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Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting.
Methods
This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate.
Results
There were 12 patients from 2013 to 2020, aged 0.07–50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed.
Conclusion
The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis.
This special communication provides an approach for applying implementation science frameworks to a Clinical and Translational Science Institutes (CTSIs) community engagement (CE) program that measures the use of implementation strategies and outcomes that promote the uptake of CE in research. Using an iterative multi-disciplinary group process, we executed a four-phased approach to developing an evaluation plan: 1) creating an evaluation model adapted from Proctor’s conceptual model of implementation research; 2) mapping implementation strategies to CTSI CE program interventions that support change in research practice; 3) identifying and operationalizing measures for each strategy; and 4) conducting an evaluation. Phase 2 employed 73 implementation strategies across 9 domains generated by the Expert Recommendations for Implementing Change project. The nine domains were used to classify each CE program implementation strategy. In Phase 3, the group used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to define measures for each individual strategy. Phase 4 demonstrates the application of this framework and measures Year 1 outcomes for the strategy providing interactive assistance, which we implemented using a centralized consultation model. This approach can support the CTSA program in operationalizing CE program measurement to demonstrate which activities and strategies may lead to benefits derived by the program, institution, and community.
OBJECTIVES/GOALS: Translating Research into Practice (TRIP), a hybrid implementation pragmatic clinical trial and CTSA collaboration, aims to implement a standardized breast cancer patient navigation protocol across five sites in Boston, MA. The goal of this study was to assess individual and institutional barriers and facilitators to implementing this protocol. METHODS/STUDY POPULATION: From November 2019 to August 2020, researchers conducted ethnographic observations of Patient Navigators (PN) at three of the five participating sites. Each PN at each site was observed for two, four-hour blocks by researchers trained in ethnographic research. Observers took notes using TRIPs 11 Step Protocol as a guide, which includes identifying patients at risk for delays in care, screening and referring patients to resources for health-related social needs, and tracking patients across the care continuum. Fieldnotes were uploaded into Dedoose and coded deductively by four researchers using a comparison and consensus approach. Researchers analyzed the data to identify barriers and facilitators to both implementing each protocol step and maximizing navigations ability to promote health equity. RESULTS/ANTICIPATED RESULTS: Across all sites, PNs faced barriers to adhering to the TRIP Protocol due to practical workflow constraints including their level of engagement across the cancer care continuum. Although there are other staff members who engage in navigation activities, navigation is often viewed solely as the responsibility of the PN. Operationalizing navigation as a person rather than a process creates confusion around the role, and PNs are often seen as a catchall position when other staff do not know how to help a patient. The time that PNs spend on tasks unrelated to core navigation activities described in the TRIP Protocol prevents PNs from navigating patients most at risk for delays in care. A lack of continuity across the care continuum can create role confusion for the PNs. DISCUSSION/SIGNIFICANCE: Patient Navigation can promote health equity; however, any task that pulls PNs away from navigating patients most at risk for delays in care diminishes this potential. PNs abilities to enact the TRIP protocol, which they saw as valuable, is circumscribed by the extent to which navigation is operationalized as a process within the institution.
Self-disorders (SDs) have been described as a core feature of schizophrenia-spectrum disorders. Previous studies conducted on heterogeneous clinical adult and adolescents samples demonstrated that SDs aggregate selectively in the schizophrenia spectrum disorders compared to other disorders.
Objectives
To examine the specificity of SDs for schizophrenia spectrum disorders in adolescent inpatient sample.
Methods
Fifty-five adolescent inpatients admitted to the Child Psychiatry Unit at the Sapienza University in Rome were assessed for psychopathology using Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), Structured Interview for Prodromal Syndromes (SIPS/SOPS),Examination of Anomalous Self-Experiences (EASE), Multidimensional Anxiety Scale for Children (MASC), Calgary depression scale for schizophrenia (CDSS)
Results
Patients, aged 14-18 years, were divided in four diagnostic groups: schizophrenia spectrum disorders (5 pts.), mood disorders (19 pts.), anxiety disorders (27 pts.) and other disorders (4 pts.). Frequency of self-disorders was different among the 4 groups. Including patients schizotypal personality disorder in the schizophrenia-spectrum disorder group, the difference is still significant. Mann-Whitney U test shows no differences between EOP and UHR patients in SD. Furthermore, correlations between EASE total score and Calgary and MASC total scores were significant.
Conclusions
Our results confirm the specificity of SDs for schizophrenia spectrum disorders and also the belonging of schizotypal personality disorder to schizophrenia-spectrum.
