Complete Hierarchy for High-Dimensional Steering Certification.

High-dimensional quantum steering can be seen as a test for the dimensionality of entanglement, where the devices at one side are not characterized. As such, it is an important component in quantum informational protocols that make use of high-dimensional entanglement. Although it has been recently observed experimentally, the phenomenon of high-dimensional steering is lacking a general certification procedure. We provide necessary and sufficient conditions to certify the entanglement dimension in a steering scenario. These conditions are stated in terms of a hierarchy of semidefinite programs, which can also be used to quantify the phenomenon using the steering dimension robustness. To demonstrate the practical viability of our method, we characterize the dimensionality of entanglement in steering scenarios prepared with maximally entangled states measured in mutually unbiased bases. Our methods give significantly stronger bounds on the noise robustness necessary to experimentally certify high-dimensional entanglement.

Metabolic syndrome following a first episode of psychosis: results of a 1-year longitudinal study conducted in metropolitan Lisbon, Portugal.

OBJECTIVE: We aimed to assess the prevalence and course of metabolic syndrome (MetS) and the associated metabolic parameters during the year following a first episode pf psychosis (FEP). METHODS: We performed a 1-year longitudinal observation of 60 patients who experienced FEP. MetS was defined using the modified definition of the National Cholesterol Education Program Adult Treatment Panel III. We assessed the metabolic parameters and socio-demographic and psychopathological data for the participants. RESULTS: The mean age of the participants was 27.1 years, and 33.3% of them were women. There was an increase in the prevalence of MetS from 6.7% to 11.7% during the year following the baseline assessment during the year following the baseline assessment (p = 0.250). There were also significant increases in the prevalences of abnormal triglyceride concentration, waist circumference, and high-density lipoprotein (HDL)-cholesterol concentration during this period. In addition, there was a considerable worsening of the metabolic profile of the participants. No baseline parameters were identified to be predictors of MetS over the 1-year follow-up period. CONCLUSIONS: We can conclude that metabolic abnormalities are common in patients with FEP and that these rapidly worsen during the first year following the diagnosis of FEP. Studies on interventions are needed to reduce metabolic risk to cardiovascular diseases following the FEP.

Suicidal behaviour after first-episode psychosis: results from a 1-year longitudinal study in Portugal.

BACKGROUND: Suicide is one of the main causes of excess of premature death in psychotic patients. Published studies found that suicide risk begins in ultra-high risk of psychosis and continues in early years of the disease. Previous studies identifying predictive and risk factors associated with suicidality in first-episode psychosis (FEP) are highly inconsistent. Also, there are relatively few longitudinal studies on suicidal behaviour in FEP. The aim of this study was to examine prevalence, evolution and predictors of suicidal behaviour at baseline and the 12-month follow-up in patients presenting with FEP. METHODS: One hundred and eighteen patients presenting with FEP were recruited from two early psychosis units in Portugal. A comprehensive assessment examining socio-demographic and clinical characteristics was administered at baseline and the 12-month follow-up. Odds ratio were calculated using logistic regression analyses. McNemar test was used to evaluate the evolution of suicidal behaviour and depression prevalence from baseline to 12 months of follow-up. RESULTS: Follow-up data were available for 60 participants from the 118 recruited. Approximately 25.4% of the patients had suicidal behaviour at the baseline evaluation, with a significant reduction during the follow-up period to 13.3% (p = 0.035). A multivariate binary logistic regression showed that a history of suicidal behaviour and depression at baseline independently predicted suicidal behaviour at baseline, and a history of suicidal behaviour and low levels of total cholesterol predicted suicidal behaviour at the 12-month follow-up. A significant proportion of patients also had depression at the baseline evaluation (43.3%), with the last month of suicidal behaviour at baseline independently predicting depression at this time. CONCLUSIONS: The findings of our study indicate that suicidal behaviour was prevalent on the year after FEP. Patients with a history of suicidal behaviour, depression at baseline and low levels of cholesterol should undergo close evaluation, monitoring and possible intervention in order to reduce suicide risk in the early phases of psychosis.

The efficacy of antidepressant medication and interpersonal psychotherapy for adult acute-phase depression: study protocol of a systematic review and meta-analysis of individual participant data.

BACKGROUND: Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, 'conventional' meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis. AIMS: We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891). METHOD: We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies. CONCLUSIONS: This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques.

