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The prognosis of patients with advanced squamous cell carcinoma of the external auditory canal and middle ear has been improved by advances in skull base surgery and multidrug chemoradiotherapy during the last two decades.
Ninety-five patients with squamous cell carcinoma of the external auditory canal and middle ear who were treated between 1998 and 2017 were enrolled. The number of patients with tumour stages T1, T2, T3 and T4 was 15, 22, 24 and 34, respectively. Oncological outcomes and prognostic factors were retrospectively investigated.
Among patients with T4 disease, invasion of the brain (p = 0.024), carotid artery (p = 0.049) and/or jugular vein (p = 0.040) were significant predictors of poor prognosis. The five-year overall survival rate of patients with at least one of these factors (T4b) was significantly lower than that of patients without these factors (T4a) (25.5 vs 65.5 per cent, p = 0.049).
It is proposed that stage T4 be subclassified into T4a and T4b according to the prognostic factors.
This chapter discusses noticing of corrective feedback (CF) and factors that affect noticing in different contexts in previous studies. Laboratory studies found that the type of error, the length and salience of the CF, the proficiency level of the learner, and their working memory capacity, attention control, and analytical ability affected noticeability of CF. In classroom studies, the explicitness of the CF and learners' anxiety in language classrooms additionally influenced their noticing of CF. A further finding of studies is that there are discrepancies between teachers' intentions in giving CF and learners' interpretations of that CF. In peer work, the relationship between learners were closely related to the noticng of CF. Computer-based text chats have certain strengths in terms of contributing to learners' noticing of CF, such as the slow pace of the communication and the re-readibility of the text messages. However, delayed CF, and less social and affective engagement due to characteristics of text chats seemed to contribute to less noticeability of CF. In future studies, it will be necessary to examine how and when noticing leads to understanding to explore the process of deeper learning.
Wheel slip prediction on rough terrain is crucial for secure, long-term operations of planetary exploration rovers. Although rough, unstructured terrain hampers mobility, prediction by modeling wheel–terrain interactions remains difficult owing to unclear terrain conditions and complexities of terramechanics models. This study proposes a vision-based approach with machine learning for predicting wheel slip risk by estimating the slope from 3D information and classifying terrain types from image information. It considers the slope estimation accuracy for risk prediction under sharp increases in wheel slip due to inclined ground. Experimental results obtained with a rover testbed on several terrain types validate this method.
The extent and profiles of heterogeneity in cognitive functioning among participants in clinical trials of antidementia medication are unknown. We aimed to quantify and identify profiles of heterogeneity of cognition in Alzheimer’s disease.
Individual-level participant data were analyzed from five pivotal clinical trials of donepezil for Alzheimer’s disease (N = 2,919). Based on Alzheimer’s Disease Assessment Scale–Cognitive Subscale total scores from baseline up to week 12, a latent class model was used to identify heterogeneous groups. A logistic regression model was used to examine factors associated with group membership. Sensitivity analysis was conducted, restricted to the donepezil, and then the placebo arm.
The latent class model identified three classes labeled as low scorers (i.e., least cognitive impairment; N = 1,666, 76.04%), improvers (N = 27, 1.23%), and high scorers (N = 498, 22.73%). Logistic modeling showed that donepezil compared to placebo was significantly (p < 0.05) positively associated with membership in the improvers class (OR = 6.88, 95% CI = 2.03, 42.95), and negatively with high scorers (OR = 0.79, 95% CI = 0.64, 0.98). Sensitivity analysis restricted to the placebo, then donepezil arms replicated similar heterogeneity patterns.
Our results inform clinicians regarding the extent of heterogeneity in cognitive functioning during treatment and contribute to trial design considerations.
During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic.
We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020.
Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic.
Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.
In the treatment of psychosis, agitation and aggression in Alzheimer's disease, guidelines emphasise the need to ‘use the lowest possible dose’ of antipsychotic drugs, but provide no information on optimal dosing.
