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Introduction Standard surgical practice of paediatric soft tissue facial injuries requires general anaesthetic (GA) if treatment with local anaesthetic is not tolerated. However, the Covid-19 pandemic has increased the risk of hospital admission for GA to patients and pre-operative Covid-19 testing can delay surgical treatment. In response, a service was established to facilitate short surgical procedures by the Oral and Maxillofacial surgical (OMFS) team with ketamine sedation (KS) at a tertiary level paediatric emergency department. Evaluation of this service demonstrates that KS is a suitable alternative to GA with reduced waiting times, low complications and equivalent surgical outcomes. Method 20 patients treated under KS from May- September 2020 were identified and compared to a control group of 20 patients treated under GA during the same time period. Data including patient demographics, surgical treatment and the KS/GA procedure was collected from the medical records and was analysed using Microsoft excel. Results The KS patients had shorter waits for treatment with 85% of patients waiting 1 day or less, compared with 55% for the GA group. Using the local KS protocol 1 or 2 doses of ketamine was sufficient in 79% of cases and adverse effects were minimal with 21% of KS patients suffering mild nausea and vomiting. Conclusions KS is an acceptable alternative to GA for the management of paediatric soft tissue injuries. KS reduces inpatient admission for GA which is of increased importance during the Covid-19 pandemic. Other OMFS units would benefit from access to a similar service.

Background Early Intervention in Psychosis (EIP) services improve health outcomes for young people with psychosis in the medium–long term, but 25% of young people disengage in the first 12 months with costs to their mental health, families, society and the NHS. This study will evaluate the effectiveness, cost-effectiveness and implementation of a team-based motivational Early Youth Engagement (EYE-2) intervention. Method The study design is a cluster randomised controlled trial (RCT) with economic evaluation, comparing the EYE-2 intervention + standardised EIP service to standardised EIP service alone, with randomisation at the team level. A process evaluation will evaluate the delivery of the intervention qualitatively and quantitatively across contexts. The setting is 20 EIP teams in 5 sites: Manchester, South London, East Anglia, Thames Valley and Hampshire. Participants are young people (14–35 years) with first episode psychosis, and EIP staff. The intervention is the team-based motivational engagement (EYE-2) intervention, delivered alongside standardised EIP services, and supported by additional training, website, booklets and social groups. The comparator is the standardised EIP service. Both interventions are delivered by EIP clinicians. The primary outcome is time to disengagement (time in days from date of allocation to care coordinator to date of last contact following refusal to engage with EIP service, or lack of response to EIP contact for a consecutive 3-month period). Secondary outcomes include mental and physical health, deaths, social and occupational function, recovery, satisfaction and service use at 6, 12, 18 and 24 months. A 12-month within-trial economic evaluation will investigate cost-effectiveness from a societal perspective and from an NHS perspective. Discussion The trial will provide the first test of an engagement intervention in standardised care, with the potential for significant impact on the mental health and wellbeing of young people and their families, and economic benefits for services. The intervention will be highly scalable, supported by the toolkit including manuals, commissioning guide, training and resources, adapted to meet the needs of the diverse EIP population, and based on an in-depth process evaluation. Trial registration ISRCTN 51629746 prospectively registered 7th May 2019. Date assigned 10th May 2019.

Our satellite has revealed secrets of the solar system – and much more besides, says Stuart Clark

Drill cores provide reliable information about fractures in subsurface formations as they present a clear and direct view of fractures. Core observation and image log interpretation are usually integrated for fracture analysis of underground layers. There has been a strong move towards developing automated fracture detection methods, however, the focus has been on extracting fracture information from log images, such as acoustic or resistivity image logs. Such efforts using core images are significantly less. This paper presents a machine learning-based approach for automatic fracture recognition from unwrapped drill-core images. The proposed method applies a state-of-the-art convolutional neural network for object identification and segmentation. The study also investigates the feasibility of using synthetic fracture images for the training of a learning model. Synthetic data can provide an alternative to real data, and thus address data availability issues common for supervised machine learning applications. We first create two types of synthetic data by using masks of real fractures and creating sinusoidal shaped fractures. The trained model is evaluated on real core images from two boreholes and provides an average precision of approximately 95%. The identified fractures are further analyzed and compared to manually segmented fractures in terms of fracture dip angle and dip direction, which achieved average absolute errors of around 2° and 11°, respectively. Overall, the study presents a novel application of an advanced machine learning algorithm for fracture detection and analysis from unwrapped core images.

