关于Concordance Process与企业竞争优势的探索

介绍了由韩国仁荷大学李庆焕教授于2001年提出的竞争战略理论Concordance Process,认为企业取得竞争优势的关键在于如何大量有效地发挥和利用权利的五个基本属性,即创造属性、保存属性、支配属性、归属属性以及结合属性。

Understanding of chemoprophylaxis and concordance in inflammatory bowel disease

AIM:To assess patients' understanding for the reasons for taking 5-aminosalicylic acid or ursodeoxycholic acid as chemoprophylaxis against colorectal carcinoma associated with in? ammatory bowel disease (IBD). METHODS: A questionnaire-based study using a 5 point opinion scale was performed. One hundred and ninety-two patients with colitis only and 74 patients with primary sclerosing cholangitis and IBD were invited to take part. RESULTS: Overall response rate was 58%. Sixtyfour percent of patients claimed full concordance with chemoprophylaxis for maintenance of remission. Eightyfour percent of patients considered daily concordance during remission to be very important. Seventy-five percent stated they understood the reasons for taking the drugs. However, only 50% of the patients were aware of any link of their condition to bowel cancer. Seventy-nine percent of patients felt their concordance and understanding would be improved if they were informed of the chemoprophylactic potential of the medication.

Magnetic resonance imaging and Crohn's disease endoscopic index of severity: Correlations and concordance

AIM To examine the correlation between magnetic resonance imaging(MRI) and endoscopic index of severity(CDEIS) in patients with Crohn's disease(CD).METHODS This was a retrospective study of 104 patients with CD that were treated at the Ruijin Hospital between March 2015 and May 2016. Among them, 61 patients with active CD were evaluated before/after treatment. MRI and endoscopy were performed within 7 d. CDEIS was evaluated. MRI parameters included Ma RIA scores, total relative contrast enhancement(tRCE), arterialRCE(aRCE), portalRCE(pRCE), delay phaseRCE(dRCE), and apparent diffusion coefficient. The correlation and concordance between multiple MRI findings and CDEIS changes before and after CD treatment were examined.RESULTS Among the 104 patients, 61 patients were classified as active CD and 43 patients as inactive CD. Gender, age, disease duration, and disease location were not significantly different between the two groups(all P > 0.05). CRP levels were higher in the active group than in the inactive group(25.12 ± 4.12 vs 5.14 ± 0.98 mg/L, P < 0.001). Before treatment, the correlations between CDEIS and MaRIAs in all patients were r = 0.772 for tRCE, r = 0.754 for aRCE, r = 0.738 for pRCE, and r = 0.712 for dRCE(all MaRIAs, P < 0.001), followed by MRI single indexes. Among the active CD patients, 44 cases were remitted to inactive CD after treatment. The correlations between CDEIS and MaRIAs were r = 0.712 for aRCE, r = 0.705 for tRCE, r = 0.685 for pRCE, and r = 0.634 for dRCE(all MaRIAs, P < 0.001).CONCLUSION Arterial Ma RIA should be an indicator for CD follow-up and dynamic assessment. CD treatment assessment was not completely concordant between CDEIS and MRI.

What's in a name? Compliance, adherence and concordance in chronic psychiatric disorders

About half or more of the patients with chronic psychiatric illnesses, either do not take their medications correctly, or completely stop taking them. The problem of poor initial compliance or adherence is often compounded by a continued decline in compliance/adherence over time. The failure to take medicines, adversely affects the outcome of treatment, and places a huge burden of wasted resources on the society. Three terms have been used to describe medication-taking among patients with chronic psychiatric disorders. Compliance is defined as "the extent to which the patient's behaviour matches the prescriber's recommendations". Though compliance has been frequently employed to describe medication-taking behaviour, it has proved problematic because it refers to a process where the clinician decides on a suitable treatment, which the patient is expected to comply with unquestioningly. Studies over the past few decades have emphasized the importance of patients' perspectives in medicationtaking, based on their own beliefs, their personal circumstances, the information and resources available for them. Adherence has been used as a replacement for compliance in an effort to place the clinician-patient relationship in its proper perspective. Adherence refers to a process, in which the appropriate treatment is decided after a proper discussion with the patient. It also implies that the patient is under no compulsion to accept a particular treatment, and is not to be held solely responsible for the occurrence of non-adherence. Adherence has been defined as "the extent to which a person's behaviour, taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider". To overcome certain problems in the concept of adherence, a third term concordance has been used. The concept of concordance has evolved from a narrower view, emphasizing an agreement between the clinician and the patient, which takes into account each other's perspective on medication-taking, to a broader process consisting of open discussions with the patient regarding medication-taking, imparting information and supporting patients on long-term medication. It is a process, which entertains patients' views on medicationtaking, and acknowledges that patients' views have to be respected even if they make choices, which appear to be in conflict with the clinician's views. Although none of these terms are ideal solutions to understanding the complex process of medication-taking behaviour of patients, the move from compliance to adherence and concordance represents genuine progress in this field, which puts the patient's perceptions at the centre of the whole process.

