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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.
Recent research about pedophilia suggested an association between pedophilia, neurocognitive disturbance and specific personality profiles. Especially neuropsychological functions associated with the prefrontal and motor processing loops showed to be impaired in pedophilia. But in most studies about pedophilia subjects were recruited from high security forensic hospitals. The results might therefore be influenced by selection bias. To overcome this bias we conducted a study that aimed to compare neurocognitive disturbance and specific personality profiles of pedophile sexual abusers, pedophile internet abusers and controls.
We included until now 5 male pedophile sexual abusers, 4 male pedophile internet abusers and 6 male control subjects. Subjects were matched for age and IQ. Personality profiles were assessed by SKID and MMPI. Response inhibition was tested in a classical Go/NoGo task.
Assessments of personality profiles showed similar sub threshold profiles for the controls and the group of internet abusers while subjects from security forensic hospital setting fulfilled criteria of personality disorders. Accordingly showed the Go/NoGo task higher rates of failed response inhibition in the group of paedophilic subjects from high security forensic hospital setting and lower rates for pedophile internet abusers and/or controls.
Our preliminary data suggests that results of recent studies about neurocognitive disturbance and neuroimaging correlates of paedophilia might be influenced by selection bias and might rather reflect impairment of personality and social interaction in a broader sense. Future research about paedophilia should consequently aim to disentangle personality impairment from sexual orientation.
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).
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.
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.
Exercise during pregnancy has beneficial effects on maternal and offspring’s health in humans and mice. The underlying mechanisms remain unclear. This comparative study aimed to determine the long-term effects of an exercise program on metabolism, weight gain, body composition and changes in hormones [insulin, leptin, brain-derived neurotrophic factor (BDNF)]. Pregnant women (n=34) and mouse dams (n=44) were subjected to an exercise program compared with matched controls (period I). Follow-up in the offspring was performed over 6 months in humans, corresponding to postnatal day (P) 21 in mice (period II). Half of the mouse offspring was challenged with a high-fat diet (HFD) for 6 weeks between P70 and P112 (period III). In period I, exercise during pregnancy led to 6% lower fat content, 40% lower leptin levels and an increase of 50% BDNF levels in humans compared with controls, which was not observed in mice. After period II in humans and mice, offspring body weight did not differ from that of the controls. Further differences were observed in period III. Offspring of exercising mouse dams had significantly lower fat mass and leptin levels compared with controls. In addition, at P112, BDNF levels in offspring were significantly higher from exercising mothers while this effect was completely blunted by HFD feeding. In this study, we found comparable effects on maternal and offspring’s weight gain in humans and mice but different effects in insulin, leptin and BDNF. The long-term potential protective effects of exercise on biomarkers should be examined in human studies.
Complications from systemic inflammation are reported in neonates following exposure to cardiopulmonary bypass. Although the use of asanguinous primes can reduce these complications, in neonates, this can result in significant haemodilution, requiring addition of blood. This study investigates whether the addition of blood after institution of bypass alters the inflammatory response compared with a blood prime. Neonatal swine were randomised into four groups: blood prime, blood after bypass but before cooling, blood after cooling but before low flow, and blood after re-warming. All groups were placed on central bypass, cooled, underwent low flow, and then re-warmed for a total bypass time of 2 hours. Although haematocrit values between groups varied throughout bypass, all groups ended with a similar value. Although they spent time with a lower haematocrit, asanguinous prime groups did not have elevated lactate levels at the end of bypass compared with blood prime. Asanguinous primes released less tumour necrosis factor α than blood primes (p=0.023). Asanguinous primes with blood added on bypass produced less interleukin 10 and tumour necrosis factor α (p=0.006, 0.019). Animals receiving blood while cool also showed less interleukin 10 and tumour necrosis factor α production than those that received blood warm (p=0.026, 0.033). Asanguinous primes exhibited less oedema than blood primes, with the least body weight gain noted in the end cool group (p=0.011). This study suggests that using an asanguinous prime for neonates being cooled to deep hypothermia is practical, and the later addition of blood reduces inflammation.
