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Even before I started studying at the SKH Opera, I was already contemplating what would happen afterwards. So it all started with the idea that I'd like to apply to an Opera Studio after graduation. I realised that the largest market for opera studies is in German-speaking countries, where I could continue to develop my talent and simultaneously earn money working in my profession. For example, in the Opera Studio, an Opera provides a monthly salary. So when I applied to the university, I had to submit the so-called document "Independent project". I didn't write much, so I'd like to quote it here: “The idea for my project consists of organising and performing a few concerts of German classical music in Scandinavia. In order to best prepare for that event, I would first like to build my vocal technique at a high level. This is my main goal. In the next coming year I would like to work on German musical literature but one of the biggest dreams is to prepare a role of Papageno from The Magic Flute.”As you can see, the goal was focused on potential future work and earnings. I was mostinterested in improving my vocal technique and working on the German repertoire. Even though German was never my favorite language and I avoided it as much as I could, I decided that during this year, I'd focus on the German repertoire while also honing my technique. It's worth mentioning - I usually and almost always sang in Slavic or Latin languages, and my favourite language in the opera world is Italian. But why the role of Papageno and the opera “The Magic Flute”? While browsing through the opera repertoire currently in production in the German language, I noticed that “The Magic Flute” was one of the most frequently performed, so I thought it could be a fascinating adventure. While perusing the opera score, I found a character for myself: Papageno5, a role not too low, not too high in the vocal tessitura, a role for a baritone voice. Even though I usually sang bass-baritone roles, I d

This paper explores a novel technique for improving recall in cross-language information retrieval (CLIR) systems using iterative query refinement grounded in the user's lexical-semantic space. The proposed methodology combines multi-level translation, semantic embedding-based expansion, and user profile-centered augmentation to address the challenge of matching variance between user queries and relevant documents. Through an initial BM25 retrieval, translation into intermediate languages, embedding lookup of similar terms, and iterative re-ranking, the technique aims to expand the scope of potentially relevant results personalized to the individual user. Comparative experiments on news and Twitter datasets demonstrate superior performance over baseline BM25 ranking for the proposed approach across ROUGE metrics. The translation methodology also showed maintained semantic accuracy through the multi-step process. This personalized CLIR framework paves the path for improved context-aware retrieval attentive to the nuances of user language., Comment: This is just an initial idea and it's implementation. The results are computed for the first 100 data points. Detailed results will be published with the actual paper

ObjectivesThe distinction between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) has been a topic of long-lasting debate. This study examined differences between BD-I and BD-II in a large, global sample of OABD, focusing on general functioning, cognition and somatic burden as these domains are often affected in OABD.MethodsCross-sectional analyses were conducted with data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database. The sample included 963 participants aged ≥50 years (714 BD-I, 249 BD-II). Sociodemographic and clinical factors were compared between BD subtypes including adjustment for study cohort. Multivariable analyses were conducted with generalized linear mixed models (GLMMs) and estimated associations between BD subtype and (1) general functioning (GAF), (2) cognitive performance (g-score) and (3) somatic burden, with study cohort as random intercept.ResultsAfter adjustment for study cohort, BD-II patients more often had a late onset ≥50 years (p = 0.008) and more current severe depression (p = 0.041). BD-I patients were more likely to have a history of psychiatric hospitalization (p < 0.001) and current use of anti-psychotics (p = 0.003). Multivariable analyses showed that BD subtype was not related to GAF, cognitive g-score or somatic burden.ConclusionBD-I and BD-II patients did not differ in terms of general functioning, cognitive impairment or somatic burden. Some clinical differences were observed between the groups, which could be the consequence of diagnostic definitions. The distinction between BD-I and BD-II is not the best way to subtype OABD patients. Future research should investigate other disease specifiers in this population.

IntroductionElectronic referral (e-referral) to quitlines helps connect tobacco-using patients to free, evidence-based cessation counseling. Little has been published about the real-world implementation of e-referrals across U.S. health systems, their maintenance over time, and the outcomes of e-referred patients.Aims and methodsBeginning in 2014, the University of California (UC)-wide project called UC Quits scaled up quitline e-referrals and related modifications to clinical workflows from one to five UC health systems. Implementation strategies were used to increase site readiness. Maintenance was supported through ongoing monitoring and quality improvement programs. Data on e-referred patients (n = 20 709) and quitline callers (n = 197 377) were collected from April 2014 to March 2021. Analyses of referral trends and cessation outcomes were conducted in 2021-2022.ResultsOf 20 709 patients referred, the quitline contacted 47.1%, 20.6% completed intake, 15.2% requested counseling, and 10.9% received it. In the 1.5-year implementation phase, 1813 patients were referred. In the 5.5-year maintenance phase, volume was sustained, with 3436 referrals annually on average. Among referred patients completing intake (n = 4264), 46.2% were nonwhite, 58.8% had Medicaid, 58.7% had a chronic disease, and 48.8% had a behavioral health condition. In a sample randomly selected for follow-up, e-referred patients were as likely as general quitline callers to attempt quitting (68.5% vs. 71.4%; p = .23), quit for 30 days (28.3% vs. 26.9%; p = .52), and quit for 6 months (13.6% vs. 13.9%; p = .88).ConclusionsWith a whole-systems approach, quitline e-referrals can be established and sustained across inpatient and outpatient settings with diverse patient populations. Cessation outcomes were similar to those of general quitline callers.ImplicationsThis study supports the broad implementation of tobacco quitline e-referrals in health care. To the best of our knowledge, no other paper has d

The interactions between aerosols and clouds are among the least understood climatic processes and were studied over Ascension Island. A ground-based UV polarization lidar was deployed on Ascension Island, which is located in the stratocumulus-to-cumulus transition zone of the southeastern Atlantic Ocean, to infer cloud droplet sizes and droplet number density near the cloud base of marine boundary layer cumulus clouds. The aerosol-cloud interaction (ACI) due to the presence of smoke from the African continent was determined during the monsoonal dry season. In September 2016, a cloud droplet number density ACIN of 0.3±0.21 and a cloud effective radius ACIr of 0.18±0.06 were found, due to the presence of smoke in and under the clouds. Smaller droplets near the cloud base makes them more susceptible to evaporation, and smoke in the marine boundary layer over the southeastern Atlantic Ocean will likely accelerate the stratocumulus-to-cumulus transition. The lidar retrievals were tested against more traditional radar-radiometer measurements and shown to be robust and at least as accurate as the lidar-radiometer measurements. The lidar estimates of the cloud effective radius are consistent with previous studies of cloud base droplet sizes. The lidar has the large advantage of retrieving both cloud and aerosol properties using a single instrument.

