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Contemporary bioethical issues are inherently cross-cultural and global in their nature. This is not surprising because bioethical matters touch everyone in many and different ways. Moral quandaries in healthcare, life sciences, and biotechnology arise ubiquitously across natural and human boundaries, the boundaries between and within nation-states, ethnicities, cultures, communities, and social groups. In addition, the simultaneously large-scale and intimate interactions between and within different cultures and civilizations and the rapid pace at which they change are phenomena that distinguish our times from previous eras. Bioethics – as a particular domain of public discourse and an academic discipline – has thus been rapidly evolving not only in the United States and other Western countries but also on a global scale over the past 50 years.
There is increasing evidence linking the gut microbiota to various aspects of human health. Nuts are a food rich in prebiotic fibre and polyphenols, food components which have been shown to have beneficial effects on the gut microbiota. This systematic review aimed to synthesise the evidence regarding the effect of nut consumption on the human gut microbiota. A systematic search of the databases MEDLINE, PubMed, Cochrane CENTRAL and CINAHL was performed until 28 November 2019. Eligible studies were those that investigated the effects of nut consumption in humans (aged over 3 years old), utilising next-generation sequencing technology. Primary outcome measures were between-group differences in α- and β-diversity metrics and gut microbial composition. A total of eight studies were included in the review. Included studies assessed the effects of either almonds, walnuts, hazelnuts or pistachios on the gut microbiota. Overall, nut consumption had a modest impact on gut microbiota diversity, with two studies reporting a significant shift in α-diversity and four reporting a significant shift in β-diversity. Walnuts, in particular, appeared to more frequently explain shifts in β-diversity, which may be a result of their unique nutritional composition. Some shifts in bacterial composition (including an increase in genera capable of producing SCFA: Clostridium, Roseburia, Lachnospira and Dialister) were reported following the consumption of nuts. Nut intake may yield a modulatory effect on the gut microbiota; however, results were inconsistent across studies, which may be explained by variations in trial design, methodological limitations and inter-individual microbiota.
Understanding the clinical risk factors for COVID-19 disease severity and outcomes requires a combination of data from electronic health records and patient reports. To facilitate the collection of patient-reported data, as well as accelerate and standardize the collection of data about host factors, we have constructed a COVID-19 survey. This survey is freely available to the scientific community to send electronically for patients to complete online. This patient survey is designed to be comprehensive, yet not overly burdensome, to gather data useful for a range of clinical investigations, and to accommodate a wide variety of implementation settings including at a COVID-19 testing site, at home during infection or after recovery, and/or for individuals while they are hospitalized. A widely adopted standardized survey that can be implemented online with minimal resources can serve as a critical tool for combining and comparing data across studies to improve our understanding of COVID-19 disease.
To determine the metacognitive deficits and behavioural and emotional regulation deficits among a group of children undergoing treatment for ADHD and to compare these with the hyperactivity/inattentive and behavioural assessments which contributed to the diagnosis.
Children and adolescents referred for ADHD assessment to a community Child & Adolescent Mental Health Service were assessed using clinical assessment, SNAP-IV, FTF and BRIEF rating scales. Comorbidities were assessed using clinical assessment and screened using the FTF. Clinical assessment included interview of parents, relatives and relevant school supervisors. The BRIEF scale was used to advise on specific executive function difficulties.
A total of 25 children and adolescents had complete assessments as part of routine clinical practice. There were particular groups which demonstrated elevated behavioural regulation difficulties; in the group with higher metacognition scores, groups were identified that had higher initiation and working memory deficits, higher planning and organisational deficits, or a mixture of all 5 items being elevated.
It is advantageous to complete an executive function assessment as part of ADHD assessment in clinical practice as it allows more detailed management advice to be given to teachers and support/special needs teachers and parents. It may also demonstrate successful patient-specific indicators of treatment response and outcome measures among those children who have high ADHD-related executive function deficits but whose core ADHD Hyperactive/Impulsive symptoms remain highly rated.
Childhood ADHD typically presents with comorbidites. Assessment tools for developmental screening vary greatly in length and complexitity, and parental preference has an impact on the usefulness of clinical tools in routine practice.
To determine among a group of children which ones may benefit from occupational therapy, speech and language therapy and educational progress re-assessment as part of routine clinical assessment for ADHD with the intention to improve service delivery.
Children were referred on a routine basis to a community clinic for ADHD assessment. SNAP-IV, FTF and BRIEF rating scales were administered. The FTF was used as a parent-rated screen for general development; it is a 200-item questionairre and includes sections on motor skills, speech and language skills and variety of other areas.
A review of freely available developmental questionaires was conducted. The FTF was introduced on a trial basis as a balance between the typical shorter scale of the SDQ and longer time needed for the DAWBA.
