Ján Kadár

When The Shop on Main Street (Obchod na korze, 1965) won the Best Foreign Film Oscar in 1966, it marked the first ever for Czechoslovakia and the decisive breakthrough in international awareness of the Czechoslovak New Wave. Yet its co-directors, Ján Kadár and Elmar Klos, were not part of the younger generation that emerged from the Prague Film School in the 1960s. Klos had begun his career before the Second World War and Kadár made his debut in 1945. After the success of The Shop on Main Street, they completed only one more film before the Soviet suppression of the Prague Spring brought an end to their partnership. In 1968-69, they shot Touha zvaná Anada (Adriftaka Desire is Called Anada), released in 1971, the only Czechoslovak-US co-production to be shot in the “socialist” era...

The Sleep Condition Indicator: a clinical screening tool to evaluate insomnia disorder

Objective: Describe the development and psychometric validation of a brief scale (the Sleep Condition Indicator (SCI)) to evaluate insomnia disorder in everyday clinical practice.<p></p> Design: The SCI was evaluated across five study samples. Content validity, internal consistency and concurrent validity were investigated.<p></p> Participants: 30 941 individuals (71% female) completed the SCI along with other descriptive demographic and clinical information.<p></p> Setting: Data acquired on dedicated websites.<p></p> Results: The eight-item SCI (concerns about getting to sleep, remaining asleep, sleep quality, daytime personal functioning, daytime performance, duration of sleep problem, nights per week having a sleep problem and extent troubled by poor sleep) had robust internal consistency (α≥0.86) and showed convergent validity with the Pittsburgh Sleep Quality Index and Insomnia Severity Index. A two-item short-form (SCI-02: nights per week having a sleep problem, extent troubled by poor sleep), derived using linear regression modelling, correlated strongly with the SCI total score (r=0.90).<p></p> Conclusions: The SCI has potential as a clinical screening tool for appraising insomnia symptoms against Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.<p></p&gt

Automated detection of actinic keratoses in clinical photographs

Backgroun

Deep Space Network Antenna Logic Controller

The Antenna Logic Controller (ALC) software controls and monitors the motion control equipment of the 4,000-metric-ton structure of the Deep Space Network 70-meter antenna. This program coordinates the control of 42 hydraulic pumps, while monitoring several interlocks for personnel and equipment safety. Remote operation of the ALC runs via the Antenna Monitor & Control (AMC) computer, which orchestrates the tracking functions of the entire antenna. This software provides a graphical user interface for local control, monitoring, and identification of faults as well as, at a high level, providing for the digital control of the axis brakes so that the servo of the AMC may control the motion of the antenna. Specific functions of the ALC also include routines for startup in cold weather, controlled shutdown for both normal and fault situations, and pump switching on failure. The increased monitoring, the ability to trend key performance characteristics, the improved fault detection and recovery, the centralization of all control at a single panel, and the simplification of the user interface have all reduced the required workforce to run 70-meter antennas. The ALC also increases the antenna availability by reducing the time required to start up the antenna, to diagnose faults, and by providing additional insight into the performance of key parameters that aid in preventive maintenance to avoid key element failure. The ALC User Display (AUD) is a graphical user interface with hierarchical display structure, which provides high-level status information to the operation of the ALC, as well as detailed information for virtually all aspects of the ALC via drill-down displays. The operational status of an item, be it a function or assembly, is shown in the higher-level display. By pressing the item on the display screen, a new screen opens to show more detail of the function/assembly. Navigation tools and the map button allow immediate access to all screens

The pros and cons of getting engaged in an online social community embedded within digital cognitive behavioral therapy for insomnia: survey among users

Background: Sleepio is a proven digital sleep improvement programme based on cognitive behavioural therapy (CBT) techniques. Users have the option to join an online community that includes weekly expert discussions, peer-to-peer discussion forums and personal message walls. Objective: The aims of this study were to (1) explore the reasons for deciding to engage with the Sleepio online community, (2) explore the potential benefits arising from engagement with the online community, (3) identify and describe any problematic issues related to use of the online community. Methods: In total, 100 respondents (70% female; mean age 51, range 26-82 years) completed the online survey. Most respondents had started Sleepio with chronic sleep problems (59% to to 10 years, 35% >10years), and had actively engaged with the online community (85% had made a discussion or wall post). At the time of the survey, respondents had used Sleepio for a median of 12 weeks (range from 3 weeks to 2 years). Results: Responses to the open-ended questions were analysed using thematic analysis. This analysis revealed five initial drivers for engagement including: 1) the desire to connect with people facing similar issues; 2) seeking personalised advice; 3) curiosity; 4) being invited by other members; and 5) wanting to use all available sleep improvement tools. Advantages of engagement included: access to continuous support, reduced sense of isolation, being part of a non-judgmental community, personalised advice, positive comparisons with others, encouragement to keep going, and altruism. Five potential disadvantages were: design and navigation issues, uncertain quality of user-generated content, negative comparisons with others, excessive time commitments, and data privacy concerns. Participants related their community experiences to engagement with the Sleepio programme with the many stating it had supported their efforts to achieve sleep improvement, as well as helping with adherence and commitment to the programme. Conclusions: Despite some concerns, members regarded the Sleepio community as a valuable resource. Online communities may be a useful means through which to support long-term engagement with online therapy for insomnia