In hydrocarbon reservoir evaluation, lithology is a key characteristic for determination of storage capacity and rock properties. Lithology is usually predicted from well log data or directly identified through manual inspection by geologists during core logging. Automatic prediction of lithology has been a focus of many studies inspired by rapid developments in machine learning. Studies mostly focus on predicting lithofacies from well logs using neural networks, and more recently from borehole image logs using convolutional neural network (CNN). Although core is more representative of reservoir lithology than well log data, employing machine learning for automatic lithology identification from core is limited. A CNN-based approach is developed to classify core images into three lithologies: sandstone, limestone, and shale. The model is based on ResNeXt-50 architecture, which had better performance in lithology prediction than ResNet-18 and Inception-v3 architectures. Our method processes core tray images and outputs lithology logs in a fully automated procedure and predicts the lithologies of new (unseen) core with an accuracy of 93.12%.

We present an automatic method that first classify seismic facies and then interpret seismic horizons through four steps; local binary pattern segmentation, unsupervised clustering, supervised classification and dynamic time warping. Our approach avoids the need to manually label data, reducing the need for specialist geological knowledge. We test our method on a structurally complex seismic cube acquired in the SW Barents Sea, targeting rotated Mesozoic fault blocks.

Trauma of the palate in children is a common presentation in emergency departments. Children have a tendency to place objects in their mouths, which leaves them at risk of traumatising the oral cavity. Most traumatic injuries, including those that penetrate the palate, can be treated conservatively, but some require surgical intervention. Careful assessment, appropriate intervention, and follow up by experienced clinicians are essential to ensure correct management and prevent long-term complications. This article presents two case studies involving children who had experienced traumatic injuries to the palate that required surgical intervention.

The interpretation of borehole images begins with the detection and classification of features—a time-consuming manual process subject to variations between interpreters. In seeking to automate the detection part for the most frequently picked features (which in circumferential images from clastic rock environments are sinusoids corresponding to planar or subplanar bedding surfaces and fractures), it is not necessary to pick all instances, but it is necessary to pick sufficient representative instances to satisfy the interpretation objective, accounting for a broad range of apparent dips, and allowing for the likelihood of fractures crossing bedding surfaces. A key challenge in this context is the minimization of false picks, as manual corrections would potentially negate the principal benefit of automation. A fast nonsubjective method is described for the detection of prominent discontinuities and the calculation of associated dip angles. It combines a gradient based approach for edge detection with a phase congruency method for validation, followed by a robust sinusoid detection technique. It has been evaluated on microresistivity images from wireline and logging-while-drilling tools, these images having a wide range of features with varying degrees of geologic complexity; the proportion of false positives in the case of noisy data is less than 5%, improving to better than 2% in the case of good-quality data. In contrast to manual picking, the method is fast and gives reproducible results. With potentially thousands of sinusoids in a single image, the method dramatically improves efficiency.

The Rosetta spacecraft has been in suspended animation for three years. Will it wake up on time to make its date with a comet, asks Stuart Clark

This paper describes a number of novel Wide-Area Monitoring System (WAMS) capabilities and analysis tools, including a new monitoring solution that covers the 4-46Hz sub-synchronous oscillation range, and the deployment of a new oscillation source location algorithm. These are being demonstrated under VISOR - an innovation project that has created the first integrated GB WAMS in order to demonstrate the capabilities and tangible business benefits of WAMS to the GB system. Other work from the project is discussed including hybrid state estimation, dynamic model validation, line parameter estimation and a new boundary constraint approach that uses angle difference in addition to power. Finally, selected learning from a review of existing GB WAMS performance is presented, along with details of next steps in the project.

Edward Bever's book The Realities of Witchcraft addresses a fundamental historiographical issue, namely the extent to which early modern magical practices really functioned. Most scholars dismiss the idea that magical rites have real efficacy, or argue that the only reality that should be considered is contingent on historical cultural structures. Bever asserts that magic, and particularly harmful witchcraft, really worked, sometimes by physical means, but often by influencing neurobiology. In this forum section, five scholars respond to and critique Bever's arguments, and Bever responds.

