Vocal nodules management

Vocal fold nodules present the voice clinic team with a number of clinical dilemmas which are not as simple as previously thought. The definition, aetiology, prevalence and diagnosis are all poorly understood. Furthermore, treatment evidence for both behavioural and surgical approaches is weak. This paper reviews the published evidence pertaining to all of these aspects. Specific areas of uncertainty that remain include poorly defined nomenclature, the natural history of paediatric vocal nodules, the establishment of criteria to measure successful treatment, optimal configuration of speech therapy regimens and the rationale for surgical intervention. The authors suggest the development of evidence‐based guidelines for UK practice

Peripheral stimulation affects subthreshold Triple Stimulation Technique.

Compared to conventional transcranial magnetic stimulation (TMS), the triple stimulation technique (TST) strongly decrease the effects of desynchronization of descending discharges and accompanying phase cancellation that follow TMS and offers a more sensitive method to quantify motor evoked potentials (MEPs). Using the TST, we explored as to whether sub-threshold TMS evokes peripheral motor neuron discharges (MNs). We compared the number of MEPs elicited by TMS and by TST in fifteen healthy participants. We used the subthreshold intensity of 80 % resting motor threshold. To control the TST assessment of the corticospinal tract, we included a peripheral stimulation control condition, which consisted of peripheral stimulation alone, in a subgroup of five volunteers. Compared to TMS, TST at sub-threshold intensities did not detect significantly more responses unequivocally attributable to the cortical stimulation. In contrast, the peripheral supra-maximal stimuli produced confounding effects in the TST condition that were, in part, indistinguishable from cortical responses. At subthreshold TMS intensities, the TST does not detect more discharges of spinal MNs than conventional TMS and, in addition, it is confounded by effects from peripheral stimulation. The TST can be useful in assessing the integrity of the MN pool and of the corticospinal tract. However, if used at near threshold intensity, the confounding effects of peripheral stimulation need to be considered; for instance, in paired-pulse stimulation paradigms assessing the cortical physiology

Resiliency of the western Chesapeake Bay to total suspended solid concentrations following storms and accounting for land-cover

The effect of storms on water quality in the Chesapeake Bay has been studied in a patchwork fashion at various sites for short periods of time. In this paper, we use a relationship between MODIS-Terra red light reflectance and total suspended solid (TSS) concentrations in order to develop a fourteen-year time period of TSS estimates during which effects of storms and land cover can be studied over a large portion of the Bay. Exponential fits were most appropriate, resulting in viable reflectance-TSS relationships for the five major Western Shore rivers and the Mainstem of the Bay. Other tributaries were less well-disposed for such relationships due to lack of a large range of TSS concentrations, shallow river beds, or low number of data points. Treating the entire Chesapeake as a single entity and modeling a single reflectance-TSS relationship for the entire estuary produced poorer models with less significance compared to treating each channel separately. Over 2800 rain events were studied in the Lower Western Shore between 2000 and 2014. We found some evidence that higher rainfall amounts correspond to a lower distribution of TSS concentrations 1 day following the event in forested watersheds. At rainfall events of <50 mm, maximum TSS within one day of the storm was highly variable, suggesting that rainfall amounts alone cannot explain variation in TSS levels. Finally, we found value in the use of prediction intervals around TSS estimates, a statistical procedure uncommonly used heretofore with satellite-based estimates but which can help to determine if results are significant or not

Genotype–phenotype associations within the Li-Fraumeni spectrum: a report from the German Registry

Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome caused by pathogenic TP53 variants. The condition represents one of the most relevant genetic causes of cancer in children and adults due to its frequency and high cancer risk. The term Li-Fraumeni spectrum reflects the evolving phenotypic variability of the condition. Within this spectrum, patients who meet specific LFS criteria are diagnosed with LFS, while patients who do not meet these criteria are diagnosed with attenuated LFS. To explore genotype-phenotype correlations we analyzed 141 individuals from 94 families with pathogenic TP53 variants registered in the German Cancer Predisposition Syndrome Registry. Twenty-one (22%) families had attenuated LFS and 73 (78%) families met the criteria of LFS. NULL variants occurred in 32 (44%) families with LFS and in two (9.5%) families with attenuated LFS (P value < 0.01). Kato partially functional variants were present in 10 out of 53 (19%) families without childhood cancer except adrenocortical carcinoma (ACC) versus 0 out of 41 families with childhood cancer other than ACC alone (P value < 0.01). Our study suggests genotype-phenotype correlations encouraging further analyses

Surf Therapy: A Scoping Review of the Qualitative and Quantitative Research Evidence

Over the past 15 years, surf therapy has emerged as a growing therapeutic intervention in diverse communities around the world.&nbsp; Although the programs operate on the premise that surf therapy provides a range of benefits for both physical and psychological health, there is limited research evidence available to support these claims. There additionally remains a need to further develop evidence-based practices around surf therapy that support the global impact of existing and future surf therapy interventions. This research provides a scoping review of academic literature focused on surf therapy.&nbsp; The objectives of the research are; (1) to gain a better understanding of the global use of surf therapy and its physical, psychological and social benefits, (2) to identify intervention and research gaps related to surf therapy, (3) to provide recommendations for future surf therapy research, (4) to use the evidence to inform best practices in the field. A systematic article search of the meta-databases Google Scholar, EbscoHost, and Wiley yielded 18 studies that met the inclusion criteria. An additional search for Master’s Theses, Doctoral Dissertations, and expert search yielded 11 studies.&nbsp; A total of 29 studies were found to meet criteria.&nbsp; The data from the studies were analyzed using metasynthesis.&nbsp; As a result, the review provides an overview of the current scientific evidence related to surf therapy, including its physical, psychological, and social benefits.&nbsp; It additionally provides a detailed description of existing research methods and measures used to evaluate the impact of surfing as a therapeutic intervention that could inform further research designs. The study supports surf therapy as a means of improving both physical and psychosocial health outcomes and includes recommendations for improving surf therapy research and practice

Freezing of gait and white matter changes: a tract-based spatial statistics study.

BACKGROUND: We hypothesized that the integrity of white matter might be related to the severity of freezing of gait in age-related white matter changes. METHODS: Twenty subjects exhibiting excessive hyperintensities in the periventricular and deep white matter were recruited. The subjects underwent the Freezing of Gait Questionnaire, computerized gait analyses, and diffusion tensor magnetic resonance imaging. Images of axial, radial and mean diffusivity, and fractional anisotropy were calculated as indices of white matter integrity and analyzed with tract-based spatial statistics. RESULTS: The fractional anisotropy, mean, axial and radial diffusivity averaged across the whole white matter structure were all significantly correlated with Freezing of Gait Questionnaire scores. Regionally, a negative correlation between Freezing of Gait Questionnaire scores and fractional anisotropy was found in the left superior longitudinal fasciculus beneath the left premotor cortex, right corpus callosum, and left cerebral peduncle. The scores of the Freezing of Gait Questionnaire were positively correlated with mean diffusivity in the left corona radiata and right corpus callosum, and with both axial and radial diffusivity in the left corona radiata. The white matter integrity in these tracts (except the corpus callosum) showed no correlation with cognitive or other gait measures, supporting the specificity of those abnormalities to freezing of gait. CONCLUSION: Divergent pathological lesions involved neural circuits composed of the cerebral cortex, basal ganglia and brainstem, suggesting that freezing of gait has a multifactorial nature

Surf Therapy: A Scoping Review of the Qualitative and Quantitative Research Evidence

