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| 2. |
- Sedaghat, Ahmad R., et al.
(författare)
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Consensus criteria for chronic rhinosinusitis disease control : an international Delphi Study*
- 2023
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Ingår i: Rhinology. - 0300-0729. ; 61:6, s. 519-530
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic rhinosinusitis (CRS) disease control is a global metric of disease status for CRS. While there is broad acceptance that it is an important treatment goal, there has been inconsistency in the criteria used to define CRS control. The objective of this study was to identify and develop consensus around essential criteria for assessment of CRS disease control. Methods: Modified Delphi methodology consisting of three rounds to review a list of 24 possible CRS control criteria developed by a 12-person steering committee. The core authorship of the multidisciplinary EPOS 2020 guidelines was invited to participate. Results: Thirty-two individuals accepted the invitation to participate and there was no dropout of participants throughout the entire study (3 rounds). Consensus essential criteria for assessment of CRS control were: overall symptom severity, need for CRS-related systemic corticosteroids in the prior 6 months, severity of nasal obstruction, and patient-reported CRS control. Near-consensus items were: nasal endoscopy findings, severity of smell loss, overall quality of life, impairment of normal activities and severity of nasal discharge. Participants’ comments provided insights into caveats of, and disagreements related to, near-consensus items. Conclusions: Overall symptom severity, use of CRS-related systemic corticosteroids, severity of nasal obstruction, and patient-reported CRS control are widely agreed upon essential criteria for assessment of CRS disease control. Consideration of near-consensus items to assess CRS control should be implemented with their intrinsic caveats in mind. These identified consensus CRS control criteria, together with evidence-based support, will provide a foundation upon which CRS control criteria with wide-spread acceptance can be developed.
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| 3. |
- Cava, José Manuel Gonzáles, et al.
(författare)
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Robust PID control of propofol anaesthesia: uncertainty limits performance, not PID structure
- 2021
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Ingår i: Computer Methods and Programs in Biomedicine. - : Elsevier BV. - 0169-2607. ; 198, s. 1-1
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: New proposals to improve the regulation of hypnosis in anaesthesia based on the development of advanced control structures emerge continuously. However, a fair study to analyse the real benefits of these structures compared to simpler clinically validated PID-based solutions has not been presented so far. The main objective of this work is to analyse the performance limitations associated with using a filtered PID controller, as compared to a high-order controller, represented through a Youla parameter.Methods: The comparison consists of a two-steps methodology. First, two robust optimal filtered PID controllers, considering the effect of the inter-patient variability, are synthesised. A set of 47 validated paediatric pharmacological models, identified from clinical data, is used to this end. This model set provides representative inter-patient variability Second, individualised filtered PID and Youla controllers are synthesised for each model in the set. For fairness of comparison, the same performance objective is optimised for all designs, and the same robustness constraints are considered. Controller synthesis is performed utilising convex optimisation and gradient-based methods relying on algebraic differentiation. The worst-case performance over the patient model set is used for the comparison.Results: Two robust filtered PID controllers for the entire model set, as well as individual-specific PID and Youla controllers, were optimised. All considered designs resulted in similar frequency response characteristics. The performance improvement associated with the Youla controllers was not significant compared to the individually tuned filtered PID controllers. The difference in performance between controllers synthesized for the model set and for individual models was significantly larger than the performance difference between the individual-specific PID and Youla controllers. The different controllers were evaluated in simulation. Although all of them showed clinically acceptable results, the robust solutions provided slower responses.Conclusion: Taking the same clinical and technical considerations into account for the optimisation of the different controllers, the design of individual-specific solutions resulted in only marginal differences in performance when comparing an optimal Youla parameter and its optimal filtered PID counterpart. The inter-patient variability is much more detrimental to performance than the limitations imposed by the simple structure of the filtered PID controller.
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| 4. |
- Cervin, Matti, et al.
(författare)
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Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters
- 2022
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Ingår i: Behavior Therapy. - : Elsevier BV. - 0005-7894. ; 53:2, s. 240-254
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Tidskriftsartikel (refereegranskat)abstract
- The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.
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| 5. |
- Cervin, Matti, et al.
