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Pharmacological treatment options for patients with dementia owing to Alzheimer's disease are limited to symptomatic therapy. Recently, the US Food and Drug Administration approved the monoclonal antibody lecanemab for the treatment of amyloid-positive patients with mild cognitive impairment (MCI) and early Alzheimer´s dementia. European approval is expected in 2024. Data on the applicability and eligibility for treatment with anti-amyloid monoclonal antibodies outside of a study population are lacking.
Aims
This study examined eligibility criteria for lecanemab in a real-world memory clinic population between 1 January 2022 and 31 July 2023.
Method
We conducted a retrospective, single-centre study applying the clinical trial eligibility criteria for lecanemab to out-patients of a specialised psychiatric memory clinic. Eligibility for anti-amyloid treatment was assessed following the phase 3 inclusion and exclusion criteria and the published recommendations for lecanemab.
Results
The study population consisted of 587 out-patients. Two-thirds were diagnosed with Alzheimer's disease (probable or possible Alzheimer's disease dementia in 43.6% of cases, n = 256) or MCI (23%, n = 135), and 33.4% (n = 196) were diagnosed with dementia or neurocognitive disorder owing to another aetiology. Applying all lecanemab eligibility criteria, 11 (4.3%) patients with dementia and two (1.5%) patients with MCI would have been eligible for treatment with this compound, whereas 13 dementia (5.1%) and 14 (10.4%) MCI patients met clinical inclusion criteria, but had no available amyloid status.
Conclusions
Even in a memory clinic with a good infrastructure and sufficient facilities for dementia diagnostics, most patients do not meet the eligibility criteria for treatment with lecanemab.
Mental illnesses are among the most common health problems in children and adolescents worldwide, and their prevalence has recently increased. At the same time, many countries face gaps in care and a shortage of services. To address these challenges, countries are developing child and adolescent mental health (CAMH) strategies and adopting their models of care. This paper aimed to give an international overview of these strategies and care models to support decision makers and stimulate mutual learning and improved CAMH care.
Methods
We identified core topics within published CAMH strategies and care model documents from seven selected countries within the Global North, which represented different healthcare systems, geographical regions, and public health traditions to maximize variety. We systematically extracted data on the identified topics and summarized them narratively by applying qualitative content analyses.
Results
The documents addressed the following core topics: awareness raising activities; prevention and promotion; detection; treatment; telemedicine; care pathways; transitional psychiatry; vulnerable patient groups; user participation; infrastructure; workforce development; implementation; digital tools for case management; and data acquisition and research. A stand-alone CAMH strategy exists in most countries.
Recommendations on CAMH care often followed a public mental health approach and placed a high priority on mental health promotion and cross-sectional organization and funding of CAMH care services. Key principles of future CAMH care included: increased flexibility of care settings; early intervention; an open and non-judgmental attitude among staff; and strengths orientation instead of focusing on deficits and diagnoses.
Conclusions
Reducing the prevalence of mental illness and current shortcomings in care requires action at the policy level (e.g., developing a CAMH strategy with a focus on mental health promotion and installing cross-sectoral governance), organizational level (e.g., reorganizing treatment settings and pathways of care), and individual level (e.g., strengthening user involvement and workforce development). Applying the recommended approaches in other countries will likely require redesign, ideally with a participatory approach and evaluation alongside piloting.
In response to Russia's aggression against Ukraine, the EU adopted a series of unprecedented ‘massive and targeted sanctions’ against the Russian economy. Whereas the EU has clarified that its restrictive measures are not directed against Russian society, it is has stated that it seeks to ‘diminish’ the Russia economy and ‘cripple’ its ability to finance the war. Such measures recall economic warfare, where the adversary's economy is targeted in order to weaken it and, if successful, would undoubtedly have an impact on Russian people. Moreover, the sanctions have had repercussions on third states and economic operators. Applying the proportionality principle, the article finds that the restrictive measures the EU has imposed on Russia in response to its aggressive war in Ukraine are disproportionate due to their impact on third parties.