The COVID-19 pandemic has required many clinical and translational scientists and staff to work remotely to prevent the spread of the virus. To understand the impact on research programs, we assessed barriers to remote work and strategies implemented to support virtual engagement and productivity. A mixed-methods RedCap survey querying the remote work experience was emailed to Colorado Clinical and Translational Sciences Institute (CCTSI) scientists and staff in April 2020. Descriptive analyses, Fisher’s Exact tests, and content analysis were conducted. Respondents (n = 322) were primarily female (n = 240; 75%), 21–73 years old (mean = 42 years) with a PhD (n = 139; 44%) or MD (n = 56; 55%). Prior to COVID-19, 77% (n = 246) never or rarely (0–1 day a week) worked remotely. Remote work somewhat or greatly interfered with 76% (n = 244) of researchers’ programs and 71% (n = 231) reported slowing or stopping their research. Common barriers included missing interactions with colleagues (n = 198; 62%) and the absence of routines (n = 137; 43%). Strategies included videoconferencing (n = 283; 88%), altering timelines and expectations (n = 180; 56%). Scientists and staff experienced interference with their research when they shifted to remote work, causing many to slow or stop research programs. Methods to enhance communication and relationships, support productivity, and collectively cope during remote work are available.
The aim of our ongoing study is to investigate the effectiveness of Zonisamide augmentation to Duloxetine in partial and non-responder patients in course of Unipolar Major Depressive Episode.
Method:
35 outpatients will be enrolled in a 12-weeks open-label study including both genders, 18 to 65 years old subjects. Unipolar Major Depressive Episode diagnosis will be performed at screening time using “Structured Clinical Interview for DSM-IV-Axis-I Disorders- Italian 1996 version” (SCID-I, First et al., 1996) and by a ≥14 total score for the “Quick Inventory of Depressive Symptomathology-Self Rated” (QIDS-SR, Rush et al., 2003). Patients will be repeatedly evaluated during the course of the study using a wide range of mood and anxiety rating scales and monitoring biomarkers such as electroretinogram b-wave amplitude, interleukins, flogosis and BDNF factors etc. At week 6, Duloxetine partial/non responders will be augmetated to Zonisamide and further evaluations of mentioned markers will be repeated. A “Fisher-test” or χ² analysis will be performed at the end of the study. Expected p will be ≤ 0,005.
Hypothesis:
We expect Zonisamide augmentation to be an effective treatment for SNRI-resistant Major Depression.
The aim of this preliminary study is to assess, in a sample of patients with Coronary Heart Disease (CHD), the specific association between depressive symptoms and systemic inflammation.
Methods
Sixty-One inpatients with CHD, 31 Unstable Angina and 28 Myocardial Infarction, participated in the study. The plasma levels of C Reactive Protein were measured using Dade Behring’s High Sensitivity CRP assay (hs-CRP) at T0, T30 and T90.
At the same timings, they were tested by an examiner, unaware of their diagnosis, with a psychometric battery (SCL90-R, HDRS, MADRS, BDI, QlesQ).
Results
The elevation of hs-CRP occurs during the whole observation period, with maximum significance at T90 (p = 0,031).
A multivariate analysis at T0 indicates a statistical correlation between SCL90-R scores and hs-CRP levels (p = 0.02).
The SCL90-R is also associated with the risk of further cardiac events (p = 0.013).
Also the BDI could be useful as a prognostic factor (p = 0.026).
We found a trend towards correlation between CRP values and depressive symptoms, but it never reaches statistical significance for the other scales.
Conclusions
The feelings of loss and the fear of death, related to the environmental and emotional situation of the hospitalization, may prevail in the acute phase of CHDs.
Some patients may overcome this reactive depression, while others may exhibit a biological depression, related to the high level of CRP and thus to an increased risk of re-infarction and other coronary events.
The aim of this study was to evaluate some Children’s Depression Inventory (CDI) psychometric properties and the prevalence of depressive symptoms in an unselected Italian sample of two hundred and eighty-four children aged 8 years. The CDI internal consistency was adequate (Cronbach’s alpha: .80). The mean and standard deviation of CDI and the percentage of children at risk of depression (10.6%) in this sample are consistent with the figures reported by other studies carried out in northern Europe and North America. There were differences in gender and socioeconomic level in that boys scored higher than girls, and in the lower socioeconomic level there were more children at risk of depression. Ten items best discriminated children at risk for depression with 94% of correct classification. Most of these items consisted of observable signs. It is suggested that the CDI has noteworthy consistency across samples of relatively different cultures, that it can reliably be employed in the assessment of young children, and that observable signs outnumber internalizing symptoms of depression among children at risk.
