Union of the European Phoniatricians' position statement on the exit strategy of phoniatric and laryngological services: staying safe and getting back to normal after the peak of coronavirus disease 2019 (issued on 25th May 2020).

BACKGROUND: The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services. OBJECTIVES: This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures. CONCLUSION: As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.

In-hospital vs. 30-day mortality in the critically ill - a 2-year Swedish intensive care cohort analysis.

BACKGROUND: Standardised mortality ratio (SMR) is a common quality indicator in critical care and is the ratio between observed mortality and expected mortality. Typically, in-hospital mortality is used to derive SMR, but the use of a time-fixed, more objective, end-point has been advocated. This study aimed to determine the relationship between in-hospital mortality and 30-day mortality on a comprehensive Swedish intensive care cohort. METHODS: A retrospective study on patients >15 years old, from the Swedish Intensive Care Register (SIR), where intensive care unit (ICU) admissions in 2009-2010 were matched with the corresponding hospital admissions in the Swedish Hospital Discharge Register. Recalibrated SAPS (Simplified Acute Physiology Score) 3 models were developed to predict and compare in-hospital and 30-day mortality. SMR based on in-hospital mortality and on 30-day mortality were compared between ICUs and between groups with different case-mixes, discharge destinations and length of hospital stays. RESULTS: Sixty-five ICUs with 48861 patients, of which 35610 were SAPS 3 scored, were included. Thirty-day mortality (17%) was higher than in-hospital mortality (14%). The SMR based on 30-day mortality and that based on in-hospital mortality differed significantly in 7/53 ICUs, for patients with sepsis, for elective surgery-admissions and in groups categorised according to discharge destination and hospital length of stay. CONCLUSION: Choice of mortality end-point influences SMR. The extent of the influence depends on hospital-, ICU- and patient cohort characteristics as well as inter-hospital transfer rates, as all these factors influence the difference between SMR based on 30-day mortality and SMR based on in-hospital mortality.

Certified Reference Material IAEA-446 for radionuclides in Baltic Sea seaweed.

A Certified Reference Material (CRM) for radionuclides in seaweed (Fucus vesiculosus) from the Baltic Sea (IAEA-446) is described and the results of the certification process are presented. The (40)K, (137)Cs, (234)U and (239+240)Pu radionuclides were certified for this material, and information values for 12 other radionuclides ((90)Sr, (99)Tc, (210)Pb ((210)Po), (226)Ra, (228)Ra, (228)Th, (230)Th, (232)Th, (235)U, (238)U, (239)Pu and (240)Pu) are presented. The CRM can be used for Quality Assurance/Quality Control of analysis of radionuclides in seaweed and other biota samples, as well as for development and validation of analytical methods, and for training purposes.

Statistical data evaluation in mobile gamma spectrometry: an optimization of on-line search strategies in the scenario of lost point sources.

There is a potential risk that hazardous radioactive sources could enter the environment, e.g., via satellite debris, smuggled radioactive goods, or lost metal scrap. From a radiation protection point of view there is a need for rapid and reliable methods for locating and identifying sources. The methods could also be used to locate hot spots after radioactive fallout. Carborne and airborne gamma spectrometry systems are suitable for the task. This work focuses on a situation where the radionuclide to search for is known, which is not an unlikely scenario. The possibility that the source is located near a road can be high, and thus motivating a carborne spectrometer system. The main object is to optimize on-line statistical methods in order to achieve a high probability for locating the point source and still have reasonably few false alarms caused by variations in the natural background radiation. Data were obtained from a carborne 3-L NaI(Tl) detector and two point sources located at various distances from the road. The nuclides used were 137Cs and 131I. Spectra were measured stationary on the road. From these measurements we have reconstructed counts in spectral windows applicable to different speed and sampling times; the time 3 s and speeds 32 and 54 km h(-1) are used in this work. The maximum distance a source can be located from the road and still be detected is estimated with four different statistical analysis methods. This distance is called the critical distance, CD. The method is applied on gross counts in the full energy peak spectral window. For each method alarm levels have been calculated from background data obtained in Scania (Skåne), in the south of Sweden. The results show large differences in CD. With the best approach, the two sources could be detected from about 180 m (137Cs, 6 GBq) and 170 m (131I, 4.5 GBq).

Alpha particle emission from reference glass surfaces implanted with 210Po.