(författare)
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Measuring misophonia in youth: A psychometric evaluation of child and parent measures
- 2023
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Ingår i: Journal of Affective Disorders. - 0165-0327. ; 338, s. 180-186
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMisophonia is characterized by intense emotional reactions to specific sounds or visual stimuli and typically onsets during childhood. An obstacle for research and clinical practice is that no comprehensively evaluated measures for pediatric misophonia exist.MethodsIn a sample of 102 youth meeting the proposed diagnostic criteria of misophonia, we evaluated the child and parent-proxy versions of the self-reported Misophonia Assessment Questionnaire (MAQ; assessing broad aspects of misophonia) and the child version of the Amsterdam Misophonia Scale (A-MISO-S; assessing misophonia severity). Confirmatory and exploratory factor analysis were used to examine factor structures of the measures. Further, child-parent agreement on the MAQ and associations between MAQ/A-MISO-S and impairment, quality of life, and misophonia-related school interference were examined to evaluate aspects of convergent validity.ResultsFor both youth- and parent-ratings, four MAQ factors emerged: pessimism, distress, interference, and non-recognition. A-MISO-S showed a unidimensional structure, but the item ‘effort to resist’ did not load significantly onto the unidimensional factor. Good child-parent agreement on the MAQ scales were found and both MAQ and A-MISO-S were moderately to strongly associated with misophonia-related impairment and school interference, and inversely associated with quality of life.LimitationsMAQ and A-MISO-S assess sensitivity to auditory but not visual stimuli, the sample size was modest, and repeated assessments were not conducted.ConclusionsThe combination of MAQ and A-MISO-S shows promise as a multidimensional assessment approach for pediatric misophonia. Future evaluations should include known-groups validity, screening performance, and sensitivity to change in symptom severity.
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| 6. |
- Cervin, Matti, et al.
(författare)
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Posttraumatic Symptoms in 3–7 Year Old Trauma‑Exposed Children: Links to Impairment, Other Mental Health Symptoms, Caregiver PTSD, and Caregiver Stress
- 2020
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Ingår i: Child Psychiatry and Human Development. - : Springer Science and Business Media LLC. - 0009-398X .- 1573-3327.
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Tidskriftsartikel (refereegranskat)abstract
- Few studies have examined how PTSD symptoms in young children are associated with other mental health symptoms and mood and functioning in caregivers. This is an important gap in the literature as such knowledge may be important for assessment and treatment. This study used network analysis to identify how the major symptom domains of PTSD in young trauma-exposed children were related to impairment, internalizing and externalizing symptoms, caregiver PTSD, and caregiver stress. Caregivers of 75 trauma-exposed 3–7 year old children reported on their child’s symptoms and impairment and their own PTSD symptoms and caregiver stress. A strong association between the child PTSD domains of intrusions and avoidance emerged, which is in line with theoretical notions of how PTSD onsets and is maintained in adolescents and adults. Externalizing child symptoms were strongly linked to PTSD-related impairment and caregiver stress, highlighting the need to carefully assess and address such symptoms when working with young trauma-exposed children. Internalizing symptoms were uniquely associated with all three of the major childhood PTSD symptom domains with further implications for assessment and treatment.
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| 7. |
- Cervin, Matti, et al.
(författare)
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Symptom-specific effects of cognitive-behavioral therapy, sertraline, and their combination in a large randomized controlled trial of pediatric anxiety disorders
- 2020
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Ingår i: Journal of Child Psychology and Psychiatry. - : Wiley. - 0021-9630 .- 1469-7610. ; 61:4, s. 492-502
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pediatric anxiety disorders are highly prevalent and associated with significant functional disabilities and lifelong morbidity. Cognitive-behavioral therapy (CBT), sertraline, and their combination are effective treatments, but little is known about how these treatments exert their effects.Methods: Using network intervention analysis (NIA), we analyzed data from the largest randomized controlled treatment trial of pediatric anxiety disorders (Child/Adolescent Anxiety Multimodal Study, NCT00052078, clinicaltrials.gov/ct2/show/NCT00052078) and outlined the causal symptom domain-specific effects of CBT, sertraline, and their combination over the course of the 12-week treatment while taking into account both specificity and overlap between symptom dimensions. Results: All active treatments produced positive effects with the most pronounced and consistent effects emerging in relation to psychological distress, family interference, and avoidance. Psychological distress was consistently the most and physical symptoms the least influential symptom domain in the disorder network.Conclusions: All active treatments showed beneficial effects when compared to placebo and NIA identified that these effects were exerted similarly across treatments and primarily through a reduction of psychological distress, family interference, and avoidance. CBT and sertraline may have differential mechanisms of action in relation to psychological distress. Given the lack of causal effects on interference outside family and physical symptoms, interventions tailored to target these domains may aid in the building of more effective treatments. Psychological distress and avoidance should remain key treatment focuses because of their central roles in the disorder network. The findings inform and promote developing more effective interventions. Keywords: CBT/cognitive behavior therapy; anxiety/anxiety disorders; pharmacotherapy; clinical trials; child/adolescent.
