Search

Limited therapies exist for neurofibromatosis type 1 (NF1)-associated plexiform neurofibroma (PN). For this reason, the activity of vinblastine (VBL) and methotrexate (MTX) was evaluated in children and young adults with NF1 and PN. Patients ≤ 25 years of age with progressive and/or inoperable NF1-PN received VBL 6 mg/m2 and MTX 30 mg/m2 weekly for 26 weeks, followed by every 2 weeks for 26 weeks. Objective response rate was the primary endpoint. Of 25 participants enrolled, 23 were evaluable. The median age of participants was 6.6 years (range 0.3–20.7). The most frequent toxicities were neutropenia and elevation of transaminases. On two-dimensional (2D) imaging, 20 participants (87%) had stable tumor, with a median time to progression of 41.5 months (95% confidence interval 16.9, 64.9). Two of eight participants (25%) with airway involvement demonstrated functional improvements including decreased positive pressure requirements and apnea-hypopnea index. A post hoc three-dimensional (3D) analysis of PN volumes was completed on 15 participants with amenable imaging; 7 participants (46%) had progressive disease on or by the end of therapy. VBL/MTX was well-tolerated but did not result in objective volumetric response. Furthermore, 3D volumetric analysis highlighted the lack of sensitivity of 2D imaging for PN response evaluation.

PURPOSE: The introduction of whole slide imaging and digital pathology has enabled greater scrutiny of visual search behaviors among pathologists. We aim to investigate zooming and panning behaviors, external markers of visual processing capabilities, and the changes with experience. APPROACHES: Twenty digitized breast core needle biopsy histopathology slides were obtained from the circulating slides from the main digital pathology trial (IRAS number: 258799). These were presented to five pathologists with varying experience (1.5 to 40 years) whose examinations were recorded. Data of visual fixations were collected using eye-tracking cameras, and the magnification data and zooming behaviors were extracted in an objective fashion by an automated algorithm. The relationship between experience and metrics was analyzed using mixed-effects regression analyses. RESULTS: There was a significant association between experience and both reading times ([Formula: see text]) and a number of fixations ([Formula: see text]), with these relationships being inversely proportional. The greater experience was also associated with greater diagnostic accuracy ([Formula: see text]). We found that experience was significantly associated with greater use of magnification changes ([Formula: see text]). Conversely, less experience showed a near significant association with the increased proportion of time spent panning ([Formula: see text]). CONCLUSIONS: Fewer fixations needed to reach a diagnosis and quicker reading times are indicative of greater cognitive and visual processing capabilities with greater experience. These cognitive capabilities may be a prerequisite for the more frequent zooming changes that are more prevalent with increasing experience.

Introduction: Paramedics and ambulance staff face many different stresses in today’s UK ambulance service, with many having reported an effect on their well-being and mental health. Humour is widely used by staff as a coping mechanism, but little is known about this topic. This literature review aims to find out how humour is used and how it can affect clinicians’ well-being.Methods: A total of nine medical databases were searched for relevant literature ‐ Cochrane, Scopus, CINAHL Complete, Science Direct, Medline Complete, Complementary Index, Academic Search Complete, Emerald Insight and Supplemental Index. Articles were included if they were published in 2005 or after, if they were a UK-based original study and if they studied humour in relation to paramedics’ well-being.Results: After limiters were applied, a total of 26 articles were found. Only four articles met all the inclusion and exclusion criteria. Two of the articles studied humour directly, whereas two found humour as a result of studying the resilience and strategies used to cope with the stresses of ambulance work. Four key themes were identified: different types of humour, the source and boundaries of humour, offloading and camaraderie.Conclusion: This review of the literature found that many in the ambulance community view their use and expression of humour as a positive coping strategy that helps them to relieve the stresses of the job. Further research is needed to investigate any negative effects that humour has on a clinician’s well-being and larger studies are needed to give a better representation of the ambulance community.

