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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.
Avian influenza virus (AIV) subtypes H5 and H7 can infect poultry causing low pathogenicity (LP) AI, but these LPAIVs may mutate to highly pathogenic AIV in chickens or turkeys causing high mortality, hence H5/H7 subtypes demand statutory intervention. Serological surveillance in the European Union provides evidence of H5/H7 AIV exposure in apparently healthy poultry. To identify the most sensitive screening method as the first step in an algorithm to provide evidence of H5/H7 AIV infection, the standard approach of H5/H7 antibody testing by haemagglutination inhibition (HI) was compared with an ELISA, which detects antibodies to all subtypes. Sera (n = 1055) from 74 commercial chicken flocks were tested by both methods. A Bayesian approach served to estimate diagnostic test sensitivities and specificities, without assuming any ‘gold standard’. Sensitivity and specificity of the ELISA was 97% and 99.8%, and for H5/H7 HI 43% and 99.8%, respectively, although H5/H7 HI sensitivity varied considerably between infected flocks. ELISA therefore provides superior sensitivity for the screening of chicken flocks as part of an algorithm, which subsequently utilises H5/H7 HI to identify infection by these two subtypes. With the calculated sensitivity and specificity, testing nine sera per flock is sufficient to detect a flock seroprevalence of 30% with 95% probability.
Occasional cases of classical bovine spongiform encephalopathy (BSE) still continue to occur within the European Union (EU) for animals born after reinforced feed bans (BARBs), which should in theory have eliminated all risk of infection. The study aimed to determine (i) whether a common rate of decline of BSE infection was evident across EU member states, i.e. to determine whether control measures have been equally effective in all member states, (ii) whether there was any evidence of spontaneous occurrence of BSE in the data and (iii) the expected date for the last BSE case in UK. It was found that there was no significant difference in the rate of decline of BSE prevalence between member states, with a common rate of decline of 33·9% per annum (95% CI 30·9–37%) in successive annual birth cohorts. Trend analysis indicated an ultimate decline to 0 prevalence, suggesting that spontaneous occurrence does not explain the majority of cases. Projecting forward the trends from the back-calculation model indicated that there was approximately a 50% probability of further cases in the UK, and should the current rate of decline continue, there remains the possibility of further occasional cases up until 2026.
Identifying youth who may engage in future substance use could facilitate early identification of substance use disorder vulnerability. We aimed to identify biomarkers that predicted future substance use in psychiatrically un-well youth.
LASSO regression for variable selection was used to predict substance use 24.3 months after neuroimaging assessment in 73 behaviorally and emotionally dysregulated youth aged 13.9 (s.d. = 2.0) years, 30 female, from three clinical sites in the Longitudinal Assessment of Manic Symptoms (LAMS) study. Predictor variables included neural activity during a reward task, cortical thickness, and clinical and demographic variables.
Future substance use was associated with higher left middle prefrontal cortex activity, lower left ventral anterior insula activity, thicker caudal anterior cingulate cortex, higher depression and lower mania scores, not using antipsychotic medication, more parental stress, older age. This combination of variables explained 60.4% of the variance in future substance use, and accurately classified 83.6%.
These variables explained a large proportion of the variance, were useful classifiers of future substance use, and showed the value of combining multiple domains to provide a comprehensive understanding of substance use development. This may be a step toward identifying neural measures that can identify future substance use disorder risk, and act as targets for therapeutic interventions.
Multiple cases of atypical scrapie in the same holding and co-existence with classical scrapie have been reported in Great Britain. A two-stage simulation tool was developed by combining a sampling algorithm and a hierarchical Bayesian model to simulate the number of positive cases of atypical scrapie from: (i) random sampling and (ii) using the actual sampled population in Great Britain, being the output probability of detection of flocks with one and more cases. Cluster analysis was conducted to assess the level of geographical over- and under-sampling over the years. The probability of detecting at least two cases of atypical scrapie in the same holding is much lower in simulated random data than in simulated actual data for all scenarios. Sampling bias in the selection of sheep for testing led to multiple sampling from fewer but larger holdings, Scotland, and areas of Wales were under-sampled and the South-West and East of England oversampled. The pattern of atypical scrapie cases observed is unlikely to be explained by a multi-case event epidemiologically linked. The co-existence of classical and atypical scrapie is a rare event with 19 holdings detected in GB and does not suggest an epidemiological link between the two types of disease.
Introduced plants threaten biodiversity and ecosystem processes, including carbon (C) and nitrogen (N) cycles, but little is known about the threshold at which such effects occur. We examined the impact of the invasive shrub Amur honeysuckle on soil organic carbon (SOC) and N density at study sites that varied in invasion history. In plots with and without honeysuckle, we measured honeysuckle abundance and size (basal area) and extracted soil cores. SOC and N densities were highest at the site with the longest invasion history and highest invasion intensity (i.e., greatest abundance and basal area of honeysuckle). Basal area of honeysuckle positively affected SOC and N densities likely because of increased litter decomposition and altered microbial communities. Because honeysuckle increases forest net primary productivity (NPP) and SOC, it also may play a role in C sequestration. Our results demonstrate the need to consider the influence of invasion history and intensity when evaluating the potential impact of invasive species.
Laminar helically-symmetric gravity-driven thin-film flow down a helically-wound channel of rectangular cross-section is considered. We extend the work of Stokes et al. (Phys. Fluids, vol. 25 (8), 2013, 083103) and Lee et al. (Phys. Fluids, vol. 26 (4), 2014, 043302) to channels with arbitrary curvature and torsion or, equivalently, arbitrary curvature and slope. We use a non-orthogonal coordinate system and, remarkably, find an exact steady-state solution. We find that the free-surface shape and flow have a complicated dependence on the curvature, slope and flux down the channel. Moderate to large channel slope has a significant effect on the flow in the region of the channel near the inside wall, particularly when the curvature of the channel is large. This work has application to flow in static spiral particle separators used in mineral processing.
There has been a rapid rise in the prevalence of cases of monophasic Salmonella Typhimurium (mST) in both humans and farm animals, and it has been found in pigs, cattle and poultry. It is therefore vital to have a good understanding of how to efficiently detect infected farms. The objective of this project was to determine sample type sensitivity in the detection of Salmonella to detect infected groups of animals on both pig (breeder, grower and finisher sites) and cattle (beef and dairy) farms, using data collected from a study investigating farms that were positive for mST, and to explore any variation between different age groups and management practices. A Bayesian approach in the absence of a gold standard was adopted to analyse the individual and pooled faecal sample data collected from each epidemiological group on each of the farms. The sensitivity of pooled sampling depended on the prevalence of infection in the group being sampled, with a higher prevalence leading to higher sensitivity. Pooled sampling was found to be more efficient at detecting positive groups of animals than individual sampling, with the probability of a random sample from a group of animals with 5% prevalence testing positive being equal to 15·5% for immature pigs (3·6% for an individual faecal sample, taking into account the sensitivity and infection prevalence), 7·1% for adult pigs (1·2% for individual sampling), 30% for outdoor cattle (2% for individual sampling) and 34% for indoor cattle (1% for individual sampling). The mean prevalence of each epidemiological group was higher in outdoor farms than indoor for both pigs and cattle (mean within-farm prevalence of 29·4% and 38·7% for outdoor pigs and cattle, respectively, compared to 19·8% and 22·1% for indoor pigs and cattle)
Previous studies have shown the association between the polymorphisms serine (S) or aspartic acid (D) at codon 146 of the PRNP gene and resistance to scrapie. All goats aged >12 months (a total of 1075 animals) from four herds with the highest prevalence of scrapie in the country were culled and tested, of which 234 (21·7%) were positive by either the rapid test or immunohistochemistry (IHC) for any of the tissues tested. The odds of scrapie infection occurring in NN146 goats was 101 [95% credible interval (CrI) 19–2938] times higher than for non-NN146 or unknown genotypes. IHC applied to lymphoreticular tissue produced the highest sensitivity (94%, 95% CrI 90–97). The presence of putatively resistant non-NN146 alleles in the Cypriot goat population, severely affected by scrapie, provides a potential tool to reduce/eradicate scrapie provided that coordinated nationwide breeding programmes are implemented and maintained over time.
