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Delineating the proximal urethra can be critical for radiotherapy planning but is challenging on computerised tomography (CT) imaging.
Materials and methods:
We trialed a novel non-invasive technique to allow visualisation of the proximal urethra using a rapid sequence magnetic resonance imaging (MRI) protocol to visualise the urinary flow in patients voiding during the simulation scan.
Of the seven patients enrolled, four were able to void during the MRI scan. For these four patients, direct visualisation of urinary flow through the proximal urethra was achieved. The average volume of the proximal urethra contoured on voiding MRI was significantly higher than the proximal urethra contoured on CT, 4·07 and 1·60 cc, respectively (p = 0·02). The proximal urethra location also differed; the Dice coefficient average was 0·28 (range 0–0·62).
In this small, proof-of-concept prospective clinical trial, the volume and location of the proximal urethra differed significantly when contoured on a voiding MRI scan compared to that determined by a conventional CT simulation. The shape of the proximal urethra on voiding MRI may be more anatomically correct compared to the proximal urethra shape determined with a semi-rigid catheter in place.
To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.
An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.
Twenty-two higher education institutions.
College students (n 17 686) enrolled at one of twenty-two participating universities.
Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04).
College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.
Research on the lateralizing value of neuropsychological tests is limited among Latino people with epilepsy (PWE). This study aims to evaluate the utility of two confrontation naming measures in laterality determination.
Data were collected from 71 Latino PWE who completed the Vocabulario Sobre Dibujos (VSD) and the Pontón-Satz Modified Boston Naming Test (MBNT). Raw and standardized scores were examined to determine diagnostic accuracy for predicting left hemisphere (LH) epilepsy for the full sample and using a sample-specific median split of educational attainment.
The MBNT demonstrated adequate classification accuracy (65.7%, 77.1%) as did the VSD (54.3%, 74.3%) for predicting LH seizure laterality using raw and standardized scores, respectively. For participants with ≥ 9 years of education (HEdu), receiver operator characteristic curve analyses showed a raw/percentile cutoff of ≤ 26/≤ 5th on the VSD, yielding 53%–58% sensitivity/87%–83% specificity. A raw score cutoff of ≤ 17 on MBNT produced 47% sensitivity/78% specificity for HEdu participants.
The VSD was found to have greater flexibility in determining cutoff scores using either raw or standardized scores for predicting seizure laterality. This study provides interpretation guidance, emphasizing education as a pertinent variable, to optimize lateralization accuracy for Latino PWE.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
In this article I caution that María Lugones's critiques of Kimberlé Crenshaw's intersectional theory posit a dangerous form of epistemic erasure, which underlies Lugones's decolonial methodology. This essay serves as a critical engagement with Lugones's essay “Radical Multiculturalism and Women of Color Feminisms” in order to uncover the decolonial lens within Crenshaw's theory of intersectionality. In her assertion that intersectionality is a “white bourgeois feminism colluding with the oppression of Women of Color,” Lugones precludes any possibility of intersectionality operating as a decolonial method. Although Lugones states that her “decolonial feminism” is for all women of color, it ultimately excludes Black women, particularly with her misconstruing of Crenshaw's articulation of intersectionality that is rooted within the Black American feminist tradition. I explore Lugones's claims by juxtaposing her rendering of intersectionality with Crenshaw's and conclude that Lugones's decolonial theory risks erasing Black women from her framework.
This paper gives a narrative account of how the Oxford Healthcare Improvement Centre has embedded continuous quality improvement (CQI) across both mental health and community services in Oxford, UK. The aim of the centre is to develop capability across healthcare services, with frontline staff leading CQI independently. The paper discusses the various methods employed to achieve this aim, including the provision of training, mentoring and support to those undertaking improvement work, alongside developing the required governance for CQI.
An experiment was conducted to test the hypothesis that meat products have digestible indispensable amino acid scores (DIAAS) >100 and that various processing methods will increase standardised ileal digestibility (SID) of amino acids (AA) and DIAAS. Nine ileal-cannulated gilts were randomly allotted to a 9 × 8 Youden square design with nine diets and eight 7-d periods. Values for SID of AA and DIAAS for two reference patterns were calculated for salami, bologna, beef jerky, raw ground beef, cooked ground beef and ribeye roast heated to 56, 64 or 72°C. The SID of most AA was not different among salami, bologna, beef jerky and cooked ground beef, but was less (P < 0·05) than the values for raw ground beef. The SID of AA for 56°C ribeye roast was not different from the values for raw ground beef and 72°C ribeye roast, but greater (P < 0·05) than those for 64°C ribeye roast. For older children, adolescents and adults, the DIAAS for all proteins, except cooked ground beef, were >100 and bologna and 64°C ribeye roast had the greatest (P < 0·05) DIAAS. The limiting AA for this age group were sulphur AA (beef jerky), leucine (bologna, raw ground beef and cooked ground beef) and valine (salami and the three ribeye roasts). In conclusion, meat products generally provide high-quality protein with DIAAS >100 regardless of processing. However, overcooking meat may reduce AA digestibility and DIAAS.