We present the wavelength-resolved reverberation mapping (RM) of combined MgII and UV FeII broad-line emissions for two intermediate redshifts (z$\sim$1), luminous quasars - HE 0413-4031 and HE 0435-4312, monitored by the SALT and 1-m class telescopes between 2012-2022. Through this technique, we aim to disentangle the Mg II and FeII emission regions and to build a radius-luminosity relation for UV FeII emission, which has so far remained unconstrained. Several methodologies have been applied to constrain the time delays for total MgII and FeII emissions. In addition, this technique is performed to quantify the inflow or outflow of broad-line region gas around the supermassive black hole and to disentangle the emission/emitting regions from lines produced in proximity to each other. The mean total FeII time delay is nearly equal to the mean total Mg II time delay for HE 0435-4312 suggesting a co-spatiality of their emissions. However, in HE 0413-4031, the mean FeII time delay is found to be longer than the mean MgII time delay, suggesting that FeII is produced at longer distances from the black hole. The UV Fe II R-L relation is updated with these two quasars and compared with the optical FeII relation, which suggests that the optical FeII region is located further than the UV FeII by a factor of 1.7-1.9 i.e. $R_{\rm FeII-opt}\sim(1.7-1.9)R_{\rm FeII-UV}$. We detected a weak pattern in the time delay vs. wavelength relation, suggesting that the MgII broad-line originates a bit closer to the SMBH than the UV FeII, however, the difference is not very significant. Comparison of MgII, UV, and optical FeII R-L relations suggests that the difference may be larger for lower-luminosity sources, possibly with the MgII emission originating further from the SMBH. In the future, more RM data will be acquired to put better constraints on these trends, in particular the UV FeII R-L relation., Comment: 24 pages, 16 figures, 5 tables, Accepted for publication in A&A, in Press

The interactions between aerosols and clouds are among the least understood climatic processes and were studied over Ascension Island. A ground-based UV polarization lidar was deployed on Ascension Island, which is located in the stratocumulus-to-cumulus transition zone of the southeastern Atlantic Ocean, to infer cloud droplet sizes and droplet number density near the cloud base of marine boundary layer cumulus clouds. The aerosol–cloud interaction (ACI) due to the presence of smoke from the African continent was determined during the monsoonal dry season. In September 2016, a cloud droplet number density ACIN of 0.3 ± 0.21 and a cloud effective radius ACIr of 0.18 ± 0.06 were found, due to the presence of smoke in and under the clouds. Smaller droplets near the cloud base makes them more susceptible to evaporation, and smoke in the marine boundary layer over the southeastern Atlantic Ocean will likely accelerate the stratocumulus-to-cumulus transition. The lidar retrievals were tested against more traditional radar–radiometer measurements and shown to be robust and at least as accurate as the lidar–radiometer measurements. The lidar estimates of the cloud effective radius are consistent with previous studies of cloud base droplet sizes. The lidar has the large advantage of retrieving both cloud and aerosol properties using a single instrument., Atmospheric Remote Sensing

Contrails (condensation trails) are line-shaped ice clouds caused by aircraft and are likely the largest contributor of aviation-induced climate change. Contrail avoidance is potentially an inexpensive way to significantly reduce the climate impact of aviation. An automated contrail detection system is an essential tool to develop and evaluate contrail avoidance systems. In this paper, we present a human-labeled dataset named OpenContrails to train and evaluate contrail detection models based on GOES-16 Advanced Baseline Imager (ABI) data. We propose and evaluate a contrail detection model that incorporates temporal context for improved detection accuracy. The human labeled dataset and the contrail detection outputs are publicly available on Google Cloud Storage at gs://goes_contrails_dataset.

Machine learning algorithms have grown in sophistication over the years and are increasingly deployed for real-life applications. However, when using machine learning techniques in practical settings, particularly in high-risk applications such as medicine and engineering, obtaining the failure probability of the predictive model is critical. We refer to this problem as the risk-assessment task. We focus on regression algorithms and the risk-assessment task of computing the probability of the true label lying inside an interval defined around the model's prediction. We solve the risk-assessment problem using the conformal prediction approach, which provides prediction intervals that are guaranteed to contain the true label with a given probability. Using this coverage property, we prove that our approximated failure probability is conservative in the sense that it is not lower than the true failure probability of the ML algorithm. We conduct extensive experiments to empirically study the accuracy of the proposed method for problems with and without covariate shift. Our analysis focuses on different modeling regimes, dataset sizes, and conformal prediction methodologies.

ObjectivesTo evaluate the presence of migraine features in patients with persistent postural-perceptual dizziness (PPPD).MethodsIn a retrospective survey study, consecutive patients presenting to a tertiary care neurotology clinic during an 18-month period were given questionnaires about headache and dizziness symptoms. The survey responses plus history and examination of the patient were used to diagnose patients with PPPD. The prevalence of migraine headache, vestibular migraine (VM), and migraine characteristics was evaluated.ResultsIn total, 36 subjects with PPPD were included in the study. The mean age of the subjects was 56 ± 16 years with a female (72%) predominance. A total of 19 (53%) patients met the International Classification of Headache Disorders criteria for migraine headache, and 6 of those (17%) met the criteria for definite VM. Of the patients who did not meet full migraine headache criteria, 6 (17%) patients met 4 of 5 criteria, and 5 (14%) patients met 3 of 5 criteria. There was no significant difference between PPPD patients who fulfilled full migraine headache criteria and those who did not in sensitivity to light, sound, smells, weather changes, feelings of mental fog/confusion, and sinus pain/facial pressure.ConclusionsThis study demonstrates that a majority of patients with PPPD fulfill the criteria for migraine headache. A large proportion of PPPD patients who do not meet the full criteria for migraine headache still meet a majority of the migraine headache criteria. This suggests an association between the 2 conditions. PPPD may be a part of the spectrum of otologic migraine, where migraine manifests as otologic symptoms.

A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and the middle ear cavity, mastoid, or intracranial cavity. A PLF most commonly forms when the integrity of the oval or round window is compromised, and it may be trauma-induced or may occur with no known cause (idiopathic). Controversy regarding the diagnosis of idiopathic PLF has persisted for decades, and the presenting symptoms may be vague. However, potential exists for this condition to be one of the few etiologies of dizziness, tinnitus, and hearing loss that can be treated surgically. The aim of this review is to provide an update on classification, diagnosis, and treatment of PLF. Particular attention will be paid to idiopathic PLF and conditions that may have a similar presentation, with subsequent information on how best to distinguish them. Novel diagnostic criteria for PLF and management strategy for PLF and PLF-like symptoms is presented.

Meniere's disease (MD) is a chronic condition affecting the inner ear whose precise etiology is currently unknown. We propose the hypothesis that MD is a migraine-related phenomenon which may have implications for future treatment options for both diseases. The association between MD and migraine is both an epidemiological and a mechanistic one, with up to 51% of individuals with MD experiencing migraine compared to 12% in the general population. The presence of endolymphatic hydrops in those with MD may be the factor that unites the two conditions, as hydropic inner ears have an impaired ability to maintain homeostasis. Migraine headaches are theorized to cause aura and symptoms via spreading cortical depression that ultimately results in substance P release, alterations in blood flow, and neurogenic inflammation. Chronically hydropic inner ears are less able to auto-regulate against the changes induced by active migraine attacks and may ultimately manifest as MD. This same vulnerability to derangements in homeostasis may also explain the common triggering factors of both MD attacks and migraine headaches, including stress, weather, and diet. Similarly, it may explain the efficacy of common treatments for both diseases: current migraine treatments such as anti-hypertensives and anti-convulsants have shown promise in managing MD. Though the etiology of both MD and migraine is likely multifactorial, further exploration of the association between the two conditions may illuminate how to best manage them in the future. MD is likely a manifestation of cochleovestibular migraine, which occurs as a result of migraine related changes in both the cochlea and vestibule.