Concordance between bio-impedance analysis and clinical score in fluid-status assessment of maintenance haemodialysis patients: A single centre experience

BACKGROUND The burden of chronic kidney disease(CKD)is rising rapidly globally.Fluid overload(FO),an independent predictor of mortality in CKD,should be accurately assessed to guide estimation of the volume of fluid to be removed during haemodialysis(HD).Clinical score(CS)and bio-impedance analysis(BIA)have been utilized in assessment of FO and BIA has demonstrated reproducibility and accuracy in determination of fluid status in patients on HD.There is need to determine the performance of locally-developed CSs in fluid status assessment when evaluated against BIA.AIM To assess the hydration status of patients on maintenance HD using BIA and a CS,as well as to evaluate the performance of that CS against BIA in fluid status assessment.METHODS This was a single-centre,hospital-based cross-sectional study which recruited adult patients with CKD who were on maintenance HD at Kenyatta National Hospital.The patients were aged 18 years and above and had been on maintenance HD for at least 3 mo.Those with pacemakers,metallic implants,or bilateral limbs amputations were excluded.Data on the patients’clinical history,physical examination,and chest radiograph findings were collected.BIA was performed on each of the study participants using the Quantum®II bio-impedance analyser manufactured by RJL Systems together with the BC 4®software.In evaluating the performance of the CS,BIA was considered as the gold standard test.A 2-by-2 table of the participants’fluid status at each of the CS values obtained compared to their paired BIA results was constructed(either++,+-,--or-+for FO using the CS and BIA,respectively).The results from this 2-by-2 table were used to compute the sensitivity and specificity of the CS at the various reference points and subsequently plot a receiver operating characteristic(ROC)curve that was used to determine the best cut-off point.Those above and below the best CS cut-off point as determined by the ROC were classified as being positive and negative for FO,respectively.The proportions of participants diagnosed with FO by the CS and BIA,respectively,were computed and summarized in a 2-by-2 contingency table for comparison.McNemar’s chi-squared test was used to assess any statistically significant difference in proportions of patients diagnosed as having FO by CS and BIA.Logistic regression analysis was conducted to assess whether the variables for the duration of dialysis,the number of missed dialysis sessions,advisement by health care professional on fluid or salt intake,actual fluid intake,the number of anti-hypertensives used,or body mass index were associated with a patient’s odds of having FO as diagnosed by BIA.RESULTS From 100 patients on maintenance HD screened for eligibility,80 were recruited into this study.Seventy-one(88.75%)patients were fluid overloaded when evaluated using BIA with mean extracellular volume of 3.02±1.79 L as opposed to the forty-seven(58.25%)patients who had FO when evaluated using the CS.The difference was significant,with a P value of<0.0001(95%confidence interval:0.1758-0.4242).Using CS,values above 4 were indicative of FO while values less than or equal to 4 denoted the best cut-off for no FO.The sensitivity and specificity for the CS were 63%and 78%respectively.None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.CONCLUSION FO is very prevalent in patients on chronic HD at the Kenyatta National Hospital.CS detects FO less frequently when compared with BIA.The sensitivity and specificity for the CS were 63%and 78%respectively.None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.