This analysis investigated the pharmacokinetic profiles of risperidone and 9-hydroxy (OH)-risperidone, and how these related to treatment-emergent extrapyramidal side-effects (EPS), using data from The Clinical Antipsychotic Trials of Intervention Effectiveness in Alzheimer's Disease study (Clinicaltrials.gov identifier: NCT00015548).
A statistical model, which described the concentration–time course of risperidone and 9-OH-risperidone, was used to predict peak, trough and average concentrations of risperidone, 9-OH-risperidone and ‘active moiety’ (combined concentrations) (n = 108 participants). Logistic regression was used to investigate the associations of pharmacokinetic biomarkers with EPS. Model-based predictions were used to simulate the dose adjustments needed to avoid EPS.
The model showed an age-related reduction in risperidone clearance (P < 0.0001), reduced renal elimination of 9-OH-risperidone (elimination half-life 27 h), and slower active moiety clearance in 22% of patients, (concentration-to-dose ratio: 20.2 (s.d. = 7.2) v. 7.6 (s.d. = 4.9) ng/mL per mg/day, Mann–Whitney U-test, P < 0.0001). Higher trough 9-OH-risperidone and active moiety concentrations (P < 0.0001) and lower Mini-Mental State Examination (MMSE) scores (P < 0.0001), were associated with EPS. Model-based predictions suggest the optimum dose ranged from 0.25 mg/day (85 years, MMSE of 5), to 1 mg/day (75 years, MMSE of 15), with alternate day dosing required for those with slower drug clearance.
Our findings argue for age- and MMSE-related dose adjustments and suggest that a single measure of the concentration-to-dose ratio could be used to identify those with slower drug clearance.
This chapter outlines a brief history of the current educational reforms in Japan. Against this historical contexts, the following issues are discussed: (1) the prioritization of English as the international language; (2) the discourse of Japanese incompetence in English; (3) the setting of English proficiency benchmarks; (4) the early introduction of English and the implications for the role of homeroom teachers; and (5) the power relationship between homeroom teachers and Assistant Language Teachers. The chapter argues that the imposition of policies and standards on teachers and teacher educators will lead to de-professionalization as they are deprived of the opportunities to exercise their own professional judgment. It suggests ways in which de-professionalization of teachers can be avoided and the power imbalance can be redressed between Japanese teachers of English and native English speaking teachers.
We have often observed dementia symptoms or severe neurocognitive decline in the long-term course of schizophrenia. While there are epidemiological reports that patients with schizophrenia are at an increased risk of developing dementia, there are also neuropathological reports that the prevalence of Alzheimer’s disease (AD) in schizophrenia is similar to that in normal controls. It is difficult to distinguish, based solely on the clinical symptoms, whether the remarkable dementia symptoms and cognitive decline seen in elderly schizophrenia are due to the course of the disease itself or a concomitant neurocognitive disease. Neuropathological observation is needed for discrimination.
We conducted a neuropathological search on three cases of schizophrenia that developed cognitive decline or dementia symptoms after a long illness course of schizophrenia. The clinical symptoms of total disease course were confirmed retrospectively in the medical record. We have evaluated neuropathological diagnosis based on not only Hematoxylin–Eosin and Klüver–Barrera staining specimens but also immunohistochemical stained specimens including tau, β-amyloid, pTDP-43 and α-synuclein protein throughout clinicopathological conference with multiple neuropathologists and psychiatrists.
The three cases showed no significant pathological findings or preclinical degenerative findings, and poor findings consistent with symptoms of dementia were noted.
Although the biological background of dementia symptoms in elderly schizophrenic patients is still unclear, regarding the brain capacity/cognitive reserve ability, preclinical neurodegeneration changes in combination with certain brain vulnerabilities due to schizophrenia itself are thought to induce dementia syndrome and severe cognitive decline.