We present the results of the reverberation monitoring aimed at MgII broad line and FeII pseudocontinuum for the luminous quasar CTS C30.10 (z = 0.90052) with the Southern African Large Telescope covering the years 2012-2021. We aimed at disentangling the MgII and UV FeII variability and the first measurement of UV FeII time delay for a distant quasar. We used several methods for time-delay measurements and determined both FeII and MgII time delays as well as performed a wavelength-resolved time delay study for a combination of MgII and FeII in the 2700 - 2900 \AA restframe wavelength range. We obtain the time delay for MgII of $275.5^{+12.4}_{-19.5}$ days in the rest frame, while for FeII we have two possible solutions of $270.0^{+13.8}_{-25.3}$ days and $180.3^{+26.6}_{-30.0}$ in the rest frame. Combining this result with the old measurement of FeII UV time delay for NGC 5548 we discuss for the first time the radius-luminosity relation for UV FeII with the slope consistent with $0.5$ within uncertainties. Since FeII time delay has a shorter time-delay component but lines are narrower than MgII, we propose that the line delay measurement is biased towards the BLR part facing the observer, with the bulk of the Fe II emission may arise from the more distant BLR region, one that is shielded from the observer., Comment: 22 pages, 19 Figures, 6 Tables, Submitted to Astronomy and Astrophysics, Comments are welcome

ObjectivesAntipsychotic drugs (APS) are widely used to treat patients with bipolar disorder (BD), but there is limited information in older-age bipolar disorder (OABD). This analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated characteristics of OABD patients prescribed APS vs. those not prescribed APS.Experimental designThe observational analysis used baseline, cross-sectional data from 16 international studies for adults aged ≥ 50 years with BD comprising 1,007 individuals with mean age 63.2 years (SD = 9.0), 57.4% women, and mean age of onset 31.6 years (SD = 15.0). The dependent variable was current APS treatment status. The independent variables included demographic and clinical variables, and a random effect for study, that were included in generalized mixed models.Principal observations46.6% of individuals (n = 469) were using APS. The multivariate model results suggest that those treated with APS were younger (p = 0.01), less likely to be employed (p < 0.001), had more psychiatric hospitalizations (p = 0.009) and were less likely to be on lithium (p < 0.001). Of individuals on APS, only 6.6% of those (n = 27) were on first-generation antipsychotics (FGAs) and experienced a greater burden of psychiatric hospitalizations (p = 0.012).ConclusionsAPS are widely prescribed in OABD, observed in nearly half of this sample with great variation across sites. Individuals with OABD on APS have more severe illness, more frequent hospitalizations and are more often unemployed vs. those not on APS. Future studies need to examine longitudinal outcomes in OABD prescribed APS to characterize underlying causal relationships.

OBJECTIVE: To investigate the use of near-infrared (NIR) imaging as a tool for outpatient clinicians to quickly and accurately assess for maxillary sinusitis and to characterize its accuracy compared to computerized tomography (CT) scan. METHODS: In a prospective investigational study, NIR and CT images from 65 patients who presented to a tertiary care rhinology clinic were compared to determine the sensitivity and specificity of NIR as an imaging modality. RESULTS: The sensitivity and specificity of NIR imaging in distinguishing normal versus maxillary sinus disease was found to be 90% and 84%, normal versus mild maxillary sinus disease to be 76% and 91%, and mild versus severe maxillary sinus disease to be 96% and 81%, respectively. The average pixel intensity was also calculated and compared to the modified Lund-Mackay scores from CT scans to assess the ability of NIR imaging to stratify the severity of maxillary sinus disease. Average pixel intensity over a region of interest was significantly different (P < .001) between normal, mild, and severe disease, as well as when comparing normal versus mild (P < .001, 95% CI 42.22-105.39), normal versus severe (P < .001, 95% CI 119.43-174.14), and mild versus severe (P < .001, 95% CI 41.39-104.56) maxillary sinus disease. CONCLUSION: Based on this data, NIR shows promise as a tool for identifying patients with potential maxillary sinus disease as well as providing information on severity of disease that may guide administration of appropriate treatments.

OBJECTIVES: There is limited information on the characteristics of older adults with bipolar disorder (OABD) treated with lithium, along with safety concerns about its use by older adults. The aim of the present study is to describe the demographic and clinical characteristics of OABD receiving lithium therapy, using data from the Global Ageing & Geriatric Experiments in Bipolar Disorder (GAGE-BD). EXPERIMENTAL PROCEDURES: Cross-sectional analysis of the GAGE-BD dataset to determine differences and similarities between lithium users and non-users. We analysed data from 986 participants aged 50 years or older (mean age 63.5 years; 57.5% females) from 12 study sites. Two subgroups (Lithium; Non-lithium) were defined according to the current prescription of lithium. We compared several outcomes between these groups, controlling for age, gender, and study site. RESULTS: OABD treated with lithium had lower scores on depression rating scales and were less likely to be categorised as with moderate or severe depression. There was a lower proportion of lithium users than non-users among those with evidence of rapid cycling and non-bipolar psychiatric diagnoses. Assessment of global cognitive state and functionality indicated better performance among lithium users. The current use of antipsychotics was less frequent among lithium users, who also reported fewer cardiovascular comorbidities than non-users. CONCLUSION: We found several potentially relevant differences in the clinical profile of OABD treated with lithium compared with those treated with other mood stabilisers. However, the interpretation of the present results must take into account the methodological limitations inherent to the cross-sectional approach and data harmonisation.

Abstract Approximately 6.8 million people die annually because of problems related to the central nervous system (CNS), and out of them, approximately 1 million people are affected by neurodegenerative diseases that include Alzheimer’s disease, multiple sclerosis, epilepsy, and Parkinson’s disease. CNS problems are a primary concern because of the complexity of the brain. There are various drugs available to treat CNS disorders and overcome problems with toxicity, specificity, and delivery. Barriers like the blood–brain barrier (BBB) are a challenge, as they do not allow therapeutic drugs to cross and reach their target. Researchers have been searching for ways to allow drugs to pass through the BBB and reach the target sites. These problems highlight the need of nanotechnology to alter or manipulate various processes at the cellular level to achieve the desired attributes. Due to their nanosize, nanoparticles are able to pass through the BBB and are an effective alternative to drug administration and other approaches. Nanotechnology has the potential to improve treatment and diagnostic techniques for CNS disorders and facilitate effective drug transfer. With the aid of nanoengineering, drugs could be modified to perform functions like transference across the BBB, altering signaling pathways, targeting specific cells, effective gene transfer, and promoting regeneration and preservation of nerve cells. The involvement of a nanocarrier framework inside the delivery of several neurotherapeutic agents used in the treatment of neurological diseases is reviewed in this study.

