Maternal Accommodation of Adolescent Body Dysmorphic Disorder: Clinical Correlates and Association with Treatment Outcomes.

Family accommodation (FA) is widely-recognised as an important clinical phenomenon in obsessive-compulsive disorder (OCD) and anxiety disorders, and is related to poorer treatment outcomes. However, FA has not been quantitatively explored in Body Dysmorphic Disorder (BDD). The aim of this study was to investigate the patterns and correlates of maternal accommodation in adolescent BDD, and its association with treatment outcomes. Participants were 131 adolescents with BDD and their mothers who completed the Family Accommodation Scale-Parent Report (FAS-PR) as part of routine clinical practice in a National and Specialist Service for Young People at the Maudsley Hospital, London. Seventy-six (58%) young people received specialist cognitive behavioural therapy for BDD and had post-treatment data available. All mothers engaged in at least one form of accommodation. Providing reassurance (98.5%) and assisting avoidance (88.5%) were the most commonly endorsed behaviours. Levels of accommodation were positively associated with clinician-rated BDD symptom severity (r = 0.18, p = 0.041) and maternal symptoms of anxiety, depression and stress (r = 0.41, p < 0.001), and negatively associated with child global functioning (r = -0.38, p < 0.001). Maternal accommodation did not predict treatment outcomes (ß = 0.055, p > 0.05). The findings indicate that maternal accommodation is common and has important clinical correlates, but does not impact on treatment response. Consequently, the relationship between maternal accommodation and BDD symptoms may differ to that evidenced in paediatric OCD. Future longitudinal research exploring maternal and paternal accommodation, and assessing variables of interest at multiple time-points throughout treatment, is needed to advance understanding of the role of FA in adolescent BDD.

Hearing outcomes in children with single sided deafness: Our experience at a tertiary paediatric otorhinolaryngology unit.

INTRODUCTION: Hearing rehabilitation options for single sided deafness (SSD) include contralateral routing of sound (CROS) aids and bone conduction devices (BCDs). This study aimed to review the management of children with SSD at our tertiary paediatric otolaryngology unit over the last 15 years. MATERIAL AND METHODS: A retrospective cohort study was performed. Primary hearing outcomes were measured using the Children's Home Inventory for Listening Difficulties (CHILD) questionnaire score and secondary hearing outcomes were measured using hearing thresholds for speech in noise. Outcomes were measured pre and post bone conduction device (BCD) trial. RESULTS: 49 patients with SSD were identified. 20 children had trial of a BCD. 16 patients had pre- and post- BCD trial CHILD scores available for analysis. There was a statistically significant improvement in CHILD scores and speech in noise testing at +5 dB and +0 dB following amplification with a BCD. The mean use of BCD was 1.3 h per day. DISCUSSION: We have described the management of children with SSD in our unit. This study demonstrated a statistically significant benefit of BCD use on hearing outcomes. However, device compliance is low suggesting hearing advice choice in the population is complex and further research is warranted.

The effect on the T-14 paediatric throat disorders outcome score of delaying adenotonsillectomy surgery due to COVID-19.

INTRODUCTION: Adenotonsillectomy is commonly performed for recurrent tonsillitis and obstructive sleep apnoea. These conditions may improve with age. The COVID-19 pandemic led to all UK elective surgery being suspended. This study aimed to determine whether delaying surgery had any effect on a patient's symptoms using the validated T-14 paediatric throat disorders outcome test. METHODS: Patients completed a T-14 questionnaire when the child was listed for surgery; this was repeated on the revised surgery date and a paired t test was used to compare the responses. RESULTS: Questionnaires were completed by 29 patients a mean of 6.4 months apart. There was a significant improvement in scores (p<0.02) for five domains: eating habits, visits to a doctor/A&E, antibiotics for less than 2 weeks, chronic infections and school missed due to sore throats. CONCLUSIONS: This study demonstrates that following delays resulting from the COVID-19 pandemic, paediatric patients experienced an improvement in some aspects of their quality of life while awaiting tonsillectomy and/or adenoidectomy. This was most apparent in quality-of-life measures relating to recurrent tonsillitis, namely visits to a doctor/A&E, antibiotics for less than 2 weeks, chronic infections and school missed due to sore throats. Patients may experience an improvement in some of their individual symptoms, in particular their infective symptoms, during an observation period.

