Clinical aspects associated with syndromic forms of Orofacial Clefts in a Colombian population

Objectives: To present descriptive epidemiology of Orofacial Clefts and to determine the association of syndromic forms with antenatal high-risk conditions, preterm birth, and comorbidities among nested-series of cases. Methods: A study of nested-series of cases was conducted. Frequencies of cleft type, associated congenital anomalies, syndromic, non-syndromic and multiple malformation forms, and distribution of Orofacial Clefts according to sex and affected-side were determined. Odds ratios were calculated as measures of association between syndromic forms and antenatal high-risk conditions, preterm birth and comorbidities. A total of three hundred and eleven patients with Orofacial Clefts were assessed in a 12-month period. Results: The most frequent type of Orofacial Clefts was cleft lip and palate, this type of cleft was more frequent in males, whereas cleft palate occurred more often in females. The most common cases occurred as non-syndromic forms. Aarskog-Scott syndrome showed the highest frequency amongst syndromic forms. Hypertensive disorders in pregnancy, developmental dysplasia of the hip, central nervous diseases and respiratory failure showed significant statistical associations (p <0.05) with syndromic forms. Conclusions: These data provide an epidemiological reference of Orofacial Clefts in Colombia. Novel associations between syndromic forms and clinical variables are determined. In order to investigate causality relationships between these variables further studies must be carried out.

Oral anticoagulation in atrial fibrillation, the patients and physicians experiences of the consultation:a qualitative study

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF), however it is still underutilized and sometimes refused by patients. This project was divided in two inter-related studies. Study 1 explored the experiences that influence prescription of OAC by physicians. Study 2 explored the experiences which influence patients' decisions to accept, decline or discontinue OAC. Methods: Semi-structured individual interviews were conducted in both studies. In Study 1four sub-groups of physicians (n = 16) experienced with OAC in AF were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. In Study 2 three sub-groups of patients (n = 11) diagnosed with AF were interviewed; those who accepted, refused, and who discontinued warfarin. Results: Study 1: Two over-arching themes emerged from doctors' experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians still adopt a paternalistic approach to decision-making. They should instead motivate patients to take part in treatment discussions and choices should reflect the patient's needs and concerns. Physician education should focus more on communication skills, individualised care and time-management as these are critical for patient adherence. Continuous OAC education for AF should adopt a multi-disciplinary approach. Further, interpreters should also be educated on medical communication skills. Study 2: Three over-arching themes comprised patients' experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients' reflections. Patient education during the initial consultation was critical in increasing patient's knowledge of OAC. On-going patient education is imperative to maintain adherence. Patients valued physicians' concern for their needs during decision-making. Patients who had experience of stroke were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Patients' perceptions of warfarin are also influenced by the media. Comment: Qualitative research is crucial in exploring barriers to treatment as it provides an excellent insight into patients' experiences of healthcare. A patient-centred approach should be adopted and incorporated into physicians' education. Education and patient involvement in the decision-making process is essential to promote treatment acceptance and long-term adherence

Functional outcomes in the Cleft Care UK study - Part 3:oral health and audiology

OBJECTIVES: To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies. SETTING AND SAMPLE POPULATION: Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system. MATERIALS AND METHODS: Oral health data were collected using a standardized proforma. Hearing was assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report. RESULTS: Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets--a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids. CONCLUSIONS: Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented.

Centralization of cleft care in the UK. Part 6:a tale of two studies

OBJECTIVES: We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). SETTING AND SAMPLE POPULATION: A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. MATERIALS AND METHODS: We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. RESULTS: We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. CONCLUSIONS: Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.

