A prospective study on the feasibility of cochlear implantation during the coronavirus disease 2019 crisis and trends of assessment: experience in a UK centre.

OBJECTIVES: To demonstrate the feasibility of continuing cochlear implantation during the coronavirus disease 2019 crisis and to report on trends of referrals via the neonatal hearing screening programme. METHODS: A prospective case series was conducted on children who underwent cochlear implantation during the coronavirus disease 2019 crisis in the UK and a sample of referrals via the neonatal hearing screening programme. A step-by-step description of peri-operative management is included. RESULTS: Regionally, between February and May 2020, 106 babies were referred via the neonatal hearing screening programme to paediatric audiology. Eleven children were operated on during the coronavirus disease 2019 study period. None of the 11 children developed coronavirus symptoms. DISCUSSION: It is widely recognised that the demands of managing the current pandemic may compromise screening, clinical assessment and elective surgery. Time-sensitive issues such as cancer management have gained prominence, but a similar need exists for timely paediatric cochlear implantation. CONCLUSION: Implantation in the paediatric population during the coronavirus disease 2019 pandemic is feasible with careful planning.

Morphological comparison of the ampullae of Lorenzini of three sympatric benthic rays.

This study investigated and compared the morphology of the electrosensory system of three species of benthic rays. Neotrygon trigonoides, Hemitrygon fluviorum and Maculabatis toshi inhabit similar habitats within Moreton Bay, Queensland, Australia. Like all elasmobranchs, they possess the ability to detect weak electrical fields using their ampullae of Lorenzini. Macroscopically, the ampullary organs of all three species are aggregated in three bilaterally paired clusters: the mandibular, hyoid and superficial ophthalmic clusters. The hyoid and superficial ophthalmic clusters of ampullae arise from both dorsal and ventral ampullary pores. The dorsal pores are typically larger than the ventral pores in all three species, except for the posterior ventral pores of the hyoid grouping. Ampullary canals arising from the hyoid cluster possessed a quasi-sinusoidal shape, but otherwise appeared similar to the canals described for other elasmobranchs. Ultrastructure of the ampullae of Lorenzini of the three species was studied using a combination of light, confocal and electron microscopy. All possess ampullae of the alveolar type. In N. trigonoides and M. toshi, each ampullary canal terminates in three to five sensory chambers, each comprising several alveoli lined with receptor and supportive cells and eight to 11 sensory chambers in H. fluviorum. Receptor cells of all three species possess a similar organization to those of other elasmobranchs and were enveloped by large, apically nucleated supportive cells protruding well into the alveolar sacs. The luminally extended chassis of supportive cells protruding dramatically into the ampullary lumen had not previously been documented for any elasmobranch species.

Spirituality and spiritual care in Iran: nurses' perceptions and barriers.

AIM: This study aimed to explore the perception of Iranian nurses concerning spiritual care and to reveal any confronted barriers. BACKGROUND: Although the context of spiritual care is a substantial aspect of holistic care, the delivery of spiritual care has been problematic due to lack of nurses' understanding of this concept. INTRODUCTION: Nurses' perceptions of spirituality and spiritual care directly influence their performance as well as their relationships with patients. METHODS: This cross-sectional survey was conducted in 2013 with 259 nurses working in hospitals affiliated with Qazvin University of Medical Sciences, Iran. Data were collected using the Spirituality and Spiritual Care Rating Scale alongside qualitative open-ended questions. Descriptive and inferential statistics were used for the quantitative data and content analysis for the qualitative data. RESULTS: The overall average for spirituality and spiritual care was 2.84 (score range: 1-4), indicating a moderate mean score. A significant relationship was found between education level and spiritual care. The majority of participants believed that they did not receive enough training in this aspect of care. The main obstacles regarding delivering spiritual care included busy working schedules, insufficient knowledge regarding spiritual care, low motivation, diversity of patients' spiritual needs and feeling 'unqualified' to provide spiritual cares. DISCUSSION: Consistent with the previous studies, this study has demonstrated that nurses had low confidence to meet the spiritual needs of patients due to lack of knowledge and training in this regard. CONCLUSION: Iranian nurses' perception of spirituality and spiritual care is moderate, reflecting that they do not receive sufficient training regarding spiritual care. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: Despite the attention focused on spiritual care in clinical settings in Iran, there remains a significant gap in terms of meeting the spiritual needs of patients in nursing practice. This finding assists nursing clinicians, educators and policy makers to more effectively approach spiritual care as a beneficial component of holistic care. It is proposed that more emphasis is placed on integrating spirituality content into educational programmes to enable more effective clinical delivery. In addition, it would be beneficial to implement more widespread cultural assessment in order to further benefit spiritual care practices.

