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Nasal obstruction when lying down is a common complaint in patients with chronic nasal obstruction, but rhinomanometry is typically performed in the sitting position. This study aimed to analyse whether adding rhinomanometry in a supine position is a useful examination.
A total of 41 patients with chronic nasal obstruction underwent rhinomanometry and acoustic rhinometry, sitting and supine, before and after decongestion, as well as an over-night polygraphy.
Total airway resistance was measurable in a supine position in 48 per cent (14 of 29) of the patients with total airway resistance of equal to or less than 0.3 Pa/cm3/second when sitting and in none (0 of 12) of the patients with total nasal airway resistance of more than 0.3 Pa/cm3/second when sitting. After decongestion, this increased to 83 per cent and 58 per cent, respectively.
Increased nasal resistance when sitting predicts nasal breathing problems when supine. Rhinomanometry in a supine position should be performed to diagnose upper airway collapse when supine.
Alexithymia is a personality construct characterized by difficulties in identifying and verbalizing feelings, a restricted imagination, and an externally oriented thinking style. As alexithymia shows marked overlap with depression, its independent nature as a personality construct is still being debated. The etiology of alexithymia is unknown, although childhood emotional neglect and attachment formation are thought to play important roles. In the FinnBrain Birth Cohort Study, experiences of early-life adversities (EA) and childhood maltreatment (CM) were studied in a sample of 2,604 men and women. The overlap and differences between depression and alexithymia were investigated by comparing their associations with EA types and adult attachment style. Alexithymia was specifically associated with childhood emotional neglect (odds ratio (OR) 3.8, p < .001), whereas depression was related to several types of EA. In depression co-occurring with alexithymia, there was a higher prevalence of emotional neglect (81.3% vs. 54.4%, p < .001), attachment anxiety (t = 2.38, p = .018), and attachment avoidance (t = 4.03, p < .001). Early-life adversities were markedly different in the alexithymia group compared to those suffering from depression, or healthy controls. Depression with concurrent alexithymia may represent a distinct subtype, specifically associated with childhood experiences of emotional neglect, and increased attachment insecurity compared to non-alexithymic depression.
In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% (‘telephone’) to 84.0% (‘psychotic symptoms’). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% (‘telephone’) and 80.6% (‘food’).
The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs.
In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received.
In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs.
It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.
The mean episode duration of adolescent major depression is 4 – 9 months among clinically referred youths, recovery rates vary between 35% - 90%, and recurrent episodes are common. In naturalistic studies comprising less selected populations than clinical trials, comorbid psychiatric disorders, poor psychosocial functioning and severity of depression at study entry are among the most consistently reported clinical predictors of less favorable prognosis of youthful depression.
The study aimed at studying the one-year course and at investigating the impact of characteristics of the depressive episode and comorbidity on the one-year outcome of adolescent depression.
A sample of 179 consecutive adolescent (13-19 years) psychiatric outpatients and 17 school-derived matched controls, all with unipolar depressive disorders at baseline, were reinterviewed for DSM-IV Axis I and II disorders at 12 months.
The outpatients had equal recovery rate and episode duration, but shorter time to recurrence than the controls. Fifty percent of the outpatients and 65 % of the depressed controls recovered during the follow-up, 13% of the outpatients and 29% of controls had at least one recurrent depressive episode. Among the outpatients, Axis II comorbidity predicted shorter time to recurrence. Longer time to recovery was predicted by earlier lifetime age of onset for depression, poor psychosocial functioning, depressive disorder diagnosis, and longer episode duration by study entry, with an interaction between episode duration and depressive disorder diagnosis.
Characteristics of depression generally predicted the outcome better than comorbidity. Axis II comorbidity has prognostic value in adolescent depression.
