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As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
Sex addiction has received substantial attention over the past decade and has been accepted by the World Health Organization as Compulsive Sexual Behavior Disorder in the forthcoming ICD-11. This chapter outlines etiology, existing controversies, measurement, and treatment approaches to helping individuals with sex addiction in clinical settings. Although a lot of research has helped researchers and practitioners better understand the associated characteristics of sex addiction, the field is still in its infancy and in need of further study.
OBJECTIVES/GOALS: 1. Understand the association between patient perceptions of care measured by the Interpersonal Processes of Care (IPC) Survey and glycemic control, appointment no-shows/cancellations and medication adherence in patients with type II diabetes. 2. Determine how these relationships differ by race for non-Hispanic White and Black patients. METHODS/STUDY POPULATION: This is a cross-sectional study of a random sample of 100 White and 100 Black Type II diabetic patients followed in Duke primary care clinics and prescribed antihyperglycemic medication. We will recruit through email and phone calls. Enrolled patients will complete the Interpersonal Processes of Care Short Form and Extent of Medication Adherence survey to measure patient perceptions of care (predictor) and medication adherence (secondary outcome). No show appointments and cancellations (secondary outcomes) and most recent hemoglobin A1c (primary outcome) will be collected from the Electronic Medical Record. We will also collect basic demographic information, insurance status, financial security, significant co-morbidities, and number and type (subcutaneous vs oral) of antihyperglycemic medications. RESULTS/ANTICIPATED RESULTS: -The study is powered to detect a 0.6% difference in HbA1c, our primary outcome, between high and low scorers on the Interpersonal Processes of Care subdomains. -We expect that higher patient scores in the positive domains of the IPC survey and lower DISCUSSION/SIGNIFICANCE OF IMPACT: This study will provide information to develop and implement targeted interventions to reduce racial and ethnic disparities in patients with Type II diabetes. We hope to gain information on potentially modifiable factors in patient-provider interactions that can be intervened upon to improve prevention and long-term outcomes in these populations.
Pervasive Refusal Syndrome (PRS) is a relatively new diagnostic concept, that describes a rare and potentially life threatening condition, in which children refuse to walk.
talk, eat, drink, engage in self care, and take part in day to day activities (Lask et al, 1991).
PRS is not included in any of the psychiatric classification systems (ICD 10, DSM IV), although consensus exists within the literature as to its existence. Lask comments in his paper on Pervasive Refusal Syndrome that he has consulted on only 50 cases worldwide (Lask, 2004).
The authors will share their clinical experience of treating seven new cases of PRS in a Regional CAMHS inpatient hospital. Patients with PRS often require hospital admission for assessment and exclusion of other medical, neurological and psychiatric disorders. However, because of the rarity many medical and psychiatric professionals have little experience of the treatment and rehabilitation required.
The specific MDT management approach necessary to meet the complex needs of patients with PRS will be discussed, as treatment is often counterintuitive, and some approaches can result in deterioration rather than improvement.
In terms of improvement and recovery from the disorder, less is known about long term follow-up, as only a few studies have reported on immediate outcome. The authors have undertaken a long term follow-up (in press) and will discuss issues relating to prognosis.
A specific MDT treatment approach for PRS will be discussed, alongside the clinical decisions and dilemmas involved in following this approach.
While evidence-based psychiatric practices (EBPs) are assumed to be more efficient, savings and sustainability are elusive during times of economic instability. This presentation uses two-years of penetration and cost-related data from46 community mental health providers to document EBP penetration and sustainability during a period of serious funding contraction.
This study sought to identify specific elements that contribute to EBP-related savings and sustainability in urban, rural and blended environments.
This study identifies critical organizational practices that sustain EBPs during difficult economic times.
Using existing claims data on the State of Michigan website, researchers used a stratified regression analysis to identify critical variables contributing to increased use of EBPs and decreased use of high-cost services. Follow-up qualitative data were collected from administrators of high and low penetration organizations to provide insight into within-agency strategies that contribute to EBP implementation and sustainability.