The parents of 25 children completed the FTF as part of routine clinical assessment for ADHD. Along with identifying groups of children who could benefit from further allied-healthcare assessment, the majority of parents had no difficulty with the length, although minority did report difficulty with understanding the language. Diagnoses were confirmed using SNAP-IV and clinical interview and assessment. Executive function scores were compared to FTF executive function screening scores.
Routine screening of developmental comorbidities may help with the development of patient -related outcome measures.
The Lifetime Impairment Survey assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children/adolescents from six European countries. Parents/caregivers of children/adolescents aged < 20 years with ADHD (ADHD group; n = 535) and without ADHD (control group; n = 424) participated in an online survey. History of ADHD diagnosis was self-reported. ADHD and control groups were compared using impairment and symptom scales; higher scores indicate greater impairment. Mean (SD) age at ADHD diagnosis was 7.0 (2.8) years, following consultation of 2.7 (2.6) doctors over 20.4 (23.9) months. Parents/caregivers (64%; 344/535) reported frustration with some aspect of the diagnostic procedure; 74% (222/298) were satisfied with their child's current medication. ADHD had a negative impact on children/adolescents in all aspects of life investigated. The ADHD group had a higher mean (SD) school impairment score (2.7 [0.7]) compared with the control group (2.1 [0.7]; P < 0.001) and were more likely to be in the bottom of their class (P < 0.001). These data provide insights into impairments associated with ADHD in childhood/adolescence, and identify areas for improvement in its management and treatment.
Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed psychiatric disorder in childhood (estimated global prevalence 3–5%). ADHD symptoms and impairments frequently continue into adulthood, but data on lifelong impact are limited.
The Lifetime Impairment Survey aimed to evaluate the extent of lifetime impairment of individuals with ADHD in six European countries. We analysed the responses obtained from adults with/without ADHD regarding their current situation.
The survey was developed by a committee of ADHD specialists and implemented by a market research organization. Participants were recruited from a database of 487,533 volunteers, and answered questions on ADHD diagnosis and current experiences. Survey items were combined into scales/scores evaluating different areas of impairment. Mean scale scores for ADHD and controls were compared. Cross-country comparisons of impairment scales were also performed.
A total of 629 adults with ADHD and 736 controls participated. ADHD was diagnosed after a median of 22 months and after consulting a median of two physicians. Impairments reported by adults with ADHD were significantly greater (p < 0.001) than controls in most areas investigated, including work, social and relationship functioning, mood/temper control, rule-breaking behaviour, self-organization/planning, and financial difficulties. Analyses of variance showed that the country effect on impairment scores was generally negligible, explaining only 1–3% of the observed variance.
Compared with controls, the impairments reported by adults with ADHD suggest a continued impact of the condition on both personal and professional life; no substantial cross-cultural differences were observed.
Optimism is associated with reduced cardiovascular disease risk; however, few prospective studies have considered optimism in relation to hypertension risk specifically. We investigated whether optimism was associated with a lower risk of developing hypertension in U.S. service members, who are more likely to develop high blood pressure early in life. We also evaluated race/ethnicity, sex and age as potential effect modifiers of these associations.
Participants were 103 486 hypertension-free U.S. Army active-duty soldiers (mean age 28.96 years, 61.76% White, 20.04% Black, 11.01% Hispanic, 4.09% Asian, and 3.10% others). We assessed optimism, sociodemographic characteristics, health conditions, health behaviours and depression status at baseline (2009–2010) via self-report and administrative records, and ascertained incident hypertension over follow-up (2010–2014) from electronic health records and health assessments. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and adjusted models for a broad range of relevant covariates.
Over a mean follow-up of 3.51 years, 15 052 incident hypertension cases occurred. The highest v. lowest optimism levels were associated with a 22% reduced risk of developing hypertension, after adjusting for all covariates including baseline blood pressure (HR = 0.78; 95% CI = 0.74–0.83). The difference in hypertension risk between the highest v. lowest optimism was also maintained when we excluded soldiers with hypertension in the first two years of follow-up and, separately, when we excluded soldiers with prehypertension at baseline. A dose–response relationship was evident with higher optimism associated with a lower relative risk (p < 0.001). Higher optimism was consistently associated with a lower risk of developing hypertension across sex, age and most race/ethnicity categories.
In a diverse cohort of initially healthy male and female service members particularly vulnerable to developing hypertension, higher optimism levels were associated with reduced hypertension risk independently of sociodemographic and health factors, a particularly notable finding given the young and healthy population. Results suggest optimism is a health asset and a potential target for public health interventions.
Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.
Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.
Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?
Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
The benefit of mandibular advancement devices in patients with sleep-disordered breathing and as a potential option for obstructive sleep apnoea syndrome is well recognised. Their use in the setting of epilepsy or other seizure disorders is typically contraindicated.