The multicomponent Dry Creek site, located in the Nenana Valley, central Alaska, is arguably one of the most important archaeological sites in Beringia. Original work in the 1970s identified two separate cultural layers, called Components 1 and 2, thought to date to the terminal Pleistocene and suggesting that the site was visited by Upper Paleolithic huntergatherers between about 13,000 and 12,000 calendar years before present (cal B.P.). The oldest of these became the typeassemblage for the Nenana complex. Recently, some have questioned the geoarchaeological integrity of the site's early deposits, suggesting that the separated cultural layers resulted from natural postdepositional disturbances. In 2011, we revisited Dry Creek to independently assess the site's age and formation. Here we present our findings and reaffirm original interpretations of clear separation of two terminal Pleistocene cultural occupations. For the first time, we report direct radiocarbon dates on cultural features associated with both occupation zones, one dating to 13,485-13,305 and the other to 11,060-10,590 cal B.P.
We present a preliminary analysis of the self-absorbed [CII]-spectra observed with SOFIA/GREAT towards NGC 2024. Together with the detected [13CII] hyperfine satellites, the observed spectra require surprisingly high column densities of C+, both in the warm core and the foreground absorption component. Such high column densities are a challenge to explain with present state-of-the-art PDR models of the UV/molecular cloud interaction.
The inclusion of winter cereals in spring-annual rotations in the northern Great Plains may reduce weed populations and herbicide requirements. A broad range of spring and winter cereals were compared for ability to suppress weeds and maximize grain yield at Lacombe (2002 to 2005) and Lethbridge (2003 to 2005), Alberta, Canada. High seeding rates (≥ 400 seeds/m2) were used in all years to maximize crop competitive ability. Spring cereals achieved high crop-plant densities (> 250 plants/m2) at most sites, but winter cereals had lower plant densities due to winterkill, particularly at Lethbridge in 2004. All winter cereals and spring barley were highly effective at reducing weed biomass at Lacombe for the first 3 yr of the study. Weed suppression was less consistently affected by winter cereals in the last year at Lacombe and at Lethbridge, primarily due to poor winter survival. Grain yields were highest for spring triticale and least for spring wheat at Lacombe, with winter cereals intermediate. At Lethbridge, winter cereals had higher grain yields in 2003 whereas spring cereals had higher yields in 2004 and 2005. Winter cereals were generally more effective at suppressing weed growth than spring cereals if a good crop stand was established, but overlap in weed-competitive ability among cultivars was considerable. This information will be used to enhance the sustainable production of winter and spring cereals in traditional and nontraditional agro-ecological zones.
CONDOR, the CO, N+, Deuterium Observations Receiver, is designed to make velocity-resolved observations of the CO, [NII], and p-H2D+ lines in the 1.4 THz (200-240μm) atmospheric windows. CONDOR's first light observations were made with the APEX telescope in November 2005. The CONDOR beam on APEX (at ν = 1.5 THz) was expected to consist of a 4.3″ main beam and a 73″ error beam; this beam structure was verified from scans of Mars. The pointing accuracy, also determined from Mars scans, was better than 7″. The average atmospheric transmission during our Orion observations (elev~57°) was 19 ± 4% along the line-of-sight. A forward efficiency of Feff = 0.8 was determined from sky dips, and observations of the Moon and Mars were used to couple the CONDOR beam to sources of different sizes (ηc = 0.40 and ~0.10, respectively). For more information, see Wiedner et al. 2006.
Experimental results on sediment erosion (scour) by a plane turbulent wall jet, issuing from a sluice gate, are presented which show clearly – it seems for the first time – that the turbulent wall layer is destabilized by the concave curvature of the water/sediment interface. The streamwise Görtler vortices which emerge create sediment streaks or longitudinal sediment ridges. The analysis of the results in terms of Görtler instability of the wall layer indicates that the strength of these curvature-excited streamwise vortices is such that the sediment transport is primarily due to turbulence created by these vortices. Their contribution to the wall shear stress is taken to be of the same form as the normal turbulent wall shear stress. For this reason, the model developed by Hogg et al. (J. Fluid Mech. Vol. 338, 1997, p. 317) remains valid; only the numerical coefficients are affected. The logarithmic dependency of the time evolution of the scour-hole depth predicted by this model is shown to be in good agreement with experiments. New scaling laws for the quasi-steady state depth and the associated time, inspired by the Hogg et al. (1997) model are proposed. Furthermore, it is emphasized that at least two scouring regimes must be distinguished: a short-time regime after which a quasi-steady state is reached, followed by a long-time regime, leading to an asymptotic state of virtually no sediment transport.
