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Background & Aim: To assess consonant proficiency and velopharyngeal function in 10-year-old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project.Methods & Procedures: Three parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B–Lip and soft palate closure at 3–4 months, hard palate closure at 36 months, Arm C–Lip closure at 3–4 months, hard and soft palate closure at 12 months, and Arm D–Lip closure at 3–4 months combined with a single-layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A–Lip and soft palate closure at 3–4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non-syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC-Rate), and a composite measure (VPC-Sum) were reported.Outcomes & Results: The mean levels of consonant proficiency (PCC score) in the trial arms were 86–92% and between 58% and 83% of the children had VPC (VPC-Sum). Only 50–73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%).Conclusions & Implications: The speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years.

Background Post-operative pain amelioration following breast cancer surgery is inconsistent. The novel multiple-injection costotransverse block (MICB) mimics the thoracic paravertebral block by possible anaesthetising the ventral rami of the thoracic spinal nerves and the sympathetic trunk. Proof of concept has been determined in a cadaveric study and needs further clinical testing. Methods This double-blinded, randomised and placebo-controlled study investigates the efficacy of the ultrasound-guided MICB versus placebo in 36 patients undergoing unilateral mastectomy and primary subpectoral reconstruction surgery. Oral pre-operative medicine is standardised for all patients. Active group is pre-operatively administered MICB with three injections of each 10 ml of ropivacaine (5 mg/ml). The placebo group is pre-operatively administered three injections of each 10 ml of saline (0.9%). Standard general anaesthesia is induced and 30 min before emergence 0.2 mu g/kg total body weight sufentanil IV, 1 g of paracetamol IV and 4 mg of ondansetron IV (post-operative nausea and vomiting, PONV, prophylaxis) will be administered. All patients are provided with a patient-controlled analgesia pump with morphine. The primary aim is total morphine consumption in the first 24 post-operative hours. Secondary aims are pain intensity, duration of the block, patient satisfaction, side effects, time to ambulation, time to discharge, and quality of recovery. Discussion Recruitment began in November 2019 and is expected to finish ultimo 2021. Results are expected to be published in an international peer-reviewed medical journal. The results will hopefully provide a substantial contribution to the knowledge of these new 'intertransverse process blocks' providing regional anaesthesia of the thoracic wall.

Background The objective of this trial is to optimize the transmuscular quadratus lumborum (TQL) block, by investigating the minimal effective volume (MEV90 ) of ropivacaine 0.75% for single-shot TQL block in percutaneous nephrolithotomy (PNL) patients. Methods This double-blind, randomized and controlled dose-finding trial is based on a biased coin up-and-down sequential design, where the volume of local anaesthetic administered to each patient depends on the response from the previous one. Investigating the TQL block, the first patient recruited receives 20 ml ropivacaine 0.75% preoperatively. In case of block failure, the next patient will receive the same volume with an increment of 2 ml. Given a successful block for the first patient, the next patient will be randomized to either a lower volume (previous volume with a reduction of 2 ml), or the same volume as the previous patient. The respective probabilities being b = 0.11 for a reduced volume and 1-b = 0.89 for the same volume. Block success is defined as patient reported pain score numeric rated scale (NRS) ≤3 (0-10/10) 30 minutes after arrival in the post anaesthesia care unit (PACU). The NRS pain score is our primary and only outcome for block success. A minimum of 25 eligible patients are needed to achieve precise estimation of MEV90 with narrow 95% confidence intervals derived by bootstrapping. Discussion Recruiting will begin June 2020 and is expected to finish November 2020. Data analysis will be performed at interims during and after the study. Results will be published in an international peer-reviewed medical journal.

