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OBJECTIVES/GOALS: Patient-specific definition of extent of surgical excision is foundational to the safety offered by computer assisted interventions. Consequently, this study aims to develop a pipeline for automated segmentation of bone removed during cortical mastoidectomy, a technically complex otologic surgery. METHODS/STUDY POPULATION: A simulator, previously developed in our lab, allows fully immersive simulation of mastoidectomy using segmented temporal bones generated from CT data. Using the simulator, one attending surgeon will perform three trials of mastoidectomy on 20 different temporal bones. From the simulator we will obtain data on the volume of bone removed for a specific anatomy, averaged between trials. No new U-net (nnU-net), an open-source three-dimensional segmentation network, will then be trained to predict the volume of bone removed using segmented pre-operative CT imaging. Segmentation accuracy will be evaluated with the Dice coefficient, modified Hausdorff distance (mHD), sensitivity and specificity. RESULTS/ANTICIPATED RESULTS: We expect the mean pairwise Dice coefficient to be high indicating relative similarity of volume removed between trials. Moreover, we predict that following five-fold cross-validation the best model will result in a Dice coefficient, mHD, sensitivity, and specificity indicative of volume removed predictions consistent with surgeon-generated data. Finally, given that network training will penalize overlap of the predicted excised bone segment and previously segmented anatomic structures, we expect that no critical anatomical structures will be marked as tissue removed. DISCUSSION/SIGNIFICANCE: We hope to show that deep learning architectures can accurately predict bone removed during mastoidectomy. These predictions can be used for preoperative planning, as clinical endpoints in surgical simulators, or be used in conjunction with surgical robots, all ultimately improving patient safety.
Pain, depression, anxiety, and psychosis are common non-cognitive symptoms of dementia. They are often underdiagnosed and can cause significant distress and carer strain. Numerous standardised assessment tools (SATs) exist and are recommended for the assessment of non-cognitive symptoms of dementia. Anecdotal evidence suggests that SATs are used rarely and inconsistently. This study aims to explore which SATs to detect non-cognitive symptoms of dementia are recommended in local guidelines and used in practice across different organisations. Secondary aims were to identify barriers and facilitators to using these tools.
Methods
This service evaluation is cross-sectional in design. A questionnaire was developed and distributed to clinicians working with patients with advanced dementia in any setting, across four geographical locations (Leeds, Bradford, Hull, and Cambridge). Quantitative data were analysed descriptively, and qualitative data from free-text comments were interpreted using thematic analysis.
Results
135 professionals from a range of backgrounds and clinical settings completed the survey. Respondents indicated that SATs for non-cognitive symptoms in dementia were rarely used or recommended. Respondents were unaware of the existence of most SATs listed. 80% respondents felt that SATs were a useful adjunct to a structured clinical assessment. The most recommended tool was the Abbey Pain Scale, with 41 respondents indicating its recommendation by their Trust. Perceived facilitators to using SATs include education and training, reliable IT systems and accessibility. Barriers include lack of time and training.
Conclusion
Numerous SATs are available for use in dementia, but they are rarely recommended in local policy or used in practice. There appears to be a lack of consensus on which, if any, are superior diagnostic tools, and on how or when they should be applied.
Childhood exposure to interpersonal violence (IPV) may be linked to distinct manifestations of mental illness, yet the nature of this change remains poorly understood. Network analysis can provide unique insights by contrasting the interrelatedness of symptoms underlying psychopathology across exposed and non-exposed youth, with potential clinical implications for a treatment-resistant population. We anticipated marked differences in symptom associations among IPV-exposed youth, particularly in terms of ‘hub’ symptoms holding outsized influence over the network, as well as formation and influence of communities of highly interconnected symptoms.
Methods
Participants from a population-representative sample of youth (n = 4433; ages 11–18 years) completed a comprehensive structured clinical interview assessing mental health symptoms, diagnostic status, and history of violence exposure. Network analytic methods were used to model the pattern of associations between symptoms, quantify differences across diagnosed youth with (IPV+) and without (IPV–) IPV exposure, and identify transdiagnostic ‘bridge’ symptoms linking multiple disorders.