Spousal concordance in academic achievements and IQ: A principal component analysis

Assortative mating, the tendency for mate selection to occur on the basis of similar traits plays an essential role in understanding the genetic variation on academic achievements and intelligence (IQ), it is also an important mechanism explaining spousal concordance. We used a subset of The Collaborative Study on the Genetics of Alcoholism sample to study the mating patterns in 84 pairs of spouses from Caucasian families with their academic achievements (reading, spelling, arithmetic, vocabulary and comprehension) and IQ (verbal IQ, performance IQ and full scale IQ). Simple correlation analysis showed that 6 of these 8 traits revealed evidence of spousal correlation (P < 0.05). The first principal component (PC1) of husbands explains 73.61% for the variation in the eight variables, which has high loadings from reading, spelling, arithmetic, verbal IQ and full scale IQ while PC1 of wives explains 72.86% for the variation in the eight variables, which has high loadings from reading, spelling, verbal IQ and full scale IQ. There was highly significant positive correlation between spouses by PC1 (P < 0.0001). The new variable PC1 may be important in spousal concordance and mate selection in society and act upon achievements and intelligence levels.

Decomposition of Independence Using the Logit Uniform Association Model and Equality of Concordance and Discordance for Two-Way Classifications

For two-way contingency tables with ordered categories, the present paper gives a theorem that the independence model holds if and only if the logit uniform association model holds and equality of concordance and discordance for all pairs of adjacent rows and all dichotomous collapsing of the columns holds. Using the theorem, we analyze the cross-classification of duodenal ulcer patients according to operation and dumping severity.

Concordance to the Poems of Kyriakos Charalambides Through the ΑntConc Application With Reference Text—The “Sweet Preserves”

This study is based on the combination of the following three primary pylons:(1)Literature;(2)Information—Communication Technology;(3)Utilization of digital means in the educational approach.The objective of this project is the utilization of the concordance with the help of AntConc application in the educational approach and specifically in the subject of Modern Greek literature.With the contribution of the above application,the educational process makes it more effective to comprehend a particularly hard kind of literature such as poetry.Thus,Kyriakos Charalambides’1 poetry can be approached in both a different and an imaginative way,compared to the traditional textual way and as a result poetry can become more attractive for the students.The project is focused on the poetic work of Kyriakos Charalambides,which consists of thirteen collections of poems.The reference text,which is included in the textbook“Modern Greek Texts”taught in the 2nd Grade of High School and is part of the curriculum,is a poem called“Sweet Preserves”(Charalambides,2000).The objective is to investigate whether in practice and particularly in the subject of Modern Greek literature,the above mentioned application can be utilized through the search of the literal type“soil”,through AntConc application for tracing the appearance frequency of this word and by extension the highlighting of this thematic motif in the poetic work of Kyriakos Charalambides.Finally,in order that both the students’response(whether the objective was reached and the educational mediations were successful)and a certain level of awareness have been achieved,a questionnaire was distributed among the students and the students’answers were decoded through a specific type of software called SPSS so that the relevant outcomes were extracted.

The effect of acculturation in the concordance of oral health related quality of life in Latino children and their parents

The Latino population is the fastest growing and the largest minority group in the United States comprising 16% of the population younger than 18 years of age. Yet, little is known about the effect of acculturation in oral health related quality of life in Latino children and their parents. Objective: The objective of this study was to assess the effect of acculturation in parent and child’s perceptions of the child’s oral health status and oral health related quality of life (OHRQoL) as well as the effect in the concordance between children and parents/caregivers. Method: Sixty-three Latino children between the ages of 8 and 15, and their parents were recruited from the waiting room at the University of California, San Francisco Orthodontic and Pediatric Clinics. Parent and children each separately completed the Child Oral Health Impact Profile questionnaire (COHIP) for children and COHIP for parent/caregiver. Results: Of the sixty-three children, fifteen children (23.8%) had a more negative perception of their oral health than their parents whereas twenty-three children (36.5%) had a more positive perception. In terms of agreement between children and parents, questions about oral health showed the lowest level of agreement (34.9%) and self-image questions the highest (55.6%). Conclusion: The study findings indicate that the more acculturated the child, the more negative their perception of their oral health. The level of disagreement between parent and child, underscores the importance of obtaining both the child and parent OHRQoL perceptions.