Geoscientists are faced with a number of complexities that represent obstacles to the development of realistic simulation of deep earth processes. Realistic 4D thermo-mechanical simulation using software packages like Underworld and Gale, when combined appropriately with geoscientific expertise, can lead to novel insights into the deformation of geological structures at a wide range of time and spatial scales. The challenge for end-user geoscientists lies in applying their knowledge within the framework of the software’s input specification, including initial, internal, and boundary conditions and output visualization parameters. We have built a Graphical User Interface (GUI) to remove many of the difficulties related to editing the Extensible Markup Language (XML) encoded input files of Underworld/Gale geomodels and therefore, to greatly broaden the user base of these software packages. By helping Underworld/Gale to meet a large audience, we provide a tool to the geoscience community that helps to move from untested conceptual models to physically valid, properly scaled modelling. Furthermore, the UnderworldGUI offers a mechanism for storing and retrieving experimental models in a centralised database, thus providing the geoscience community with a means to share the outcomes of its experimental research. Further details of the UnderworldGUI are available at the web site http://www.wiki.vislab.usyd.edu.au/moinwiki/UnderworldGUI.

Odontogenic infections are often referred to the oral and maxillofacial surgical department, which can cause a dilemma for junior clinicians who have to decide whether such patients require admission. We have devised a score to be used on admission to our unit to help junior on-call staff, and designed a prospective pilot study to assess it.

Odontogenic infections can range from simple toothache to life-threatening swellings in the neck. We conducted a national survey to assess the confidence of the "first on-call" in oral and maxillofacial surgery (OMFS) to admit or discharge these patients, and to see if local protocols or guidelines were in place to aid decision-making. We designed a questionnaire and emailed it to all OMFS units across the UK over a 3-week period in June 2015. We also contacted first on-call OMFS juniors by phone. A total of 54 respondents were confident and 24 were very confident to admit patients with odontogenic infections without a senior review, but only 45 were confident and 9 very confident to discharge patients from the emergency department without a senior review. Twenty-one were fairly confident to admit patients, and 37 were fairly confident to discharge them. One respondent was not confident to admit patients at all, and 9 did not feel confident to discharge patients without a senior review. Seventy-eight reported that no local protocols or structured guidance on odontogenic infections were used in their unit. This survey highlights the need for admission criteria to help junior clinicians decide whether to admit or discharge these patients.

This case series considers the incidence of patients taking bisphosphonate medication that suffer with bisphosphonate-related osteonecrosis of the jaw (BRONJ) following an exodontia procedure. Forty five such patients who attended the Wigan Royal Albert Edward Infirmary (RAEI) Oral and Maxillofacial Surgery (OMFS) department for an exodontia procedure were examined. A patient's age, gender, exodontia technique, bisphosphonate route (Oral/IV), smoking status and reason for taking the bisphosphonates, eg osteoporosis/cancer/arthritis was considered. All of the patients that experienced BRONJ were smokers. Clinical Relevance: Bisphosphonates are now widely accepted for the management of medical conditions, including arthritis, osteoporosis and various forms of cancer. Such patients are regularly referred to OMFS departments for dental extractions.

The main objective of the study was to compare the techniques of thermographic and laser Doppler imaging in the assessment of digital blood flow. Thermography measures surface temperature; laser Doppler measures microciculatory flow. Seventeen healthy control subjects and 40 patients with Raynaud's phenomenon (7 primary, 33 secondary to systemic sclerosis) underwent a 20-min acclimatization period at 23 degrees C. Thermographic and then laser Doppler images were taken of the dorsal aspect of both hands, and the procedure was repeated at a room temperature of 30 degrees C. Three regions/values of interest from each hand were chosen for analysis: the dorsum of the hand, the tip of the middle finger, and the "gradient" between these. Thermographic and laser Doppler results correlated poorly. For example, correlations between techniques for the gradient value were as follows: left hand 23 degrees C, r = 0.61; right hand 23 degrees C, r = 0.64; left hand 30 degrees C, r = 0.47; right hand 30 degrees C, r = 0.48. One explanation for these findings is that laser Doppler imaging is more sensitive to blood flow changes and therefore more likely to show inhomogeneities than the highly damped temperature response. Therefore one technique cannot substitute for another.