Introduction: Seasonal inactivated influenza vaccine (IIV) is routinely recommended during pregnancy to protect both mothers and infants from complications following influenza infection. While previous studies have evaluated the risk of major structural birth defects in infants associated with prenatal administration of monovalent pandemic IIV, fewer studies have evaluated the risk associated with prenatal seasonal IIV. Methods: We conducted a population-based cohort study of 125,866 singleton births between 2012 and 2016 in Western Australia. Birth registrations were linked to the state's registers for congenital anomalies and a state prenatal vaccination database. We estimated prevalence ratios (PR) of any major structural birth defect and defects by organ system. Vaccinated pregnancies were defined as those with a record of IIV in the first trimester. Inverse probability treatment weighting factored for baseline probability for vaccination. A Bonferroni correction was applied to account for multiple comparisons. Results: About 3.9% of births had a major structural birth defect. Seasonal IIV exposure during the first trimester was not associated with diagnosis of any major structural birth defect diagnosed within 1 month of birth (PR 0.98, 95% CI: 0.77, 1.28) or within 6 years of life (PR 1.02, 95% CI: 0.78, 1.35). We identified no increased risk in specific birth defects associated with seasonal IIV. Conclusion: Based on registry data for up to 6 years of follow-up, results suggest there is no association between maternal influenza vaccination and risk of major structural birth defects. These results support the safety of seasonal IIV administration during pregnancy.

We introduce CAN, a simple, efficient and scalable method for self-supervised learning of visual representations. Our framework is a minimal and conceptually clean synthesis of (C) contrastive learning, (A) masked autoencoders, and (N) the noise prediction approach used in diffusion models. The learning mechanisms are complementary to one another: contrastive learning shapes the embedding space across a batch of image samples; masked autoencoders focus on reconstruction of the low-frequency spatial correlations in a single image sample; and noise prediction encourages the reconstruction of the high-frequency components of an image. The combined approach results in a robust, scalable and simple-to-implement algorithm. The training process is symmetric, with 50% of patches in both views being masked at random, yielding a considerable efficiency improvement over prior contrastive learning methods. Extensive empirical studies demonstrate that CAN achieves strong downstream performance under both linear and finetuning evaluations on transfer learning and robustness tasks. CAN outperforms MAE and SimCLR when pre-training on ImageNet, but is especially useful for pre-training on larger uncurated datasets such as JFT-300M: for linear probe on ImageNet, CAN achieves 75.4% compared to 73.4% for SimCLR and 64.1% for MAE. The finetuned performance on ImageNet of our ViT-L model is 86.1%, compared to 85.5% for SimCLR, and 85.4% for MAE. The overall FLOPs load of SimCLR is 70% higher than CAN for ViT-L models., Comment: Mishra and Robinson contributed equally

Maternal influenza vaccination is highly recommended to pregnant women to provide protection against influenza infection for both the mother and their infants in their first six months of life. Few studies have evaluated the longer-term health outcomes beyond the infant period and into early childhood. My longitudinal, population-based linked cohort studies mostly support the safety of seasonal influenza vaccination during pregnancy and observed potential protection against asthma, anaphylaxis and seizure disorders in young children.

These documents are designed to introduce students to some of the fundamental concepts, principles, and values of human rights and to a basic knowledge of human rights legal instruments as they apply to daily lives. Student handbook 1 is a series of lessons and activities that stimulate reading and discussion around the following ideas: What is a human being? What is a human right? Rights and Responsibilities; A Canadian human rights story: Nellie McClung; The Diary of Anne Frank; and The Universal Declaration of Human Rights: Background and Application. Student handbook 2 features five case studies, each of which presents a situation where an individual's rights have been denied or infringed upon. The case studies raise the issues of discrimination based upon a disability, age, HIV status, religion, and race. Student handbook 3 invites students to write some of their own thoughts and ideas concerning how some of the human rights principles raised by the curriculum may apply to their own lives. Generous space for student writing is provided on each page following a prompting suggestion such as "We need to know what our rights are because..."; "The Universal Declaration of Human Rights says that..."; and "Here is a story about discrimination...." The teachers' guides accompany the student handbooks and contain helpful materials such as discussion topics, vocabulary words, and teacher's documentation. No teacher's guide exists for student handbook 3. These materials are designed to be used in adult literacy classes in Canada with adults who are reading at an intermediate level. However, as the materials generally are not focused on Canada, they can be used in other countries and are presented in a manner that should be accessible to students of middle school level or higher. (DB)

Objectives/hypothesisTo examine the hearing outcomes of patients with sudden sensorineural hearing loss (SSNHL) treated with oral and intratympanic (IT) steroid only or a combination of steroid and migraine treatment. Our hypothesis was that adjuvant migraine medications may improve outcomes in SSNHL.MethodsA retrospective chart review at a tertiary otology center was conducted to identify patients with SSNHL who received oral steroid and IT dexamethasone injection(s) with or without migraine medications (a combination of nortriptyline and topiramate).ResultsA total of 47 patients received oral steroid and IT dexamethasone injection(s) only, and 46 patients received oral steroid and IT dexamethasone injection(s) as well as migraine lifestyle changes plus a combination of nortriptyline and topiramate. There were no significant differences in demographics and baseline audiometric data between the two groups. Both groups demonstrated improvements in pure tone average (PTA) and hearing thresholds at 250 Hz and 8000 Hz posttreatment. However, compared to steroid-only group, the adjuvant migraine medications group had significantly greater improvements in hearing thresholds at the lower frequencies (250 Hz, 500 Hz, 1000 Hz). Patients in the latter cohort also had greater improvement in PTA (P = .01) and received fewer IT injections (P = .04) PTA improvement of ≥ 10 dB was observed in 36 patients (78%) in the adjuvant migraine medications group and 22 patients (46%) in the control group (P < .001).ConclusionIn multimodal treatment of SSNHL, supplementing oral and IT steroid with migraine medications may result in greater improvements in lower frequency hearing thresholds and PTA. Furthermore, adjuvant migraine treatment can lead to decrease in number of IT injections, thus reducing procedure-related risks and complications.Level of evidence3 Laryngoscope, 131:E283-E288, 2021.

BackgroundTobacco smoking using a hookah (i.e., waterpipe) is a global epidemic. While evidence suggests that sexual minorities (SM) have higher odds of hookah use compared to heterosexuals, little is known about their hookah use patterns and transitions. We sought to examine transitions between hookah smoking and use of other tobacco and electronic (e-) products among SM adults aged 18 years of age and older versus their heterosexual counterparts.MethodsWe analyzed nationally representative data of ever and current hookah smokers from Wave 1 (2013-2014; ever use n = 1014 SM and n = 9462 heterosexuals; current use n = 144 SM and n = 910 heterosexuals) and Wave 2 (2014-2015; ever use n = 901 SM and n = 8049 heterosexuals; current use n = 117 SM and n = 602 heterosexuals) of the Population Assessment of Tobacco and Health Study. Comparisons between groups and gender subgroups within SM identity groups were determined with Rao-Scott chi-square tests and multivariable survey-weighted multinomial logistic regression models were estimated for transition patterns and initiation of electronic product use in Wave 2.ResultsEver and current hookah smoking among SM adults (ever use Wave 1: 29% and Wave 2: 31%; current use Wave 1: 4% and Wave 2: 3%) was higher than heterosexuals (ever use Wave 1: 16% and Wave 2: 16%; current use Wave 1: 1% and Wave 2: 1%; both p < 0.0001). Among SM adults who reported hookah use at Wave 1, 46% quit hookah use at Wave 2; 39% continued hookah use and did not transition to other products while 36% of heterosexual adults quit hookah use at Wave 2 and 36% continued hookah use and did not transition to other products. Compared with heterosexuals, SM adults reported higher use of hookah plus e-products (Wave 2 usage increased by 65 and 83%, respectively).ConclusionsCompared to heterosexuals, in addition to higher rates of hookah smoking, higher percentages of SM adults transitioned to hookah plus e-product use between 2013 and 2015. Results have imp