This study builds on the findings of previous research into church-related tweets by considering and analysing the content of 1,004 tweets containing the word “church” which were posted from within Greater London during a 10-week period. The qualitative analysis of the resultant Twitter dataset enabled the research team to validate a previously proposed coding framework for church-related tweets, subject to a minor change, and provide new evidence around the types of content discussed in church-related tweets posted from across all London boroughs. This paper concludes by drawing-out some of the key lessons which sociologists of religion can learn by exploring church-related tweets.

Background/Aims The UK Government piloted a COVID-19 digital contact tracing smartphone app on the Isle of Wight, England, in June 2020 in attempt to contain the spread of the virus. This study aimed to investigate the factors that affected the decision to download the app among individuals in the Isle of Wight. Methods Online questionnaires were distributed over social media to the sample population. Quantitative data were analysed, both descriptively and using a Chi-square or Fisher's test. Qualitative data were analysed through content analysis. Results Overall, 74.2% of participants downloaded the COVID-19 app, citing compliance, protection and fighting the pandemic or returning to normal as their main reasons. There was a significant negative correlation between having concerns about the app and downloading the app (P=Conclusions Concerns about the COVID-19 app, particularly in terms of its security, significantly affected whether participants were likely to download it. The results provide insight into factors influencing mass public health behaviours and can form the basis for future research into app-based interventions.

Background Cryptococcosis due to Cryptococcus neoformans and Cryptococcus gattii varies with geographic region, populations affected, disease manifestations, and severity of infection, which impact treatment. Methods We developed a retrospective cohort of patients diagnosed with culture-proven cryptococcosis during 1995–2013 from 5 centers in North America and Australia. We compared underlying diseases, clinical manifestations, treatment, and outcomes in patients with C. gattii or C. neoformans infection. Results A total of 709 patients (452 C. neoformans; 257 C. gattii) were identified. Mean age was 50.2 years; 61.4% were male; and 52.3% were white. Time to diagnosis was prolonged in C. gattii patients compared with C. neoformans (mean, 52.2 vs 36.0 days; P Conclusions This study emphasizes differences in species-specific epidemiology and outcomes of patients with cryptococcosis, including underlying diseases, site of infection, and mortality. Species identification in patients with cryptococcosis is necessary to discern epidemiologic patterns, guide treatment regimens, and predict clinical progression and outcomes.

BackgroundReal-world data (RWD) from the Society for Vascular Surgery Vascular Quality Initiative (VQI) registry has been used to support US Food and Drug Administration (FDA) regulatory decisions regarding vascular devices. The variables of cost and time needed for these registry-based studies have not been previously compared to traditional, independent, industry studies that would otherwise have been conducted to support regulatory decisions.ObjectivesTo determine the potential value (cost and time saving and return on investment) created by device evaluation studies using the VQI registry infrastructure.MethodsWe compared studies that used data from the VQI registry with estimated costs of independent industry studies (counterfactual studies) using an established model using design specifications determined by FDA reviewers.ResultsWe analyzed the initial six studies evaluating vascular devices for regulatory decisions using data from the VQI registry that generated evidence for four device manufacturers. Return on investment for these studies was estimated to be 143% and cost saving as 59% based on an actual per patient (with 5-year follow-up) cost of US$11K using VQI data versus US$26K from the counterfactual when averaged across all studies. Significant enrollment time savings (45%–71%) were also realized compared with industry-based estimates.ConclusionsThe use of RWD from the VQI registry in this study and the transcatheter valve treatment coordinated registry network in a prior study indicates that substantial value was added to device evaluation projects by the reuse of registry data, with additional potential savings if linked claims data can be used instead of costly long-term in-person follow-up.