Edoxaban versus enoxaparin–warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial

Background Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. Methods We did a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin–warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The dose of edoxaban was reduced to 30 mg per day if one or more factors (creatinine clearance 15–50 mL/min, low bodyweight [≤60 kg], or concomitant use of P-glycoprotein inhibitors) were present. Block randomisation (block size four)—stratified by cardioversion approach (transoesophageal echocardiography [TEE] or not), anticoagulant experience, selected edoxaban dose, and region—was done through a voice-web system. The primary efficacy endpoint was a composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular mortality, analysed by intention to treat. The primary safety endpoint was major and clinically relevant non-major (CRNM) bleeding in patients who received at least one dose of study drug. Follow-up was 28 days on study drug after cardioversion plus 30 days to assess safety. This trial is registered with ClinicalTrials.gov, number NCT02072434. Findings Between March 25, 2014, and Oct 28, 2015, 2199 patients were enrolled and randomly assigned to receive edoxaban (n=1095) or enoxaparin–warfarin (n=1104). The mean age was 64 years (SD 10·54) and mean CHA2DS2-VASc score was 2·6 (SD 1·4). Mean time in therapeutic range on warfarin was 70·8% (SD 27·4). The primary efficacy endpoint occurred in five (<1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin–warfarin group (odds ratio [OR] 0·46, 95% CI 0·12–1·43). The primary safety endpoint occurred in 16 (1%) of 1067 patients given edoxaban versus 11 (1%) of 1082 patients given enoxaparin–warfarin (OR 1·48, 95% CI 0·64–3·55). The results were independent of the TEE-guided strategy and anticoagulation status. Interpretation ENSURE-AF is the largest prospective randomised clinical trial of anticoagulation for cardioversion of patients with non-valvular atrial fibrillation. Rates of major and CRNM bleeding and thromboembolism were low in the two treatment groups. Funding Daiichi Sankyo provided financial support for the study. © 2016 Elsevier Ltd

Improved model of an electric calciner for carbon materials

Teknova have 2D steady-state models of the calciner but wish, in the long term, to have a 3D model that can also cover unsteady conditions, and can can model the loss of axisymmetry that someties occurs. Teknova also wish to understand the processes happening around the tip of the upper electrode, in particular the formation of a lip on it and the the shape of the empty region below it. The Study Group proposed potential models for the degree of graphitization, and for the granular flow. Also the Study Group considered the upper electrode in detail. The proposed model for the lip formation is by sublimation of carbon from the hottest parts of the furnace with redeposition in the region around the electrode, which may stick particles onto the electrode surface. In this model the region below the electrode would be a void, roughly a vertex-down conical cavity. The electric field near the lower rim of the electrode will then have a singularity and so the most intense heating of the charge will be around the rim. We conjecture that the reason why the lower electrode lasts so much longer than the upper is that it is not adjacent to a cavity like this, and therefore does not have a singularity in the field.

Climate seasonality limits leaf carbon assimilation and wood productivity in tropical forests.

The seasonal climate drivers of the carbon cy- cle in tropical forests remain poorly known, although these forests account for more carbon assimilation and storage than any other terrestrial ecosystem. Based on a unique combina- tion of seasonal pan-tropical data sets from 89 experimental sites (68 include aboveground wood productivity measure- ments and 35 litter productivity measurements), their asso- ciated canopy photosynthetic capacity (enhanced vegetation index, EVI) and climate, we ask how carbon assimilation and aboveground allocation are related to climate seasonal- ity in tropical forests and how they interact in the seasonal carbon cycle. We found that canopy photosynthetic capacity seasonality responds positively to precipitation when rain- fall is < 2000 mm yr-1 (water-limited forests) and to radia- tion otherwise (light-limited forests). On the other hand, in- dependent of climate limitations, wood productivity and lit- terfall are driven by seasonal variation in precipitation and evapotranspiration, respectively. Consequently, light-limited forests present an asynchronism between canopy photosyn- thetic capacity and wood productivity. First-order control by precipitation likely indicates a decrease in tropical forest pro- ductivity in a drier climate in water-limited forest, and in cur- rent light-limited forest with future rainfall < 2000 mm yr-1.