Findings identify direct and indirect contributors to sustainability and efficiency when implementing evidence-based practices. Direct contributors include unit-cost funding and the number of EBPs implemented. Indirect contributors include organizational promotion activities that create an atmosphere of excellence. Findings vary across urban, rural and blended environments.
Evidence-based practices require a strong organizational commitment to remain viable during difficult financial times.
The grain structure of electrodeposited Cobalt is important to device electrical and reliability performance. This paper describes thermal annealing studies performed on electroplated blanket and pattern Cobalt wafers. A systematic study of Co film properties and effect of various anneal parameters such as temperature, time, hydrogen pressure and thermal cycling was completed. Co film resistivity, purity, grain structure, phase composition and orientation as well as in-feature grain size have been characterized by various analytical methods such as XRD, STEM, SIMS and EBSD. It was observed that electroplated cobalt films with resistivity approaching bulk Cobalt value can be obtained by annealing in the temperature range of 300°C - 350°C which is favorable for hcp Co phase formation.
As life expectancy increases, more people have chronic psychiatric and medical health disorders. Comorbidity may increase the risk of premature mortality, an important challenge for health service delivery.
Population-based cohort study in Ontario, Canada of all 11 246 910 residents aged ⩾16 and <105 on 1 April 2012 and alive on 31 March 2014. Secondary analyses included subjects having common medical disorders in 10 separate cohorts. Exposures were psychiatric morbidity categories identified using aggregated diagnosis groups (ADGs) from Johns Hopkins Adjusted Clinical Groups software® (v10.0); ADG 25: Persistent/Recurrent unstable conditions; e.g. acute schizophrenic episode, major depressive disorder (recurrent episode), ADG 24: Persistent/Recurrent stable conditions; e.g. depressive disorder, paranoid personality disorder, ADG 23: Time-limited/minor conditions; e.g. adjustment reaction with brief depressive reaction. The outcome was all-cause mortality (April 2014–March 2016).
Over 2 years' follow-up, there were 188 014 deaths (1.7%). ADG 25 conferred an almost threefold excess mortality after adjustment compared to having no psychiatric morbidity [adjusted hazard ratio 2.94 (95% CI 2.91–2.98, p < 0.0001)]. Adjusted hazard ratios for ADG 24 and ADG 23 were 1.12 (95% CI 1.11–1.14, p < 0.0001) and 1.31 (95% CI 1.26–1.36, p < 0.0001). In all 10 medical disorder cohorts, ADG 25 carried significantly greater mortality risk compared to no psychiatric comorbidity.
Psychiatric disorders, particularly those graded persistent/recurrent and unstable, were associated with excess mortality in the whole population, and in the medical disorder cohorts examined. Future research should examine whether service design accounting for psychiatric disorder comorbidity improves outcomes across the spectrum of medical disorders.
The air gap technique (AGT) is an approach to radiation dose optimisation during fluoroscopy where an “air gap” is used in place of an anti-scatter grid to reduce scatter irradiation. The AGT is effective in adults but remains largely untested in children. Effects are expected to vary depending on patient size and the amount of scatter irradiation produced.
Fluoroscopy and cineangiography were performed using a Phillips Allura Fluoroscope on tissue simulation anthropomorphic phantoms representing a neonate, 5-year-old, and teenager. Monte Carlo simulations were then used to estimate effective radiation dose first using a standard recommended imaging approach and then repeated using the AGT. Objective image quality assessments were performed using an image quality phantom.
Effective radiation doses for the neonate and 5-year-old phantom increased consistently (2–92%) when the AGT was used compared to the standard recommended imaging approaches in which the anti-scatter grid is removed at baseline. In the teenage phantom, the AGT reduced effective doses by 5–59%, with greater dose reductions for imaging across the greater thoracic dimension of lateral projection. The AGT increased geometric magnification but with no detectable change in image blur or contrast differentiation.