A genetic model for central chondrosarcoma evolution correlates with patient outcome

Background Central conventional chondrosarcoma (CS) is the most common subtype of primary malignant bone tumour in adults. Treatment options are usually limited to surgery, and prognosis is challenging. These tumours are characterised by the presence and absence of IDH1 and IDH2 mutations, and recently, TERT promoter alterations have been reported in around 20% of cases. The effect of these mutations on clinical outcome remains unclear. The purpose of this study was to determine if prognostic accuracy can be improved by the addition of genomic data, and specifically by examination of IDH1, IDH2, and TERT mutations. Methods In this study, we combined both archival samples and data sourced from the Genomics England 100,000 Genomes Project (n = 356). Mutations in IDH1, IDH2, and TERT were profiled using digital droplet PCR (n = 346), whole genome sequencing (n=68), or both (n = 64). Complex events and other genetic features were also examined, along with methylation array data (n = 84). We correlated clinical features and patient outcomes with our genetic findings. Results IDH2-mutant tumours occur in older patients and commonly present with high-grade or dedifferentiated disease. Notably, TERT mutations occur most frequently in IDH2-mutant tumours, although have no effect on survival in this group. In contrast, TERT mutations are rarer in IDH1-mutant tumours, yet they are associated with a less favourable outcome in this group. We also found that methylation profiles distinguish IDH1- from IDH2-mutant tumours. IDH wild-type tumours rarely exhibit TERT mutations and tend to be diagnosed in a younger population than those with tumours harbouring IDH1 and IDH2 mutations. A major genetic feature of this group is haploidisation and subsequent genome doubling. These tumours evolve less frequently to dedifferentiated disease and therefore constitute a lower risk group. Conclusions Tumours with IDH1 or IDH2 mutations or those that are IDHwt have significantly different genetic pathways and outcomes in relation to TERT mutation. Diagnostic testing for IDH1, IDH2, and TERT mutations could therefore help to guide clinical monitoring and prognostication

'Ain't it a Ripping Night': Alcoholism and the Legacies of Empire in Salman Rushdie's Midnight's Children.

In the era of decolonisation that followed the Second World War, various authors sought to engage with India and the Empire’s past anew throughout their novels, identifying medicine and illness as key parts of Imperial authority and colonial experience. Salman Rushdie’s approach to the Raj in Midnight’s Children (1981) focused on the broad sweep of colonial life, juxtaposing the political and the personal. This article argues that Rushdie explores the history of colonial India by employing alcohol and alcoholism as lenses through which to explore the cultural, political and medical legacies of Empire. Through analysis of Midnight’s Children as well as a range of medical sources related to alcohol and inebriation, it will illustrate how drinking is central to Rushdie’s approach to secular and religious identities in newly independent India, as well as a means of satirising and undermining the supposed benefit that Empire presented to India and Indians

Growth zoning of garnet porphyroblasts: grain boundary and microtopographic controls

Chemical zoning in the outer few 10s of microns of garnet porphyroblasts has been investigated to assess the scale of chemical equilibrium with matrix minerals in a pelitic schist. Garnet porphyroblasts from the Late Proterozoic amphibolite‐facies regional metamorphic mica schists from Glen Roy in the Scottish Highlands contain typical prograde growth zoning patterns. Edge compositions have been measured via a combination of analysis of traverses across the planar edges of porphyroblast surfaces coupled to X‐ray mapping of small areas within polished thin sections at the immediate edge of the porphyroblasts. These approaches reveal local variation in garnet composition, especially of grossular (Ca) and almandine (Fe) components, with a range at the edge from <7 mol% grs to >16 mol% grs, across distances of less then 50 mm. This small‐scale patchy compositional zoning is as much variation as the core‐rim compositional zoning across the whole of a 3 mm porphyroblast. Ca and Fe heterogeneity occurs on a scale suggesting a combination of inefficient diffusive exchange across grain boundaries during prograde growth and the evolving microtopography of the porphyroblast surface control garnet composition. The latter creates haloes of compositional zoning adjacent to some inclusions, which typically extend from the inclusion towards the porphyroblast edge during further growth. The lack of a consistent equilibrium composition at the garnet edge is also apparent in the internal zoning of the porphyroblast and so processes occurring during entrapment of some mineral inclusions have a profound influence on the overall chemical zoning. Garnet compositions and associated zoning patterns are widely used by petrologists to reconstruct P‐T‐t paths for crustal rocks. The evidence of extremely localized (10‐50 mm scale) equilibrium during growth further undermines these approaches

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie