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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.
We aimed to assess the validity of maternal recall of exclusive breastfeeding (EBF) at 3 months obtained 12 months after childbirth.
A population-based birth cohort study. The gold standard is maternal report of EBF at the age of 3 months (yes or no) and age of introduction of other foods in the infant’s diet. EBF was considered when the mother reported that no liquid, semi-solid or solid food was introduced up to that moment. The variable to be validated was obtained at 12 months after childbirth when the mother was asked about the age of food introduction. The prevalence of EBF at 3 months, and sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of 12-month recall with 95 % CI were calculated.
3700 mothers of participants of the Pelotas 2004 Birth Cohort.
The prevalence of EBF at 3 months was 27·8 % (95 % CI 26·4, 29·3) and 49·0 % (95 % CI 47·4, 50·6) according to gold standard and maternal recall, respectively. The sensitivity of maternal recall at 12 months was 98·3 % (95 % CI 97·4, 99·0), specificity 70·0 % (95 % CI 68·2, 71·7), PPV 55·8 % (95 % CI 53·4, 58·1), NPV 99·1 % (95 % CI 98·6, 99·5) and accuracy 77·9 % (95 % CI 76·6, 79·2). When the analyses were stratified by maternal and infant characteristics, the sensitivity remained around 98 %, and the specificity ranged from 64·4 to 81·8 %.
EBF recalled at the end of the first year of infant’s life is a valid measure to be used in epidemiological investigations.
The European Prediction of Psychosis Study (EPOS) aimed to study a large sample of young patients who are at risk of psychosis and to estimate their conversion rate to psychosis during 18 months follow-up. This presentation describes quality of life and its changes in patients at risk of psychosis.
In six European centres, 16 to 35 year old psychiatric patients were examined. Risk of psychosis was defined by occurrence of basic symptoms, attenuated psychotic symptoms, brief, limited or intermittent psychotic symptoms or familial risk plus reduced functioning. Quality of life (QoL), measured by the Modular System for Quality of Life, was assessed at baseline and at 9 and 18 months’ follow-ups. Psychiatric patients without prodromal symptoms and healthy subjects were comparison groups.
In all, 245 risk patients were included. At baseline, they reported lower QoL than non-risk patients and healthy controls. Basic symptoms associated negatively with QoL, and there were differences between the study centres. During the follow-up, QoL raised less in risk patients than in non-risk patients. Baseline QoL did not predict transition to psychosis. However, its development was poorer in patients with than in those without transition to psychosis.
Those of the psychiatric patients who are at risk of psychosis have lower QoL than other psychiatric patients or healthy controls. QoL does not predict transition to psychosis, but its changes correlates with changes in clinical state. The results indicate that there is a need for comprehensive intervention with the patients at risk of psychosis.
Attention Deficit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Given this background, there is great need for an effective treatment of adult ADHD patients.
Therefore, our research group has conducted a first controlled randomized multicenter study on the evaluation of disorder-tailored DBT-based group program in adult ADHD compared to a psychophar-macological treatment.
Between 2007 and 2010, in a four-arm-design 433 patients were randomized to a manualized dialectical behavioural therapy (DBT) based group program plus methylphenidate or placebo or clinical management plus methylphenidate or placebo with weekly sessions in the first twelve weeks and monthly sessions thereafter. Therapists are graduated psychologists or physicians. Treatment integrity is established by independent supervision. Primary endpoint (ADHD symptoms measured by the Conners Adult ADHD Rating Scale) is rated by interviewers blind to the treatment allocation (Current Controlled Trials ISRCTN54096201). The trial is funded by the German Federal Ministry of Research and Education (01GV0606) and is part of the German network for the treatment of ADHD in children and adults (ADHD-NET). In the lecture the first data of our interim analysis are presented (baseline data, results of treatment compliance and adherence).
In the European Prediction of Psychosis Study (EPOS) a large sample of young patients at high risk of psychosis (HR) were examined and their conversion rate to psychosis during 18 months follow-up was estimated. This presentation describes quality of life (QoL) and its changes in patients at risk of psychosis who did or did not convert to psychosis.
In all, 245 young HR patients were recruited and followed for 9 and 18 months. Risk of psychosis was defined by occurrence of basic symptoms (BS), attenuated psychotic symptoms (ATP), brief, limited or intermittent psychotic symptoms (BLIPS) or familial risk plus reduced functioning (FR-RF). QoL was assessed at baseline and at 9 and 18 months’ follow-ups, and analysed in the HR-patients who converted (HR-P; n = 40) or did not converted to psychosis (HR-NP; n = 205).
There were no differences in the course of QoL between the HR-P and HR-NP patients. Of the inclusion criteria, only BS associated with poor QoL at baseline. Among HR-NP subjects, depressive symptoms associated with QoL at baseline and predicted poor QoL at 9 and 18 month follow-ups.
QoL of the HR-NP patients is as poor as that of the HR-P. From the QoL point of view, all HR patients require intensive treatment intervention from the first contact on. Especially, depressive disorders need to be treated vigorously.
Schizotypal features indicate proneness to psychosis in the general population. It is also possible that they increase transition to psychosis (TTP) among clinical high-risk patients (CHR). Our aim was to investigate whether schizotypal features predict TTP in CHR patients.
In the EPOS (European Prediction of Psychosis Study) project, 245 young help-seeking CHR patients were prospectively followed for 18 months and their TTP was identified. At baseline, subjects were assessed with the Schizotypal Personality Questionnaire (SPQ). Associations between SPQ items and its subscales with the TTP were analysed in Cox regression analysis.
The SPQ subscales and items describing ideas of reference and lack of close interpersonal relationships were found to correlate significantly with TTP. The co-occurrence of these features doubled the risk of TTP.
Presence of ideas of reference and lack of close interpersonal relations increase the risk of full-blown psychosis among CHR patients. This co-occurrence makes the risk of psychosis very high.
The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires.
CAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales.
Coefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales.
The reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.
A considerable number of patients at clinical high risk of psychosis (CHR) are found to meet criteria for co-morbid clinical psychiatric disorders.
It is not known how clinical diagnoses correspond to transitions to psychosis (TTP).
We aimed to examine distributions of life-time and current Axis I diagnoses, and their association with TTP in CHR patients.
In the European Prediction of Psychosis Study project, 245 young help-seeking CHR patients were examined, and their baseline and life-time diagnoses were assessed by the Structured Clinical Interview for DSM-IV (SCID-I). TTP was defined by continuation of BLIPS for more than seven days.
Altogether, 71 % of the CHR patients had one or more life-time and 62 % one or more current SCID-I diagnosis; about a half in each category received a diagnosis of life-time depressive and anxiety disorder. Currently, 34 % suffered from depressive, 39 % from anxiety disorder, 4 % from bipolar and 6.5 % from somatoform disorder. During follow-up, 37 (15.1 %) TTPs were identified. In multivariate Cox regression analyses, current bipolar disorder, somatoform and unipolar depressive disorders associated positively, and anxiety disorders negatively, with TTP.
Both life-time and current mood and anxiety disorders are highly prevalent among help-seeking CHR patients and need to be carefully evaluated. Among them, occurrence of bipolar, somatoform and depressive disorders seem to predict TTP, while anxiety disorder may predict non-transition to psychosis. Treatment of bipolar, somatoform and depressive disorders may prevent CHR patients from developing full-blown psychotic disorders.
The link between depression and paranoia has long been discussed in the psychiatric literature. Because this association is difficult to study in patients with full-blown psychosis, we investigated clinical high-risk (CHR) patients.
To clarify the causal connection between depression and paranoia.
To investigate how clinical depression relates to presence and new occurrence of paranoid symptoms in CHR patients.
Altogether, 245 young help-seeking CHR patients were assessed for suspiciousness/paranoid symptoms with the Structured Interview for Prodromal Syndromes at baseline, 9-month and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood stressful experiences by the Trauma and Distress Scale, trait of suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressive symptoms by the Positive and Negative Syndrome Scale.
At baseline, 54.3 % of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 % and 24.4 %. Depressive disorder, sexual abuse and anxiety symptoms associated with paranoid symptoms. Depressive, obsessive-compulsive and somatoform disorders, sexual abuse, and anxiety predicted occurrence of paranoid symptoms.
Depressive disorder is one of the major clinical factors associating with and predicting paranoid symptoms in CHR patients; also childhood sexual abuse and anxiety symptoms associate with paranoia. In addition, obsessive-compulsive and somatoform disorders seem to predict paranoid symptoms. Low self-esteem may be a common mediator between affective disorders and paranoia. Effective treatment of these disorders may alleviate paranoid symptoms and improve interpersonal functioning in CHR patients.
In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their premorbid adjustment.
In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganized, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9- month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analyzed.
During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 45% to 25%. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.
A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are executed.
This study explored how older Punjabi-speaking South-Asian immigrants (four focus groups; 33 participants) in Surrey, British Columbia, perceive oral health and related problems. Content analysis revealed two umbrella themes: (a) interpretations of mouth conditions and (b) challenges to oral health. The umbrella themes had four sub-themes: damage caused by heat (wai), disturbances caused by caries, coping with dentures, and quality of life. Three challenges were considered: home remedies, Western dentistry, and difficulties accessing dentists. Participants explained oral diseases in terms of a systemic infection (resha), and preferred to decrease imbalances of wai in the mouth with home remedies from India. We conclude that older Punjabi-speaking immigrants interpret oral health and disease in the context of both Western and Ayurvedic traditions, and that they manage dental problems with a mix of traditional remedies supplemented, if possible, by elective oral health care in India, and by emergency dental care in Canada.
Many metallic actinide systems host partially filled 5f electrons in the low-energy spectrum. Consequently, they exhibit diverse quantum mechanical phenomena such as magnetism, superconductivity, a mysterious hidden-order phase, or heavy-fermion behavior. Here we present results of a unified theoretical method based on the self-consistent GW formalism for the electronic many-body self-energy. We calculate the dynamic electronic correlation spectra starting from materials specific first-principles electronic band-structure. In particular, we present results for four isostructural intermetallic actinides PuCoIn5, PuCoGa5, PuRhGa5, and UCoGa5. A common underlying property of these materials is a strong spin–orbit coupling split band structure that enables substantial spin fluctuations. In a feedback effect on the electronic structure they create electronic ‘hot spots’, where the single-particle spectral weight is maximum, resulting in a universal peak-dip-hump feature. These results are in good agreement with experiments, suggesting that actinides are adequately described by the intermediate Coulomb interaction regime, where both itinerant (peak) and localized (hump) features coexist.
Social factors, such as farming methods, have an impact on farm vulnerability to drought, but have received little research or policy attention. Some researchers and advocates have argued that sustainable agriculture systems are less vulnerable to climate risk than conventional systems because sustainable agriculture requires producers to have skills promoting adaptability. In this paper, we investigate producers’ perceptions on the use of sustainable agriculture in reducing drought risk, and what they believe would help them better adapt to drought. We surveyed and interviewed farmer members of two sustainable agriculture organizations in Nebraska, USA, during a multi-year drought period from 1999 to 2007. Producers reported implementing a range of practices, such as organic soil building techniques, reduced tillage, targeted crop selection and diversification of crop and livestock production systems, to reduce their drought vulnerability. Although some practices were implemented specifically to reduce drought risk, producers felt that the practices they implemented as part of their normal operation were largely responsible for reducing their risk. Respondents held mixed views on the effects of insurance and farm programs on their drought management decisions. Finally, producers indicated that their ability to adapt to drought is limited by a number of barriers, especially a lack of capital and the need to respond to markets and maximize production to maintain cash flows.