Variant of the Technique for Laryngeal Microsurgery in Cases of Difficult Laryngoscopy

Abstract Introduction Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools. Objective To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution. (AU)

Variant of the Technique for Laryngeal Microsurgery in Cases of Difficult Laryngoscopy.

Introduction Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools. Objective To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution.

Suicidal ideation in medical students: recent insights.

BACKGROUND: Previous studies have indicated that suicidal ideation is prevalent in medical students. The factors related to school admission processes and medical school environments contribute to this high prevalence. The consequences of suicidal ideation include suicide attempts and completed suicide. This article reviewed the recent literature on suicidal ideation in medical students. MATERIALS AND METHODS: A systematic review of the literature was conducted to identify the articles published on the prevalence of suicidal ideation and associated factors in medical students. Original articles published from 2011 were included. RESULTS: Seventeen studies comprising a total of 13,244 medical students from 13 Western and non-Western countries were included. The prevalence of suicidal ideation ranged from 1.8% to 53.6%. The most frequent factors associated with suicidal ideation in medical students were depression and depressive symptoms, a previous diagnosis of a psychiatric disorder, lower socioeconomic status/financial difficulties, having a history of drug use, and feeling neglected by parents. We did not find studies on interventional studies on suicidal ideation in medical students published in recent years. CONCLUSION: We identified a number of non-Western studies published in recent years, overcoming the previous scarcity of research in this area. Findings confirmed that suicidal ideation in medical students remains a significant concern. Future studies should focus on preventive and treatment programs targeting the identified factors associated with suicidal ideation in medical students.

Depression and Obesity: Integrating the Role of Stress, Neuroendocrine Dysfunction and Inflammatory Pathways.

Literature on depression and obesity describes the relevance of the hypothalamic pituitary adrenal axis dysfunction, sympathetic nervous system (SNS) activation, and inflammatory processes as well as the interaction of genetic and environmental factors. Recent investigation in obesity highlights the involvement of several regulation systems, particularly in white adipose tissue. The hypothalamic pituitary adrenal axis, gonadal, growth hormone, leptin, sympathetic nervous system and adrenergic, dopaminergic, and serotoninergic central pathways, all seem interconnected and involved in obesity. From another perspective, the role of psychosocial chronic stressors, determining poor mental and physical health, is well documented. Empirical data can support biologically conceivable theories describing how perceptions of the external social environment are transduced into cellular inflammation and depression. Although in neurobiological models of depression, stress responses are associated with neuroendocrine and neuro-inflammatory processes, concerning similar pathways to those described in obesity, an integrating model is still lacking. The aim of this mini-review is to offer a reflexion on the interplay between the neuroendocrine dysfunctions related to chronic stress and the nature of the shared biologic mechanisms in the pathophysiology of both clinical entities, depression and obesity. We highlight dysfunctional answers of mind body systems that are usually activated to promote regulation and adaptation. Stress response, as a mediator between different level phenomena, may undertake the role of a plausible link between psychological and biological determinants of disease. Depression and obesity are major public health issues, urging for new insights and novel interventions and this discussion points to the need of a more in-depth approach.

Depressive symptoms are associated with poor glycemic control among women with type 2 diabetes mellitus.

OBJECTIVE: In patients with type 2 diabetes mellitus, depressive symptoms may be associated with metabolic deterioration. The impact of sex on this association is unclear. The aim of this study is to analyze the relationship between depression and metabolic control by sex. The data presented is the side product of the clinical investigation by Rui Duarte, MD, Treatment Response in Type 2 Diabetes Patients with Major Depression from 2007. RESULTS: A sample of 628 outpatients with type 2 diabetes mellitus was taken from a specialized diabetes outpatient clinic. In a univariate analysis: women's glycohemoglobin mean levels were 8.99% whereas men's were 8.41% and the difference was statistically significant. The proportion of women (34.3%) with pathological levels of depression (Hospital Anxiety Depression Scale score ≥ 8) was significantly higher than men's (15.2%). A linear regression analysis performed by sex and controlling for demographic, clinical and psychological variables, showed poorer metabolic control in women with depressive symptoms. No association was observed in men. These results support depression as a predictor for poor metabolic control in women and the need for detecting depressive symptoms when glycemic levels deteriorate.

