Clinical Outcomes of Orthopedic Surgery Comanagement by Internal Medicine Advanced Practice Clinicians: A Cohort Study.

OBJECTIVE: Compare clinical outcomes between advanced practice clinician-based comanagement and usual orthopedic care. BACKGROUND: Comanagement of orthopedic surgery patients by internal medicine hospitalists is associated with improvements in clinical outcomes including complications, length of stay, and cost. Clinical outcomes of orthopedic comanagement performed solely by internal medicine advanced practice clinicians have not been reported. METHODS: Retrospective cohort study in patients 18 years or older, hospitalized for orthopedic joint or spine surgery between May 1, 2014, and January 1, 2022. Outcomes assessed were length of stay, ICU transfer, return to operating room, inhospital and 30-day mortality, 30-day readmission, and total direct cost excluding surgical implants. Generalized boosted regression and propensity score weighting was used to compare clinical outcomes and healthcare cost between usual care and advanced practice clinician comanagement. RESULTS: Advanced practice clinician comanagement was associated with a 5% reduction in mean length of stay (RR=0.95, p=0.009), decreased odds of returning to the operating room (OR= 0.51, p=0.002), and a significant reduction in 30-day mortality (OR= 0.32, p=0.037) compared to usual orthopedic care in a weighted analysis. Need for ICU transfer was higher with advanced practice clinician comanagement (OR= 1.54, p=0.009), without significant differences in 30-day readmission or inhospital mortality. CONCLUSIONS: We observed reductions in length of stay, healthcare costs, return to the operating room, and 30-day mortality with advanced practice clinician comanagement compared to usual orthopedic care. Our findings suggest advanced practice clinician-based comanagement may represent a safe and cost-effective model for orthopedic comanagement.

Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India.

Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.

CLEAR - clozapine in early psychosis: study protocol for a multi-centre, randomised controlled trial of clozapine vs other antipsychotics for young people with treatment resistant schizophrenia in real world settings.

BACKGROUND: Clozapine is an antipsychotic drug with unique efficacy, and it is the only recommended treatment for treatment-resistant schizophrenia (TRS: failure to respond to at least two different antipsychotics). However, clozapine is also associated with a range of adverse effects which restrict its use, including blood dyscrasias, for which haematological monitoring is required. As treatment resistance is recognised earlier in the illness, the question of whether clozapine should be prescribed in children and young people is increasingly important. However, most research to date has been in older, chronic patients, and evidence regarding the efficacy and safety of clozapine in people under age 25 is lacking. The CLEAR (CLozapine in EARly psychosis) trial will assess whether clozapine is more effective than treatment as usual (TAU), at the level of clinical symptoms, patient rated outcomes, quality of life and cost-effectiveness in people below 25 years of age. Additionally, a nested biomarker study will investigate the mechanisms of action of clozapine compared to TAU. METHODS AND DESIGN: This is the protocol of a multi-centre, open label, blind-rated, randomised controlled effectiveness trial of clozapine vs TAU (any other oral antipsychotic monotherapy licenced in the British National Formulary) for 12 weeks in 260 children and young people with TRS (12-24 years old). AIM AND OBJECTIVES: The primary outcome is the change in blind-rated Positive and Negative Syndrome Scale scores at 12 weeks from baseline. Secondary outcomes include blind-rated Clinical Global Impression, patient-rated outcomes, quality of life, adverse effects, and treatment adherence. Patients will be followed up for 12 months and will be invited to give consent for longer term follow-up using clinical records and potential re-contact for further research. For mechanism of action, change in brain magnetic resonance imaging (MRI) biomarkers and peripheral inflammatory markers will be measured over 12 weeks. DISCUSSION: The CLEAR trial will contribute knowledge on clozapine effectiveness, safety and cost-effectiveness compared to standard antipsychotics in young people with TRS, and the results may guide future clinical treatment recommendation for early psychosis. TRIAL REGISTRATION: ISRCTN Number: 37176025, IRAS Number: 1004947. TRIAL STATUS: In set-up. Protocol version 4.0 01/08/23. Current up to date protocol available here: https://fundingawards.nihr.ac.uk/award/NIHR131175# /.