The cost of offshore wind energy production has to be reduced continuously to improve its competitiveness compared to other energy sources. To contribute to this goal, a 4- year research project REDWIN – REDucing cost of offshore WINd by structural and geotechnical integrated design – is currently ongoing, addressing the challenge of integrating the geotechnical discipline in the design process. The project aims to develop foundation and soil models to be used in dynamic time-domain analyses of offshore wind turbine structures. A library of models has been developed for representation of the most common foundation types. The models can be applied to different ground conditions by site-specific model input. To make the models applicable for practical usage, it has been important to balance the need for computational effectiveness against the need for accuracy. Studies so far indicate that the foundation models improve the accuracy in the integrated analyses. Content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI. Published under licence by IOP Publishing Ltd

The purpose of this study is to examine the effect of PTH(1-84) treatment over 24 months followed by 12 months discontinuation on BMD, bone turnover markers, fractures and the impact of adherence on efficacy.There is limited information about the effect of PTH(1-84) after 18 months and limited data about the impact of compliance on response to anabolic therapy.Seven hundred and eighty-one subjects who received active PTH(1-84) in the Treatment of Osteoporosis with Parathyroid hormone trial for approximately 18 months were entered into a 6-month open-label extension. Thereafter, they were followed for 12 additional months after discontinuation of treatment. Endpoints examined included changes in BMD and biochemical markers.PTH(1-84) treatment over 24 months increased BMD at the lumbar spine by 6.8% above baseline (p0.05).The total corresponding BMD increases at the hip and femoral neck were 1.1 and 2.2% above baseline. Larger increases in spine BMD were observed in participants with ≥80% adherence to daily injections of PTH(1-84) (8.3% in adherent vs 4.9% in poorly adherent patients). Total hip BMD gains were 1.7% in adherent vs 0.6% in poorly adherent participants. Markers of bone turnover (BSAP and NTx) peaked 6 months after starting PTH(1-84) treatment and declined slowly but remained above baseline at 24 months. After discontinuation of PTH(1-84) treatment (at 24 months), bone turnover markers returned to near baseline levels by 30 months. The adherent group sustained significantly fewer fractures than the poorly adherent group.PTH(1-84) treatment over 24 months results in continued increases in lumbar spine BMD. Adherence to treatment with PTH(1-84) for up to 24 months is also associated with greater efficacy.

We explored the effects of PTH(1–84) compared with strontium ranelate on bone remodeling as measured by bone remodeling markers in postmenopausal women with osteoporosis. Biochemical markers of bone formation were significantly increased after treatment with PTH(1–84) but not strontium ranelate, indicating a different mechanism of action between these agents. PTH(1–84) and strontium ranelate (SR) are both known to reduce fracture risk in osteoporosis. Measuring changes in biochemical markers of bone turnover induced by these agents can help in characterizing the action of PTH(1–84) and SR on bone remodeling. A 24-week, randomized, open-label, parallel group, phase IV trial was conducted in 81 postmenopausal women with primary osteoporosis (≥50 years of age, lumbar spine, or total hip T-score ≤−2.5 SD) to assess the effect of SR as compared to PTH(1–84) on bone formation markers P1NP and BSAP. The bone resorption marker CTX was also measured. Subjects were randomly assigned to receive daily either 100 μg PTH(1–84) (n = 41) (subcutaneous injection) or oral 2 g SR (n = 40) for 24 weeks with daily supplements of 800 IU vitamin D3 and 1,000 mg calcium. Patient-reported outcomes were collected to investigate the effect of treatment on quality of life (QoL). Percentage changes from baseline in P1NP and BSAP were significantly increased for PTH(1–84) by week 24 compared with SR (p

A prospective follow-up study of 51 patients hospitalized due to minor head injury (MHI) was performed. After one year 28 patients answered the General Health Questionnaire, the Impact of Event Scale and a symptom checklist. A significant impact on general wellbeing attributed to head injury, was indicated. Half of the patients reported some sequelae from head injury, only 25% to a degree that resulted in a case score on General Health Questionnaire. Incidence of prominent post-traumatic stress symptoms was around 20%. Outcome seemed without correlation to trauma severity. Patients with sequelae after one year reported more symptoms at one week after trauma, and the results point to the magnitude of the health problems due to sequelae throughout follow-up. Aspects of prevention and treatment are discussed.