Apparitions were the subject of fierce theological and philosophical debate in the period after the Reformation. But these controversies also raised issues fundamental to the nature and organization of human vision. They crossed and recrossed the boundaries between religion and the science and psychology of optics. Apparitions, after all, are things that appear, and spectres are things that are seen. Before they could mean anything to anyone they had to be correctly identified as phenomena. Their religious role, whether Protestant or Catholic, presupposed a perceptual judgement — essentially visual in character — about just what they were. During the early modern period this judgement — this visual identification — became vastly more complex and contentious than ever before, certainly much more so than in the case of medieval ghosts. The sceptics, natural magicians, and atheists turned apparitions into optical tricks played by nature or human artifice; the religious controversialists and demonologists thought that demons might also be responsible. This essay argues that the debate that ensued, irrespective of the confessional allegiances of the protagonists, was the occasion for some of the most sustained and sophisticated of the early modern arguments about truth and illusion in the visual world.

An otherwise-healthy 11-month-old white girl presented with a polyp-like lesion on the anteromedial part of the maxillary alveolar ridge. It looked like a congenital epulis, but histological examination showed fascicles of smooth muscle cells dispersed in collagenous stroma with a few peripheral nerve bundles that were intermingled with smooth muscle fibres. The muscle cells stained strongly for desmin and alpha-smooth-muscle actin. However, S-100 was found only in peripheral nerve bundles. It was therefore a leiomyomatous hamartoma.

We present broad-band, near-infrared (IHKn) imaging linear polarimetry of the young stellar object GSS 30. The overall polarization pattern is centrosymmetric about the illuminating source, IRS 1. The model by Clark & McCall is used to derive the wavelength dependence of the degrees of polarization of the scattered radiation in the nebula. The results suggest that the axis of the nebula is inclined at an angle of - 25°-30° to the plane of the sky, with the northern lobe towards us. The grain size distribution is best fitted by grains covering the range 0.005 to 0.35 ~m. However, the model cannot reproduce the observed polarization pattern across the nebula, which is seen to decrease towards its edge. A polarization disc, i.e. a band of aligned polarization vectors, is seen close to the source. This pattern breaks down to the east of the source where the polarization pattern reverts back to a centro symmetric one. We speculate that a binary system could disrupt the density gradient across the circumstellar disc such that photons can easily escape in this direction and are then scattered (singly) towards us. To the west of the source the pattern of the polarization disc remains intact. The degrees of polarization, both in the line of sight to the source and along the disc, are higher at I and H than they are at Kn. We propose that the wavelength dependence of the polarization here may be produced by a combination of scattering and dichroism, with the grains aligned by a magnetic field parallel to the plane of the disc.

The oral cavity is an uncommon site for a true lipoma. A distinct histological variant is the spindle cell lipoma. This is a rare oral lesion. A case of an intra-oral spindle cell lipoma in a 55-year-old female is reported, a differential diagnosis is presented and the histopathology is discussed.An oral swelling is a common presenting complaint and requires further investigation.

The principal purpose of discretio spirituum is judging the merits of any ostensibly spiritual personal experience. The idea in medieval and early modern theology that the devil, even with divine permission, could control all natural causation, including that governing human vision, can still occasion surprise. That he could become an "angel of light"-mimicking sanctity, impersonating saints, faking miracles-seems even more alarming in its own terms, as well as intriguing enough historically to inspire a volume such as this one. The most important context for the appearance of "angels of light" in early modern religious images, however, was the subject of the temptations of the third-to fourth-century Egyptian hermit St Anthony, depicted in an enormous number of early modern paintings and other art forms. Of all the links between sanctity and discernment, those emerging from a lifetime spent under egregious demonic assault assumed particular significance. Keywords:Angels of Light; images of sanctity; St Anthony

It's a giant sphere of a trillion rocks encircling us that occasionally sends comets slinging our way. That's a convincing story – but we'd love some direct evidence