A growing body of research shows that women legislators outperform their male counterparts in the legislative arena, but scholars have yet to examine whether this pattern emerges in non-policy aspects of representation. We conducted an audit study of 6,000 U.S. state legislators to analyze whether women outperform or underperform men on constituency service in light of the extra effort they spend on policy. We find that women are more likely to respond to constituent requests than men, even after accounting for their heightened level of policy activity. Female legislators are the most responsive in conservative districts, where women may see the barriers to their election as especially high. We then demonstrate that our findings are not a function of staff responsiveness, legislator ideology, or responsiveness to female constituents or gender issues. The results provide additional evidence that women perform better than their male counterparts across a range of representational activities.
In the present study, we aimed to compare anthropometric indicators as predictors of mortality in a community-based setting.
We conducted a population-based longitudinal study nested in a cluster-randomized trial. We assessed weight, height and mid-upper arm circumference (MUAC) on children 12 months after the trial began and used the trial’s annual census and monitoring visits to assess mortality over 2 years.
Children aged 6–60 months during the study.
Of 1023 children included in the study at baseline, height-for-age Z-score, weight-for-age Z-score, weight-for-height Z-score and MUAC classified 777 (76·0 %), 630 (61·6 %), 131 (12·9 %) and eighty (7·8 %) children as moderately to severely malnourished, respectively. Over the 2-year study period, fifty-eight children (5·7 %) died. MUAC had the greatest AUC (0·68, 95 % CI 0·61, 0·75) and had the strongest association with mortality in this sample (hazard ratio = 2·21, 95 % CI 1·26, 3·89, P = 0·006).
MUAC appears to be a better predictor of mortality than other anthropometric indicators in this community-based, high-malnutrition setting in Niger.
Human alteration of the planet’s terrestrial landscapes for agriculture, habitation and commerce is reshaping wildlife communities. The threat of land cover change to wildlife is pronounced in regions with rapidly growing human populations. We investigated how species richness and species-specific occurrence of bats changed as a function of land cover and canopy (tree) cover across a rapidly changing region of Florida, USA. Contrary to our predictions, we found negligible effects of agriculture and urban development on the occurrence of all species. In contrast, we found that a remotely sensed metric of canopy cover on a broad scale (25 km2) was a good predictor of the occurrence of eight out of ten species. The occurrence of all smaller bats (vespertilionids) in our study increased with 0–50% increases in canopy cover, while larger bats showed different patterns. Occurrence of Brazilian free-tailed bats (Tadarida brasiliensis) decreased with increasing canopy cover, and Florida bonneted bats (Eumops floridanus) were not influenced by canopy cover. We conclude that remotely sensed measures of canopy cover can provide a more reliable predictor of bat species richness than land-cover types, and efforts to prevent the loss of bat diversity should consider maintaining canopy cover across mosaic landscapes with diverse land-cover types.
Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (P<0.001). VAS-AP improved from 5.8±2.9 to 3.5±3.0 at 12 months (P<0.001). The MCIDs for VAS-NP and VAS-AP were also reached at 12 months. Based on the NDI, patients were grouped into those with mild pain/no pain (33%) versus moderate/severe pain (67%). At 3 months, a significantly high proportion of patients with moderate/severe pain (45.8%) demonstrated an improvement into mild/no pain, whereas 27.2% with mild/no pain demonstrated worsening into moderate/severe pain (P <0.001). At 12 months, 17.4% with mild/no pain experienced worsening of their NDI (P<0.001). Conclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.
