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The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services.
This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures.
As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.
Some studies found that providing micronutrient powder (MNP) causes adverse health outcomes, but modifying factors are unknown. We aimed to investigate whether Fe status and inherited Hb disorders (IHbD) modify the impact of MNP on growth and diarrhoea among young Lao children. In a double-blind controlled trial, 1704 children of age 6–23 months were randomised to daily MNP (with 6 mg Fe plus fourteen micronutrients) or placebo for about 36 weeks. IHbD, and baseline and final Hb, Fe status and anthropometrics were assessed. Caregivers provided weekly morbidity reports. At enrolment, 55·6 % were anaemic; only 39·3 % had no sign of clinically significant IHbD. MNP had no overall impact on growth and longitudinal diarrhoea prevalence. Baseline Hb modified the effect of MNP on length-for-age (LAZ) (P for interaction = 0·082). Among children who were initially non-anaemic, the final mean LAZ in the MNP group was slightly lower (–1·93 (95 % CI –1·88, –1·97)) v. placebo (–1·88 (95 % CI –1·83, –1·92)), and the opposite occurred among initially anaemic children (final mean LAZ –1·90 (95 % CI –1·86, –1·94) in MNP v. –1·92 (95 % CI –1·88, –1·96) in placebo). IHbD modified the effect on diarrhoea prevalence (P = 0·095). Among children with IHbD, the MNP group had higher diarrhoea prevalence (1·37 (95 % CI 1·17, 1·59) v. 1·21 (95 % CI 1·04, 1·41)), while it was lower among children without IHbD who received MNP (1·15 (95 % CI 0·95, 1·39) v. 1·37 (95 % CI 1·13, 1·64)). In conclusion, there was a small adverse effect of MNP on growth among non-anaemic children and on diarrhoea prevalence among children with IHbD.
We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
The spatial-intensity profile of light reflected during the interaction of an intense laser pulse with a microstructured target is investigated experimentally and the potential to apply this as a diagnostic of the interaction physics is explored numerically. Diffraction and speckle patterns are measured in the specularly reflected light in the cases of targets with regular groove and needle-like structures, respectively, highlighting the potential to use this as a diagnostic of the evolving plasma surface. It is shown, via ray-tracing and numerical modelling, that for a laser focal spot diameter smaller than the periodicity of the target structure, the reflected light patterns can potentially be used to diagnose the degree of plasma expansion, and by extension the local plasma temperature, at the focus of the intense laser light. The reflected patterns could also be used to diagnose the size of the laser focal spot during a high-intensity interaction when using a regular structure with known spacing.
Bias in self-reported dietary intake is important when evaluating the effect of dietary interventions, particularly for intervention foods. However, few have investigated this in children, and none have investigated the reporting accuracy of fish intake in children using biomarkers. In a Danish school meal study, 8- to 11-year-old children (n 834) were served the New Nordic Diet (NND) for lunch. The present study examined the accuracy of self-reported intake of signature foods (berries, cabbage, root vegetables, legumes, herbs, potatoes, wild plants, mushrooms, nuts and fish) characterising the NND. Children, assisted by parents, self-reported their diet in a Web-based Dietary Assessment Software for Children during the intervention and control (packed lunch) periods. The reported fish intake by children was compared with their ranking according to fasting whole-blood EPA and DHA concentration and weight percentage using the Spearman correlations and cross-classification. Direct observation of school lunch intake (n 193) was used to score the accuracy of food-reporting as matches, intrusions, omissions and faults. The reporting of all lunch foods had higher percentage of matches compared with the reporting of signature foods in both periods, and the accuracy was higher during the control period compared with the intervention period. Both Spearman's rank correlations and linear mixed models demonstrated positive associations between EPA+DHA and reported fish intake. The direct observations showed that both reported and real intake of signature foods did increase during the intervention period. In conclusion, the self-reported data represented a true increase in the intake of signature foods and can be used to examine dietary intervention effects.
Atomic layer deposition (ALD) was used to deposit a laminate structure of alternating SiO2 and TiO2 monolayers onto a Si wafer. The resulting samples were analyzed in detail by X-ray photoelectron spectroscopy (XPS) revealing a distinct O 1s signature due to the presence of Si-O-Ti species. These findings are in good agreement with those reported for thin ALD films of TiO2 grown on SiO2.
Conflicts, of various sizes and purported purposes, cast a long and dark shadow on the lives of many and on the histories of nations and peoples. Theories of conflict abound – for wars between nations, internal civil conflicts, and terrorist operations – primarily based on national or group leaders convincing followers to take up a fight for some purpose, noble (to advance an idea, a religion, a culture, a form of government) or otherwise (to appropriate). While leaders, on occasion, do profit from conflict, they do so less often than they might ever imagine. Indeed, leaders, depending on institutional constraints, can separate the spoils of war (land, resources) from the dim costs of war.