The objective of this study was to estimate the sensitivity and specificity of a culture method and a polymerase chain reaction (PCR) method for detection of two Campylobacter species: C. jejuni and C. coli. Data were collected during a 3-year survey of UK broiler flocks, and consisted of parallel sampling of caeca from 436 batches of birds by both PCR and culture. Batches were stratified by season (summer/non-summer) and whether they were the first depopulation of the flock, resulting in four sub-populations. A Bayesian approach in the absence of a gold standard was adopted, and the sensitivity and specificity of the PCR and culture for each Campylobacter subtype was estimated, along with the true C. jejuni and C. coli prevalence in each sub-population. Results indicated that the sensitivity of the culture method was higher than that of PCR in detecting both species when the samples were derived from populations infected with at most one species of Campylobacter. However, from a mixed population, the sensitivity of culture for detecting both C. jejuni or C. coli is reduced while PCR is potentially able to detect both species, although the total probability of correctly identifying at least one species by PCR is similar to that of the culture method.
Surrogates involved in decisions to limit life-sustaining treatment for a loved one in the intensive care unit (ICU) are at increased risk for adverse psychological outcomes that can last for months to years after the ICU experience. Post-ICU interventions to reduce surrogate distress have not yet been developed. We sought to (1) describe a conceptual framework underlying the beneficial mental health effects of storytelling, and (2) present formative work developing a storytelling intervention to reduce distress for recently bereaved surrogates.
An interdisciplinary team conceived the idea for a storytelling intervention based on evidence from narrative theory that storytelling reduces distress from traumatic events through emotional disclosure, cognitive processing, and social connection. We developed an initial storytelling guide based on this theory and the clinical perspectives of team members. We then conducted a case series with recently bereaved surrogates to iteratively test and modify the guide.
The storytelling guide covered three key domains of the surrogate's experience of the patient's illness and death: antecedents, ICU experience, and aftermath. The facilitator focused on the parts of a story that appeared to generate strong emotions and used nonjudgmental statements to attend to these emotions. Between September 2012 and May 2013, we identified 28 eligible surrogates from a medical ICU and consented 20 for medical record review and recontact; 10 became eligible, of whom 6 consented and completed the storytelling intervention. The single-session storytelling intervention lasted from 40 to 92 minutes. All storytelling participants endorsed the intervention as acceptable, and five of six reported it as helpful.
Significance of Results:
Surrogate storytelling is an innovative and acceptable post-ICU intervention for recently bereaved surrogates and should be evaluated further.
Neuroimaging measures of behavioral and emotional dysregulation can yield biomarkers denoting developmental trajectories of psychiatric pathology in youth. We aimed to identify functional abnormalities in emotion regulation (ER) neural circuitry associated with different behavioral and emotional dysregulation trajectories using latent class growth analysis (LCGA) and neuroimaging.
A total of 61 youth (9–17 years) from the Longitudinal Assessment of Manic Symptoms study, and 24 healthy control youth, completed an emotional face n-back ER task during scanning. LCGA was performed on 12 biannual reports completed over 5 years of the Parent General Behavior Inventory 10-Item Mania Scale (PGBI-10M), a parental report of the child's difficulty regulating positive mood and energy.
There were two latent classes of PGBI-10M trajectories: high and decreasing (HighD; n = 22) and low and decreasing (LowD; n = 39) course of behavioral and emotional dysregulation over the 12 time points. Task performance was >89% in all youth, but more accurate in healthy controls and LowD versus HighD (p < 0.001). During ER, LowD had greater activity than HighD and healthy controls in the dorsolateral prefrontal cortex, a key ER region, and greater functional connectivity than HighD between the amygdala and ventrolateral prefrontal cortex (p's < 0.001, corrected).
Patterns of function in lateral prefrontal cortical–amygdala circuitry in youth denote the severity of the developmental trajectory of behavioral and emotional dysregulation over time, and may be biological targets to guide differential treatment and novel treatment development for different levels of behavioral and emotional dysregulation in youth.