Recurrent acute otitis media: a survey of current management in England.

OBJECTIVE: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. METHODS: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. RESULTS: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. CONCLUSION: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.

Increased incidence of idiopathic paediatric facial palsy during the coronavirus disease 2019 pandemic.

BACKGROUND: Bell's palsy is a lower motor neurone facial weakness of unknown aetiology, although reactivation of a virus within the facial nerve has been proposed. METHODS: A prospective study was conducted of Bell's palsy cases presenting to our paediatric ENT unit over a 19-week period, from February to June 2020. Patients were invited for severe acute respiratory syndrome coronavirus-2 antibody testing. A text-message questionnaire was sent to other ENT centres to determine their observational experience. RESULTS: During the study period, 17 children presented with Bell's palsy, compared with only 3 children in the same time period in the previous year (p < 0.0001). Five patients underwent severe acute respiratory syndrome coronavirus-2 antibody testing, the results of which were all negative. Four out of 15 centres questioned perceived an increased incidence in paediatric Bell's palsy. CONCLUSION: Clinicians are encouraged to be vigilant to the increase in paediatric Bell's palsy seen during the coronavirus disease 2019 pandemic, which may represent a post-viral sequela of coronavirus disease 2019.

The negative impact of wearing personal protective equipment on communication during coronavirus disease 2019.

BACKGROUND: Coronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally. METHOD: Bamford-Kowal-Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice. RESULTS: There was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB). CONCLUSION: Wearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.

The role of Personal KinetiGraph™ fluctuator score in quantifying the progression of motor fluctuations in Parkinson's disease.

Motor fluctuations (MF) are important determinants of quality of life in Parkinson's disease (PD). To determine whether the Personal Kineti Graph (PKG), a wearable motion tracking device, can define MF progression, we correlated PKG fluctuator scores (FS) with clinical motor fluctuator profiles in a case-control cohort study. 54 subjects completed a 6-day PKG trial and completed a standardized motor diary. We distinguished non-fluctuators (NF), early (EF), moderate (MF) and troublesome fluctuators (TF), based on Wearing Off Questionnaire and Movement Disorders Society-Unified Parkinson's Disease Rating Scale scores. PKG FS significantly differentiated EF and TF, as well as dyskinetic and non-dyskinetic subjects. Motor diaries could not distinguish the four study groups on the basis of average OFF time, while average time with dyskinesia distinguished NF and MF. In conclusion, PKG FS can distinguish EF from TF, as well as dyskinetic from non-dyskinetic patients, but cannot discriminate subtler MF. PKG may provide objective MF measures for routine PD management and clinical trials.

A high-fidelity, fully immersive simulation course to replicate ENT and head and neck emergencies.

BACKGROUND: Simulation-based training has a fundamental role in medical education as it allows the learner to gain experience managing emergencies in a safe, controlled environment. METHODS: This 1-day course consisted of eight high-fidelity simulation scenarios, followed by a video-assisted debrief focusing on the technical and non-technical (communication skills, teamwork, leadership and situational awareness) aspects of managing ENT and head and neck emergencies. RESULTS: Eight courses have run since June 2014. Post-course questionnaires demonstrated that candidates' confidence scores in managing airway and head and neck emergencies increased following completion of the course (p < 0.0001). CONCLUSION: This was the first fully immersive ENT simulation course developed in the region. The learning objectives for each scenario were mapped to the ENT Intercollegiate Surgical Curriculum Programme. Feedback from the course indicated a continued demand for this style of training, leading to its inclusion in the training calendar.

Functional xylem anatomy of aspen exhibits greater change due to insect defoliation than to drought.

