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Remitted psychotic depression (MDDPsy) has heterogeneity of outcome. The study's aims were to identify subgroups of persons with remitted MDDPsy with distinct trajectories of depression severity during continuation treatment and to detect predictors of membership to the worsening trajectory.
One hundred and twenty-six persons aged 18–85 years participated in a 36-week randomized placebo-controlled trial (RCT) that examined the clinical effects of continuing olanzapine once an episode of MDDPsy had remitted with sertraline plus olanzapine. Latent class mixed modeling was used to identify subgroups of participants with distinct trajectories of depression severity during the RCT. Machine learning was used to predict membership to the trajectories based on participant pre-trajectory characteristics.
Seventy-one (56.3%) participants belonged to a subgroup with a stable trajectory of depression scores and 55 (43.7%) belonged to a subgroup with a worsening trajectory. A random forest model with high prediction accuracy (AUC of 0.812) found that the strongest predictors of membership to the worsening subgroup were residual depression symptoms at onset of remission, followed by anxiety score at RCT baseline and age of onset of the first lifetime depressive episode. In a logistic regression model that examined depression score at onset of remission as the only predictor variable, the AUC (0.778) was close to that of the machine learning model.
Residual depression at onset of remission has high accuracy in predicting membership to worsening outcome of remitted MDDPsy. Research is needed to determine how best to optimize the outcome of psychotic MDDPsy with residual symptoms.
To assess the incidence of radiological inflammation within the paranasal sinuses, middle ear and mastoid in patients with confirmed severe acute respiratory syndrome coronavirus-2.
A retrospective cohort study was conducted to examine consecutive adults (aged over 18 years) with coronavirus disease 2019 (confirmed on polymerase chain reaction within 7 days of imaging) who underwent computed tomography of the head between 1 March 2020 and 24 June 2020. Lund–Mackay and mastoid and middle-ear opacification scores were used to categorise the extent of sinus and mastoid opacification on axial and coronal computed tomography images.
Of 147 patients originally identified, only 83 met the inclusion criteria. Sinus opacification was present in 51.8 per cent of patients (n = 43), and middle-ear or mastoid opacification was observed in 24.1 per cent (n = 20). There was no statistically significant difference in sinus or middle-ear and mastoid opacification between patients after stratification based on 30-day all-cause mortality.
Radiological computed tomography findings suggest mild mucosal disease within the sinuses, middle ear and mastoid. There was no statistical correlation between such opacification and 30-day mortality.
The reduction of computational costs in the context of the Multidisciplinary Design Optimisation of a typical medium-range aircraft was investigated through an assessment of active constraints and the use of multi-fidelity models-based estimation of drag and structural stress. The results show that for this problem, from the set of considered constraints that includes flutter boundary, the active constraint is a 2.5g pull up Maximum Take Off Weight. Results show that the multi-fidelity approach reduced the required high-fidelity aerodynamic number of evaluations, for both drag assessment and stress assessment with sufficient level of accuracy for the former and conservatively for the latter. Further computational cost reduction can be achieved using a surrogate model based Multidisciplinary Design Optimisation. The best configuration attained shows an Aspect Ratio increase of 16%, a reduction of 4.5% in fuel consumption and wing structural weight increase of 2.7% relative to a predefined baseline configuration.
We surveyed pediatric antimicrobial stewardship program (ASP) site leaders within the Sharing Antimicrobial Reports for Pediatric Stewardship collaborative regarding discharge stewardship practices. Among 67 sites, 13 (19%) reported ASP review of discharge antimicrobial prescriptions. These findings highlight discharge stewardship as a potential opportunity for improvement during the hospital-to-home transition.
In November 2017, eight confirmed measles cases were reported to Public Health England from a hospital in the West Midlands. A multidisciplinary Incident Management Team (IMT) was established to determine the extent of the problem and coordinate an outbreak response. Between 1 November 2017 and 4 June 2018, a total of 116 confirmed and 21 likely measles cases were linked to this outbreak; just under half (43%) were aged over 15 years of age. Fifty-five of the confirmed cases were hospitalised (48%) and no deaths were reported. At the start of the outbreak, cases were mostly individuals of Romanian origin; the outbreak subsequently spread to the wider population. Over the 8-month response, the IMT conducted the following control measures: extensive contact tracing, immediate provision of post-exposure prophylaxis, community engagement amongst specific high-risk groups, MMR awareness raising including catch-up campaigns and enhanced vaccination services at selected GP surgeries. Key challenges to the effective control measures included language difficulties limiting community engagement; delays in diagnosis, notification and appropriate isolation of cases; limited resources for contact tracing across multiple high-risk settings (including GPs and hospitals) and lack of timely data on vaccine coverage in sub-groups of the population to guide public health action.