ObjectivesTo develop a smartphone application providing sound therapy and cognitive behavioral therapy (CBT) for treating tinnitus and performing a proof-of-concept pilot study evaluating its potential efficacy.MethodsAn interactive smartphone application available on iOS and Android platforms was developed, which provided an 8-week tinnitus-specific CBT and personalized and frequency-matched sound therapy. Included patients presented to our tertiary clinic between 2017 and 2018, while those waitlisted were regarded as controls. Three surveys were administrated: Tinnitus Handicap Inventory (THI), Generalized Anxiety Disorder 7-item (GAD-7), and Perceived Stress Scale (PSS).ResultsA total of 30 patients enrolled in this study consisting of 20 treatment and 10 control patients and mean age was 55.4 ± 11.6 years. Treatment and control patients had similar age, sex, and pre-enrolment GAD and PSS (all P > .05). Baseline THI scores were also similar between treatment and control cohorts (50.1 ± 21.9 vs 62.0 ± 20.7; P = .15). After 8 weeks, though changes in GAD and PSS scores were similar (P > .05), the treatment group reported a significantly greater improvement in THI scores (17.7 ± 15.8 vs 5.3 ± 10.5, P = .04).ConclusionsThis pilot study demonstrated potentially promising efficacy of a smartphone-based CBT and sound therapy platform for treating tinnitus and encourages future randomized controlled trials on this treatment modality.

ObjectivesTo describe a cohort of patients presenting with long-term sudden sensorineural hearing loss (SSNHL) treated with prophylactic migraine and intratympanic steroid therapy.MethodsPatients presenting to a neurotology clinic at least 6 weeks from SSNHL onset were included. All patients received migraine prophylactic medication (nortriptyline, topiramate, and/or verapamil) and lifestyle changes for at least 6 weeks, as well as intratympanic steroid injections, if appropriate.ResultsTwenty-one patients (43% female) with a mean age of 64 ± 11 years who presented 9 ± 8 months (median = 5) from symptom onset were included. Posttreatment hearing thresholds were significantly improved compared with pretreatment thresholds at 500 Hz (49 ± 19 dB versus 55 ± 20 dB, p = 0.01), 1000 Hz (52 ± 19 dB versus 57 ± 21 dB, p = 0.03), low-frequency pure-tone average (53 ± 15 dB versus 57 ± 17 dB, p = 0.01), and speech-frequency pure-tone average (57 ± 13 dB versus 60 ± 15 dB, p = 0.02). Posttreatment word-recognition-score (WRS) and speech-recognition-threshold (SRT) were also significantly improved (45 ± 28% versus 70 ± 28% and 57 ± 18 dB versus 50 ± 16 dB, respectively, both p < 0.01). Notably, ≥15% improvement in WRS and ≥10 dB improvement in SRT was observed in 13 (68%) and 8 (40%) patients, respectively. Of the 11 patients who presented with initial < 50% WRS, 8 (73%) had improved posttreatment >50% WRS with an average improvement of 39 ± 9%.ConclusionsMigraine medications in addition to intratympanic steroid injections significantly improved SRT and hearing frequencies in 40% and 29% of SSNHL patients, respectively, while significant WRS recovery was observed in most (68%) patients. This suggests SSNHL may be an otologic migraine phenomenon, which may be at least partially reversible even after the traditional 30-day postonset window.

Accurate lidar-based measurements of cloud optical extinction, even though perhaps limited to the cloud base region, are useful. Arguably, more advanced lidar techniques (e.g. Raman) should be applied for this purpose. However, simpler polarisation and backscatter lidars offer a number of practical advantages (e.g. better resolution and more continuous and numerous time series). In this paper, we present a backscatter lidar signal inversion method for the retrieval of the cloud optical extinction in the cloud base region. Though a numerically stable method for inverting lidar signals using a far-end boundary value solution has been demonstrated earlier and may be considered as being well established (i.e. the Klett inversion), the application to high-extinction clouds remains problematic. This is due to the inhomogeneous nature of real clouds, the finite range resolution of many practical lidar systems, and multiple scattering effects. We use an inversion scheme, where a backscatter lidar signal is inverted based on the estimated value of cloud extinction at the far end of the cloud, and apply a correction for multiple scattering within the cloud and a range resolution correction. By applying our technique to the inversion of synthetic lidar data, we show that, for a retrieval of up to 90g m from the cloud base, it is possible to obtain the cloud optical extinction within the cloud with an error better than 5g %. In relative terms, the accuracy of the method is smaller at the cloud base but improves with the range within the cloud until 45g m and deteriorates slightly until reaching 90g m from the cloud base., Atmospheric Remote Sensing, Geoscience and Remote Sensing

This thesis presents a new method for the continuous observation of aerosol-cloud interactions with ground-based remote sensing instruments. The described method is based on the measurements from UV lidar, radar and radiometer. All of those instruments are capable of obtaining continuous, high-resolution measurements. In order to facilitate its easy implementation to measuring sites the method is based on a standardized Cloudnet data format. The main goal is to monitor the change in the cloud droplet concentration, as obtained from the measurements by cloud radar and radiometer, to then compare it to the aerosol background below the cloud, represented by the attenuated backscatter measured by UV lidar. The response of the cloud to the aerosol background can best be measured when the amount of available water is kept constant. Hence the measurements from the radiometer, specifically the derived liquid water path (LWP), which is used to constrain the cloud response. Based on the value of the LWP, analyzed data is divided into bins and for each of these the relation between cloud droplet effective radius and integrated value of the attenuated backscatter are calculated. This metric is called ACIr and is used to describe the strength of the relation between the clouds microphysical properties and the aerosol background below the cloud. The method was first tested and applied to pristine marine clouds as measured at the Graciosa Island in the Azores. The application was then extended to the Cabauw site located in the Netherlands. On both sites a decrease in the cloud size was observed in combination with a simultaneous increase of the aerosol loading below the cloud. This relation was particularly strong for a mid range of the LWP, between 40 and 60 gm-2 LWP for the cases from Azores and between 60 and 105 gm-2 for the cases from the Netherlands. These results indicate that the process of aerosol-cloud interactions is a predominant one only under those conditions whe, Atmospheric Remote Sensing