The men and women who conduct the battles, however, can seldom avoid the costs of war, and so are fully saddled with the loss of life, limb, loved ones, livelihood, and way of life. Nor are the soldiers’ interests fully reflected in the interests of those who make the decision to initiate, continue or to change the course of battle. In his famous letter to his World War I commanding officer, Lt. Siegfried Sassoon of the Royal Welch Fusiliers, wrote:
I believe that the war upon which I entered as a war of defence and liberation has now become a war of agression [sic] and conquest. . . . I have seen and endured the sufferings of the troops and I can no longer be a party to prolonging these sufferings for ends which I believe to be evil and unjust. I am not protesting against the conduct of the war, but against the political errors and insincerities for which the fighting men are being sacrificed. On behalf of those who are suffering now, I make this protest against the deception which is being practised upon them; also I believe it may help to destroy the callous complacency with which the majority of those at home regard the continuance of agonies which they do not share and which they have not enough imagination to realise. July, 1917
To determine whether enhanced daily cleaning would reduce contamination of healthcare worker (HCW) gowns and gloves with methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Acinetobacter baumannii (MDRAB).
A cluster-randomized controlled trial.
Four intensive care units (ICUs) in an urban tertiary care hospital.
ICU rooms occupied by patients colonized with MRSA or MDRAB.
Extra enhanced daily cleaning of ICU room surfaces frequently touched by HCWs.
A total of 4,444 cultures were collected from 132 rooms over 10 months. Using fluorescent dot markers at 2,199 surfaces, we found that 26% of surfaces in control rooms were cleaned and that 100% of surfaces in experimental rooms were cleaned (P < .001). The mean proportion of contaminated HCW gowns and gloves following routine care provision and before leaving the rooms of patients with MDRAB was 16% among control rooms and 12% among experimental rooms (relative risk, 0.77 [95% confidence interval, 0.28-2.11]; P = .23). For MRSA, the mean proportions were 22% and 19%, respectively (relative risk, 0.89 [95% confidence interval, 0.50-1.53]; P = .16).
Intense enhanced daily cleaning of ICU rooms occupied by patients colonized with MRSA or MDRAB was associated with a nonsignificant reduction in contamination of HCW gowns and gloves after routine patient care activities. Further research is needed to determine whether intense environmental cleaning will lead to significant reductions and fewer infections.
To examine the relationship between the neighbourhood food environment and dietary intake among adolescents.
Cross-sectional design using: (i) a geographic information system to assess characteristics of the neighbourhood food environment and neighbourhood socio-economic status; (ii) the modified Healthy Eating Index (HEI) to assess participants’ overall diet quality; and (iii) generalized linear models to examine associations between HEI and home and school food environmental correlates.
Mid-sized Canadian city in Ontario, Canada.
Grade 7 and 8 students (n 810) at twenty-one elementary schools.
Students living in neighbourhoods with a lower diversity of land-use types, compared with their higher diversity counterparts, had higher HEI scores (P < 0·05). Students with more than 1 km between their home and the nearest convenience store had higher HEI scores than those living within 1 km (P < 0·01). Students attending schools with a distance further than 1 km from the nearest convenience store (P < 0·01) and fast-food outlet (P < 0·05) had higher HEI scores than those within 1 km. Those attending schools with three or more fast-food outlets within 1 km had lower HEI scores than those attending schools with no fast-food outlet in the school surroundings (P < 0·05).
Close proximity to convenience stores in adolescents’ home environments is associated with low HEI scores. Within adolescents’ school environments, close proximity to convenience and fast-food outlets and a high density of fast-food outlets are associated with low HEI scores.
Scanning probe microscopy (SPM) was used to probe piezoelectric vibrations and local conductivity in CaCu3Ti4O12(CCTO) ceramics at room temperature. Piezoelectric contrast was observed on the polished surfaces of CCTO in both vertical (out-of-plane) and lateral (in-plane) modes and depended on the grain orientation varying in sign and amplitude. The piezoelectric contrast is shown to be controlled by the electrical bias (local poling) and displayed a ferroelectric-like reversible hysteresis accompanied with a change of the phase of piezoelectric signal. Flexoelectric effect (strain-gradient-induced polarization) due to surface relaxation was invoked to explain the observed contrast inside the grains.