Concordance between Clinical and Histopathological Diagnoses at Komfo Anokye Teaching Hospital Oral and Maxillofacial Unit

Background: Accurate diagnosis of orofacial tumours is important as this determines the treatment options as well as the eventual treatment outcome. Agreement between clinical and histopathological diagnosis becomes important in this regard. Aims: The aim was to determine the level of agreement between clinical and histopathology diagnosis of orofacial lesions. Method: This is a retrospective study of all histopathology reports seen at KATH maxillofacial unit. Thedata collected included, clinical diagnosis and histological diagnosis. Results: A total of 567 histopathology reports were evaluated. The percentage of agreement between clinical and histopathological diagnosis was 62.8%. Conclusion: The agreement between clinical and histopathological diagnosis was high. However clinicians cannot rely on only the clinical diagnosis in managing patients.

Concordance among indices of intrinsic brain function： Insights from inter-individual variation and temporal dynamics

Various resting-state fMRI(R-fMRI) measures have been developed to characterize intrinsic brain activity. While each of these measures has gained a growing presence in the literature, questions remain regarding the common and unique aspects these indices capture. The present work provided a comprehensive examination of inter-individual variation and intra-individual temporal variation for commonly used measures, including fractional amplitude of low frequency fluctuations, regional homogeneity,voxel-mirrored homotopic connectivity, network centrality and global signal correlation. Regardless of whether examining intra-individual or inter-individual variation, we found that these definitionally distinct R-fMRI indices tend to exhibit a relatively high degree of covariation, which doesn't exist in phase randomized surrogate data. As a measure of intrinsic brain function, concordance for R-fMRI indices was negatively correlated with age across individuals(i.e., concordance among functional indices decreased with age). To understand the functional significance of concordance, we noted that higher concordance was generally associated with higher strengths of R-fMRI indices, regardless of whether looking through the lens of inter-individual(i.e., high vs. low concordance participants) or intra-individual(i.e., high vs.low concordance states identified via temporal dynamic analyses) differences. We also noted a linear increase in functional concordance together with the R-fMRI indices through the scan, which may suggest a decrease in arousal. The current study demonstrated an enriched picture regarding the relationship among the R-fMRI indices, as well as provided new insights in examining dynamic states within and between individuals.

Evaluation of concordance between environment and economy in Qinghai Lake Watershed, Qinghai- Tibet Plateau

Qinghai Lake Watershed （QLW） is a hot place of a series of ecological restoration and environmental remediation programs nowadays.However,little information is available on change of ecosystem service and economic practice in this area.As ecosystem service and natural capital are closely related with social and economic development,an index of concordance between environment and economy （ICEE） has been proposed to compare the annual variation rate of ecosystem service value （RESV） with that of gross domestic product （RGDP）.Using this Index,we have assessed concordance between environment and economy （CEE） for the QLW in the period 1977-2004.The result showed that from 1977 to 2004,the ecosystem service value in the QLW descended from 128.81×10 8 yuan to 127.32×10 8 yuan;In contrast,the GDP increased from 0.931×10 8 yuan to 8.856×10 8 yuan.The values of the I CEE were -1.14,-0.22,and -0.14 in the stages of 1977-1987,1987-2000 and 2000-2004,respectively.The result indicated that during the first stage 1977-1987,the relationship between environment and economy in the QLW was not concordant but at a high conflict;from 1987 to 2004,there was a low conflict between environment and economy,and the CEE appeared to increase slowly.Analysis of the assessment results showed that the national policies and industrial adjustment practice play an important role in the CEE changes.

以企业竞争优势为中心的3M经营成果测定法

在日益复杂化的市场竞争环境中,影响企业经营成果水平的因素越来越多。使用何种方法对企业经营成果进行测定才更为合理准确,一直是广大学者和企业战略家们探讨的热门话题。本文分析了传统企业成果测定方法的局限性,从战略角度出发,以企业竞争优势为中心,介绍了3M经营成果测定法;剖析了其与企业竞争优势之间的关系,并设定了3M经营成果测定模型。希望能够为以Concordance Process理论为代表的关于企业竞争优势的各种研究提供一种准确可行的成果测定方法,使今后的实证研究更加严谨科学。

民营企业竞争优势来源解析模型研究——基于PP与CP的辩证关系

Power Process和Concordance Process作为两大竞争战略理论在韩国被提出,其科学性已为一些实证研究所证明.本文以此为基础,针对民营中小企业的竞争优势来源进行实证研究,确定了民营企业竞争来源解析模型,并进一步揭示了Power Process和Concordance Process两理论的辩证关系.