This keywords entry proposes that critical infrastructure studies allows us to better understand the cultural lives of nineteenth-century theatrical repertoires and asks: How would conceptualizing theatrical repertoire as an imaginative infrastructure help us understand its cultural legacies in our own day? Nineteenth-century theatrical repertoires functioned in analogous ways to material-technical infrastructure: on one hand, providing routine and taken-for-granted conditions of performance; on the other, encoding asymmetric patterns of belonging and inclusion, proximity and distance, that we see reinforced by infrastructure. Repertoire is thus recast as a means of actively communicating and managing meaning on an enormous scale.
Image enhancement systems are important diagnostic tools in the detection of laryngeal pathologies. This study aimed to compare three different image enhancement systems: professional image enhancement technology, Image1 S and narrow-band imaging.
Method
Using the three systems, 100 patients with laryngeal lesions were investigated using a flexible and a 30° rigid endoscope. The lesions were diagnosed by three experts and classified using the Ni classification. The findings were compared.
Results
Lesions classified as ‘benign’ were histopathologically confirmed in 50 per cent of patients, malignant lesions were confirmed in 41 per cent and recurrent respiratory papillomatosis were confirmed in 9 per cent. There was no significant difference between the experts’ assessments of each image enhancement system.
Conclusion
The three systems give comparable results in the detection of laryngeal lesions. With two additional systems, more users can perform image-enhanced endoscopy, resulting in a broadly available tool that can help to improve oncological assessment.
Recent advancements in natural language processing (NLP) methods have significantly improved their performance. However, more complex NLP models are more difficult to interpret and computationally expensive. Therefore, we propose an approach to dictionary creation that carefully balances the trade-off between complexity and interpretability. This approach combines a deep neural network architecture with techniques to improve model explainability to automatically build a domain-specific dictionary. As an illustrative use case of our approach, we create an objective dictionary that can infer conflict intensity from text data. We train the neural networks on a corpus of conflict reports and match them with conflict event data. This corpus consists of over 14,000 expert-written International Crisis Group (ICG) CrisisWatch reports between 2003 and 2021. Sensitivity analysis is used to extract the weighted words from the neural network to build the dictionary. In order to evaluate our approach, we compare our results to state-of-the-art deep learning language models, text-scaling methods, as well as standard, nonspecialized, and conflict event dictionary approaches. We are able to show that our approach outperforms other approaches while retaining interpretability.
Autism spectrum disorders (ASD) are associated with high services use, but European data on costs are scarce.
Objectives
Utilisation and annual costs of 385 individuals with ASD (aged 4-67 years; 18.2% females; 37.4% IQ < 85) from German outpatient clinics were assessed.
Methods
Client Service Receipt Inventory
Results
Average annual costs per person were 3287 EUR, with psychiatric inpatient care (19.8%), pharmacotherapy (11.1%), and occupational therapy (11.1%) being the largest cost components. Females incurred higher costs than males (4864 EUR vs. 2936 EUR). In a regression model, female sex (Cost Ratio: 1.65), lower IQ (1.90), and Asperger syndrome (1.54) were associated with higher costs.
Conclusions
In conclusion, ASD-related health costs are comparable to those of schizophrenia, thus underlining its public health relevance. Higher costs in females demand further research.
The relationship between early multilingual learning and metalinguistic awareness is a particularly intriguing one. Not surprisingly, research into the effects of multilingualism on children’s linguistic development and awareness of language has attracted a lot of attention over the past years and decades as studies have found both positive effects of multilingualism on the development of metalinguistic awareness, and also facilitative effects of metalinguistic awareness on language learning. In the recent literature, metalinguistic awareness has been linked to important qualitative changes in the language and learning processes of multilinguals.
The adoption of Design for Additive Manufacturing (DfAM) practices brought new industrial components embedding unconventional shapes such as lattice structures or freeform surfaces resulting from topological optimisations. As a drawback of design freedom, designers need to use thermal post-processing to achieve homogeneous properties in metal 3D printing. This contribution analyses the effect of T6-like heat treatment on the hardness of a complex component. Hardness values are reported along with good design practices for effective thermal post-processing to complement the DfAM knowledge base.