Utilisation of the Head and Neck Cancer Risk Calculator version 2 has been recommended during the coronavirus disease 2019 pandemic for the assessment of head and neck cancer referrals. As limited data were available, this study was conducted to analyse the use of the Head and Neck Cancer Risk Calculator version 2 in clinical practice.
Patients undergoing telephone triage in a two-week wait referral clinic were included. Data were collected and analysed using appropriate methods.
Sixty-four patients in the study were risk-stratified into low-risk (51.6 per cent, 33 of 64), moderate-risk (14.1 per cent, 9 of 64) and high-risk (34.4 per cent, 22 of 64) groups. Of the patients, 53.1 per cent (34 of 64) avoided an urgent hospital visit, and 96.9 per cent (62 of 64) were cancer free, while 3.1 per cent (2 of 64) were found to have a head and neck malignancy. The sensitivity, specificity, negative predictive value and accuracy were 50.00 per cent, 66.13 per cent, 99.92 per cent and 66.11 per cent, respectively.
It is reasonable to use the calculator for triaging purposes, but it must always be accompanied by a meticulous clinical thought process.
Through diversity of composition, sequence, and interfacial structure, hybrid materials greatly expand the palette of materials available to access novel functionality. The NSF Division of Materials Research recently supported a workshop (October 17–18, 2019) aiming to (1) identify fundamental questions and potential solutions common to multiple disciplines within the hybrid materials community; (2) initiate interfield collaborations between hybrid materials researchers; and (3) raise awareness in the wider community about experimental toolsets, simulation capabilities, and shared facilities that can accelerate this research. This article reports on the outcomes of the workshop as a basis for cross-community discussion. The interdisciplinary challenges and opportunities are presented, and followed with a discussion of current areas of progress in subdisciplines including hybrid synthesis, functional surfaces, and functional interfaces.
The coronavirus disease 2019 pandemic has resulted in various changes in knowledge, attitude and practice among doctors. A survey was conducted of otolaryngologists in India regarding these aspects in relation to the coronavirus disease 2019 pandemic.
Otolaryngologists from West Bengal (India) were invited to participate in an online self-administered survey. Data were collected and analysed using appropriate methods.
Responses from 133 participants, grouped into 4 groups by their career stage, were collected and analysed. Of the participants, 36.8 per cent were directly involved in treating a known or suspected coronavirus disease 2019 patient, although 66.2 per cent considered the personal protective equipment inadequate. Ninety-four per cent indicated that their willingness to perform procedures depended on personal protective equipment availability. Of the respondents, 83.5 per cent revealed additional mental stress due to the pandemic. Of the participants, 41.4 per cent took hydroxychloroquine as coronavirus disease 2019 prophylaxis.
This study provides an insight into which issues may need attention, to help ENT surgeons tackle the coronavirus disease 2019 pandemic more effectively based on analysis of responses in the survey.
In response to increasing concerns about the use of anti-psychotic drugs in dementia, the Department of Health in England commissioned an independent ministerial review.
Aims and methods
The report was based upon an expert review of policy and publications; systematic review of the benefits and harms; and new pharmacoepidemiology.
This review finds that these drugs are used too often in dementia and potential benefits are outweighed by their risks overall. It estimates 180,000 people with dementia receive antipsychotic medication in the UK per year. Of these, 20% (36,000) will derive some benefit. Negative effects directly attributable to antipsychotics equates to an additional 1,620 cerebrovascular adverse events (around half severe), and an additional 1,800 deaths per year. The report's analysis is that this overuse is a specific symptom of a general cumulative failure over the years in health and social care systems to develop an effective response to dementia.
The report contains 11 recommendations to reduce the use of these drugs to the level where benefit will outweigh risk. These include: making reduction a clinical governance priority; audit to drive down the level and up the quality of use of these drugs; specialist services to support primary care in its work in care homes and the community; research on alternatives to antipsychotic medication. The report estimates that, if this is implemented then we can reduce the rate of use of antipsychotic medication to a third of its current level safely over a 36 months.
A scalable battery recycling strategy to recover and regenerate solid electrolytes and cathode materials in spent all solid-state batteries, reducing energy consumption and greenhouse gases.
With the rapidly increasing ubiquity of lithium-ion batteries (LIBs), sustainable battery recycling is a matter of growing urgency. The major challenge faced in LIB sustainability lies with the fact that the current LIBs are not designed for recycling, making it difficult to engineer recycling approaches that avoid breaking batteries down into their raw materials. Thus, it is prudent to explore new approaches to both fabricate and recycle next-generation batteries before they enter the market. Here, we developed a sustainable design and scalable recycling strategy for next-generation all solid-state batteries (ASSBs). We use the EverBatt model to analyze the relative energy consumption and environmental impact compared to conventional recycling methods. We demonstrate efficient separation and recovery of spent solid electrolytes and electrodes from a lithium metal ASSB and directly regenerate them into usable formats without damaging their core chemical structure. The recycled materials are then reconstituted to fabricate new batteries, achieving similar performance as pristine ASSBs, completing the cycle. This work demonstrates the first fully recycled ASSB and provides critical design consideration for future sustainable batteries.