Primary health care is in the central position in the general sphere of mental health services. This article deals with, as a part of a joint Nordic project, the occurrence of mental disorders of patients in primary health care as based on the material (n = 1,000) collected in the health centre of Turku. The relation of the occurrence of mental disorders as diagnosed by means of a standardized psychiatric interview method (PSE) to the disorders, recognized by general practitioners (GPs) working in the health centre is also observed. It was found that one fourth of the patients had a clear mental disorder that required treatment, while studies in the general population, using the same method, reveal only 10% as having some kind of mental disorder. Three quarters of the evident mental disorders recognized by GPs were diagnosed as such also by the PSE, but the GPs were capable of recognizing only 43% of the cases identified by the PSE. On the basis of these results, the importance of the mental health issue in the basic and postgraduate training of the general practitioners must be emphasized.
Radar sounding is a powerful geophysical approach for characterizing the subsurface conditions of terrestrial and planetary ice masses at local to global scales. As a result, a wide array of orbital, airborne, ground-based, and in situ instruments, platforms and data analysis approaches for radioglaciology have been developed, applied or proposed. Terrestrially, airborne radar sounding has been used in glaciology to observe ice thickness, basal topography and englacial layers for five decades. More recently, radar sounding data have also been exploited to estimate the extent and configuration of subglacial water, the geometry of subglacial bedforms and the subglacial and englacial thermal states of ice sheets. Planetary radar sounders have observed, or are planned to observe, the subsurfaces and near-surfaces of Mars, Earth's Moon, comets and the icy moons of Jupiter. In this review paper, and the thematic issue of the Annals of Glaciology on ‘Five decades of radioglaciology’ to which it belongs, we present recent advances in the fields of radar systems, missions, signal processing, data analysis, modeling and scientific interpretation. Our review presents progress in these fields since the last radio-glaciological Annals of Glaciology issue of 2014, the context of their history and future prospects.
Describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015–2017 and were reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).
Data from central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical site infections (SSIs) were reported from acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities. This analysis included device-associated HAIs reported from adult location types, and SSIs among patients ≥18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated for each HAI type, location type, surgical category, and surgical wound closure technique.
Overall, 5,626 facilities performed adult HAI surveillance during this period, most of which were general acute-care hospitals with <200 beds. Escherichia coli (18%), Staphylococcus aureus (12%), and Klebsiella spp (9%) were the 3 most frequently reported pathogens. Pathogens varied by HAI and location type, with oncology units having a distinct pathogen distribution compared to other settings. The %NS for most pathogens was significantly higher among device-associated HAIs than SSIs. In addition, pathogens from long-term acute-care hospitals had a significantly higher %NS than those from general hospital wards.
This report provides an updated national summary of pathogen distributions and antimicrobial resistance among select HAIs and pathogens, stratified by several factors. These data underscore the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.
To describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) among pediatric patients that occurred in 2015–2017 and were reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).
Antimicrobial resistance data were analyzed for pathogens implicated in central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonias (VAPs), and surgical site infections (SSIs). This analysis was restricted to device-associated HAIs reported from pediatric patient care locations and SSIs among patients <18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated by HAI type, location type, and surgical category.
Overall, 2,545 facilities performed surveillance of pediatric HAIs in the NHSN during this period. Staphylococcus aureus (15%), Escherichia coli (12%), and coagulase-negative staphylococci (12%) were the 3 most commonly reported pathogens associated with pediatric HAIs. Pathogens and the %NS varied by HAI type, location type, and/or surgical category. Among CLABSIs, the %NS was generally lowest in neonatal intensive care units and highest in pediatric oncology units. Staphylococcus spp were particularly common among orthopedic, neurosurgical, and cardiac SSIs; however, E. coli was more common in abdominal SSIs. Overall, antimicrobial nonsusceptibility was less prevalent in pediatric HAIs than in adult HAIs.
This report provides an updated national summary of pathogen distributions and antimicrobial resistance patterns among pediatric HAIs. These data highlight the need for continued antimicrobial resistance tracking among pediatric patients and should encourage the pediatric healthcare community to use such data when establishing policies for infection prevention and antimicrobial stewardship.