The majority of refugees are children and youth and their integration and life-course transitions are a research priority. This paper examines the timing of refugee children and youths’ entrance into the labour market and family formation (marriage/common law union and parenthood). It does so by examining how admission category, knowledge of a host country’s official languages, and age at arrival shape their transition to adulthood. Using data from the Canadian Longitudinal Immigration Database and Heckman selection estimation, the paper finds minimal variation in refugee children and youths’ entry into the labour market compared to children of other immigrant streams. It also finds that refugee children and youth start forming families at a younger age than children of economic class immigrants, but at an older age than family class children. The analysis also shows limited effects of knowledge of official language prior to arrival while age at arrival has a robust impact on their adulthood transitions. These findings shed light on the unique patterns of life-course transition among refugee children and youth and contribute to a better conceptualization of their experiences relative to children and youth of other immigrants.
This chapter describes Paul Pedersen’s Triad Training Model, which is a unique experiential activity originally designed for counselors-in-training to help them better understand culturally different others. While it is a versatile tool that can be effective in other types of training situations, it is not well-known outside the field of multicultural counseling. While many popular intercultural simulations target cultural awareness, the Triad Training model is more holistic in that it is able to simultaneously raise awareness, impart cultural knowledge, address emotional issues, and help participants develop skills. This chapter begins by explaining the cultural context that gave birth to the model as well as its research foundation in psychology. Next, it examines its goals as well as how it evolved during the forty years since its creation. Finally, because the model is confrontational in its approach, the author shows how she adapted it for collectivist cultures.
Implantable neural interfaces are important tools to accelerate neuroscience research and translate clinical neurotechnologies. The promise of a bidirectional communication link between the nervous system of humans and computers is compelling, yet important materials challenges must be first addressed to improve the reliability of implantable neural interfaces. This perspective highlights recent progress and challenges related to arguably two of the most common failure modes for implantable neural interfaces: (1) compromised barrier layers and packaging leading to failure of electronic components; (2) encapsulation and rejection of the implant due to injurious tissue–biomaterials interactions, which erode the quality and bandwidth of signals across the biology–technology interface. Innovative materials and device design concepts could address these failure modes to improve device performance and broaden the translational prospects of neural interfaces. A brief overview of contemporary neural interfaces is presented and followed by recent progress in chemistry, materials, and fabrication techniques to improve in vivo reliability, including novel barrier materials and harmonizing the various incongruences of the tissue–device interface. Challenges and opportunities related to the clinical translation of neural interfaces are also discussed.
Entamoeba histolytica infection causes amoebiasis, which is a global public health problem. The major route of infection is oral ingestion of E. histolytica cysts, cysts being the sole form responsible for host-to-host transmission. Cysts are produced by cell differentiation from proliferative trophozoites in a process termed ‘encystation’. Therefore, encystation is an important process from a medical as well as a biological perspective. Previous electron microscopy studies have shown the ultrastructure of precysts and mature cysts; however, the dynamics of ultrastructural changes during encystation were ambiguous. Here, we analysed a series of Entamoeba invadens encysting cells by transmission electron microscopy. Entamoeba invadens is a model for encystation and the cells were prepared by short interval time course sampling from in vitro encystation-inducing cultures. We related sampled cells to stage conversion, which was monitored in the overall population by flow cytometry. The present approach revealed the dynamics of ultrastructure changes during E. invadens encystation. Importantly, the results indicate a functional linkage of processes that are crucial in encystation, such as glycogen accumulation and cyst wall formation. Hence, this study provides a reference for studying sequential molecular events during Entamoeba encystation.
Hypertensive disorders of pregnancy (HDP) affect up to 10% of women during pregnancy and influence child neurodevelopment, including mental and motor function. We assessed whether HDP, including gestational hypertension, preeclampsia, superimposed preeclampsia, and eclampsia, correlate with motor and mental developmental abnormalities in 3-year-old children, using data obtained between April 2004 and March 2013 through a mandatory population-based health checkup of mothers and children in Kobe city, Japan. The primary outcome was motor and mental developmental abnormalities at 3 years of age; parental-reported questionnaires and physician’s medical examinations were evaluated. The association between maternal HDP and child neurodevelopmental abnormality was evaluated using a logistic regression model. Of the 43,854 participating children, 1120 were born to women with HDP and 42,734 were born to women without HDP. The prevalence of motor developmental abnormality was 1.7% in the exposed group and 0.95% in the control group; the prevalence of mental developmental abnormality was 2.41% in the exposed group and 1.22% in the control group. Children born to mothers with HDP did not have an increased risk of motor developmental abnormality at the age of 3 years [adjusted odds ratio (OR) 1.17, 95% confidence interval 0.72–1.91], but had an increased risk of mental developmental abnormality (adjusted OR 1.80, 95% confidence interval 1.21–2.69). Maternal HDP were associated with mental development abnormality in 3-year-old children. These findings may be clinically relevant; mental abnormality in children born to women with HDP could be detected during early stages, which would facilitate early intervention.