Atom probe tomography (APT) is a powerful technique to characterize buried three-dimensional nanostructures in a variety of materials. Accurate characterization of those nanometer-scale clusters and precipitates is of great scientific significance to understand the structure–property relationships and the microstructural evolution. The current widely used cluster analysis method, a variant of the density-based spatial clustering of applications with noise algorithm, can only accurately extract clusters of the same atomic density, neglecting several experimental realities, such as density variations within and between clusters and the nonuniformity of the atomic density in the APT reconstruction itself (e.g., crystallographic poles and other field evaporation artifacts). This clustering method relies heavily on multiple input parameters, but ideal selection of those parameters is challenging and oftentimes ambiguous. In this study, we utilize a well-known cluster analysis algorithm, called ordering points to identify the clustering structures, and an automatic cluster extraction algorithm to analyze clusters of varying atomic density in APT data. This approach requires only one free parameter, and other inputs can be estimated or bounded based on physical parameters, such as the lattice parameter and solute concentration. The effectiveness of this method is demonstrated by application to several small-scale model datasets and a real APT dataset obtained from an oxide-dispersion strengthened ferritic alloy specimen.
OBJECTIVES/SPECIFIC AIMS: Glaucoma is a leading cause of irreversible blindness worldwide; in the United States alone, over 2.7 million individuals are affected. Various risk factors for glaucoma are known and include age, race/ethnicity, genetics, and ocular measures. Despite numerous studies, molecular and environmental factors that contribute to glaucoma remain elusive. Our objective was to conduct a genome-wide association for glaucoma among black and white HRS respondents, and to determine the feasibility for future analyses examining shared genetic markers between glaucoma and other comorbidities, behaviors, and environmental risk factors. METHODS/STUDY POPULATION: The University of Michigan Health and Retirement Study (HRS) is a longitudinal survey of a representative sample of Americans over the age of 50. Supported by the National Institute on Aging and the Social Security Administration, the HRS is designed to provide reliable data on the decisions, choices, and behaviors of people as they age and respond to changes in public policy, the economy, and health. The study obtains information every two years about income and wealth, health and use of health services, work and retirement, and family connections. Through its unique and in-depth interviews, the HRS provides an invaluable and growing body of multidisciplinary data that researchers can use to address important questions about the challenges and opportunities of aging. Because of its innovation and importance, the HRS has become the model and hub for a growing network of harmonized longitudinal aging studies around the world. Saliva was collected on half of the HRS sample each wave starting in 2006 and respondents were genotyped on the Illumina Human Omni2.5-Quad (Omni2.5) BeadChip at the NIH Center for Inherited Disease Research. We accessed survey results to evaluate prevalence of glaucoma in this dataset and performed a genome-wide association study (GWAS) adjusting for age, sex, and significant Principal Components and stratifying by self-reported race (White / Black). RESULTS/ANTICIPATED RESULTS: Of 8179 respondents passing quality filters, 6409 (78.40%) were white and 985 (12.05%) were black. Self-reported glaucoma prevalence was 7.85% and 16.34% in white and black respondents, respectively. White respondents had a mean age of 76.97 (SD 7.53) and were 57.25% female. Black respondents had a similar mean age of 74.96 (SD 7.27) and were 62.54% female. More than 87% of both groups were assessed in 2012. Preliminary GWAS analyses did not replicate known glaucoma loci and no variants attained genome-wide significance. A suggestive variant (p<1e-05) in the black population was within 10kb of a known locus, rs1196998. Future analyses will evaluate genetic association with combinations of glaucoma and comorbidities. DISCUSSION/SIGNIFICANCE OF IMPACT: Glaucoma risk is higher in minority groups than in whites, and the majority of reported genetic studies of glaucoma have been performed in individuals of European descent. It is imperative to better understand the role of genetics, environment, and health behavior in glaucoma risk. Further, understanding common mechanisms underlying diseases that co-occur with glaucoma could illuminate novel disease mechanisms that can be targeted for early intervention and/or treatment.
Despite a recent increase in research on its sociopolitical implications, many questions regarding rap music’s influence on mass-level participation remain unanswered. We consider the possibility that “imagining a better world” (measured here as the degree to which young African Americans are critical of the music’s negative messages) can correlate with a desire to “build a better world” (operationalized as an individual’s level of political participation). Evidence from the Black Youth Project (BYP)’s Youth Culture Survey (Cohen 2005) demonstrates that rap critique exerts a conditional impact on non-voting forms of activism. Rap critique enhances heavy consumers’ civic engagement, but this relationship does not occur among Blacks who consume the music infrequently. By demonstrating rap’s politicizing power and contradicting certain criticisms of Hip Hop culture, our research celebrates the possibilities of Black youth and Black music.