Background: Overuse of antibiotics and inappropriate prescribing has resulted in a rapid increase in the rate of antibiotic resistance, with poorer patient outcomes and increased health costs. In the out-of-hours setting, a high proportion of antibiotics are prescribed and practices need to improve to reduce antibiotic resistance.Purpose: To identify antibiotic prescribing practices in European out-of-hours primary care services that are contributing to antibiotic resistance.Design: The review was conducted in alignment with the PRISMA statement (Moher, Liberati, Tetzlaff, Altman, & PRISMA Group, 2009).Methods: A literature search was performed using MySearch to identify European literature. The search was focused on antibiotic/antimicrobial prescribing in an out-of-hours environment, and any reports that described factors correlating with the nature of prescribing practices were examined.Results: The literature search located 91 articles, out of which seven met the inclusion criteria. Two articles described clinicians’ experiences in antibiotic prescribing in out-of-hours, two compared in-office and after-hours prescribing, two described prescribing patterns in out-of-hours and one examined prescribing in children. Four main themes were identified: antibiotics prescribed and conditions associated with prescribing; consultation time; the day of consultation; and parental opinion.Conclusion: Overprescribing to self-limiting conditions, prescribing of broad-spectrum antibiotics, time constraints, safeguarding issues and poor communication are all contributing to inappropriate antibiotic prescribing. Further research is needed relating to whether clinicians are adhering to antibiotic guidelines and to explore patients’ experiences and expectations from the out-of-hours practitioners with respect to antibiotic prescribing.

Acute cough is one of the most common illnesses in the UK with an estimated 48 million cases per annum (Morice, McGarvey, Pavord, 2006). The majority of these presentations are thought to be of viral aetiology and self-limiting in nature (Woodhead et al, 2011), yet Meropol, Localio and Metlay (2013) report antibiotic prescription rates of approximately 65% in the UK. Clincians’ decision-making process can be influenced by both patient expectations and difficulty in differentiating between viral and bacterial aetiologies by clinical examination alone. Despite warnings about antimicrobial resistance (AMR) from the World Health Organisation (WHO, 2011) clinicians in the UK continue to have high prescription rates for acute cough presentations in comparison to other developed health care systems (Cooke et al, 2015; Smith et al, 2014; Hawker et al, 2014). This article will consider the feasibility, efficacy, benefits and limitations of using point of care testing (POCT) of C-reactive protein (CRP) within primary care in the United Kingdom to help inform management of acute cough.

This article seeks to define Digital Theology, first by exploring the development of the CODEC Research Centre at Durham University – perhaps the only centre developed to explore Digital Theology. The aims of the centre and some of its projects are explored leading to a discussion of CODEC’s place within Digital Humanities. The article concludes with a focus on different aspects and definitions of Digital Theology.

This article looks at Bible engagement in a digital age, focusing both on multimedia engagement with the Bible through the ages and on the changes that new technologies bring to the reading process, and asking some questions about our use of different technologies for different tasks. The article opens up the new possibilities afforded to scholars through the digitization of manuscripts and libraries, but also looks at the limitations of digital Bibles in their current forms. What new areas of research do the digital humanities open up for us?