Arid and semi-arid climates are mainly characterised as those areas where precipitation is less (and often considerably less) than potential evapotranspiration. These climate regions are ideal environments for salt to accumulate in natural soil and groundwater settings since evaporation and transpiration essentially remove freshwater from the system, leaving residual salts behind. Similarly, the characteristically low precipitation rates reduce the potential for salt to be diluted by rainfall. Thus arid and semi-arid regions make ideal ‘salt concentrator’ hydrologic environments. Indeed, salt flats, playas, sabkhas and saline lakes, for example, are ubiquitous features of arid and semi-arid regions throughout the world (Yechieli and Wood,2002). In such settings, variable density flow phenomena are expected to be important, especially where hypersaline brines overlie less dense groundwater at depth. In contrast, seawater intrusion in coastal aquifers is a global phenomenon that is not constrained to only arid and semi-arid regions of the globe and is inherently a variable density flow problem by its very nature. These two examples make it clear that variable density flow problems occur in, but importantly extend beyond, arid and semi-arid regions of the globe. The intention of this chapter is therefore not to limit ourselves to modelling arid zone hydrological systems, but rather to present a more general treatment of variable density groundwater flow and solute transport phenomena and modelling. The concepts presented in this chapter are therefore not climatologically constrained to arid or semi-arid zones of the world, although they do apply equally there.
We demonstrate how data mining techniques can be applied to complex combinatorial data sets and how data from multiple sources can be aggregated via the developed scientific data management system. An example is shown for the case of aggregated combinatorial data for the study of composition, processing, structure, and property relationships of transparent conducting oxides by applying data mining techniques such as principal component analysis. Data mappings of mined results are shown to effectively enable visualization of data trends, identification of anomalies in Fourier transform infrared spectroscopy patterns, and scientifically interesting libraries and spectral regions.
Theoretical work based on one-dimensional (1D) models indicates that Bi wires with diameter smaller than 50 nm can exhibit superior thermoelectric properties since the density of states at the Fermi level of a 1D system can be tuned to very high values. Recently, angle-resolved photoemission spectroscopy (ARPES) studies of Bi surfaces have shown that Bi nanowires support Rashba spin-orbit surface states, with high carrier densities of around 5×1012/cm−2, that have not been considered in current models of Bi nanowires. According to our estimates, the sheath of surface charge on Bi nanowires should contribute substantially to the thermopower of Bi nanowires. We carried out an experimental study of the transport properties and thermopower of bismuth nanowire arrays (NWA) with wire diameters ranging between 60 nm and 13 nm to investigate these phenomena. The Rashba interaction is a spin orbit interaction that is important for surfaces of materials consisting of heavy ion elements; thermoelectric materials frequently consist of these elements (i.e.PbTe) because they scatter phonons and form low thermal conductivity materials.
Molecular beam epitaxy-grown GaN with different Mn concentrations (5–23 × 10 cm-3) and codoped with Si were investigated by cathodoluminescence (CL) spectroscopy and optical transmission measurements. In the GaN:Mn, an intense absorption peak at 1.414 +/- 0.002 eV was observed. This peak was attributed to an internal T2∼> E transition of the deep neutral Mn3+ state since its intensity scaled with the Mn3+ concentration. The CL measurements showed that Mn-doping concentrations around 1020 cm-3 had three effects on the emission spectrum: (i) the donor bound exciton at 3.460 eV was reduced by more than one order of magnitude, (ii) the donor-acceptor-pair band at 3.27 eV was completely quenched and (iii) the yellow luminescence centered at 2.2 eV was the strongly decreased. The latter two effects were attributed to a reduced concentration of VGa. In the infrared spectral range, three broad, Mn-doping related CL emission bands centered at 1.01 ± 0.02 eV, 1.09 ± 0.02 eV and 1.25 ± 0.03 eV were observed. These bands might be related to deep donor complexes, which are generated as a result of the heavy Mn-doping, rather than internal transitions at the Mn atom.
We fabricated Bi nanowire array composites with wire diameters from 30 to 200 nm by high-pressure injection (HPI) of Bi melt into porous anodic alumina templates. The composites were dense, with Bi volume fraction in excess of 50%. The parallel Bi nanowires, whose length appeared to be limited only by the thickness of the host template (up to 55 μm), terminated at both sides of the composite in the Bi bulk. The individual Bi nanowire crystal structure was rhombohedral, with the same lattice parameters as that of bulk Bi; the wires in the array were predominantly oriented with the trigonal axis along the wire length. Low contact resistance was achieved by bonding the composite to copper electrodes.