High-throughput screening identifies compounds that enhance lentiviral transduction.

A difficulty in the field of gene therapy is the need to increase the susceptibility of hematopoietic stem cells (HSCs) to ex vivo genetic manipulation. To overcome this obstacle a high-throughput screen was performed to identify compounds that could enhance the transduction of target cells by lentiviral vectors. Of the 1280 compounds initially screened using the myeloid-erythroid-leukemic K562 cell line, 30 were identified as possible enhancers of viral transduction. Among the positive hits were known enhancers of transduction (camptothecin, etoposide and taxol), as well as the previously unidentified phorbol 12-myristate 13-acetate (PMA). The percentage of green fluorescent protein (GFP)-positive-expressing K562 cells was increased more than fourfold in the presence of PMA. In addition, the transduction of K562 cells with a lentiviral vector encoding fVIII was four times greater in the presence of PMA as determined by an increase in the levels of provirus in genetically modified cells. PMA did not enhance viral transduction of all cell types (for example, sca-1(+) mouse hematopoietic cells) but did enhance viral transduction of human bone marrow-derived CD34(+) cells. Notably, the percentage of GFP-positive CD34(+) cells was increased from 7% in the absence of PMA to greater than 22% in the presence of 1 nM PMA. PMA did not affect colony formation of CD34(+) cells or the expression of the hematopoietic markers CD34 and CD45. These data demonstrate that high-throughput screening can be used to identify compounds that increase the transduction efficiency of lentiviral vectors, identifying PMA as a potential enhancer of lentiviral HSC transduction.

Frontotemporal atrophy associated with paranoid delusions in women with Alzheimer's disease.

BACKGROUND: Paranoid delusions are a common and difficult-to-manage feature of Alzheimer's disease (AD). We investigated the neuroanatomical correlates of paranoid delusions in a cohort of AD patients, using magnetic resonance imaging (MRI) to measure regional volume and regional cortical thickness. METHODS: 113 participants with probable AD were assessed for severity of disease, cognitive and functional impairment. Presence and type of delusions were assessed using the Neuropsychiatric Inventory (NPI). Structural MRI images were acquired on a 1.5 T scanner, and were analyzed using an automated analysis pipeline. RESULTS: Paranoid delusions were experienced by 23 (20.4%) of the participants. Female participants with paranoid delusions showed reduced cortical thickness in left medial orbitofrontal and left superior temporal regions, independently of cognitive decline. Male participants with delusions did not show any significant differences compared to males without delusions. An exploratory whole brain analysis of non-hypothesized regions showed reduced cortical thickness in the left insula for female participants only. CONCLUSION: Frontotemporal atrophy is associated with paranoid delusions in females with AD. Evidence of sex differences in the neuroanatomical correlates of delusions as well as differences in regional involvement in different types of delusions may be informative in guiding management and treatment of delusions in AD.

Apathy and cortical atrophy in Alzheimer's disease.

OBJECTIVES: Apathy has been reported as the most prevalent behavioural symptom experienced in Alzheimer's disease (AD), associated with greater functional decline and caregiver distress. The aim of the current study was to investigate structural correlates of apathy in AD using magnetic resonance imaging (MRI) regional volume and regional cortical thickness measures. METHODS: Semi-structured interviews were conducted with 111 AD patients and their caregivers as part of the European multi-centre study AddNeuroMed. Apathy was measured using the apathy domain of the Neuropsychiatric Inventory (NPI). All AD patients were scanned using a 1.5T MRI scanner and the images analysed using an automated analysis pipeline. RESULTS: We found apathy to be the most prevalent neuropsychiatric symptom occurring in 57% of patients. Apathetic patients had significantly greater cortical thinning in left caudal anterior cingulate cortex (ACC) and left lateral orbitofrontal cortex (OFC), as well as left superior and ventrolateral frontal regions, than those without apathy symptoms. CONCLUSIONS: Apathy is mediated by frontocortical structures but this is specific to the left hemisphere at least for patients in the mild to moderate stages of AD.