The AGT is an effective approach for dose reduction in larger patients, particularly for lateral imaging. Compared to the current dose optimisation guidelines, the technique may be harmful in smaller children where scatter irradiation is minimal.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
This Research Communication describes an investigation of the nutritional depletion of total mixed rations (TMR) by pest birds. We hypothesized that species-specific bird depredation of TMR can alter the nutritional composition of the ration and that these changes can negatively impact the performance of dairy cows. Blackbirds selected the high energy fraction of the TMR (i.e., flaked corn) and reduced starch, crude fat and total digestible nutrients during controlled feeding experiments. For Holsteins producing 37·1 kg of milk/d, dairy production modeling illustrated that total required net energy intake (NEI) was 35·8 Mcal/d. For the reference TMR unexposed to blackbirds and the blackbird-consumed TMR, NEI supplied was 41·2 and 37·8 Mcal/d, and the resulting energy balance was 5·4 and 2·0 Mcal/d, respectively. Thus, Holsteins fed the reference and blackbird-consumed TMR were estimated to gain one body condition score in 96 and 254 d, and experience daily weight change due to reserves of 1·1 and 0·4 kg/d, respectively. We discuss these results in context of an integrated pest management program for mitigating the depredation caused by pest birds at commercial dairies.
Knowledge of the effects of burial depth and burial duration on seed viability and, consequently, seedbank persistence of Palmer amaranth (Amaranthus palmeri S. Watson) and waterhemp [Amaranthus tuberculatus (Moq.) J. D. Sauer] ecotypes can be used for the development of efficient weed management programs. This is of particular interest, given the great fecundity of both species and, consequently, their high seedbank replenishment potential. Seeds of both species collected from five different locations across the United States were investigated in seven states (sites) with different soil and climatic conditions. Seeds were placed at two depths (0 and 15 cm) for 3 yr. Each year, seeds were retrieved, and seed damage (shrunken, malformed, or broken) plus losses (deteriorated and futile germination) and viability were evaluated. Greater seed damage plus loss averaged across seed origin, burial depth, and year was recorded for lots tested at Illinois (51.3% and 51.8%) followed by Tennessee (40.5% and 45.1%) and Missouri (39.2% and 42%) for A. palmeri and A. tuberculatus, respectively. The site differences for seed persistence were probably due to higher volumetric water content at these sites. Rates of seed demise were directly proportional to burial depth (α=0.001), whereas the percentage of viable seeds recovered after 36 mo on the soil surface ranged from 4.1% to 4.3% compared with 5% to 5.3% at the 15-cm depth for A. palmeri and A. tuberculatus, respectively. Seed viability loss was greater in the seeds placed on the soil surface compared with the buried seeds. The greatest influences on seed viability were burial conditions and time and site-specific soil conditions, more so than geographical location. Thus, management of these weed species should focus on reducing seed shattering, enhancing seed removal from the soil surface, or adjusting tillage systems.
Metal–insulator–metal (MIM) resonant absorbers comprise a conducting ground plane, a thin dielectric, and thin separated metal top-surface structures. The dielectric SiO2 strongly absorbs near 9 µm wavelength and has correspondingly strong long-wave-infrared (LWIR) dispersion for the refractive index. This dispersion results in multiple absorption resonances spanning the LWIR, which can enhance broad-band sensitivity for LWIR bolometers. Similar considerations apply to silicon nitride Si3N4. TiO2 and AlN have comparatively low dispersion and give simple single LWIR resonances. These dispersion-dependent features for infrared MIM devices are demonstrated by experiment, electrodynamic simulation, and an analytic model based on standing waves.