In the midst of a global pandemic, hospitals around the world are working to meet the demand for patients ill with the 2019 coronavirus disease (COVID-19) caused by the novel coronavirus first identified in Wuhan, China. As the crisis unfolds, several countries have reported lower numbers as well as less morbidity and mortality for pediatric patients. Thus, pediatric centers find themselves pivoting from preparing for a patient surge to finding ways to support the regional response for adults. This study describes the response from 2 West Coast freestanding academic children’s hospitals that were among the first cities in the United States impacted during this pandemic.
The authors examined the effect of tandospirone on tardive dyskinesia (TD) and parkinsonian symptoms in an open study. Tandospirone did not bring about any favourable effect on TD, but it had a good effect on the parkinsonian symptoms.
We have reported a blood flow increase in the prefrontal cortex during the performance of the computer version TMT. Although TMT-A was first performed and followed by TMT-B in the previous study, the order was reversed in the present study,i.e., TMT-B was first performed and then followed by TMT-A, and differences in the change of blood flow were compared between the two modes of TMT.
Nine healthy student volunteers (20.7 ± 1.6 yr) performed two different sets of TMT-B. After a resting period of 30 sec, they performed four different sets of TMT-A. Changes of oxyHb and deoxyHb were monitored by 22-channel NIRS from 30 sec before the start of TMT-B through 30 sec after the end of TMT-A. The mean changes of blood flow over a period of 10 sec just before the start of TMT-B and TMT-A, and over a period of 100 sec after the start of TMT-B and TMT-A were determined.
The increase of oxyHb was prominent in the right lateral prefrontal cortex.
The results suggest that the blood flow increases in the prefrontal cortex during the start of either TMT-A or TMT-B. The location of blood flow increase did not change whether TMT-B was performed first or after TMT-A. Therefore, the blood flow increase observed only in the right prefrontal cortex in the previous study could not be due to familiarization of the test. In contrast, TMT-A apparently exhibits a familiarization effect, since blood flow increase was not observed when TMT-A was performed after TMT-B.
We measured concentration changes of oxyHb and deoxyHb in the prefrontal cortex during the performance of the computer version Trail Making Test(TMT) by multichannel NIRS using near infrared light pairs which are more sensitive for detecting changes of oxyHb and deoxyHb.
Sixteen healthy student volunteers performed four different TMT-A sets, and following 30 a sec resting period, two different TMT-B sets. Changes of oxyHb and deoxyHb were monitored by 22 channel NIRS from 30 sec before the start of TMT-A through 30 sec after the end of TMT-B. The mean changes in subjects over a period of 10 sec just before the start of TMT-A and TMT-B, and a period of 50 to 60 sec after the start of TMT-A and TMT-B were determined. OxyHb increased while deoxyHb decreased in the bilateral prefrontal cortices during the performance of TMT. The increase of oxyHb was prominent in the right lateral prefrontal cortex, especially during TMT-A.
On the other hand, deoxyHb significantly decreased in the bilateral prefrontal cortices especially during TMT-A.
The results suggest that blood flow increases in the prefrontal cortex during the performance of the computer version TMT.
We herein report a case of new-onset epileptic seizures induced by carbamazepine in an individual with autism spectrum disorders (ASD). We clinicians should bear in mind the possibility that epileptic seizures may possibly be either precipitated or exacerbated by carbamazepine especially in individuals with ASD.