A 48-year-old patient with a history of poorly controlled epilepsy and obstructive sleep apnoea syndrome was referred for ENT review for possible tracheostomy. The patient was wheelchair-bound with 24-hour continuous positive airway pressure, but sleep studies demonstrated persistent, severe episodes of apnoea and notable sleep disturbance. Sleep nasendoscopy demonstrated marked improvement on capnography with the laryngeal mask airway in situ, and this was maintained with mandibular advancement using jaw thrust following removal of the laryngeal mask airway. A mandibular advancement device was subsequently trialled; this had no subjective benefit for the patient, but the seizures resolved and control of apnoea was achieved with the combination of a mandibular advancement device and continuous positive airway pressure.
This paper highlights a novel application of mandibular advancement devices, used in combination with continuous positive airway pressure, which resulted in complete resolution of sleep deprivation and apnoea-induced epileptic events.
This chapter aims to present the EU perspective on the controversial issue of carbon emission trading and aviation. The article analyses how the EU advanced to the concrete implementation of emissions trading in the aviation sector. It analyses why the EU first proposed and then introduced GHG emissions trading while at the same time seeking multilateral solutions to the issue of climate change contributions from the aviation sector. It highlights the technical issues at stake, the global resistance to what was perceived as a unilateral act by the EU, and how the fact that the EU had introduced the system influenced the 2016 ICAO climate decision to adopt the CORSIA carbon offsets scheme. The article documents how the EU system eventually influenced the global debate and the global compromise that arguably respected the most important sustainable development principles. It reviews ongoing EU policy respecting sustainable development and ends with an outlook on the unlikely scenario that the new ICAO mechanism could fail, in which case the EU’s original scheme could be resurrected under EU law.
This chapter describes the prospects for reducing the impact of aviation on the environment through operational changes, new airframe and engine technologies, and biofuels. The focus is on the in-flight impact on the environment with particular emphasis on climate change impact. Examples of operational changes include optimized profile descents, reduced vertical separation, multistage long-distance travel, formation flight, and large aircraft for short ranges. New airframe technologies described include active laminar flow control and novel aircraft configurations such as the double bubble and the blended wing-body. Various possible approaches to improve the efficiency of jet engines are described as well as means of reducing nitrogen oxide emissions, such as lean premixed combustion. Prospects for large-scale use of biofuels are discussed and the technical path that should be taken in developing and adopting alternative jet fuels is presented.
International aviation is growing at a rate of roughly 5 percent per year. Its greenhouse gas (GHG) emissions are forecast to increase by 3–4 percent per year. At present, international aviation’s contribution to global GHG emissions is approximately 2 percent. However, these emissions are expected to increase considerably under a business-as-usual scenario.
Although the International Civil Aviation Organization (ICAO) has discussed environmental protection in connection with aviation since the 1970s, climate change issues are relatively new. Ever since the Kyoto Protocol entrusted the ICAO with handling GHG emissions from international aviation, the Organization has been at the center of the storm. This chapter seeks to explore the ICAO’s involvement in climate change issues, and its merits and shortcomings, as well as identifying better ways for the organization to handle GHG emissions from international aviation, in particular bearing in mind the recent agreement to develop a global market-based measure (MBM) scheme. Understanding the constraints under which the ICAO operates is central to determining its limitations and establishing realistic corrective actions to facilitate not only its adoption and implementation but, more importantly, participation in the ICAO’s global MBM.
To this end, the chapter discusses two main topics. First, it analyzes the suitability of the ICAO’s institutional setting to handle climate change issues. Secondly, the chapter studies the ICAO’s specific involvement in climate change issues. Although the ICAO has in the past taken many initiatives to tackle climate change, the chapter focuses on five key aspects: (1) the CO2 standard; (2) State action plans; (3) the aspirational goals; (4) the framework for MBMs; and, (5) the global scheme. These topics adequately illustrate the challenges faced and the political implications involved. Finally, the chapter provides some concluding observations with some suggested realistic corrective actions that the ICAO may take to better handle the issue of GHG emissions from international aviation.
This article aims to present the dispute settlement mechanism established in Chapter XVIII of the Chicago Convention. To this end, the article will analyze how the Council could resolve a potential dispute involving a defense of sustainable development. For this exercise, purely hypothetical cases will be analyzed, in which the European Union (EU) decides to unilaterally implement its emissions trading scheme in the field of aviation or in which the EU or a major aviation state applies the GHS emissions scheme mandated by the ICAO Assembly in 2016 to a state that considers it should be exempted. These cases will serve as hypotheticals to consider whether the dispute settlement mechanism set out at Article 84 of the Chicago Convention could serve to resolve such a dispute. The ICAO dispute settlement mechanism has been criticized many times in the ICAO’s history. In fact, the five disputes brought under the present article have each been resolved through diplomatic channels, involving the good offices of the President of the ICAO Council. Therefore, despite the difficulties presented by the procedure and the peculiarity of the EU representation at the ICAO, this chapter seeks to demonstrate that a potential dispute with respect to sustainable development will most likely be resolved the same way as has been done previously.