Comparative Study of Surgical Outcome in Endoscopic-Assisted Versus Conventional Septoplasty Using Nasal Surgical Questionnaire (NSQ): A Randomized Control Trial.

Deviated nasal septum (DNS) causes nasal obstruction, secretions, decreased sense of smell, bleeding, headache and snoring. This study aims to compare endoscopic-assisted septoplasty versus conventional septoplasty in terms of surgical outcome and intra- and post-operative complications. A prospective study was done on 50 patients aged between 18 and 41 years of which, 41 (82%) cases were males and 9 (18%) were females who had DNS based on clinical examination and diagnostic nasal endoscopy. Patients were randomized by simple randomization into two groups. Functional outcome was assessed using nasal surgical questionnaire (NSQ) prior to and after surgery for 3 months post-operatively and complications associated with the surgery were compared between two groups. In this study, most of the patients had anterior dislocations, present in 37 cases (74%). Improvement in pre- to post-operative visual analogue scale (VAS) for nasal obstruction was significantly better in endoscopic-assisted than conventional septoplasty (p < 0.001*). Pre-and post-operative differences in 4-point likert scale for other nasal symptoms like decreased sense of smell, snoring, secretions, headache and crusting were better in endoscopic-assisted septoplasty (p < 0.001*). Complications in endoscopic-assisted septoplasty were less common compared to conventional septoplasty (p = 0.05). In endoscopic-assisted septoplasty patients, pre-to post-operative NSQ (Nasal Surgical Questionnaire) VAS improvement for nasal obstruction, likert scale change from pre-to post-op were better and complications were lesser compared to conventional septoplasty. This suggests endoscopic-assisted septoplasty has better surgical outcomes and fewer complications and posterior deviations, spurs and inferior deviations can be corrected with ease and fewer complications.

A Survey of Speech-Language Pathologists' Applications of Motor Learning Principles in Dysphagia Therapy in Adults in India.

PURPOSE: In the study, we investigated whether speech-language pathologists (SLPs) in India use practice and feedback conditions of motor learning principles (MLPs), including biofeedback, in dysphagia therapy in adults using a problem-solution approach. METHOD: Based on a literature review and clinical experience, we developed and validated a hypothetical case involving an adult with dysphagia (representing the problem) and a purpose-built 22-item questionnaire (representing the solution). We distributed the questionnaire electronically by sending an e-mail to 2,069 SLPs and also published a flyer on the dysphagia special interest group of India. RESULTS: A total of 107 SLPs anonymously submitted their responses. In practice conditions, most of the SLPs reported following massed over distributed, small over large, blocked over random, whole over part, variable over constant, and internal over external practice strategies. In feedback conditions, most of the participants reported using knowledge of results over performance, high over low, immediate over delayed, and self over therapist feedback strategies. Lastly, more than two thirds of SLPs did not use biofeedback devices for dysphagia therapy. CONCLUSION: The findings from our study indicate that SLPs in India do not adhere uniformly to the recommended practices of MLPs for dysphagia therapy in adults.

Impact of Truncation on Optoelectronic Properties of Azaborole Helicenes.