Wild carnivores are threatened by human activities, particularly by lethal responses to livestock predation. As natural prey populations decline, predation of livestock and consumption of discarded livestock ‘waste’ (carcasses and body parts) should increase. We investigated whether parameters linked to the production of livestock waste affected the likelihood of livestock predation. We interviewed 160 households near Ruaha National Park in Tanzania to obtain information on households, livestock ownership, predation and parameters linked to livestock waste production. Our analysis identified parameters that affected the likelihood of predation on cattle, sheep and goats. When these parameters were controlled for, we found an increased likelihood of cattle predation as waste from diseased and slaughtered cattle increased. Sheep predation was more likely and cattle predation was less likely as sheep deaths from starvation increased. Goat predation was more likely in medium-sized than smaller or larger villages, suggesting a trade-off to predators between the increasing benefit of more livestock waste and the costs of higher human disturbance and diminishing natural prey abundance as village size category increased. Our findings suggest that improved disposal of livestock waste from slaughtered cattle and measures to decrease cattle deaths from disease should reduce predation of highly prized cattle.
In Book 19, Augustine concentrates on leading two audiences, both beset by different forms of violence, unrest, and insecurity within and without, to accept God’s offer of the peace that endures in heaven’s everlasting life as the supreme good. Primarily, this appeal for peace has a protreptic quality to attract a non-Christian audience. Especially for their sake Augustine uses, in addition to the divine authority of Scripture, the reason of philosophical argument in Book 19. Secondarily, the appeal has a didactic exhortation for a Christian audience to seek more ardently the peace of the heavenly Jerusalem. Even the pilgrim Church has “sheer misery compared to the happiness we call ultimate” (ciu. Dei 19.10; Babcock, 2.364; CCSL 48.674). Augustine makes his appeal for peace by humbling the peace of what each of the two audiences experiences. All people experience in this life on earth, in different ways, not only a broken society, but also a broken heart. But without recognizing that experience in humility, why would readers yearn for heaven’s peace? To all, Augustine makes an appeal for what he calls pax plenissima atque certissima (ciu. Dei 19.10; CCSL 48.674).
Research demonstrates that the prevalence of overweight and obesity in the general population is increasing rapidly worldwide and that the environmental changes that have provoked these increases have also affected people with severe mental illness (SMI). Of note, obesity is two to three times more common among people with SMI and it contributes to a significantly reduced quality of life and to an increased morbidity and mortality rate in this population. The most important factor related to weight gain in people with SMI is the use of antipsychotic medication. Weight gain often occurs within 6-8 weeks after the initiation of antipsychotic treatment and may continue for at least 4 years. This can lead to non-adherence and risk of relapse. Next to behavioural interventions several pharmacological approaches have been investigated to deal with antipsychotic-induced weight gain. They target different receptor systems including dopaminergic, glutamatergic, serotonergic, adrenergic, opioid, and glucagon-like peptide 1 receptors. This symposium will provide an overview of the effectiveness of different add-on medications to treat weight gain in patients with SMI.
Polygon meshes and particularly triangulated meshes can be used to describe the shape of different types of geometry such as bicycles, bridges, or runways. In engineering, such polygon meshes can be supplied as finite element meshes, resulting from topology optimization or from laser scanning. Especially from topology optimization, frame-like polygon meshes with slender parts are typical and often have to be converted into a CAD (Computer-Aided Design) format, e.g., for further geometrical detailing or performing additional shape optimization. Especially for such frame-like geometries, CAD designs are constructed as beams with cross-sections and beam-lines, whereby the cross-section is extruded along the beam-lines or beam skeleton. One major task in the recognition of beams is the classification of the cross-section type such as I, U, or T, which is addressed in this article. Therefore, a dataset consisting of different cross-sections represented as binary images is created. Noisy dilatation, the distance transformation, and main axis rotation are applied to these images to increase the robustness and reduce the necessary amount of samples. The resulting images are applied to a convolutional neuronal network.
I will argue that Kochen-Specker arguments do not provide an algebraic proof for quantum contextuality since, for the argument to be effective, (1) operators must be uniquely associated with measurements and (2) commuting operators must represent simultaneous measurements. However, in all Kochen-Specker arguments discussed in the literature either 1 or 2 is not met. Arguments meeting 1 contain commuting operators that do not represent simultaneous measurements and hence fail to physically justify the functional composition principle. Arguments meeting 2 associate some operators with more than one measurement and hence need to invoke an extra assumption different from noncontextuality.