Introduction: Despite revolutionary changes in the medical education landscape, journal club (JC) continues to be a ubiquitous pedagogical tool and is a primary way that residency programs review new evidence and teach evidence-based medicine. JC is a community of practice among physicians, which may help translate research findings into practice. Program representatives state that JC should have a goal of translating novel research into changes in clinical care, but there has been minimal evaluation of the success of JC in achieving this goal. Specifically, emergency medicine resident perspectives on the utility of JC remain unknown. Methods: We designed a multi-centre qualitative study for three distinct academic environments at the University of British Columbia (Vancouver, Victoria and Kelowna). Pilot testing was performed to generate preliminary themes and to finalize the interview script. An exploratory, semi-structured focus group was performed, followed by multiple one-on-one interviews using snowball sampling. Iterative thematic analysis directed data collection until thematic sufficiency was achieved. Analysis was conducted using a constructivist Grounded Theory method with communities of practice as a theoretical lens. Themes were compared to the existing literature to corroborate or challenge existing educational theory. Results: Pilot testing has revealed the following primary themes: (1) Only select residents are able to increase their participation in JC over the course of residency and navigate the transition from peripheral participant to core member; (2) These residents use their increased clinical experience to perceive relevance in JC topics, and; (3) Residents who remain peripheral participants identify a lack time to prepare for journal club and a lack of staff physician attendance as barriers to resident engagement. We will further develop these themes during the focus group and interview phases of our study. Conclusion: JC is a potentially valuable educational resource for residents. JC works as a community of practice only for a select group of residents, and many remain peripheral participants for the duration of their residency. Incorporation of Free Open-Access Medical Education resources may also decrease preparation time for residents and staff physicians and increase buy-in. To augment clinical impact, the JC community of practice may need to expand beyond emergency medicine and include other specialties.
Background: Current lumbar intervertebral disc prostheses provide suboptimal symptom relief with little natural load-cushioning. PVA-C is a promising biocompatible material, however previous studies from our lab show that it does not have adequate elastic modulus to mimic the annulus fibrosus. Here we present a prototype of an artificial lumbar intervertebral disc. Methods: The tensile properties of pure (5-35% PVA-C) and particle-reinforced (15% PVA-C with 5% of either Sephadex or hydroxyapatite) composite PVA-C formulations were evaluated. Simple tension and tensile stress relaxation tests were performed. Woven Teflon mesh was embedded in PVA-C and tested under compression. Endplate pull-out tests were performed. Results: Tensile testing showed that all PVA-C formulations behaved linearly for physiologic levels of strain (<20%). Tensile elastic modulus is an order of magnitude lower than the annulus fibrosus. Teflon has similar elastic modulus as collagen and compression of the hybrid Teflon-PVA-C construct revealed good biomechanical mimicry with elastic modulus of 20-25MPa at 20% deformation, similar to human data. Bonding between PVA-C and porous titanium endplate is excellent. Conclusions: A fiber-reinforced PVA-C impregnated composite adequately mimics the annulus fibrosus. Our prototype of a tissue mimicking artificial intervertebral disc utilizes a woven Teflon fiber with 20% PVA-C (+Hydroxyapatite) annulus and 5% pure PVA-C nucleus bonded to porous titanium foam endplates.
Background: Current lumbar intervertebral disc prostheses provide suboptimal symptom relief with little natural load-cushioning. PVA-C is a promising biocompatible material, and our previous study finds that it can closely mimic the properties of nucleus pulposus. However, pure PVA-C does not possess adequate stiffness to mimic the annulus fibrosus. Methods: Composite particle-reinforced PVA-C formulations were tested to identify methods that could increase the elastic modulus. This included: sephadex, hydroxyapatite (stock) and hydroxyapatite (in-solution synthesis). All formulations were tested using 15% PVA-C and 5% reinforcing agent. Indentation and durometer tests were performed as well as simple compression, compressive stress relaxation and creep. Results: Indentation and durometer results did not clearly reveal any specific formulations that significantly improved stiffness. The addition of in-solution synthesized hydroxyapatite resulted in 1.15 to 2 time increase in elastic modulus (0.3-0.9 MPa) and associated decrease in stress relaxation and creep. The addition of stock hydroxyapatite and spehadex (G100f and G50sf) lowered the elastic modulus and increased stress relaxation and creep. Conclusions: In-solution synthesized hydroxyapatite is the only particle-reinforced composite PVA-C formulation that exhibited greater stiffness than pure PVA-C. The elastic modulus will need to be increased by 5-10x to adequately mimic the annulus fibrosus. A fiber-reinforced composite will likely be needed to accomplish this.