We assessed the lifetime prevalence of major depression in a sample of 145 patients with a current diagnosis of panic disorder and/or social phobia. The prevalenee tended to be higher in patients with both diagnoses. Patients with panic disorder and social phobia had an earlier onset of the former condition. Familial rates of panic were higher in patients with pure panic disorder, and the rate of depression was increased in relatives of probands who had a lifetime diagnosis of depression.
it is well established that adversities and GRIN2B genetic variants (encoding NMDAR GluN2B subunit) are independently associated with behavioral and cognitive impairments in childhood. However, a high proportion of children exposed to risk have good, long-term outcomes.
Objectives
for the first time, we explored how environmental adversities and GRIN2B genetic variants influence children's cognitive abilities and behavioral problems.
Aims
we adopted a gene-by-environment interaction (GxE) approach, to identify children with an unfavorable developmental outcome with the potential of better informing the understanding of susceptibility to developmental disorders.
Methods
6 SNPs of GRIN2B were genotyped in 625 children aged 6-11 years from an Italian community-based sample. The interactive effect of GRIN2B variants with 4 measures of adversities (low socioeconomic status - SES, preterm delivery, maternal smoking, absence of breastfeeding) was investigated upon cognitive abilities (vocabulary, block design, forward/backward digit spans of Wechsler's Intelligence Scale, and Rey Figure test) and parents-rated behavioral problems (Child Behavior Checklist/6-18).
Results
rs5796555 x gestational age interaction (p= .00145) influenced cognition, with lower IQ memory among children in the ‘A/A genotype and ≤ 36 gestational age’ group, compared to all other groups. Rs2268119 x SES interaction (p= .00008) influenced behavior, with more attention problems among children in the ‘either A/T or T/T genotype and low SES’ group, compared to all other groups.
Conclusions
GRIN2B targets children with the worst outcome in memory and attention functioning among children exposed to environmental adversities. Identification of children with the highest risk may prompt cost-effective preventive/treatment strategies.
Co-morbidity between depression and diabetes is a common underdiagnosed condition. Individuals with diabetes have about a 2- fold increased risk for major depression, affecting one of every 10 diabetic patients. The association between depression and diabetes may be due to biologic effects of depression on the hypothalamic-pituitary axis, platelet adhesion, inflammation or the autonomic nervous system; alternatively, the association may be due to non-adherence with medication leading to worse control of glycemia.
Objectives:
To investigate the association between diabetes and depression symptoms within a community-based sample with type 2 diabetes mellitus, while controlling for socio-demographic, diabetes-related characteristics and complications, disability, other chronic illness and other health-related variables.
Methods:
180 patients with diagnosis of diabetes mellitus type 2 were tested to evaluate mood (Montgomery-Asberg Depression Rating Scale, MADRS), health status (Short Form 36, SF-36) and personality (Temperament and Character Inventory, TCI) related to variables (sex, age, education, marital status, socioeconomic status).
Results:
We found 1) mild depressive symptoms in 73% of patients (6≤ MADRS score ≤20), with a greater prevalence in female gender (94% females vs 53% males) and in older age (58% males vs 94% females); 2) a poor quality perception of health status in 68,7% of diabetics/depressed patients (subthreshold ISM, mental health index); 3) frequency methodical type personality (low NS, high HA, low RD) in 53% of sample (48% males, 71% females).
Conclusion:
Diabetic population has increased risk of developing depression. Early identification of depressive symptoms may occur through the study of risk factors.
Valerian officinalis roots extract is a popular medication for insomnia and anxiety treatment. Sedative effect of Valerian is mainly attributed to the modulation of gabaergic transmission, but its pharmacodynamics has not been fully elucidated.
Objects
To investigate the acute effects of Valerian Officinalis extracts intake on corticoexcitability as measured by TMS.
Aims
To obtain further data on Valerian pharmacodynamics.
Methods
Twelve healthy volunteers participated in a double-blind randomized crossover placebo-controlled study. They were required to take either 900 mg of Valerian officinalis extract (valerenic acid 0.8%) or placebo. Focal TMS of the hand area of left motor cortex was used to test Resting motor threshold (RMT), Motor evoked potentials (MEPs) amplitude and silent period duration (SP). We also tested Short-interval Intracortical Inhibition (SICI), Intracortical facilitation (ICF), Short and Long afferent Inhibition (SAI and LAI). All parameters were investigated at baseline, 1 hour and 6 hours after drug intake. After a 3-week washout period the subjects switched to the alternate arm of the study.