Despite 70 years of study, Dickinsonia remains one of the Ediacara biota’s most enigmatic taxa with both morphological characters and phylogenetic affinities still debated. A large population of relatively small Dickinsonia costata present on a semi-contiguous surface from the Crisp Gorge fossil locality in the Flinders Ranges (South Australia) provides an opportunity to investigate this taxon in its juvenile form. This population supports earlier findings that suggest D. costata’s early growth was isometric, based on the relationship between measured variables of length and width. The number of body units increases with length, but at a decreasing rate. A correlation between a previously described physical feature, present as a shrinkage rim partially surrounding some specimens and a novel, raised lip in some specimens, suggests that both features may have been the result of a physical contraction in response to the burial process, rather than due to a gradual loss of mass during early diagenesis. A marked protuberance in 15% of the population is also noted in limited specimens within the South Australian Museum collections and appears to be present only in juvenile D. costata. Both the abundance and narrow size range of this population support the notion that Dickinsonia was a hardy opportunist, capable of rapid establishment and growth on relatively immature textured organic-mat substrates.
To identify predominant dietary patterns in four African populations and examine their association with obesity.
We used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of non-communicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men.
We identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern’s lowest tertile (both P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity.
We identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.
In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR = 1.49, p = 0.008), NAS abuse (PR = 2.06, p = 0.02) and IPV (PR = 2.93, p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31, p < 0.001)], female (OR = 0.48, p = 0.036) were protective of NAS but current smokers (OR = 2.98, p < 0.001) and those reporting IPV (OR = 2.16, p = 0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.
We present multi–epoch VLBI observations of the methanol and water masers in the high–mass star formation region G 339.884−1.259, made using the Australian Long Baseline Array (LBA). Our sub–milliarcsecond precision measurements trace the proper motions of individual maser features in the plane of the sky. When combined with the direct line–of–sight radial velocity (vlsr), these measure the 3 D gas kinematics of the associated high–mass star formation region, allowing us to probe the dynamical processes to within 1000 AU of the core.
We introduce the newly developed database of circumstellar maser sources. Until now, the compilations comprehensively including the three major maser species in evolved stars (i.e., SiO, H2O, OH) has been practically limited only to the Benson’s catalog (Benson et al. 1990), which was published more than a quarter of a century ago. For OH masers alone, there exists the University of Hamburg (UH) database, but there is no updated compilation work for H2O and SiO masers. In order to utilize the information of masers in actual studies, it is highly desirable to have a database containing all the three masers. We are currently constructing a database covering SiO, H2O and OH masers. This database consists of a web-service, which accesses compiled maser observations in available archives and combines them with the data we newly collected and IR databases. The archives currently used are the OH maser archive from Engels & Bunzel (2015), and H2O and SiO archives, which are currently under construction. So far, the information of about 27,000 observations (about 10,000 objects) has been implemented. We also have a plan to extend the database by including higher transitions and other types of objects, such as young stellar objects, in future. In this paper, we briefly summarize, (1) outline of the data collected, and (2) future development plans of the eDAMS system. The URL of the database is as follows: http://maserdb.ins.urfu.ru/
The dwarf galaxies in the Local Group (LG) reveal a surprising amount of spatial structuring. In particular, almost all non-satellite dwarfs belong to one of two planes that show a very pronounced symmetry. In order to determine if these structures in the LG are dynamically stable or, alternatively, if they only represent transient alignments, proper motion measurements of these galaxies are required. A viable method to derive proper motions is offered by VLBI studies of 22-GHz water (and 6.7-GHz methanol) maser lines in star-forming regions.
In 2016, in the framework of the Early Science Program of the Sardinia Radio Telescope (SRT), we have conducted an extensive observational campaign to map the entire optical body of all the LG dwarf galaxies that belong to the two planes, at C and K band, in a search for methanol and water maser emission.
Here, we outline the project and present its first results on 3 targets, NGC 6822, IC 1613, and WLM. While no luminous maser emission has been detected in these galaxies, a number of interesting weaker detections has been obtained, associated with particularly active star forming regions. In addition, we have produced deep radio continuum maps for these galaxies, aimed at investigating their star forming activity and providing an improved assessment of star formation rates in these galaxies.