This study aimed to investigate the rate of dizziness and occurrence of benign paroxysmal positional vertigo in the elderly by physical examination in those reporting dizziness symptoms when lying down or turning over in bed.
A total of 498 people, aged 70–85 years, were asked to complete a questionnaire regarding dizziness symptoms. Subjects answering that they became dizzy in bed were asked to participate in a physical examination and diagnostic manoeuvres investigating benign paroxysmal positional vertigo.
A total of 324 participants (65 per cent) completed the questionnaire. More than one-quarter (29 per cent) reported dizziness and 32 (10 per cent) reported dizziness when turning in bed. Of these 32 persons, 22 (69 per cent) underwent a physical examination. Six participants tested positive for benign paroxysmal positional vertigo.
Ten per cent of the elderly participants reported positional symptoms, and 6 out of 22 fulfilled diagnostic criteria for benign paroxysmal positional vertigo. Furthermore, benign paroxysmal positional vertigo was established despite a delay between questionnaire completion and investigation, emphasising that this type of dizziness may not be a self-limiting disorder.
Engabreen is an outlet glacier of the Svartisen Ice Cap located in Northern Norway. It is a unique glacier due to the Svartisen Subglacial Laboratory which allows direct access to the glacier bed. In this study, we combine both sub- and supraglacial observations with ice-flow modelling in order to investigate conditions at the bed of Engabreen both spatially and temporally. We use the full-Stokes model Elmer/Ice and satellite-based surface-velocity maps from 2010 and 2014 to infer patterns of basal friction. Direct measurements of basal sliding and deformation of lower layers of the ice are used to adjust the ice viscosity and provide essential input to the setup of our model and influence the interpretation of the results. We find a clear seasonal cycle in the subglacial conditions at the higher elevation region of the study area and discuss this in relation to the subglacial hydrological system. Our results also reveal an area with an overdeepening where basal friction is significantly lower than elsewhere on the glacier all year round. We attribute this to either water pooling at the base, or saturated sediments and increased strain heating at this location which softens the ice further.
Schizophrenia is associated with impaired neurodevelopment as indexed by lower premorbid IQ. We examined associations between erythrocyte sedimentation rate (ESR), a marker of low-grade systemic inflammation, IQ, and subsequent schizophrenia and other non-affective psychoses (ONAP) to elucidate the role of neurodevelopment and inflammation in the pathogenesis of psychosis.
Population-based data on ESR and IQ from 638 213 Swedish men assessed during military conscription between 1969 and 1983 were linked to National Hospital Discharge Register for hospitalisation with schizophrenia and ONAP. The associations of ESR with IQ (cross-sectional) and psychoses (longitudinal) were investigated using linear and Cox-regression. The co-relative analysis was used to examine effects of shared familial confounding. We examined mediation and moderation of effect between ESR and IQ on psychosis risk.
Baseline IQ was associated with subsequent risk of schizophrenia (adjusted HR per 1-point increase in IQ = 0.961; 95% confidence interval (CI) 0.960–0.963) and ONAP (adjusted HR = 0.973; 95% CI 0.971–0.975). Higher ESR was associated with lower IQ in a dose-response fashion. High ESR was associated with increased risk for schizophrenia (adjusted HR = 1.14; 95% CI 1.01–1.28) and decreased risk for ONAP (adjusted HR = 0.85; 95% CI 0.74–0.96), although these effects were specific to one ESR band (7–10 mm/hr). Familial confounding explained ESR-IQ but not ESR-psychoses associations. IQ partly mediated the ESR-psychosis relationships.
Lower IQ is associated with low-grade systemic inflammation and with an increased risk of schizophrenia and ONAP in adulthood. Low-grade inflammation may influence schizophrenia risk by affecting neurodevelopment. Future studies should explore the differential effects of inflammation on different types of psychosis.