Haemocytes play a commensal rôle in the synthesis of the dihydroxybenzoate required as a precursor for sclerotization of the egg case (ootheca) in the cockroach Periplaneta americana (L).

The secretions of the two colleterial glands give rise to the walls of the ootheca which, when hardened, serve to protect fertilised eggs in the cockroach P. americana. The larger left gland (LCG) secretes a ß-D-glucoside of 3,4-dihydroxybenzoate, several proteins (oothecins), calcium oxalate crystals and a latent phenoloxidase enzyme. The smaller right gland (RCG) secretes a ß-glucosidase. When the two secretions mix in the genital vestibulum, the glucoside is hydrolyzed to glucose and free dihydroxybenzoate, which is then oxidized by the phenoloxidase to the o-benzoquinone, which cross-links the oothecins Scanning and thin section electron microscopy (EM) showed haemocytes adhering to the LCG. The haemocytes were obtained by washing the gland with insect saline; and, when they were incubated with labelled tyrosine, they showed an enhanced ability to decarboxylate L-p-tyrosine to tyramine and then deaminate and oxidize tyramine to give p-hydroxyphenylacetate. After removal of adhering haemocytes, the LCG was no longer able to decarboxylate tyrosine. Injection of α-ecdysone into the abdomens of recently emerged adult females inhibited synthesis of a phenolic glucoside in the developing LCG but not of ß-glucosidase produced by RCG. Furthermore, injecting inhibitors of the decarboxylase and monoamineoxidase enzymes partly closed down synthesis in vivo of the phenolic glucoside by LCG. Therefore, in the adult female cockroach, tyramine was converted to p-hydroxyphenylacetate in the haemocytes and then transferred to the gland where it was hydroxylated to 3,4-dihydroxyphenylacetate, which gave rise to a dihydroxybenzoate. Evidence suggested that biosynthesis of the oothecal sclerotizing agent could be controlled by juvenile hormone (JH) acting on the LCG or on haemocytes adhering to the gland.

Jugular foramen schwannoma presenting with glossopharyngeal neuralgia syncope syndrome.

INTRODUCTION: Jugular foramen schwannomas are rare skull base tumours which typically have a variable clinical presentation. Glossopharyngeal syncope syndrome is an unusual clinical presentation; in the following case report, it was the sole presentation of an extracranial jugular foramen tumour. METHODS: The presentation of a patient with glossopharyngeal neuralgia syncope syndrome is reviewed and the pathophysiology, clinical features and treatment discussed. RESULTS: A 45-year-old woman presented with unilateral throat pain, bradycardia and hypotension leading to episodes of impaired consciousness when lying on her left side or turning her head to the left. Imaging detected a left-sided extracranial jugular foramen schwannoma. The tumour was excised, and the patient had no more syncopal attacks. CONCLUSION: Glossopharyngeal neuralgia syncope syndrome can be the sole presentation of a jugular foramen schwannoma. Although this syndrome may be treated with anti-dysrhythmic drugs, cardiac pacing or nerve section, in the presented patient excision of the jugular foramen schwannoma was successful in preventing further episodes of syncope.

Insight, cognition and quality of life in Alzheimer's disease.