Background Interleukin-13 (IL-13) is a key mediator of T-helper-cell-type-2 (Th-2)-driven asthma, the inhibition of which may improve treatment outcomes. We examined the safety, pharmacokinetics, pharmacodynamics, and immunogenicity of VR942, a dry-powder formulation containing CDP7766, a high-affinity anti-human-IL-13 antigen-binding antibody fragment being developed for the treatment of asthma. Methods We conducted a phase 1, randomized, double-blind, placebo-controlled, ascending-dose study at Hammersmith Medicines Research, London, UK, which is now complete. Healthy adults aged 18–50 years (n = 40) were randomized 3:1 to a single inhaled dose of VR942 0.5, 1.0, 5.0, 10, or 20 mg, or placebo. Adults aged 18–50 years who were diagnosed with asthma for ≥6 months before screening, and had forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) values ≥70% of the predicted values at screening (n = 45), were randomized to once-daily inhaled VR942 0.5 or 10 mg, or placebo (2:2:1), or VR942 20 mg or placebo (3:2), for 10 days. All participants were randomized to receive VR942 or placebo based on a randomization list prepared by an independent HMR statistician using SAS® software ( SAS Institute , Cary, NC). The primary outcome was safety and tolerability of VR942 (safety population, defined as all who received at least one dose of VR942 or placebo). This study is listed on ClinicalTrials.gov (NCT02473939). Findings In the VR942 and placebo groups, treatment-emergent adverse events (TEAEs) were reported in 10/30 (33%) and 0/10 (0%) healthy participants, and in 16/29 (55%) and 9/16 (56%) participants with asthma, respectively. Mild intermittent wheezing occurred in 7 participants (VR942 20 mg, n = 4; corresponding placebo, n = 3), resolving spontaneously within 1 h. All TEAEs were mild or moderate; there were no deaths, serious adverse events, or clinically significant changes in vital signs, electrocardiograms, or laboratory parameters. There was no clinically significant immunogenicity, with only one participant with asthma considered positive for treatment-related immunogenicity for CDP7766. Interpretation This study, considered to be the only example of a dry powder anti-IL-13 fragment antibody being administered via inhalation, demonstrated that single and repeat doses were well tolerated over a period of up to 10 days in duration. Rapid and durable inhibition of fractional exhaled nitric oxide (FeNO) (secondary outcome) provided evidence of pharmacological engagement with the IL-13 target in the airways of participants diagnosed with mild asthma. These data, together with the numerical improvements observed for predose FEV1, justify further clinical evaluation of VR942 in a broader population of patients with asthma, and continue to support the development of an inhaled anti-IL-13 antibody fragment as a potential future treatment that is alternative to monoclonal antibodies delivered via the parenteral route. Funding Study funding and funding for the medical writing and editorial support for preparation of the manuscript were split equally between the two study co-funders (Vectura Ltd and UCB Pharma).

Summary Background Appropriate use of highly active antiretroviral therapy (ART) can substantially decrease the risk of progression to AIDS and of premature mortality. We aimed to characterise the trends between 1981 and 2013 in AIDS-defining illnesses (ADIs) and the number AIDS-related deaths in British Columbia, Canada, where ART has been fully subsidised since 1996. Methods We included data on HIV-positive individuals, aged 19 years or older, from four administrative databases in British Columbia: the British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, the British Columbia Vital Statistics Agency, the British Columbia Cancer Agency. We estimated the relative risk of developing an ADI over time by use of a negative binomial model, and we investigated trends in the proportion of all deaths associated with AIDS by use of generalised additive models. Findings Data were available for 3550 people with HIV. 6205 ADIs were recorded. In 2013, 84 ADIs occurred, the lowest number since 1990. The peak of the AIDS epidemic in the region happened in 1994 with 696 ADIs reported (42 ADIs per 100 person-years). Since 1997, the number of ADIs decreased from 253 (7 per 100 person-years) to 84 cases in 2013 (1 per 100 person-years; p Pneumocystis jirovecii pneumonia remained prominent (albeit with much reduced overall prevalence). 2828 deaths were from AIDS-related causes, peaking in 1996 with 241 (96%) of 252 deaths in people with HIV and declining to 44 (20%) of 218 in 2013. Interpretation Our results provide further evidence that integrated comprehensive free programmes that facilitate testing and deliver treatment and care can be effective in decreasing AIDS-related morbidity and mortality, thus suggesting that control of and eventually an end to AIDS are possible. Funding British Columbia Ministry of Health, US National Institutes of Health, US National Institute on Drug Abuse, Canadian Institutes of Health Research, Michael Institute for Health Research.

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease. FMD once considered rare, is increasingly a condition recognised as an incidental finding. It is an important cause of stroke especially in younger, female patients and therefore a high index of suspicion is required. FMD has distinct pathological findings along with some pathognomonic angiographic findings (“string of beads” appearance). The mainstay of cerebrovascular FMD treatment is antiplatelet therapy but intervention with percutaneous transluminal angioplasty is indicated under some circumstances. We present an interesting case of a woman in her 60 s who underwent extensive investigation to identify the underlying aetiology of her stroke.