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| 8. |
- Cervin, Matti, et al.
(författare)
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The p Factor Consistently Predicts Long-Term Psychiatric and Functional Outcomes in Anxiety-Disordered Youth
- 2021
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Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567. ; 60:7, s. 902-912
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivePediatric anxiety disorders can have a chronic course and are considered gateway disorders to adult psychopathology, but no consistent predictors of long-term outcome have been identified. A single latent symptom dimension that reflects features shared by all mental health disorders, the p factor, is thought to reflect mechanisms that cut across mental disorders. Whether p predicts outcome in youth with psychiatric disorders has not been examined. We tested whether the p factor predicted long-term psychiatric and functional outcomes in a large naturalistically followed-up cohort of anxiety-disordered youth.MethodYouth enrolled in a randomized controlled treatment trial of pediatric anxiety during childhood/adolescence were followed-up on average six years posttreatment and then annually for four years. Structural equation modeling was used to estimate p at baseline. p and previously established predictors were modeled as predictors of long-term outcome.ResultsHigher levels of p at baseline were related to more mental health disorders, poorer functioning, and greater impairment across all measures at all follow-up time points. p predicted outcome above and beyond previously identified predictors, including diagnostic comorbidity at baseline. Post hoc analyses showed that p predicted long-term anxiety outcomes, but not acute treatment outcome, suggesting that p may be uniquely associated with long-term outcome.ConclusionYouth with anxiety disorders who present with a liability towards broad mental health problems may be at a higher risk for poor long-term outcome across mental health and functional domains. Efforts to assess and address this broad liability may enhance long-term outcome.
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| 9. |
- Davis, R. A., et al.
(författare)
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Evaluation of natural resveratrol multimers as marine antifoulants
- 2023
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Ingår i: Biofouling. - : Taylor and Francis Ltd.. - 0892-7014 .- 1029-2454. ; 39:8, s. 775-784
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Tidskriftsartikel (refereegranskat)abstract
- In the current study we investigate the antifouling potential of three polyphenolic resveratrol multimers (-)-hopeaphenol, vaticanol B and vatalbinoside A, isolated from two species of Anisoptera found in the Papua New Guinean rainforest. The compounds were evaluated against the growth and settlement of eight marine microfoulers and against the settlement and metamorphosis of Amphibalanus improvisus barnacle cyprids. The two isomeric compounds (-)-hopeaphenol and vaticanol B displayed a high inhibitory potential against the cyprid larvae metamorphosis at 2.8 and 1.1 mu M. (-)-Hopeaphenol was also shown to be a strong inhibitor of both microalgal and bacterial adhesion at submicromolar concentrations with low toxicity. Resveratrol displayed a lower antifouling activity compared to the multimers and had higher off target toxicity against MCR-5 fibroblasts. This study illustrates the potential of natural products as a valuable source for the discovery of novel antifouling leads with low toxicity.
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| 10. |
- Grant, T. M., et al.
(författare)
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Towards eco-friendly marine antifouling biocides-Nature inspired tetrasubstituted 2,5-diketopiperazines
- 2022
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697. ; 812
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Tidskriftsartikel (refereegranskat)abstract
- Marine biofouling plagues all maritime industries at vast economic and environmental cost. Previous and most current methods to control biofouling have employed highly persistent toxins and heavy metals, including tin, copper, and zinc. These toxic methods are resulting in unacceptable environmental harm and are coming under immense regulatory pressure. Eco-friendly alternatives are urgently required to effectively mitigate the negative consequence of biofouling without causing collateral harm. Amphiphilic micropeptides have recently been shown to exhibit excellent broad-spectrum antifouling activity, with a non-toxic mode of action and innate biodegradability. The present work focused on incorporating the pharmacophore derived from amphiphilic micropeptides into a 2,5-diketopiperazine (DKP) scaffold. This privileged structure is present in a vast number of natural products, including marine natural product antifoulants, and provides advantages of synthetic accessibility and adaptability. A novel route to symmetrical tetrasubstituted DKPs was developed and a library of amphiphilic 2,5-DKPs were subsequently synthesised. These biodegradable compounds were demonstrated to be potent marine antifoulants displaying broad-spectrum activity in the low micromolar range against a range of common marine fouling organisms. The outcome of planned coating and field trials will dictate the future development of the lead compounds.
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