Results
A mixed RMANOVA revealed a significant main effect of “time” [F(1,22) = 4.03, P = 0.02] and a significant “treatment × time” interaction [F(1,22) = 6.3, P = 0.003]. Post-hoc analysis indicated that the amount of ICF was significantly reduced 1 hour after Valerian intake (P = 0.01) returning to baseline values after 6 hours. No significant changes between the Valerian and placebo groups were observed for the other parameters investigated.
Conclusions
The modulation of ICF induced by Valerian officinalis is likely due to glutamatergic antagonism and might underlie the anti-anxiety therapeutic effects.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Pediatric bipolar disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders, with high levels of morbidity and disability and with a great risk of suicide.
Objectives
While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified.
Aims
To assess the prevalence, demographics, clinical correlates and course of these euphoric versus irritable pediatric mania.
Methods
Systematic review of the available studies assessing the phenomenology, course and outcome of pediatric mania.
Results
Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common. Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age.
Conclusions
Severe irritability is the most common presentation of abnormal mood described in children with bipolar disorder. Longitudinal studies of samples with irritable versus elated mood presentation and chronic versus episodic course may help clarify whether these are factors predicting different long-term course, treatment-response and outcome of pediatric onset bipolar disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Methane contributes substantially to global warming as the second most important anthropogenic greenhouse gas. Radiocarbon (14C) measurements of atmospheric methane can be used as a source apportionment tool, as they allow distinction between thermogenic and biogenic methane sources. However, these measurements remain scarce due to labor-intensive methods required. A new setup for the preparation of atmospheric methane samples for radiocarbon analysis is presented. The system combines a methane preconcentration line with a preparative gas chromatography technique to isolate pure methane samples for a compound-specific radiocarbon analysis. In order to minimize sample preparation time, we designed a simplified preconcentration line for the extraction of methane from 50 L atmospheric air, which corresponds to 50 µg C as required for a reliable 14C analysis of methane-derived CO2 gas measurement with accelerator mass spectrometry (AMS). The system guarantees a quantitative extraction of methane from atmospheric air samples for 14C analysis, with a good repeatability and a low processing blank. The setup was originally designed for the measurement of samples with low methane concentrations, but it can also be adapted to apportion sources from environmental compartments with high methane levels such as freshwaters or wetlands.
Introduction: Procedural skills training varies significantly across Canadian medical schools, and there is currently no standardized assessment tool to evaluate its benefits. This project aims to develop a curriculum that teaches 2nd-year medical students to perform and evaluate procedural skills. The goals of this program include decreasing anxiety, increasing confidence, and achieving competence for students and also allowing staff to judge the appropriate level of supervision when delegating learners to perform basic procedures in the team setting. Our curriculum incorporates, near-peer teaching as well as near peer formative assessment. Methods: Each of the twelve 2nd year participants completed a State Trait Anxiety Inventory and self-reported confidence questionnaire related to procedural skills. Students participated in four sessions taught by expert physicians over a five month period. A new skill was taught at each monthly workshop and an opportunity to practice previously taught skills was provided. Skills were assessed in a skills integration simulation OSCE, and the anxiety and confidence questionnaire was repeated. Results: Students who completed this pilot program showed a significant decrease in mean anxiety state (2.48 vs 1.74, p-value <0.001), while the control group did not (p-value = 0.408). When assessing confidence, students who completed this program showed increased self-assessed knowledge and confidence in each of the program's assessed skills. An increased level of competency was achieved in each skill by each student as assessed by the expert physicians. Conclusion: There is evidence to suggest that implementation of this procedural skills training model within the Canadian medical school curriculum may improve student anxiety, confidence, and competency for success in clerkship and could be the foundation for developing milestones for EPAs.
Introduction: In order to better characterize procedural skills curricula in Canada, a national survey was conducted. The objectives of the survey were: (i) to characterize procedural skills education currently employed in pre-clerkship and clerkship curricula; (ii) to determine what skills physician-educators think medical students should know upon graduation; and (iii) to identify physician-educator perceptions regarding the development of pre-clerkship procedural curriculum. Methods: A web-based survey was distributed to 201 clinician-educators across Canada's 17 medical schools. Respondents were directed to an individualized survey based on their self-identified roles at their institution. Respondents were asked demographic questions, what procedural skills are being taught and in what setting at their institution, and their opinions on the value of a pre-clerkship procedural curriculum. Results: From the 17 school's surveyed, 12 schools responded, with 8 schools responding “yes” that they had a clerkship procedural curriculum. For a pre-clerkship procedural curriculum, only 4 schools responded “yes”. The 5 of the top 10 procedurals skills identified that medical students should know upon graduation, in order, are: IV Access, Airway Management/Ventilator Management, Local anesthesia/field block, Casting, Spontaneous Vaginal Delivery. On a Likert scale, clinician-educators strongly supported a pre-clerkship procedural curriculum (median = 4.00/5.00, mode = 5.00/5.00), and they believed it would decrease anxiety (median = 4.00/5.00), increase confidence (median = 4.00/5.00), and increase technical ability (median = 3.00/5.00) in incoming clerks. Conclusion: Across Canada, the state of undergraduate medical education procedural skills education is inconsistent. With the identification of the Top 10 procedural skills medical students should know upon graduation, the learning objectives of a formal curriculum can be developed. With overwhelming support from physician-educators, a formal pre-clerkship procedural curriculum is poised to redefine the landscape of procedural care for a whole new generation of physicians.