Poland was one of the countries that was hit by the Covid-19 pandemic in 2020, and its government imposed restrictions to combat the spreading of the virus. The Internet and social media became outlets for people’s reactions to the events that unfolded, including the lockdown. A part of this reaction came in the form of creating and sharing memes – an expression of digital participatory culture. This paper aims to analyze how Covid-19 was communicated and narrated through Internet memes and how they presented the pandemic and actors responsible for fighting it. 1,763 memes from six media platforms were analyzed using content analysis with framing elements and a comparative narrative analysis. The results show that the memes provided a form of commentary on the situation experienced by Poles. The most common category of memes was “bans and orders”, involving restrictions that were often criticized and ridiculed as pointless. The main characters within the memes were ordinary citizens, often portrayed in a comedic way as careless in regards to the virus and violating the restrictions. They were also presented as victims of the police and the government. Furthermore, the people responsible for fighting the pandemic were portrayed as incompetent and imposing needlessly severe restrictions and penalties for not abiding by them., Polonia fue uno de los países golpeados por la pandemia del Covid-19 en 2020, cuyo gobierno impuso restricciones para combatir la propagación del virus. Internet y las redes sociales se convirtieron en un escape para las reacciones de las personas a estos eventos, incluido el confinamiento. Una parte de esta reacción vino en forma de creación y difusión de memes, una expresión de la cultura digital y participativa. El presente estudio tiene como objetivo analizar cómo el Covid-19 fue comunicado y narrado a través de los memes en Internet y cómo fue presentada la pandemia y los responsables de combatirla. Fueron analizados 1.763 memes de seis medios empleando un análisis de contenidos con elementos de enmarque y análisis comparativo narrativo. Los resultados muestran que los memes fueron una forma de expresión sobre la situación vivida por los polacos. La categoría más popular fue la de «prohibiciones y órdenes», aludiendo a las restricciones que frecuentemente fueron criticadas y ridiculizadas como inútiles. El personaje principal de los memes fueron los ciudadanos, frecuentemente retratados de una manera cómica como personas irresponsables en cuanto al virus y violaciones de las restricciones. También fueron presentados como víctimas de la policía y el gobierno. Además, las personas responsables de combatir la pandemia fueron retratadas como incompetentes, al imponer restricciones y sanciones excesivamente estrictas por no obedecerlas.

ObjectivesTo investigate the clinical presentation, treatment breakdown, and overall survival (OS) outcomes of patients with neurofibromatosis type 2 (NF2)-associated bilateral vestibular schwannoma (NVS).MethodsThe 2004 to 2016 National Cancer Database was queried for patients with a diagnosis of VS. The "Laterality" code was used to stratify patients into sporadic unilateral vestibular schwannoma (UVS) and NVS.ResultsOf the 33,839 patients with VS, 155 (0.46%) were coded for NVS with an average age and tumor size of 37.4 ± 20.5 years and 23.5 ± 18.2 mm. Patients underwent observation (45.3%), surgery (29.3%), and radiotherapy (20.0%), and had a 5.8% 5-year mortality rate. Compared with UVS, NVS was negatively associated with receiving surgery (40.2% versus 29.3%, p = 0.02) while watchful observation was more prevalent (30.1% versus 45.3%, p = 0.001). In NVS, undergoing surgery was associated with larger tumor size (34.5 ± 21.2 versus 17.8 ± 13.3 mm, p = 0.001) and shorter diagnosis-to-treatment time (49.1 ± 60.6 versus 87.0 ± 78.5 d, p = 0.02), radiotherapy was associated with older age (44.4 ± 18.9 versus 35.2 ± 20.6 yr, p = 0.02) and longer diagnosis-to-treatment time (85.9 ± 77.9 versus 53.9 ± 65.5 d, p = 0.04), and observation was associated with smaller tumor size (17.8 ± 15.9 versus 28.0 ± 19.2 mm, p = 0.01). Kaplan-Meier log-rank analysis demonstrated similar 10-year OS between NVS and UVS patients (p = 0.58) without factoring the earlier age of presentation. Furthermore, there were no temporal changes in presentation/management of NVS, and OS was not dependent on the received treatment (p = 0.30).ConclusionsWith younger age, larger tumors, and more conservative management, NVS's OS was not treatment-dependent and was similar to sporadic UVS, though the latter should not be interpreted as similar life expectancies due to the much earlier presentation.

ObjectivesTo identify migraine features present in a cohort of patients with recurrent benign paroxysmal positional vertigo (BPPV).MethodsPatients presenting with recurrent BPPV were surveyed. Recurrent BPPV was defined as three episodes or greater in 6 months before presentation, with resolution of symptoms after Epley maneuver. Current or past migraine headache (MH) diagnosis was made according to the International Headache Society guidelines.ResultsFifty-eight patients with recurrent BPPV with a mean age of 53.8 ± 17.4 years were included. Half (29 patients) fulfilled criteria for MH and half (29 patients) did not meet the criteria for MH (non-MH). No statistically significant difference was found in a majority of migraine-related symptoms between the MH and non-MH cohorts with recurrent BPPV. History of migraine medication usage (p = 0.008), presence of a weekly headache (p = 0.01), and duration of dizziness after positional vertigo (p = 0.01) were the only variables that were different on multivariate analysis between the MH and non-MH cohorts.ConclusionsHalf of recurrent BPPV patients suffer from migraine headaches. The other half presented with migraine-related symptoms, but do not meet criteria for MH. The high comorbidity of MH in our recurrent BPPV cohort as well as the absence of a statistically significant difference in a majority of migraine-related features among patients who did and did not fulfill criteria for MH may suggest that recurrent BPPV has a relationship with migraine. Recurrent BPPV may potentially be a manifestation of migraine in the inner ear, which we term otologic migraine including cochlear, vestibular, or cochleovestibular symptoms.

Poland was one of the countries that was hit by the Covid-19 pandemic in 2020, and its government imposed restrictions to combat the spreading of the virus. The Internet and social media became outlets for people’s reactions to the events that unfolded, including the lockdown. A part of this reaction came in the form of creating and sharing memes – an expression of digital participatory culture. This paper aims to analyze how Covid-19 was communicated and narrated through Internet memes and how they presented the pandemic and actors responsible for fighting it. 1,763 memes from six media platforms were analyzed using content analysis with framing elements and a comparative narrative analysis. The results show that the memes provided a form of commentary on the situation experienced by Poles. The most common category of memes was “bans and orders”, involving restrictions that were often criticized and ridiculed as pointless. The main characters within the memes were ordinary citizens, often portrayed in a comedic way as careless in regards to the virus and violating the restrictions. They were also presented as victims of the police and the government. Furthermore, the people responsible for fighting the pandemic were portrayed as incompetent and imposing needlessly severe restrictions and penalties for not abiding by them., Polonia fue uno de los países golpeados por la pandemia del Covid-19 en 2020, cuyo gobierno impuso restricciones para combatir la propagación del virus. Internet y las redes sociales se convirtieron en un escape para las reacciones de las personas a estos eventos, incluido el confinamiento. Una parte de esta reacción vino en forma de creación y difusión de memes, una expresión de la cultura digital y participativa. El presente estudio tiene como objetivo analizar cómo el Covid-19 fue comunicado y narrado a través de los memes en Internet y cómo fue presentada la pandemia y los responsables de combatirla. Fueron analizados 1.763 memes de seis medios empleando un análisis de contenidos con elementos de enmarque y análisis comparativo narrativo. Los resultados muestran que los memes fueron una forma de expresión sobre la situación vivida por los polacos. La categoría más popular fue la de «prohibiciones y órdenes», aludiendo a las restricciones que frecuentemente fueron criticadas y ridiculizadas como inútiles. El personaje principal de los memes fueron los ciudadanos, frecuentemente retratados de una manera cómica como personas irresponsables en cuanto al virus y violaciones de las restricciones. También fueron presentados como víctimas de la policía y el gobierno. Además, las personas responsables de combatir la pandemia fueron retratadas como incompetentes, al imponer restricciones y sanciones excesivamente estrictas por no obedecerlas.