Retinoblastoma is the most common primary intraocular tumor of childhood with >95% survival rates in the US. Traditional therapy for retinoblastoma often included enucleation (removal of the eye). While much is known about the visual, physical, and cognitive ramifications of enucleation, data are lacking about survivors' perception of how this treatment impacts overall quality of life.
Qualitative analysis of an open-ended response describing how much the removal of an eye had affected retinoblastoma survivors' lives and in what ways in free text, narrative form.
Four hundred and four retinoblastoma survivors who had undergone enucleation (bilateral disease = 214; 52% female; mean age = 44, SD = 11) completed the survey. Survivors reported physical problems (n = 205, 50.7%), intrapersonal problems (n = 77, 19.1%), social and relational problems (n = 98, 24.3%), and affective problems (n = 34, 8.4%) at a mean of 42 years after diagnosis. Three key themes emerged from survivors' responses; specifically, they (1) continue to report physical and intrapersonal struggles with appearance and related self-consciousness due to appearance; (2) have multiple social and relational problems, with teasing and bullying being prominent problems; and (3) reported utilization of active coping strategies, including developing more acceptance and learning compensatory skills around activities of daily living.
Significance of results
This study suggests that adult retinoblastoma survivors treated with enucleation continue to struggle with a unique set of psychosocial problems. Future interventions can be designed to teach survivors more active coping skills (e.g., for appearance-related issues, vision-related issues, and teasing/bullying) to optimize survivors' long-term quality of life.
Duck production has the potential to play a major role in agricultural economy. Asian countries alone contribute 84.2% of total duck meat produced in the world. Driven by the demand of processed foods among consumers, the global duck meat market is expected to grow at a steady pace, reaching a value of about $11.23 billion in the coming years. Duck meat has higher muscle fibre content in breast meat compared to chicken, and is considered as red meat. Moreover, due to a higher fat content (13.8%) than chicken and a stronger gamey flavour, duck meat can be less appreciated by the consumer. Development and diversification of ready-to-eat duck meat products is expected to increase consumption levels. Hence, the status of duck meat production, physicochemical properties, processing, including traditional products, and development of novel value-added ready-to-eat products from spent duck meat is discussed in detail to explore its importance as an alternative to chicken.
We observed pediatric S. aureus hospitalizations decreased 36% from 26.3 to 16.8 infections per 1,000 admissions from 2009 to 2016, with methicillin-resistant S. aureus (MRSA) decreasing by 52% and methicillin-susceptible S. aureus decreasing by 17%, among 39 pediatric hospitals. Similar decreases were observed for days of therapy of anti-MRSA antibiotics.
To evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).
Materials and methods
A total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.
Among the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.
In our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.
Sitathali is an olivine-bronzite chondrite, consisting largely of olivine (Fa18) and orthopyroxene (Fs19) with minor amounts of a clinopyroxene (Ca36Fe12Mg52), plagioclase (An12), nickel-iron, troilite, chromite, and a phosphate (apatite or merrillite). The chemical analysis of a 4 gm sample gave SiO2 39·85, TiO2 0·10, Al2O3 2·84, Cr2O3 0·35, FeO 13·27, MnO 0·28, MgO 23·01, CaO 1·84, Na2O 0·65, K2O 0·15, H2O+ 0·23, H2O− 0·05, P2O5 0·25, FeS 5·09, Fe 10·22, Ni 1·58, Co tr. total 99·76. The metal displays Neumann bands, some deformed, as well as areas of apparent flowage. Troilite locally exhibits twin lamellae and in places replaces kamacite in the plessite fields. Elsewhere it is in braided veinlets and globules, both reflecting former melting. The varied textures suggest a complex post-formational history encompassing several deformational events presumably due to breakups and possible extraterrestrial impacts.
The optimisation results for composite and metallic versions of a regional aircraft wing are compared using the multidisciplinary optimisation (MDO) program CALFUNOPT. The program has been developed for the conceptual design stage and models the wing using just 11 beam elements. The wing has been optimised for three combinations of the following constraint cases: static strength; aeroelastic roll efficiency (represented by limiting the twist of the wing for an aileron loading) and aeroelastic divergence. As expected, comparison shows that the composite wing designs are significantly lighter than the metallic ones, due to the well-known tailoring of the composite material. However, the simple model reveals some insight that may be useful to the designer, and which could be lost within a more detailed finite element approach.
The upper-skin compression panels produced by the conceptual MDO program, for both versions of the wing, have then been optimised using the more detailed and accurate panel sizing tool VICONOPT, which takes buckling into account. Such optimisation increases the panel mass by 5-10% and also provides a suitable ratio of stiffener to skin area for use in the conceptual MDO model.