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Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).
Methods
The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.
Results
The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.
Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.
Conclusion
The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.
Parental language input influences child language outcomes but may vary based on certain characteristics. This research examined how parental language differs during two contexts for toddlers at varying likelihood of autism based on their developmental skills. Parental language (quantity, quality, and pragmatic functions) was analyzed during dyadic play and mealtime interactions as a secondary data analysis of observational data from a study of toddlers at elevated and lower likelihood of autism. Child developmental skills and sensory processing were also assessed. Parents used more words per minute, directives, and verbs during play and more adjectives, descriptions, and questions during mealtime. Parental language differed based on child fine motor skills, receptive language, and levels of sensory hyporesponsiveness but not autism likelihood. Overall, this study found that parental language varies based on context and child developmental skills. Future research examining parental language should include pragmatic functions and context across developmental trajectories.
Sensory-based subtypes among autistic children have been well documented, but little is known about longitudinal sensory subtypes beyond autistic populations. This prospective study aimed to identify subtypes based on trajectories of parent-reported sensory features measured at 6–19 months, 3–4, and 6–7 years of age among a community-based birth cohort (N = 1,517), and to examine their associations with school-age clinical and adaptive/maladaptive outcomes on a subset sample (N = 389). Latent class growth analysis revealed five trajectory subtypes varying in intensity and change rates across three sensory domains. In contrast to an Adaptive-All Improving subtype (35%) with very low sensory features and overall better school-age outcomes, an Elevated-All Worsening subtype (3%), comprised of more boys and children of parents with less education, was associated with most elevated autistic traits and poorest adaptive/maladaptive outcomes. Three other subtypes (62% in total) were generally characterized by stable or improving patterns of sensory features at mild to moderate levels, and challenges in certain outcome domains. Our findings indicate that characterizing children based on early sensory trajectories may contribute to earlier detection of subgroups of children with sensory challenges who are more likely to experience developmental challenges by school age, followed by early targeted interventions for improved long-term outcomes.
We found that star-forming regions in extended ultraviolet (XUV) disks are generally consistent with the molecular-hydrogen Kennicutt-Schmidt law that applies within the inner, optical disk. This is true for star formation rates based on Hα + 24 μm data or FUV + 24 μm data. We estimated that the star-forming regions have ages of 1 − 7 Myr and propose that the presence or absence of molecular gas provides an additional “clock” that may help distinguish between aging and stochasticity as the explanation for the low Hα-to-FUV flux ratios in XUV disks. This contribution is a summary of the work originally presented in Watson et al. (2016).
This cross-sectional study seeks to (a) describe developmental correlates of sensory hyporesponsiveness to social and nonsocial stimuli, (b) determine whether hyporesponsiveness is generalized across contexts in children with autism relative to controls, and (c) test the associations between hyporesponsiveness and social communication outcomes. Three groups of children ages 11–105 months (N = 178; autism = 63, developmental delay = 47, typical development = 68) are given developmental and sensory measures including a behavioral orienting task (the Sensory Processing Assessment). Lab measures are significantly correlated with parental reports of sensory hyporesponsiveness. Censored regression models show that hyporesponsiveness decreased across groups with increasing mental age (MA). Group differences are significant but depend upon two-way interactions with MA and context (social and nonsocial). At a very young MA (e.g., 6 months), the autism group demonstrates more hyporesponsiveness to social and nonsocial stimuli (with larger effects for social) than developmental delay and typically developing groups, but at an older MA (e.g., 60 months) there are no significant differences. Hyporesponsiveness to social and nonsocial stimuli predicts lower levels of joint attention and language in children with autism. Generalized processes in attention disengagement and behavioral orienting may have relevance for identifying early risk factors of autism and for facilitating learning across contexts to support the development of joint attention and language.
This contribution discusses the prospect of using millimeter interferometry to survey molecular gas in a large number of galaxies beyond the distance of Virgo.