© 2017 IEEE. We present a method for synthesizing a frontal, neutralexpression image of a person's face given an input face photograph. This is achieved by learning to generate facial landmarks and textures from features extracted from a facial-recognition network. Unlike previous generative approaches, our encoding feature vector is largely invariant to lighting, pose, and facial expression. Exploiting this invariance, we train our decoder network using only frontal, neutral-expression photographs. Since these photographs are well aligned, we can decompose them into a sparse set of landmark points and aligned texture maps. The decoder then predicts landmarks and textures independently and combines them using a differentiable image warping operation. The resulting images can be used for a number of applications, such as analyzing facial attributes, exposure and white balance adjustment, or creating a 3-D avatar.

© 2018 IEEE. We present a method for training a regression network from image pixels to 3D morphable model coordinates using only unlabeled photographs. The training loss is based on features from a facial recognition network, computed on-the-fly by rendering the predicted faces with a differentiable renderer. To make training from features feasible and avoid network fooling effects, we introduce three objectives: A batch distribution loss that encourages the output distribution to match the distribution of the morphable model, a loopback loss that ensures the network can correctly reinterpret its own output, and a multi-view identity loss that compares the features of the predicted 3D face and the input photograph from multiple viewing angles. We train a regression network using these objectives, a set of unlabeled photographs, and the morphable model itself, and demonstrate state-of-the-art results.

Given a set of solution snapshots of a hyperbolic PDE, we are interested in learning a reduced order model (ROM). To this end, we propose a novel decompose then learn approach. We decompose the solution by expressing it as a composition of a transformed solution and a de-transformer. Our idea is to learn a ROM for both these objects, which, unlike the solution, are well approximable in a linear reduced space. A ROM for the (untransformed) solution is then recovered via a recomposition. The transformed solution results from composing the solution with a spatial transform that aligns the spatial discontinuities. Furthermore, the de-transformer is the inverse of the spatial transform and lets us recover a ROM for the solution. We consider an image registration technique to compute the spatial transform, and to learn a ROM, we resort to the dynamic mode decomposition (DMD) methodology. Several benchmark problems demonstrate the effectiveness our method in representing the data and as a predictive tool.

Disentangled visual representations have largely been studied with generative models such as Variational AutoEncoders (VAEs). While prior work has focused on generative methods for disentangled representation learning, these approaches do not scale to large datasets due to current limitations of generative models. Instead, we explore regularization methods with contrastive learning, which could result in disentangled representations that are powerful enough for large scale datasets and downstream applications. However, we find that unsupervised disentanglement is difficult to achieve due to optimization and initialization sensitivity, with trade-offs in task performance. We evaluate disentanglement with downstream tasks, analyze the benefits and disadvantages of each regularization used, and discuss future directions., Comment: Accepted at the ICML 2021 Self-Supervised Learning for Reasoning and Perception Workshop

We propose a data-driven model order reduction (MOR) technique for parametrized partial differential equations that exhibit parameter-dependent jump-discontinuities. Such problems have poor-approximability in a linear space and therefore, are challenging for standard MOR techniques. We build upon the methodology of approximating the map between the parameter domain and the expansion coefficients of the reduced basis via regression. The online stage queries the regression model for the expansion coefficients and recovers a reduced approximation for the solution. We propose to apply this technique to a transformed solution that results from composing the solution with a spatial transform. Unlike the (untransformed) solution, it is sufficiently regular along the parameter domain and thus, is well-approximable in a low-dimensional linear space. To recover an approximation for the (untransformed) solution, we propose an online efficient regression-based technique that approximates the inverse of the spatial transform. Our method features a decoupled online and offline stage, and benchmark problems involving hyperbolic and parabolic equations demonstrate its effectiveness.

Background: Progressive supranuclear palsy is a neurodegenerative disorder associated with tau protein aggregation. Tilavonemab (ABBV-8E12) is a monoclonal antibody that binds to the N-terminus of human tau. We assessed the safety and efficacy of tilavonemab for the treatment of progressive supranuclear palsy. Methods: We did a phase 2, multicentre, randomised, placebo-controlled, double-blind study at 66 hospitals and clinics in Australia, Canada, France, Germany, Italy, Japan, Spain, and the USA. Participants (aged ≥40 years) diagnosed with possible or probable progressive supranuclear palsy who were symptomatic for less than 5 years, had a reliable study partner, and were able to walk five steps with minimal assistance, were randomly assigned (1:1:1) by interactive response technology to tilavonemab 2000 mg, tilavonemab 4000 mg, or matching placebo administered intravenously on days 1, 15, and 29, then every 28 days through to the end of the 52-week treatment period. Randomisation was done by the randomisation specialist of the study sponsor, who did not otherwise participate in the study. The sponsor, investigators, and participants were unaware of treatment allocations. The primary endpoint was the change from baseline to week 52 in the Progressive Supranuclear Palsy Rating Scale (PSPRS) total score in the intention-to-treat population. Adverse events were monitored in participants who received at least one dose of study drug. Prespecified interim futility criteria were based on a model-based effect size of 0 or lower when 60 participants had completed the 52-week treatment period and 0·12 or lower when 120 participants had completed the 52-week treatment period. This study is registered at ClinicalTrials.gov, number NCT02985879. Findings: Between Dec 12, 2016, and Dec 31, 2018, 466 participants were screened, 378 were randomised. The study was terminated on July 3, 2019, after prespecified futility criteria were met at the second interim analysis. A total of 3

Introduction: In the multisystem inflammatory disorder systemic sclerosis (SSc), gastrointestinal tract (GIT) affliction is highly prevalent. There are no known disease modifying therapies and the negative impact is substantial. Aiming for a new therapeutic principle, and inspired by recent work showing associations between gut microbiota changes and GIT symptoms in SSc, we performed a pilot study on faecal microbiota transplantation (FMT) with the single-donor bacterial culture 'Anaerobic Cultivated Human Intestinal Microbiome (ACHIM)'. Motivated by positive pilot study signals, we designed the ReSScue trial as a phase II multicentre, placebo-controlled, randomised 20-week trial to evaluate safety and efficacy on lower GIT symptoms of FMT by ACHIM in SSc. Methods and analyses: We aim to include 70 SSc participants with moderate to severe lower GIT symptoms, defined by the validated patient-reported University of California Los Angeles Scleroderma Clinical Trial Consortium GIT 2.0 2.0 questionnaire. The trial includes three parts. In part A1 (induction phase) lasting from week 0 to week 12, participants will be randomised 1:1 to repeat infusions of 30 mL ACHIM or placebo at week 0 and 2 by gastroduodenoscopy. In part A2, which is an 8-week subsequent maintenance phase, all study participants will receive 30 mL ACHIM at week 12 and followed until week 20 on continued blind. In part B, which will last until the last participant completes part A2, the participants will be followed through a maximum 16-week extended monitoring period, for longer-term data on safety and intervention effects. Primary endpoint is change from baseline to week 12 in UCLA GIT subscale scores of diarrhoea or bloating, depending on the worst symptom at baseline evaluated separately for each patient. Secondary endpoints are safety measures and changes in UCLA GIT scores (total, diarrhoea and bloating). Ethics and dissemination: This protocol was approved by the Northern Norwegian Committee for M