Adenotonsillar Hypertrophy in Pre-School Children with Sickle Cell Disease and Diagnostic Accuracy of the Sleep Disturbance Scale for Children.

Introduction Adenotonsillar hypertrophy is more common in children with sickle cell disease, and can lead to sleep-disordered breathing. Objectives To determine the frequency of adenotonsillar hypertrophy in pre-school children with sickle cell disease and assess the diagnostic accuracy of the sleep-disordered breathing subscale in the Sleep Disturbance Scale for Children. Method Observational study with a group of 48 children with sickle cell disease and a control group of 35 children without the disease. The children underwent oropharingoscopy and video nasal endoscopy. The parents and/or guardians answered the questions of the subscale. Results Adenotonsillar hypertrophy was observed in 25% of the children in the study group, and in 20% of the children in the control group, with no statistical difference between the groups. The subscale score ranged from 3 to 11 in both groups. There was a statistical significance in the study group. The average was 4.79 (standard deviation [SD] ± 2.50), with 4.19 (SD ± 1.72) among the children without adenotonsillar hypertrophy, and 6.5 (SD ± 3.40) among the children with adenotonsillar hypertrophy. There was also a statistical significance in the control group. The average was 5.23 (SD ± 2.81), with 4.44 (SD ± 2.2) among the children without adenotonsillar hypertrophy, and 7.87 (SD ± 2.89) among the children with adenotonsillar hypertrophy. Conclusion Adenotonsillar hypertrophy was not associated with sickle cell disease in pre-school children. The subscale of sleep-disordered breathing in the Sleep Disturbance Scale for Children was a useful tool for the diagnostic suspicion of adenotonsillar hypertrophy in children in this age group.

Adenotonsillar Hypertrophy in Pre-School Children with Sickle Cell Disease and Diagnostic Accuracy of the Sleep Disturbance Scale for Children

Abstract Introduction Adenotonsillar hypertrophy is more common in children with sickle cell disease, and can lead to sleep-disordered breathing. Objectives To determine the frequency of adenotonsillar hypertrophy in pre-school children with sickle cell disease and assess the diagnostic accuracy of the sleepdisordered breathing subscale in the Sleep Disturbance Scale for Children. Method Observational study with a group of 48 children with sickle cell disease and a control group of 35 children without the disease. The children underwent oropharingoscopy and video nasal endoscopy. The parents and/or guardians answered the questions of the subscale. Results Adenotonsillar hypertrophy was observed in 25% of the children in the study group, and in 20% of the children in the control group, with no statistical difference between the groups. The subscale score ranged from 3 to 11 in both groups. There was a statistical significance in the study group. The average was 4.79 (standard deviation [SD] ± 2.50), with 4.19 (SD ± 1.72) among the children without adenotonsillar hypertrophy, and 6.5 (SD ± 3.40) among the children with adenotonsillar hypertrophy. There was also a statistical significance in the control group. The average was 5.23 (SD ± 2.81), with 4.44 (SD ± 2.2) among the children without adenotonsillar hypertrophy, and 7.87 (SD ± 2.89) among the children with adenotonsillar hypertrophy. Conclusion Adenotonsillar hypertrophy was not associated with sickle cell disease in pre-school children. The subscale of sleep-disordered breathing in the Sleep Disturbance Scale for Children was a useful tool for the diagnostic suspicion of adenotonsillar hypertrophy in children in this age group.

Depressive symptoms and suicidal behavior after first-episode psychosis: A comprehensive systematic review.

Depressive symptoms and suicidal behavior are common among patients that suffered a first-episode psychosis. We searched Web of KnowledgeSM and Pubmed® for English and Portuguese original articles investigating prevalence of depressive symptoms and/or suicidal behavior and associated factors after first-episode psychosis. We included 19 studies from 12 countries, 7 studied depressive symptoms and 12 suicidal behavior. The findings confirm that depressive symptoms and suicidal behavior have high rates in the years after first-episode psychosis. Factors identified as being associated with depressive symptoms after first-episode psychosis were anomalies of psychosocial development, poor premorbid childhood adjustment, greater insight, loss, shame, low level of continuing positive symptoms and longer duration of untreated psychosis. Suicidal behavior was associated with previous suicide attempt, sexual abuse, comorbid polysubstance use, lower baseline functioning, longer time in treatment, recent negative events, older patients, longer duration of untreated psychosis, higher positive and negative psychotic symptoms, family history of severe mental disorder, substance use, depressive symptoms and cannabis use. Data also indicate that treatment and early intervention programs reduce depressive symptoms and suicidal behavior after first-episode psychosis. Future research should overcome some methodological discrepancies that exist between studies and limit generalization of current findings.