Herein, we report configurationally stable singly-truncated (ST) and structurally flexible doubly-truncated (DT) helically chiral compounds derived from azabora[7]helicenes by a hypothetical removal of a single or two C=C double bonds. The singly-truncated constitutional isomers were synthesized from either benzoisoquinoline (BIQ) or phenantherene building blocks and the corresponding biaryls in excellent yields to give azabora[5]helicenes with a pendant phenyl ring at a sterically hindered position. These systems highlight the electronic impact of the nitrogen donor substitution position. The compounds with a disrupted BIQ moiety (STN) possess remarkable photoluminescence quantum yields of up to 0.53 in the solid state and a blue emission in solution with dissymmetry factors of up to ca. 3×10-3 . Upon cooling to 79 K all compounds exhibit phosphorescence with lifetimes of up to ca. 0.5 s. A methyl complex of azabora[7]helicene showing excellent configurational stability was used as a chiral inducer embedded in an emissive polymer (F8BT) to produce circularly polarized organic light emitting diodes with an electroluminescence dissymmetry factor gEL of up to 0.54.

Fatty acid isotopic composition in Atlantic pollock is not influenced by environmentally relevant dietary fat concentrations.

The application of fatty acid (FA) isotopic analysis has great potential in elucidating food web structure, but it has not experienced the same wide-spread use as amino acid isotopic analyses. The failure to adopt FA isotopic methods is almost certainly linked to a lack of reliable information on trophic fractionation of FA, particularly in higher predators. In this work, we attempt to address this shortfall, through comparison of FA δ13C values in captive Atlantic pollock (Pollachius virens) liver and their known diets. Since catabolism is likely the main cause of fractionation and it may vary with dietary fat content, we investigated the impact of dietary fat concentration on isotopic discrimination in FA. We fed Atlantic pollock three formulated diets with similar FA isotopic compositions but different fat concentrations (5-9% of diet), representative of the range found in natural prey, for 20 weeks. At the conclusion of the study, δ13C values of liver FA were very similar to the FA within the corresponding diets, with most discrimination factors < 1. For all FA except 22:6n-3, dietary fat had no effect on discrimination factors. Only for 22:6n-3 did fish fed the highest fat diet have lower δ13C values than the diet consumed. Thus, these FA-specific discrimination factors can be applied to evaluate diets in marine fish consuming natural diets and will serve as additional and valuable biomarkers in fish feeding ecology.

Effect of managed transition on mental health outcomes for young people at the child-adult mental health service boundary: a randomised clinical trial.

BACKGROUND: Poor transition planning contributes to discontinuity of care at the child-adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC). METHODS: A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and sharing of information between CAMHS and adult mental health services. The primary outcome was HoNOSCA (Health of the Nation Outcome Scale for Children and Adolescents) score 15-months post-entry to the trial. RESULTS: The mean difference in HoNOSCA scores between the MT and UC arms at 15 months was -1.11 points (95% confidence interval -2.07 to -0.14, p = 0.03). The cost of delivering the intervention was relatively modest (€17-€65 per service user). CONCLUSIONS: MT led to improved mental health of YP after the SB but the magnitude of the effect was small. The intervention can be implemented at low cost and form part of planned and purposeful transitional care.

Exploring the sorghum race level diversity utilizing 272 sorghum accessions genomic resources.

Due to evolutionary divergence, sorghum race populations exhibit significant genetic and morphological variation. A k-mer-based sorghum race sequence comparison identified the conserved k-mers of all 272 accessions from sorghum and the race-specific genetic signatures identified the gene variability in 10,321 genes (PAVs). To understand sorghum race structure, diversity and domestication, a deep learning-based variant calling approach was employed in a set of genotypic data derived from a diverse panel of 272 sorghum accessions. The data resulted in 1.7 million high-quality genome-wide SNPs and identified selective signature (both positive and negative) regions through a genome-wide scan with different (iHS and XP-EHH) statistical methods. We discovered 2,370 genes associated with selection signatures including 179 selective sweep regions distributed over 10 chromosomes. Co-localization of these regions undergoing selective pressure with previously reported QTLs and genes revealed that the signatures of selection could be related to the domestication of important agronomic traits such as biomass and plant height. The developed k-mer signatures will be useful in the future to identify the sorghum race and for trait and SNP markers for assisting in plant breeding programs.