BACKGROUND: The detrimental impact of dementia upon patient health-related quality of life (HRQL) is well established, as is the importance of improving HRQL. However, relatively little is known about the natural history of HRQL in dementia and those factors influencing it. This limited knowledge potentially restricts the evaluation of the efficacy of interventions designed to improve HRQL. One such area concerns the relationship between HRQL and patient insight. It remains unclear what impact, if any, impaired insight has upon a patient's HRQL. The present study aimed to investigate the relationship between insight and HRQL in a sample of patients with Alzheimer's disease (AD) and their carers. METHODS: 256 patients with AD were recruited as part of AddNeuroMed, a multicentre European AD biomarkers study. Of these, 174 completed a quality-of-life measure in addition to a comprehensive battery of clinical and neuropsychological assessments. RESULTS: Insight was found to be differentially related to patient perceptions of HRQL in mild and moderate dementia. Within moderate dementia, impaired insight was associated with better perceived HRQL. Conversely, cognition, but not insight, was associated with impaired HRQL in mild dementia. Insight was not found to be associated with carer perceptions of patient HRQL. CONCLUSION: Impairment of insight is associated with better HRQL in moderate dementia. This finding has implications for interventions which focus on increasing patient awareness and orientation, as impairment of insight appears to have a positive impact upon HRQL.

Laser micro/nano fabrication in glass with tunable-focus particle lens array.

Based on medium-tuned optical field enhancement effect around a self-assembled particle-lens array (PLA) irradiated with a femtosecond (fs) laser source, we demonstrated that high-precision periodical array of micro/nano-structures can be readily fabricated on glass surface or inside glass in large areas in parallel without any cracks or debris. The technique has potential for rapid fabrication of three-dimensional structures in multiple layers inside glass.

The changing role of incentives in health promotion and wellness.

Incentives have been a part of the health promotion and wellness landscape for over three decades. The mounting need for engagement and risk mitigation are changing the role that incentives play in programming strategies. Incentives are increasing in size and are undergoing a fast process of assimilation within large employer organizations. More sophisticated communication strategies are helping maximize the motive force element in many settings. Health plans have been slower to innovate with incentives but are now attempting to catch up. A possible "ideal" or "endgame" incentive strategy is suggested and one scenario for the future of wellness incentives is proposed.

The influences of particle number on hot spots in strongly coupled metal nanoparticles chain.

In understanding of the hot spot phenomenon in single-molecule surface enhanced Raman scattering (SM-SERS), the electromagnetic field within the gaps of dimers (i.e., two particle systems) has attracted much interest as it provides significant field amplification over single isolated nanoparticles. In addition to the existing understanding of the dimer systems, we show in this paper that field enhancement within the gaps of a particle chain could maximize at a particle number N>2, due to the near-field coupled plasmon resonance of the chain. This particle number effect was theoretically observed for the gold (Au) nanoparticles chain but not for the silver (Ag) chain. We attribute the reason to the different behaviors of the dissipative damping of gold and silver in the visible wavelength range. The reported effect can be utilized to design effective gold substrate for SM-SERS applications.

Changes in composition, structure and aboveground biomass over seventy-six years (1930-2006) in the Black Rock Forest, Hudson Highlands, southeastern New York State.

We sought to quantify changes in tree species composition, forest structure and aboveground forest biomass (AGB) over 76 years (1930-2006) in the deciduous Black Rock Forest in southeastern New York, USA. We used data from periodic forest inventories, published floras and a set of eight long-term plots, along with species-specific allometric equations to estimate AGB and carbon content. Between the early 1930s and 2000, three species were extirpated from the forest (American elm (Ulmus americana L.), paper birch (Betula papyrifera Marsh.) and black spruce (Picea mariana (nigra) (Mill.) BSP)) and seven species invaded the forest (non-natives tree-of-heaven (Ailanthus altissima (Mill.) Swingle) and white poplar (Populus alba L.) and native, generally southerly distributed, southern catalpa (Catalpa bignonioides Walt.), cockspur hawthorn (Crataegus crus-galli L.), red mulberry (Morus rubra L.), eastern cottonwood (Populus deltoides Bartr.) and slippery elm (Ulmus rubra Muhl.)). Forest canopy was dominated by red oak and chestnut oak, but the understory tree community changed substantially from mixed oak-maple to red maple-black birch. Density decreased from an average of 1500 to 735 trees ha(-1), whereas basal area doubled from less than 15 m(2) ha(-1) to almost 30 m(2) ha(-1) by 2000. Forest-wide mean AGB from inventory data increased from about 71 Mg ha(-1) in 1930 to about 145 Mg ha(-1) in 1985, and mean AGB on the long-term plots increased from 75 Mg ha(-1) in 1936 to 218 Mg ha(-1) in 1998. Over 76 years, red oak (Quercus rubra L.) canopy trees stored carbon at about twice the rate of similar-sized canopy trees of other species. However, there has been a significant loss of live tree biomass as a result of canopy tree mortality since 1999. Important constraints on long-term biomass increment have included insect outbreaks and droughts.