Comparison of two otologic suspensions of ciprofloxacin 2 mg/mL and hydrocortisone 10 mg/mL in the treatment of otitis externa: a multicenter, double-blind, randomized study / Comparação de duas suspensões otológicas de ciprofloxacino 2 mg/mL e hidrocortisona 10 mg/mL no tratamento da otite externa: um estudo multicêntrico, duplo-cego e randomizado

This was Phase III multicenter, double-blind, randomized, comparative safety and efficacy study in parallel groups of subjects, assessing non-inferiority between two commercially available otologic suspensions containing ciprofloxacin 2mg/mL and hydrocortisone 10mg/mL (Otociriax and Cipro HC®) in the treatment of acute diffuse otitis externa. Following screening and informed consent, subjects were randomly allocated into two treatment groups: Group A (treated with Otociriax) and Group B (treated with Cipro HC®). Treatment regimen in both groups was three drops, twice daily for seven days. The primary study endpoint was otitis cure, defined as elimination of pain, edema, and otorrhea. The secondary study endpoint was presence of side effects. Efficacy assessments included presence and intensity of otitis externa manifestations. Safety assessments included vital signs and physical examination, as well as adverse event monitoring. Study data analysis was performed using GraphPad Prism 5.0...

Premalignant laryngeal lesions: twenty-year experience in specialized service.

Introduction Premalignant lesions are considered both a hyperplastic and dysplastic stage of epithelial lesions in the glottic larynx that may or may not progress into an invasive carcinoma. The evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies. Objective The goal of this study was to determine the accuracy of the preoperative exam for diagnosis of premalignant laryngeal lesions and their connection with benign diseases of the vocal folds, as well as to assess their epidemiologic characteristics. Methods This is a retrospective and longitudinal cohort study performed through the review of surgical records of patients who underwent laryngeal microsurgery performed by a single surgeon from 1990 to 2009. Results Preoperative assessment of outpatients was 64.4% accurate. Vocal fold cysts were the most frequently associated benign lesions. The patients who apparently had premalignant lesions represented 10.57% of those who underwent laryngeal microsurgery. Premalignant lesions prevailed in men (69.49%) age from 41 to 50 years (32.20%). Conclusion Although the evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies, about one-third of premalignant lesions are diagnosed just during the laryngeal microsurgery. Cysts were the most prevalent concomitant benign lesion of the vocal folds. Males were more prevalent than females and the predominant age bracket was between 41 and 50 years.

Premalignant Laryngeal Lesions: Twenty-Year Experience in Specialized Service

Introduction Premalignant lesions are considered both a hyperplastic and dysplastic stage of epithelial lesions in the glottic larynx that may or may not progress into an invasive carcinoma. The evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies. Objective The goal of this study was to determine the accuracy of the preoperative exam for diagnosis of premalignant laryngeal lesions and their connection with benign diseases of the vocal folds, as well as to assess their epidemiologic characteristics. Methods This is a retrospective and longitudinal cohort study performed through the review of surgical records of patients who underwent laryngeal microsurgery performed by a single surgeon from 1990 to 2009. Results Preoperative assessment of outpatients was 64.4% accurate. Vocal fold cysts were the most frequently associated benign lesions. The patients who apparently had premalignant lesions represented 10.57% of those who underwent laryngeal microsurgery. Premalignant lesions prevailed in men (69.49%) age from 41 to 50 years (32.20%). Conclusion Although the evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies, about one-third of premalignant lesions are diagnosed just during the laryngeal microsurgery. Cysts were the most prevalent concomitant benign lesion of the vocal folds. Males were more prevalent than females and the predominant age bracket was between 41 and 50 years...

The relationship between temperament, diabetes and depression.