Contribution of Imaging to the Diagnosis of Non-Traumatic Tendinopathies of the Thoracic Limb in a Resource-Constrained Country

Introduction: Tendinopathy of the thoracic limb (TMT) is frequent, and is responsible for an important socio-professional handicap. Medical imaging, in particular, ultrasound has a major role in contributing to the diagnosis. As the use of ultrasound is recent in osteoarticular pathology, especially in Africa, we proposed to determine the contribution of imaging in the diagnosis of tendinopathy of the thoracic limbs in a country with limited resources. Patients and Method: A descriptive and analytical cross-sectional study of patients with tendinopathy of the thoracic limb who consulted the rheumatology department of the CNHU-HKM of Cotonou from August 6, 2019 to October 6, 2019. We evaluated the concordance of thoracic limb tendinopathy between imaging (radiography and ultrasound) and the clinic on the one hand and then between radiography and ultrasound on the other hand. The analysis of the collected data was carried out with the Epi-info software version 7.2.1.0. Then the concordance was evaluated by the kappa coefficient. Results: Fifty- two (52) patients with 104 joints were evaluated. The average age was 54.92 ± 3.40 years. Clinically, rotator cuff tendinopathy was the most frequent abarticular pathology (45.19%). The clinical-ultrasound agreement was strong (k = 0.7527) for the shoulders, very strong (k = 0.9360) for the elbows and moderate for the wrists (k = 0.6695). The clinical-radiographic agreement was weak (k = 0.2316) at the shoulder level and very weak (k = 0.2087) at the elbow level. The radio-ultrasound agreement was very low in the shoulders (k = 0.1522), elbows (k = 0.1859) and wrists (k = 0.0001). Conclusion: The contribution of imaging in the diagnosis of TMT remains certain even in a country with limited resources like ours. Ultrasound is a reliable examination for the diagnosis of non-traumatic tendinopathy of the thoracic limb with a good clinical-ultra- sound concordance and a weak radio-clinical and radio-ultrasound concordance.

The Reliability of Assessment of Ki-67 Expression on Core Needle Biopsy and the Surgical Specimens of Invasive Breast Cancer: Comparison of Local Pathologists’ Assessment and Central Review

Purpose: The aim of this study was to assess the reliability of Ki-67 expression on core needle biopsy (CNB) and the surgical specimens of invasive breast cancer. We examined the concordance rate of Ki-67 expressions, hormone receptors, and human epidermal growth factor receptor 2 (HER2) status from a CNB with from a surgery in invasive breast cancer. Methods: A retrospective study was conducted on a clinical database of patients who underwent surgery for early breast cancer. Of these, 193 patients who underwent CNB before the surgery were enrolled. A cut-off value of 20% was used for Ki-67-positive criteria. Expression of estrogen receptor (ER), progesterone receptor (PgR), and HER2 were examined and compared with that of Ki-67. To evaluate discordance between the pathologists’ earlier assessments, we re-examined Ki-67 expression among the Ki-67 discordant group in a central laboratory. Results: The concordance rate for Ki-67 expression between the two specimen types was 77.7%, which was significantly lower than that for ER, PgR, and HER2 expression (95.9%, 88.1%, and 91.6%, respectively). The concordance rate for re-examined Ki-67 expression among the Ki-67 discordant group improved to 93.8% and was not significantly different from that for the other receptors. Conclusion: The concordance rate for Ki-67 expression between biopsy and surgical specimens was significantly lower than that for ER, PgR, and HER2 expressions, but re-examination of Ki-67 expression in a central laboratory revealed no significant difference among the receptors, suggesting the need for standard pathological assessment of Ki-67 expression for clinical use as a predictive marker of breast cancer.

Comparison of tumor regression grading systems for locally advanced gastric adenocarcinoma after neoadjuvant chemotherapy