Over the past 15 years, surf therapy has emerged as a growing therapeutic intervention in diverse communities around the world.&nbsp; Although the programs operate on the premise that surf therapy provides a range of benefits for both physical and psychological health, there is limited research evidence available to support these claims. There additionally remains a need to further develop evidence-based practices around surf therapy that support the global impact of existing and future surf therapy interventions. This research provides a scoping review of academic literature focused on surf therapy.&nbsp; The objectives of the research are; (1) to gain a better understanding of the global use of surf therapy and its physical, psychological and social benefits, (2) to identify intervention and research gaps related to surf therapy, (3) to provide recommendations for future surf therapy research, (4) to use the evidence to inform best practices in the field. A systematic article search of the meta-databases Google Scholar, EbscoHost, and Wiley yielded 18 studies that met the inclusion criteria. An additional search for Master’s Theses, Doctoral Dissertations, and expert search yielded 11 studies.&nbsp; A total of 29 studies were found to meet criteria.&nbsp; The data from the studies were analyzed using metasynthesis.&nbsp; As a result, the review provides an overview of the current scientific evidence related to surf therapy, including its physical, psychological, and social benefits.&nbsp; It additionally provides a detailed description of existing research methods and measures used to evaluate the impact of surfing as a therapeutic intervention that could inform further research designs. The study supports surf therapy as a means of improving both physical and psychosocial health outcomes and includes recommendations for improving surf therapy research and practice

NGS-Based Diagnosis of Treatable Neurogenetic Disorders in Adults: Opportunities and Challenges.

The identification of neurological disorders by next-generation sequencing (NGS)-based gene panels has helped clinicians understand the underlying physiopathology, resulting in personalized treatment for some rare diseases. While the phenotype of distinct neurogenetic disorders is generally well-known in childhood, in adulthood, the phenotype can be unspecific and make the standard diagnostic approach more complex. Here we present three unrelated adults with various neurological manifestations who were successfully diagnosed using NGS, allowing for the initiation of potentially life-changing treatments. A 63-year-old woman with progressive cognitive decline, pyramidal signs, and bilateral cataract was treated by chenodeoxycholic acid following the diagnosis of cerebrotendinous xanthomatosis due to a homozygous variant in CYP27A1. A 32-year-old man with adult-onset spastic paraplegia, in whom a variant in ABCD1 confirmed an X-linked adrenoleukodystrophy, was treated with corticoids for adrenal insufficiency. The third patient, a 28-year-old woman with early-onset developmental delay, epilepsy, and movement disorders was treated with a ketogenic diet following the identification of a variant in SLC2A1, confirming a glucose transporter type 1 deficiency syndrome. This case study illustrates the challenges in the timely diagnosis of medically actionable neurogenetic conditions, but also the considerable potential for improving patient health through modern sequencing technologies

How war, drought, and dam management impact water supply in the Tigris and Euphrates Rivers

The fast-paced conflicts in the Middle East can disrupt management and supply of water, particularly on dams and barrages along the Tigris and Euphrates rivers that have experienced threats or changes in sovereignty. Water supply is also under pressure from upstream water management, drought, and structural decline. In this research, we used a satellite-based algorithm, the normalized difference water index (NDWI), to monitor changes in the extent of surface reservoirs (1985-present). We compared the timeline of reservoir fluctuations with the timeline of events related to conflicts, droughts, and dam management. Our results show that the most sudden changes in water supply occurred during events related to conflict, but conflict was not often a cause of the greatest absolute changes to reservoir area. Though not as precise as on-the-ground information, satellite data can give insights to water supply when conflict has disrupted the flow of information or restricted on-the-ground data collection

The use of visual methods to explore how children construct and assign meaning to the ''self'' within two urban communities in the Western Cape, South Africa

This study aimed to explore how children construct and assign meaning to the ''self'' within two urban communities of Cape Town in South Africa. Using a child participation methodological framework data were collected using Photovoice and community maps with 54 participants between the ages of 9 and 12. Feelings of safety, social connectedness, and children's spaces were found to be central to the ways in which the participants constructed and assigned meaning to the ''self.'' The study provides implications for intervention programmes aimed at improving children's well-being to be inclusive of activities aimed at improving children's self-concept, including the construction of safe spaces for children to play, learn, and form meaningful relationships