Visual processing problems may be one underlying factor for cognitive impairments related to autism spectrum disorders (ASDs). We examined associations between ASD-traits (Autism-Spectrum Quotient) and visual processing performance (Rey–Osterrieth Complex Figure Test; Block Design task of the Wechsler Adult Intelligence Scale-III) in young adults (mean age=25.0, s.d.=2.1 years) born preterm at very low birth weight (VLBW; <1500 g) (n=101) or at term (n=104). A higher level of ASD-traits was associated with slower global visual processing speed among the preterm VLBW, but not among the term-born group (P<0.04 for interaction). Our findings suggest that the associations between ASD-traits and visual processing may be restricted to individuals born preterm, and related specifically to global, not local visual processing. Our findings point to cumulative social and neurocognitive problems in those born preterm at VLBW.
In Germany tularemia is a re-emerging zoonotic disease. Therefore, we investigated wild animals and environmental water samples for the presence and phylogenetic diversity of Francisella tularensis in the poorly studied Berlin/Brandenburg region. The phylogenomic analysis of three isolates from wild animals revealed three new subclades within the phylogenetic tree of F. tularensis [B.71 from a raccoon dog (Nyctereutes procyonoides); B.74 from a red fox (Vulpes vulpes), and B.75 from a Eurasian beaver (Castor fiber albicus)]. The results from histological, PCR, and genomic investigations on the dead beaver showed that the animal suffered from a systemic infection. Indications were found that the bacteria were released from the beaver carcass into the surrounding environment. We demonstrated unexpectedly high and novel phylogenetic diversity of F. tularensis in Germany and the fact that the bacteria persist in the environment for at least one climatic season. These findings support a broader host species diversity than previously known regarding Germany. Our data further support the assumption derived from previous serological studies of an underestimated frequency of occurrence of the pathogen in the environment and in wild animals. F. tularensis was isolated from animal species not previously reported as natural hosts in Germany.
Enset [Ensete ventricosum (Welw.) Cheesman (Musaceae)] is a multi-purpose and drought-tolerant crop, traditionally grown in Ethiopia. Food from enset has nutritive values similar to potato; it could improve food and livelihood security for many in larger geographical areas. Agronomical advice is needed which requires increased knowledge of management techniques. The purposes of this study were to (i) compare traditional corm pre-treatments when planting for sucker production, (ii) compare all six officially released cultivars regarding sprouting and (iii) investigate the effect of watering on newly buried corms. Emergence rate and number and characteristics of sprouts were recorded. Corms, from 63 two year old plants, were buried in local soil supplied with cow manure in Wolaita Sodo, Ethiopia. Emergence was recorded daily. After nine months, including one rainy season, all suckers (totally 4405) were harvested and individually recorded. Regardless of cultivar, minimum time to emergence was 50 days. Sprouts from split parent corms emerged earlier than from entire. Emergence occurred from 100% of corms, number of sprouts was strongly correlated to cultivar: average 28–106. The cultivars responded similarly to corm splitting: the more pieces the corm was split into, the more sprouts per parent corm. Average pseudostem diameter of the seven largest per parent corm: 8–10 cm for all cultivars, leaf length: 3.1–3.7 m, remaining 2700 smaller suckers: diameter 3 cm (SD 1.8). Watering decreased the average time to emergence and levelled out the differences between pre-treatments. The traditional belief is that watering as well as manure on corm cause rotting; manure is therefore usually put on the soil surface. On the contrary, full emergence and unexpected large suckers may be a result of careful soil preparation with manure applied on corm directly; watering resulted in an even emergence and growth. In conclusion, vegetative propagation of enset is efficient, but methods used and agronomical advice can be improved.
Performing basic activities of daily living (ADLs) is one of the major difficulties encountered in dementia, which can have considerable negative impacts on the quality of life (QoL) of people with dementia (PwD). However, the extent to which basic ADL performance deteriorates across mild, moderate, and severe dementia is little examined and its impact, together with depression and neuropsychiatric behavior, upon QoL, is of considerable relevance across European countries.