Remote assessment of ADHD in children and adolescents: recommendations from the European ADHD Guidelines Group following the clinical experience during the COVID-19 pandemic.

The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.

First results of fast visible imaging diagnostic in Aditya-U tokamak.

A Fast Visible Imaging Diagnostic (FVID) system, measuring the visible light emission spectrum (400-1000 nm) from tokamak plasma, has been installed on the Aditya-U tokamak to monitor the two-dimensional dynamics of the poloidal cross section of the plasma. In this work, we present the design and installation of the FVID system on the Aditya-U tokamak. The evolution of plasma and plasma-wall interactions is described. The signature of the runaway electron beam in visible imaging and its correlation with other diagnostics is presented. The estimation of the electron cyclotron resonance layer position during pre-ionization is also discussed in this work.

Investigating the effect of density variation on pitch angle scattering events of runaway electrons as observed through electron cyclotron emission diagnostic at Aditya-upgrade tokamak.

Nascent observations about the influence of kinetic instabilities on electron cyclotron emission (ECE) from runaway electrons (REs) have been detected and explored at the Aditya-Upgrade (Aditya-U) tokamak. The developed broadband ECE radiometer system offers wideband measurements by integrating several radio frequency units with a fixed intermediate frequency receiver with multiple channels, which is a novel approach to meet the needs of the localized measurements at various toroidal fields and extend the system dynamic range. The low density (ne ≤ 1 × 10-19 m-3) plasma discharges at Aditya-U are consistently accompanied by a 20%-40% increase in the ECE radiometer signal amplitude within 100 µs and sporadic step-like modulations. The Pitch Angle Scattering (PAS) of REs induced by kinetic instabilities is a potential candidate for their occurrence. This steep jump in the radiometer signals was detected due to its high temporal resolution of 10 µs. A "PREDICT" code that employs the relativistic test particle model validates these experimental findings of the radiometer diagnostic for the first time for Aditya-U tokamak. Preliminary observations of the ECE radiometer signals also show that additional gas puffs can be used to vary the trigger timings of such PAS events or even lead to their complete avoidance.

Evaluation of optical transmission across the ITER hard x-ray monitor system designed for the first plasma scenarios.

Hard x-ray (HXR) spectroscopy is applied for diagnostics of runaway electrons in nuclear fusion reactors. The scintillation counter is one of the most commonly used types of detectors for HXR spectroscopy. It consists of a detector that emits light when excited by HXR radiation (scintillator) directly coupled to a PMT (Photomultiplier Tube) that converts light pulses into an electrical signal. This type of detector is commonly used in existing tokamaks, such as Joint European Torus (JET), Experimental Advanced Superconducting Tokamak (EAST), Compact Assembly (COMPASS), and Axially Symmetric Divertor Experiment (ASDEX-U). In all these cases, the scintillator is directly coupled to the PMT to provide the best possible light transmission efficiency. The Hard X-ray Monitor (HXRM) is one among the first plasma diagnostic systems at ITER that provides information about the energy distribution of runaway electrons inside a tokamak by HXR spectroscopy. This system also uses a scintillator and a PMT as a detector. Due to the heavy shielding of the blanket modules, vacuum vessel, and port-plugs, it is not possible to assemble the scintillator outside the tokamak vacuum vessel. The PMT detector cannot be installed in the close vicinity of the tokamak due to either the significant magnetic field or temperature. A possible solution is to decouple the scintillator from the PMT and place the PMT inside the port-cell. Light pulses will be transmitted to the PMT via a 12 m long optical fiber bundle. Evaluation of the optical transmission was carried out to assess the performance of the HXR monitor and verify possible problems related to the PMT pulse discrimination under low light conditions.

Deposited layer substrate (DeLaS)-A module for radiation measurement.