We present results from infrared spectroscopic projects that aim to test the relation between the mass of a black hole MBH and the velocity dispersion of the stars in its host-galaxy bulge. We demonstrate that near-infrared, high-resolution spectroscopy assisted by adaptive optics is key in populating the high-luminosity end of the relation. We show that the velocity dispersions of mid-infrared, high-ionization lines originating from gas in the narrow-line region of the active galactic nucleus follow the same relation. This result provides a way of inferring MBH estimates for the cosmologically significant population of obscured, type 2 AGN that can be applicable to data from spectrographs on next-generation infrared telescopes.
The possible relationship between psychological responses among breast cancer patients and discase outcome continues to be an area of controversy and debate. Two parallel findings are reported separately in the literature: first, that emotional control is more common among women with breast cancer than in women with benign breast disease or in healthy controls and second, that a helpless attitude towards the disease is related to a poor prognosis.
These previously unrelated psychological responses are examined here in a group of women (N = 359) with early stage breast cancer, who were seen one to three months after diagnosis. The relationships between emotional control, adjustment to cancer and psychological morbidity were examined. Prevalence levels of 16 and 6% were observed for anxiety and depression respectively, which are lower than reported more generally in the literature. The results indicated a highly significant association between scores for the tendency to control emotional reactions and a fatalistic attitude toward cancer. A significant association was observed between anger control and a helpless attitude. Psychological morbidity was also linked to type of adjustment to cancer. The data are interpreted in terms of a process model of psychological responses which suggests that emotional control (an important component of the Type C behaviour pattern) fatalism, helplessness and psychological morbidity are linked.
The post-genomic technologies are generating vast quantities of data but many nutritional scientists are not trained or equipped to analyse it. In high-resolution NMR spectra of urine, for example, the number and complexity of spectral features mean that computational techniques are required to interrogate and display the data in a manner intelligible to the researcher. In addition, there are often multiple underlying biological factors influencing the data and it is difficult to pinpoint which are having the most significant effect. This is especially true in nutritional studies, where small variations in diet can trigger multiple changes in gene expression and metabolite concentration. One class of computational tools that are useful for analysing this highly multivariate data include the well-known ‘whole spectrum’ methods of principal component analysis and partial least squares. In this work, we present a nutritional case study in which NMR data generated from a human dietary Cu intervention study is analysed using multivariate methods and the advantages and disadvantages of each technique are discussed. It is concluded that an alternative approach, called feature subset selection, will be important in this type of work; here we have used a genetic algorithm to identify the small peaks (arising from metabolites of low concentration) that have been altered significantly following a dietary intervention.
By
LuAnn Wilkerson, Senior Associate Dean for Medical Education David Geffen School of Medicine at UCLA; Director of the Center for Educational Development and Research David Geffen School of Medicine at UCLA,
J. Michael McCoy, Chief Information Officer UCLA Healthcare; Senior Associate Director UCLA Medical Center; Associate Dean David Geffen School of Medicine at UCLA,
Linda Watson, Associate Dean University of Virginia School of Medicine; Director Claude Moore Health Sciences Library, University of Virginia,
Sherrilynne Fuller, Professor of Biomedical and Health Informatics University of Washington School of Medicine; Director of Health Sciences Libraries University of Washington Health Sciences Center
Enabled by technological developments and accompanied by an economy undergoing fundamental changes, the knowledge age has arrived. Its impact is already evident in the nature, scope, and pace of competition among businesses, work of individuals, and expectations of the public. As this new era unfolds, organizations are assuming new roles, acquiring new capabilities, developing new business models, and interacting with consumers in different ways. Simultaneously, a flood of advances in the ability to preserve health and treat disease is creating exciting prospects and greater challenges for health care organizations and professionals and their patients.
At first glance it might appear that as institutions with a strong tradition of discovering and sharing knowledge, academic health centers (AHCs) would automatically become leaders of the health domain within the emerging knowledge economy. In fact, however, this leadership position is not assured. Academic health centers have been surpassed by other industries in the practices used to manage and leverage knowledge. They face growing competition in the discovery of new knowledge and are being challenged for the role of preferred source of health knowledge. Moreover, they must update their educational models for effectiveness in the digital era. Thus, AHCs need to attend to their organizational knowledge capabilities and to their role in the future health care environment.