The study of dwarf spheroidal galaxies (dSph) is of great importance to understand galaxy evolution at the low-mass end. In the Local Group the majority of them are found to be satellites of the Milky Way or M31. The closest ones have been studied in great detail, however it is hard to constrain if their present-day observed properties are mainly caused by internal or environmental mechanisms. In order to minimize these effects and gain an insight into their intrinsic properties, we are studying two of the three isolated dSph galaxies in the Local Group, i.e. Cetus and Tucana, located far beyond the virial radius of the Milky Way and M31. We present here results from our recently published analysis of Cetus (Taibi2018) and preliminary results for Tucana (Taibi et al. in prep.).
Understanding the peculiar properties of Ultra Diffuse Galaxies (UDGs) via spectroscopic analysis is a challenging task that is now becoming feasible. The advent of 10m-class telescopes and high sensitivity instruments is enabling the gathering of high quality spectra even for the faintest systems. In addition, advances in the modelling of stellar populations, stellar libraries, and full-spectral fitting codes are allowing the recovery of the stellar content shaping those spectra with unprecedented reliability. In this contribution we report on the extensive tests we have carried out using the inversion code STECKMAP. The similarities between the Star Formation Histories (SFH) recovered from STECKMAP (applied to high-quality spectra) and deep Colour-Magnitude diagrams fitting (resolved stars) in two Local Group dwarf galaxies (LMC and LeoA) are remarkable, demonstrating the impressive performance of STECKMAP. We exploit the capabilities of STECKMAP and perform one of the most complete and reliable characterisations of the stellar component of UDGs to date using deep spectroscopic data. We measure radial and rotation velocities, SFHs and mean population parameters, such as ages and metallicities, for a sample of five UDG candidates in the Coma cluster. From the radial velocities, we confirm the Coma membership of these galaxies. We find that their rotation properties, if detected at all, are compatible with dwarf-like galaxies. The SFHs of the UDG are dominated by old (∼ 7 Gyr), metal-poor ([M/H] ∼ -1.1) and alpha-enhanced ([Mg/Fe]∼ 0.4) populations followed by a smooth or episodic decline which halted ∼ 2 Gyr ago, possibly a sign of cluster-induced quenching. We find no obvious correlation between individual SFH shapes and any UDG morphological properties. The recovered stellar properties for UDGs are similar to those found for DDO 44, a local UDG analogue resolved into stars. We conclude that the UDGs in our sample are extended dwarfs whose properties are likely the outcome of both internal processes, such as bursty SFHs and/or high-spin haloes, as well as environmental effects within the Coma cluster.
Corrensite and chlorite-rich chlorite-smectite (Chl-S) mixed-layers occurring in the Macigno Formation of northwestern Tuscany were investigated by XRPD/SEM techniques. The samples from the Macigno outcrops were affected by metamorphism corresponding to the high-diagenesis/low-anchizone transition boundary. The basal spacing of corrensite measured from 00l reflections on EG–Mg2+-saturated samples ranges from 30.97 to 31.18 Å with a coefficient of variation (CV) of 0.46–0.77%, consistent with the rational pattern of a 1:1 Chl-S periodic stacking sequence. X-ray patterns of heated K+-saturated specimens reveal the presence of two types of corrensite, probably with different interlayer charges on their respective smectite-like layers. The chlorite-rich Chl-S mixed layers coexisting with corrensite consist of R2 chlorite (0.70–0.75)/S and chlorite (0.90)/S with long-range ordering R ⩾ 1. SEM observations show that corrensite and chlorite-rich Chl-S mixed-layers are closely mixed on a sub-micron scale. Some grains of corrensite and chlorite-rich Chl-S mixed-layers include zones (2–10 μm) of chlorite composition, as shown by microprobe analyses.