BACKGROUND: Temperament is the stable core of personality and it may represent the underlying continuity between how the person typically is (trait) and how the person temporarily changes (state). Comorbid depression in patients with Type 2 diabetes is important because of the negative consequences on the prognosis of diabetes. Little research has explored the relationships between temperament, depression and type 2 diabetes. The aims of the present paper are first to describe current research that has examined the relationship between temperament, diabetes and depression, and second to make recommendations for future research. METHODS: Literature search from Medline and references in published papers. RESULTS: Current research has described the relationship of temperament with cyclothymia, bipolar disorder, mood instability and suicidality. Studies on the relationship between temperament and depressive disorders are scarce. Nevertheless, there is likely a continuum between depressive temperament and related personality traits and subthreshold and clinical depressive states and disorders and diabetes outcomes. LIMITATIONS: The greatest limitation concerns the scarcity of papers on this issue. There are also methodological limitations in accurately assessing depressive temperament versus current depressive disorders and residual symptoms from these disorders. CONCLUSION: Depressive temperament may be a promising construct to understand better the interplay between depression and diabetes.

Depressive temperament, distress, psychological adjustment and depressive symptoms in type 2 diabetes.

Major depression, depressive symptoms, distress with diabetes and psychological adjustment to type 2 diabetes (T2DM) are somehow overlapping constructs with shared covariance. Nevertheless, diabetes distress remains the most prevalent long-lasting factor associated with hyperglycemia in T2DM. This ought to be taken on account when treatment is planned, namely when one is looking for metabolic control and emotional distress integrative care. Temperament or other long-term individual characteristics may support the interplay of distress, psychological adjustment and depressive states in T2DM. Depressive temperament may constitute a vulnerability factor to behavioral or biological T2DM outcome or even a potential risk factor to T2DM later incidence.

Vulnerability to stress, anxiety and depressive symptoms and metabolic control in type 2 diabetes.

BACKGROUND: Vulnerability to stress has been associated to distress, emotional distress symptoms and metabolic control in type 2 diabetes mellitus (T2DM) patients as well. Furthermore some conflicting results were noticed. We aimed to evaluate the effect over metabolic control in what concerns vulnerability to stress beyond depressive and anxiety symptoms. FINDINGS: This cross-sectional study assessed 273 T2DM patients with depressive and anxiety symptoms using the Hospital Anxiety Depression Scale (HADS) and the 23 Questions to assess Vulnerability to Stress (23QVS), along with demographic and clinical diabetes-related variables. Hierarchical logistic regression models were used to investigate predictors of poor glycemic control. The results showed an association of depressive symptoms (odds ratio = 1.12, 95%CI = 1.01-1.24, P = 0.030) with increased risk of poor glycemic control. Anxiety symptoms and vulnerability to stress on their own were not predictive of metabolic control, respectively (odds ratio = 0.92, 95%CI = 0.84-1.00, P = 0.187 and odds ratio = 0.98, 95%CI = 0.95-1.01, P = 0.282). CONCLUSIONS: Our data suggested that vulnerability to stress was not predictive of poor glycemic control in T2DM, but depressive symptoms were.

Psychological adjustment to diabetes mellitus: highlighting self-integration and self-regulation.

Psychological adjustment to any chronic disease, such as diabetes mellitus, concerns self-view rearrangement toward self-integrity and self-regulation. Both distance between self and disease paired with positive and negative new identities may contribute to adaptation to diabetes. The present investigation aimed to detect main trends on self-management in patients with both diabetes types within a self-regulatory framework. Sample consisted of 121 adult patients with both diabetes types. Answer to question about having diabetes or being a diabetic was combined with self-benefices or self-damages concerning diabetes in a 2 × 2 combination. Psychological adjustment to diabetes, anxiety and depression were evaluated among subgroups. Almost 16% of patients had any benefit with diabetes and a better psychological adjustment than patients reporting losses. Type 1 diabetes answered more "being diabetic" and type 2 "having diabetes". Education was positively associated with profits with diabetes. Patients referring "to have diabetes" and profits had the best diabetes psychological adjustment. Distance between self and diabetes does not seem to relate to psychological adjustment. Type 1 diabetes patients are likely to identify more with their disease comparing with type 2 diabetes, independently from gains or losses associated with diabetes. Better psychological adjustment related to more education and positivity highlights future interest on working with gains in diabetes patient education, fostering patient self-growth, self-integration and resilience.