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Keywords: voice onset time, acquired apraxia of speech, longitudinal, stability Background: We report an investigation of the stability of voice onset time (VOT) patterns in a participant with acquired apraxia [...]

Elevated nitrogen (N) inputs into terrestrial ecosystems are causing major changes to the composition and functioning of ecosystems. Understanding these changes is challenging because there are complex interactions between ‘direct’ effects of N on plant physiology and soil biogeochemistry, and ‘indirect’ effects caused by changes in plant species composition. By planting high N and low N plant community compositions into high and low N deposition model terrestrial ecosystems we experimentally decoupled direct and indirect effects and quantified their contribution to changes in carbon, N and water cycling. Our results show that direct effects on plant growth dominate ecosystem response to N deposition, although long-term carbon storage is reduced under high N plant-species composition. These findings suggest that direct effects of N deposition on ecosystem function could be relatively strong in comparison with the indirect effects of plant community change. [ABSTRACT FROM AUTHOR]

Linear growth occurs during childhood and results from endochondral ossification in the growth plate. Prepubertal growth is primarily regulated by growth hormone (GH) and insulin-like growth factor (IGF)-I, with important contributions from glucocorticoids (GC) and thyroid hormone (T[sub 3] ). The somatomedin hypothesis proposed that GH stimulates hepatic IGF-I production, which then regulates growth via IGF-I receptor expressing chondrocytes in an endocrine fashion. Recent studies indicate that locally acting IGF-I is a key determinant of endochondral ossification and that GH, GC and T[sub 3] regulate expression of IGF-I and its receptor in the growth plate directly. Analysis of hormone imbalance during childhood and studies of genetically modified mice provide support for an important GH and IGF-I autocrine/paracrine pathway and for direct effects of GC and T[sub 3] during endochondral ossification. Thus, the epiphyseal growth plate is a key site for convergent hormone action that mediates the control of linear growth.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: The craniofacial abnormalities found in infants with cleft palate (CP) decrease their airway patency and increase their risk of obstructive sleep apnoea (OSA). We hypothesise that optimising sleep position in infants with CP may improve airway patency and offer a 'low-cost, high-impact' intervention to prevent the negative impacts of OSA. Because cleft centres give inconsistent advice about sleep position: some recommend back-lying and others side-lying, we will compare these in a randomised controlled trial., Methods and Analysis: The aim is to determine the clinical effectiveness of side-lying as compared with back-lying sleep positioning in terms of reducing oxygen desaturation resulting from OSA in 244 infants aged 3-5 weeks of age, diagnosed with an isolated CP in/by UK cleft centres. Primary outcome is the 4% Oxygen Desaturation Index measured using pulse oximetry during sleep., Research Plan: 1. Multicentre randomised controlled trial of side-lying compared with back-lying sleep positioning in reducing oxygen desaturation resulting from OSA in infants with CP at one month of age. 2. Internal pilot questionnaire-based study to support parents and clinicians regarding study participation, seeking to identify and address any barriers to recruitment. Monitoring data from the internal pilot will be used in the final analysis. 3. Co-development of new UK recommendations with Cleft Lip and Palate Association (CLAPA) regarding sleep position for infants with CP., Ethics and Dissemination: The study protocol has received the favourable opinion of the West Midlands-South Birmingham Research Ethics Committee. Study results will be published on affiliated webpages and in peer-reviewed publications and conference contributions., Trial Registration Number: NCT04478201., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Percutaneous endoscopic gastrostomy (PEG) using the pull through technique is the most widely used insertion method. An alternative is a per-oral image-guided gastrostomy (PIG), which may be advantageous in high-risk patients. As there are no large studies comparing PEG against PIG, we wished to analyse mortality after endoscopic or radiological gastrostomy insertion., Methods: Patients referred for a gastrostomy are prospectively included in a database along with demographic, biochemical and outcome data. Analysis of gastrostomy insertions from February 2004 to 2007 was performed with reference to method of insertion and 30-day outcome. Patients were subgrouped into cognitive impairment, dysphagic stroke, oropharygeal cancer, neurological cancer and other., Results: One hundred and seventy PIGs and 233 PEGs were inserted (mean age 62 years, 268 males). There were no differences in age between the PIG and the PEG group. The PIG 30-day mortality was 26 of 170 (15.3%) and the PEG 30-day mortality was 25 of 233 (10.7%) (P=0.17). One-year mortality was 92 of 170 (54.1%) for PIG and 131 of 233 (56.7%) for PEG (P=0.60). Subgroup analysis revealed higher 30-day mortality in patients with nasopharyngeal cancer undergoing PIG; 14 of 106 (13.2%) versus one of 69 (1.4%) (P=0.005). However, PIG patients were older than PEG patients (mean age 64 vs. 59.7 years, P=0.019) and had more comorbidities (21.1% in the PEG group and 37.7% in the PIG group)., Conclusion: Overall PIG and PEG seem to have similar 30-day and 1-year mortality rates. Our data suggest that clinicians may opt for either approach depending on technical considerations and local availability.

Linear growth occurs during development and the childhood years until epiphyseal fusion occurs. This process results from endochondral ossification in the growth plates of long bones and is regulated by systemic hormones and paracrine or autocrine factors. The major regulators of developmental and childhood growth are GH, IGF-I, glucocorticoids, and thyroid hormone. Sex steroids are responsible for the pubertal growth spurt and epiphyseal fusion. This review will consider interactions between GH, IGF-I, glucocorticoids, and thyroid hormone during linear growth. It is well known from physiologic and clinical studies that these hormones interact at the level of the hypothalamus and pituitary. Interacting effects on peripheral tissues such as liver are also well understood, but we concentrate here on the epiphyseal growth plate as an important and newly appreciated target organ for convergent hormone action.