomy to deal with endometriosis, fibromyalgia, connective tissue disorder Ehlers-Danlos and a battle with addiction. (She has been sober since April of 2018).
She says: "Sobriety for me means so much more than just not doing drugs, it also means that I abstain from negative relationships. It means I've taken a hiatus from dating, which has been amazing for me."
Dunham continues: "I think it's been 14 months now that I've just been totally single. I may have smooched a guy at a party once, but that's not illegal. I hang out with my dogs, my cats. It's created a lot of clarity because I think for so many of us, even though the world has become much more sex-positive, as young, ambitious, independent women our relationship to sex is fraught and complicated. On the one hand, we're taught to demand what we want; on the other hand we're scared we'll never find anyone and have to settle."


glass glass pitcher plants * a type of meat-eating plants , limited more time than your vitamin elements within the planting ground environment , must depend on animals for getting adequate nitrogen suitable for improvement important .present in Borneo peatlands together with Heath Raffles consume glass pitcher plants, known for long insect-catching package . In the previously evaluation found out that the quantity of it's actually quarry insects , a common extra Borneo 1/7 on the meat-eating seed .
Ullman ( area ) Details Ulmar Grafe and the group at this vegetable is how you can product the intake of nitrogen , nevertheless was initially taken aback to completely situated at the bank account of that insect-catching long-haired bat . Doctor. Graff announced ,a period ago , experts found out the real wood to another meat-eating plant , the Malay finish glass glass pitcher blossoms and plants find out insects tablet being a However, it is a first-time completely found on the pockets on the meat-eating plants get animals animals with vivo .


text:
Q: ON DUPLICATE KEY UPDATE with where or if I currently have quiz results from 3 separate quizs stored in 3 seperate tables that are exactly the same, so I have quiz_results_1, quiz_results_2 and quiz_results_3 in this structure:
username | quest1 | quest2 | quest3 | quest4 | quest5 | quest6 | quest7 | quest8 | quest9 | quest10 | complete
I would like to merge these tables into 1 table and include a quiz_id to identify which results are for which quiz:
quiz_id | username | quest1 | quest2 | quest3 | quest4 | quest5 | quest6 | quest7 | quest8 | quest9 | quest10 | complete
I can use this query to update the relevant table, with username as a primary key:
mysql_query("INSERT INTO quiz_results_1 (quest1,quest2,quest3,quest4,quest5,quest6,quest7,quest8,quest9,quest10,username,complete) VALUES $queryData ON DUPLICATE KEY UPDATE quest1=VALUES(quest1),quest2=VALUES(quest2),quest3=VALUES(quest3),quest4=VALUES(quest4),quest5=VALUES(quest5),quest6=VALUES(quest6),quest7=VALUES(quest7),quest8=VALUES(quest8),quest9=VALUES(quest9),quest10=VALUES(quest10),complete=VALUES(complete)");

I would like to use only one table and insert if the row doesn't exist or update if the username and the quiz_id exist.
Any help would be appreciated.

A: Having 3 tables for the 3 quizzes is not a very good design.
So your choice to move into using one table only seems appropriate but you should change the Primary Key to (quiz_id, username) - and this will also solve the UPDATE statement problem.
Or, if you want to store different versions/histories of the quiz per user, change the Primary Key to: (quiz_id, username, complete)

redpajama_set_name: RedPajamaStackExchange