Objectives. Hospitalisation for medical illness has ongoing impact on individuals, healthcare services and society beyond discharge. This study’s objective was to determine the 12-month mortality and functional outcomes of patients admitted to the acute medical service at Groote Schuur Hospital (GSH). Methods. Follow-up, using the hospital records system and provincial death registry, together with telephonic interviews or home visits, was attempted for 465 medical inpatients admitted to GSH between 14 September and 16 November 2009. Functional outcomes were assessed using the Katz activities of daily living (ADL) score and Barthel index (BI). Outcome measures. The major study outcomes included: 12-month mortality (overall and unexpected), changes in functional status and pre- and post-admission employment rates. Results. Inpatient mortality was 11%. At 12-month follow-up, 35% (145/415) were deceased and 30% (125/415) could not be traced; 38% (55/145) of deaths were considered expected and unexpected mortality was associated with age >40 years (p=0.02) and an admission urea >7.0 mmol/l (p=0.004). Katz ADL deteriorated in 15% (21/143) of interviewed patients and was associated with age >50 years (p=0.005); 23% (33/143) had improved Katz ADL associated with admission human immunodeficiency virus (HIV) (p=0.01), tuberculosis (TB) infection (p=0.05) and sepsis (p=0.02). Employment rates declined from 41% (59/145) pre-admission to 18% (26/145) at 12 months (p

We use the word “supernatural” when speaking of some native belief, because that is what it would mean for us, but far from increasing our understanding of it, we are likely by the use of this word to misunderstand it. We have the concept of natural law, and the word “supernatural” conveys to us something outside the ordinary operation of cause and effect, but it may not at all have that sense for primitive man. For instance, many peoples are convinced that deaths are caused by witchcraft. To speak of witchcraft being for these peoples a supernatural agency hardly reflects their own view of the matter, since from their point of view nothing could be more natural. In a treatise on witchcraft first published in Trier in 1589 a German bishop explained that all apparently occult operations that were not in fact miracles could be ascribed in principle to physical causes. For whether or not any particular instance was actually demonic in inspiration, “magic” was simply the art of producing wonderful natural effects outside the usual course of things and above the common understanding of men. It followed that “if this part of philosophy was practised in the schools in the manner of the other ordinary sciences … it would lose the name of ‘magic’ and would be assigned to physics and natural science [ et Physicae naturalique scientiae asscriberetur ].” Likewise, in a set of theses on magical operations and witchcraft published a year later in Helmstadt, a natural philosopher and physician began by arguing that “magical actions and motions are reducible to considerations of physics [ Ad Physicam considerationem reducuntur motus et actiones magicae ]”.

We wish to draw your attention to the possible repercussions of Ambassador Falconer’s revised language on food aid in the draft modalities text, 10 July 2008. The revisions in paragraph 12, Annex L, broaden the scope for food aid monetization. We, the undersigned, are concerned by these revisions and attach alternative language for your consideration.

Aim: To asses the on-call night time DF2 (Dental foundation year 2) experience and its value as the first on call in a major trauma centre. Methods: 8 DF2’s with 6 months experience, while doing their week of night on-calls completed a comprehensive assessment form to grade the value of the experience they gained in the domains of COPDEND curriculum. The value of their experience was quantified from 1 to 5. They also documented in which domains that experience occurred and how they were employed along the course of the evening. Results: The results showed that the night DF2 was bleeped between 10 to 15 times, in the majority of cases from accident and emergency followed by ward bleeps and calls from other hospitals. Regarding how they were employed during the evening they spent the majority of the time suturing facial laceration and the rest of the time dealing with facial swellings and doing ward jobs. They gained a wide spread good experience in COPDEND domains particularly in patient management with high results in communication and technical skills and benefits in team work and decision making. Conclusion: We conclude that night time on-calls are of significant value to all DF2 trainees for both technical and transferable skills and this was unaffected by their proposed career choices.