Purpose: To design, implement and evaluate the effect of an educational intervention on student radiographer attitudes across their educational tenure. \ud \ud Methods: In the first phase, an educational intervention that involved didactic lectures, reflective exercises and simulation suits, aimed at improving student radiographer attitudes towards the older person, was designed and implemented. Kogan’s attitudes towards older people (KoP) scale was administrated at five test points; pre-intervention; post-intervention; 6 months post intervention; 12 months post intervention and 24 months post intervention. At the final test point these quantitative data was supplemented with qualitative data for triangulation of the findings. \ud \ud Results: Students held positive attitudes towards older people pre intervention, these increased significantly post intervention (p=0.01). However, this increase in positive scores was not noted at 6 months and 12-months post intervention. At 24-months post intervention, although there was a slight increase in positive attitudes when compared to the 6 and 12 month scores, this increase was not found to be significant (p=.178) \ud \ud Conclusions: The results post-intervention suggested that an educational intervention can have a significant impact on student radiographer’s attitudes towards older people. However, the qualitative data suggests that experiences on initial clinical placement can be detrimental to attitudinal scores, particularly if the intervention does not include Dementia care strategies.

As navigation speed increases, gaze of the reader becomes more central and polyp identification rates fall., Purpose To investigate the effect of increasing navigation speed on the visual search and decision making during polyp identification for computed tomography (CT) colonography Materials and Methods Institutional review board permission was obtained to use deidentified CT colonography data for this prospective reader study. After obtaining informed consent from the readers, 12 CT colonography fly-through examinations that depicted eight polyps were presented at four different fixed navigation speeds to 23 radiologists. Speeds ranged from 1 cm/sec to 4.5 cm/sec. Gaze position was tracked by using an infrared eye tracker, and readers indicated that they saw a polyp by clicking a mouse. Patterns of searching and decision making by speed were investigated graphically and by multilevel modeling. Results Readers identified polyps correctly in 56 of 77 (72.7%) of viewings at the slowest speed but in only 137 of 225 (60.9%) of viewings at the fastest speed (P = .004). They also identified fewer false-positive features at faster speeds (42 of 115; 36.5%) of videos at slowest speed, 89 of 345 (25.8%) at fastest, P = .02). Gaze location was highly concentrated toward the central quarter of the screen area at faster speeds (mean gaze points at slowest speed vs fastest speed, 86% vs 97%, respectively). Conclusion Faster navigation speed at endoluminal CT colonography led to progressive restriction of visual search patterns. Greater speed also reduced both true-positive and false-positive colorectal polyp identification. © RSNA, 2017 Online supplemental material is available for this article.

The following article was delivered as the annual lecture of the Methodist Sacramental Fellowship at the 2016 Methodist Conference in London. Beginning with the original context of John Wesley's well-known phrase, ‘the world as my parish’, this article explores the digital aspects of our global parish today. Putting the digital age on the agenda of the Church's mission is seen as a similar response to Wesley's decision to become ‘more vile’ and enter the world of field preaching. The lecture concludes by offering a fresh approach to Methodist identity magnified by aspects of digital culture, calling for the creation of digital Arminianism, digital field preaching, digital creativity and, ultimately, a digital parish. The article proposes that Methodism embrace a digital social holiness to spread scriptural holiness throughout the geographic and digital landscape.

We aimed to identify the effect of computer-aided detection (CAD) on visual search and performance in CT Colonography (CTC) of inexperienced and experienced readers. Fifteen endoluminal CTC examinations were recorded, each with one polyp, and two videos were generated, one with and one without a CAD mark. Forty-two readers (17 experienced, 25 inexperienced) interpreted the videos during infrared visual search recording. CAD markers and polyps were treated as regions of interest in data processing. This multi-reader, multi-case study was analysed using multilevel modelling. CAD drew readers’ attention to polyps faster, accelerating identification times: median ‘time to first pursuit’ was 0.48 s (IQR 0.27 to 0.87 s) with CAD, versus 0.58 s (IQR 0.35 to 1.06 s) without. For inexperienced readers, CAD also held visual attention for longer. All visual search metrics used to assess visual gaze behaviour demonstrated statistically significant differences when “with” and “without” CAD were compared. A significant increase in the number of correct polyp identifications across all readers was seen with CAD (74 % without CAD, 87 % with CAD; p

Objective: Eye tracking in three dimensions is novel, but established descriptors derived from two-dimensional (2D) studies are not transferable. We aimed to develop metrics suitable for statistical comparison of eye-tracking data obtained from readers of three-dimensional (3D) “virtual” medical imaging, using CT colonography (CTC) as a typical example.\ud \ud Methods: Ten experienced radiologists were eye tracked while observing eight 3D endoluminal CTC videos. Sub-sequently, we developed metrics that described their visual search patterns based on concepts derived from 2D gaze studies. Statistical methods were developed to allow analysis of the metrics.\ud \ud Results: Eye tracking was possible for all readers. Visual dwell on the moving region of interest (ROI) was defined as pursuit of the moving object across multiple frames. Using this concept of pursuit, five categories of metrics were defined that allowed characterization of reader gaze behaviour. These were time to first pursuit, identi-fication and assessment time, pursuit duration, ROI size and pursuit frequency. Additional subcategories allowed us to further characterize visual search between readers in the test population.\ud \ud Conclusion: We propose metrics for the characterization of visual search of 3D moving medical images. These metrics can be used to compare readers’ visual search patterns and provide a reproducible framework for the analysis of gaze tracking in the 3D environment. Advances in knowledge: This article describes a novel set of metrics that can be used to describe gaze behaviour when eye tracking readers during interpretation of 3D medical images. These metrics build on those established for 2D eye tracking and are applicable to increasingly common 3D medical image displays.

In this paper a new approach is proposed to track the perceptual behaviour of radiologists when they examine mammographic images displayed on large dual clinical monitors. Zooming and panning are inevitably performed by the radiologist to examine such large images by using the DICOM viewing software. Such image manipulating movements on the target displays makes eye tracking techniques difficult to perform and also the size of the dual clinical monitors makes existing eye tracking techniques generally inadequate. Hence a method using the Smart Eye Pro eye tracker and optical character recognition techniques was designed to relate the recorded radiologists’ eye gaze behaviour on the monitors to the actual zoomed and panned medical image areas. This then allows clinical studies involving radiologists interacting with these mammographic images to be successfully carried out.

This article presents a case study in which the author piloted the flipped classroom on a cohort of paramedic science students at a UK higher education institution. The flipped classroom will be explained alongside the rationale for considering it as a good pedagogical addition for paramedic students. As a new pedagogy, the flipped classroom will be considered against what is currently known about learning theories and teaching styles. There are potential drawbacks to this method of teaching and learning and these will be discussed, as will suggestions to mitigate these drawbacks. Finally, the impact upon the students will be considered and the author will comment on the pilot and what this means for paramedic education in the future.

Objective: To assess the effect of expected abnormality prevalence on visual search and decision-making in CT colonography (CTC).Methods: 13 radiologists interpreted endoluminal CTC flythroughs of the same group of 10 patient cases, 3 times each. Abnormality prevalence was fixed (50%), but readers were told, before viewing each group, that prevalence was either 20%, 50% or 80% in the population from which cases were drawn. Infrared visual search recording was used. Readers indicated seeing a polyp by clicking a mouse. Multilevel modelling quantified the effect of expected prevalence on outcomes.Results: Differences between expected prevalence were not statistically significant for time to first pursuit of the polyp (median 0.5 s, each prevalence), pursuit rate when no polyp was on screen (median 2.7 s21, each prevalence) or number of mouse clicks [mean 0.75/ video (20% prevalence), 0.93 (50%), 0.97 (80%)]. There was weak evidence of increased tendency to look outside the central screen area at 80% prevalence and reduction in positive polyp identifications at 20% prevalence.Conclusion: This study did not find a large effect of prevalence information on most visual search metrics or polyp identification in CTC. Further research is required to quantify effects at lower prevalence and in relation to secondary outcome measures.Advances in knowledge: Prevalence effects in evaluating CTC have not previously been assessed. In this study, providing expected prevalence information did not have a large effect on diagnostic decisions or patterns of visual search.

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich., This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively., Objective: The aim of this study was to explore reader gaze, performance, and preference during interpretation of cranial computed tomography (cCT) in stack mode at two different sizes. Background: Digital display of medical images allows for the manipulation of many imaging factors, like image size, by the radiologists, yet it is often not known what display parameters better suit human perception. Method: Twenty-one radiologists provided informed consent to be eye tracked while reading 20 cCT cases. Half of these cases were presented at a size of 14 x 14 cm (512 x 512 pixels), half at 28 x 28 cm (1,024 x 1,024 pixels). Visual search, performance, and preference for the two image sizes were assessed. Results: When reading small images, significantly fewer, but longer, fixations were observed, and these fixations covered significantly more slices. Time to first fixation of true positive findings was faster in small images, but dwell time on true findings was longer. Readers made more false positive decisions in small images, but no overall difference in either jackknife alternative free-response receiver operating characteristic or reading time was found. Conclusion: Overall performance is not affected by image size. However, small-stack-mode cCT images may better support the use of motion perception and acquiring an overview, whereas large-stack-mode cCT images seem better suited for detailed analyses. Application: Subjective and eye-tracking data suggest that image size influences how images are searched and that different search strategies might be beneficial under different circumstances.

Crime activities are geospatial phenomena and as such are geospatially, thematically and temporally correlated. We analyze crime datasets in conjunction with socio-economic and socio-demographic factors to discover co-distribution patterns that may contribute to the formulation of crime. We propose a graph based dataset representation that allows us to extract patterns from heterogeneous areal aggregated datasets and visualize the resulting patterns efficiently. We demonstrate our approach with real crime datasets and provide a comparison with other techniques.

Climate change and energy efficiency are some of the most pressing issues facing China today. With its economic growth since the economic reforms in 1978 the government has struggled to contain environmental damage and social strife related to the economy’s rapid transformation. With the rapid growth in population and urbanization the demand for housings escalated and thus existing houses are under threat of being demolished to make way for new construction. However there was a strong debate that existing houses should be maintained and upgraded instead of demolishing for new development as improvements to energy and water efficiency of existing homes can significantly reduce greenhouse gas emissions and decrease utility bills. This paper aims at reviewing the importance of existing houses and their environmental significance in conservation as opposed to demolition. This paper presents and discusses the preliminary results for the first two stages of a research project undertaken at the University of Technology Sydney to investigate environmental performance of historic housings in Xiao He Zhi Jie in Hangzhou, China.

Intelligent crime analysis allows for a greater understanding of the dynamics of unlawful activities, providing possible answers to where, when and why certain crimes are likely to happen. We propose to model density change among spatial regions using a density tracing based approach that enables reasoning about large areal aggregated crime datasets. We discover patterns among datasets by finding those crime and spatial features that exhibit similar spatial distributions by measuring the dissimilarity of their density traces. The proposed system incorporates both localized clusters (through the use of context sensitive weighting and clustering) and the global distribution trend. Experimental results validate and demonstrate the robustness of our approach.

An essential technique used in emulator development is a useful addition to any programmer's toolbox.

Clinical outcomes were reviewed for 4 patients with Cryptococcus gattii central nervous system infection who received dexamethasone for the treatment of persisting mental status abnormalities and focal lesions on brain scan despite culture-negative cerebrospinal fluid and the management of intracranial pressure. Favorable clinical responses were observed in 3 patients. Although corticosteroids are not recommended for the treatment of cryptococcal meningitis, these observations suggest that dexamethasone should be further evaluated in this subset of patients.