Infrared Imaging Video Bolometer (IRVB) measures the radiation from plasma in two-dimensions. IRVB uses a few micrometer thick metal foil as a radiation absorber. The foil being ultra-thin has several limitations. A new radiation absorbing module is proposed here that can effectively overcome the shortcomings of the foils used in IRVB. This module is developed by depositing carbon and metal thin films on an infrared transmitting substrate using magnetron sputtering. This patented module is termed Deposited Layer on a Substrate. A prototype is developed and laboratory tests are carried out using a laser source to demonstrate its feasibility as a radiation detector. The advantages of this module over conventional foils, its development, and experimental results validating the concept are discussed in this article.

Susceptibility-Weighted MRI as an Imaging Marker for Reperfusion Injury in Acute Ischemic Stroke Following Mechanical Thrombectomy.

Background/Purpose: Following endovascular intervention for stroke, hyperattenuated areas are common in brain parenchyma and it is difficult to differentiate on non-contrast CT whether it is contrast staining or reperfusion hemorrhage. Differentiation between contrast staining from reperfusion hemorrhage is of paramount importance for early initiation of antiplatelets and/or anticoagulants to prevent reocclusion of vessel. This study demonstrates signal characteristics of contrast-staining and reperfusion hemorrhage on susceptibility weighted MRI and its role to differentiate between two. Materials/Methods: Between July 2017 to March 2019, 36 patients who presented with acute ischemic stroke due to large vessel occlusion underwent mechanical thrombectomy. Low-osmolar non-ionic (Iopromide 300 mg/L) iodinated contrast was used in all patients who underwent endovascular intervention. All patients underwent noncontrast CT brain and SWI on 3T MRI within 30 minutes of endovascular intervention. MRI was evaluated by two neuroradiologists. Reperfusion hemorrhage was defined as ECASS criteria II. Symptomatic ICH was defined as hemorrhagic transformation temporally related to a negative shift in NIHSS score >/=4. Results: Out of 36 patients, 15 had hyperattenuated areas in brain on NCCT. Out of 15, 13 patients had blooming on SWI, suggestive of bleed. Two patients had no blooming on SWI, suggestive of contrast staining. Two patients didnot show any hyperdensity on NCCT but blooming on SWI, suggestive of bleed. Conclusion: All patients with hyperdensity on NCCT secondary to bleed showed blooming on SWI whereas those with contrast staining didnot show any signal changes on SWI. Thus, it is possible to differentiate reperfusion hemorrhage from contrast staining using SWI MRI. The significance of SWI in normal CT may be low where a small bleed maynot have any clinical significance.

Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: Barriers and recommendations.

Transition in mental health care is the process ensuring continuity of care of a young patient arriving at the CAMHS (Child and Adolescent Mental Health Service) age boundary within mental health services. Transition refers to a transfer to an adult mental health service (AMHS), to private care or other mental health community services. A transition plan can also lead to a managed end of specialized care with involvement of a general practitioner or social services. For young people with a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) or ASD (Autism Spectrum Disorder), two disorders that persist into adulthood, an optimal transition would ensure continuity of care or facilitate access to specialized care in the case of a discharge. Transition typically occurs during adolescence, a known sensitive period when young people may experience major changes at several levels: physiological, psychological and social. Any barrier in the transition process resulting in discontinuity of care may worsen the symptoms of ADHD or ASD and can ultimately adversely affect the global mental health of young people with such neurodevelopmental disorders. The objectives of this narrative review are: 1/to identify the barriers in the transition process in mental health services often faced by young people with these two disorders; 2/to highlight specific recommendations for strengthening the CAMHS-AMHS interface that have been proposed by various countries in Europe.

Genetic Dissection and Quantitative Trait Loci Mapping of Agronomic and Fodder Quality Traits in Sorghum Under Different Water Regimes.