Not just music but medicine. Podcasting surgical procedures in otolaryngology.

Audiovisual teaching material can now be watched using a personal computer or portable media device. The cost of delivering video across the Internet has fallen considerably in recent years. Podcasting technology automates the distribution of audio and video across the Internet. Podcasting technology, with the Internet, has the potential to improve learning. To access podcasts all you need is a computer, free software and an Internet connection.

Triggering of acute coronary syndromes by physical exertion and anger: clinical and sociodemographic characteristics.

OBJECTIVE: To investigate the role of vigorous physical exertion and anger as triggers of acute coronary syndromes (ACS) and to identify the clinical and sociodemographic correlates of triggering. DESIGN: Prospective observational clinical cohort study. SETTING: Four coronary care units in the London area. PATIENTS: 295 men and women with electrocardiographically and biochemically verified ACS. MAIN OUTCOME MEASURES: Physical exertion in the 1 h and anger in the 2 h before symptom onset were assessed with structured interviews. Control periods were the equivalent hours one day earlier and usual rates over the past six months. Data were analysed by case-crossover methods. RESULTS: Physical exertion was reported by 10% and anger by 17.4% of patients in the hazard period. The risk of ACS onset after physical exertion compared with light or no activity was 3.50 (95% confidence interval (CI) 1.37 to 10.6). The risk of onset with anger was 2.06 (95% CI 1.12 to 3.92). Physical exertion during the hazard period was related to an absence of premonitory symptoms, presentation with an ST elevation myocardial infarction (STEMI), low socioeconomic deprivation and higher future cardiovascular risk. Anger during the hazard period was more common in younger, socioeconomically deprived patients who presented with a STEMI. CONCLUSIONS: Triggers are relevant across the spectrum of ACS. The distinct clinical and sociodemographic factors associated with physical exertion and anger suggest that different pathophysiological processes may be involved.

Post-traumatic stress disorder in patients with cardiac disease: predicting vulnerability from emotional responses during admission for acute coronary syndromes.

OBJECTIVES: To assess frequency and predictors of post-traumatic stress disorder (PTSD), measured by the Post Traumatic Stress-self report version, at three months after admission for acute coronary syndromes (ACS). DESIGN: Two-phase prospective study. SETTING: Four coronary care units. PATIENTS: 135 patients admitted to hospital with ACS confirmed by ECG and cardiac enzyme changes. RESULTS: 20 patients (14.8%) showed a symptom pattern characteristic of PTSD at three months assessed by a conservative scoring criterion. Severity of chest pain and psychological factors during admission were predictive of PTSD severity. Acute stress symptoms, depression, negative affect, hostility, and pain scores were independent predictors of three-month PTSD symptoms (R(2) = 0.495, p < 0.001). In contrast, demographic factors (age, sex, education level and income) were unrelated to post-traumatic symptoms, as were markers of clinical disease severity. CONCLUSIONS: Patient vulnerability to PTSD three months after ACS is predictable on the basis of psychological state and chest pain at the time of admission. This may be valuable to the clinician, as PTSD after myocardial infarction is associated with poorer quality of life, reduced adherence to drug treatment and increased likelihood of cardiovascular morbidity.

Recent advances in analytical construct resins.

The area of solid-phase synthesis has witnessed exponential growth in the last fifteen years, but difficulties associated with the monitoring and analysis of resin-bound reactions and products have been apparent due to a limited number of analytical methods available. With the substrate tethered to an insoluble support traditional chromatographic monitoring is only possible after cleavage. In order to address this 'analytical bottleneck' Geysen, in 1996 elaborated Merrifield's initial dual linker strategy by incorporating an encoding system between two in-line linkers. These analytical construct resins represented a new approach for both the quality control of solid-phase combinatorial libraries and for the development of new synthetic sequences on solid-support. This review will summarize the development and application of analytical construct resins focusing on recent applications of the technology.