This paper reports upon an operation to displace camps of Black Flying-foxes Pteropus alecto using non-lethal methods from the town of Batchelor. The flying-foxes showed a preference for camping in African Mahogany trees Khala senegalensis. Flying-foxes were dispersed by a team of Parks and Wildlife staff and community volunteers using a combination of smoke, non-lethal plastic shot and noise. The flying-foxes ceased roosting in the town during the operation but continued efforts were required to ensure that flying-fox camps did not re-establish within the town. The use of methods for dispersal, the removal of camp trees and public relations are discussed.

Computers have increasingly become part of our everyday lives, with many activities either involving their direct use or being supported by one. This has prompted research into developing methods and mechanisms to assist humans in interacting with computers (human-computer interaction, or HCI). A number of HCI techniques have been developed over the years, some of which are quite old but continue to be used, and some more recent and still evolving. Many of these interaction techniques, however, are not natural in their use and typically require the user to learn a new means of interaction. Inconsistencies within these techniques and the restrictions they impose on user creativity can also make such interaction techniques difficult to use, especially for novice users. This article proposes an alternative interaction method, the conductor interaction method (CIM), which aims to provide a more natural and easier-to-learn interaction technique. This novel interaction method extends existing HCI methods by drawing upon techniques found in human-human interaction. It is argued that the use of a two-phased multimodal interaction mechanism, using gaze for selection and gesture for manipulation, incorporated within a metaphor-based environment, can provide a viable alternative for interacting with a computer (especially for novice users). Both the model and an implementation of the CIM within a system are presented in this article. This system formed the basis of a number of user studies that have been performed to assess the effectiveness of the CIM, the findings of which are discussed in this work.

Background Cryptococcus gattii (Cg) infection emerged in British Columbia in 1999. A longitudinal, clinical description of patients has not been reported. Methods Medical records were reviewed for Cg patients identified through surveillance (1999-2007). Risk factors for Cg mortality were explored using multivariate Cox regression; longitudinal patterns in serum cryptococcal antigen (SCrAg) titers and the probability of chest cryptococcomas over time were estimated using cubic B-splines in mixed-effects regression models. Results Among 152 patients, 111 (73.0%) were culture confirmed. Isolated lung infection was present in 105 (69.1%) patients; 47 (30.9%) had central nervous system infection, with or without lung involvement. Malignancy was the provisional diagnosis in 64 (42.1%) patients. Underlying diseases were present in 91 (59.9%) patients; 23 (15.1%) were immunocompromised, and 23 (15.1%) had asymptomatic disease. There were only 2 (1.8%) culture positive relapses, both within 12 months of follow-up. The estimated median time to resolution of lung cryptococcomas and decline in SCrAg titer to 50 years (hazard ratio [HR], 15.6; 95% confidence interval [CI], 1.9-130.5) and immunocompromise (HR, 5.8; CI, 1.5-21.6). All Cg-related mortality occurred among culture-positive cases within 1 year of diagnosis. Conclusions Cryptococcomas and serum antigenemia were slow to resolve. However, late onset of failed therapy or relapse was uncommon, suggesting that delayed resolution of these findings does not require prolongation of treatment beyond that recommended by guidelines.

In recent years there has been much debate, from scholars and performers alike, about the voice-types to be found in Tudor sacred music. This article considers these arguments as applied to the music that Tallis wrote both for the Anglican and the Catholic churches. The examination is based almost entirely on practical considerations, taking into account the inevitable changes that have occurred in a performing tradition where women are now employed to sing parts that were originally written for boys and men. The conclusion is that effectively all the ranges that Tallis would have recognized as normal no longer approximate to the ranges that modern professors of singing find normal, and the practical problems this throws up for present-day performers of Tallis are addressed. The author considers the demands that both the high-pitch and the written-pitch ranges make on modern performers, ultimately preferring the former for its greater luminousness.

Typical software development involves one of two processes: the creation of new software to fit particular requirements or the modification (maintenance) of old software to fix problems or fit new requirements. These transformations happen at the source-code level. But what if the problem is not the maintenance of old software but the need to create a functional duplicate of the original? And what if the source code is no longer available?