Audience attitudes towards simil sync: a pilot study

This thesis is based on a pilot investigation which explores the attitudes of a sample of Italian viewers towards the simil sync technique which in Italy is used for the dub of non-fictional television contents. The thesis seeks to analyse and define the characteristics of this dubbing modality which is often considered by scholars and professionals in the dubbing industry a hybrid modality of standard synchronised dubbing and voice-over. In order to investigate viewers’ attitudes, I organised 4 focus groups sessions which, due to the impact of Covid-19 pandemic, were carried out online. The online recruitment of participants, which was a difficult task, resulted in a small sample of eighteen participants (and two interviewees). The four online focus groups revealed that participants were aware of the simil sync technique. They recognised that the clips were dubbed in a different modality from standard synchronised dubbing. The characteristic that was mostly mentioned for detecting simil sync was the original soundtrack that was audible below the dub, followed by the identification of the genre of the programme in the clip and the absence of lip sync. Moreover, while simil sync with a barely audible original soundtrack received neutral or positive attitudes, simil sync with a more audible original soundtrack, instead, was tolerated or considered annoying. Simil sync passed unnoticed in the in-depth interviews in which the discussion about dubbing was not focused on the distinction between two dubbing modalities, for instance simil sync versus standard synchronised dubbing, but rather on the distinction between programmes that originated in Italian and those that were translated into Italian from another language and then dubbed.

Augmented Audiovisual Translation: the Perks and Perils of the Implementation of Artificial Intelligence in Subtitling and Dubbing

This thesis examines the state of audiovisual translation (AVT) in the aftermath of the COVID-19 emergency, highlighting new trends with regards to the implementation of AI technologies as well as their strengths, constraints, and ethical implications. It starts with an overview of the current AVT landscape, focusing on future projections about its evolution and its critical aspects such as the worsening working conditions lamented by AVT professionals – especially freelancers – in recent years and how they might be affected by the advent of AI technologies in the industry. The second chapter delves into the history and development of three AI technologies which are used in combination with neural machine translation in automatic AVT tools: automatic speech recognition, speech synthesis and deepfakes (voice cloning and visual deepfakes for lip syncing), including real examples of start-up companies that utilize them – or are planning to do so – to localize audiovisual content automatically or semi-automatically. The third chapter explores the many ethical concerns around these innovative technologies, which extend far beyond the field of translation; at the same time, it attempts to revindicate their potential to bring about immense progress in terms of accessibility and international cooperation, provided that their use is properly regulated. Lastly, the fourth chapter describes two experiments, testing the efficacy of the currently available tools for automatic subtitling and automatic dubbing respectively, in order to take a closer look at their perks and limitations compared to more traditional approaches. This analysis aims to help discerning legitimate concerns from unfounded speculations with regards to the AI technologies which are entering the field of AVT; the intention behind it is to humbly suggest a constructive and optimistic view of the technological transformations that appear to be underway, whilst also acknowledging their potential risks.

Modello neurocomputazionale per lo studio del benefit dell’integrazione multisensoriale nel processo mnemonico-associativo fra nomi propri e volti

Associare nomi propri a volti di persona è un compito importante, fondamentale nella quotidianità di tutti i giorni. Nonostante questa operazione avvenga quasi sempre in maniera automatica, essa coinvolge una rete neurale complessa ed articolata. Diversi studi offrono strategie che possono aiutare in questo compito; in particolare, è stato riportato che rafforzare i nomi con stimoli cross-modali, ossia presentando più input sensoriali esterni contemporaneamente, può costituire un vantaggio per il recupero in memoria dei nomi stessi. Lo scopo di questa tesi è stato quello di svolgere un’analisi di sensibilità tramite un modello neuro-computazionale su MatLab di ispirazione biologica. Nello specifico sono stati considerati due macro-network: uno per i volti, l’altro per i nomi propri; quest’ultimo in particolare a sua volta si compone di tre aree uni-sensoriali, ciascuna delle quali corrisponde ad un modo specifico con cui codificare un nome (traccia audio, lip reading, name tag). Questi network sono stati dunque implementati attraverso una configurazione articolata su due strati: si potrebbe infatti pensare alla fase di addestramento, basata su un algoritmo hebbiano, come un primo layer del processo, seguito così da un secondo layer, dato invece dalla fase di utilizzo. Dalle simulazioni svolte sembra emergere che addestrare in maniera efficiente le connessioni fra le aree uni-sensoriali dei nomi, ricreando così un'integrazione multi-sensoriale, sia un fattore fondamentale per favorire non solo il ricordo di un nome in sé, ma anche processi mnemonici-associativi che coinvolgono anche lo stimolo visivo di un volto. Le evidenze prodotte risultano inoltre qualitativamente coerenti con analoghi esperimenti in vivo.