Academic health center leaders face the pressing and pivotal question of how to position their organizations for future success.
Cerebral palsy (CP) can occur in term infants with or without preceding newborn encephalopathy. We compared the type and severity of CP and associated disability in these two groups. Participants from a population-based case-control study of term newborn encephalopathy were followed up for 6 years and linked to the Western Australian Cerebral Palsy Register. The remaining term infants with CP for the same period were also identified from the Cerebral Palsy Register. 13% of neonatal survivors of term newborn encephalopathy had CP, a rate of 116 per 1000 term live births. Overall, 24% of term infants with CP followed newborn encephalopathy. CP following newborn encephalopathy was more likely to: affect males (72% vs 56%); be severe (47% vs 25%); and be of spastic quadriplegia or dyskinetic types. Cognitive impairment was more common (75% vs 43%) and severe (41% vs 16%), as was epilepsy (53% vs 29%) in survivors of encephalopathy. These children were also more likely to: be non-verbal (47% vs 22%); have a severe composite disability score (47% vs 26%); and die between time of diagnosis of CP and age 6 years (5-year cumulative mortality 19% vs 5%). Children born at term who develop CP following newborn encephalopathy have a poorer prognosis than those with CP who were not encephalopathic in the first week of life.
It is known that the maximal ideals in the rings C(X) and C*(X) of continuous and bounded continuous functions on X, respectively, are in one-to-one correspondence with βX. We have shown previously that the same is true for any ring A(X) between C(X) and C*(X). Here we consider the problem for rings A(X) contained in C*(X) which are complete rings of functions (that is, they contain the constants, separate points and closed sets, and are uniformly closed). For every noninvertible f ∈ A(X), we define a z–filter ZA(f) on X which, in a sense, provides a measure of where f is ‘locally invertible’. We show that the map ZA generates a correspondence between ideals of A(X) and z–filters on X. Using this correspondence, we construct a unique compactification of X for every complete ring of functions. Each such compactification is explicitly identified as a quotient of βX. In fact, every compactification of X arises from some complete ring of functions A(X) via this construction. We also describe the intersections of the free ideals and of the free maximal ideals in complete rings of functions.
An exploratory factor analysis of the HAD was carried out in 568 cancer patients. Two distinct, but correlated, factors emerged which corresponded to the questionnaire's anxiety and depression subscales. The factor structure proved stable when subsamples of the total sample were investigated. The internal consistency of the two subscales was also high. These results provide support for the use of the separate subscales of the HAD in studies of emotional disturbance in cancer patients.
Cows (no. = 11) were classified from liver biopsies taken 7 to 10 days after calving as having mild (FL1, no. = 6), or moderate (FL2, no. = 5) fatty infiltration of the liver. Blood samples were collected from the jugular vein: (1) three times weekly and assayed for progesterone and oestradiol; (2) at 10-min intervals for 8-h periods on three occasions during the early post-partum period and assayed for LH; (3) every 2 h, with ovarian palpation performed every 4 h around the second or third post-partum ovulation, and assayed for LH and oestradiol.
Mean weekly concentrations of oestradiol were not significantly different between FL1 and FL2 cows. FL2 cows tended to have short (< 17 days) first cycles (3/4 FL2 v. 0/5 FL1) with significantly lower concentrations of plasma progesterone (P < 0·05). Mean basal concentrations of LH in the samples collected at 10-min intervals tended to be lower in FL2 than in FL1 cows; however, the difference was significant only in the 2nd week of sampling (P = 0·05). Mean basal concentrations of LH were significantly higher in weeks 3 and 4 than in week 2 in FL1 but not in FL2 cows (P < 0·05). The frequency and amplitude of LH pulses were not affected by week of sampling or by fat content of the liver. The total area under the profile of LH during the pre-ovulatory surge was lower in FL2 than in FL1 cows (P < 0·05) but peak plasma concentrations of pre-ovulatory oestradiol and timing of ovulation after the LH surge were similar.
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