The sewer system for the Greater Copenhagen area covers an area of 4460 ha contributing to the runoff. The total area serves in total 8 municipalities, however it is dominated by the areas in the City of Copenhagen proper. The catchments merge into interceptors, which feed two large treatment plants. The effluent from the two treatment plants discharges during dry weather to Øresund, the sound between Denmark and Sweden. This large system has been analysed for selected scenarios with respect to handling runoff in an optimal way in order to minimise the loads on the most sensitive receiving waters and optimising treatment plant performance.

Objective: To review the literature on the psychobiology and pharmacotherapy of PTSD. Method: Relevant studies were identified by literature searches (Pub-med, web of science) and through reference lists. The search was ended by May 2001. Results: There is evidence of involvement of opioid, glutamatergic, GABAergic, noradrenergic, serotonergic and neuroendocrine pathways in the pathophysiology of PTSD. Medications shown to be effective in double-blind placebo-controlled trials includes selective serotonin reuptake inhibitors, reversible and irreversible MAO-inhibitors, tricyclic antidepressants and the anticonvulsant lamotrigine. Still more agents appear promising in open-label trials. Conclusion: The complexity of the psychobiology is reflected by the difficulties in treating the disorder. According to the present knowledge, suggestions for drug treatment of PTSD are made.

An increasing number of patients with chronic mental disease are now integrated in society. As a consequence, women with severe psychiatric illness may become pregnant and wish to complete the pregnancy and to give birth to a child. The lack of sensation of reality in these patients and their social situation may result in particular problems in their treatment, and it may be necessary to admit them to a psychiatric ward before delivery. In this paper five cases of pregnant women with severe and chronic psychosis are described. These patients had many problems in common. Thus, they were all schizophrenics with very severe psychopathology, had poor understanding of their own situation, and lacked social networks. All the fathers were non-Danish. Coercion was used in all cases. To help women with severe mental illness to go through pregnancy and childbirth requires close collaboration between psychiatric and obstetric staff and social workers, and this should be organized in an institution with experience in the treatment of this type of patient.

The simple split-window and the transmittance ratio method for estimation of atmospheric precipitable water content were analysed using data gathered through the Hapex Sahel Experiment conducted in Niger from August to October 1992. Results are presented for the Hapex Sahel square degree. Both methods are designed to work with thermal infrared data from the Advanced Very High Resolution Radiometer flown on the NOAA polar orbiting satellites. The performance of the methods were evaluated with radiosonde measurements and prognosticated water vapour fields obtained from the global circulation model used at the European Centre for Medium Weather Forecast. The implications of extending the simple split-window method to work over land surfaces were investigated by use of both simulated and observed data. It was shown that changing surface conditions, i.e., emissivity and surface temperature, could significantly influence the split-window estimate of water vapour content and therefore inhibit the implem...

SummaryPsychiatric morbidity was measured in a prospective follow-up study of 51 patients admitted to hospital after minor head injury. By means of self report questionnaires (eg General Health Questionnaire (SHQ) and Impact of Event Scale), semistructured interviews and symptom-checklists, it was found that nearly half of the patients suffered considerable discomfort after 1 week. Improvement during the 3 months follow-up was generally poor. Both concussional symptoms and stress response contributed to the compromised well-being as measured by the GHQ, but outcome did not correlate to severity of injury. The GHQ-60 score of 1 week showed a strong positive correlation with outcome after 3 months. The incidence of post-traumatic stress disorder was low.

The phosphorylation of key proteins on tyrosine residues is an important part of many different intracellular signaling cascade mechanisms triggered by hormones and other agents. The deactivation of such signaling processes is catalyzed by protein-tyrosine phosphatases (PTPs), and therefore inhibition of these enzymes is being explored in different indications as a means whereby signaling may be prolonged or even initiated in the absence of the triggering agent. In the case of the signaling cascade initiated by the activation of the insulin receptor, an important gene knockout study in mice has identified PTP-1B as a potential target for anti-diabetes therapy, and has thus made it a focus of attention for several groups. Recent advances in the structure-based design of potent and selective inhibitors of this enzyme are described, as well as some preliminary data for such inhibitors in animal models which, together with more recently published data from further studies on PTP-1B knockout mice and from antisense studies, illustrate the potential of this approach for the treatment of both Type I and Type II diabetes.