ObjectivesTo evaluate the efficacy of a multi-modal migraine prophylaxis therapy for patients with hyperacusis.MethodsIn a prospective cohort, patients with hyperacusis were treated with a multi-modal step-wise migraine prophylactic regimen (nortriptyline, verapamil, topiramate, or a combination thereof) as well as lifestyle and dietary modifications. Pre- and post-treatment average loudness discomfort level (LDL), hyperacusis discomfort level measured by a visual analogue scale (VAS), and scores on the modified Khalfa questionnaire for severity of hyperacusis were compared.ResultsTwenty-two of the 25 patients (88%) reported subjective resolution of their symptoms following treatment. Post-treatment audiograms showed significant improvement in average LDL from 81.3 ± 3.2 dB to 86.4 ± 2.6 dB (P < .001), indicating increased sound tolerability. The VAS discomfort level also showed significant improvement from a pre-treatment average of 7.7 ± 1.1 to 3.7 ± 1.6 post-treatment (P < .001). There was also significant improvement in the average total score on modified Khalfa questionnaire (32.2 ± 3.6 vs 22.0 ± 5.7, P < .001).ConclusionsThe majority of patients with hyperacusis demonstrated symptomatic improvement from migraine prophylaxis therapy, as indicated by self-reported and audiometric measures. Our findings indicate that, for some patients, hyperacusis may share a pathophysiologic basis with migraine disorder and may be successfully managed with multimodal migraine prophylaxis therapy.

IntroductionProperly educated nurses delivering evidence-based tobacco dependence treatment could contribute to improving health and reducing regional disparities in tobacco-related disease and death in Central and Eastern Europe. The aims of this study are to describe development of the Eastern European Nurses' Centre of Excellence for Tobacco Control (COE) and evaluate its online educational program on tobacco dependence treatment using the 5As framework.MethodsThe online education evaluation followed a prospective, single group, pre- and post-assessment of changes in nurses' self-reported tobacco cessation interventions. Leaders from five Eastern European countries (Hungary, Czech Republic, Romania, Slovakia, Slovenia) developed protocols for in-country tobacco control education. Nurses responded to a baseline survey, accessed an online nursing educational program, and completed a follow-up survey at 3 months, in the period December 2015 to June 2016. A total of 695 nurses from five countries answered questions on cessation interventions at baseline and of these 507 (73%) completed a follow-up survey at 3 months.ResultsAt the follow-up at 3 months, the 507 nurses self-reported a significant increase in providing all 5A components, i.e. nurses were significantly (p<0.0001) more likely to always /usually advise a patient to quit, assess interest in quitting (p=0.002), assist with a quit plan, review barriers to quitting and recommend a smoke-free home post-discharge (all p<0.0001). They were also significantly more likely (p=0.01) to agree or strongly agree that nurses have an obligation to advise patients on the risks of smoking. There was a significant increase (p<0.0001) in nurses' estimate of the number of patients they provided a cessation intervention the previous week. Nurses who smoked were 60% more likely to assist and arrange compared to nurses who never smoked.ConclusionsCoordinating multi-country activities through a COE was successful in engag

ObjectivesTo compare two statistical models, namely logistic regression and artificial neural network (ANN), in prediction of vestibular schwannoma (VS) recurrence.MethodsSeven hundred eighty-nine patients with VS diagnosis completed an online survey. Potential predictors for recurrence were derived from univariate analysis by reaching the cut off P value of .05. Those nine potential predictors were years since treatment, surgeon's specialty, resection amount, and having incomplete eye closure, dry eye, double vision, facial pain, seizure, and voice/swallowing problem as a complication following treatment. Multivariate binary logistic regression model was compared with a four-layer 9-5-10-1 feedforward backpropagation ANN for prediction of recurrence.ResultsThe overall recurrence rate was 14.5%. Significant predictors of recurrence in the regression model were years since treatment and resection amount (both P < .001). The regression model did not show an acceptable performance (area under the curve [AUC] = 0.64; P = .27). The regression model's sensitivity and specificity were 44% and 69%, respectively and correctly classified 56% of cases. The ANN showed a superior performance compared to the regression model (AUC = 0.79; P = .001) with higher sensitivity (61%) and specificity (81%), and correctly classified 70% of cases.ConclusionThe constructed ANN model was superior to logistic regression in predicting patient-answered VS recurrence in an anonymous survey with higher sensitivity and specificity. Since artificial intelligence tools such as neural networks can have higher predictive abilities compared to logistic regression models, continuous investigation into their utility as complementary clinical tools in predicting certain surgical outcomes is warranted.

Between 2016 and 2017, several U.S. Diplomats in Havana, Cuba, experienced perplexing vestibular and neurological symptoms attributed to an unknown source. They presented with significant vestibular and headache symptoms similar to individuals who experience vestibular migraine (VM). As such, we hypothesize that VM may be a possible explanation for the Havana cohort's presenting symptoms. To evaluate this hypothesis, we compared symptoms reported by the affected individuals in Havana, Cuba, to symptoms reported by corresponding patients from a tertiary academic neurotology clinic with a chief complaint of vertigo or disequilibrium, who met the International Classification of Headache Disorders criteria for VM. The prevalence of the Havana subjects experiencing various symptomatic domains was compared with the VM cohort, leading to 26 unique domains and statistical comparisons between the cohorts. Of the 26 domains compared between the two cohorts, 18 were not significantly different. This included the two most important components of meeting criteria for VM, namely the co-existence of headache and vestibular symptoms. On regression analysis, the only feature which kept its significant difference between the two cohorts was acute intense head pressure (P = 0.007). The domains with similar occurrence ratios included dizziness, headache, light sensitivity, hearing reduction, and tinnitus. In other words, multiple headache and vestibular symptoms, consistent with VM criteria, were similar between the two cohorts. The considerable similarities across various domains between VM patients and Havana subjects could be due to migraine as a possible common etiology for both groups. We propose VM as a potential etiology for the symptomatology in the U.S. diplomats in Cuba.

We present the monitoring of the AGN continuum and MgII broad line emission for the quasar HE 0413-4031 ($z=1.38$) based on the six-year monitoring by the South African Large Telescope (SALT). We managed to estimate a time-delay of $302.6^{+28.7}_{-33.1}$ days in the rest frame of the source using seven different methods: interpolated cross-correlation function (ICCF), discrete correlation function (DCF), $z$-transformed DCF, JAVELIN, two estimators of data regularity (Von Neumann, Bartels), and $\chi^2$ method. This time-delay is below the value expected from the standard radius-luminosity relation. However, based on the monochromatic luminosity of the source and the SED modelling, we interpret this departure as the shortening of the time-delay due to the higher accretion rate of the source, with the inferred Eddington ratio of $\sim 0.4$. The MgII line luminosity of HE 0413-4031 responds to the continuum variability as $L_{\rm line}\propto L_{\rm cont}^{0.43\pm 0.10}$, which is consistent with the light-travel distance of the location of MgII emission at $R_{\rm out} \sim 10^{18}\,{\rm cm}$. Using the data of 10 other quasars, we confirm the radius-luminosity relation for broad MgII line, which was previously determined for broad H$\beta$ line for lower-redshift sources. In addition, we detect a general departure of higher-accreting quasars from this relation in analogy to H$\beta$ sample. After the accretion-rate correction of the light-travel distance, the MgII-based radius-luminosity relation has a small scatter of only $0.10$ dex., Comment: 39 pages (23 pages - Main text, 16 pages - Appendix), 21 figures, 14 tables; accepted for publication in the Astrophysical Journal