Epitaxial single-crystal films of La0.7Sr0.3MnO3 (100) having smooth surface morphology were deposited on SrTiO3 (100) substrates by pulsed laser deposition (PLD). Electrical conductivity relaxation (ECR) measurements were carried out at elevated temperatures over a range of absolute oxygen pressures to determine the oxygen surface exchange coefficient. Steady-state conductivity data of the thin films show good agreement with the bulk material's properties. The values of the oxygen exchange coefficients (Kchem) are found to be similar for both oxidation and reduction process between 50 and 500 mTorr O2. The activation energy (Ea) of Kchem is 1.00±0.27 eV at temperatures above 600 °C and Kchem (T=612°C)≈1.2×10-6 cm/s.
No compositional variations of periodically poled lithium niobate (PPLN) (period of ~28 μm) are found using spatially resolved near edge X-ray adsorption fine structure (XANES) spectra taken at the Nb K-edge. The periodicity the ferroelectric domain patterns can be imaged using piezoresponse force microscopy (PFM) and atomic force microscopy (AFM) and the periodic variations in the optical properties of PPLN result in a nonlinear optical response in the IR region at a fixed scattering angle.
Perovskite type oxide thin films have attracted a lot of attention, because they are essential materials which will be used for various electric devices such as ferroelectric random access memory (FeRAM) and tunable filter devices. When the materials are used for such capacitive devices, bottom electrode layers for oxide films are very important, since they significantly affect the crystallinity of the oxide films. Platinum (Pt) is one of the well known bottom electrode materials used for the oxide thin films. Pt provides also better nucleation sites for such perovskite materials due to small lattice misfit. Since dielectric properties of ferroelectric films are originated from the displacement of ions in a crystal along the c-axis direction, c-axis oriented ferroelectric thin films are required to attain better dielectric properties. (100) oriented Pt layers are required to attain c-axis oriented perovskite type ferroelectric films. In our previous report, we succeeded in preparing (100)-oriented Pt thin films with thickness of 20 nm on SiO2/Si substrate at substrate temperature Ts above 400 °C using MgO (100) buffer layers which deposited on Fe (100) seed layers. However, the growth of Pt(111) texture appeared when the thickness was increased from 20 nm to 100 nm, since (100) texture has relatively higher surface energy than (111) closely packed texture for Pt surface. It suggested that surface energy of the films changed during the deposition. In order to keep the surface energy, addition of O2 gas was performed during Pt deposition. Pt thin films with (100) preferred orientation with thickness above 100 nm were deposited on the (100) oriented MgO layer prepared on very thin seed Fe layers deposited on SiO2/Si substrates at Ts of 500 °C by facing-targets sputtering. It was also succeeded to attain (100) oriented perovskite oxide layer when they were deposited on the Pt(100)/Mg(100)/Fe/SiO2/Si underlayer.
The objective of this study was to test whether the use of tannin-rich shrub legume forage is advantageous for methane mitigation and metabolic protein supply at unchanged energy supply when supplemented in combination with tannin-free legumes to sheep. In a 6 × 6 Latin-square design, foliage of two tannin-rich shrub legume species (Calliandra calothyrsus and Flemingia macrophylla) were used to replace either 1/3 or 2/3, respectively, of a herbaceous high-quality legume (Vigna unguiculata) in a diet composed of the tropical grass Brachiaria brizantha and Vigna in a ratio of 0.55 : 0.45. A Brachiaria-only diet served as the negative control. Each experimental period lasted for 28 days, with week 3 serving for balance measurement and data collection inclusive of a 2-day stay of the sheep in open-circuit respiration chambers for measurement of gaseous exchange. While Vigna supplementation improved protein and energy utilisation, the response to the partial replacement with tannin-rich legumes was less clear. The apparent total tract digestibilities of organic matter, NDF and ADF were reduced when the tannin-rich plants partially replaced Vigna, and the dose–response relationships were mainly linear. The tannin-rich plants caused the expected redistribution of more faecal N in relation to urinary N. While Flemingia addition still led to a net body N retention, even when fed at the higher proportion, adding higher amounts of Calliandra resulted in body protein mobilisation in the growing lambs. With respect to energy, supplementation of Vigna alone improved utilisation, while this effect was absent when a tannin-rich plant was added. The inclusion of the tannin-rich plants reduced methane emission per day and per unit of feed and energy intake by up to 24% relative to the Vigna-only-supplemented diet, but this seems to have been mostly the result of a reduced organic matter and fibre digestion. In conclusion, Calliandra seems less apt as protein supplement for ruminants while Flemingia could partially replace a high-quality legume in tropical livestock systems. However, methane mitigation would be small due to associated reductions in N and energy retention.