Livestock provides an additional source of income for marginal cropping farmers, but crop residues that are used as a main source of animal feed are characteristically low in digestibility and protein content. This reduces the potential livestock product yield and quality. The key trait, which influences the quality and the cost of animal feed, is digestibility. In this study, we demonstrate that sorghum breeding can be directed to achieve genetic gains for both fodder biomass and digestibility without any trade-offs. The genotypic variance has shown significant differences for biomass across years (13,035 in 2016 and 3,395 in 2017) while in vitro organic matter digestibility (IVOMD) showed significant genotypic variation in 2016 (0.253) under drought. A range of agronomic and fodder quality traits was found to vary significantly in the population within both the control and drought conditions and across both years of the study. There was significant genotypic variance (σg2) and genotypic × treatment variance (σgxt2) in dry matter production in a recombinant inbred line (RIL) population in both study years, while there was only significant σg2 and σgxt2 in IVOMD under the control conditions. There was no significant correlation identified between biomass and digestibility traits under the control conditions, but there was a positive correlation under drought. However, a negative relation was observed between digestibility and grain yield under the control conditions, while there was no significant correlation under drought population, which was genotyped using the genotyping-by-sequencing (GBS) technique, and 1,141 informative single nucleotide polymorphism (SNP) markers were identified. A linkage map was constructed, and a total of 294 quantitative trait loci (QTLs) were detected, with 534 epistatic interactions, across all of the traits under study. QTL for the agronomic traits fresh and dry weight, together with plant height, mapped on to the linkage group (LG) 7, while QTL for IVOMD mapped on to LG1, 2, and 8. A number of genes previously reported to play a role in nitrogen metabolism and cell wall-related functions were found to be associated with these QTL.

Reversible redox switching between local and global aromaticity for core-modified expanded carbaisophlorinoids.

Two dithienothiophene based 28π antiaromatic macrocycles with benzene and azulene units and their effects on local and global (anti)aromaticity have been described. Experimental and computational studies confirmed the presence of weak paratropic and strong diatropic ring current effects in neutral and dicationic states, respectively.

Demographic, clinical, and service-use characteristics related to the clinician's recommendation to transition from child to adult mental health services.

PURPOSE: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians' advice to continue treatment at AMHS. METHODS: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians' transition recommendations. RESULTS: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. CONCLUSION: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services.

Evaluation of efficacy 3Dimensional 4-hole trapezoid condyle plate for treatment of base of condyle fracture.

Aim: The aim of our study was to evaluate the effectiveness of open reduction and internal fixation of the base of condyle using a 3D 4-hole trapezoid condyle plate (4-HTCP). Materials and Methods: A group of 25 subjects of an age range of 21-52 years (mean 32.7 ± 8.7 years) were treated of which, 7(28%) were female and 18 (72%), were male. All the patients were examined according to standard protocol. A retromandibular approach was used in all the patients. Results: The time taken for operating on the condyle alone was recorded it was between 30 minutes to one hour in 5 (20%) patients, between one-two hours in 19 (76%) patients and greater than two hours in 1 (4%) patient. Time taken from reduction of fracture to placement of the last screw was recorded. In 15 (60%) patients the time taken was less than ten minutes, in 10 (40%) patients the time taken ranged from 10-15 minutes. 6 (24%) patients needed additional exposure to facilitate the procedure. Postoperatively all the patients were followed up for a minimum of 9 months and a maximum of 30 months (mean 19.5 ± 5.87 months). The range of mandibular movements was satisfactory. The maximum incisal opening was in the range of 25-37 mm (mean- 31.4 ± 3.38 mm)on the first post-operative day. 31.4 ± 3.4 mm 6 weeks postoperatively, 43.8 ± 4.3 mm 3 months postoperatively, 46.7 ± 2.9 mm 6 months postoperatively and 49.7 ± 4.5 mm 9 months postoperatively. Taking into consideration the transient hypofunction of the facial nerve (8%) and TMJ disorder (8%) the aggregate complication rate in our study was 16%. Conclusion: Our study concludes that 4HTCP is a reliable and rigid choice of osteosynthesis for the base of condyle fractures.