Notes

[S3 guidelines on "full-term vaginal birth" coming from an anesthesiological point of view : Beneficial knowledge with regard to anesthesiologists].
The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. this website Most interventive findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).Background Graves' disease may be associated with thyroid cancer, particularly differentiated thyroid cancer. Medullary thyroid cancer (MTC) is less common. The occurrence of sporadic MTC in Graves' disease in the presence of a RET proto-oncogene has never been reported.Clinical presentation A 63-year-old woman was referred for Graves' disease. A thyroid ultrasound disclosed five nodules, one of which was classified as Eu-Tirads 5 with a size of 6.7 × 6.5× 11 mm. Fine needle aspiration was reported as Bethesda class IV follicular neoplasm of a Hürthle cell subtype. Calcitonin level was found to be elevated. A total thyroidectomy confirmed the diagnosis of MTC and a bilateral cervical lymphadenectomy was performed, with four lymph nodes being infiltrated by MTC. Genetic testing revealed a M918T mutation in the RET proto-oncogene.Conclusion MTC may occur in Graves' disease, especially if a nodule is present. In this case, genetic testing should always be performed even if MTC is sporadic. Increased incidence of thyroid cancer in autoimmune thyroid diseases, as well as the link existing between autoimmunity, inflammation and carcinogenesis, leads us to hypothesize that the association here reported is not coincidental.
Limited information is available regarding the risk of incident liver disease in patients with psoriasis receiving systemic therapies.

To describe the liver safety findings of conventional and modern systemic therapies for moderate-to-severe psoriasis, and to compare the relative incidence rates of hepatic adverse events (AEs) for each drug.

All the patients on the BIOBADADERM registry were included. Crude and adjusted incidence rate ratios (cIRR and aIRR, respectively) of hepatic AEs, using anti-TNF drugs as reference, were determined. Outcomes of interest were hypertransaminasemia, nonalcoholic fatty liver disease (NADFLD) and a group of other, less represented, hepatic AEs.

Our study included 3,171 patients exposed to systemic drugs (6279 treatment cycles). Incident hypertransaminasemia was the most frequent hepatic AE (incidence rate of 21 per 1000 patients-years [CI 95% CI 18-23]), followed by NAFLD (8 cases per 1000 patients-years [95% CI 6-10]). Methotrexate (aIRR 3.06 [2.31-4.4];
 = 0.000) and cyclosporine (aIRR 2.37 [1.05-5.35];
 = 0.0378) were associated with an increased risk for hypertransaminasemia when compared to anti-TNF-α agents. No differences were observed between different groups of biologics. Conventional therapies were not associated with new incident NAFLD.

Comparative information of the incidence of hepatic AEs could facilitate drug selection in moderate-to-severe psoriasis.
Comparative information of the incidence of hepatic AEs could facilitate drug selection in moderate-to-severe psoriasis.
This study characterised the relationship between speech intelligibility and quality in listeners with hearing loss for a range of hearing-aid processing settings and acoustic conditions.

Binaural speech intelligibility scores and quality ratings were measured for sentences presented in babble noise and processed through a hearing-aid simulation. The intelligibility-quality relationship was investigated by (1) assessing the effects of experimental conditions on each task; (2) directly comparing intelligibility scores and quality ratings for each participant across the range of conditions; and (3) comparing the association between signal envelope fidelity (represented by a cepstral correlation metric) and intelligibility and quality.

Participants were 15 adults (7 females; age range 59-81 years) with mild to moderately severe sensorineural hearing loss.

Intelligibility and quality showed a positive association both with each other and with changes to signal fidelity introduced by the entire acoustic and signal-processing system including the additive noise and the hearing-aid output. As signal fidelity decreased, quality ratings changed at a slower rate than intelligibility scores. Individual psychometric functions were more variable for quality compared to intelligibility.

Variability in the intelligibility-quality relationship reinforces the importance of measuring both intelligibility and quality in clinical hearing-aid fittings.
Variability in the intelligibility-quality relationship reinforces the importance of measuring both intelligibility and quality in clinical hearing-aid fittings.A continuous electrocoagulation reactor, with curved electrodes, polarity switch, and cylindrical geometry, was used for emulsified crude oil in water separation. Apparatus novelty consists of an inlet arranged to promote a circular flow regime. The effects of flow rate (2 and 6 mL.s-1), electrical current (2 and 4 A), and distance between electrodes (1.5 and 2.5 cm) were investigated using a full factorial design and statistical analysis. Using 6 mL.s-1 flow rate, 2 A electric current and 2.5 cm electrode distance; 86% oil removal was obtained at a pH less then 9.0. For this configuration, the system will process 21.6 L of oily emulsion while consuming 6.92 Wh. Oil removal increased with flow rate, a novel characteristic created by the unusual geometry of the system.
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