The study of tree rings can reveal long-term records of a tree's response to the environment. This dendroecological approach, when supplemented with finer-scale observations of the xylem anatomy, can provide novel information about a tree's year-to-year anatomical and hydraulic adjustments. Here we use this method in aspen (Populus tremuloides Michx.) to identify xylem response to drought and insect defoliation. Surprisingly, we found that precipitation influenced vessel diameter mostly in the trees' youth, while this correlation was less pronounced at maturity. This is likely due to a reduction in stress the stand experiences as it ages, and reflects an ability to mediate drought stress as trees mature. Defoliation events caused consistent and profound changes in fiber anatomy likely leading to reduced structural support to vessels. We therefore expect that in years of defoliation trees may be vulnerable to drought-induced cavitation when leaf area recovers. This study highlights how the inclusion of cellular level measurements in tree ring studies provides additional information on how stress events may alter tree functioning through alterations in structure.

The use of health related quality of life data to produce information sheets for patients with head and neck cancer.

INTRODUCTION: Health related quality of life information gives patients and carers an indication of how they will be affected following treatment. Such knowledge can promote realistic expectations and help patients come to terms with their outcome. The aim of this paper is to describe the background development of patient information sheets produced at our unit. METHODS: The data were compiled using a common head and neck cancer specific quality of life questionnaire (University of Washington Quality of Life [UW-QOL]). There are 12 domains comprising activity, appearance, anxiety, chewing, mood, pain, recreation, saliva, shoulder, speech, swallowing and taste. The data were collected over 19 years at our unit and focus on follow-up records at around 2 years as this gives a good indication of health related quality of life in survivorship. UW-QOL questionnaires were available from 1,511 patients treated following primary diagnosis of head and neck cancer, and there were 24 subgroups based on cancer site, stage and treatment. There were 2 other subgroups: 132 having transoral laser resection and 176 having laryngectomy. RESULTS: The patient and carer research forum helped to design the information sheets, which display overall quality of life, percentages with 'good' outcome and 'significant problem' by domain, and the most important domains. Three examples are included in this paper: early stage oral cancer treated by surgery alone, early laryngeal cancer treated by surgery alone, and late stage oropharyngeal cancer treated by surgery and postoperative radiotherapy. All 26 subgroup information sheets are available in booklet form and on the internet. CONCLUSIONS: How the surgical community best utilises this type of resource needs further research.

'What will I be like' after my diagnosis of head and neck cancer?

Consequences of treating head and neck cancer are reflected in health-related quality of life (HRQOL) patient-reported outcomes. HRQOL is an important outcome alongside survival and recurrence. However, relatively little HRQOL information is in a format that patients and oncology teams can easily interpret as a guide to likely outcomes following curative treatment. The study aim was to collate University of Washington Quality of Life (UW-QOL) questionnaires collected 1995-2012 at the Regional Head and Neck Surgical Unit with a view of summarizing key clinical-demographic influences on HRQOL outcomes at 2 years following diagnosis. Patients completing UW-QOL questionnaires at 9-60 months had their record closest to 2 years selected for cross-sectional analyses, while all questionnaires were analyzed to assess temporal trends. 65 % (1,134) of survivors to 9 months had a UW-QOL record in the cross-sectional analysis (median 23 months). Overall 1,349 completed 5,573 UW-QOL questionnaires. Various associations were seen, notably late overall clinical staging and treatment adversely associated with UW-QOL physical functioning domains. Logistic regression was used to better understand the predictive factors of UW-QOL outcome and determined the final formatting of tables for results. These tables provide important reference data about UW-QOL outcome at 2 years relevant to patients at the outset of their cancer journey. The increasing amount of HRQOL data allows for quite detailed subgroup analysis, which can help give patients and the clinical team a better understanding of likely long-term HRQOL outcomes. How this is best utilized in clinical care needs further evaluation.

Growth-climate relationships vary with height along the stem in lodgepole pine.

This study tests the hypothesis that ring growth in the upper stem portion of trees is affected by climatic conditions differently than rings formed at breast height (1.3 m). A total of 389 trees from a network of 65 lodgepole pine (Pinus contorta Dougl. ex Loud. var. latifolia Engelm.) sites in Alberta were examined using detailed stem analysis in order to examine interannual patterns of basal area increment and volume increment at different positions along the stem. Growth at lower sections of the bole was mainly driven by temperature and moisture conditions in the seasons prior to the growing season in the year of ring formation, while upper stem growth was more related to conditions during the year of growth, i.e., temperature in the early summer, or moisture in late winter to early spring. This translates into increased allocation of wood to the lower stem when prior late summer conditions are cool and wet, prior winters are mild (warm with little snow) and early summer conditions in the year of ring formation are hot and dry.