The development of new acaricides is a long and very expensive process. Worryingly, there is increasing resistance to available acaricides worldwide leading to the real possibility that our dwindling supply of effective acaricides will be exhausted unless action is taken to increase the number of new acaricidal products and reduce the rate of resistance development. In 1995, eight major animal health pharmaceutical companies formed the Veterinary Parasite Resistance Group (VPRG) to act as an expert consultative group to guide the FAO in resistance management and collaborate in the prudent use of acaricides. In this paper, members of the VPRG discuss the problems and processes in acaricide development, resistance in the field to commonly used acaricides and the different considerations when targeting the cattle and pet market, and give their view of the future for tick control from the perspective of the animal health industry.
In many internal flows there are only limited regions in which the velocity can be considered irrotational; i.e. in which the motion is such that particles travel without local rotation. In an irrotational, or potential, flow the velocity can be expressed as the gradient of a scalar function. This condition allows great simplification and, where it can be employed, is of enormous utility. Although we have given examples of its use, potential flow theory has a narrower scope in internal flow than in external flow and the description and analysis of non-potential, or rotational, motions plays a larger role in the former than in the latter. One reason for this difference is the greater presence of bounding solid surfaces and the accompanying greater opportunity for viscous shear forces to act. Even in those internal flow configurations in which the flow can be considered inviscid, however, different streamtubes can receive different amounts of energy (from fluid machinery, for example), resulting in velocity distributions which do not generally correspond to potential flows. Because of this, we now examine two key fluid dynamic concepts associated with rotational flows: vorticity, which has to do with the local rate of rotation of a fluid particle, and circulation, a related, but more global, quantity.
Before formally introducing these concepts, it is appropriate to give some discussion concerning the motivation for working with them, rather than velocity and pressure fields only. The equations of motion for a fluid contain expressions of forces and acceleration, derived from Newton's laws.
In this chapter we address three-dimensional flows in which streamwise vorticity is a prominent feature. Three main topics are discussed. The first, and principal, subject falls under the general label of secondary flows, cross-flow plane (secondary) circulations which occur in flows that were parallel at some upstream station. The second is the enhancement of mixing by embedded streamwise vorticity and the accompanying motions normal to the bulk flow direction (see for example Bushnell (1992)). The third is the connection between vorticity generation and fluid impulse.
The different topics are linked in at least three ways. First, the class of fluid motions described are truly three-dimensional. Second, focus on the vortex structure in these flows is a way to increase physical insight. The perspective of the chapter is that the flows of interest are rotational and three-dimensional, and the appropriate tools for capturing their quantitative behavior are three-dimensional numerical simulations (e.g. Launder (1995)). Results from such computations, as well as from experiments, are used to illustrate the overall features. To complement detailed simulations and experiments, however, it is often helpful to have a simplified description of the motion which can guide the interrogation and scope of the computations, enable understanding of why different effects are seen, and suggest scaling for different mechanisms. The ideas about vorticity evolution and vortex structure, introduced in Chapter 3, provide a skeleton for this type of description.
In this chapter the discussion of fluid component and system response to disturbances, begun in Chapter 6, is extended to a broader class of flow non-uniformities. Whereas Chapter 6 considered primarily one-dimensional disturbances, that restriction is now dropped and we address more general (two- and three-dimensional) non-uniformities with variations transverse to the bulk flow direction. Examples of interest are turbomachines subjected to circumferentially varying inlet conditions and the behavior of components with geometry generated non-uniformity, such as is caused by a contraction or a bend in close proximity.
Three important issues relating to these situations can be identified. One is the effect of the fluid component on the flow non-uniformity, or distortion: how are the non-uniformities altered by passage through the component? A second is the effect of the non-uniformity on the component: how does the distortion modify the component performance? The approaches needed to address these two questions are fundamentally different. For the former, qualitative aspects, and even many quantitative features, can be resolved within the framework of a linearized description. For the latter, however, the problem is inherently nonlinear and a different level of analysis is needed. Beyond component performance there is a third issue. Because fluid components typically occur as part of an overall system, what changes in interactions with the rest of the system arise due to the non-uniformity?
Several integrating themes thread through the different applications discussed. The first is that fluid components do not passively accept non-uniform flow but play a major role in modifying the velocity distribution.