Cervical lympadenopathy is a common presentation in patients seen by the oral and maxillofacial surgeon. In addition to a full medical examination, fine-needle aspiration cytology is a valuable investigation in assessment of this condition. If metastatic carcinoma is diagnosed, the search for the primary site involves panendoscopy, biopsy, and computed tomography.1 If no primary site is identified, a neck dissection can still be effective treatment.2 Prostatic carcinoma is common in the elderly and can metastasize to the neck.3 A case is presented to remind clinicians of this possibility. Report of Case

This was a pilot study to investigate the new technique of laser Doppler imaging (scanning laser Doppler) as a tool to quantify microvascular blood flow in the digits of patients with primary Raynaud's phenomenon (PRP) and systemic sclerosis (SSc), and to determine in the first instance whether the flux patterns obtained differ between patients with SSc, patients with PRP, and healthy control subjects. Laser Doppler images of the dorsum of the hand and fingers were acquired at 23 and 30 degrees C in 17 healthy control subjects, 7 patients with PRP, 9 patients with the diffuse cutaneous variant of SSc, and 24 patients with the limited cutaneous variant of SSc. Different flux parameters were compared between groups. Analysis of variance found significant differences between groups in two tests: maximum difference in flux between fingertips of the same hand at 23 degrees C (P = 0.001) and maximum gradient in flux along a finger ("distal-dorsal" flux difference) at 30 degrees C (P = 0. 019). Post hoc tests highlighted the differences between controls and patients with limited cutaneous SSc. This pilot study suggests that laser Doppler imaging may allow objective measurement of microvascular flow in patients with PRP and SSc. This new technique may overcome many of the problems inherent in single-channel laser Doppler equipment.

What's your call? ![Figure][1] Sinus (left) and chest (right) computed tomography scan of a 59-year-old male ex-smoker with chronic sinusitis and intermittent hemoptysis of 2 months' duration. This patient had a history of fleeting arthralgia, and he had an elevated erythrocyte

In primary and secondary Raynaud’s phenomenon, measurement of activity or severity, or both, of the digital vascular disease is a major challenge. We need to identify objective measures of digital vascular disease that are helpful in predicting those patients with Raynaud’s who have underlying connective tissue disease, and to measure reliably digital vascular disease progression, and responses to treatment. None of the various physiological measurement techniques used in the assessment of patients with primary or secondary Raynaud’s are ideal. In this review we outline these techniques, highlighting their applications and limitations. The discussion concentrates on the physiological assessment of patients with primary Raynaud’s phenomenon (PRP) and systemic sclerosis (SSc), but is also applicable to other connective tissue diseases. We have not included biochemical markers of vascular injury or measurement of tissue oxygen levels. In PRP, episodic ischaemia in response to cold exposure or to emotional stimuli is entirely reversible: absence of tissue damage is a defining feature.1 In contrast, SSc may be associated with irreversible tissue damage with ulceration, scarring and sometimes gangrene, and structural change occurs in the vasculature.2 3 Indeed, SSc is probably primarily a disease of the vasculature, although it is not clear how this interrelates with collagen and other connective tissue matrix metabolism.4 5 Assessment of digital vascular disease needs to take into account: (a) Digital vasospasm. This is best assessed by dynamic testing with standard stimuli, such as a standard cold stress. (b) Structural vascular disease. This may affect basal blood flow in addition to vascular responses to standard stimuli. In the patient presenting with Raynaud’s phenomenon, we must assess both the microvasculature and the digital arteries. Different physiological measurement techniques may be used in combination, especially if investigators wish to examine both digital artery and microvascular flow.6 On widefield capillaroscopy, …

In this paper, two patients are described who presented with trigeminal neuralgia which turned out to be an early symptom of multiple sclerosis. General dental practitioners need to be aware of the possible causes for atypical facial pain, especially in patients under 40 years.

After primary education at Hyndland School, Glasgow, Alistair Aitken Clark (“Alistair”) attended the High School of Glasgow between 1929 and 1936. He served as second lieutenant in the 6th Battalion Argyll and Sutherland Highlanders (TA) but returned to university in January 1940, graduating MB ChB in January 1942. He married Connie in June 1942, and his first medical post was casualty house surgeon at the Western Infirmary during 1942-3. He served as lieutenant and then captain in the Royal Army Medical Corps, including being posted to India as a medical officer …

Super-thin layers of ordinary materials could solve the engineering challenges of building an invisibility cloak