Results
Symptoms organized into six ‘disorder’ communities (e.g. Intrusive Thoughts/Sensations, Depression, Anxiety), that exhibited considerably greater interconnectivity in IPV+ youth. Five symptoms emerged in IPV+ youth as highly trafficked ‘bridges’ between symptom communities (11 in IPV– youth).
Conclusion
IPV exposure may alter mutually reinforcing symptom co-occurrence in youth, thus contributing to greater psychiatric comorbidity and treatment resistance. The presence of a condensed and unique set of bridge symptoms suggests trauma-enriched nodes which could be therapeutically targeted to improve outcomes in violence-exposed youth.
Crime, Deviance and Society: An Introduction to Sociological Criminology offers a comprehensive introduction to criminological theory. The book introduces readers to key sociological theories, such as anomie and strain, and examines how traditional approaches have influenced the ways in which crime and deviance are constructed. It provides a nuanced account of contemporary theories and debates, and includes chapters covering feminist criminology, critical masculinities, cultural criminology, green criminology, and postcolonial theory, among others. Case studies in each chapter demonstrate how sociological theories can manifest within and influence the criminal justice system and social policy. Each chapter also features margin definitions and timelines of contributions to key theories, reflection questions and end-of-chapter questions that prompt students reflection. Written by an expert team of academics from Australia, New Zealand and the United Kingdom, Crime, Deviance and Society is a highly engaging and accessible introduction to the field for students of criminology and criminal justice.
Internationally, intimate partner violence (IPV) cohorts have demonstrated associations with depression and anxiety. However, this association has not yet been described in a UK population, nor has the association with serious mental illness (SMI).
Aims
To explore the relationship between IPV exposure and mental illness in a UK population.
Method
We designed a retrospective cohort study whereby we matched 18 547 women exposed to IPV to 74 188 unexposed women. Outcomes of interest (anxiety, depression and SMI) were identified through clinical codes.
Results
At baseline, 9174 (49.5%) women in the exposed group had some form of mental illness compared with 17 768 (24.0%) in the unexposed group, described as an adjusted odds ratio of 2.62 (95% CI 2.52–2.72). Excluding those with mental illness at baseline, 1254 exposed women (incidence rate 46.62 per 1000 person-years) went on to present with any type of mental illness compared with 3119 unexposed women (incidence rate 14.93 per 1000 person-years), with an aIRR of 2.77 (95% CI 2.58–2.97). Anxiety (aIRR 1.99, 95% CI 1.80–2.20), depression (aIRR 3.05, 95% CI 2.81–3.31) and SMI (aIRR 3.08, 95% CI 2.19–4.32) were all associated with exposure to IPV.
Conclusions
IPV remains a significant public health issue in the UK. We have demonstrated the significant recorded mental health burden associated with IPV in primary care, at both baseline and following exposure. Clinicians must be aware of this association to reduce mental illness diagnostic delay and improve management of psychological outcomes in this group of patients.
By upbringing, family connections, and education, Felix Mendelssohn was ideally positioned to contribute to the historical legacies of the German people, who in the aftermath of the Napoleonic Wars discovered that they were a nation with a distinct culture. The number of cultural icons of German nationalism that Mendelssohn "discovered," promoted, or was asked to promote (by way of commissions) in his compositions is striking: Gutenberg and the invention of the printing press, Dürer and Nuremberg, Luther and the Augsburg Confession as the manifesto of Protestantism, Bach and the St. Matthew Passion, Beethoven and his claims to universal brotherhood. The essays in this volume investigate Mendelssohn's relationship to the music of the past from a variety of perspectives, including the pervasive presence of Bach's music within the larger Mendelssohn family, the influence of Beethoven in the Reformation Symphony, and Mendelssohn's compositions for organ and his relationship to English organs in particular. Together, they shed light on the construction of legacies that, in some cases, served to assert German cultural supremacy only two decades after the composer's death. Contributors: Celia Applegate, John Michael Cooper, Hans Davidsson, Wm. A. Little, Peter Mercer-Taylor, Siegwart Reichwald, Glenn Stanley, Russell Stinson, Benedict Taylor, Nicholas Thistlewaite, Jürgen Thym, R. Larry Todd, Christoph Wolff. Jürgen Thym is Professor Emeritus of Musicology at the Eastman School of Music and editor of Of Poetry and Song: Approaches to the Nineteenth-Century Lied (University of Rochester Press, 2010).