Responses of trembling aspen and hazelnut to vapor pressure deficit in a boreal deciduous forest.

The branch bag method was used to monitor photosynthesis and transpiration of trembling aspen (Populus tremuloides Michx.) and hazelnut (Corylus cornuta Marsh.) over a 42-day midsummer period in 1996, as part of the Boreal Ecosystem-Atmosphere Study (BOREAS). During the same period, daytime measurements of stomatal conductance (g(s)) and leaf water potential (Psi(leaf)) were made on these species, and sap flow was monitored in aspen stems by the heat pulse method. Weather conditions during the study period were similar to the long-term average. Despite moist soils, both species showed an inverse relationship between daytime g(s) and vapor pressure deficit (D) when D was > 0.5 kPa. Daytime Psi(leaf) was below -2 MPa in aspen and near -1.5 MPa in hazelnut, except on rainy days. These results are consistent with the hypothesis that stomatal responses are constrained by hydraulic resistance from root to leaf, and by the need to maintain Psi(leaf) above a minimum threshold value. Reductions in g(s) on sunny afternoons with elevated ambient D (maximum 2.3 kPa) were associated with a significant decrease in photosynthetic rates. However, day-to-day variation in mean carbon assimilation rate was small in both species, and appeared to be governed more by solar radiation than D. These results may be generally applicable to healthy aspen stands under normal midsummer conditions in the southern boreal forest. However, strong reductions in carbon uptake may be expected at the more extreme values of D (> 4 kPa) that occur during periods of regional drought, even if soil water is not locally limiting.

Sap flow in trembling aspen: implications for stomatal responses to vapor pressure deficit.

We monitored sap flow and estimated diurnal changes in transpiration rates of two trembling aspen (Populus tremuloides Michx.) stands, located in the southern boreal forest and aspen parkland of Saskatchewan, Canada. In both stands during the peak growing season (June and July), sap flow during the day (0700-1700 h local time) increased linearly with vapor pressure deficit (VPD) from 0 to about 1 kPa, but then remained remarkably constant at VPD > 1 kPa (up to 4.8 kPa in the aspen parkland stand). The results imply an inverse relationship between stomatal conductance and VPD under well mixed conditions, for VPD > 1 kPa. We postulate that the stomata are operating to maintain leaf water potentials above a critical minimum value, which in turn places a maximum value on the rate of sap flow that can be sustained.

Effects of drinking water monochloramine on lipid and thyroid metabolism in healthy men.

The purpose of this study was to determine whether a 4-week consumption of 1.5L per day of drinking water containing monochloramine at a concentration of 2 ppm (ppm = mg/L) or 15 ppm under controlled conditions would alter parameters of lipid or thyroid metabolism in healthy men. Forty-eight men completed an 8-week protocol during which diet (600 mg cholesterol per day, 40% calories as fat) and other factors known to affect lipid metabolism were controlled. During the first 4 weeks of the protocol, all subjects consumed distilled water. During the second 4 weeks, one-third of the subjects were assigned randomly to drink 1.5 L per day of water containing 2 ppm of monochloramine, to drink 1.5 L per day of water containing 15 ppm monochloramine, or to continue drinking distilled water. Four blood samples were collected from each subject at the end of each 4-week study period. Subjects drinking monochloramine at a concentration of 2 ppm showed no significant changes in total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoproteins A1, A2, or B when compared to the distilled water group. Parameters of thyroid function also were unchanged by exposure to monochloramine at this concentration. However, subjects drinking monochloramine at a concentration of 15 ppm experienced an increase in the level of apolipoprotein B. Other parameters of lipid and thyroid metabolism did not change. We conclude that consumption of drinking water containing 2 ppm of monochloramine does not alter parameters of lipid and thyroid metabolism in healthy men. Consumption of water containing 15 ppm monochloramine may be associated with increased levels of plasma apolipoprotein B.