Implanted long-lived radon decay products in glass surfaces have been used as a measure of past radon exposure in homes. Special track-etch devices (so-called 'retro-detectors') attached to the glass surface, have the ability to specifically measure the implanted activity of 210Po in situ. Calibrating these devices for 210Po is fairly straightforward, but the retro-detectors are also sensitive to the background activity of the glass substrate. Thus, for the successful calibration of retro-detectors, it is necessary to determine the complete alpha emission energy spectrum of the reference glass sheet utilised as a calibration pad. In order to achieve accurate knowledge of the alpha surface emission rate, we have combined several different approaches, i.e. alpha spectrometry of the pad surface with both surface-barrier and pulse-ionisation detectors, and activity determination of the glass matrix by means of radiochemical methods. The part of the alpha emission spectrum originating from the glass volume is then calculated theoretically and compared with experimental results.

Decreased cortical levels of astrocytic glutamate transport protein GLT-1 in a rat model of posttraumatic epilepsy.

The extracellular homeostasis of glutamate in the brain is maintained by the efficient uptake into astroglial cells. The high extracellular glutamate levels seen during seizures are therefore probably a result of both an increased synaptic release and a deranged glutamate uptake. In this study we used immuno-blotting technique to measure the cortical levels of the astrocytic glutamate transport protein (GLT-1) and of the glutamate and aspartate transporting protein (GLAST) in an epilepsy model induced by ferrous chloride injection in the cortex of rats. The levels of GLT-1 were lower in epileptic rats than in controls, day 1 and 5 after induction, but not at 3 months. Glial fibrillary protein (GFAP) levels increased with time in the epileptic model, whereas GLAST and beta-tubulin III remained unchanged compared to controls. The results suggest that the transient decrease of GLT-1 could play a role in epileptogenesis, while recurrent seizure activity may be maintained by other mechanisms.

Studies on the interaction between hyaluronan and a rat colon cancer cell line.

Binding studies with 125I-Tyr labelled hyaluronan (HA) on a cultured rat colon cancer cell line were performed to characterize the association of HA to tumour cells in vitro. Results show a specific and saturable binding (Kd=1.36 nM) which indicates the presence of an HA binding receptor on the tumour cells. There is a specific constant increase of cell-associated HA over time, which indicates that HA is specifically taken up by the cells through endocytosis. The binding of 125I-Tyr labelled HA was more effectively inhibited by unlabelled HA of high MW in relation to low MW species of the polysaccharide indicating that the receptor binds HA of high MW with greater affinity than low MW species. In competition experiments, the HA-binding could not be inhibited by other polysaccharides such as chondroitin sulphate and heparin. Nor could ligands for scavenger receptors and antibodies directed towards ICAM-1, CD 44 and RHAMM (Receptor for HA Mediated Motility) significantly inhibit the association of HA to tumour cells.

Retrospective determination of radon in houses.

In the 1970s it was statistically proved that exposure to radon daughter products caused lung cancer in miners. High concentrations of radon daughters have since been found in houses. Any epidemiological radon study begun today is hampered because relevant exposure data are difficult to obtain owing to the long latency period between exposure and tumour manifestation. Here I present a method for measuring cumulative radon daughter levels, which takes advantage of the fact that the first long-lived radon daughter (210Pb, half-life 22 yr) becomes firmly attached to glass surfaces in a house. By measuring the surface activity concentration of the alpha-emitter 210Po, the time-integrated radon, or radon daughter, concentration can be estimated. Thus, indoor glass can act as a long-term retrospective or prospective exposure meter for radon in dwellings.

Influence of air cavities on central depth dose curves for 33 MV roentgen rays.

The relative central absorbed dose preceding and following air layers and channels in a polytetrafluorethylene (teflon) phantom has been measured with LiF-teflon dosimeters. Focus phantom distance is set to 100 cm and the field sizes range from 3 cm X 3 cm to 6 cm X 6 cm. Absorbed dose decrease and build-up factors in front of and behind the air cavity are evaluated. The build-up factor is strongly dependent on field size. Measurements of absorbed dose in water and polystyrene yield approximately the same results as in teflon if the linear dimensions of the irradiation geometry (including depth in phantom) in water and polystyrene are equal to 1.84 and 1.99 respectively times the corresponding parameter in teflon. The underlying transformation procedure is derived. The absorbed dose correction factors in the region behind the slab are discussed in terms of tissue-air-ratio and effective attenuation formulae.