Serving military can be regarded as exposure to a moderate enforced stressor independent of other vulnerability factors. The aims of this study were i) to explore psychiatric morbidity and mortality during 10 years of follow-up in a cohort of healthy adolescent Danish conscripts and ii) to investigate whether stress-related disorders precede other psychiatric disorders.Controlled national cohort study on all psychiatric hospital contacts in young men referred to the Military Psychiatric Department (MPD) with 10 years of follow-up.During the follow-up period, 24% of conscripts seen at the MPD were diagnosed with a psychiatric disorder compared with 4% in the control cohort. Almost all diagnostic categories were over-represented but especially psychotic disorders. Mortality was substantially increased. Of subjects initially diagnosed with stress-related disorders at the MPD, 20% later on developed psychopathology.Young healthy men complaining of mental distress following a stressor are strongly disposed to psychiatric morbidity and mortality. The study suggests that stress-related disorders often precede more severe psychopathology.

We have previously shown that maternal iron (Fe) deficiency not only reduces fetal size, but also increases blood pressure in the offspring when they are adults. In this paper we examine whether there are critical periods when supplementation reverses or fails to reverse the effect both on size and on expression of genes of Fe metabolism. We made dams Fe deficient, mated them and provided supplements of Fe in the diet from the beginning of gestation (0.5 days), from 7.5 days or from 14.5 days. Within 12 h of birth, dams and neonates were killed and tissues taken and examined. Fe deficiency throughout pregnancy reduces neonatal size. Supplementation from the beginning of the first, second or third week all reduced the effect. Maternal haematocrit was restored to normal levels only in animals given supplements for at least 2 weeks. In contrast, the neonates' Fe levels were normal in all supplemented groups. These results were mirrored in liver Fe levels and in transferrin receptor mRNA. Iron-responsive element (IRE)-regulated divalent metal transporter 1 (DMT1) increased in maternal and neonatal liver. Non-IRE-regulated DMT1 levels did not change in the maternal liver, but decreased in the neonatal liver. H and L ferritin mRNA levels also showed different patterns in the mother and her offspring. Finally, the neonatal size correlated with maternal Fe stores, and not with those of the fetus. The data demonstrate that Fe supplementation during pregnancy is most effective when given early, rather than later, in gestation.

To review the literature on the psychobiology and pharmacotherapy of PTSD.Relevant studies were identified by literature searches (Pub-med, Web of Science) and through reference lists. The search was ended by May 2001.There is evidence of involvement of opioid, glutamatergic, GABAergic, noradrenergic, serotonergic and neuroendocrine pathways in the pathophysiology of PTSD. Medications shown to be effective in double-blind placebo-controlled trials includes selective serotonin reuptake inhibitors, reversible and irreversible MAO-inhibitors, tricyclic antidepressants and the anticonvulsant lamotrigine. Still more agents appear promising in open-label trials.The complexity of the psychobiology is reflected by the difficulties in treating the disorder. According to the present knowledge, suggestions for drug treatment of PTSD are made.

To compare two levels of stress (solitary confinement (SC) and non-SC) among remand prisoners as to incidence of psychiatric disorders in relation to prevalent disorders.Longitudinal repeated assessments were carried out from the start and during the remand phase of imprisonment. Both interview-based and self-reported measures were applied to 133 remand prisoners in SC and 95 remand prisoners in non-SC randomly selected in a parallel study design.Incidence of psychiatric disorders developed in the prison was significantly higher in SC prisoners (28%) than in non-SC prisoners (15%). Most disorders were adjustment disorders, with depressive disorders coming next. Incident psychotic disorders were rare. The difference regarding incidence was primarily explained by level of stress (i.e. prison form) rather than confounding factors. Quantitative measures of psychopathology (Hamilton Scales and General Health Questionnaire) were significantly higher in subjects with prevalent and incident disorders compared to non-disordered subjects.Different levels of stress give rise to different incidence of psychiatric morbidity among remand prisoners. The surplus of incident disorders among SC prisoners is related to SC, which may act as a mental health hazard.