Lack of effect of drinking water chlorine on lipid and thyroid metabolism in healthy humans.

Animal studies and a single human epidemiological study have suggested that chlorine in drinking water may raise the level of blood cholesterol. The purpose of this study was to determine whether a 4-week exposure to drinking water chlorine (1.5 L per day) at a concentration of 20 ppm (ppm = mg/L) under controlled conditions would alter circulating parameters of lipid metabolism in healthy humans. Thirty men and thirty women each completed an 8-week protocol during which diet (600 mg cholesterol per day, 40% calories as fat) and other factors known to affect lipid metabolism were controlled. For the first 4 weeks of the protocol, all subjects consumed distilled water. For the second 4 weeks, half of the subjects were assigned randomly to drink 1.5 L per day of chlorinated water (20 ppm), while the others continued drinking distilled water. Four blood samples were collected from each subject at the end of each 4-week study period. Compared to the control group, those subjects given chlorine showed no significant changes in total plasma cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, or apolipoproteins A1, A2, or B. There was a trend toward low serum thyroxine and triiodothyronine levels in men given chlorine, though thyroid-stimulating hormone levels were unchanged. This trend, if real, was not clinically significant. Thus, short-term exposure to chlorinated drinking water at 20 ppm appears to have no significant impact on parameters of lipid or thyroid metabolism in healthy humans.

Seasonal changes in shoot regrowth potential in Calamagrostis canadensis.

A series of laboratory experiments was conducted to examine seasonal change in shoot regrowth potential following disturbance in Calamagrostis canadensis. On several dates during the 1988 and 1989 growing seasons, soil cores were collected from field sites dominated by this grass. Shoot regrowth from cores after clipping at the soil surface was monitored under dark or light laboratory conditions at 20°C. seasonal changes in field concentrations of total nonstructural carbohydrate and nitrogen in rhizomes largely accounted for the observed seasonal change in etiolated regrowth potential of shoots in laboratory experiments. In contrast, shoot regrowth potential in the light showed a very different seasonal pattern. The ratio of shoot biomass regrowth 20 d after clipping in the light versus dark treatment showed a gradual seasonal decrease from 12:1 in the early May experiment to near 1:1 in the September experiment. However, the rate of photosynthesis of regrowing shoots in the light was highest in experiments conducted late in the growing season. This may indicate a strong seasonal decrease in the proportion of current photosynthate of regrowing shoots that is allocated to new shoot growth. Alternatively, mobilization of rhizome carbohydrate reserves for shoot regrowth may have been inhibited during the re-establishment of photosynthesis in the light treatment. Either mechanism would explain why shoot regrowth in the light is poorly correlated with levels of belowground carbohydrate reserves, even under controlled laboratory conditions.

Mammary tumorigenesis in feral Mus cervicolor popaeus.

A pedigreed breeding population of feral Mus cervicolor popaeus with a high incidence of mammary tumors, arising between 6 and 14 months of age, is described. These mice were chronically infected with a type B retrovirus which is distantly related to the mouse mammary tumor virus (MMTV) of inbred strains of Mus musculus. MMTV-induced mammary tumors in inbred mice frequently (80%) contained an insertion of the viral genome into the int-1 or int-2 loci of the tumor cellular genome. These two cellular genetic loci were also altered by viral insertion in 11 of 20 M. cervicolor popaeus mammary tumor cellular DNAs tested. Results of our study of mammary tumorigenesis in feral mice demonstrate that viral-induced rearrangement and activation of the int loci are not limited to the genetic background of inbred mice selected for highly infectious MMTV and a high incidence of mammary tumors.

An endogenous mouse mammary tumor virus genome common in inbred mouse strains is located on chromosome 6.

We have examined EcoRI-restricted cellular DNA from mouse-hamster somatic cell hybrids. Results of this analysis show that the unit II mouse mammary tumor virus proviral genome is located on mouse chromosome 6. Restriction analysis of cellular DNA from (C3H/OuJ X Czech II) X Czech II backcross mice showed a strong linkage between unit II and Igk. The gene order of these markers on chromosome 6 relative to the Raf and Kirsten murine sarcoma virus ras-2 proto-oncogenes was established.