Incorporation of cover crop residue into the soil has been suggested as a means for reducing weed seedbanks. To explore this hypothesis, we buried mesh bags of seeds mixed with sand at 15-cm depth in late fall in plots that had been planted with rye (Secale cereale L.) or hairy vetch (Vicia villosa Roth.) or left unplanted. Separate bags contained either velvetleaf (Abutilon theophrasti Medik.), giant foxtail (Setaria faberi Herrm.), Powell amaranth (Amaranthus powellii S. Watson), or common lambsquarters (Chenopodium album L.). The experiment used a randomized complete block design with five replications, and enough bags were buried to allow a final recovery in each of the following three springs. Each spring, bags were exhumed, and seeds were either counted and tested for viability or mixed with chopped cover crop material or simply stirred for control bags, and the material was reburied. The experiment was completed twice with initial burials in fall of 2011 and 2013. Rye had no consistent effect on persistence of seeds of any of the species. For two observation intervals, rye increased persistence of a species; for another two intervals, it decreased persistence relative to the control; but mostly rye did not affect persistence. Hairy vetch decreased persistence of C. album and A. powellii in both runs of the experiment but had no effect on persistence of A. theophrasti and S. faberi. Germination of the first two species is promoted by nitrate, whereas A. theophrasti germination is not sensitive to nitrate, and S. faberi is only rarely nitrate sensitive. We suggest that nitrate released during decomposition of hairy vetch may have promoted fatal germination of C. album and A. powellii. Incorporation of legume cover crops like hairy vetch may provide a means for decreasing the seedbanks of the many weed species whose germination is promoted by nitrate. The lack of any reduction of A. theophrasti and S. faberi seed persistence in response to hairy vetch and the inconsistent and mostly negligible effect of rye indicate that a general increase in readily decomposable organic matter through incorporation of cover crops may be ineffective at reducing weed seedbanks.
Latrodectism following Black Widow envenomation is rare in Canada. We present the case of a previously healthy 50 year old male who presented with an acute abdomen, hypertension, and urinary retention. After a thorough work up it was determined to be as a result of a Black Widow spider bite. Due to climate change we may see more cases of Latrodectism in the future and it should be considered as a differential diagnosis in anyone presenting with an acute abdomen after an insect bite.
Some experiments concerned with the wake flows of a number of flat plates of low aspect ratio (Fail, Owen and Eyre) have suggested that for large angles of inclination to the undisturbed stream the wake includes a region of recirculation. The present observations include a detailed study of this region, with particular reference to the wake produced by an equilateral triangular plate, and an attempt is made to explain why the recirculatory flow is found only at angles of incidence greater than 35°. The data includes some wind tunnel measurements of force coefficients, static pressure and mean velocity, and observations of the wake flow made in a smoke tunnel and in a water tunnel.
We have mapped cold atomic gas in 21cm line H i self-absorption (HISA) at arcminute resolution over more than 90% of the Milky Way's disk. To probe the formation of H2 clouds, we have compared our HISA distribution with CO J = 1-0 line emission. Few HISA features in the outer Galaxy have CO at the same position and velocity, while most inner-Galaxy HISA has overlapping CO. But many apparent inner-Galaxy HISA-CO associations can be explained as chance superpositions, so most inner-Galaxy HISA may also be CO-free. Since standard equilibrium cloud models cannot explain the very cold H i in many HISA features without molecules being present, these clouds may instead have significant CO-dark H2.
IAU Commission 40 for Radio Astronomy (hereafter C40) brought together scientists and engineers who carry out observational and theoretical research in radio astronomy and who develop and operate the ground and space-based radio astronomy facilities and instrumentation. As of June 2015, the Commission had approximately 1,100 members from 49 countries, corresponding to nearly 10 per cent of the total IAU membership.