Data were drawn from people living in the community who were participants in a large-scale European study on transition from community living to care homes of PwD. PwD completed measures on cognitive functioning and QoL, and informal carers reported upon QoL, depressive symptomatology, psychopathology, and functional ability of the PwD.
ADL performance deteriorated differently for each activity. In particular, toileting, transfer, and feeding remained relatively intact throughout, whereas performance on bathing and dressing deteriorated to a greater extent from mild to severe dementia. It appears that continence was not affected by the stage of dementia with similar levels of impairment. Basic ADL performance impacted to different degrees on QoL across dementia stages and countries.
Interventions aimed at maintaining independence or QoL need to target different ADLs across different dementia stages and perhaps also tailor interventions to the context of different countries. Findings contribute to the development of non-pharmaceutical interventions and governmental pledges to promote independence in dementia.
The potential for future dynamical instability of Pine Island Glacier, West Antarctica, has been addressed in a number of studies, but information on its past remains limited. In this study we use airborne radio-echo sounding (RES) data acquired over Pine Island Glacier to investigate past variations in accumulation pattern. In the dataset a distinctive pattern of layers was identified in the central part of the glacier basin. We use these layers as chronological identifiers in order to construct elevation maps of the internal stratigraphy. The observed internal layer stratigraphy is then compared to calculated stratigraphy from a three-dimensional ice-flow model that has been forced with different accumulation scenarios. The model results indicate that the accumulation pattern is likely to have changed at least twice since the deposition of the deepest identified layer. Additional RES data linked to the Byrd ice core provide an approximate timescale. This timescale suggests that the layers were deposited at the beginning of or during the Holocene period. Thus the widespread changes occurring in the coastal extent of the West Antarctic ice sheet at the end of the last glacial period could have been accompanied by changes in accumulation pattern.
We observed Hydroxyl, water, ammonia, carbon monoxide and neutral carbon towards the +50 km s−1 cloud (M−0.02−0.07), the circumnuclear disk (CND) and the +20 km s−1 (M−0.13−0.08) cloud in the Sgr A complex with the VLA, Odin and SEST. Strong OH absorption, H2O emission and absorption lines were seen at all three positions. Strong C18O emissions were seen towards the +50 and +20 km s−1 clouds. The CND is rich in H2O and OH, and these abundances are considerably higher than in the surrounding clouds, indicating that shocks, star formation and clump collisions prevail in those objects. A comparison with the literature reveals that it is likely that PDR chemistry including grain surface reactions, and perhaps also the influences of shocks has led to the observed abundances of the observed molecular species studied here. In the redward high-velocity line wings of both the +50 and +20 km s−1 clouds and the CND, the very high H2O abundances are suggested to be caused by the combined action of shock desorption from icy grain mantles and high-temperature, gas-phase shock chemistry. Only three of the molecules are briefly discussed here. For OH and H2O three of the nine observed positions are shown, while a map of the C18O emission is provided. An extensive paper was recently published with Open Access (Karlsson et al. 2013, A&A 554, A141).
Structures comprising single-crystal, iron-carbon-based nanowires encapsulated by multiwall carbon nanotubes self-organize on inert substrates exposed to the products of ferrocene pyrolysis at high temperature. The most commonly observed encapsulated phases are Fe3C, α-Fe, and γ-Fe. The observation of anomalously long-period lattice spacings in these nanowires has caused confusion since reflections from lattice spacings of ≥0.4 nm are kinematically forbidden for Fe3C, most of the rarely observed, less stable carbides, α-Fe, and γ-Fe. Through high-resolution electron microscopy, selective area electron diffraction, and electron energy loss spectroscopy we demonstrate that the observed long-period lattice spacings of 0.49, 0.66, and 0.44 nm correspond to reflections from the (100), (010), and (001) planes of orthorhombic Fe3C (space group Pnma). Observation of these forbidden reflections results from dynamic scattering of the incident beam as first observed in bulk Fe3C crystals. With small amounts of beam tilt these reflections can have significant intensities for crystals containing glide planes such as Fe3C with space groups Pnma or Pbmn.