Every year millions tons of steel are produced worldwide from recycled scrap loads.
Although the detection systems in the steelworks prevent most orphan radioactive sources
from entering the furnace, there is still the possibility of accidentally melting a
radioactive source. The MetroMetal project, carried out in the frame of the European
Metrology Research Programme (EMRP), addresses this problem by studying the existing
measurement systems, developing sets of reference sources in various matrices (cast steel,
slag, fume dust) and proposing new detection instruments. This paper presents the key
lines of the project and describes the preparation of radioactive sources as well as the
intercomparison exercises used to test the calibration and correction methods proposed
within the project.
Campylobacter is a common cause of intestinal disease in humans and is often linked to the consumption of contaminated poultry meat. Despite considerable research on the topic there is a large amount of uncertainty associated with Campylobacter epidemiology. A Bayesian model framework was applied to multiple longitudinal datasets on Campylobacter infection in UK broiler flocks to estimate the time at which each flock was first infected with Campylobacter. The model results suggest that the day of first infection ranges from 10 to 45 days; however, over half had a time of infection between 30 and 35 days. When considering only those flocks which were thinned, 48% had an estimated day of infection within 2 days of the day of thinning, thus suggesting an association between thinning and Campylobacter infection. These results demonstrate how knowledge of the time of infection can be correlated to known events to identify potential risk factors for infection.
A key element of national control programmes (NCPs) for Salmonella in commercial laying flocks, introduced across the European Union, is the identification of infected flocks and holdings through statutory sampling. It is therefore important to know the sensitivity of the sampling methods, in order to design effective and efficient surveillance for Salmonella. However, improved Salmonella control in response to the NCP may have influenced key factors that determine the sensitivity of the sampling methods used to detect Salmonella in NCPs. Therefore the aim of this study was to compare estimates of the sensitivity of the sampling methods using data collected before and after the introduction of the NCP, using Bayesian methods. There was a large reduction in the sensitivity of dust in non-cage flocks between the pre-NCP studies (81% of samples positive in positive flocks) and post-NCP studies (10% of samples positive in positive flocks), leading to the conclusion that sampling dust is not recommended for detection of Salmonella in non-cage flocks. However, cage dust (43% of samples positive in positive flocks) was found to be more sensitive than cage faeces (29% of samples positive in positive flocks). To have a high probability of detection, several NCP-style samples need to be used. For confirmation of Salmonella, five NCP faecal samples for cage flocks, and three NCP faecal boot swab samples for non-cage flocks would be required to have the equivalent sensitivity of the EU baseline survey method, which was estimated to have an 87% and 75% sensitivity to detect Salmonella at a 5% within-flock prevalence in cage and non-cage flocks, respectively.
Non-stoichiometric and impurity doped titanium dioxide materials are good candidates for use in high temperature thermoelectric devices. Nanolayers of non-stoichiometric (TiO2-x) thin films were deposited on Al-foil by atomic layer deposition growth method. X-ray diffraction experiments showed anatase phase for these nanolayers. This crystal structure was maintained even after an annealing treatment of 600 °C for 60 minutes under an O2 pressure of ∼ 10 psi. This investigation presents for the first time how Al-foil can be functionalized by manipulating the Seebeck coefficient of these TiO2-x nanolayers.
The Laboratoire des Sciences du Climat et de l'Environnement (LSCE) research program on prehistoric art conducts chronological studies of parietal representations with their associated archaeological context. This multidisciplinary approach provides chronological arguments about the creation period of parietal representations. This article presents chronological investigations carried out in several decorated caves in France (La Grande Grotte, Labastide, Lascaux, La Tête-du-Lion, Villars) and Spain (La Garma, Nerja, La Pileta, Urdiales). Several types of organic materials, collected from different areas of the caves close to the walls and in connection with parietal art, were dated to determine the periods of human presence in the cave, a presence that may have been related to artistic activities. These new radiocarbon results range from 33,000–29,000 (La Grande Grotte) to 16,000–14,000 cal BP (Urdiales).