BACKGROUND Current tumor regression grade(TRG)evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results.The recent six-tier system(JGCA2017-TRG)recommended by the Japanese Gastric Cancer Association(JGCA)is worth investigating,as four-tier TRG systems are favored in various parts of the world.AIM To compare the predictive accuracies of five published TRG systems.METHODS Data were retrospectively collected from patients with locally advanced gastric cancer(LAGC)who underwent neoadjuvant chemotherapy followed by D2 Lymphadenectomy between January 2005 and January 2014 at our institution.Outcomes were overall survival(OS)and disease-free survival(DFS),which were evaluated separately using the following TRG systems:JGCA2017,JGCA,Becker,AJCC/CAP,and Mandard.RESULTS All five published TRG systems were independent predictors for OS and DFS.Concordance indices of the JGCA2017,JGCA,Becker,AJCC/CAP-TRG,and Mandard systems were 0.651/0.6480.652/0.649,0.693/0.695,0.688/0.685,and 0.674/0.675 for OS and DFS,respectively.The four-tier Becker system showed the highest c-index,which was significantly greater than that of the six-tier JGCA2017 and five-tier JGCA systems(P<0.05 in OS and DFS).When residual tumor percentages were reset as:“no residual tumor”,<10%,<100%,and“no response”,the rearranged cutoff values achieved a maximum c-index with 0.728 for OS and 0.737 for DFS,which was superior to the other five systems.CONCLUSION The newly introduced six-tier JGCA-TRG system cannot increase prognostic stratification.The four-tier Becker system is more suitable for LAGC patients.A population-based study is warranted to define the optimal criterion for TRG in LAGC patients.

Standardized Assessment of Ki-67 in Breast Cancer Patients Using Virtual Slides and an Automated Analyzer in Comparison to Central/Local Pathological Assessments

Purpose: To standardize the methods to measure Ki-67, there is an interest in automating the assessment of Ki-67. Therefore, we reviewed the possibility of introducing an automated analyzer to standardize the Ki-67 evaluation method. Methods: We retrospectively reviewed a clinical database of patients who underwent surgery for early breast cancer at Tokyo-West Tokushukai Hospital. Among them, those who underwent preoperative core needle biopsy (CNB) were enrolled. The concordance rates of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), and Ki-67 by local pathologists were reviewed (valuations made by local pathologists), and nonmatching cases (from August 2008 to October 2011) were reassessed both by central review and using an automated analyzer with virtual slides. The results were compared with the evaluations made by local pathologists, and we reexamined the concordance rate by using central review and the automated analyzer. Results: The concordance rate of Ki-67 evaluations made by local pathologists in the preoperative CNB and surgical specimens was 78.7% in 287 cases pathologically assessed from October 2008 to March 2013. This rate was significantly lower (p < 0.01) than that of ER (95.6%), PgR (88.5%), and HER2 (91.6%). Reassessment of the 37 cases of nonmatching Ki-67 values from 2008 to October 2011 using central review and an automated analyzer resulted in clear improvement in matching of 22 (92.1%) and 24 (93.1%) of 37 cases, respectively. Conclusion: The concordance rate of Ki-67 in preoperative CNB and surgical specimens was lower than that of other biological markers;however, they were nearly equal by reassessment using central review and an automated analyzer.

限制性团体沙箱体验在心理教育中的应用

心理教育与培训在越来越多的成人培训中被广泛重视与应用。但是传统的理论讲解已不能满足学员多层次、多视角的需要,应运而生的新的心理培训模式正在不断地产生和发展。其中限制性团体沙箱体验近年来发展成为了成人心理教育与培训的一种行之有效的培训模式。

Current understandings of the pathogenesis of type 1 diabetes:Genetics to environment

Type 1 diabetes(T1D)is an autoimmune disease that usually strikes early in life,but can affect individuals at almost any age.It is caused by autoreactive T cells that destroy insulin-producing beta cells in the pancreas.Epidemiological studies estimate a prevalence of 1 in 300 children in the United States with an increasing incidence of 2%-5%annually worldwide.The daily responsibility,clinical management,and vigilance required to maintain blood sugar levels within normal range and avoid acute complications(hypoglycemic episodes and diabetic ketoacidosis)and long term micro-and macro-vascular complications significantly affects quality of life and public health care costs.Given the expansive impact of T1D,research work has accelerated and T1D has been intensively investigated with the focus to better understand,manage and cure this condition.Many advances have been made in the past decades in this regard,but key questions remain as to why certain people develop T1D,but not others,with the glaring example of discordant disease incidence among monozygotic twins.In this review,we discuss the field’s current understanding of its pathophysiology and the role of genetics and environment on the development of T1D.We examine the potential implications of these findings with an emphasis on T1D inheritance patterns,twin studies,and disease prevention.Through a better understanding of this process,interventions can be developed to prevent or halt it at early stages.