Post-traumatic stress disorder (PTSD) has been subjected to several epidemiological studies during the last 10 years. Large differences in prevalence between different studies can only partly be explained by differences in methodology, impact of the trauma and populations. Changes in diagnostic criteria, the stressor criteria, general mentality over time and cultural differences may account for some of the differences. In general populations a lifetime prevalence of PTSD of between 1% and 9% has been found. In unselected traumatized populations 20-45% will develop PTSD after exposure to significant traumas. Among soldiers who have participated in battles of war a PTSD prevalence of 15-20% has been found. After exposure to lesser traumas and among well-trained corps 5-10% develop PTSD. Over long periods the point prevalence of PTSD in a given traumatized population diminishes. Predictive factors related to PTSD are complex.

Heroin-abusing Danish prisoners remanded in custody were based on interviews grouped as either smoking dependent (n = 18) or intravenous dependent (n = 55). Intravenous users had a longer duration and earlier debut of abuse than users who smoked opiates. Only intravenous users had serious somatic complications. Both groups of opioid dependent prisoners were marked by severe psychosocial dysfunction and considerable psychiatric co-morbidity. The intravenous users were generally more affected than the smokers concerning social and psychiatric parameters and earlier criminality, perhaps due to their longer duration of abuse.

Forty-five patients with schizophrenia or schizophreniform disorder admitted to hospital for the first time had a neurological examination, including integrative sensory and complex motor acts, by a trained neurologist. The patients were studied by CT and regional cerebral blood flow as well. A control group of 24 healthy volunteers was included. The patients had significantly more neurological abnormalities (NA) than the healthy volunteers. Medication did not explain the discrepancy. The NA were associated with sulcal enlargement and smaller brains as visualized by CT but not with ventricular enlargement. There was no association between the regional flow values and NA.

A review of sensory deprivation is presented. The history of the concept and the terminological problems are reviewed. The symptoms are subdivided into: perceptual, cognitive and affective and the physiological disturbances are reviewed. Various etiological theories are discussed. These include biological, psychodynamic and social psychological theories. Experimental variables related to the subject, the investigator and the design of the research are presented. A review of the clinical and practical implications of sensory deprivation is given. It is emphasized that sensory deprivation might contribute to development of symptomatology in numerous situations. Finally, the potential therapeutic effects of controlled sensory deprivation are discussed.

A prospective follow-up study of 51 patients hospitalized due to minor head injury (MHI) was performed. After one year 28 patients answered the General Health Questionnaire, the Impact of Event Scale and a symptom checklist. A significant impact on general wellbeing attributed to head injury, was indicated. Half of the patients reported some sequelae from head injury, only 25% to a degree that resulted in a case score on General Health Questionnaire. Incidence of prominent post-traumatic stress symptoms was around 20%. Outcome seemed without correlation to trauma severity. Patients with sequelae after one year reported more symptoms at one week after trauma, and the results point to the magnitude of the health problems due to sequelae throughout follow-up. Aspects of prevention and treatment are discussed.

The principles of short-term psychotherapy for the posttraumatic stress disorder are summarized. A review is presented of psychopharmacological treatment of the posttraumatic stress disorder (PTSD). The case histories of three patients with PTSD are briefly mentioned.

This article gives a review of the theoretical and clinical conditions in the posttraumatic stress disorder (PTSD), a diagnosis which was introduced in 1980. Investigations suggest a definite relationship between the traumata and the subsequent stress disturbances while the roles played by premorbid factors and the paratraumatic happenings are still not elucidated. The conditions is common after violent traumata. The subsequent course tends to be chronic although the prognosis in many cases in which rapid intervention is instituted is good. Greater awareness of the occurrence of PTSD is recommended.